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Dieting and Surgery – Q&A

So in keeping with my attempt to do some short video updates, I want to do a Q&A about dieting and surgery.

Hi, Lyle. Currently reading the awesome Women’s Vol. 1 and PSMF… I am on day 7 of PSMF (Cat 2, 30BMI, 14BF%). Protocol recommends FDB every 2-6s. Since, yes, I did week one wrong using Cat 1, I would like to do a full 3 weeks on diet. Dilemma is I have breast revision Feb 12 and I am required to stop Fish Oil ten days prior. I planned to stop it Feb 2nd, BUT can I continue one more week doing PSMF.

I got this question earlier this year and my answer won’t be helpful to them since their surgery has already passed.  But since I often get questions about the topic of dieting and surgery, I still want to address it.

Dieting After Surgery or Recovering from an Injury?

A common question I get is whether you can diet when recovering from an injury.  And the answer is that, yes you can, but no you shouldn’t.  The same for people recovering from surgery.  Same question, same answer.

The drive for this comes from the annoyance of gaining body fat after an injury since you usually can’t train as much.  The problem is that dieting has the potential to negatively impact on healing.

As I discuss in my injury recovery nutrition book, metabolic rate is increased after surgery.  It may be increased by 10-20% after more minor surgery and this can go up to 50% after burn injury.  Less extreme injuries don’t cause this as much but the effect is there.

Regardless of the amount, the body needs sufficient calories and building blocks to recover from an injury.  Eating at maintenance or even slightly above will optimize hormonal status to generate the most anabolic situation possible.

Because while gaining body fat is annoying, it can always be taken off.  In contrast, if injuries don’t heal properly, they may not heal completely at all.  The body is laying down new tissue and some of it can be pathological, scar tissue and such.  Dieting won’t help this.

Short version of the above: after an injury, heal first, diet later.  The fat gain is a temporary annoyance but not fully recovering from an injury may be a permanent problem.

Dieting Before Surgery

While not the genesis of the above question, I think it’s worth addressing dieting before surgery.  In many cases, this is can be beneficial.  And it’s especially the case when someone is carrying a lot bodyfat.  Now, I’m trying to be careful in my words and only reporting physiology and I hope people understand that.

But it’s generally been felt that pre-operative fat loss can improve the outcomes.  Mind you, the effect may not be enormous to begin with although it does appear to reduce the hospital stay.  This isn’t totally relevant to this Q&A so I’ll move on.

Rapid Fat Loss Duration with Surgery Looming

Ok, so let me get to the actual question.  Now I’ll be honest that it’s a little bit confusing as I’m not 100% sure what they are exactly asking.  I’ll do my best.

First and foremost, the writer’s stats put them in my Category 1, not 2 at 14% bodyfat.  So I’m not sure what they meant by being in Category 2.   Regardless.

So Category 2 suggests taking a full diet break (FDB above) every 2-6 weeks.  And the question seems to be if extending it an extra week, to Feb 2 with a Feb 12 surgery is ok.  I’m presuming this means extending it a week longer than I normally recommend.

If your’e wondering about the fish oil thing…So fish oils are mandatory part of the RFL program (well w-3).  And you have to go off of them prior to surgery since they are a blood thinner.  Otherwise you risk bleeding out.

And the genesis of this question is that I tend to be fairly adamant to “Do what’s in the book”.  Because invariably when people don’t do what’s in the book, it messes them up and I have to deal with their complaining emails that my program sucked.

It’s also why, in a lot of cases, I tend to be rather absolute in my statements.  This is simply experience.  If you give people flexible options, they usually pick the worst one.  So I head them off at the pass.

In the case of Rapid Fat Loss, what happens is that extending the diet tends to cause metabolic rate to go down more than it should, fat loss continues but is hellishly inefficient, etc.  So you need to do the diet breaks when I say to do them.

Exceptions That Make the Rule

But of course there are always context specific exceptions.  And the category that this falls into is when there is going to be a forced diet break due to some life situation. This can include spring break, summer vacation, special events.  Or, in this case, surgery.

In those situations, where the person is getting put on a break for some period of time, extending the diet by an extra week is fine.  They can lose a bit more fat and they’ll be moving to maintenance or higher.

And contrast that to me saying “Ok, you can extend your dieting an extra week before the break.” Which becomes one week and two weeks and three weeks and now I’m getting complaining emails from people.

But in this case the upcoming surgery is going to force a break.  So rather than stop 2 weeks before the surgery and then have the even longer break after the surgery, it’s ok to stop 10 days out when the fish oils have to stop.

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