Tuesday, May 03, 2005

Prepping the System

"Surgery is one of the biggest stresses the body can endure." The mental stress that goes hand in hand with surgery is a given. The stress that panelist Allan Spreen, M.D., refers to in the above quote concerns the demands that surgery puts on the immune system. In the alert "Answering the Call" Dr. Spreen shared his insights on five immunonutrients that have been shown to improve immune system function after surgery. But if you regularly take a host of dietary supplements, there are some important adjustments you'll need to make prior to any surgical procedure that requires anesthesia. As Dr. Spreen told us in a previous alert , high levels of vitamin C can complicate the anesthesia process. Here's how Dr. Spreen explains the interaction: "The specifics of vitamin C apply to the mega-vitamin takers. Very high doses of C over time cause the body to 'awaken' dormant enzyme systems that more fully utilize high doses of the nutrient. If you take low doses, the body shuts these pathways down for your benefit. If it didn't it would too rapidly empty the body's 'C pipeline' and you'd be constantly deficient. "For those people I tell them to TAPER the C over time, reaching nearly zero just before surgery (not weeks before). This is because such high doses are good enough detoxifiers that more anesthetic drugs may be necessary for the anesthesiologist to keep you under. BUT, the absolute INSTANT you tolerate oral intake, you jack the C back up to heroic levels." In one of the commentaries I found on the immunonutrients report that appeared in the British Medical Journal, osteopathic physician Dr. Joseph Mercola stated his opinion that herbal supplements should be discontinued prior to surgery, noting that some of these supplements are powerful enough to function like drugs. I asked Dr. Spreen about the herbal issue, and he agreed with Dr. Mercola...to a point. "Yes, herbs are like drugs. The simple reason is that no drug companies design their drugs using mere brilliance. Pharmaceutical developers get their ideas from herbal effects, then try to alter the molecule enough to patent the thing (and cause all sorts of toxic side effects), hoping it'll still do what the herb did, without killing you first. "The developers are good, however, at picking good herbs. Proscar is an excellent example. It is a derivative of the herb Serenoa repens (saw palmetto), which does work against benign enlargement of the prostate (better than Proscar), and with no side effects. Of course, the drug company will admit neither detail. "As to when, and whether, to quit an herb, the situation is much the same as with prescription drugs. You should seek advice from someone educated in the agent's effects to know whether to stop it and when (or whether to increase it and how much!). I'd certainly never stop my saw palmetto weeks before surgery (or the day before, or ever)." Returning to the subject of non-herbal supplements, Dr. Spreen had this final note: "Surgery is a major stress, and for that you want the maximum dose of nutrients for the body to choose from for the repair function. Vitamin C, and probably NAC should be discontinued (my sister-in-law required half-again as much medication to put her under as she was pumping the vitamin C heavily as 'insurance'...the anesthesiologist even commented on it). "However, the instant I could hold something down I'd be right back at them (and tons of other supplements) full force - C, A, E, B-complex, NAC, alpha lipoic acid, milk thistle extract, zinc, essential fatty acids, and others." In addition to dietary supplements, any over-the-counter medications need to be scrutinized before surgery as well - especially aspirin. Most patients are advised that aspirin therapy for heart health should be discontinued well before surgery to minimize bleeding. And even though it might be a good idea to stop aspirin therapy altogether (see the alert "Wonder Goes Under"), evidence shows that coronary bypass surgery patients may want to talk with their doctors about aspirin use after surgery. In a 2002 New England Journal of Medicine study that examined more than 5,000 coronary bypass patients, the use of aspirin immediately after surgery was associated with a 48 percent reduction in ischemic complications and a 50 percent reduction in the incidence of stroke. The current rule of thumb is to avoid aspirin for the first 24 hours after bypass surgery because aspirin increases the risk of bleeding. However, in an editorial accompanying the study, Dr. Eric J. Topol of the Cleveland Clinic Foundation called the findings "powerful." Based on the study, Dr. Topol believes aspirin should be given within the first six hours after surgery.


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