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For Med Pros Medical Professionals

ERAS® Implementation in Orthopedic Surgery

ERAS® protocols have gained traction in the realm of orthopedic surgery, particularly showcasing benefits in elective hip and knee arthroplasty. The integration of ERAS® protocols across the preoperative, intraoperative, and postoperative phases of care has demonstrated a reduction in the length of hospital stay, readmission rates, and an enhancement in functional recovery. Notably, the implementation of ERAS® programs has the potential to ameliorate patient outcomes, curtail costs, and mitigate readmission rates following surgical procedures.

Why Should My Hospital Implement ERAS® Protocols?

The duration of hospital stay serves as a pivotal indicator of the financial strain on the healthcare system. Postoperative care expenses, encompassing physical and occupational therapy as well as nutritional support, significantly contribute to the overall costs. By embracing ERAS® protocols, healthcare facilities can foster improvements in both hospital and patient outcomes within the domain of orthopedic surgery.

What is the Benefit of Preoperative Carbohydrate Loading?

Preoperative administration of a carbohydrate load up to 2 hours before surgery has been identified as a strategy to induce a fed state in patients, thereby reducing postoperative protein loss and preserving muscle mass. Furthermore, postoperative insulin resistance (PIR) can precipitate hyperglycemia, elevating the susceptibility to surgical site infections. Orthopedic patients, given their heightened vulnerability due to compromised blood supply to injured or surgically manipulated bones and joints, are at an escalated risk of such infections.

What is the Problem With Fasting Before Surgery?

The conventional practice of fasting from midnight, lacking substantial evidence-based support, engenders a catabolic state that disrupts the normal interplay between insulin and glucose. This metabolic imbalance prompts the body to deplete its crucial glycogen reserves and subsequently resort to breaking down fat and muscle for energy. Consequently, patients develop insulin resistance, impeding the responsiveness of target cells to insulin.

How Does CF(Preop)® Help My Patients?

In contrast, the utilization of CF(Preop)®, a preoperative drink, has been shown to safeguard critical glycogen stores in orthopedic patients. Administering CF(Preop)® in the immediate preoperative window has the potential to stabilize blood sugar levels, ultimately diminishing the risk of hyperglycemia and its associated complications.

Does Research Support Preoperative Carbohydrate Loading?

Research findings have consistently underscored the advantages of ERAS® implementation in orthopedic surgery. Notably, the ERAS® group has exhibited a propensity for reducing the incidence of postoperative complications, 30-day mortality rates, and the Oswestry Disability Index (ODI) following orthopedic procedures. Moreover, studies have reported a substantial reduction in the length of hospital stay after total arthroplasty, with no significant upsurge in readmission rates for any reason.

In a retrospective analysis encompassing 6000 patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA), ERAS® was found to significantly diminish the occurrence of postoperative complications, including myocardial infarction, readmission rates, and 30-day mortality rates compared to traditional protocols. Similarly, a large-sample trial involving 5002 orthopedic surgery patients revealed that ERAS implementation correlated with reductions in hospital length of stay and postoperative complication rates.Furthermore, the administration of a preoperative oral carbohydrate solution, administered up to 2 hours before anesthesia induction, has been associated with a marked enhancement in the well-being and comfort of postoperative patients, as evidenced by research conducted by Chada et al.

In conclusion, preoperative carbohydrate loading is an evidence based practice that helps improve surgical outcomes. Reach out today to request samples for your practice!

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Medical Professionals Preparing for Surgery

How is L-Citrulline better than L-Arginine?

CF(Preop)® contains L-citrulline to help improve blood flow by increasing nitric oxide levels. Other pre-surgery carbohydrate drinks contain L-arginine. Today, we break down why L-citrulline is more effective than L-arginine further illustrating that CF(Preop)® is the superior carbohydrate drink before surgery.

What is L-citrulline?

L-citrulline is a non-essential amino acid and we can make it in our bodies. L-citrulline is a key component of the urea cycle. 

What role does L-citrulline play in CF(Preop)®?

  CF(Preop)® contains L-citrulline. L-citrulline improves circulation by increasing nitric oxide levels, boosts the immune system by nourishing bowel electrolytes, and is efficiently converted to L-arginine. CF(Preop)®’s competitors do not contain L-citrulline.

Why is L-citrulline better than L-arginine?

When L-arginine is consumed orally, it undergoes significant breakdown by the enzyme arginase in our gastrointestinal pathway. Arginase hydrolyses arginine into ornithine and urea. When this happens, the result is low plasma L-arginine levels and lower bioavailability of L-arginine for nitric oxide synthesis. 

Furthermore, L-citrulline supplements are shown to increase arginine levels more than arginine supplements themselves. Arginine is subject to a number of pre-systematic and systematic elimination processes. Arginine is rapidly metabolized by liver and small intestine but catabolism of L-citrulline in the intestine is limited. L-citrulline is not metabolized by arginases and bacteria. L-citrulline is not extracted from the systemic circulation for clearance by the liver.

What are the benefits of supplementing L-citrulline?

Supplementation of L-citrulline:

  • May help with muscle recovery and blood flow
  • May reduce blood lactate levels
    •  L Citrulline can decrease lactate production and therefore increase time to exhaustion, in turn increasing physical performance 
  • Increases the circulation and tissue Arginine than an equivalent dose of Arginine 
  • May reduce blood pressure
  • Can increase nitric oxide synthesis activation
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Featured Posts Medical Professionals Presurgery Nutrition

CF(Preop)®: The Superior Pre Surgery Drink

Enhanced Recovery After Surgery (ERAS®)  protocols are becoming more widely known and used throughout medical facilities. Preoperative carbohydrate loading is one of the most inexpensive and easy to implement ERAS® protocols. With that being said, we know as a medical professional you have options when choosing a pre-surgical drink. Today, we break down why CF(Preop)® is truly the superior pre-surgical carbohydrate drink to provide to your patients.

What sets CF(Preop)® apart?

At CF Nutrition, we take pride in formulating our beverages with the most premium ingredients. We use evidence-based research to design products that actually serve a purpose. We strive to include everything the consumer needs and nothing extra or artificial.  CF(Preop)® ingredients all serve a purpose to help enhance your patient’s recovery after surgery and improve surgical outcomes. We use simple and effective ingredients that you can feel good about giving to your patients. 

Benefits of using CF(Preop)®:

  • 50 g Complex Carbohydrates
  • Electrolytes
  • Natural ingredients
  • No artificial colors or flavors
  • Vegan
  • Kosher, Halal 
  • Non-GMO, Soy Free, Dairy-free
  • Meets ERAS® guidelines for pre-surgery use of clear carbohydrate beverage
  • Meets ASA® guidelines for use with preoperative fasting
  • Osmolarity: 270 mOsm

What makes CF(Preop)® different from other pre-surgery drinks?

  One benefit of CF(Preop)® over other pre-surgery drinks is the added sugar content. CF(Preop)® has 2 grams less added sugar than other products available. Added sugars are to be limited as much as possible to avoid health complications such as obesity and diabetes. Therefore, having 2 g less of added sugar makes CF(Preop)® a better choice before surgery when compared to other products.

CF(Preop)® has 50% of Vitamin A’s daily value, whereas other products available have none. Vitamin A is an antioxidant to support the function of the health of the epithelial tissue.  Zinc boosts the immune system and supports your recovery. When comparing CF(Preop)®  to other products, CF(Preop)® has 20% more DV of Zinc, making it a more suitable choice. 

CF(Preop)® also contains L-citrulline. L-citrulline improves circulation by increasing nitric oxide levels, boosts the immune system by nourishing bowel electrolytes, and is efficiently converted to L-arginine; CF(Preop)®’s competitors do not contain L-citrulline.

 The lower osmolarity in CF(Preop)® will allow more effective gastric emptying to prevent any risk for aspiration. CF(Preop)® contains filtered water to avoid dehydration and the accompanying headache and collapsed veins.

 CF(Preop)® uses stevia, which is a natural sweetener that comes from a plant. CF(Preop)®’s competitors use sucralose, which is an artificial sweetener that is not broken down well by the body. Sucralose is a modified form of sugar made by removing sugar oxygen groups.

Why don’t sports drinks cut it?

Over and over again, we hear medical professionals recommending sport drinks as a pre-surgical drink. Unfortunately, this can do more harm than good. Sports drinks DO NOT meet the ASA® guidelines for a pre-surgical drink and should not be recommended for patients in the hours before surgery.

Here are a few reasons why:

  • Sport drinks typically contain >20 g of added sugar
  • Sport drinks don’t contain complex carbohydrates
  • Sport drinks do not have a low osmolarity
  • Sport drinks may not be clear and colorless

Overall, we believe our product CF(Preop)® is the best choice for your patients before surgery. Compared to other products, it contains the least amount of sugar and is the most natural source of nutrition. There are no artificial sweeteners as it uses stevia, a natural sweetener that is generally recognized as safe. It contains enough complex carbohydrates (50 g) to shift the body from a fasted to a fed state to enhance your recovery. It contains vitamin A and Zinc to help boost your immunity and further enhance your recovery. It also contains L-citrulline, which improves circulation by increasing nitric oxide levels, promotes the immune system by nourishing bowel electrolytes, and is efficiently converted to L-arginine. It has a low osmolarity to allow for complete gastric emptying, so there is no risk for aspiration. It is vegan, Kosher, Halal, dairy-free, non-GMO, and soy-free, making it suitable for diet restrictions. We hope you choose CF(Preop)® before surgery so your patients can have a safe and effective recovery.

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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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Featured Posts Medical Professionals Nutrition Wellness + Medical Tips

CF(Protein)®- Plant Based Protein Beverage

   CF(Protein)® is a plant-based protein drink that provides a concentrated dose of natural electrolytes, antioxidants, and essential fats. It can be used as a delicious addition to your everyday diet or the ideal supplement to improve overall health before surgery. 

CF(Protein)® Benefits:

  • Promotes muscle maintenance and recovery
  • Comprehensive nutrition on the go
  • Strengthens immune support
  • Reduces risk of malnourishment 
  • Antioxidants and anti-inflammatory ingredients
  • Concentrated nutrition on the go
  • Healthy omega-three and omega-six fats
  • Naturally derived vitamin and minerals
  • Essential amino acids
  • Natural fiber sources
  • Shelf-stable
  • Gluten-free, kosher, non-GMO, vegan and dairy-free
  • Convenient on the go protein source

CF(Protein)® Ingredients: 

   CF(Protein)® uses plant protein that is easily digested with yellow pea protein, contributing a significant amino acid dose that promotes muscle recovery and repair. CF(Protein)® has complex carbohydrates derived from fruit. This makes CF(Protein)® a rich energy source without any added sugar. There are no cheap, low-quality additives or simple sugars seen in other protein drinks. CF(Protein)® also contains healthy fats, mono and polyunsaturated fats. The use of chia seed oil provides consumers with essential omega-three and omega-six fatty acids to minimize inflammation and help prevent cardiovascular disease. CF(Protein)® also contains turmeric, which may help support your immune system. 

CF(Protein)® Nutrient Information per 8-ounce bottle:

• Calories: 200

• Total fat: 6g

• Saturated fat: 1g

• Sodium: 230mg

• Total Carbohydrate: 29g

• Dietary Fiber: 13 g

• Total Sugar: 14g

• Includes 0 added sugar

• Protein: 13g 

CF(Protein)® Compared to Other Similar Products:

    CF(Protein)® uses natural ingredients and is free from artificial flavors and dyes. Competitors of CF(Protein)® use ingredients like sugar, high oleic safflower oil, cellulose gel, and cellulose gum. Additionally, other products on the market contain added sugar that can lead to diabetes and other health conditions. CF(Protein)® had 0g of added sugar.  Ideally, consumers should limit added sugar as much as possible in the diet. Consuming added sugar can lead to overweight and obesity and may increase your risk for developing diabetes and even cancer. Added sugars should be no more than 10% of total calories. CF(Protein)® also stands out from its competitors because it has 13g dietary fiber to promote GI regularity and increase satiety. Most Americans fall short of the recommended amount of fiber. The RDA for fiber is 38g for adult males under 50 and 30g for adult males over 50. The RDA for women 50 years and younger is 25g/day, and for women over 51, 21g/day. It is essential to get enough fiber because it will help normalize bowel movements, help manage blood sugars, increase satiety, and help lower cholesterol. Consuming CF(Protein)® will help you achieve the RDA for fiber. 

      At CF Nutrition, we feel CF(Protein)® is superior to other protein supplements due to its natural, clean, immune-supporting ingredients and high fiber and low added sugar content. CF(Protein)® is a well-balanced, nutrient-rich protein drink that will help increase your energy levels and support your immunity. Unlike other protein drinks, there is no added sugar, and one 8-ounce bottle allows you to meet almost ½ of the RDA for fiber. Several detrimental effects to consuming added sugar, including high blood pressure, inflammation, weight gain, diabetes, and fatty liver, all like an increased risk for heart attack and stroke. With CF(Protein)®, you can find peace knowing there is no added sugar or artificial ingredients. Additionally, it has omega-three essential fatty acids that will help lower cholesterol and prevent cardiovascular diseases. 

So what are you waiting for? Now that you know CF(Protein)® is the best plant based protein drink on the market, visit our website to purchase yours today!

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