11th January 2022
Is pre-operative nutrition necessary for optimal recovery after surgery, or hype?Devan Patel
Why is nutrition so vital?
According to the CDC, fewer than 1 in 10 adults and adolescents eat enough fruits and vegetables. In addition, 5 in 10 adults consume a sugary drink daily. Combine this with little or no physical activity, and there is an increased risk of heart attack and stroke, obesity, type 2 diabetes, and cancer. Lacking a proper diet can cause inflammation in our bodies leading to destructive diseases if not taken care of and treated early. Our bodies are complex and require the proper nutrients, antioxidants, minerals, and vitamins for each cell to function daily. It is even more imperative when injured or recovering from surgery.
The good and bad of Cortisol.....
Cortisol is an important hormone in the body. It regulates the body's daily functions such as blood glucose levels, tissue repair, blood pressure, and the distribution of proteins, fats, and carbohydrates. Cortisol is also highly activated during the fight or flight response.
Surgery causes the body to fall into a stressed state, resulting in a cascade of metabolic events, inflammation, and immune response activation. During this time, cortisol levels will increase and redirect the body's functions to the injury site to aid in repair. However, if cortisol levels do not decrease, and there are underlying conditions such as Type 2 Diabetes, this can lead to complications if blood sugar is not under control. Before any surgery, make sure to decrease stress and consume a proportioned nutritious diet to have the most successful outcome.
How does a wound heal?
Wound healing occurs in phases, and nutrients have a huge role. When there is an injury, the body will respond immediately, signaling cells to help stop the bleeding by forming a clot. Second, inflammation will occur, which looks like swelling and redness in the injured area. During this phase, white blood cells, nutrients, and growth factors are released to the injured area to remove damaged cells, prevent bacterial infections, and stimulate tissue growth. Third, many cells work on the injured site to form new tissue and vessels to nourish and repair the area. It is usually visible as a scar or scab in the injured area. When the rebuilding and repairing process is complete, the scab will fall off, and the wounded area should look similar before the injury.
Why are Proteins, Carbohydrates, and Fats so Important during healing?
Protein comes in many forms, such as lean meats, plant protein, seafood, and protein supplements. Any time a patient has surgery, they can expect to have some immobility for a certain amount of time. The muscle can break down in that time, which is critical for the malnourished, elderly, or individual who does not have a lot of muscle mass. Protein is responsible for cell structure, repairing and making various cells, hormones, DNA, and much more. Maintaining muscle must be done either by weightlifting or consuming protein through diet or a supplemental source. In recent years, the consumption of carbohydrates and fats has had a terrible reputation, but they are essential for maintaining normal cellular functions. Carbohydrates help fuel your body, and fats are present in the structure of your cells. Both of these have a substantial role in rebuilding and repairing cells.
Last but not least and one of the most important…
Vitamins and Minerals are present in various fruits and vegetables, and they are essential in metabolic functions, bone health, heart health, injury repair, and much more. Many people fall below the minimum required nutrient levels. Not only that, but many diseases can affect the absorption of these nutrients. An example would be diabetes, Crohn's disease, or leaky gut syndrome. Lacking dietary fiber and water can decrease the absorption of these nutrients. If you cannot eat enough nutritious food, consider supplements in your diet.
Vitamin A is just not for eye health.....
Beta-Carotene is a precursor that converts to Vitamin A in the body. Vitamin A helps activate a process that forms a barrier between the wound bed and the exterior. This micronutrient aids in tissue repair by enhancing the immune response and releasing epithelial cells to heal wounds. Vitamin A is a fat-soluble vitamin and should not exceed the recommended amounts. Vitamin A comes in many forms and can be taken orally and applied topically.
Vitamin C- The most popular micronutrient of them all.
Vitamin C (Ascorbic Acid) has become quite popular in skincare and increasing immunity since the pandemic began. Vitamin C helps in all the phases of wound healing, but it has the most significant influence on collagen synthesis, scar formation (epithelialization), and immune support. Without scar formation, the wound will not close and will be susceptible to infection, and debris, thus prolonging the healing process. Vitamin C took daily aids in the absorption of Iron, which is vital for blood to be healthy.
The Power of Zinc
A substantial amount of Zinc is present in the body and acts as a catalyst or cofactor to many enzymes that produce chemical reactions . In wound healing, zinc has been shown to increase immunity and decrease chronic inflammation. Zinc has a significant role in the entire immune response, specifically affecting T Cells which help the body fight infection and cancer. A study found that diabetic patients with foot ulcers improved the size of the ulcer with adequate amounts of Zinc. It is critical to replenish zinc levels because it is rapidly broken down in the body, leading to zinc deficiency quickly.
Why Turmeric and Bromelain might change the future of healing?
Bromelain is an enzyme that originates in the stem of the pineapple plant. Bromelain has been shown to decrease the healing time of wounds, decrease inflammation, remove damaged skin cells, decrease swelling, and possibly prevent cancer. Bromelain has so much potential and is still being researched for more uses.
Turmeric (Curcuma longa) originates from India and has been used in Ayurvedic medicine for centuries. Turmeric is an anti-inflammatory agent and an antioxidant and participates in all the phases of wound healing. It contributes to rebuilding and repairing the tissue of the wounded area and stimulating growth factors to start the healing process. Turmeric also is being researched for its effects on cancer.
Take away message............
Preparation and prevention are essential for the best outcome. A balanced diet of proteins, carbohydrates, and fats with the right proportions will make the process of recovery a lot smoother. However, nutrients are just as vital, if not even more. Vitamin A, C, and Zinc serve in the many phases of wound healing, and these can be taken through diet or supplements. It will be interesting to see healthcare evolve with an open-minded approach to alternative treatments like Turmeric and Bromelain in wound healing. Remember to check with your doctor or pharmacist first before making any changes to your health.
Author: Manisha N. Patel, RPh, PharmD