It is very important that patients having surgery are well nourished. This is important for any operation, but particularly important for patients having pilonidal surgery, and especially important if previous pilonidal surgery has failed.
If you are coming to see us at the Evergreen Surgical Pilonidal Clinic for a cleft lift, there are certain things related to nutrition that we would like you to do both before and after the operation to help insure that your ability to heal is optimized.
There are four things we need you to do:
1. Eat a healthy, high protein diet.
2. Supplement the diet with additional protein smoothies.
3. Take a specific group of vitamins and supplements.
4. Take a good probiotic.
These four items will be explained in more detail below:
A proper diet both before and after surgery should consist of generous amounts of protein as found in meat, poultry, fish, eggs, nuts, etc. Carbohydrates, such as bread, cookies, pastries, rice, potatoes, etc, are not beneficial – and a high carbohydrate diet will cause a person to gain weight. This can be a real problem in patients with pilonidal wounds who may have their activity restricted because they are not burning off as many calories as normal. Surprisingly, fats and oils are less of a problem than carbohydrates regarding weight gain – but the goal should be a high protein intake, low carbohydrate diet, with lots of healthy fats.
We would like you to be consuming at least 50-100 grams of protein a day. Here are some examples to give you an idea of the protein content of certain foods.
1/4 lb hamburger 30 gms
4 oz chicken breast 25 gms
4 oz lunch meat 20 gms
2 large eggs 12 gms
5 oz tuna 33 gms
1 oz slice of Swiss cheese 8 gms
1/2 cp Peanuts 20 gms
8 oz bottle Carnation “Breakfast Essentials” Drink 10 gms
8 oz bottle Ensure Plus Nutrition Shake 13 gms
3/4 cup Special K Protein Cereal 10 gms
8 oz Whole milk 8 gms
Not So Good Sources
1 cup spaghetti 8 gms
1 bagel 6 gms
1 cup cooked rice 3 gms
1 banana 1 gm
2 Twinkies 2 gms
3/4 cup Honey Bunches of Oats Honey Roasted 2 gms
1 Strawberry Pop-Tart 2 gms
Nutritional shakes or “smoothies” are an excellent way to supplement the protein eaten with meals. (Protein bars are another method, but many of these bars have too many carbohydrates and taste terrible.)
Here is a simple recipe for a high-protein, low-carb smoothie that can be enjoyed once, or even twice, a day.
Process in blender until smooth and drink immediately. Of course, you can add yogurt, honey, maple syrup, ice cream, half a banana, etc. But the above recipe is simple, very healthy, and tastes good.
There are many different protein powders on the market, but the one in the recipe is composed of high quality protein, and provides 20 grams of protein in one scoop of powder. It also tastes good! It also comes in chocolate, in which case when making a smoothie you might want to skip the frozen fruit and add some plain yogurt (from grass-fed cows, like Siggi’s or Stonyfield Organic and ice cubes instead.
It is possible to have more than one of these smoothies in a day, but keep in mind that in general it’s best to keep the amount of protein consumed in one meal to 35 grams or less for the most benefit.
If you would like to know more about why I recommend these specific products, here is more explanation: https://www.pilonidal.com/smoothie
Proper healing relies on a patient having adequate vitamin levels, and surprisingly many patients are deficient in some critical vitamins. The reasons that a patient may have low vitamins levels are:
There used to be controversy regarding the value of additional vitamin supplements in a well nourished individual. But, because of issues with vitamin depletion in our current food supply, even a seemingly well nourished person can be deficient in certain of the vitamins which can adversely effect pilonidal wound healing. The vitamin content of our food supply is not what it used to be! Since it can be difficult to determine vitamin deficiencies, it is a good idea to supplement even a healthy diet with additional vitamins, minerals, and amino acids.
These can be ordered from a company called Fullscript, from Amazon, or from wherever you feel is best.
For patients of Evergreen Surgical we have a ordering template set up at https://www.fullscript.com. In order to have use this service, you have to be registered as one of our patients on the Fullscript website. Contact Angela at our office to set you up as a patient and you will have access to this. It has high quality, low cost, supplements, and as our patient you will get an additional 10% discount. Our clinic does not make money from this, but we offer this to our patients as a way for them to easily get the recommended, quality, supplements at a good price. Feel free to order other vitamins and supplements from the website as well. If you use Fullscript look for the prescription template Pilonidal Surgery Supplements 2023, and it will have links to everything we recommend.
If ordering from Amazon, this group of products will meet the necessary requirements:
Metagenics Phytomulti (without iron) 2 caps/day
Metagenics Argenine Plus 2 tabs/day
Pure Encapsulations L-Glutamine 1,000 mg 3 caps/day
Pure Encapsulations Glucosamine Sulfate 1,000 mg 1-2/day
Vitamin K2 + D3 (Sports Research Brand) 100mcg K2 + 5000u D 1 softgel/day
Klaire Labs Ther-Biotic Complete Probiotic
Because of antibiotics that you may have taken in the past, and the ones that will be prescribed after surgery, we recommend that you take a probiotic for several months after surgery to replenish the normal bacteria in the intestines. Klaire Labs Ther-Biotic Complete Probiotic is a good option, and is listed along with the vitamin recommendations above.
Juven is marketed as a “Therapeutic nutrition powder for wound healing” and is sold by Abbot Labs. It comes in 23.0 g packets and is meant to be a nutritional supplement when mixed with juice or water. The recommendation is two packets per day. I mention this here because there is a lot of internet discussion about this product. It is not my specific recommendation that you take Juven, but if you feel compelled to, here are some considerations:
In the column to the right is the nutritional composition of one Juven packet. As you can see it has several of the things that I recommend; but with lesser quantities of some things, and greater quantities of others. Although it lists the protein content as 2.5 gms, if you add in the 14 grams of arginine and glutamine (which are amino acids, the building blocks of protein) you would get 16.6 gms of protein in one packet. If you take two packets a day it would add up to 33 grams of protein.
Taking Juven in place of the nutritional smoothy described above, but also taking my vitamin recommendations is a reasonable approach, but I would not add additional L-Arginine, L-Glutamine and Zinc when using Juven supplementation, and I would be sure to take additional vitamin C and Vitamin D along with the Juven.
Should I be taking any of the supplements after my surgery has healed?
It is our recommendation that you continue the multivitamins, vitamin C, Vitamin D + K2, and probiotics indefinitely for good health – but feel free to research this on your own and come up with your own opinions! Here is a link that you may find helpful.
If you noticed improvement in the healing of your pilonidal wounds while taking these vitamins and supplements, this may be an indication of a significant nutritional deficiency. Therefore, you may want to consider having your nutritional status evaluated, or at least continuing some, or all, of these supplements.