Gastrointestinal

Post-Op Recovery Supplements Provide New Options For Patients

post-op recovery supplements

In the context of modern medicine, surgery is ubiquitous. Malaises ranging from congenital defects to acute injury are routinely treated with surgical procedures. Unfortunately, even the least invasive surgeries can be hard on the body. Surgeries with local anesthesia still leave behind wounds that take time to heal. For more serious surgeries, patients are heavily medicated with sedative and analgesic drugs and experience substantial tissue damage caused by surgical tools. Without any complications, major surgery still causes blood loss, trauma, and a prolonged period of chemical washout once the procedure ends.

For patients, waiting while doctors operate or being unconscious in the operating room is the easiest part of surgery. A new set of challenges arise as soon as the patient begins their postoperative recovery, particularly as patients struggle with the therapeutic coverage and side effects of their postoperative medications. But they don’t have to. For many patients, these struggles can be eased by post-op recovery supplements with the right compounds, starting with those which help them to deal with inflammation.

Supplements Can Control Post-Op Inflammation

Inflammation commonly crops up in the postoperative environment with symptoms like painful swelling, redness, and heat at the site of wounds. Recently, researchers have started to consider inflammation as a systemic phenomenon that causes wide-ranging problems. Even when far from any surgical sites, inflammation hampers the operation of the brain, and, when paired with the toll that anesthesia takes on the brain, may be temporarily debilitating. For example, patients often experience a variety of mood issues like minor depression after surgery, which may in part be caused by excess inflammation. Thus, inflammation is a major factor influencing the rate at which patients recover from surgery and countless therapies aim to reduce inflammation as a result. Nonetheless, inflammation remains one of the most challenging aspects of human illnesses because of its systemic effects, which may be particularly dangerous following surgery.

Many surgeons recommend commercially available non-steroidal anti-inflammatories (NSAIDs) for use after discharge; others prescribe extra strength NSAIDs or corticosteroid anti-inflammatory medications. While these medications are effective at reducing inflammation to safe levels, patients who are still uncomfortable may end up taking more than is safe, potentially compromising their health. NSAIDs are known to cause ulcers when used in excess, and in severe cases may even degrade the integrity of the colon. Additionally, even when taken in therapeutic quantities, NSAIDs may slow wound healing and thin the blood, which makes them an imperfect solution at a time when healing is paramount. Therefore, while anti-inflammatory medications are ubiquitous among postoperative therapies, many patients are still searching for adjunct treatments that don’t cause uncomfortable or counterproductive side effects.

Aside from anti-inflammatory drugs suggested by doctors, patients also commonly turn to ice packs to calm inflammation and provide pain relief. Application of ice shrinks blood vessels, which prevents the swelling caused by plasma which flushes into the site of the wound. When used for too long, however, ice packs can cause damage of their own or inhibit wound healing. Furthermore, the packs can’t be kept on the patient 24/7; there’s a large amount of therapeutic “downtime” during which patients aren’t able to use the therapy. As such, ice packs are often insufficient to relieve patients from discomfort.

Due to the shortcomings of standard inflammation control, both patients and practitioners are increasingly looking toward alternative anti-inflammatories, including:

Butyrate

Today, a growing body of evidence suggests that postoperative inflammation can be treated by a natural compound which may be more effective than the standard regimen of anti-inflammatories. That compound is butyrate, also known as butyric acid, a physiological chemical produced by the cells of the large intestine. In the large intestine, butyrate is responsible for regulating cellular behavior, suppressing inflammation, and helping immune cells manage the gut microbiome. Critically, butyric acid has been identified in a research review as helping to prevent the translocation of bacteria from the intestines to the bloodstream, which can cause systemic inflammation and infections.

In the review, researchers specifically noted that daily supplementation with a small quantity of butyric acid increased the proliferation of cells responsible for controlling inflammation in the gastrointestinal tract by 60%. This means that more of those cells were present in the GI tract, reducing the overall level of inflammation. When recovering from surgery, these additional cells could help the gastrointestinal tract return to its normal function much faster than it otherwise would. The researchers went on to estimate that this impact on proliferation could help as many as 66% of elderly people with gastrointestinal issues would benefit from butyrate supplementation.

The applications of butyrate in the postoperative environment are likely beneficial to patients struggling with inflammation, and large clinical trials demonstrating its impact are forthcoming. Prior investigations into the tolerability of butyrate are promising, with few studies reporting any adverse effects among participants. Excitingly, butyrate is, in principle, compatible with many other anti-inflammatory postoperative supplements. Supplements like fish oil are natural companions to butyrate when it comes to postoperative inflammation.

Fish Oil

Fish oil is widely recognized as having proven applications in postoperative inflammation. A 2012 study examining the impact of fish oil administration on postoperative outcomes found that patients who received fish oil experienced 33.3% reduced liver dysfunction caused by inflammation and 27.8% fewer infections. Furthermore, the patients who were supplemented with fish oil exhibited lower levels of a wide swath of proinflammatory molecules. These effects are due to the presence of compounds called eicosanoids which behave as cellular signaling molecules. While the study wasn’t blinded or controlled, the data are unambiguous: fish oil is effective in reducing inflammation after surgery.

In normal therapeutic quantities, fish oil carries no side effects. However, when taken in excess, the vitamin A present in fish oil may cause vitamin A toxicity. This toxicity causes brittle bones and liver malfunction but is very rarely a result of fish oil consumption. As such, fish oil is considered to be a safe and well-tolerated supplement with broad appeal. But it has newer challengers, including tetrahydrocurcumin, a particularly promising solution to postoperative inflammation.

Tetrahydrocurcumin

Tetrahydrocurcumin is a member of the curcuminoid class of compounds which are derived from the turmeric root. Curcuminoids have a history of medicinal use going back thousands of years, and modern research has found them to be a compelling avenue of investigation owing to their anti-inflammatory properties.

The anti-inflammatory capabilities of the curcuminoids are especially pronounced in the case of tetrahydrocurcumin because it is a more efficient suppressor of proinflammatory genes than other curcuminoid types. One study found that in vitro a mix of curcuminoid compounds containing predominantly tetrahydrocurcumin suppressed the activity of a gene coding for a critical inflammatory molecule by 85%. The gene, NF-kB, is one of the core molecules the body uses to signal cells to initiate inflammation. Importantly, in 2018, an in vivo study by a different group of researchers found that tetrahydrocurcumin administration reduced the production of NF-kB molecules by as much as 90% depending on the dosage of tetrahydrocurcumin. Furthermore, that study also found that tetrahydrocurcumin administration sharply reduced the production of another proinflammatory molecule known as COX2. Between the two anti-inflammatory actions of tetrahydrocurcumin, there is a significant potential for reducing patient discomfort.

Inhibiting the gene by 85% does not directly correlate to 85% lower inflammation in vivo, but it does suggest that administering tetrahydrocurcumin could reduce the ability of the body to cause future inflammation. The same goes for reductions in the production of the NF-kB molecule itself. Reducing the ability to cause inflammation would be very useful for postoperative patients seeking an additional boost to their anti-inflammatory regimen, potentially addressing an array of postoperative challenges.

Post-Op Recovery Supplements for Gastrointestinal Distress

Of course, controlling inflammation is far from the only postoperative concern. Many of the medications administered during surgery conducted under general anesthesia have an array of side effects ranging from depression to constipation. These medications may include antibiotics, analgesics, sedatives, anxiolytics, and muscle relaxants.

Of these drugs, all but anxiolytics have the potential to negatively impact the gastrointestinal system in the short term by slowing it down or stopping its activity altogether. Doctors compensate for the impact of these drugs by limiting patients to certain kinds of foods before and after surgery, but by the time patients are discharged, there are still traces of the drugs impacting their systems. When paired with postoperative pain management, gastrointestinal issues are some of the hardest to solve and are highly unpleasant to patients.

Unfortunately, gastrointestinal tract issues often persist well after the patient leaves the hospital; constipation is all but assured from the surgical medicine regimen and the tools which patients receive to control their pain while at home can make the problem even worse. In particular, nearly all but the most minor surgical procedures involve operative and postoperative administration of opioid painkillers. Opioids are notorious for reducing intestinal motility, diminishing intestinal energy usage, and subsequently inhibiting normal bowel movements. To make matters worse, typical nutritional aids which help patients with bowel movements may not be accessible while recovering from surgery. Coffee or green tea, for example, may be forbidden after surgery due to their stimulating properties. Likewise, fiber-rich foods like lentils may be restricted until the patient’s gastrointestinal tract has recovered. This is where butyrate can once again play a significant role.

Today, a growing number of patients are using butyrate as a powerful tool in the face of postoperative constipation owing to its ability to reduce inflammation and promote a healthy gut microbiome. According to a group of Polish researchers, butyrate is an effective remedy for constipation. In their study, the researchers administered small quantities of butyrate to patients with constipation over a 12-week period. After 4 weeks, stools in the patients who received butyrate were twice as consistently textured than the patients who didn’t, and patients treated with butyrate reported 69% less discomfort. Furthermore, the patients who received butyrate supplementation experienced constipation half as frequently and reported a 42.1% reduction in pain during bowel movements compared to the patients who didn’t. These effects were durable for the remainder of the 12-week period and beyond. Importantly, the results corroborate the group’s prior research.

The group’s prior clinical review also suggests a broader role for butyrate in treating a wide variety of other gastrointestinal diseases. In the context of postoperative care, patients may be inclined to take a butyrate supplement to address more than one of their health challenges. Because butyrate reduces constipation as well as inflammation, it’s uniquely disposed to help patients recover after surgery.

New Horizons of Recovery

With tetrahydrocurcumin and butyrate post-op recovery supplements, patients have access to better anti-inflammatory and laxative resources than ever before. While robust clinical trials supporting the use of these compounds in the postoperative niche is still forthcoming, an abundance of evidence suggests that the buzz generated by their impressive in vitro results will carry over to patients. Researchers have already found enough confidence in these two compounds to formulate specialized delivery systems to help patients take advantage of them to the fullest extent possible. Thanks to these compounds, patients can deal with the side effects of surgery and postoperative medications without resorting to excessive pharmaceutical interventions.

Foundational Medicine Review offers brings you the latest in gastrointestinal and neurological health research, including key findings on popular and emerging supplements. Join our mailing list to get insight and analysis delivered straight to your inbox.

Works Cited

Banasiewicz, T., Borycka-Kiciak, K., Dobrowolska-Zachwieja, A., Friediger, J., Kiciak, A, et al. (2010). Clinical aspects of sodium butyrate application in dietary treatment of bowel diseases. Gastroenterology Review, 6, 329-334.  https://www.termedia.pl/,41,15728,0,1.html

Han, Y., Lai, S., Ko, W., Chou, C., Lai, H, et al. (2012, January 06). Effects of fish oil on inflammatory modulation in surgical intensive care unit patients. Nutrition in Clinical Practice,27(1), 91-98.  https://onlinelibrary.wiley.com/doi/abs/10.1177/0884533611429796

Hyllested, M., Jones, S., Pedersen, J., & Kehlet, H. (2002). Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. British Journal of Anaesthesia, 88(2), 199-214.  https://bjanaesthesia.org/article/S0007-0912(17)36531-5/abstract

Pituch, A., Walkowiak, J., & Banaszkiewicz, A. (2013). Butyric acid in functional constipation. Gastroenterology Review, 5, 295-298.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027827/#CIT0014

Sandur, S. K., Pandey, M. K., Sung, B., Ahn, K. S., Murakami, A, et al. (2007). Curcumin, demethoxycurcumin, bisdemethoxycurcumin, tetrahydrocurcumin and turmerones differentially regulate anti-inflammatory and anti-proliferative responses through a ROS-independent mechanism. Carcinogenesis, 28(8), 1765-1773.  https://academic.oup.com/carcin/article/28/8/1765/2526767

Trads, M., Deutch, S. R., & Pedersen, P. U. (2017). Supporting patients in reducing postoperative constipation: Fundamental nursing care – a quasi-experimental study. Scandinavian Journal of Caring Sciences.  https://onlinelibrary.wiley.com/doi/full/10.1111/scs.12513

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