The Bone Whisperers

Nutrition & Surgical Recovery

Episode Summary

Muscle mass deteriorates quickly after a surgery - we have tips on how to minimize the impact.

Episode Notes

Dr. Dennis Cardone talks with Dr. Reza Jazayeri about the importance of nutritional supplementation after surgery. To help prevent muscle loss in recovery, protein is crucial. NYU Langone Orthopedics experts bring you the latest research.  

Episode Transcription

Narrator: SiriusXM presents an NYU Langone Orthopedics podcast. Orthopedics is just very important to the population in this country. Its ability to restore patient function. Problems related to cartilage, to someone who has more advanced forms of arthritis.  Getting people back to their activities and the things that they like to do. Featuring NYU's experts in the field of orthopedics trying to figure out that problem before it even is a problem. Problems with solutions. Well beyond physical therapy, to conservative pain management, to surgery. The best medical minds now come together. Applying all of our minds to solve these problems. We're here to get people feeling better so they can get back to their lives. And that's really what we try and accomplish. These are the Bone Whisperers.

Dr. Dennis Cardone: Hello, and welcome, everyone, to the Bone Whisperers, brought to you by the Department of Orthopedic Surgery at NYU Langone Health. I'm Doctor Dennis Cardone, and I'm joined by a very special guest, Doctor Reza Jazayeri, and Dr. Jazayeri, is an orthopedic sports medicine specialist orthopedic surgeon. And he's joining us from California. He's part of Southern California Permanente Group - a sports medicine orthopedic surgeon and founder of Xcelerated Recovery, a perioperative nutritional optimization company. And we're talking about this webinar, an emerging concept: Nutritional optimization for enhanced surgical recovery. Dr. Jazayeri, great to have you joining us, and always great to speak with you. Welcome to the webinar.

Dr. Reza Jazayeri: Dennis, thank you so much. It's really fun to be here, and I appreciate the opportunity.

Dr. Dennis Cardone: Such great stuff. And, you know, number one, let me just say from everybody in New York, we miss you - everybody misses you, your presence here in New York City and especially here at NYU Langone Health. Truly great that doing as well as you are and doing all the great things that you're doing. So talk to us about this really, really interesting stuff, let's call it an emerging concept, again, nutritional optimization for enhanced surgical recovery. Maybe tell us a little bit about your background and how this became an important part of orthopedic surgery for you. Very atypical for an orthopedic surgeon to suddenly talk to us about nutrition.

Dr. Reza Jazayeri: Yeah, you know, for a lot of us, I think sports and athletics has been a part of our lives as orthopedists. The nutritional piece for me was a little bit unique because just my personal background - before med school, I was kind of interested in skeletal metabolism, did some research on exercise physiology. And being able to share this in particular, coming back to New York is great. I did my residency at NYU, and I kind of got into the sports medicine side after my fellowship and practicing in L.A., some of my patients are pretty high demand, as you know, in New York as well. And it was really inspired by a patient I had a few years back. This was a gentleman who I done a revision ACL reconstruction on, needed an osteotomy. He did well, but except when he came back, his legs were atrophied, as we typically see from our patients who go through reconstructive surgery. And he asked me, hey, doc, what do you recommend for me to get back faster? And so I've always had personal interest in taking supplements personally for athletics and working out. And so I gave him kind of a list of some of the stuff that I had, and he said, doc, don't you have something? Kind of this great surgery and my legs stabilized, but don't you have something, the new stuff? And I kind of looked at him and said, what do you mean? What do you know? And it turned out that he was actually on the nutrition team for NASA. And so that really sparked my thoughts to say, what's going on with what you guys are doing? And when I went to speak with him some more, I realized there's been a lot of tremendous work that NASA has already been doing for many years to address muscle loss secondary to microgravity. And so he kind of sparked my interest. You know, I went home that night, and my dad's a PhD in chemistry. I said, dad, I did this great surgery on this guy who did well, but I got schooled by him. He's telling me I don't know anything about nutrition. And he's like, well, you know, he's like, just call him back. You know, call him back, and maybe you guys can put your heads together, you know? So I did, you know, I called him back. I said I appreciate, you know, you kind of humbling me, but I'd like to learn some more with some of the stuff that you guys have done. And this story was about four and a half, five years old and kind of triggered for me to kind of start on this passion project. I ended up doing a real deep dive on this and doing a sabbatical on nutrition. And the research that we found really helped me actually come up with this product and become a founder of this accelerator recovery science organization to really better understand how, as surgeons, we can better implement nutrition in addressing our patients. As surgeons, we're really so focused on whatever we can do as the carpenters, as the technicians to, you know, what's the implant we're using? You know, what kind of technique are we going to use? But, you know, we didn't get any education on this at all in medical school, residency, particularly when it comes to the surgical improvement from a metabolic perspective. The only thing we really got from on nutrition, if you look at the medical school curriculum, it's about 16 hours, and in residency, it's make sure everyone is NPO - nobody eats - so we can operate on them, and that's it. And then we get into our practice and we never really picked this back up again. And then it was through this process that, you know, I just gained a lot more information and realized, you know, we actually could address this low hanging fruit.

Dr. Dennis Cardone: You know, it's extraordinary. Like you said, I mean, when you look at all of our training in medical school and residency training, and not just in orthopedics, right, when you look across the board at all the specialties, I mean, there really is just about nothing on nutrition. And it's really - we have some, you know, we face it a little bit when we do our hospital rotations in hospital, and we see how important nutrition is and healing and wounds and just overall recovery. So I think all of our hats, oh my goodness, off to you that you're doing what you're doing, and you took it another step. You did a sabbatical on nutrition and, uh, really great stuff. So this is exciting. I mean, this is really exciting to get to talk to you about this and about the company and about Xcelerated Recovery and your product, this perioperative nutritional optimization product. So maybe, yeah, take us down, you know, so now you're doing your research, you put your time in. So maybe for our listeners, what did you find? How important is nutrition in terms of really everything, but especially from an orthopedic perspective. In terms of maybe in terms of recovery, or do you use it also pre surgical, post surgical? Where are we heading with this? What did you find?

Dr. Reza Jazayeri: Right, you know, so I'll tell you one thing, just to kind of put things in perspective. When I was in college and high school, I used to race cars. And so in figuring out how every little piece kind of works and the fuel behind the parts was kind of what really captured, you know, my interest. So I always kind of thought that way. And being in sports medicine, working with athletes and thinking about what athletes eat and their nutrition to performance was kind of the foundation for me to kind of go down this path. And so that was kind of the impetus for me to kind of get going on this. And what we don't understand during the surgical process is what's happening on the patient side, on the metabolic side. And so what has been shown in the literature now is, of all the factors that we look at that we know are bad things - smoking, obesity, diabetes, being overweight - these are all what we call modifiable risk factors. This is what, what can the patient do to improve their outcome? And over and over again, the number one modifier risk factor is nutrition. So, okay, great, we say, okay, nutrition, but what does that really exactly mean? We tell patients, eat a well-balanced diet. But if you look critically, what are we really trying to achieve with this? And I think the most important thing for us to kind of understand as surgeons is surgery itself is a very stressful, catabolic state where the body's breaking down. And so your body's requirement for energy is exponentially elevated during this time because the body needs this increased fuel to be able to provide the energy needs for recovery. But if you get a little more deep, what do we mean exactly with fuel? Well, you know, we have body fat as an energy source, and that that's why you can provide the fat for the energy that we need for our daily life. But when it comes to healing, specifically, we need amino acids. And amino acids come from protein. And so when you and I were cavemen, we fell, we broke our leg. There wasn't always food around. And so your body says, okay, well, I'm going to use the fat reserves that I have to provide the energy that I need to keep you alive. But when it comes to healing a bone or healing a wound, well, your body needs these specific amino acids that are essentially the building blocks to put these pieces back. You can't turn fat into these building blocks you need for collagen or bone or muscle. And unless you get that from your diet, your body then needs to turn to its own reservoir, and that's skeletal muscle. So our own muscle essentially acts as this reservoir for providing these substrates, these building blocks, for healing. And this is why we see around the surgical time, people lose a lot of weight, but a lot of that weight is actually come from your own muscles. You're harvesting your own muscle to provide these nutrients that you need in order to heal.

Dr. Dennis Cardone: Such an interesting concept, especially for orthopedics when many of the surgeries potentially, if they're not directed at muscle tendon, it's certainly whatever it is or bone surgeries for you, being a sports orthopedic surgeon, you say, just giving an example like that, we all know ACL reconstructions. And it's amazing the amount of atrophy, muscle tendon atrophy, that you see post surgical, just across the board. And sometimes months and even years go by and longer even, and that muscle atrophy never quite makes it to the other side. You know, and there's other factors involved also. But extraordinary it’s just such an interesting concept that many of us would never think about the nutrition piece, right, and how important it is for this.

Dr. Reza Jazayeri: Right? And you brought up the ACL injured athlete. That's the best case scenario. You got these young athletes who even at one year, when we tell them we can go back to play, they're about 75, 80% on average of their normal side. And then even at two years, 24 months, if you look at the literature on this, 90% are still below 100%. So we have a large percentage of patients who fail to ever get back to normal. And this is a problem for recurrence. If you look at the recurrence for ACL injuries, it's 15 times higher in the first year just because they don't have the skeletal muscle to prevent that. And I think that's a part of it. Obviously, there are multiple variables involved, but having that asymmetry is a big factor in reinjury.

Dr. Dennis Cardone: So it's kind of interesting, too. So you brought up really interesting concepts. So you start talking about amino acids, and it'd be interesting, especially for our listeners. When you say, um, amino acids, immediately I think about protein and protein in your diet. But, you know, then I also think, well, you know, the American diet is very high in protein, right? And, you know, so my little that I know and truly, like we talked about, I know so little when it comes to nutrition. We just don't get a lot of it. But it just seems that we do get a lot of protein, but it's just not enough. We don't have enough stores? So how would you describe it? Is it that we don't have enough stores for, say, that postoperative stress that you spoke about, enough protein on board? Or potentially we don't take in enough protein, or we're not taking in the right proteins? Or is it, again, just a combination of this?

Dr. Reza Jazayeri: It's a great question. It's a combination of a few. I mean, I'll tell you first, when it comes around protein intake, our recommended daily allowance - that's the RDA - this is what we've been taught to consume. So the average RDA or the recommended RDA, is 0.8 grams/kg. And that number is the value that was initially based about in the 1920s for what should a young (and this was done in 22 year olds) by the way, that's the number of protein not even a patient or person who's healthy should consume in order to avoid being malnourished. That's like saying, how much vitamin C should you take to avoid scurvy? Okay, that number is much different than the optimal dose you need to recover during this really catabolic state. And that number, by the way, is in someone who's young. As we get older, we are dealing with something called anabolic resistance, which means you just need much more of a signal, whether from exercise or even protein, to be able to stimulate that muscle protein synthesis. And this is why we see this problem with sarcopenia, which is age related muscle loss. You know, as orthopedists and I think just in the general community, we know about bone loss and osteoporosis and how important that is. But just as important is the sarcopenia variable. And as I'm sure you know yourself and with all our patients, the older we get, we lose skeletal muscle. And one of these variables is this anabolic resistance that we see. And even though we're eating traditionally, we think high protein, it's really the quality of protein that matters. Not all proteins are really created equal. But there are ways of profiling a protein, which has to do with their digestibility, and how well the amino, uh, acid profile of that amino acid can be replicated or represents good skeletal muscle. So it's a combination of, as we get older, we have this anabolic resistance. That's why we see muscle loss being much more of an issue in our hip replacements and I knee replacements, and it's even worse in hip fractures. The quality of protein that we're getting is not the ideal protein. And then also the timing of this protein around surgery is really critical. And most of our patients are not really that hungry during that time. So this is where we see a deficit. And so, regardless of how much muscle you have, that reservoir gets tapped into. And what we're realizing is that the muscle that we carry is protective and predictive of how our patients are going to do down the line.

Dr. Dennis Cardone: We're talking with Dr. Reza Jazayeri. And Dr. Jazayeri is an orthopedic surgeon, sports medicine specialist at Southern California Permanente group. And we're talking about an emerging concept: Nutritional optimization for enhanced surgical recovery. Really new concept for orthopedic surgery, and one that really need to pay attention to. So, it sounds like, number one, very interesting - not all proteins are created equal, is what you're saying, right? So even though, if our diet's rich in protein, there are better sources or different sources with maybe more amino acids or better amino acids, in terms of the body's ability to utilize these amino acids, these proteins?

Dr. Reza Jazayeri: That's correct. So there's something called the DIAAS score, and I don't want to get into too much, but essentially, this is a scoring profile for amino acids. It stands for the digestible, indispensable amino acid score. Essentially, what that's saying is, the protein that you're consuming, how well can you digest it, and how well does that represent the ideal amino acid profile that you're looking for? So, just a quick little review on amino acids. Our body has 20 amino acids, and of these amino acids, nine of them are essential, which means your body can't, like Lego pieces, put them together. You have to get them from your diet. The other ones are non essential - that means your body can kind of maneuver things around and create those. But those nine being essential, having those nine essential amino acids in your protein is what creates a higher protein profiling quality. So, for example, something like a wheat protein, that's got the lower essential amino acids, and it's not as digestible. So only about half of the protein that come from a plant, your body can actually consume in a way that you can turn into the essential amino acids, as opposed to something like a whey protein. This is why you see a lot of athletes taking something like a whey protein. And even better yet, you can take these isolated, free form amino acids that are directly absorbed. And these are the ones that we're seeing to have the highest utility in that critical surgical time where your body really needs those amino acids for healing. If you provide those at that time where you have this increased metabolic stress, whether it's burns or trauma or surgery, you can now blunt your own body's breakdown of your own skeletal muscle and improve patients’ recovery. So that's really the essence here, is providing the right fuel at the right time to mitigate or kind of minimize that muscle loss. We can't stop the muscle loss, but we can mitigate it. And the timing of this is what we're learning is critical. These first two weeks after surgery is when we see the most amount of stress. So by intervening at that critical time, we can have improved outcomes on our patients.

Dr. Dennis Cardone: So is it as important to supplement this protein nutrition pre-surgical as it is after surgical, or can we store these important proteins to that degree? Or it's really important in that postoperative, much more important in a postoperative period.

Dr. Reza Jazayeri: So our only storage of amino acids is skeletal muscle. And you know how hard it is to gain muscle. And so you, ideally, in an ideal world, you try to really minimize tapping into your own skeletal muscle reserves. It's not like fat stores, which they're just hanging out and not doing anything. The skeletal muscle that you have has a functional role, but from an, uh, evolutionary perspective, it has this kind of reservoir for times of stress. So when you have a burn, when you have a fracture, when you're under critical stress, your muscular function, as far as, mobility plays second to your survival. So it will kind of harvest your own tissue to take what's priority, which is, hey, we got to heal. We got to close this wound, we got to repair this fracture so then we can move on with our lives. And so I think the critical time is right around the surgical time. And you try to minimize tapping into your own reserves by providing the ideal amino acid profile that you need that's specific for that function. So this is what I kind of tapped into – learning, okay, what's happening in orthopedic surgery? What are the critical pathways that the body is looking to heal? And how can we then provide those amino acids at the right ratio at the right time to then have better outcomes?

Dr. Dennis Cardone: So now talk to us about. So what if you're talking to a patient, and we could talk about any surgery - we could say ACL surgery - You're scheduled two weeks from now to have your ACL surgery. How does Dr. Jazayeri speak to the patient about optimizing everything that they could do pre-surgery for their recovery post surgery?

Dr. Reza Jazayeri: Yeah. So I have a whole protocol with my patients. One of the variables that I look at is prehabilitation. So I treat all my patients as athletes going into an event. This is the conversation I have with you, so if you were my patient, I say, okay, look, this event, being your surgery, is what we're gonna prepare for emotionally, physically, and nutritionally. These are all things that you have to be prepared for. So just like an athlete is getting you ready for that event, we really gotta prep you up for this. And my patients who are above 55, I also would check their albumin level that's something that we know is the number one kind of risk factor for these complications. So again, albumin being a proxy for nutritional status. If the albumin is low, less than 3.5, then I pause. I say, look, we're not ready. I optimize them - we put them on a high protein diet. I work with our dietitians. We give them XR as a supplement to kind of get them going. I recheck their albumin. Once they're better, then I proceed. So one is that nutritional evaluation. Check their albumin if they're older. And then I also put all my patients into prehab. I'm a huge advocate of pre surgical exercise because that's the other signal that turns on muscle synthesis. Number one is exercise. And then you add the nutrition with the correct amino acid profile. The combination of the two is where you really get your patients to do everything they can on their end so when they come to the operating room table, they're optimized. Those patients do much better, much better than if you don't address these variables. So that's the conversation I had with them, is prehabilitation. I put everyone into pre surgical exercise program, and then we checked their nutrition, we put them on a high protein diet. So with XR, we have something on the website, it's called a muscle centric calculator. So you can go on there, put in your age, your sex, your height, and then it'll immediately give you a profile of the optimal diet that you should be eating. And then we send patients a PDF of foods to eat. And that's free, that's on the website. You can take a look at it. And that's something that is tangible. You take something that's kind of complex, but say, okay, look, we're going to give you the resources, so then you can help yourself, help us get you back.

Dr. Dennis Cardone: Is that an optimal diet, pre surgical, or is that just an optimal diet forever?

Dr. Reza Jazayeri: No. So, you know, most of the time when patients are thinking about diet, we're thinking of weight loss. This is definitely not a weight loss program. This is a muscle centric diet, which means what is the ideal amount of protein and fat and carbohydrates that you should be consuming around the surgical time to minimize muscle loss. And that number, the number of protein, the normal grams of protein that most people should be eating for that time, when we looked at it, most patients fall way short of that number, particularly when it comes to right around surgery, when they're not hungry and your body's like, well, I need these nutrients, and I'll tap into my own skeletal muscle to get it if you're not gonna provide it for me. So this is where we've been finding it very valuable to intervene with both. I mean, look, number one, exercise is really key. But you can't always exercise, particularly after surgery. Number two is eat a diet - whole foods – that provide you the quality proteins. And so that's where, you know, we can give patients a recommendation of what to eat. And then thirdly, supplement with these amino acids and some of the other supplements that are in this blend to then optimize the recovery. So I think if you have that, we call that the trifecta, one being exercise, two being the diet, and three being the supplement. You put that trifecta together, this is where you can have some success in providing a better, optimal result.

Dr. Dennis Cardone: So I would think, like patients, when they hear this, which is really, really valuable, valuable information, they might think, okay, well, let me go to my nutrition store, get one of those protein powders, and just get going with that. Right? So, number one, is that appropriate? And I think it's a good segue for you to talk to us about the company. You're a founder of Xcelerated Recovery, so maybe talk to us a little bit about that. And also because you mentioned about a website and people go to for a formula, etcetera. So maybe also give us information about the company and the website.

Dr. Reza Jazayeri: Sure. So you can go to the website. It's xrscience.org. and all the information, everything that we're discussing. I work with residents and involved in research and academics, so if you're interested, there's a whole, essentially a library of all the articles that are related to this topic as we were kind of going through this. So that's all available. If you want to check out the muscle centric calculator, you can go on there now and put in your information and see what that diet would look like for you around that time. And then you brought up the point with the supplements. So that's exactly what I was doing before that one patient who worked for an acid diet came to me - I had a list of supplements that have been shown to be effective, and I had that list there. And patients would come back and say, hey, doc, thanks, I feel great, except I don't know about this brand. The guy at GNC was telling me, there's a sale on that one, this one is it safe? Does it really work? And I got to mix one scoop of this and three scoops of that, and it just became too complex. And so that was one of the issues. And I also work with a lot of athletes and parents of these athletes. So safety was a big issue. And so we wanted to make sure that we knew where this was coming from. And so we went down this path of kind of identifying through the research what's been clinically looked at, what's been clinically shown to be effective and safe, and then putting the right dose, that was the issue. You know, you can go to their health food store, but the problem is you don't actually know what's in there unless it's been tested. And so, as for me, when I started out with this thing, I said, look, I went to the FDA, I said, look, can you help us with this? This is going to be going into patients. I actually had my mom take this when she had her total hip replacement. I said, you know, how can you help us kind of navigate through this? Because I don't know what's on the market. Is it actually safe? Is it real? Is it legit? So what it really helped us was the NSF for sports certification. That validation, essentially, they check every ingredient, make sure there's no banned substances, there’s third party testing. And that kind of gave us, you know, now this product is being used by high level athletes. This is a global kind of, um, organization that overlooks these supplements. And this is why now we're using it for international sports. Actually, athletes cannot take a supplement unless it's been tested through the NSF for sport. So this was kind of the whole journey as we went through this, you know, identifying which ingredients that are safe are effective at the right dose. Having the NSF certification really helped us. And then the last thing that came up was taste, you know, getting the tasting down. And then, you know, in California, a lot of patients who are vegetarian, they're plant based, you know, and patients who are, you know, vegetarian, vegan, plant based, there's nothing wrong with that, except plant protein has a much lower diaspora, has a much lower amino acid profile than we need in our skeletal muscle. So eating 20 grams of a plant protein and eating 20 grams of something like a whey, you're taking an inferior amount of protein. So then we had to create something that was also an amino acid profile that was a vegetarian supplement those patients can also kind of enjoy. So this is kind of where we came down. This whole pathway of four and a half years of identifying this and then creating a product that we could provide for safety and efficacy.

Dr. Dennis Cardone: And so people can go to the website and, uh, find out more information about the product.

Dr. Reza Jazayeri: Yeah, if you go to XRScience.org you can see all the information there. You know, right now, this is mostly something that initially started out, really, for us as surgeons to provide this for our patients, for our athletes. But we're finding a lot of my, you know, a lot of our patients are coming back now saying, hey, I felt great taking this. And now they're kind of taking it more for daily and recovery. We have a lot of our athletes who are just taking this now for recovery from their training. You know, what the body goes through after surgery is not that dissimilar from high level athletes who are beating their bodies up day after day after day. So this is where there's some utility in these high level athletes. And interestingly, a lot of these athletes are kind of taking some of these supplements, but this was kind of an all in one formulation that kind of covered both of these kind of ends of the spectrum.

Dr. Dennis Cardone: So you could really say with this, it's not only just as a review, not only just to take potentially the preoperative, postoperative period, but especially for an athletic, maybe someone for an athlete trying to optimize performance, something that could be taking long term.

Dr. Reza Jazayeri: You know, I can talk to you for hours about this. What was really exciting, some of the Japanese studies that looked at stress response after surgery, like, what happens to your body after surgery? What are some of these cytokines that get elevated that you and I are more familiar with as practitioners and insurgents and, uh, healthcare professionals, where we see ESR, CRP, you know, these laboratory values go up that are reflective of stress. So they identify some of these amino acids that are anticatabolic. They're able to deal with some of these stress responses and kind of really what we're trying to do from a surgical side. And I'll tell you, orthopedics is actually really late to this. Some of the other fields, like burns and patients who have been going through cancer treatment, who are under a lot more critical, like in ICU settings, they've been using these amino acids for a long time. So these studies that looked at, okay, how can we kind of mitigate some of those stress response that we see in surgery? They found utilities, amino acids. They took some of these amino acids and put them in athletes. And they chose - this was very interesting - they chose runners, ultra runners and bodybuilders. The reason they chose those two athletes is because they can over and train them and they can really clearly identify and objectively look at their training. So if you're a runner, you can look at how fast you ran, the duration and the intensity. You can quantify that. Similarly, with a bodybuilder, you can say, okay, how many sets, how many reps did you do in a week? And then double that. Essentially, that's exactly what they did. They put these athletes into ultra-stress situations and what happened to them? The same laboratory values that we see go up, they went up during surgery, they went up after these athletes were what we call overtrained. Things like DOMS, which is delayed onset muscle soreness, and the other one is exercise induced muscle damage, creatine kinase. Some of these objective values that we can look at from a sports performance side, those were also impacted by overtraining. And then when they provide these amino acids, they found some utility in preventing some of those issues. So it was really fascinating to see the commonality between the surgical patients and then these high intense athletes. So this is where I think we're seeing some overlap between the physiological response that the body goes through.

Dr. Dennis Cardone: And it makes so much sense, right. It's just great that you brought this and are bringing this to the forefront and uh, you know, truly opening our eyes to this. Something that you would think, well, sure, of course! But it's really something without us being trained or having this in the front of our armamentarium and in our treatment bag, in our rehabilitation bag, and our recovery bag that we typically wouldn't go to and something that really can make, as you were saying, just such a big difference, especially when we talk about orthopedic surgery and that post operative period and optimizing recovery. Really extraordinary. And I know yourself, being as academic as you are, you have ongoing studies and studies that have been done. And even anecdotally maybe you could tell us what's, uh, been your experience once.

Dr. Reza Jazayeri: Once we started to put this supplement together, this is really a targeted nutritional supplement for orthopedic surgery. I'll tell you, I've been very fortunate to be able to stand on some really amazing academicians before me. You know, NASA has been working on this some time, guys before me who've been looking at these countermeasures from microgravity, Doctor Wolf, who's really the pioneer in looking at amino acid supplementation to address some of these issues, understanding the pathways. So, you know, there's over 100 papers on amino acid supplementation and its efficacy, but that addressed the muscle loss. So when these athletes are dealing with performance, we've had these astronauts who are dealing with muscle loss. So even if we get to a point where we have the technology to go out of space, there's such a rapid amount of muscle loss that happens because of lack of gravity, they had to identify nutritional strategies to mitigate muscle loss. And you can't take a bunch of steak and food up there with you. So they were able to say, okay, well, what is it in protein? What is in the amino acids? Which ones are actually the ones that we need, that are specific for the target that we're looking for? So, we know the story of, for example, when you eat turkey, you get kind of sleepy. Well, why is that? Well, because turkey has an amino acid that has more tryptophan. Tryptophan kind of induces some feelings of sleepiness. So you definitely don't want to put tryptophan in this amino acid profile because you don't want to get sleepy, right? But. But there are other amino acids that are, for example, leucine, that are really the triggers for turning on muscle protein synthesis. So our research was really based on what these guys had already done and then implementing that, and then you can just keep going like things, so, that one was muscle. But then if you look at burns, for example, these diabetic wound ulcers, HIV, and these chemo patients who are really catabolic situations, they've been using amino acids, the specific ones that improve blood flow and wound healing and collagen synthesis. So when I looked at that, I said, wow, look at these burn patients getting better with these amino acid mixtures. Well, how is that any different than a rotator cuff tear that keeps tearing? Or how is that any different than the collagen that happens in a ACL graft that we want to incorporate faster? What's exciting is now we're seeing slowly this emerging studies showing that, hey, you know what? Even in orthopedics patients now, we're seeing improved outcomes. Whether it's in trauma patients or amino acid supplementation in total knees, we're seeing faster recovery, less pain, preserve muscle. So I think it's really exciting to be able to take some of these studies that have already been done in other really challenging subspecialties, but really cherry pick the ones that are applicable to us and provide this kind of target of supplementation for us. And I think that's where we're really excited to collaborate with some of the universities, and NYU in particular, to be able to move forward in better understanding this.

Dr. Dennis Cardone: Dr. Jazayeri, on our final minutes, what would you say to our listeners, maybe to the listener who's planning a new replacement three months from now, a different orthopedic, uh, elective surgery, right, because hopefully there's going to be people who are injured, but they don't know about it, and hopefully no one will get injured, but someone, maybe, who's planning elective orthopedic surgery, what would you say to them? In the final words of advice in preparation for surgery?

Dr. Reza Jazayeri: I would really stress the importance of understanding the role that the patient plays in their outcome. And don't just leave it up to the doctor who may or may not have been educated on this topic. I can tell you most of us have not. And so I would say, you know, be more engaged in your care, be an advocate of your own care, and, don't overlook how important it is, what you put into your body before you approach this elective surgery and see it as this athletic event and use modern science. And we can really capitalize on what we've learned and using these supplementation strategies to preserve your ability to deal with the stressful surgery that's ahead.

Dr. Dennis Cardone: And please give us information, again about the company and how people can get information about the product and the company and the website.

Dr. Reza Jazayeri: Sure. So this website initially was designed for orthopedic surgeons, but now we've kind of opened it up as an educational platform for anyone who wants to go on there. So it's XRscience.org. The program that we're utilizing, we start patients with supplementation one week prior to surgery. There's good research now demonstrating that loading the body with these amino acids prior to surgery increases your reserve and gives you a better ability to kind of combat the stress of surgery. And then we follow patients for two weeks after. This is the most critical time where your body really burns up its own muscle. And so by providing the supplementation one week before and two weeks after, you're able to really blunt this breakdown of your own muscle and have improved outcomes.

Dr. Dennis Cardone: Doctor Jazayeri, great information. We've been talking with Doctor Reza Jazayeri and Doctor Jazayeri, founder of Xcelerated Recovery Sports medicine, orthopedic surgeon practicing in Southern California Permanente group. Jazayeri, great information. Really great to have you join our series. Thank you so much for joining.

Dr. Reza Jazayeri: Awesome. Just if , there's one more thing I would just love to throw in there with. You know, NYU is where I trained, and really a lot of this kind of forward thinking and being able to kind of think outside the box - I credit that to my mentors and the people who helped me be where I'm at now, and having the ability to recently go back to NYU and present this and have them be supportive of this has really been an exciting opportunity. So now at NYU, we're going to be looking at hip fractures. I think that's where we're going to see a tremendous improvement in our outcomes. We're also going to be doing a multicenter study, including NYU, to look at ACL outcomes. So what I'm really excited is to build on this collaboration to work with NYU for further research to better understand how to best intervene and move forward on this really critical topic.

Dr. Dennis Cardone: Really fantastic stuff. And, uh, again, couldn't thank you enough. Great information. Really great to have you as a guest. Doctor Reza Jazayeri, founder of Xcelerated Recovery, orthopedic sports surgeon at Southern California Permanente group. Doctor Jazzieri, thanks so much for joining us.

Dr. Reza Jazayeri: Awesome. Thank you for having me. I appreciate your time.

Narrator: The Bone Whisperers is a co production of NYU Langone Health and SiriusXM. The podcast is produced by Scott Uhing, sound design by Sam Doyle. SiriusXM's executive producer is Beth Ameen and senior operations manager is Emily Anton. Narration and additional sound design by Michael Luce. Don't miss a single episode of the Bone Whisperers and subscribe for free wherever you listen to podcasts. To hear more from the world renowned doctors at NYU Langone Health, tune into Doctor radio on SiriusXM Channel 110 or listen anytime on the SiriusXM app. For the Bone Whisperers podcast, I'm Michael Luce. Join us next time for the latest advances in orthopedics on the Bone Whisperers.