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Nutrition before surgery Dr Leow

Nutrition before surgery Dr Leow

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Published by Dr Leow
If you need to learn more, you may always visit my blog at http://drgeorgeleow.blogspot.com/
If you need to learn more, you may always visit my blog at http://drgeorgeleow.blogspot.com/

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Published by: Dr Leow on May 06, 2009
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02/01/2013

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or more than 40 years, we have known thatmalnutrition greatly increases surgicalmortality – with malnourished patients being tentimes more likely to die soon ater surgery.Unortunately, most o us are deluded into thinkingour bodies look alright and that a malnourishedperson would look more like an Ethiopian reugee.But the true act is that you can be malnourishedand obese at the same time. Taking a cue rom the word “undernourished”, a newterm has been coined to describe this syndrome –“under-nutritioned”. It is an important term thathas begun to gain medical attention because it hasbeen shown that people with even a single vitamindefciency can have a poorly unctioning immunesystem. Looks, indeed, can be deceiving.
Nutrition’s impact on surgery
By Dr George Leow Chee Seng
Despite knowing that even a single vitamin deciency can affect the immune
system compromised by surgery, a recent study has found that many patientsare still facing unnecessarily higher risks – because of their poor diets.
F
 To illustrate the previously unrecognised prevalenceo this condition, it would be good to draw on theconclusions o a most enlightening study donesome years ago. The study included a careul survey o surgicalpatients admitted to the hospital and ound that44% o the patients had general malnutritionon admission. This means that the patients wereunder-nutritioned long beore needing surgeryand coming to the hospital.Even worse, 75% o the patients admitted toan intensive care unit were ound to be under-nutritioned. This put the patients in even greaterdanger because their bodies and immune systemswere placed under much greater stress. The sad irony is that such stress is a tremendousdrain on nutrition at a time when the patient’snutritional status needs to be better – to improvethe odds or survival and post-surgical recovery.I such a prognosis wasn’t already bad enough,the study also uncovered another even moreshocking fnding – that 69% o the patients actuallyexperienced a deterioration in their nutritionalstatus while in the hospital; thus pointing to arather sad indictment o hospital nutrition.
Deciency efects
Another study involving a number o hospitalsound that 38% o patients had obvious vitamindefciencies and even a larger percentage wasmarginally defcient. These statistics were worrying because patients
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with marginal nutritional defciencies are at asignifcantly higher risk o complications, especiallyin terms o poor wound healing and sueringpotentially higher rates o inections.Most bleeding tendencies ollowing surgery areminimal two days ater the operation. This meansyou can saely resume taking your nutritionalsupplements. The only contraindication would be i you werereceiving blood-thinning medications. In thatcase, I would avoid using vitamin E in doses over200 international units (IUs), even though blood-thinning eects are rare below 1,000 IUs.Several supplements can thin the blood (and aectcoagulation) and they include ginkgo, garlic extract, quercetin, curcumin, and high-dose vitaminE (greater than 1,000 IUs). But this concern is moreapparent than real as, in general, the blood-thinningeect o these supplements is no more than that o taking one aspirin tablet a day.
Magnesium factor
Maintaining adequate magnesium levels isespecially important in preventing surgical andpost-surgical complications. Magnesium is one o those nutrients that seem to have an unlimited listo benefts.In addition to playing a role in more than 300
enzymes,itregulatesbloodfow,protectsbrain
cells, protects the heart muscle, reduces the risk o cardiac arrhythmia, improves lung unction,improves kidney unction, and prevents one o themost rightening complications o major surgery –blood clots.I have used magnesium in my neurosurgicalpatients or more than 15 years and I have neverhad a patient develop post-operative blood clotsin the legs or lungs. In most cases, the blood clotorms in the veins o the legs or pelvis – where it cansuddenly enter the bloodstream, producing a atalclot in the lungs called a pulmonary embolism.Sudden cardiac arrest can be another catastrophicevent during surgery, leaving the patient witha stroke or myocardial inarction (heart attack).Magnesium signifcantly protects against thesecomplications as well.Several studies have shown that magnesiuminusions can reduce the severity o a stroke orheart attack by 50%. What is important is that yourtissue magnesium level be normal beore surgery.An ounce o prevention is truly worth more than apound o cure.People who take diuretics or birth control pills, orwhose diet is low in ruits and vegetables, are at avery high risk o magnesium depletion. Teenagersoten drink large amounts o carbonated sot drinksthroughout the day. These drinks signifcantlylower the tissue magnesium levels. All o theseindividuals thereore have a higher risk o surgicalcomplications.Magnesium is also essential or normal immuneunction. The bottom line is that the better yournutrition is beore surgery, the less likely it is that youwill have a major complication and the aster, andmore completely, you will recover rom surgery.
Detection fallacies
Overtheyears,Ihavenoticedthatpatientswho
take these supplements regularly have signifcantlyless pain and atigue ater surgery as well. Post-
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operative atigue has always been a problem orpatients and one or which surgeons usually havelittle to oer.We are becoming increasingly aware o the act thateven nutrient defciencies too small to be recognisedby clinical examination can impair the body’sunctioning. We call these defciencies subclinical.A large number o people living in industrialisedcountries suer rom these subclinical defciencies,and the number is continuing to grow.When doctors want to know i you have adequateamounts o a certain vitamin in your body, theyusually draw your blood and have it tested or thevitamin in question. When they want to assessthe adequacy o your nutrition in general, theyrequently have your blood tested or your olateand vitamin B12 levels.
Newerstudies,however,haveshownthismethodto
be very inaccurate. In one study, doctors comparedthe usual blood levels o the vitamins olate, B6, andB12 to the actual levels in the tissues as measuredbiochemically. What they discovered was quiteshocking.When they measured the conventional vitaminlevels in a group o healthy elderly, they oundthat approximately 19% o the study subjects haddefciencies. Yet, when they used the more accuratebiochemical method, they ound that 63% o thesesame individuals were signifcantly defcient in oneor more o these critical vitamins.A similar comparison o sick elderly subjectsound that 60% were defcient using conventionalmeasurement and a whopping 83% were defcientwhen the biochemical method was used. This study clearly demonstrates that measuringvitamin blood levels by the conventional methodcan result in a alse assurance that all is well –when in act, severe defciencies may exist. This isespecially true or the chronically ill.
Immunitysuppression
It is well known that surgery and especiallyanaesthesia are powerul suppressors o thebody’s immunity unction. This is especially so orsurgeries lasting longer than two hours and in caseswhere more than a unit o blood is lost during theprocedure.
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