THE IMPORTANCE OF NUTRITION BEFORE SURGERY AMONG CANCER PATIENTS

Most cancer patients have as their primary treatment the surgical removal of the tumor. Sometimes this can be a relatively minor procedure, as with a skin cancer, but more often it is complicated, entailing the surgical removal of the cancer and any surrounding lymph nodes. The more complicated and prolonged surgeries can be extremely stressful, both physically and psychologically.

For more than forty years, we have known that malnutrition greatly increases surgical mortality, with malnourished patients being ten times more likely to die soon after surgery.
Most of us think of a malnourished person as looking like someone from Ethiopia. In fact, you can be malnourished and obese at the same time. The new term is undernutritous. It has been shown that people with even a single vitamin deficiency can have a poorly functioning immune system. Looks, indeed, can be deceiving.

A most enlightening study was done some years ago. The study included a careful survey of surgical patients admitted to the hospital and found that 44 percent of the patients had general malnutrition on admission. This means that the patients were malnutritous long before coming to the hospital. Even worse, 75 percent of the patients admitted to an intensive care unit were malnutritous. This put them at an even greater danger because they were under much greater stress. Stress is a tremendous drain on nutrition, and survival depends on nutritional status. Yet even more shocking was the finding that 69 percent of the patients underwent a deterioration in nutritional status while in the hospital, which is an indictment of hospital nutrition.

Another study involving a number of hospitals found that 38 percent of patients had obvious vitamin deficiencies and even a larger percentage were marginally deficient. Patients with mar ginal deficiencies are at a significantly higher risk of complications, especially of poor wound healing and infections.

For cancer patients, not only is wound healing and avoiding all the complications associated with surgery important, but so is making sure the immune system is functioning at peak activity. The status of a person's nutrition is critical to the immune system. Again, I emphasize that even a single nutrient deficiency can severely impair the immune system. For example, a vitamin B6 deficiency alone can lower immunity, even when the levels of all the other vitamins are perfectly normal.

Most bleeding tendencies following surgery are minimal two days after the operation. This means you can safely resume taking your nutritional supplements. The only contraindication would be if you were receiving blood-thinning medications. In that case, I would avoid using vitamin E in doses over 200 in ternational units, even though blood-thinning effects are rare below 1,000 international units. Several supplements can thin the blood (affect coagulation). They include ginkgo, garlic ex tract, quercetin, curcumin, and high-dose vitamin E (greater than 1,000 international units). In general, the blood-thinning effect of these supplements is no more than that of taking one aspirin a day.

Maintaining adequate magnesium levels is especially important in preventing surgical and postsurgical complications. Magnesium is one of those nutrients that seem to have an un limited list of benefits. In addition to playing a role in more than 300 enzymes, it regulates blood flow, protects brain cells, protects the heart muscle, reduces the risk of cardiac arrhythmia, improves lung function, improves kidney function, and prevents one of the most frightening complications of major surgery: blood clots.

I have used magnesium in my neurosurgical patients for more than fifteen years and have never had a patient develop postoperative blood clots in the legs or lungs. In most cases, the blood clot forms in the veins of the legs or pelvis, where it can suddenly enter the bloodstream, producing a fatal clot in the lungs called a pulmonary embolism.

Sudden cardiac arrest can be another catastrophic event during surgery, leaving the patient with a stroke or myocardial in farction (heart attack). Magnesium significantly protects against these complications as well. Several studies have shown that magnesium infusions can reduce the severity of a stroke or heart attack by 50 percent. What is important is that your tissue magnesium level be normal before surgery. An ounce of prevention is truly worth more than a pound of cure.
People who take diuretics or birth control pills, or whose diet is low in fruits and vegetables, are at a very high risk of magnesium depletion. Teenagers often drink large amounts of carbonated soft drinks throughout the day. These drinks significantly lower the tissue magnesium levels. All of these individuals have a higher risk of surgical complications. Magnesium is also essential for normal immune function.

The bottom line is that the better your nutrition is before surgery, the less likely it is that you will have a major complication and the faster, and more completely, you will recover from surgery. Over the years, I have noticed that patients who take these supplements regularly have significantly less pain and fatigue after surgery as well. Postoperative fatigue has always been a problem for patients and one for which surgeons usually have little to offer.


We are becoming increasingly aware of the fact that even nutrient deficiencies too small to be recognized by clinical examination can impair the body's functioning. We call these deficiencies subclinical. A large number of people living in industrialized countries suffer from these subclinical deficiencies, and the number is continuing to grow.

VITAMIN BLOOD LEVELS VERSUS REAL DEFICIENCIES

When doctors want to know if you have adequate amounts of a certain vitamin in your body, they usually draw your blood and have it tested for the vitamin in question. When they want to assess the adequacy of your nutrition in general, they frequently have your blood tested for your folate and vitamin B12 levels. Newer studies, however, have shown this method to be very in accurate. In one study, doctors compared the usual blood levels of the vitamins folate, B6, and B12 to the actual levels in the tissues as measured biochemically. What they discovered was quite shocking.
When they measured the conventional vitamin levels in a group of healthy elderly, they found that approximately 19 per cent of the study subjects had deficiencies. Yet, when they used the more accurate biochemical method, they found that 63 per cent of these same individuals were significantly deficient in one or more of these critical vitamins. A similar comparison of sick elderly subjects found that 60 percent were deficient using conventional measurement and a whopping 83 percent were deficient when the biochemical method was used.

This study clearly demonstrates that measuring vitamin blood levels by the conventional method can result in a false assurance that all is well, when in fact severe deficiencies may exist. This is especially true for the chronically ill.

It is well known that surgery and especially anesthesia are powerful suppressors of immune function. This is especially so for surgeries lasting longer than two hours and in cases where more than a unit of blood is lost during the procedure. This immune suppression can last for several weeks and can be made even worse if the patient has to receive blood during or after the surgery. Immune suppression caused by blood transfusion, especially multiple transfusions, can equal that caused by acquired immune deficiency syndrome (AIDS).

This profound level of immune suppression can give cancer a chance to invade and spread. A combination of poor nutrition, the trauma of surgery, blood transfusion, and anesthesia can temporarily wipe out the immune system. It also puts you at a much higher risk of postoperative wound infection and pneumonia.

It has been shown that this immune suppression caused by surgery, anesthesia, and blood transfusion can be reversed or even prevented by proper nutrition. It will, of course, require special immune stimulants, but it can easily be done.

Of special concern are patients who undergo preoperative chemotherapy-that is, who receive a dose of chemotherapy be fore surgery. It is well recognized that most chemotherapy drugs cause significant immune suppression and interfere with wound healing, thereby significantly increasing the risk of infections after surgery.

Several studies have shown that nutritional immune enhancement can significantly reduce complications, especially infections, following major surgeries. In one study, almost 70 percent of immune-deficient cancer patients undergoing surgery developed postoperative complications as compared to 25 per cent with functioning immune systems. This is a dramatic difference. It should be appreciated that the patients in the group with a functioning immune system did not have specific nutritional immune stimulation. My experience, as well as that of others, is that immunity not only can be restored in patients, but can also be maximized with special supplements.