Nutritional Programs for Pre- and Postsurgery (and Injuries)







  • Pre- and Post Surgery Nutrient Program (And for Healing Injuries)





  • This program, although it is simple, can really make a difference—a few changes and supplements can lessen stress, improve healing, and prevent infections after surgery. I have done my own independent research through the years, suggesting a program similar to this for my patients who have had elective surgery, and they have routinely told me that “the doctors and nurses couldn’t believe how fast I healed and was up and about” — and invariably there were no complications. In addition, many medical studies reviewing postsurgical healing time and morbidity, particularly from infections, have shown that with a few basic nutritional supplements, namely vitamin A, vitamin C, and zinc, healing time speeds up; in addition, there are fewer complications, and people are out of bed and out of the hospital sooner.


    Many doctors, particularly surgeons, resist these findings. I do not know whether this is due to economics or because they just do not want to believe that taking nutrients in higher dosages than “normal” is necessary. I would bet that having patients follow a few basic nutritional suggestions would improve both doctor and patient success. A good nourishing diet and additional vitamin C, vitamin A, and zinc with adequate fluid intake will usually do it. More recently, I have had patients scheduled for elective surgery tell me that their surgeons suggested they take additional supplements starting two weeks prior to their operations, so there may be some progress in regard to nutrition in the general medical profession.


    I suggest that anyone having elective surgery should follow this program for three to four weeks prior to and four to six weeks after surgery. With emergency or urgent surgery, it is wise to begin taking the extra supplements as soon as possible and to eat the most nutritious diet available. This program will also work to support tissue healing following an injury, burn, or other traumas or with an infection or sickness that causes tissue damage. My surgical program is designed to increase the reuniting of collagen fibers, facilitate protein metabolism, and strengthen the immune system.


    General measures important to healing include proper rest and sleep, fluid intake, and, of course, a nutritious and balanced diet high in fiber and low in fats and junk foods. High-quality protein foods (fish, poultry, eggs, nuts and seeds) are essential because tissue healing requires protein synthesis, so our body needs all of the important amino acids. A “healthy” intestinal flora is also important to health and healing. Additional Lactobacillus acidophilus culture may help replenish the colon. The diet should also contain adequate amounts of high-fiber foods (whole grains, vegetables, and legumes), calcium foods (greens, grains, nuts, and small amounts of dairy products), and foods containing essential fatty acids (some nuts, seeds, or vegetable oils). Congestive foods (excess dairy products, sweets, and baked goods) and fatty foods (fried foods, heavy meats, and ham and other cured meats) should be avoided.


    Minimizing and handling stress is also essential to keeping the immune system strong, which is in turn important for preventing infections and supporting healing. It is wise to stay away from steroid drugs, both topical and systemic, as they suppress our immune system. Doctors tend to overprescribe and patients to overuse these steroid medicines. Smoking should be stopped or minimized if possible before surgery. Avoiding stimulating drugs, such as coffee and cocaine, and sedating drugs, such as alcohol and marijuana, prior to elective surgery, is also a wise idea.


    I usually do not recommend that people fast or make any major diet revisions prior to surgery; rather, they should maintain a nutritious diet with some shifts toward the healthier practices mentioned above. If possible, people should be close to, or just above, their ideal weight for surgery. Obesity increases surgical risks (infection, poor healing), while underweight people often do not have sufficient energy reserves to heal rapidly.


    Of course, I recommend a wonderful diet all of the time, but it is a good idea to begin increasing protein intake and adding the healing nutrients a few weeks before surgery to build up both the strength and the tissues. Usually, the diet can be a little lighter a few days prior to surgery, emphasizing more fruits, vegetables, and liquids along with the nutritional supplements. This will help lessen digestive organ stress.


    Recovery from surgery takes time. The diet should be a little lighter initially, and
    low in fats. With any abdominal surgery, often a liquid or soft diet is necessary for a while. This is where protein and/or nutrient powders are useful. There are also more healthful suggestions than the bouillon, jello, coffee, and colas that might be served. Some examples are vegetable and meat broths, fresh juices, light soups, pureed carrots, squash, mashed potatoes, bananas, applesauce, or other fruits or vegetables, progressing to oatmeal, cream of rice cereal, and richer soups.


    After surgery, it is sensible to eat foods as tolerated and as suggested by the doctor or the nutritionist, gradually resuming the nourishing, presurgery diet. Then after two or three months, when most tissue healing is complete and the body is stronger, a mild cleansing and detoxification may be initiated, especially if general anesthesia was used during the surgery or other potentially toxic drugs were used afterward.


    This fine art of administering potentially lethal drugs to reduce pain, induce unconsciousness, and yet maintain life has progressed significantly in the past century. Many procedures are possible now that were only fantasies generations ago. Yet, many people realize that the anesthesia is often more difficult to recover from postsurgically than the actual cutting of tissues. Thus, I suggest using the least amount of drugs and the simplest anesthetic procedure possible; clearly the toxicity of anesthesia can be worse with suboptimal nutrition. Local anesthesia is clearly a big advance in medicine of recent years. Before general anesthesia, it is wise for people to nourish themselves well first with a high-nutrient diet containing good quality protein foods, and by taking supportive supplements to strengthen tissues and create nutrient reserves. The antioxidant nutrients (vitamins C and A, selenium, zinc, and L-cysteine) are suggested. Vitamin E can be taken, but in lower doses (100–200 IUs) so that it does not affect blood clotting or tissue healing.


    Most books on medical dietetics include many specific diets for various types of surgery. The program suggested here is more general and, I assure you, more healthful. The current hospital diet might make more economic sense, and it is probably the way that the bureaucrats who create these diets eat anyway, but it is not in the best interest of the patients. Our hospitals need to provide more nutrient-rich, healing diets, with more wholesome foods and liquids to help revitalize and nourish (and heal) the patients so that they can return to their normal lives as quickly as possible. Hospitals should also provide a hypoallergenic (low in wheat, yeast, corn, eggs, or milk) and low-chemical (no additives, binders, artificial colors) diet. If, as dieticians believe, “we do not need supplements if we eat a balanced diet,” they should then clearly provide a chemical-free, hypoallergenic and wholesome diet. However, the RDAs do not apply to hospitalized and surgical patients; these people need more of most nutrients due to the stress and possible inadequate digestion and assimilation. In addition, the RDAs do not include many important nutrients, such as manganese, selenium, chromium, boron, and vanadium. Hospital diets should also be providing supplemental electrolyte powders to provide additional magnesium, and protein powders to support patients’ healing and to prevent muscle wasting. I suggest, as Dr. Robert Haas does in his book Eat to Succeed (New American Library, New York, 1986) that people take their own nutritional supplements to the hospital; bring (or have family and friends bring them) good food, drinking water, and fresh juices; and encourage hospitals to provide more natural foods prepared with little or no saturated fats, salts, and chemicals or preservatives.


    Another reminder for improved healing from surgery is to become active and involved in the healing process as soon as possible. Most surgeons and nurses are supportive of this practice and will provide encouragement. “Think/Feel healing”—know, believe, and see (through internal visual imagery) that complete recovery is taking place.


    Several specific nutrients are particularly important in this program. Vitamin A in the retinol form helps in tissue healing and immune support. The beta-carotene form, provitamin A, adds further vitamin A and has an antioxidant effect. Vitamin C also improves collagen tissue healing and is needed in regular frequent amounts to replenish the increased amounts of vitamin C used during the stress of surgery and sickness. The bioflavonoids support the beneficial vitamin C effects and aid in tissue healing as well. Zinc is important to tissue healing and immune support through its function in a variety of enzymes. Magnesium also activates many enzymes useful in healing.


    The B vitamins are needed, particularly extra riboflavin (B2), which seems to help tissue repair, and pantothenic acid (B5) to deal with the extra stress of surgery. Adequate vitamin K in our diet supports normal blood clotting, so important during surgery. Various other vitamins, such as B1, B3, B6, and B12, and other minerals, such as selenium, copper, iron, calcium, potassium, manganese, molybdenum, and cobalt, are also important to healing. Of course, with surgical blood loss, more iron may be needed in the recovery stage to build blood cells. Silica is useful to skin and tissues. Bromelain, the pineapple enzyme, has a mild anti-inflammatory effect and may be useful after surgery to aid in food digestion as well as to reduce micro blood clots (thrombi). Moderate levels of supplemental L- amino acids can be helpful, and some recent research suggests that additional amounts of L-arginine and L-lysine in particular aid tissue healing as well. The essential fatty acids (omega-3 and omega-6) are also very important to wound healing.


    Healthy immune function is, of course, essential to healing and preventing infections. The antioxidant nutrients are useful in supporting the immune system, but for this program, a lower than usual amount of vitamin E is suggested, usually about 200 IUs and definitely not more than 400 IUs. Vitamin E has been shown in some studies to slow wound healing time, in contradiction of the popular belief that oral vitamin E and topical E are good for healing tissues; many vitamin E caps have been popped and the oil applied to the skin to help in healing. It would make sense to use vitamin A oil for this purpose, as it is a nutrient known for its tissue healing properties.


    Herbs can also be used to support wound healing. Horsetail is very high in silica, a mineral that helps strengthen tissues, especially skin, hair, and nails. Goldenseal root is a tonic herb when taken internally and also has mild anti-infection properties. Used locally, it works as an antiseptic. It has been used effectively in helping heal wounds internally and externally, in strengthening mucous membranes, and in ulcer treatment. Comfrey leaf has always been believed to have healing properties when taken internally, though there is not much specific research data to support this observation. It is more often used externally for sprains and bone, muscle, and ligament injuries or internally for broken bones than for healing surgical wounds.


    The following table lists the basic nutrients to be taken before and after surgery when possible. Usually, following this program for two to three weeks prior to surgery and four to six weeks afterward is sufficient. This program may also be used when recovering from wounds, injuries, burns, or infections. My experience has led me to believe that it will reduce healing time, reduce morbidity secondary to surgery, and lessen the duration of hospital stays.



    Pre- and Postsurgery Nutrient Program

    (and for Healing Injuries)
























































































    Water 2–3 qt.
    Fiber10–15 g.
    Protein70–100 g.
    Fat50–75 g.

    Vitamin A20,000 IUs* Copper2–3 mg.**
    Beta-carotene15,000 IUs Iodine100–200 mcg.
    Vitamin D400 IUs Iron20 mg.
    Vitamin E200 IUs Magnesium500–800 mg.
    Vitamin K300 mcg. Manganese10 mg.
    Thiamine(B1)50 mg. Molybdenum800 mcg.
    Riboflavin(B2)25–100 mg. Potassium2–3 g.
    Niacin(B3)25 mg. Selenium, as
    selenomethione
    200 mcg.
    Niacinamide(B3)50 mg. Silicon100–200 mg.
    Pantothenic acid(B5)1,000 mg. Sulfur400–800 mg.
    Pyridoxine (B6)50 mg. Vanadium150–300 mcg.
    Pyridoxal-5-phosphate25 mg. Zinc60–100 mg.**
    Cobalamin (B12)200 mcg.
    Folic acid800 mcg. L-amino acids1,000 mg.
    Biotin300 mcg. L-arginine500–1,000 mg.
    Inositol1,000 mg. L-lysine500–1,000 mg.
    Vitamin C 4–6 g. Lactobacillus2 billion organisms
    Bioflavonoids500 mg. Bromelain200–400 mg.
    Boron2–3 mg.
    Calcium800–1,200 mg.
    Chromium200 mcg.


    *20,000 IU vitamin A should only be used for four to six weeks, beginning a week or two prior to surgery and two to three weeks afterward. At other times, the amount should be limited to 5,000–10,000 IUs daily.

    **Amount should be higher if more zinc is taken—about a 20:1 ratio of zinc to copper.

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    Elson M. Haas MD Written by Elson M. Haas MD

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