7 replies to this topic

[zoolander]

I recently tasked myself to put together a perioperative supplement regime for a friend who is having surgery.

I found the following helpful paper

Plast Surg Nurs. 2005 Jan-Mar;25(1):21-8; quiz 29-30
Perioperative nutrition and nutritional supplements.
Rahm D.Vita Medica Corporation, Manhattan Beach, CA, USA. david@vitamedica.com

Due to the combination of poor dietary habits and aging in the U.S. population, an increase in the incidence of chronic disease is occurring in this country. The prevalence of poor nutrition, obesity, diabetes, and other chronic diseases can have a significant impact on surgical outcome and complications. The number of patients with pre-existing nutritional deficiencies and health problems who are seeking cosmetic surgical procedures is growing. Nutritional intervention and supplements can have a beneficial effect on such patients who are undergoing surgery. Plastic surgeons performing aesthetic procedures may want to incorporate nutritional guidance and supplementation into their perioperative office regimen to mitigate complications and to optimize surgical outcome.

PMID: 15785351 [PubMed - indexed for MEDLINE]

For those of you who cannot access the full article I will outline which supplements you should not take and which supplements you should take. I will name the supplement followed by reasoning

Personally I find the following list to be an invaluable refernce point for any about to have an operation. In general perioperative means 2 weeks before and 2 weeks after

Supplements to excluse in the perioperative period

Bilberry:Antiplatelet, inhibition of clot formation

Dong Quai (Angelica sinensis): May potentiate anticoagulant medications

Echinacea(Echinacea augustfolia): Can cause hepatotoxicity, contraindicated with hepatic drugs (eg. anabolic steroids, methotrexate)

Ephedra (ma huang): Hypertension, tachycardia, cardiomyopathy, dysrhthmia, myocardial infaraction

Feverfew (tanacetum parthenium): May effect clotting components, contraindicated with warfarin or other anticoagulants

Fish Oil: EPA and DHA inhibit platelet adhesion and aggregation; Excessive doses can inhibit wound healing

Garlic (Zingiber officinale): Contraindicated with warfarin or other anticoagulants, NSAIDS, Aspirin

Ginger (Zingiber officinale): Risk of prolonged clotting time, contraindicated with warfarin or other anticoagulants, NSAIDS, Aspirin

Ginkgo Biloba: Inhibition of platelet activity factor (PAF), contraindicated with warfarin or other anticoagulants, NSAIDS, Aspirin

Ginseng (Panax ginseng; Panax quinquefolium): May interact with cardiac and hyoglycemic agents, contraindicated with warfarin or other anticoagulants, NSAIDS, Aspirin

Goldenseal (Hydrastis canadensis): May worsen swelling and or high blood pressure

Hawthorne (Crataegus laevigata): Potentiates actions of digitalis and other cardiac glycosides

Kava Kava (Piper methysticum): May potentiate CNS effects of barbituates, antidepressants, antipyschotics, and general anesthesia.

Licorice (Glycyrrhiza glabta): May cause high blood pressure, hypokalemia and edema

Melatonin: May potentiate CNS effects of barbituates, antidepressants, antipyschotics, and general anesthesia.

Red Clover (Trifolium pretense): May potentiate existing anticoagulant medications

St. John's Wort (Hypericum Perforatum): Contraindicated with other MAOIs or SSRIs. photosensitivity, many drug interactions

Valerian (Valeriana officinale): Contraindicated with sedatives and anxiolytics

Vitamin E: Anti-clotting benefits may prolong bleeding time

Yohimbine (Corynanthe yohimbe): Hypertension, tachycardia, increases potency of anesthetic agents

Supplements to include in the perioperative period*

Vitamin A (Carotenoid or retinol palmitate): Antioxidant; required for new cell growth; maintenance and repair or epithelial tissue
Dosage: 15,000-25,000 IUs daily (carotenoid or palmitate blend); limit to 4 weeks use

Vitamin C (Ascorbic acid): Antioxidant; necessary for tissue growth and repair; primary role in the formation of collagen
Dosage: 500-750mg daily (divided doses)

B-Vitamins: Anti-stress group of water soluable vitamins
Dosage: best taken as a B-complex (B1,2,3,6, biotin, pantothenic acid, folic acid, B12, choline, and inositol

Zinc: Antioxidant; essential for protein synthesis and collagen formation
Dosage: 15-21 mg/day

Selenium: Antioxidant; inhibits oxidation of fats and protects Vitamin E
Dosage: 150-210 mcg/day

Copper: Required for cross-linking of collagen and elastin; required for formation of hemaglobin, red blood cells, and bone
Dosage: 1.5-2.0 mcg/day

Bromelain: protelytic enzyme used to minmize inflammation and soft tissue injury
Dosage: 1500 mg/day:2,000-3000MCUs per day; starting 72 hours preoperatively

Flavonoids (Quercetin and citrus Bioflavonoids): Antioxidants; antiinflammatory; function with vitamin C to prevent bruising and support immune function
Dosage: 600-1500 mg/day

* I removed Arnica Montana off the above list. Arnica was proposed to help woth bruising and swelling but a recent study demonstrated no significant difference when compared to placebo

This is by no means an extensive list.

Please feel free to add any supplements that you think are either contraindicated or use periopertavitly. Please do so with caution. I prefer that people use references. Especially in this situation where we are talking about a life or death situation.

Edited by zoolander, 21 January 2008 - 03:27 PM.

[FunkOdyssey]

Watch out for anything that thins the blood or interferes with clotting (such as fish oil)! If they need to thin your blood they're going to give you warfarin, and if you've already been self-treating with anti-coagulation supplements, you set the stage for some serious uncontrolled bleeding. This happened to my father after a hip replacement and he almost had to go into surgery again to stop internal bleeding.

[balance]

Indeed, check that you don't include blood thinners, ginkgo, high dose of vitamin E, fish oil, high dose pomegranate, arginine, as these can enhance vasodilation and also increase bleeding. Also, watch out with those immune boosters, because that can hamper the body from letting itself get damaged during surgery which might hinder their progress. Don't know if that's a reasonable explanation but they usually advice against immune boosters for surgery, and I'm guessing it could be because of that reason I mentioned, might be total bs reason, but still, the point is don't pump immune boosters in your system at that time.

[zoolander]

added tables

Piet3r, agree with the arginine but do you have any references?

A few cancer studies seem to suggest the opposite i.e not bad

Am J Clin Nutr. 2001 Feb;73(2):323-32.

Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients.

van Bokhorst-De Van Der Schueren MA, Quak JJ, von Blomberg-van der Flier BM, Kuik DJ, Langendoen SI, Snow GB, Green CJ, van Leeuwen PA.

Department of Dietetics, the Nutrition Support Team, University Hospital Vrije Universiteit, Amsterdam, The Netherlands. m.vanbokhorst@azu.nl

BACKGROUND: Malnourished head and neck cancer patients are at increased risk of postoperative complications. OBJECTIVE: We studied the effect of perioperative, arginine-supplemented nutritional support on nutritional status, immune status, postoperative outcome, and survival in severely malnourished (weight loss >10% of body weight) head and neck cancer patients undergoing major surgery. DESIGN: Forty-nine patients were randomly assigned to receive 1) no preoperative and standard postoperative tube feeding, 2) standard preoperative and postoperative tube feeding, or 3) arginine-supplemented preoperative and postoperative tube feeding. RESULTS: Patients in both prefed groups received approximately 9 d of preoperative tube feeding, resulting in energy intakes of 110% and 113% of calculated needs (compared with 79% in the control group; P = 0.007). Compared with no preoperative feeding, preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes. Major postoperative complications occurred in 53%, 47%, and 59% of patients in study groups 1, 2, and 3 (NS). A trend was seen toward better survival in the arginine-supplemented group (P = 0.15). Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes (P = 0.05) and higher endotoxin-induced cytokine production (P = 0.010 for tumor necrosis factor alpha and P = 0.042 for interleukin 6) at the start of the study than did patients who died. CONCLUSIONS: Nine days of preoperative tube feeding, with or without arginine, did not significantly improve nutritional status, reduce the surgery-induced immune suppression, or affect clinical outcome in severely malnourished head and neck cancer patients. Patients supplemented with arginine-enriched nutrition tended to live longer. Some markers of immune function may distinguish patients with good or bad prognoses.

PMID: 11157331 [PubMed - indexed for MEDLINE]

Edited by zoolander, 21 January 2008 - 03:34 PM.

[balance]

Hey Zoolander,

I know, the arginine issue with cancer is two faced, some seem to recommend it whilst others tell you to avoid it. I think it varies with the type of cancer in question. I'll go and look for some references when I get my hands on enough time.

Nice list you composed there btw! The vitamin A seems like quite a high dosage, is this as pure retinol or as beta carotene..?

I thought they found bone loss at more than 4000IU, or at least, AOR stated that they did..

[unbreakable]

I think the most important question is which supplements/herbs not to take before a surgery (eg. blood thinning substances). If I had surgery I would probably stop taking most of my supplements. On the other side if I had a big heart surgery I would probably take Q10, Propionyl Carnitine, Magnesium Orotate, Ribose and ALA/NAC before the operation.

[rfarris]

I just finished having spine surgery. When I knew I was having surgery I immediately added Jarrow Ultra Bone-up, RI Strontium Citrate and a special form of K3, also from Relentless Improvement...

[zoolander]

I've had 2 ops in the last 4-5 years and in both situations I didn't change a thing. I continued taking fish oil and vitamin E. Lucky there were no complications.

Perhaps a side note but when I cut myself shaving the blood runs like water. I always let it run for a little and then I take photos and hang them on my wall besides all my UFC posters