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Category: For Med Pros

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For Med Pros

CF(Rehydrate)® Immunity+ and Immune Support This Fall

As we enter fall, it’s time to start thinking about how to keep our immune systems strong and healthy. CF(Rehydrate)® Immunity+ has the perfect plant-based formula to support your immune health this season! Packed with powerful ingredients like Vitamin C, Magnesium, Zinc and Vitamin D, CF(Rehydrate)® Immunity+ helps you feel the effects of better health and immune protection the natural way. In today’s blog we break down how each of the vitamins and minerals in CF(Rehydrate)® Immunity+ help support the immune system.

What is the Immune System?

The immune system is an intricate and sophisticated biological system that defends the body from foreign, invading organisms. Maintaining our immune defense systems can help lower the incidence of infection, lessen the severity of symptoms, and decrease the length of illness from the common cold and other illnesses. 

How Does CF(Rehydrate)® Immunity+ Support the Immune System?

CF(Rehydrate)® Immunity+  is a natural electrolyte replacement drink that may help support healthy immune function, especially when the risk of contracting illness is high. CF(Rehydrate)® Immunity+ has immune-supporting ingredients like Vitamin D and Zinc that may support optimal health and nourishment. 

In one 12 oz serving of CF(Rehydrate)® Immunity+, there are 40 calories and no added sugar. Additionally, it contains 25% of the recommended daily values (DV) of Vitamin D and Zinc, 100% of the DV of Vitamin C, 20% of the DV of Selenium, 15% of the DV of Phosphorus, 4% of the DV of Potassium, and 10% of the DV of Magnesium. 

Each vitamin and mineral are crucial to support a healthy, fully functioning immune system. Drinking CF(Rehydrate)® Immunity+  can help meet the recommended daily amounts (RDA) of specific vitamins and minerals that support immunity. Eating a wide variety of fruits and vegetables and a well-balanced diet is crucial, but CF(Rehydrate)® Immunity+  is an excellent addition to any healthy diet. 

What is Each Vitamin and Mineral’s Role in the Immune System?

Vitamin D plays an essential role in immune health. Its function is to regulate adaptive immune responses. Recent data has shown that Vitamin D deficiency appears to increase susceptibility to certain illnesses. Additionally, cross-sectional studies associate lower levels of Vitamin D with increased infection. One study showed that individuals with lower Vitamin D levels were more likely to have recent upper respiratory tract infections than those with sufficient Vitamin D levels.. Consuming just one serving of CF(Rehydrate)® Immunity+ meets 25% of the DV of Vitamin D. 

Vitamin C is an antioxidant that helps the formation of collagen. As an antioxidant, Vitamin C protects against environmental oxidative stress. Vitamin C deficiency leads to impaired immunity and increased infection. Vitamin C can readily donate electrons and, in turn, protect from damage by oxidants. Vitamin C also plays a crucial role in promoting wound healing. Consuming one serving of CF(Rehydrate)® Immunity+ provides 100% of the DV of Vitamin C.  

Selenium is a mineral that is not as commonly discussed as Zinc, Vitamin C, or Vitamin D as it relates to immune health. Selenium is also an antioxidant that helps support the immune system. It plays an essential role in our body, and adequate amounts promote optimal health. Sufficient quantities of Selenium are needed to initiate immunity and regulate excessive immune response and chronic inflammation.. Research has shown that selenium deficiency negatively affects the immune cells and leads to increased oxidative stress. One serving of CF(Rehydrate)® Immunity+ has 20% of the DV of Selenium. 

Magnesium is necessary for healthy muscle function. Magnesium supports glucose metabolism and plays a vital role in the use of energy-rich compounds. Exercise may deplete Magnesium, and the ability to perform physical work is sometimes compromised. The immune function may also temporarily suffer during bouts of prolonged exercise or excessive training. Sometimes, this can lead to infection. Replacing Magnesium is crucial, so consuming CF(Rehydrate)® Immunity+ after a workout is ideal. Magnesium also has a strong relationship with the immune system. Magnesium deficiency may pose a risk to the immune system and lead to an inflammatory response. There is 10% of the DV of Magnesium in one serving of CF(Rehydrate)® Immunity+.

Zinc strengthens the immune system and promotes healthy cell function. Plasma Zinc levels decline during bacterial infections, and dietary Zinc deficiency predisposes individuals to certain infectious diseases. Zinc may also strengthen immunity by defending against harmful internal macrophages and decreasing oxidative stress. There is 25% of the DV of Zinc in one serving of CF(Rehydrate)® Immunity+. 

Phosphorus is vital for cellular function, acid-base balance, and cellular structure. If phosphorus becomes low, it can be life-threatening. CF(Rehydrate)® Immunity+ contains 15% of the DV of Phosphorus. 

Get your immune support this fall and order your CF(Rehydrate)® Immunity+  today!

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For Med Pros Nutrition Preparing for Surgery

Is CF(Preop)® Safe For Patients with Diabetes?

One of the most asked questions when it comes to CF(Preop)® is whether or not patients with diabetes may consume it before surgery. Today, we break down the research surrounding preoperative carbohydrate loading for patients with diabetes. We also discuss CF Nutrition’s protocol for carbohydrate loading in patients with diabetes.

 Why is preoperative carb loading necessary?

Before ERAS® protocols were discovered, the traditional approach to surgery was to fast after midnight prior to surgery to decrease the risk for aspiration. In the 1990’s, evidence-based research suggested that this was not necessary. There are detrimental effects caused by this period of prolonged fasting. Prolonged fasting worsens the catabolic state, increases metabolic stress, hyperglycemia and insulin resistance. Furthermore, when the body is fasted for a prolonged time, glycogen stores are depleted which can lead to protein and muscle breakdown. Postoperative insulin resistance (PIR), a result of the stress response from surgery and further exaggerated with prolonged fasting, is directly related to delayed wound healing, increased morbidity/mortality and LOS . To enhance recovery after surgery, it is important to decrease PIR. Preoperative carbohydrate loading maximizes glycogen stores in the body as an energy source in order to minimize degeneration of body tissues and reduce insulin resistance. By changing the metabolic state, and shortening preoperative fasting (aka providing a complex carbohydrate 2-3 hours prior to surgery), PIR will be decreased, protein loss will be reduced, and muscle function will improve.

What has CF Nutrition done to research the use of CF(Preop)® for patients with diabetes?

The founder of CF Nutrition, Dr. Lou Marsh, researched CF(Preop)® and blood glucose levels extensively. She found that after ingestion of 50 grams of carbohydrate, the blood glucose levels will spike in any individual. What becomes important is the time the patient drinks CF(Preop)® and the time the blood glucose levels are checked. This will help to see where each specific patient’s blood glucose levels are at two hours after consuming CF(Preop)® and eliminate any excess intervention which leads to hypoglycemia intra-operatively. If blood sugars are checked prior to the two hour mark, excess insulin may be prescribed which leads to hypoglycemia intra-operatively. CF Nutrition provides a questionnaire to help create a standardization of care for checking blood glucose before, during and after surgery. 

What research studies support preoperative carb loading in patients with diabetes?

Administering a carbohydrate drink prior to surgery leaves some surgeons skeptical on the effects it may have on blood glucose levels. Unfortunately, several studies exclude diabetic patients. However, there are some studies that have been done to evaluate the safety of administering dextrose to diabetic patients undergoing surgery. Gustafsson et al conducted a study to evaluate the safety of preoperative carbohydrate loading on patients with diabetes. Twenty-five patients were included with type 2 diabetes (mean HbAlc 6.2± 0.2%) and 10 healthy control subjects. A carbohydrate drink (400mL, 12.5%) was given with the determination of gastric emptying. 

As expected, peak glucose was significantly higher in the diabetic patients compared to the control (p<0.01) and occurred later after intake of the carbohydrate drink (p<0.01). Glucose returned to baseline in 180 minutes in diabetic patients and 120 minutes in the control group (p<0.01). In terms of gastric emptying, at 120 minutes, 10.9 ± 0.7% and 13.3 ± 1.2% of paracetamol remained in the stomach in diabetic and healthy subjects respectively. Gastric half-emptying time occurred at 49.8 ± 2.2 minutes in diabetics and 58.6± 3.7 minute in healthy subjects (p<0.05). These results illustrate that there are no signs of delayed gastric emptying. Therefore, a carbohydrate drink can safely be administered 180 minutes before anesthesia without risk of hyperglycemia or aspiration risk preoperatively according to the results from this study.

​Furthermore, Li Na Ge et al conducted a systematic review to examine the effectiveness and safety of oral carbohydrates in those with diabetes. The review included 5 randomized control trials. Because there are no widely accepted indicators of the effects of preoperative carbohydrate in surgical patients with diabetes, this systematic review intended to offer a basis for the progress of ERAS® pathways for diabetic patients. This systematic review concludes that preoperative oral carbohydrate is effective, safe, and feasible for patients with diabetes. When a diabetic patient is fasted, the lack of glycogen reserve can lead to an insufficient energy supply, strong fluctuation of blood glucose, increased risk of hypoglycemia, nerve and kidney damage, and injury of tissues and organs. Additionally, prolonged fasting increases stress. This increased stress joint with surgical trauma can lead to increased glucocorticoids and glucagon, reduced insulin sensitivity, and reduced utilization of glucose in peripheral tissues. As a result, patients are at risk for postoperative hyperglycemia and increased insulin resistance. Postoperative insulin resistance can increase risk for developing infection and increasing length of stay. By consuming an oral carbohydrate 2-3 hours before surgery, the energy supply is enhanced consequently reducing perioperative hypoglycemia and insulin resistance. 

Providing a carbohydrate drink prior to surgery may help to reduce the stress response of surgery and put the body into a FED state entering surgery. Putting the body into a more normal physiological state entering surgery may be advantageous in overall recovery. 

What are CF Nutrition’s recommendations for CF(Preop)® and patients with diabetes?

With all this being said, here are important things to consider when providing CF(Preop)® to a diabetic patient:

1. Do they have a known risk for delayed gastric emptying? If so, consider adjusting the window for consuming CF(Preop)® per MD recommendations

2. A pt’s blood glucose will spike after the consumption CF(Preop)® however, it should return to baseline

3. Blood glucose should be checked regularly 

CF Nutrition  Recommendations:

Type 1 Diabetic 

With appropriate insulin administration, yields euglycemia. 

• 1st Bottle: Drink the night before surgery once in the fasting window 

• 2nd Bottle: Complete 2 hours before surgery Patients simply “match their short-acting insulin injections” to their blood glucose level and to the carb load that is listed on the drink label.

Type 2 Diabetic 

With preservation of their oral antihyperglycemic agent schedule at bedtime. 

• 1st Bottle: Drink the night before surgery once in the fasting window

• 2nd Bottle: Complete 2 hours before surgery Morning dose of oral agent may be held based on the actual surgical time, e.g., as when surgery is scheduled as one of the first cases of the morning.

Now that you know CF(Preop)® may be used in patients with diabetes, visit our website to purchase today!

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For Med Pros Nutrition Preparing for Surgery

Prepare Your Patient for Surgery With CF Nutrition

At CF Nutrition, our goal is to help prepare your patient for surgery with premium nutrition beverages. Our mission is to use clean ingredients you can feel good about giving to your patients and we do not use any artificial ingredients or dyes. We know that surgery can be a stressful time so our products are designed to help reduce the surgical response of surgery and improve surgical outcomes. We have a full product suite that provides support to your patient before, during, and after their procedure.

Provide CF(Protein)® in the weeks leading up to surgery:

CF(Protein)® is a plant-based protein drink that provides a concentrated dose of natural electrolytes, antioxidants, and essential fats. CF(Protein)® is a great choice for anyone who is preparing for, or recovering from an operation. Plant protein is the modern way to give your body the best nutrients with the lowest impact on your digestive system.

Each CF(Protein)® has 13g of protein per bottle. So, depending on what else your patient is eating or drinking, and their specific protein needs, consuming 1 to 2 CF(Protein)® drinks per day can help ensure your patient is optimizing their nutrition prior to surgery. Prior to surgery, drinking 1-2 bottles per day (in addition to a well-balanced diet) for at least 2 weeks prior to surgery, will help your patient feel strong and well-nourished for their operation. 

Some benefits of drinking CF(Protein)® are:

·      Promote muscle maintenance, repair, and recovery

·      Strengthen the immune system

·      Reduce risk of malnourishment

·      Antioxidants & anti-inflammatory ingredients

·      Concentrated nutrition on-the-go

·      Healthy omega-3 and omega-6 fats

·      Naturally derived vitamins & minerals

·      Essential amino acids

·      Natural fiber sources

·      No artificial colors or flavors

·      Shelf-stable

·      Gluten-Free, Kosher, Vegan, Dairy-Free

·      Convenient on-the-go protein source

Recommend CF(Preop)® the night before and morning of surgery:

CF(Preop)® is a clear, colorless drink specifically formulated by an anesthesiologist for safe consumption in the hours before surgery. Each of its premium ingredients has been intentionally chosen to promote the highest level of presurgery safety, comfort, and nourishment.

It takes approximately 90 minutes for the oral carbohydrate solution to pass the stomach. Solid foods can be ingested up to 6 hours prior to surgery. The amount of carbohydrate to induce an effect must be enough to shift the body from a fasted to a fed state (50g carbohydrates 2 hours prior to surgery). There is no protein or fat in CF(Preop)® in order for it to safely empty your patient’s stomach before surgery. If your patient has delayed gastric emptying due to an underlying condition, CF(Preop)®  should be consumed 3-4 hours before the procedure. 

Provide CF(Rehydrate)®  or CF(Rehydrate)® Immunity+ after surgery:

After surgery, patients are oftentimes very dehydrated and can only have clear liquids. The intentional formulation behind both CF(Rehydrate)® and CF(Rehydrate)® Immunity+ replenishes lost fluids and essential electrolytes. CF(Rehydrate)® and CF(Rehydrate)® Immunity+ also has an ideal combination of carbohydrates and sodium to help you recover quicker. Recommending either post surgery can help promote recovery and hydration. 

Now that you know CF Nutrition offers a wide variety of products to help improve surgical outcomes, head to our website to purchase or receive samples!

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Featured Posts For Med Pros

CF Nutrition Pairs With Goldfinch Health to Help Reduce Opioid Use Post Surgery

The overuse of opioids after surgery has become a worldwide issue. Though important after surgery to reduce pain, opioids have become misused causing chronic use and addiction. Goldfinch Health has designed a program to help reduce the use of opioids post surgery. They have teamed up with CF Nutrition to include CF(Preop)® as part of their Prepared for Surgery Toolkit. Today, we break down what the program and kit entails and how it may help millions with opioid addiction. 

What is the Billion Pill Pledge Program?

The Billion Pill Pledge Program was designed to help reduce the need for opioids post surgery. Opioids are important and serve a purpose in reducing pain after surgery. However, over the years, the use of opioids after surgery has developed into misuse and addiction affecting the lives of many. The mission of the Billion Pill Pledge Program is to help resolve this crisis by implementing Enhanced Recovery After Surgery (ERAS®) protocols, like the use of CF(Preop)®, to reduce the need for opioids. The Billion Pill Pledge Program is currently in the pilot phase and has rolled out into 4 rural hospitals in Iowa. 

The program was designed by Goldfinch Health and the cofounder John Greenwood aims to remove billions of unused opioids with the program. With this program, patients are given a care package before their procedure.

 The care package includes:

  • Ice and heat packs
  • A drug disposal bag
  • One bottle of CF(Preop)®

The goal of the kit is to reduce pain using non-addictive procedures so that the need for opioids is eliminated or at least reduced. 

How will CF(Preop)® help reduce opioid use?

The intention of Goldfinch Health in including CF(Preop)® is to help the patient’s pain tolerance. CF(Preop)® is a clear, colorless drink specifically formulated by an anesthesiologist for safe consumption hours before surgery. CF(Preop)®  is formulated for surgery and meets the ASA® requirements to make it safe for consumption before your surgery. Choosing to drink CF(Preop)® before your surgery helps you feel back to normal as soon as possible. 

The main ERAS® principles include protocols for preoperative, intraoperative and postoperative care. All ERAS® protocols aim to lessen the body’s response to surgical trauma and maintain normal physiological function during surgery. Preoperative carbohydrate loading with CF(Preop)® is one of the preoperative principles of ERAS®. The American Society of Anesthesia has promoted the use of clear carbohydrate beverages up to 2 hours before surgery to help reduce dehydration among patients. 

Non-opioid oral analgesia NSAID is one of the postoperative protocols in ERAS®.  The more ERAS® principles observed throughout the patient’s surgical journey, the better the chances for a smooth recovery with reduced complications. All ERAS® protocols are evidence-based and require patient education as well as a knowledgeable team approach. 

CF Nutrition is beyond excited to be a part of the Billion Pill Pledge Initiative to help save the lives of many and reduce the opioid crisis worldwide.

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For Med Pros Medical Professionals Presurgery Nutrition Wellness + Medical Tips

Why Do Patients Need More Protein Before Surgery?

At CF Nutrition, our goal is to help support patients through the entire journey of surgery. This not only includes the days leading up to surgery but the weeks prior to and immediately following surgery. It is crucial to prepare your patients as best as possible in order for them to recover quickly. Protein is a key macronutrient in helping support your patients through surgery. 

What is CF(Protein)® ?

CF(Protein)® is a plant-based protein drink that provides a concentrated dose of natural electrolytes, antioxidants, and essential fats. CF(Protein)® is a great choice for anyone who is preparing for, or recovering from surgery. Plant protein is the modern way to give the body the best nutrients with the lowest impact on the digestive system. CF(Protein)® contains13 g of delicious, clean plant protein packed into an 8-oz bottle. 

Some benefits of drinking CF(Protein)® are:

·      Promote muscle maintenance, repair, and recovery

·      Strengthen the immune system

·      Reduce risk of malnourishment

·      Antioxidants & anti-inflammatory ingredients

·      Concentrated nutrition on-the-go

·      Healthy omega-3 and omega-6 fats

·      Naturally derived vitamins & minerals

·      Essential amino acids

·      Natural fiber sources

·      No artificial colors or flavors

·      Shelf-stable

·      Gluten-Free, Kosher, Non-GMO, Vegan, Dairy-Free

·      Convenient on-the-go protein source

How often should your patient drink CF(Protein)® before and surgery?

Each CF(Protein)® has 13 g of protein per bottle.  Prior to surgery, drinking 1-2 bottles per day (in addition to a well-balanced diet) for at least 2 weeks prior to surgery, will help your patient to feel strong and well-nourished for their operation.  CF(Protein)® is not designed to be a sole source of nutrition. Therefore, consuming whole foods, high in protein, is recommended before and after surgery in order to meet protein and calorie needs.

What else does CF(Protein)® contain that can support your patient for surgery?  

In addition to the protein content in CF(Protein)®, it also contains chia seed oil and turmeric which are anti-inflammatory. These will also help you to ensure your patients are at optimal nutrition status for their surgery as well as strengthen their immune system. The antioxidants in CF(Protein)® will help your patient to fight off diseases and strengthen their immunity.

Are protein needs increased before surgery?

There are a variety of factors that determine specific protein needs. These include age, activity level, chronic diseases, weight, and fitness goals. Typically, someone who is preparing for, or recovering from surgery has increased protein needs. This is to help the body ensure a speedy recovery.

If your patient is malnourished, it is important that you ensure they are consuming adequate calories and protein leading up to their surgery. Nutritional status is crucial prior to surgery. A nutritional assessment should be completed prior to any surgery to reduce the risk for postoperative complications, increased length of stay, and risk for infection. A patient can be diagnosed with mild or severe malnutrition by the MD. A Registered Dietitian can also assess the patient for mild to severe malnutrition. 

The following criteria from Academy Adult Malnutrition Criteria (ASPEN) is used to identify moderate malnutrition. A patient must have at least two of following to be diagnosed with moderate malnutrition: weight loss >2% in 1 week, >5% in one month or >7.5% in 3 months; Energy intake less than or equal to 50% compared to estimated needs for greater than or equal to 5 days; Moderate body fat depletion; Moderate muscle mass depletion; Moderate to Severe Fluid Accumulation; and reduced grip strength. Furthermore, a patient must have at least two of the following to be diagnosed with severe malnutrition: Weight loss 1-2% in 1 week, 5% in one month, 7.5% in 3 months; Energy intake <75% compared to estimated needs in 7 days; mild body fat depletion; mild muscle mass depletion; mild fluid accumulation; and reduced grip strength.

What if my patient is malnourished?

It is imperative to correct malnutrition in a patient prior to their surgery. Research proves that malnutrition is a leading reason for poor outcomes postoperative. Studies show that preoperative nutritional deficiency is a strong predictor of 90 days mortality and poor overall survival. Nutrition status can be improved with recommendations from a Registered Dietitian. Common recommendations include high protein supplements such as CF(Protein)®. Other ways to improve nutritional status can include enteral or parenteral nutrition. For obese patients, it is often required to lose excess weight prior to surgery.

How do I determine the protein needs for my patients before surgery?  

To determine how much protein your patient needs before or after surgery, take their body weight in kilograms and times it by 1.5 to 2.0.

If your patient’s weight is 150LB.

·      Divide the weight in LB by 2.2 to get the weight in kg

o  150/2.2 = 68.2 kg

·      Next, multiply the body weight by 1.5 to 2.0

o  68 times 1.5=102; 68 times 2.0=136 g

·      They should consume 102-136 g per day of protein

Now that you understand how crucial protein is before surgery, head to our website to order samples or purchase CF(Protein)® today!

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For Med Pros Preparing for Surgery

    CF Nutrition Products During Cancer Treatment

CF Nutrition products help nourish, hydrate, and better prepare your patients for surgery. Our products may be beneficial to your patients diagnosed with cancer to help them recover faster after surgery and to stay hydrated during treatments. 

 CF(Preop)® Before a Cancer Procedure

   If your patient is undergoing surgery related to their cancer treatment, CF(Preop)® can help them enhance their recovery after surgery. We recommend advising your patients to consume one CF(Preop)® at 8:00 PM the night before their surgery and one CF(Preop)® on the morning of their surgery (up to two hours before surgery/procedure).

           ERAS® protocols, specifically preoperative carbohydrate loading before surgery, have shown positive results in recent studies on cancer patients. Often, surgical resection is the only cure for certain types of cancer. During surgery, the body’s stress response increases, inhibiting immune function and increasing inflammatory markers (Wang et al.). In turn, recovery is delayed, and the risk for infection and postoperative complications increases. The goal of ERAS® protocols is to maintain organ function and decrease stress response following surgery. By reducing the stress response, the body will return to normal physiology sooner, which is crucial in cancer patients. Therefore, consuming CF(Preop)® before surgery will allow them to recover from their surgery sooner and decrease the risk for postoperative complications. 

CF Nutrition Products During Chemotherapy 

 If your patient is undergoing chemotherapy, consuming CF(Rehydrate)® throughout their chemotherapy duration can help them replenish their body with medical-grade nutrition and hydration needed to prevent dehydration. 

 If they are receiving chemotherapy, replenishing their body afterward is crucial. Dehydration is a common side effect of cancer treatments. Additionally, vomiting and diarrhea are also common side effects of chemotherapy which again lead to dehydration. We recommend advising patients to consume CF(Rehydrate)® or  CF(Rehydrate)® IMMUNITY+ after their session, along with the days following. In doing so, they will replenish their body with the vitamins, minerals, electrolytes, and fluid they need to feel better as soon as possible. Consuming CF(Rehydrate)® or  CF(Rehydrate)® IMMUNITY+ throughout their chemotherapy duration can help your patient to combat chemotherapy’s adverse side effects and prevent dehydration.  

         Unfortunately, if your patient is receiving chemotherapy, CF(Protein)® may not be recommended. It is important to note CF(Protein)® contains turmeric. Turmeric has blood-thinning properties and may interact with certain chemotherapy medications. When it comes to turmeric, the dosage does make a difference. There is 0.3g of turmeric in one bottle of CF(Protein)®.  Curcumin may act as an estrogen hormone. So, it may make hormone-sensitive conditions worse. Although this is not proven, if your patient has any hormone-sensitive need, avoid turmeric or use it with caution and only with MD approval. Hormone-sensitive conditions include breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids.

Now that you know what CF Nutrition products may be right for your patient undergoing a procedure or cancer treatment, head to our website to learn more and receive samples for your patients to try. 

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Featured Posts For Med Pros Preparing for Surgery Presurgery Nutrition

What is ERAS®?

     ERAS® stands for Enhanced Recovery After Surgery. In the 1990s, Professor Henrik Kehlet founded Enhanced Recovery After Surgery (ERAS®), specifically in colorectal surgeries. There is now available research on ERAS in colorectal, vascular, thoracic, urosurgery, spine, neurosurgery, orthopedic, liver, pancreatic, and cardiac surgery. In the early 2000’s an ERAS society was formed that dedicated time to research preoperative care to improve recovery after surgery. The ERAS® society discovered that some traditional practices were no longer the best practice through evidence-based research. Since then, ERAS has gained much more consideration because of its overall advantageous effect on recovery after surgery, increased patient comfort, psychological well-being, decreased complications post-surgery, and reduced length of stay (LOS). 

What are the main pillars of ERAS®?

      The main ERAS® principles include protocols for preoperative, intraoperative, and postoperative care. All ERAS® protocols aim to lessen the body’s response to surgical trauma and maintain normal physiological function during surgery. 

ERAS® preoperative principles include:

  • pre admission counseling
  • fluid and carbohydrate loading
  • removing prolonged fasting
  • no/selective bowel preparation
  • antibiotic prophylaxis
  • thromboprophylaxis
  • no premedication

ERAS® intraoperative protocols include:

  • short-acting anesthetic agents
  • no drains
  • mid-thoracic epidural anesthesia
  • avoidance of salt and water overload
  • maintenance of normothermia

ERAS® postoperative protocols include:

  •  mid-thoracic epidural anesthesia
  • no nasogastric tubes
  • prevention of nausea and vomiting
  • avoidance of salt and water overload
  • early removal of the catheter
  • early oral nutrition
  • non-opioid oral analgesia NSAID
  • early mobilization
  • stimulation of gut motility
  • an audit of compliance and outcomes

What is the goal of ERAS® protocols? 

       As mentioned before, the goal of ERAS® protocols is to reduce the stress response of surgery. When the body undergoes surgical trauma, it can result in a metabolic state of stress. When the body is in this catabolic state, recovery will be slower, and complications are more likely to occur. Some complications associated with this exaggerated stress response are pain, paralytic ileus, increased cardiac demand, respiratory difficulties, increased insulin resistance, and increased infections. These complications lead to delayed recovery post-surgery. By lessening the body’s response to stress, ERAS® protocols help achieve early recovery and decrease LOS. Increased LOS and increased complications post-surgery is a significant issue for many medical professionals. ERAS® is beneficial to both the hospitals due to decreased LOS and costs and the patient as it increases patients comfort, reduces anxiety, and leads to faster recovery. 

Nutrition’s Role in ERAS®

    Nutritional status is critical before surgery. Ideally, a nutritional assessment is done before any surgery to reduce the risk of postoperative complications, increased length of stay, and infection risk. A patient can be diagnosed with mild or severe malnutrition by the MD. A Registered Dietitian assesses the patient for mild to severe malnutrition. The following criteria from Academy Adult Malnutrition Criteria (ASPEN) help to identify moderate malnutrition. A patient must have at least two of following to be diagnosed with moderate malnutrition: weight loss >2% in 1 week, >5% in one month, or >7.5% in 3 months; Energy intake less than or equal to 50% compared to estimated needs for greater than or equal to 5 days; Moderate body fat depletion; Moderate muscle mass depletion; Moderate to Severe Fluid Accumulation; and reduced grip strength. Furthermore, a patient must have at least two of the following to be diagnosed with severe malnutrition: Weight loss 1-2% in 1 week, 5% in one most, 7.5% in 3 months; Energy intake <75% compared to estimated needs in 7 days; mild body fat depletion; mild muscle mass depletion; Mild fluid accumulation; and Reduced grip strength. 

How to correct malnutrition before surgery?

If you need to correct malnutrition before surgery, using CF(Protein)® is a great way to build muscle and strength for a speedy recovery. Other ways to improve nutritional status can include enteral or parenteral nutrition. Obese patients may need to lose excess weight before surgery.

Why should you use CF(Preop)® over the NPO approach?

     Before ERAS® protocols, the traditional approach to surgery was to fast after midnight before surgery to decrease aspiration risk. In the 1990s, evidence-based research suggested that this was not necessary. Furthermore, there are detrimental effects caused by this period of prolonged fasting. Prolonged fasting worsens the catabolic state, increases metabolic stress, hyperglycemia, and insulin resistance. Furthermore, when the body fasts for a lengthy time, glycogen stores are depleted, leading to protein and muscle breakdown. Postoperative insulin resistance (PIR), a result of the stress response from surgery and further exaggerated with prolonged fasting, is directly related to delayed wound healing, increased morbidity/mortality, and LOS. PIR must decrease to enhance recovery after surgery.

Preoperative carbohydrate loading maximizes glycogen stores in the body as an energy source to minimize body tissues’ degeneration and reduce insulin resistance. By changing the metabolic state by shortening preoperative fasting (aka providing a complex carbohydrate 2-3 hours before surgery), PIR will decrease, protein loss reduces, and muscle function will improve. Additionally, preoperative carbohydrate loading increases patients’ comfort and reduces hunger, thirst, and anxiety, leading to surgery, all decreasing stress entering surgery. 

Specific Amounts of Nutrients Needed to Support Enhanced Recovery

CF(Preop)®  is a clear, colorless drink specifically formulated by an anesthesiologist for safe consumption hours before surgery. Each of its premium ingredients promote the highest level of pre surgery safety, comfort, and nourishment. It is designed to lower the risk of surgical site infections, reduce post-op recovery time, minimize post-op complication risk, and promote comfort and minimize stress. 

CF(Preop)®  is formulated for surgery and has all the ASA requirements to make it safe for consumption before your surgery. These requirements include a low osmolarity of 270mOsm to promote gastric emptying. It is clear and colorless and has no fat or protein and contains 50g CHO to shift the body from a fasted to fed state and promote enhanced recovery. It contains maltodextrin to help replenish glycogen depletion by catabolism related to fasting and surgery. Choosing to drink CF(Preop)® before your surgery helps you feel back to normal as soon as possible. 

Now that you know everything about ERAS® and how to prepare for surgery, visit our website to learn more. 

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Featured Posts For Med Pros Preparing for Surgery

CF(Preop)® Before Surgery

Is CF(Preop)® safe before surgery?

Yes, CF(Preop)® is safe before surgery. CF(Preop)® was designed to be a pre-surgical drink. When you order CF(Preop)® you will be sent two bottles. One to be taken the night before your procedure, and one to be taken up to two hours prior to your surgery.

Since 1999 (and republished in 2011 & 2017) the American Society of Anesthesiologists guidelines on preoperative fasting have dictated that it is safe for healthy patients to have clear liquids up to 2 hours before surgery.

Click here to see the latest guidelines from the American Society for Anesthesiologists. 

Why was NPO even started?

Before Enhanced Recovery After Surgery (ERAS®) protocols were discovered, the traditional approach was to fast after midnight prior to surgery to decrease the risk for aspiration. In the 1990’s, evidence-based research suggested that this was not necessary. Furthermore, there are detrimental effects caused by this period of prolonged fasting. Prolonged fasting worsens the catabolic state, increases metabolic stress, hyperglycemia and insulin resistance. Furthermore, when the body is fasted for a prolonged time, glycogen stores are depleted which can lead to protein and muscle breakdown. Postoperative insulin resistance (PIR), a result of the stress response from surgery and further exaggerated with prolonged fasting, is directly related to delayed wound healing, increased morbidity/mortality and length of stay. 

Why is CF(Preop)® consumed up to 2 hours before surgery?

It takes approximately 90 minutes for the oral carbohydrate solution to pass the stomach. Solid foods can be ingested up to 6 hours prior to surgery. The amount of carbohydrate to induce an effect must be enough to shift the body from a fasted to a fed state (50g carbohydrate 2 hours prior to surgery). There is no protein or fat in CF(Preop)® in order for it to safely empty your stomach before surgery. 

If you or your patient have delayed gastric emptying due to an underlying condition,  CF(Preop)®  should be consumed 3-4 hours before the procedure. 

How can I be sure that CF(Preop)® is out of my system in time?

Low osmolarity 240mosmol/l solution is also recommended to promote effective gastric emptying and dispel concerns for gastric emptying. CF(Preop)® meets this requirement. The recommended approach is to provide a carbohydrate drink with complex carbohydrates 800mL at bedtime and 400mL 2 hours prior to any procedure. The drink should contain 12.5% maltodextrin to allow for complete gastric emptying prior to surgery. CF(Preop)® meets this requirement as well so there is no concern for delayed gastric emptying.

What are the benefits of CF(Preop)®?

To enhance recovery after surgery, it is important to decrease PIR. Preoperative carbohydrate loading maximizes glycogen stores in the body as an energy source in order to minimize degeneration of body tissues and reduce insulin resistance. By changing the metabolic state, by shortening preoperative fasting (aka providing a complex carbohydrate 2-3 hours prior to surgery like CF(Preop)®, PIR will be decreased, protein loss will be reduced, and muscle function will improve. Additionally, preoperative carbohydrate loading increases patients comfort and reduces hunger, thirst, and anxiety, all decreasing stress entering surgery. In conclusion, consuming CF(Preop)®before your procedure is not only safe but also beneficial in your recovery outcomes.

Now you know everything you need to know about CF(Preop)® and why it is so important to consume before surgery.

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Featured Posts For Med Pros Healthy Lifestyle

Fiber’s Role in Our Diet

Fiber is a crucial component of the diet, yet many of us don’t reach the Recommended Daily Allowance (RDA). Today we break down how much is recommended and how to incorporate it into your diet. Plus we discuss how CF(Protein)® can help us meet the RDA.

 What is fiber?

Fiber is a type of carbohydrate that the body cannot digest. It helps regulate bowel movements, keep blood glucose levels in the normal range, and helps increase satiety which can support weight management. There are two different types of dietary fiber – soluble and insoluble. Insoluble fiber passes through the body undigested, unlike other carbohydrates. Soluble fiber dissolves in water and may help lower blood glucose and cholesterol. Examples of foods with soluble fiber are oatmeal, nuts, beans, lentils, apples, and blueberries. Insoluble fiber does not dissolve in water and helps food move through your digestive system. Consuming insoluble fiber helps regulate your digestive system and may help prevent constipation. Some examples of insoluble fiber are wheat, whole wheat bread, whole grain couscous, brown rice, legume, carrots, cucumbers, and tomatoes.

How much should I consume each day?  

The 13 grams of fiber per 8-ounce bottle of CF(Protein)® comes from non-GMO soluble vegetable fiber. The RDA for total fiber intake for men and women 19-50 years of age is 38 grams/day and 25 grams/day, respectively. The RDA for men and women over 51 is 31 grams/day and 21 grams/day, respectively. Consuming CF(Protein)® can help you meet the RDA and get all the benefits of consuming adequate amounts of fiber.

How can I include more in my diet?

Most Americans do not consume enough dietary fiber. On average, Americans consume about 15 grams of fiber per day, far lower than the RDA, regardless of age or gender. The best ways to increase fiber intake are choosing whole grains whenever possible, consuming legumes and beans, and increasing fruit and vegetable intake. Drinking CF(Protein)® can help support you in achieving the RDA because it contains 13 grams per one 8 ounce bottle.

Preventing diseases with adequate fiber:

Fiber may help reduce the risk of developing various diseases, including heart disease and diabetes. Studies show that the intake of fiber lowers the risk of developing cardiovascular disease. NHANES cross-sectional Data (2003-2006) showed that intake of whole grains (rich in fiber) was associated with enhancing the effects of statin in lowering cholesterol.

Fiber may help prevent constipation by regulating bowel movements. Constipation is a common gastrointestinal problem that many people experience. If you have chronic constipation, you may need to ramp up your fiber intake, and drinking CF(Protein)® is an easy and effective way to do so. As always, if you have a chronic health issue, it is best to speak to your doctor for any specific recommendations.

Fiber can also help maintain a healthy weight. High fiber foods are typically more filling than lower fiber foods. They also help keep you feeling fuller for longer. Satiety is the term used to describe your fullness. Fiber increases satiety after a meal. If you are looking to lose weight, increasing your fiber intake may help by increasing satiety and preventing the intake of excess calories.   

If you are not getting enough fiber, we recommend drinking one CF(Protein)® a day as a simple yet effective way to reap the benefits of adequate fiber intake.

Now that you know everything about fiber, check our our website to purchase CF(Protein)® to easily meet the RDA.

Categories
Featured Posts For Med Pros Nutrition

What is Ketosis?

The ketogenic diet has become popular over the past few years. As many of us know, a ketogenic diet is a very low carbohydrate and high fat diet. But what is actually going on when you follow a keto diet correctly?  Today on the blog we break down what happens when your body enters ketosis. We will also discuss how many carbohydrates are in each of our products to help you understand which products you can have to remain in ketosis. 

What is ketogenesis?

Ketogenesis is a metabolic pathway that produces ketone bodies and provides an alternative energy source for the body. Your body and brain need glucose to function. When carbohydrates are restricted, and glucose is not available, ketogenesis occurs. It is a metabolic process to help the body survive on low levels of exogenous glucose. 

 In healthy individuals, small amounts of ketones are continually being produced and used in the body as energy. During a prolonged period of fasting, the nervous system can oxidize ketone bodies as an alternate energy source. In ketosis, ketone body production increases when there are decreased carbohydrates or increased fatty acids. 

How many carbohydrates can I have to stay in ketosis?

The number of carbohydrates it will take to “kick you out of ketosis” can vary from person to person. Typically, limiting your carbohydrate intake to under 35g will keep you in ketosis. However, some people may need to restrict their carbohydrate intake to under 20g/day, while others can reach up to 50g/day and stay in ketosis. So, depending on your specific carbohydrate limit, some or all of our products may “kick you out of ketosis.”

How many carbohydrates are in CF Nutrition Products?

CF Nutrition’s products carbohydrate content in grams:

  • CF(PreOp)® – 50 g carbohydrate/bottle
  • CF(Protein)®- 29 g carbohydrate/bottle
  • CF(Rehydrate)® – 10g carbohydrate/serving (3 servings per bottle)
  • CF(Rehydrate)® Immunity+ – 6g carbohydrate/ serving (3 servings per bottle)

What CF Nutrition products can I have to stay in ketosis?

If you are trying to stay in ketosis, we do not recommend CF(PreOp)® or CF(Protein)® as those contain higher amounts of carbohydrates and will likely take you out of ketosis. CF(PreOp)® is a presurgical drink and typically consumed in the hours before surgery. Depending on how many other carbohydrates you are consuming throughout the day, one serving of either CF(Rehydrate)® or CF(Rehydrate)® Immunity+  should keep you in ketosis.  

What is ketoacidosis?

An overproduction of ketone bodies through increased ketogenesis can cause a problem because ketones are acidic. Ketoacidosis occurs when there are too many ketone bodies (occurs in cases of uncontrolled DM). Overproduction of ketone bodies through increased ketogenesis can be detrimental. An example of this is Diabetic Ketoacidosis or DKA. DKA occurs when there is a lack of insulin or insulin resistance and is more common in Type 1 Diabetics. The threshold for DKA is a glucose level of 250 mg/dL.

Should I follow a keto diet?

Following a keto diet has become a very popular way to lose weight. At CF Nutrition, we feel it is important to discuss what type of diet is right for you with your Dietitian or Doctor as everyone is different. Our mission is to provide you with the information you need and separate fact and fiction. 

Now that you know all about ketosis, check out our blog for more information on health and wellness. While you’re at it, head to our https://drinkclearfast.com/ to purchase CF Nutrition products.

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