Nutrients which can Improve the Outcome of Surgery and Wound Healing

by John & Barbara Connor, M.Ac., L.Ac.

John and I feel it is important to have certain nutrients in one’s diet before surgery in order to improve the outcome of the surgery. We have put together this little article in hopes that it might help if you or a loved one ever needs surgery.

According to a recent study optimization of a person’s metabolic state prior to major surgery leads to improved surgical outcomes. Nutrition screening protocols should be implemented in the preoperative evaluation, possibly as part of a bundle. Strategies to minimize hyperglycemia and insulin resistance may promote maintenance of a perioperative anabolic state, improving healing, reducing complications, and shortening the time to recovery of bowel function and hospital discharge. (Evans et al 2014)

Molecular oxygen plays a central role in the pathogenesis and therapy of chronic wounds. When reactive oxygen species are overproduced, oxidative stress results, with detrimental cytotoxic effects causing delayed wound healing. Therefore, elimination of reactive oxygen species could be an important strategy to improve healing of chronic wounds. Currently first therapeutic strategies targeting reactive oxygen species by antioxidants are being introduced into the treatment of chronic wounds. (Dissemond et al 2002) Foods, herbs and nutrients high in antioxidants are listed at the end of this article.

A good foundation protocol to have in place before surgery should include a variety of the following nutrients:

Anthocyanins – which enhance wound healing. (Xu et al 2013) 

Foods rich in anthocyanins include red grape, blueberry, pomegranate, aroniaberry, elderberry and red raspberry.

Antioxidants and adenosine – It has been shown that adenosine and antioxidants promote wound healing. (Ojeh et al 2014) 

Arginine and omega-3 fatty acids – Short courses of preoperative immune-modulating formulas, using combinations of arginine, omega-3 fatty acids, and other nutrients, have been associated with improved surgical outcomes. These immune-modulating nutrients are key elements of metabolic pathways that promote attenuation of the metabolic response to stress and improve both wound healing and immune function. (Evans et al 2014)

Arginine
– A study in animals showed that the impaired healing subsequent to trauma/hemorrhage can be greatly alleviated by L-arginine supplementation. (Shi et al 2007) 

Foods rich in arginine include sesame seed flour, soy protein isolate, shrimp and crab (cooked under moist heat), spinach (raw or cooked), raw seaweed, roasted turkey, cooked chicken and cooked fish.

Arginine – Immune-enhancing diets (IEDs) rich in arginine (ARG) reduce morbi-mortality in trauma and surgical patients. The ARG present in IED can serve to supply glutamine to ICU patients, who are usually depleted in this conditionally essential AA during injury. (Loi et al 2009)

Arginine – Perioperative arginine-enriched enteral nutrition significantly improved the long-term overall survival and long-term disease-specific survival in malnourished patients with head and neck cancer. (Buijs et al 2010) 

Arginine plus N-3 fatty acids – The perioperative administration of an enriched enteral formula enriched with arginine, RNA, and omega-3 fatty acids significantly improved gut function and positively modulated postsurgical immunosuppressive and inflammatory response in forty patients with neoplasm of the colorectum or stomach. (Braga et al 1996) 

Foods highest in omega-3 fatty acids (also known as n-3 fatty acids) include flaxseed oil and seeds, fish oil (salmon, sardine, cod liver) dried chia seeds, dried butternuts, walnuts, fresh basil, dried oregano, cooked Chinese broccoli and cooked salmon.

Bromelain – was shown to be beneficial in a double-blind, placebo-controlled, crossover study of individuals undergoing dental surgery. (Tassman et al 1964) 

CAPE (caffeic acid phenethyl ester) – Cutaneous injury causes a depression in antioxidant status, as reactive oxygen species (ROS) are produced in response to injury. This animal study has demonstrated that CAPE (an antioxidant and anti-inflammatory agent) partly accelerates full-thickness wound healing by its antioxidant and ROS-scavenging capabilities. (Serarsian et al 2007) Caffeic acid phenethyl ester is an active component of propolis from honeybee hives.

Coenzyme Q(10), magnesium orotate, lipoic acid, omega-3 fatty acids and selenium Perioperative metabolic therapy (coenzyme Q(10), magnesium orotate, lipoic acid, omega-3 fatty acids and selenium) for cardiac surgery is safe and inexpensive and is associated with improved redox status, reduced myocardial damage, and shortened length of postoperative hospital stay. (Leong et al 2010) 

Food sources of CoQ10 include spinach, peanuts, tuna, sardines and beef. 

Food sources of magnesium include seafood, whole grains, dark green vegetables, beans and peas, molasses and nuts.

Food sources of alpha lipoic acid include yeast, organ meats like liver and heart, spinach and broccoli. 

Foods sources of omega-3 fatty acids include flaxseed oil and seeds, fish oil (salmon, sardine, cod liver) dried chia seeds, dried butternuts, walnuts, fresh basil, dried oregano, cooked Chinese broccoli and cooked salmon.

Food sources of selenium include tuna, herring, oysters, clams, chicken liver, brewer’s yeast, wheat germ and bran, whole grains, wheat flour, sesame seeds, Brazil nuts and sunflower seeds.

Glutamine – has shown to be beneficial in the surgical and critically ill patient, and it has been shown to be beneficial for the metabolically stressed patient, (Vermeulen et al 2007) In a controlled trial of 20 trauma patients with wounds that were failing to heal after trauma or surgery, the provision of antioxidant micronutrients and glutamine for 2 weeks resulted in significantly reduced wound closure time. (Chow & Barbul 2014) The healing process can be stimulated by preoperative feeding and by certain nutrients such as glutamine, arginine, butyrate, and antioxidants. (Campos et al 2008) 

Food sources of L-glutamine include beef, chicken, fish, eggs, milk, dairy products, wheat, cabbage, beets, beans, spinach, and parsley. 

Glutamine, arginine, butyrate, and antioxidants – The healing process can be stimulated by preoperative feeding and by certain nutrients such as glutamine, arginine, butyrate, and antioxidants. (Campos et al 2008)  

Butyrate is a type of short chain fatty acid which is produced naturally by bacterial fermentation of dietary fibers as a fuel in the colon. (Moeinian et al 2014) 

Fiber pectin is fermented to short-chain fatty acids including butyrate by the colonic microflora. (Cho et al 2014)

Food sources of dietary fiber include cooked split peas, cooked lentils, cooked black beans, cooked lima beans, cooked vegetarian baked beans, cooked artichoke, green peas and raspberries.

Food sources of pectin include pears, apples, guavas, quince, plums, gooseberries, oranges and other citrus fruits.

Resveratrol – The findings in this animal study show that resveratrol may have a beneficial effect on incisional wound healing. (Yaman et al 2013) 

Food sources of resveratrol inlcude grapes, red wine, purple grape juice, peanuts, blueberries, bilberries and cranberries.

Siberian Sea Bucktorn oil super-concentrate posseses significant wound healing activity and has no associated toxicity or side effects. (Food Chem Toxicol 2009 Jun; 47(6):1146-53) 

Vitamin C and Vitamin E – In a randomized double-blinded study, the role of supplementation with vitamin E, vitamin C, and zinc in 32 children was evaluated; the supplementation decreased the time of wound healing, which correlated with decreased oxidative stress. Overall, vitamin C supplementation has consistently shown benefit to wound healing. (Chow & Barbul 2014) 

Food sources of Vitamin C include citrus fruits, rose hips, acerola cherries, alfalfa seeds (sprouted), black currants, guava, grapefruit, lemons, orange juice, tomatoes, pimientos, cantaloupe, strawberries, kiwi fruit, broccoli, red sweet peppers, green peppers, Brussels sprouts, broccoli, cabbage, cauliflower, kale and peas.

Food sources of Vitamin E include cold-pressed oils, eggs, wheat germ, organ meats, molasses, sweet potatoes, leafy vegetables, sunflower seeds, walnuts, peanuts, Brazil nuts, cashews, pecans, almonds, hazelnuts, wheat germ, soybeans, lima beans and desiccated liver.

Foods, Herbs and Nutrients High in Antioxidants
Allspice, Alpha-lipoic acid, Amla, Apples (dried), Apricots (dried), Artichoke, Barley, Beets (red), Bilberries (dried), Black currants, Blueberries, Broccoli, Buckwheat, Cabbage (red), Carrot, Cinnamon, Clove, Coffee, CoQ10, Cranberries, Curcumin, Dates (dried), Espresso, Guava, Mangoes (dried), Millet, N-acetyl cysteine, Olives (black & green), Oregano, Paprika, Pecans, Peppermint, Plums (dried), Prunes (dried), Pomegranate juice, Quercetin, Resveratrol, Rhodiola rose, Spinach, Strawberries (wild), Sunflower seeds, Thyme, Vitamin C & E, Walnuts

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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-309-7753.

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