Modern surgery is, without a doubt, one of the greatest medical achievements of our time. Thousands of lives are saved through emergency trauma surgery, delicate organ transplants and your quality of life is also vastly improved by not having to live with that dodgy knee you busted playing footy.

 

Surgery is an enormous stress on the body. There is the physical tissue repair, bruising and inflammation involved with wound healing, as well as the side effects from anesthetics, pain medication and antibiotics 1.

 

Emotionally it can also be a stressful time with fears about your health condition and worry about the outcome.

 

So, it makes sense that if you want the best and fastest recovery possible to ensure your body (both physically and emotionally) is functioning optimally. The food you eat in additional to strategic nutritional supplements and herbal medicines can be your secret weapon.

 

Here’s a guide to ensure you recover from your surgery brighter and better than you were before!

 

 

*** But first a caveat: Before starting any supplementation make sure to check your pre-surgery guidelines and discuss with your health care team (both medical and complimentary) regarding their use and timing. For most conditions they will generally need to stop any supplements at least 48 hours before your surgery. Particular concerns will be supplements and herbs that interfere with blood clotting such as garlic, vitamin E and fish oil.***

 

 

Ok, our mission now is to promote wound healing in the shortest time, with minimal pain, discomfort and scarring.

 

Here’s your plan.

 

Your wound healing diet

 

If you are having elective surgery you will have weeks or months to prepare. Use this time to knock your diet into shape. Optimal nutrition will support a speedier recovery, not to mention it’s a damn fine idea for ongoing health. I mean, we all have to eat so let’s make it count.

 

 

There’s nothing here you haven’t heard before but…

Include:

  • 5-7 servings per day of a variety of fresh, seasonal vegetables, organic if possible
  • Two servings of fruit per day
  • Adequate protein from animal and/or plants sources. Aim for between 0.8-1.0 grams per kilo of your body weight.
  • Moderate amount of whole grains (if tolerated)
  • Small amounts of “good fats” such as nuts, avocado, butter, olive oil
  • Maintain adequate hydration with filtered water. Aim for 30mL per kilo of body weight and adjust for weather and activity levels

 

Things that will undermine your foundation.

Limit or avoid:

  • Alcohol: no more than 1-2 standard drinks per day with a minimum of 2 alcohol-free days per week. Alcohol depletes the body of key nutrient stores required for tissue repair such as B group vitamins, vitamin c and zinc. High alcohol consumers are 2-3 times more likely to suffer from post-operative complications than abstainers.
  • Excessive caffeine intake. Limit your “cup o Joe” to 1 /day. Too much caffeine puts your adrenals on overdrive and we don’t want any more stress than is absolutely necessary.
  • Refined sugar and trans fats. Refined sugar/carbs add next to no nutrients and actually knock nutrients such as vitamin, magnesium and zinc out of your cells. Not to mention the inflammation they cause.

 

Lifestyle

  • Exercise within the limits of your current health. Aim to break a sweat 5 times a week for at least 30 minutes.
  • Include mindfulness and relaxation exercises to support emotional resilience.
  • Sleep: ensure you are well rested. Your body resets and cleans out the cellular garbage while you sleep so this needs to be a priority. If you have a hospital stay the chances are your sleep will be disrupted so having your sleep account in credit will be beneficial.

 

 

My top 10 wound healing supplements

 

There are a multitude of supplements and herbs that promote wound healing but here are the big guns that form my top 10.

Herbal Supplements

Grape seed extract (Vitis vinifera)

Grape seed extract as its name implies is made from the seeds of wine grapes. But, you’re not going to get the same benefits from drinking wine. Sorry!

This herb has been shown to reduce swelling, bruising and increase connective tissue formation enabling faster wound healing. It may also protect against hospital acquired methicillin-resistant staphylococcus aureus (MRSA) infection which is very difficult to treat as it has now outsmarted most pharmaceutical treatments 2.

 

Gotu kola (Centella asiatica)

Gotu kola has a long history of traditional use in Asia for wound healing. Modern research has validated this and identified that one of the components of the plants (the triterpenoids) increases the synthesis of collagen to speed wound healing and reduce scarring 3. This plant also has a host of other benefits for post surgery, including reducing swelling, and promoting lymphatic circulation. But wait there’s more… the asiatic acid in Gotu kola modulates GABA receptors resulting in reduced feelings of anxiety and improving sleep 4.

 

Ginger (Zingiber officinale)

Ginger is widely known to be beneficial against nausea but it also is one of the most powerful anti-inflammatories modulating multiple pathways to reduce pain and reliance on pharmaceutical painkillers 5.

 

Garlic (Allium sativum)

Garlic is another well-known culinary herb that helps post-surgical recovery on multiple fronts including reducing inflammation, supporting the immune system, preventing bacterial infection, reducing the likelihood of clotting and supporting the growth of new blood vessels. If using as a supplement the research has been conducted primarily using aged-garlic extracts 6,7. This is good news because this form of garlic is less likely to make you smell like you’ve been eating at your favourite Italian restaurant for the last month!

 

Nutritional Supplements

 

Proteolytic Enzymes

These are usually a mix of proteolytic (protein digesting) enzymes and supporting nutrients and should contain bromelain, papain, pancreatin, serrapeptase, quercetin and rutin. These formulations act primarily to reduce inflammation to speed the repair and regeneration of injured tissue. They also provide support to immune system cells and digest blood borne pathogens, reducing the risk of infection 8–10.

 

Take proteolytic enzymes 1 hour before meals or between meals to protect them from destruction by high levels of stomach acid.

Adult dosage guide:

Post surgery: refer to instructions on individual formulations

 

Probiotics

Your gut houses a large part of your immune system so it makes sense to ensure you’ve got the right mix of good bacteria playing on your team. A high quality, multi-strain probiotic is a good idea if you’ve been given a prophylactic antibiotic as part of your surgery. This will ensure your digestive tract is repopulated with good bacteria and reduce the risk of antibiotic diarrhoea in addition to promoting healthy digestion and immune function 11,12.

Adult dosage guide:

Pre surgery: A broad spectrum probiotic with 50 billion CFU /day

Post surgery: A broad spectrum probiotic with 100 billion CFU/day until the wound is healed. If taking antibiotics consider using Saccromyces boulardii which can be taken concurrently with antibiotics and then switch to a probiotic when the course of antibiotics is complete.

 

Vitamin C

Even if you’re not a salty, old, sea dog most of us are familiar with vitamin C’s role in preventing scurvy. Scurvy occurs when a diet lacking in vitamin C causes degradation of collagen fibres and is first evident by bleeding gums and lesions in the mouth. For the best kind of wound healing you need your collagen fibres to be high tensile and stable and vitamin C will be the key weapon in your healing arsenal 13.

 

Collagen aside, vitamin C also supports the immune system, may decrease the risk of post surgical hemorrhage and helps ensure your adrenal glands are in tip top shape so you can better manage and physical or psychological stress 14.

 

Adult dosage guide:

Pre surgery: 500g day 2 weeks prior to build up stores

Post surgery 1-2 grams/day until wounds are healed

 

Zinc

Zinc is a mineral that is very busy in your body participating in over 300 enzyme reactions. Unfortunately it is rapidly excreted from the body during times of stress, if your blood sugar is unstable and if you have diarrhoea. Zinc is also involved in collagen production and keeps wounds free from bacteria. In the first week after surgery the body will gorge itself on zinc so supplementation during this time is a good idea15.

 

Adult dosage guide:

Pre surgery: 15mg/day 2 weeks prior

Post surgery 15-30mg/day

 

Vitamin A

Vitamin A is another nutrient that is important in tissue and bone development and repair. Adequate Vitamin A ensures that immature cells can transform into the correct type required for wound healing. This vitamin is a huge player in your immune function. It helps your mucous membranes to repel microbes and increases the amount of infection fighting immune cells at the wound site 14. Always good to have a big army on your side!

 

** Be cautious with supplementing Vitamin A if you are pregnant, on steroid medication or have a liver condition. Do not supplement vitamin A in large doses for extended periods of time.

 

Adult dosage guide:

Pre-surgery: 10,000IU/day for two weeks prior

Post surgery 25,000IU/day until healing is complete

 

Protein

Lots of protein (and its component parts, amino acids) is required to repair your body after surgery. If you don’t have enough protein your body will start breaking down your skeletal muscle to get the amino acids you need and this will prolong recovery time and keep inflammation levels high for longer14. The two most important amino acids are arginine (required for proline that is part of collagen, cartilage, tendons and bone) and glutamine that powers your immune cells to ensure they are operating at maximum capacity 16.

 

Adult dosage guide:

Pre-surgery: ensure good dietary intake as per recommendations above.

Post surgery: a good quality complete protein supplement can be used in addition to your regular diet. Aim for 20-40g per day.

 

 

“Best practice in surgery requires the support of the whole of the patient not just the hole in the patient” Keast & Ostead 17

 

Remember, surgery is a stressful event both physically and psychologically.

Support yourself with food and supplements but also support yourself with positive people and activities that nurture you mentally, emotionally and spiritually.

 

 

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References:

  1. Fearon KCH, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery. Proc Nutr Soc. 2003;62(4):807–811. doi:10.1079/PNS2003299.
  2. Ulbricht C. Peripheral Vascular Disease: An Integrative Approach. Altern Complement Ther. 2012;18(1):44–50. doi:10.1089/act.2012.18101.
  3. Incandela I, Cesarone R, Cacchio M, De Sanctis M, Scantvenere C. Total triterpenic Fraction of Centella asiatica in Chronic Venous Insufficiency and in High-Perfusion Microangiopathy. Angiology. 2001;52(2):S9–S13. Available at: http://www.proquest.com. Accessed May 31, 2015.
  4. Valdivieso D, Kenner C, Lucia A, et al. Evaluation of the Anxiolytic and Antidepressant Effects of Asiatic Acid, a Compound from Gotu Kola or Centella asiatica, in the Male Sprague Dawley Rat. Am J Health Behav. 2015;83(2):91–99. Available at: http://www.ebsoehost.com. Accessed May 31, 2015.
  5. Abascal K, Yarnell E. Herbs for Curbing Inflammation. Altern Complement Ther. 2006;(February):22–29. Available at: www.proquest.com. Accessed March 22, 2013.
  6. Majewski M. Allium sativum: facts and myths regarding human health. Rocz Państwowego Zakładu Hig. 2014;65(1):1–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24964572.
  7. Ejaz S, Chekarova I, Cho JW, Lee SY, Ashraf S, Lim CW. Effect of aged garlic extract on wound healing: a new frontier in wound management. Drug Chem Toxicol. 2009;32(3):191–203. doi:10.1080/01480540902862236.
  8. Mpharm N, Sengottuvelu S, Manoj G, Sethumathi PP. Efficacy , Tolerabilíty , and Safety of a Multicomponent Antiinflammatory With Glucosamine Hydrochioride vs Glucosamine Sulfate vs an NSAID in the Treatment of Knee Osteoarthritis — A Randomized , Prospective , Double-Blind , Comparative Study. Integr Med. 2009;8(3):32–38. Available at: www.ebscoe.com. Accessed September 1, 2014.
  9. Pasqualicchio M, Gasperini R, Velo G, Davies M. Effects of copper and zinc on proteoglycan metabolism in articular cartilage. Mediat Inflamm. 1996;5:95–99. Available at: www.ebscoe.com. Accessed May 27, 2014.
  10. ková MD &#119, Wald M. Orally Administered Proteases in Aesthetic Surgery. Aesthetic Plast Surg. 1999;23(1):41–44. doi:10.1007/s002669900241.
  11. Chon H, Choi B. The effects of a vegetable-derived probiotic lactic acid bacterium on the immune response. Microbiol Immunol. 2010;54(4):228–36. doi:10.1111/j.1348-0421.2010.00202.x.
  12. Kelly D, Mulder IE. Microbiome and immunological interactions. Nutr Rev. 2012;70(SUPPL. 1). doi:10.1111/j.1753-4887.2012.00498.x.
  13. Ursini F, Pipicelli G. Nutritional Supplementation for Osteoarthritis. Altern Complement Ther. 2009;15(4):173–177. doi:10.1089/act.2009.15404.
  14. MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev. 2003;8(4):359–377.
  15. Lansdown ABG, Mirastschijski U, Stubbs N, Scanlon E, Agren MS. Zinc in wound healing: theoretical, experimental, and clinical aspects. Wound Repair Regen. 2007;15(1):2–16. doi:10.1111/j.1524-475X.2006.00179.x.
  16. Swaid F, Sukhotnik I, Matter I, et al. Dietary glutamine supplementation prevents mucosal injury and modulates intestinal epithelial restitution following acetic acid induced intestinal injury in rats. Nutr Metab (Lond). 2013;10(1):53. doi:10.1186/1743-7075-10-53.
  17. Keast DH, Orsted H. The basic principles of wound care. Ostomy Wound Manage. 1998;44(8):24–8, 30–1. Available at: http://europepmc.org/abstract/med/9782957. Accessed February 9, 2016.

 

Need help with your health?

Norelle Hentschel is an experienced Naturopath with a clinic in Stones Corner, Brisbane who enjoys supporting her clients to reach their health goals.

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