This week, we dove into the fascinating world of pharmaconeutrition with Dr. Sagar Desai, an orthopedic surgeon, and Dr. Kyle Waldman, an anesthesiologist. These two “bros,” as I lovingly refer to them, might fit some of the stereotypes of their specialties—Kyle with his focus and finesse, Sagar with his sports-driven energy—but their work goes far beyond the clichés. Together, they’re pioneering a nutritional revolution in the surgical world.
https://anesthesia.utoronto.ca/faculty/kyle-waldman
Breaking Down the Stereotypes
We kicked off the episode with a lighthearted look at the stereotypes surrounding their professions. Dr. Waldman tackled the classic anesthesiologist image—cool, calm, and maybe trading stocks behind the curtain. He admitted there’s downtime in certain procedures but insisted, “Our attention is always on the patient.” Meanwhile, Dr. Desai embraced the “ortho bro” persona, acknowledging how his athletic background naturally led him to orthopedics. He shared his teenage experiences in sports medicine clinics and his passion for “fixing things” as key inspirations.
This blend of humor and reflection perfectly set the tone for a deeper dive into their shared passion for innovation: pharmaconeutrition.
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What Is Pharmaconeutrition?
Pharmaconeutrition, a term that evolved from immunonutrition, refers to the use of specific nutrients to improve surgical outcomes. Dr. Waldman explained its origins in the 1990s, when studies on amino acids like arginine and glutamine, combined with omega-3 fatty acids, revealed their ability to enhance immune responses. These combinations were shown to reduce complications like infections, surgical site breakdowns, and even anastomotic leaks (a dreaded complication of bowel surgery).
The approach has since expanded to include other perioperative interventions aimed at reducing inflammation, preserving muscle mass, and improving recovery. Pharmaconeutrition doesn’t just treat the patient—it optimizes their physiological response to surgery, targeting the surgical stress response that can wreak havoc on the body.
Nutrition vs. Pills: A Paradigm Shift
As an internist, I couldn’t help but marvel at how impactful nutrition-based interventions can be compared to the lifelong medications we often prescribe. The evidence Drs. Waldman and Desai shared was compelling. For instance, they highlighted a study of over 7,000 patients undergoing major surgery, which showed that pre- and post-operative immunonutrition significantly reduced infection rates and other complications. What stood out most? The simplicity of the intervention—oral supplementation with targeted nutrients.
Dr. Desai explained how these findings have translated to orthopedics. While anastomotic leaks might not be a concern, issues like wound infections, muscle loss, and post-operative pain are universal. By focusing on these areas, pharmaconeutrition has become a valuable tool in his practice, especially for athletes and high-demand patients.
https://www.facs.org/media/bofbztus/immunonutrition_studies_compendium.pdf
Behind the Scenes of Innovation
The road to creating their own pharmaconeutrition product wasn’t easy. Two years of research, trial and error, and navigating Health Canada’s rigorous approval process culminated in a powder-based supplement. The result? A product packed with amino acids, omega-3s, and essential vitamins designed to be taken for five days before and after surgery.
Dr. Waldman shared how they drew on cancer nutrition research to perfect the product’s flavor and texture. Patients loved the citrusy taste, and some even got creative, blending it into smoothies or making slushies. “It’s not something you take for life,” Dr. Desai noted, “but for the perioperative period, it’s a game-changer.”
https://proventherapeutics.com/
Why Isn’t This Standard Everywhere?
One of the most surprising revelations was that pharmaconeutrition isn’t yet standard care in Canada, despite being recommended by major institutions like the American College of Surgeons. Dr. Waldman noted that institutions in the U.S., like Duke Health, now routinely use immunonutrition for surgical patients, but adoption in Canada has lagged. Both doctors are working to change that, educating surgeons and patients about its benefits.
From the OR to Entrepreneurship
For Drs. Desai and Waldman, this journey has been about more than just improving surgical outcomes—it’s been a chance to channel their shared passion for nutrition and innovation. They spoke candidly about the challenges of entrepreneurship, from funding the project themselves to handling regulatory hurdles. But they also emphasized how rewarding the experience has been, both professionally and personally.
Their advice to other medical entrepreneurs? Start small, focus on what you know, and embrace the process. “It wasn’t something we forced,” Dr. Desai said. “It came organically, and that made it all the more meaningful.”
Takeaways for Patients and Providers
Pharmaconeutrition represents a shift toward holistic, evidence-based approaches in medicine. Whether you’re prepping for surgery or simply exploring ways to optimize recovery, nutrition can play a powerful role. As Dr. Waldman put it, “We’re not just treating the patient—we’re treating the surgery.” This focus on optimizing the body’s response to stress could revolutionize perioperative care.
So, whether you’re a patient or a provider, remember: the future of medicine might just start with what’s on your plate—or, in this case, in your shaker bottle.
Thank you to Drs. Sagar Desai and Kyle Waldman for sharing their expertise and passion on this week’s episode. If you enjoyed the conversation, don’t forget to subscribe to Ditch The Labcoat! Keep exploring, keep innovating, and most importantly, keep ditching the lab coat. See you next week!
