Evidence Shows Using Amino Acids for Surgery Recovery Leads to Improved Outcomes

Injury and surgery place a similar type of stress on the body, and essential amino acid therapy can help mitigate this stress and accelerate muscle recovery. An essential amino acid supplement with abundant leucine can slow the net loss of muscle protein.

Surgery can be a life-saving necessity, but it places significant strain on the human body. Developing a proactive plan for navigating the post-surgery healing process can help surgical patients avoid—or at least mitigate the effects of—pitfalls such as protein-energy malnutrition, the loss of lean body mass, and systemic inflammation. High-quality scientific research indicates that essential amino acids can offset the physical stress caused by surgery and accelerate the recovery process. To understand the benefits of amino acids for surgery recovery, you must first have an understanding of the role amino acids play in the body.

Dietary supplements of essential amino acids are the most important aspect of nutritional therapy for recovery from injury or surgery.

It’s no secret that amino acids make vital contributions to your overall health and well-being, particularly when it comes to the growth and repair of muscle tissue.

There are two general types of amino acids: essential amino acids and nonessential amino acids. Both are necessary, but because your body can produce nonessential amino acids, you do not need to monitor your intake in the same way you must do for essential amino acids that must be obtained either from the food you eat or from supplements.

Researchers have found that a subgroup of essential amino acids called branched-chain amino acids (BCAAs) increase the body’s ability to  synthesize protein, regulate the rate of muscle tissue breakdown, repair muscle tissue, and transport fuel into muscle cells.

The Toll Surgery Takes on the Body

Think of surgery as a controlled injury. If you are hurt in a car crash, for example, you can go from perfectly healthy to seriously injured in a matter of seconds. The same is often true in the case of surgery.

When going in for elective surgery, you typically feel fine as the anesthesia is administered, but when you wake up, you feel roughly as if a truck ran over you. And even if an underlying pathological condition necessitates surgery, the stress of the surgery itself increases the challenge of rehabilitation.

Although the exact nature of the stress on the body may differ, the body’s response to either the controlled injury of surgery or an uncontrolled injury involves the same fundamental elements. The path to recovery can be nearly identical whether you are healing from an injury or from surgery.

Why People Lose Muscle Mass and Function During Recovery

Whether you are severely injured or recuperating from surgery, one thing’s for sure—you are going to lose muscle mass and function. It’s inevitable. Recovery requires some degree of inactivity, and inactivity means the muscles aren’t maximizing their movement and performance capabilities. This makes a decline in muscle mass and function inescapable. What you can control, however, is the degree of decline. It does not have to be substantial (more on that in a moment).

The detrimental effects of inactivity on muscle mass and function are well established. If you’ve ever had a broken limb put in a cast, you’ve seen the effects firsthand. When it’s time to remove the cast, you’re greeted with the startling withered look of a limb unused. Even if you have been working out the rest of your body, the limb that has remained inactive will show visible signs of decline. An event such as heart surgery that physically limits activity has the same effect as casting a broken limb but on the whole-body level.

The muscle loss triggered by inactivity is amplified by your body’s overall physiological response to injury, which we call the catabolic state. A catabolic state occurs in response to severe injury or illness and is characterized by whole-body protein loss, mainly due to increased breakdown of muscle proteins. The catabolic state can last anywhere from a week to several months.

Anyone who is interested in muscle building for functional or aesthetic reasons knows that failure to consume an adequate supply of nutrients—in particular, protein—slows the body’s rate of muscle protein synthesis, resulting in the loss of a certain amount of muscle. When your body enters the catabolic state, the loss of muscle mass and strength occurs at a much faster rate than it occurs in the absence of key nutrients.

The Physiological Processes Behind Muscle Loss

The simplest way to encapsulate the processes that result in muscle loss is to state that when the rate of muscle protein breakdown exceeds the rate of muscle protein synthesis, we lose muscle mass. Our bodies just can’t make enough new muscle protein to offset the rapid rate of muscle breakdown.

When our bodies enter a catabolic state, the rate of muscle protein breakdown shoots way up. It is not unusual for the rate of protein breakdown to increase by more than threefold!

A large increase in the rate of protein breakdown releases a flood of amino acids into the muscle cells. This increased availability of amino acids stimulates the rate of muscle protein synthesis. Unfortunately, the increased synthesis is not enough to balance the increase in breakdown. The net result is a large increase in the loss of muscle protein.

How Hormones and Inflammation Drive the Catabolic State

The catabolic state following surgery, injury, or illness stems from a variety of underlying factors.

First, a flood of stress hormones, most prominently epinephrine, norepinephrine, and cortisol, activate the sympathetic nervous system. You have likely heard this referred to as the fight-or-flight response.

Next, inflammation kicks in. There are two types of inflammation, and their impact on the body is quite distinct. Local, acute inflammation arises at the site of injury or surgery. This type of inflammation can be quite beneficial in the early phase of wound healing. When local inflammation lingers too long, however, it can begin to inhibit tissue repair.

Systemic inflammation, also called long-term, chronic inflammation, has no identifiable benefits. In fact, this type of inflammation can escalate the catabolic state in the whole body, increasing the severity of associated muscle loss.

To better understand the impact systemic inflammation can have on the body, let’s examine that process in the context of a severe burn injury to the leg. A local response at the site of tissue injury would result in a decline in muscle protein synthesis and a loss of muscle mass and strength to the injured leg. A systemic response, however, disrupts muscle protein metabolism in the unburned leg to nearly the same extent as it does in the leg that sustained the severe burn injury.

Furthermore, the consequences of a catabolic state extend beyond muscle loss. Your appetite decreases, making it more difficult to consume the nutrients required to fuel muscle protein synthesis. Metabolic changes transpire, too, such as reduced sensitivity to the action of the hormone insulin. Insulin resistance may persist for months after other symptoms of the catabolic state have resolved.

Using Amino Acid Therapy to Help Your Body Heal

Loss of muscle mass and strength after injury or surgery delays recovery and an individual’s return to normal activity. In severe cases, or in elderly individuals with little reserve, muscle loss can be a direct contributor to mortality.

In all cases of injury and surgery, the speed and extent of recovery to normal functional capacity is determined in large part by how much muscle has been lost. Injury or surgery causes muscle loss at a rate so fast that consequences can be evident in a matter of days. If you can decrease the amount of muscle you lose, you can accelerate the time it takes you to recover. A balanced essential amino acid supplement can help tremendously with both those goals.

How Essential Amino Acids Decrease Muscle Loss

In order to decrease muscle mass losses during the recovery period, you must counteract the changes to your body’s protein metabolism processes.

After an injury (including the controlled injury of surgery), an alteration in muscle protein metabolism transpires, limiting the normal stimulatory effect of dietary protein on muscle protein synthesis. The lack of responsiveness of muscle protein synthesis to the normal stimulatory effect of dietary protein is called severe anabolic resistance.

The Crucial Role Played by mTOR

Anabolic resistance in the catabolic state occurs because of a molecular factor called mTOR inside the muscle cell. Under normal conditions, mTOR activates muscle protein synthesis, however, anabolic resistance in the catabolic state decreases mTOR activity. In order for muscle protein synthesis to return to optimal levels, mTOR activity must be escalated. Once this occurs, other intracellular molecules involved in initiating protein synthesis respond by escalating their activity levels as well.

So, how do we get mTOR up and running? By supplementing with a complete blend of free essential amino acids formulated with a relatively high proportion of leucine.

Perhaps you’re wondering: why not get leucine from the diet? One of the biggest therapeutic challenges presented by the catabolic state that arises after surgical procedures, injuries, or severe illnesses is reduced appetite. Loss of appetite makes it difficult to take in the dietary protein needed to offset increased muscle protein breakdown and help prevent muscle decline. For many, taking a well-formulated amino acid supplement is a desirable alternative to attempting to eat a sufficient amount of leucine-rich dietary protein.

Then there’s the fact that free leucine activates mTOR more efficiently than leucine contained in intact protein. This is because free leucine does not require digestion and is therefore absorbed more rapidly. Free leucine reaches a higher peak concentration in blood more rapidly than when leucine is consumed as part of an intact dietary protein that must be digested before the constituent amino acids can be absorbed. During the catabolic state, therefore, consuming a mixture of free essential amino acids with abundant leucine slows the net loss of muscle protein more effectively than either intact protein in a meal or meal replacement beverages do.

Once mTOR is activated by leucine, an increased availability of a full balance of all the essential amino acids is necessary to stimulate protein synthesis. Single amino acid therapy with leucine, or a combination of the three BCAAs, just won’t do it. Thus, although leucine is the key to overcoming anabolic resistance, consumption of leucine alone is not sufficient to stimulate muscle protein synthesis.

Dietary supplements of essential amino acids are the most important aspect of nutritional therapy for recovery from injury or surgery.

In addition to providing precursors for making new muscle protein, if enough essential amino acids are consumed, concentrations will rise high enough to inhibit muscle protein breakdown and stimulate protein synthesis.

In this way, essential amino acid nutritional therapy during the recovery period following surgery can help you return to full function by protecting against muscle loss. Taking an essential amino acid supplement can:

  • Activate mTOR
  • Provide amino acid precursors needed to make new muscle
  • Inhibit the breakdown of muscle
  • Improve the net balance between muscle protein synthesis and breakdown

A stimulation of muscle protein synthesis and inhibition of muscle protein breakdown is the metabolic basis for restoring muscle mass and strength.

Key Scientific Evidence on Using Amino Acids for Surgery Recovery

Much of the work done on how best to preserve lean body mass in the wake of major surgery has been focused on protein breakdown and amino acid oxidation. The manipulation of hormones involved in the development of the catabolic state, as well as the stimulation of insulin and insulin-growth factors, has also been a major priority.

Decreasing the release of so-called catabolic hormones as well as insulin resistance in post-surgery patients has been shown to both lower rates of whole body protein breakdown as well as to minimize decreases to muscle protein synthesis. A key element of this, researchers have found, is providing the correct balance of nutrients.

According to findings published in Anesthesiology, delivering an infusion of amino acids to patients can actually reverse the catabolic state. Previous studies demonstrated that amino acid infusions can decrease whole body protein breakdown and increase protein synthesis, resulting in a positive protein balance.

A research team led by scientists from the Department of Anesthesia at the McGill University Health Centre in Montreal enrolled patients scheduled to undergo colon resection, a surgical procedure that involves a hospital stay. On the second postoperative day, all patients received a solution of 10% amino acids. Levels of whole body leucine and glucose were measured, and blood samples were taken to analyze levels of hormones including cortisol, glucagon, and insulin.

The scientists found that the infusion of amino acids resulted in a positive protein balance as well as other beneficial metabolic effects. Their findings showed that the amino acids suppressed protein breakdown by over 25%, and that 12-16% of amino acids made available from proteolysis were redirected toward protein synthesis. “The infusion of amino acids in the current study caused an average increase in protein balance of 36.7 μmol · kg−1· h−1,” the authors wrote. They concluded that even the short-term use of amino acids after surgery can inhibit protein breakdown while stimulating protein synthesis.

A separate study carried out by a team based in Oregon and published in the June 28, 2018 issue of the Journal of Bone and Joint Surgery focused specifically on how amino acids impact post-surgical muscle volume loss.

The double-blind, placebo-controlled, randomized trial enrolled adult patients undergoing total knee arthroplasty (TKA), also known as total knee replacement surgery. The authors’ goal was to determine whether supplementing with amino acids during the perioperative period—which includes time spent in the hospital prior to as well as after surgery—can mitigate muscle atrophy.

Study participants ingested either 20 grams of essential amino acids (EAAs) or a placebo twice daily for 7 days prior to their procedures and for 6 weeks following them. Magnetic resonance imaging was used to measure quadricep and hamstring muscle volume at the time of enrollment and at the study’s conclusion. Data on functional mobility and strength came from patient-reported outcomes.

Compared with the placebo group, participants who took EAAs experienced significantly smaller losses of mean quadriceps muscle volume in the leg on which the operation was performed as well as their other leg. A greater muscle-volume-sparing effect was seen for the hamstrings of individuals who took EAAs than for those in the control group as well. The authors concluded that EAA supplementation is a safe way to reduce the loss of muscle volume for patients undergoing TKA.

Strategies for Preserving Muscle Strength and Function During Recovery

Even if you’re able to use amino acids to alleviate or avoid the the short-term catabolic state that follows physical trauma, your body will enter a depleted state marked by significant muscle loss. This will be evident in overall body weight loss—how many times have you heard that the only good thing about someone’s injury or surgery was that they lost weight?

As recovery continues, the lost weight will be gradually regained. However, without diligent adherence to an exercise and nutrition program, the lost muscle weight will be regained as fat. To return to your daily activities in the best possible health, it is crucial to replace the lost weight with new muscle, not fat. In this article, I go deeper into how amino acids can fuel good weight after a serious illness, injury, or surgery.

For our purposes here, I’ll provide an overview of best practices related to exercise and nutritional strategies to rebuild muscle during recovery.

Be Sure to Prioritize Exercise

At the outset of recovery, your capacity for exercise will be limited. Even so, it is essential to engage in both aerobic and resistance exercise as soon as possible.

Depending on the specifics of your situation, it may be advisable—or even mandatory—for you to engage in a structured physical therapy program. Whether or not that is the case, at some point in your functional recovery process, it will be vital to devise your own approach to reintroducing physical activity.

Aerobic exercise can take any form—walking, elliptical, cycling, swimming, and so on—as long as the option you choose elevates your heart rate to 120 beats per minute or above. As you regain your fitness, your speed and the amount of distance you cover will increase.

Some moderate stretching may also be needed to regain range of motion. As strength returns, work up to the recommended guideline of 150 minutes a week of aerobic exercise. However, because most of your cardio output recovery will be walking as opposed to more strenuous aerobic activity, it’s advisable to increase to 5 hours per week of aerobic exercise in addition to resistance sessions.

Resistance exercise is the most important type of exercise for rebuilding muscle. Machines are optimal for resistance workouts, particularly at the outset. The loss of muscle function in the catabolic state impairs coordination, and the possibility of injury is greater with free weights. Machines provide specificity in terms of the muscles involved in any exercise, and this may be of particular importance when addressing specific areas affected by injury or surgery.

The weight lifted should be progressively increased as strength returns. Most individuals will find that they regain lost strength in a shorter period of time than that required to originally gain that strength. The amount of resistance used should be adjusted accordingly. A general guideline is to increase the resistance by 10% per week, but progress may be more rapid in the first few weeks of recovery.

Make a Post-Surgery Nutrition Plan

Nutrition plays a crucial role in recovery. Eating a balanced diet featuring ample high-quality protein is essential. However, that alone will not ensure you regain more muscle than fat.

The single most important aspect of nutritional therapy during the recovery period will be essential amino acid supplementation.

Essential amino acids are the active components of dietary proteins. Balanced essential amino acid supplements stimulate muscle protein synthesis to a greater extent than any naturally occurring protein food source.

Essential amino acid supplements work synergistically with exercise to provide a greater stimulus than either produces on its own. To maximize the beneficial effects of each element, you should take essential amino acids 30 minutes before an exercise session as well as immediately following the session.

When consuming essential amino acids without accompanying physical activity, the greatest effect will be when taken between meals. That said, there is no wrong time to take an essential amino acid supplement. If you miss the optimal dosing window, simply take your EAA supplement at your earliest opportunity.

For more information on a balanced amino acid supplement created for recovery after injury or surgery, check out our Amino Company blends.

Maintaining Muscle When You’re Sick or Injured: Why It Matters and How to Do It

Muscle loss is accelerated in response to serious illness or injury, and that can have a direct impact on your recovery, which is why maintaining muscle mass when you’re sick is so very important. Essential amino acids can help reverse muscle loss associated with illness, injury, or high stress levels, and help accelerate recovery.

It is unfortunately true that, at some point in our lives, most of us will have to deal with a major health issue. This may be surgery, serious illness such as pneumonia, or chronic disease such as kidney disease. Muscle loss is accelerated under such conditions, which can have a direct impact on your recovery. In this article, I’ll first explain the biological processes that contribute to accelerated muscle loss and why it’s so vital to counteract those. Then I’ll equip you with evidence-based good advice on maintaining muscle when you’re sick, a key piece of which is to focus on obtaining a steady supply of essential amino acids to help reverse muscle loss and accelerate your recovery.

The Importance of Maintaining Muscle When You’re Sick or Injured

The consequences of muscle loss as a result of serious injury or illness can be severe and immediate. Muscle mass can be a direct contributor to survival during times of critical illness and can significantly contribute to the speed and extent of recovery. When we age, we lose muscle slowly and gradually. However, battling a serious illness or injury can result in rapid weight loss—a significant portion of which may come from the loss of muscle tissue rather than body fat. This deterioration of muscle mass occurs so quickly that consequences can be evident in a matter of days or weeks.

Understanding the Catabolic State

In technical terms, the biological mechanisms that result in rapid muscle loss can be referred to collectively as a catabolic state. This state itself can be seen as a subcomponent of the body’s overall physiological response to intense stress. Regardless of the underlying cause of that stress (i.e., cancer, injury, surgery, etc.), the body’s response features certain common aspects.

In a catabolic state, you not only lose an increased percentage of your muscle mass in a shorter period of time, but you also experience decreased appetite as well as metabolic changes, such as reduced sensitivity to the action of the hormone insulin, that intensify the associated adverse outcomes. The loss of appetite results in decreased nutritional intake at a time when demand for dietary nutrients, particularly protein, is increased.

Interestingly, regardless of the clinical condition that causes the stress response, changes in muscle protein metabolism are basically the same. Therefore, the body’s response to stress and the effects of the catabolic state can be discussed generally without the need to specify what instigated them.

Muscle Protein Metabolism in a Catabolic State

The rapid loss of muscle protein that transpires during a catabolic state reflects an imbalance between the rates of muscle protein synthesis and muscle protein breakdown. This imbalance has less to do with changes to muscle synthesis (muscle growth) and instead stems from a large increase in the rate of muscle protein breakdown. You can see in the figure below how different illnesses affect a similar increase in muscle protein breakdown.

Maintaining muscle when you're sick

Certain physiological states, such as illness, cause the rate of muscle protein breakdown to accelerate. This, in turn, releases a flood of essential amino acids into the muscle cells to stimulate muscle protein synthesis. The message sent by the availability of essential amino acids is to amp up muscle growth to attempt to keep pace with muscle loss. However, the increased synthesis is still not enough to balance the dramatic increase in breakdown. The net result is a large increase in the loss of muscle mass because muscle protein synthesis just can’t match the speed of muscle protein breakdown.

While free amino acids released during muscle protein breakdown can be reincorporated during muscle protein synthesis, that process is further stimulated only marginally (or not at all) by nutritional intake. The catabolic state suppresses appetite so much that it is hard to eat enough food, and even when you do force down food or rely on traditional protein shakes and meal replacement beverages, you see little or no beneficial response. Food doesn’t have much of a beneficial effect due to the abundance of essential amino acids already available. Accelerated protein breakdown has freed so many essential amino acids for protein synthesis that the rate of synthesis is already close to maximal.

Furthermore, the catabolic state causes severe anabolic resistance, which means eating dietary protein doesn’t increase muscle protein synthesis in times of injury and stress as it does in times of optimal health. The body absorbs essential amino acids from intact protein slowly and the extent of the increase in essential amino acids is not particularly large. Therefore, dietary protein is essentially rendered ineffective in stimulating protein synthesis because consuming it doesn’t induce enough of a change in essential amino acid concentrations in the muscle.

Activating Muscle Building In a Catabolic State

In order for muscle protein synthesis to be further increased in the stress response, there must be an activation of the intracellular molecules involved in initiating protein synthesis. The central factor in this process is an initiation factor of protein synthesis called mTOR.

New evidence indicates that the most effective way to activate mTOR is to fortify your body with an essential amino acid supplement formulated with a high proportion of leucine. The leucine stimulates mTOR activity, and the available essential amino acids serve as precursors for newly synthesized protein. If enough essential amino acids are consumed, concentrations will rise high enough to inhibit muscle protein breakdown as well. The combination of activating mTOR and stimulating protein synthesis while inhibiting protein breakdown improves the net balance between protein synthesis and breakdown.

To synthesize the most important and actionable point: supplementing with a mixture of free essential amino acids high in leucine can slow the net loss of muscle protein, whereas consuming intact protein in a meal or a meal replacement beverage is ineffective during physiological stress.

Why Inactivity Exacerbates Muscle Loss

Illness, injury, and surgery bring about inactivity. If you are ill or injured enough to be admitted to the intensive care unit, you will almost certainly be confined to bed. Those over 65 years old may find themselves confined to their beds during hospital stays even when they are capable of walking due to concerns with stability and risk of a fall.

After surgery, you are likely to be physically limited until incisions are healed and you show some degree of recovery. This is particularly true after orthopedic surgery. Even illnesses that don’t require hospitalization take a serious toll on the body and health care practitioners advise pausing your exercise program until you have fully recuperated.

Hopefully, you have made sleep a priority during times of health. Your body needs high-quality rest to recover between training sessions and maximize the strength and fitness gains you hope to achieve with your hard work. Short-changing your rest periods will hold you back. This holds particularly true when you’re sick or injured. Not only do sleep and rest enhance immune function, but physical activity can also suppress it. Plus, if you’ve fallen victim to flu season or a respiratory infection, heading back to the gym too soon means you’re likely to infect your fellow gym-goers. And while injuries are not contagious, returning to your usual exercise program too soon increases the likelihood that the original injury will not heal properly, which often necessitates further time off in order to make a full recovery.

Scientific Studies on Inactivity and Muscle Loss

For all these reasons, the metabolic effects involved in muscle loss that I explained above are usually coupled with the catabolic impact of inactivity.

A series of studies sponsored by the National Aeronautics and Space Agency (NASA) showed how inactivity amplifies the catabolic response to stress. Spaceflight offers a perfect model for experimentation. The lack of gravity during spaceflight reduces the physical work of movement drastically, and muscle loss during space flight can be severe.

NASA has used strict bed rest as a model for the effects of zero gravity during space flight. Bed rest studies have been done on young, healthy subjects and older subjects. As you might expect, inactivity produces the opposite effects of exercise. Muscle mass and strength are reduced, and the rate of deterioration is faster in older individuals.

By itself, inactivity is detrimental to muscle mass and function. When coupled with the physiological stress response to illness or injury, inactivity accelerates muscle loss.

Studies have shown that the use of amino acids can, once again, effectively counterbalance the processes that result in the loss of muscle mass. Consumption of a balanced essential amino acid mixture (15-gram doses) throughout bed rest slowed the loss of muscle mass and strength in both young and older subjects as illustrated in the figure below.

Further confirmation of the role essential amino acids play in maintaining muscle mass comes from a blinded study of a large number of patients in which a carefully formulated blend of amino acids was shown to speed recovery from hip or knee replacement, procedures which inevitably involve a significant limitation in activity.

How to Maintain Muscle During Acute Crises and Ongoing Recovery

The acute period of the catabolic state can be considered the most severe phase. The word “acute” implies a short time, but in fact, this phase can last for months in some cases, such as for individuals with cancer. During the acute phase, body weight and muscle mass are rapidly lost. Decreased appetite complicates the metabolic response.

Essential amino acid supplements are uniquely suited for the acute phase because they can be formulated to elicit a stimulation of muscle protein synthesis, even in the state of anabolic resistance. Given that your appetite is flagging, many find it preferable to consume the necessary essential amino acids in supplement form because of the small volume in which an effective dose can be delivered.

The recovery phase still presents metabolic challenges, as many of the responses in the acute phase are slow to heal in the recovery phase. For these reasons, an essential amino acid supplement should be used as a supportive aid during the recovery phase. Essential amino acid intake is crucial to avoid replacing lost muscle with fat.

The specific goals for recovery and strategies for achieving those goals will vary from person to person, however, the following pieces of advice apply almost universally for everyone seeking to preserve muscle in the wake of sickness or injury.

Maintaining muscle when you're sick

1. Fuel the Healing Process

As discussed, the catabolic state decreases appetite. You may also find that nutrient-poor comfort food such as ice cream holds the most appeal. While there’s no shame in indulging (in moderation, of course), be sure to provide your immune system with the nutrients it needs to carry out the healing process.

If you’re in the habit of targeting your caloric intake in accordance with your weight-training regimen, for instance, you should err on the side of generosity when calculating your maintenance caloric intake. It’s more likely that you will undershoot your nutrient goals, catalyzing further muscle loss. If you do overshoot and gain a little fat, chances are your weight will even out once you start training again.

Given that you’ll likely be working with lower appetite levels, it can be helpful to divide your overall caloric intake into six smaller meals spread throughout the day.

2. Prioritize Protein Intake

While dietary protein intake does not get utilized as effectively when your body is coping with injury or illness, that does not mean you should neglect to consume an appropriate quantity of protein.

As a general rule, you should aim to take in approximately 1 to 1.5 grams of protein per pound of lean body mass. This will help to prevent excess muscle protein breakdown.

According to a study published in the American Journal of Clinical Nutritionwhen critically ill patients in hypermetabolic and catabolic states consumed higher quantities of protein they had positive nitrogen balances. Those with lower protein intakes, however, had continued negative nitrogen balances and continued to experience muscle protein catabolism.

Work with the constraints of your appetite and seek out easy-to-eat, easy-to-digest sources of protein, such as cottage cheese, yogurt, and omelettes.

3. Avoid Simple Carbohydrates

Though it can be tempting to base your diet on white toast with cinnamon and sugar, that type of meal plan will compromise muscle mass maintenance and encourage your body to store any calories not used for essential functions as fat.

If you are going to eat a carbohydrate-heavy meal, timing matters. Plan to consume your simple carbohydrates early in the day when your muscle cells are primed to store calories as glycogen.

4. Liberalize Fats

Per the American Journal of Clinical Nutrition study cited earlier, your body can use fats more effectively than it can carbohydrates while in a catabolic state.

While an increased carbohydrate intake was associated with lipogenesis (fat formation) and decreased fat oxidation (fat burning), the reverse proved to be true for an increased fat intake.

Furthermore, fatty acids form a crucial element of cell membranes, which your immune system will be rapidly generating as you navigate the recovery process. Ensure your immune response can produce all the new cells it needs (in particular, white blood cells) by providing it with a steady supply of healthy fats. A good goal would be to take in 30% of your total daily caloric intake from high-quality, omega-3-rich fatty foods.

5. Hydrate, Hydrate, Hydrate

It bears repeating. Our bodies constantly lose fluids, and when you consider increased mucus production, fevers, rapid generation of new cells, and so on, you can easily see how your hydration needs increase when your health has been compromised.

It’s incredibly unlikely you will over-hydrate. According to some experts, a gallon of water is the minimum you should consume during an acute health crisis. And it should go without saying that you should continue to drink plenty of water as you move from the crisis to recovery phase.

Amino Acids and Gaining “Good” Weight After Serious Illness, Surgery or Injury

Recovery almost inevitably involves regaining the weight that was lost. It is important that the regained weight is largely muscle, and that you don’t replace the muscle you lost with new fat. The key to gaining good weight is optimal amino acid nutrition.

Obesity has become such a pervasive problem in the United States that few people think about gaining weight on purpose. That is, until they lose a drastic amount of weight due to serious illness, surgery, or injury. The weight lost in these circumstances includes a significant amount of muscle. Recovery almost inevitably involves regaining the weight that was lost. It is important that the regained weight is largely muscle, and that you don’t replace the muscle you lost with new fat. The key to gaining good weight is optimal amino acid nutrition.

Why Illness, Surgery, or Injury Often Results in Weight Loss

When you become seriously ill, undergo the physical stress associated with major surgery, or suffer a severe injury, your body may enter what’s known as a catabolic state.

The catabolic state refers to the rapid loss of weight, especially muscle, accompanying physiological stress. Some events that might cause a catabolic state include major surgery or trauma, serious chronic diseases like cancer and heart failure, or acute illnesses such as pneumonia. Even a serious case of the flu can create a catabolic state. There are two components of the catabolic state:

  1. Changes in muscle metabolism that are part of the stress response
  2. Decreased appetite

Many catabolic states involve hospitalization during the most severe stage, perhaps even in the intensive care unit. Receiving an adequate intake of nutrients in a severe catabolic state becomes challenging for several reasons. First, the normal anabolic (muscle building) response to protein intake diminishes, a condition called anabolic resistance. Second, glucose metabolism is altered significantly—insulin resistance kicks in and fat accumulates in the liver. And third, fatty acid levels in the blood drastically increase. During the acutely severe stage, the debilitative effects of bedrest are often superimposed onto those fundamental elements of the body’s stress response.

The primary nutritional focus for helping individuals weather a catabolic state with the most minimal damage possible should be the consumption of essential amino acids (EAAs). Providing your body with a steady supply of essential amino acids can effectively slow down the loss of muscle that accompanies anabolic resistance. Even EAAs have a limited effectiveness in the catabolic state, however, and some degree of muscle loss is inevitable.

Full Recovery Involves Gaining Good Weight

Once the initial health issue has passed and you’ve entered the recovery phase, you may actually be happy to have lost some weight. The problem with this perspective is that the stress response specifically targets muscle loss. Although some fat is lost as well, a significant portion of weight loss that occurs in a catabolic state comes directly from your muscle mass.

Further, it’s important to make peace with the fact that you will almost inevitably regain the weight that you lost in one way or another. The key is to restore your lost muscle mass, and avoid unfavorably affecting your body composition by regaining the weight you shed as fat.

Making a Healthy Weight-Gain Meal Plan

Making the decision to gain weight should not be interpreted as a license to binge on high-calorie, sugary, salt-laden junk food. While that could very well provide you with the extra calories required to gain weight, you’ll be undermining your overall health in the process.

The point of gaining good weight is to restore your lost muscle mass and subcutaneous fat, not to build up deposits of belly fat that have been linked to adverse health outcomes including type 2 diabetes and heart disease.

The best healthy weight-gain strategy for you will depend on your individual circumstances and goals; however, there are certain strategies for devising a healthy weight-gain meal plan and exercise protocol that can be universally beneficial.

The Importance of Protein

Protein should be the macronutrient that dominates your meal plan for gaining good weight. As you may be aware, your muscles are formed from protein. Making protein the base of your diet, therefore, makes it far more likely that the extra calories you take in will be transformed into muscles, not excess body fat.

Initially, anabolic resistance lingers after recovery, which will limit the efficacy of the protein you consume. As your physical condition improves, your body will become more efficient at putting the dietary protein you consume to work promoting muscle growth.

Research has consistently demonstrated that getting your extra calories from protein results in more lean muscle mass gains and less fat mass gains.

A study published in JAMA compared the effects of low-, normal-, and high-protein diets on weight gain and body composition. All participants ate diets designed to provide approximately 40% more calories than needed to maintain their current weights. The authors found that participants on the high-protein diet gained significantly more lean body mass—in other words, muscle mass—than those on the normal- and low-protein diets.

Aim to consume between 25% and 30% of your daily calories in the form of high-quality protein. Another way to conceptualize the amount of protein needed to gain weight is to shoot for between 0.7 and 1 grams of protein per pound of body weight. Depending on your calorie intake, you may find you have room to increase that.

One thing to keep in mind: protein is highly filling. You may find that increasing the number of grams of protein you eat each day substantially reduces your appetite. That’s why increasing your protein intake is also a helpful strategy for meeting weight-loss goals (albeit, without the overall strategy of eating more than enough calories to meet your body’s energetic needs). While this could make it challenging for you to eat the extra calories needed for weight gain, I’ll provide helpful tips on how to overcome this hurdle later on in the article.

Structuring your diet around protein will involve incorporating a variety of high-quality protein sources, such as:

  • Meat
  • Fish
  • Eggs
  • Many dairy products
  • Legumes
  • Nuts

Unless you have dietary restrictions that rule out animal proteins, I recommend making those the focal point of your healthy weight-gain meal plan. Animal-based proteins, including many dairy products, not only contain all the essential amino acids your body needs to build muscle, but also have a higher ratio of overall calories from protein. On average, about 50% of the calories in animal protein food sources come from protein. In contrast, around 70% or more of the calories in many plant-based protein food sources may come from carbohydrates.

How to Handle Fats and Carbohydrates

Since your primary—and quite likely, unfamiliar—goal is to gain weight, you may need to adjust the way you typically think about food. If you’re accustomed to restricting your carbohydrate or fat intake, this is the moment to let go of that. Placing limits on how much fat or how many carbs you eat will only make it harder for you to eat the calorie-dense foods required for healthy weight gain.

Yet another reason to prioritize animal protein as a mainstay of your meal plan for gaining good weight is that the majority of the non-protein calories in these foods come from fat. While many of us have been conditioned to think eating fat is harmful, that is certainly not the case—especially if you are recovering from a catabolic state. Adding more healthy fats to your diet is a wonderful way to increase your total caloric intake and support your body as it re-builds lost muscle.

If you’re going to worry about eating too much of any of the three macronutrients (and as long as you’re eating healthy, whole foods, there’s little cause for any concern at all), direct your attention to carbohydrate consumption. The metabolism of dietary carbohydrate requires the effective action of insulin, and the catabolic state induces a resistance to the normal action of insulin that may persist for months. Insulin resistance makes carbohydrate metabolism less effective as an energy substrate. In simpler terms, this makes it more likely that the carbohydrates you consume will be converted to fat and stored in the liver.

Because of this potentiality, I find it reasonable to limit carbohydrate consumption to between 20% and 30% of your overall caloric intake. That said, you will likely see the greatest weight-gain results if you include plenty of protein, fat, and carbohydrates at each meal.

Strive to eat at least three macronutrient-optimized meals per day. If you have a good appetite (and the physical activity routine I describe below will help to stimulate that), you should also feel free to add in energy-dense healthy snacks whenever possible.

As you regain your muscle mass and approach complete recovery, your basic diet should evolve towards one of the diet options that suits your individual needs and preferences. Maintaining a high-protein intake (about 25% of your daily calories) will help to maintain the muscle you have regained during recovery.

24 of the Best Foods to Help You Gain Weight in a Healthy Way

Whole, single-ingredient, healthy foods should form the basis of your healthy weight-gain meal plan. However, as I mentioned in reference to high-protein foods, these foods do tend to be more filling than the quick-and-easy processed foods that can be so tempting to rely on. This can make it challenging to create the calorie surplus necessary to gain weight.

To encourage yourself to eat enough of these foods to gain the weight you lost, get creative with your use of spices, sauces, and condiments. Make your meals so irresistibly delicious that you simply have to clean your plate.

Another helpful tip for getting the amount of calories needed to gain weight fast is to emphasize energy-dense foods. These foods contain a high number of calories relative to their weight. Here are seven types of energy-dense foods to add to your grocery list:

  1. High-fat dairy: There are a plethora of good options in this category. Think whole milk, full-fat yogurt, organic cheese, and so on. If you’re vegan, full-fat coconut milk is your best option.
  2. Meat: Let your tastes, and the usual best practices for buying meat, guide you. Choose pasture-raised or free-range options whenever possible. And the fattier the cut, the better.
  3. Nuts: Go nuts for nuts! Avoid overly processed options—you can always add your own flavor enhancers if you like. Almonds, walnuts, and macadamia nuts are particularly nutrient-rich. Nut butters can be a fabulous, calorie-dense treat, but steer clear of varieties with added sugar.
  4. Fats and oils: It’s hard to get more energy-dense than fats and oils! Extra virgin olive oil, coconut oil, and grass-fed butter all have many desirable characteristics. And don’t forget avocados, that beautifully fatty fruit!
  5. Root vegetables: These starchy veggies are the perfect way to add healthy carbohydrates to your plate. Load up on sweet potatoes, yams, rutabaga, turnips, and even plain old potatoes.
  6. Grains: Whole grains can be another solid option when it comes to healthy carbohydrates. Try making oats for breakfast or serving brown rice with your dinner.
  7. Healthy snacks: This is the broadest category, and your personal tastes will, of course, come into play here. Some of my personal favorites include dark chocolate and dried fruit as well as homemade granola and trail mixes.

You may have noticed that few fruits and vegetables appear on the list above. I’m certainly not suggesting that you stop eating fruits and vegetables, however, those foods are unlikely to contribute significantly to the caloric excess you are attempting to create.

Exercising to Rebuild Lost Muscle Mass

Exercise is always important in relation to muscle mass and function, and never more so than when you are recovering from a catabolic state. Exercise is the best way to reverse muscle loss and regain normal function. Prioritizing exercise—and strength training in particular—during your recovery period encourages your body to store the extra calories you eat as muscle, not fat.

However, depending on your particular situation, it may be difficult to follow the general guidelines of the American College of Sports Medicine for the amount and intensity of exercise. It may be necessary to go to a physical therapist initially, followed by an experienced trainer, to formulate the best plan for recovery exercises.

The general guideline of resistance exercise 2 times per week and aerobic exercise 5 times per week is appropriate, with the understanding that the level of intensity can be quite limited at first. Try to increase the weight you lift as well as the number of repetitions and sets you do over time. When it comes to cardio, there’s no need to deprive yourself of the fitness benefits associated with this type of exercise, but be sure to adjust your caloric intake to account for the calories you burn off. Remember, your goal at the moment is to consume an excess of calories.

The key to successful recovery is understanding that your exercise capacity will eventually return if you stick with it. This may be easier said than done in the depleted state after recovery from a catabolic state, but there is no substitute for persistence.

Using Essential Amino Acid Supplements to Maximize Your Recovery

As I explained earlier, essential amino acids play a key role in helping your body recover from catabolic stress. That’s part of the reason why it’s so vital that you increase your protein intake.

You may also find it helpful to add on an essential amino acid supplement specifically formulated to target an increase in muscle mass and function.

Ideally, you will want to take your essential amino acid supplement between meals to avoid the muscle loss that normally occurs in the absence of the absorption of dietary protein. As you regain strength, you will want to start coordinating the timing of your supplement intake with your exercise routine. It is optimal to take essential amino acids about 30 minutes before exercise and then again after exercise. Regardless of how light the exercise is, it is, in fact, activating the muscle to begin the process of restoration to full strength. Essential amino acids should be taken in conjunction with whatever physical activity you perform.

You’ll want to choose an amino acid supplement formulated with essential amino acids in a relatively pure form. That means avoiding blends that include other ingredients that simply add non-protein, non-amino acid calories.

The dosage of essential amino acids that gives the greatest stimulation of muscle protein synthesis is 15 grams—more than 15 grams at one time won’t provide much additional benefit. On a gram-for-gram basis, smaller doses may be more effective. A dose as low as 3.6 grams has been shown to be a potent stimulator of muscle protein synthesis. Therefore, there is quite a bit of flexibility in dosing.

Nonetheless, the larger the dose (up to 15 grams), the greater the muscle gain with each dosage. For optimal restoration of lost muscle, 15 grams twice per day between meals will give you the fastest results.