Pre And Post Surgery Health

Glutamine, one of the most abundant amino acids in the body, supports the health of the cells lining the gastrointestinal tract and is important for immune function.² Glutamine is depleted when the body is under stress, including the stress of surgery.³ Blood levels of glutamine decrease following surgery, and as they return to normal, their increase parallels the increase in immune cells.⁴ Two controlled trials have shown that the use of glutamine-enriched intravenous formulas, providing approximately 20 grams of glutamine per day, resulted in increased immune cell activity and shorter hospital stays.^5,6 Double-blind studies report that patients receiving intravenous formulas supplemented with glutamine after surgery had better nutritional status and better health outcomes, including fewer infections and other complications, compared with patients receiving regular formulas.^7,8

The amino acid arginine has a role in immune function, infection prevention, and tissue repair after injury, including surgery.⁹ Animal research suggests that supplemental arginine may improve the outcomes in cardiovascular¹⁰ and colon surgeries.¹¹ Other animal studies suggest a possible role for arginine in prevention of adhesions, a painful type of internal scarring that can occur with surgery.¹² Human trials of formulas including arginine are discussed below, but the benefits of supplemental arginine alone have not been studied in surgery patients.

Omega-3 fatty acids have anti-inflammatory properties,¹³ and animal studies suggest that supplementation with omega-3 fatty acids may improve recovery and prevent infection after surgery.^14,15 A controlled human trial found that intravenous nutritional formulas containing omega-3 fatty acids given post-operatively lowered the production of inflammatory chemicals compared with standard nutritional formulas.¹⁶ Other human studies of omega-3 fatty acid-supplemented nutritional formulas used in surgery patients have included other supplemental nutrients as well and are discussed below.¹⁷

A recent study found that 24% of surgery patients had taken herbal supplements before their surgeries, and 50 different herbs had been used among these patients.¹⁸ Little research exists, however, on the safety or efficacy of herbs before surgery. Some researchers and healthcare providers are concerned about possible harmful interactions between herbs and medications used around or during surgery, or the possibility that some herbs may increase bleeding during and after surgery.^19,20 The use of herbs around the time of surgery should be discussed with a knowledgeable healthcare practitioner.

Nausea and vomiting can be experienced post-operatively as a result of anesthesia. Ginger (Zingiber officinale) has antinausea properties and has been examined for its ability to prevent post-operative nausea and vomiting in several controlled trials. In two of these controlled trials, ginger was found more effective than placebo and equal to an antinausea medication;^21,22 however, in two other controlled trials ginger was not found to have any benefit.^23,24 A review considering the results of these trials concluded that 1 gram of ginger taken before surgery prevents nausea and vomiting slightly better than placebo, but this difference is not significant.²⁵ However, a more recent review concluded that ginger is an effective means for reducing postoperative nausea and vomiting.²⁶

One preliminary study found iron levels to be reduced after both minor and major surgeries, and iron supplementation prior to surgery was not able to prevent this reduction.²⁷ A controlled trial found that intravenous iron was more effective than oral iron for restoring normal iron levels after spinal surgery in children.²⁸ One animal study reported that supplementation with fructo-oligosaccharides (FOS) improved the absorption of iron and prevented anemia after surgery,²⁹ but no human trials have been done to confirm this finding. Some researchers speculate that iron deficiency after a trauma such as surgery is an important mechanism for avoiding infection, and they suggest that iron supplements should not be given after surgery.³⁰

Patients who have undergone major surgery frequently need blood transfusions to replace blood lost during the procedure. Studies have found that 18 to 21% of surgery patients were anemic prior to surgery,^31,32 and these anemic patients required more blood after surgery than did non-anemic surgery patients. Supplementation with iron prior to surgery was found in a controlled trial to reduce the need for blood transfusions, whether or not iron deficiency was present.³¹Iron supplements (99 mg per day) given before and for two months after joint surgery in another controlled trial improved blood values but did not change the length of hospitalization or the risk of post-operative fever.³⁴ Pre-operative iron supplementation in combination with a medication that stimulates red blood cell production in the bone marrow is considered by some doctors to be an effective way to minimize the need for post-operative blood transfusions.³⁵

Ribonucleic acid (RNA) is a member of the nucleotide family of biomolecules and supports protein synthesis and cell growth. During times of physical stress, RNA helps stimulate immune cell division and activity,^36,37 and is needed in greater amounts. Animal studies show that nucleotides given in the diet support the immune response and decrease death rates in infected animals.^38,39,40 In human infants, those fed nucleotide-enriched formulas have healthier gastrointestinal systems and better immune function than do those fed ordinary formulas.^39,42,40 RNA is included in some oral and intravenous nutritional formulas used for surgery patients, and these formulas are discussed below.

Taurine is an amino acid abundantly present in the body that also appears to have an important role in immune cell functions.⁴² A preliminary trial found that patients receiving an oral formula enriched with taurine (1 gram per liter) beginning two days before surgery and continuing until five days after surgery had less inflammation after surgery compared with those receiving a standard formula.⁴³

AKG (alpha-ketoglutarate) is used by cells during growth and in healing from injuries and other wounds,⁴⁴ and is especially important in the healing of muscle tissue.⁴⁵ Controlled studies have found intravenous AKG helpful for supporting protein synthesis, which often declines as a result of surgery, and for protecting the heart muscle from damage during heart surgery,⁴⁶ but no research has investigated whether oral AKG would be similarly effective.

One preliminary study found iron levels to be reduced after both minor and major surgeries, and iron supplementation prior to surgery was not able to prevent this reduction.⁴⁷ A controlled trial found that intravenous iron was more effective than oral iron for restoring normal iron levels after spinal surgery in children.⁴⁸ One animal study reported that supplementation with fructo-oligosaccharides (FOS) improved the absorption of iron and prevented anemia after surgery,⁴⁹ but no human trials have been done to confirm this finding. Some researchers speculate that iron deficiency after a trauma such as surgery is an important mechanism for avoiding infection, and they suggest that iron supplements should not be given after surgery.⁵⁰

Selenium is a mineral nutrient with an important role in immune function and infection prevention,^51,52,53 and selenium deficiency has been reported in patients after intestinal surgery.⁵⁴ A controlled trial of critically ill patients, including some with recent major surgery, found that those receiving daily intravenous selenium injections for three weeks showed less biochemical signs of body stress compared with unsupplemented patients. The amount used in this trial was 500 mcg twice daily for the first week, 500 mcg once daily for the second week, and 100 mcg three times daily for the third week.⁵⁵

A recent study found that 24% of surgery patients had taken herbal supplements before their surgeries, and 50 different herbs had been used among these patients.⁵⁶ Little research exists, however, on the safety or efficacy of herbs before surgery. Some researchers and healthcare providers are concerned about possible harmful interactions between herbs and medications used around or during surgery, or the possibility that some herbs may increase bleeding during and after surgery.^57,58 The use of herbs around the time of surgery should be discussed with a knowledgeable healthcare practitioner.

Turmeric (Curcuma longa) is an herb with anti-inflammatory effects.⁵⁹ One trial found curcumin (from turmeric) at 400 mg three times daily was more effective than either placebo or anti-inflammatory medication for relieving post-surgical inflammation. However, as the different treatment groups had different degrees of inflammation at the start of the study, firm conclusions cannot be drawn from this study.⁶⁰

Vitamin A plays an important role in wound healing,⁶¹ and one animal study suggests that vitamin A deficiency might contribute to poor recovery after surgery.⁶² Vitamin A may be particularly beneficial to post-surgical patients who are using corticosteroid medications. These medications typically slow wound healing, and a number of animal studies have found that both topical and oral vitamin A reverse this effect; however, vitamin A does not change healing time in animals not given corticosteroids.^63,64,65 Similar results have been reported for topical vitamin A in some human cases, and these researchers suggest a topical preparation containing 200,000 IU of vitamin A per ounce for improved surgical wound healing in patients using corticosteroids after surgery.⁶⁴ Topical vitamin A may also reduce scarring in patients taking corticosteroids.⁶⁷

Vitamin B1, given as intramuscular injections of 120 mg daily for several days before surgery, resulted in less reduction of immune system activity after surgery in a preliminary trial.⁶⁷ In a controlled trial, an oral B vitamin combination providing 100 mg of B1, 200 mg of vitamin B6, and 200 mcg of vitamin B12 daily given for five weeks before surgery and for two weeks following surgery also prevented post-surgical reductions in immune activity.⁶⁸ However, no research has explored any other benefits of B vitamin supplementation in surgery patients.

Vitamin B1, given as intramuscular injections of 120 mg daily for several days before surgery, resulted in less reduction of immune system activity after surgery in a preliminary trial.⁶⁹ In a controlled trial, an oral B vitamin combination providing 100 mg of B1, 200 mg of vitamin B6, and 200 mcg of vitamin B12 daily given for five weeks before surgery and for two weeks following surgery also prevented post-surgical reductions in immune activity.⁷⁰ However, no research has explored any other benefits of B vitamin supplementation in surgery patients.

Vitamin B1, given as intramuscular injections of 120 mg daily for several days before surgery, resulted in less reduction of immune system activity after surgery in a preliminary trial.⁷¹ In a controlled trial, an oral B vitamin combination providing 100 mg of B1, 200 mg of vitamin B6, and 200 mcg of vitamin B12 daily given for five weeks before surgery and for two weeks following surgery also prevented post-surgical reductions in immune activity.⁷² However, no research has explored any other benefits of B vitamin supplementation in surgery patients.

Some studies of surgery patients,^73,74 though not all, ⁷⁵ have found that blood levels of vitamin E decrease during and after surgery. Animal research suggests that vitamin E may prevent skin scarring when used topically after surgery,⁷⁶ but a human study reported disappointing results.⁷⁷ Vitamin E taken by mouth may interfere with blood clotting⁷⁸; therefore, use of vitamin E before surgery should be discussed with the surgeon. No research on either the usefulness or hazards of vitamin E supplementation around surgery has been done.

Zinc is a mineral nutrient important for proper immune system function and wound healing.⁷⁹ One study found most surgery patients recovering at home had low dietary intakes of zinc.⁸⁰ Low blood levels of zinc have been reported in patients after lung surgery.^81,82 In one study this deficiency lasted for up to seven days after surgery and was associated with higher risk of pneumonia,⁸¹ while another study found an association between post-operative zinc deficiency and fatigue.⁸² Poor post-operative wound healing is also more common in people with zinc deficiency.⁸⁵ Zinc supplements given to patients before surgery prevented zinc deficiency in one study, but the effect of these supplements on post-surgical health was not evaluated.⁸⁶