Benefits of G.E.D. versus other Options for “Carb Loading”
The entire goal around the concept of "carb loading" for surgery is to prevent/diminish the risk of postoperative resistance due to surgical trauma. The points below are meant to define what we at SOF Health believe are the important and distinct benefits related to the use of G.E.D. for this important component of enhanced surgical recovery.
- We have used maltodextrin as the sole source of carbohydrate because the only data confirming improvement in postoperative insulin sensitivity with oral loading has been with maltodextrin. These benefits were defined by actual assessment of insulin sensitivity. There is no published data confirming similar benefits associated with the use of sugar containing sports drinks, or fruit juices.
- Although maltodextrin has demonstrated benefit related to insulin sensitivity if still has a relatively high glycemic index. Assessing data with administration of drink formulations with maltodextrin in the 40 gram range patients may still spike their glucose to 180mg/dl (see the graph below from a publication assessing this outcome). At this level there is an approximately doubling of the risk of surgical site infection (SSI), cardiovascular complications, and acute kidney injury. We have reduced the maltodextrin level to provide insulin sensitization while minimizing the risk of an unnecessary spike in glucose postoperatively.
- We added chromium (not present in the other product) because it has demonstrated the ability to reduce acute insulin resistance in physiologically stressed patients. This same benefit doesn't seem to persist chronically but still an advantage in the periop setting.
- We added l-citrulline to support eNOS function via elevating the Arginine/Asymmetric Dimethyl Arginine ratio. Surgery leads to an acute decrease in this ratio which is associated with the same complication set as hyperglycemia and the latter actually increases those risks. In addition, citrulline impedes gluconeogenesis in the liver further reducing the risk of hyperglycemia.
- We did not include fructose as is present in the other product because acutely (and chronically; ie NASH) it leads to increased hepatic gluconeogenesis and de novo lipogenesis (leads to increased inflammatory free fatty acids).
- Finally, from a logistics standpoint as a powder we are much easier to stock and distribute to patients. The significantly lower weight also lowers the net cost of warehousing and purchase.