What to Take After Surgery

There are lots of good reasons to try and follow a healthier diet–you lose weight, you feel good, but the main reason–to live a longer, happy, productive life.  Sounds good, right?   And though it may sound deceptively easy, the devil is in the details.   Welcome to the Nutrition Facts podcast.  I’m your host, Dr. Michael Greger. 

Medicine is messy. One of the reasons researchers experiment on animals is that they can create uniform, standardized injuries to test potential remedies. It’s not like you can just cut open 50 people and see if something works better than a sugar pill. Oh, but we can! People go into surgery all the time. Today, we take a close like at how to speed recovery after surgery.

The efficacy of turmeric curcumin in pain and postoperative fatigue after laparoscopic cholecystectomy—people getting their gallbladder removed: a double-blind, randomized placebo-controlled study. Fifty people were cut into, given curcumin, or an identical-looking placebo, along with rescue analgesics (actual pain killers) to take if the pain becomes unbearable. Even though it’s just laparoscopic surgery, people don’t realize what a toll it can take—you can be out of commission for a month. In India, turmeric, in curry powder, has traditionally been used as a remedy for traumatic pain and fatigue; so, let’s put it to the test.

In the weeks following surgery, a dramatic drop in pain and fatigue scores in the turmeric pigment group, the curcumin group. Those are my kind of p-values. It’s hard to come up with objective measures of pain and fatigue, but drug-wise, the curcumin group was still in so much pain, they were forced to take seven of the rescue painkillers. In the same time period, though, the control group had to take 39. Of course, better to not get gallstones in the first place, but their conclusion was like no other I’ve ever read in a drug trial. “Turmeric is a natural food ingredient, palatable, and harmless.” Okay, so far so good. “It proves to be beneficial as it may be an ecofriendly alternative to synthesized anti-inflammatory drugs which have a definite carbon footprint due to industrial production.” Since when do surgeons care about the greenhouse gas emissions from drug companies? I just had to look up this reference. And, there it is, The Journey of the Carbon-literate and Climate-conscious Endosurgeon. I don’t know what’s stranger, seeing the word holistic in a surgical journal or the name of this guy’s practice: Dr. Agarwal’s Surgery & Yoga.

Here is another interesting study on the use of curcumin to speed recovery. Dietary strategies, including the use of black pepper, can boost blood levels of curcumin from the spice turmeric by up to 2,000%. Here’s the research.

“Historians from [all] around the world have produced evidence to show that apparently all primitive peoples used herbs—often in a sophisticated way. Quinine from Cinchona bark was used to treat the symptoms of malaria long before the disease was identified and the raw ingredients of a common…aspirin tablet have been a popular painkiller for far longer than we have had access to tablet-making machinery. Indeed today many pharmacological classes of drugs include a natural product prototype…which [we] originally discovered through the study of traditional cures and folk knowledge of indigenous people.”

There’s a plant in South Asia called adhatoda. Adu means goat, and thoda means not touch— because it’s so bitter even the goats won’t eat it. But, it has compounds that help open one’s airways, and as such, adhatoda tea has been used traditionally to treat asthma—where the leaves are steeped with black peppercorns. That sounds kind of gross to me; I mean why would they do that? Because they’re smart. Back in 1928, scientists discovered what the people evidently already knew, which was that adding pepper “increased the antiasthmatic properties” of the leaves. Black pepper alone didn’t work; it was the combination. And now, we know why.

Just like approximately 5% of the spice turmeric is an active compound called curcumin, about 5% of black pepper by weight is this compound called piperine. Curcumin is responsible for the yellow color of turmeric, and piperine for the pungent flavor of pepper, and it’s a potent inhibitor of drug metabolism. One of the ways our liver gets rid of foreign substances is by making them water-soluble so they can be more easily excreted, but this black pepper molecule inhibits that process.

And, it doesn’t take much. If you give people a bunch of turmeric curcumin, within an hour, you can see a little bump in the level in their bloodstream. The reason we don’t see more is that our liver is actively trying to get rid of it. But, what if you suppress that process by taking just a quarter teaspoon’s worth of black pepper? Even just a little pinch of pepper—1/20th of a teaspoon—can significantly boost levels. And, guess what a common ingredient in curry powder is besides turmeric? Black pepper.

Another way to boost the absorption of curcumin is to consume it as the whole food, turmeric root (fresh or dried), and powdered as turmeric, because natural oils found in turmeric root and turmeric powder can enhance the bioavailability of curcumin seven- to eight-fold. When eaten with fat, curcumin can be directly absorbed into the bloodstream through the lymphatic system, thereby in part kind of bypassing the liver.

And, how is it prepared in India? With fat and black pepper. Amazing how they could figure that out without double-blind trials, though maybe it just tasted good, and was a coincidence? Their traditional knowledge certainly failed them with ghee, though, which is practically pure butterfat, which may explain their relatively high rates of heart disease, despite all their turmeric.

 In our next story, we look at what happen when type 2 diabetes is reversed after gastric bypass surgery.  And we ask the question, is it due to the actual operation or just the severely restrictive diet required for recovery?

Roux-en-Y gastric bypass surgery is one of the most successful treatment strategies for diabetes accompanying morbid obesity. Long-term diabetes remission rates of 83% have been reported. These findings have led to the suggestion that the surgery improves diabetes by somehow altering digestive hormones, but this interpretation ignores the fact that they are placed on a severely limited diet for a week or two after the operation just to recover from the major surgery. And just severe caloric restriction alone can improve diabetes. So, is it the diet or the surgery? We didn’t know… until this study. They put diabetics on the exact same post-surgery diet, with and without the actual surgery.

They found that their diabetes improved rapidly on the surgery diet before they had the surgery. In fact, the improvement in blood sugar control was better on the diet alone than after the surgery. Blood sugar control improved better in the absence of surgery, suggesting the whole surgical-diabetes-reversal is not due to the surgery at all, but just the diet people had to go on in the hospital during recovery. So, the clinical implication is that nonsurgical interventions have the potential to resolve diabetes just as much as major organ rearranging surgery.

If you remember my video about Diabetes as a Disease of Fat Toxicity, you’ll understand what is occurring. Type II diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intra-organ fat. Too much fat in the cells of the liver, pancreas, and muscles. Within seven days of eating like 600 calories a day by either dietary intervention or bariatric surgery, fasting glucose levels can normalize, blood sugars can normalize, thanks to a fall in liver fat and when the cause of diabetes goes away, the diabetes goes away.

The insulin-producing beta-cells of the pancreas have woken up! Clearly, the beta cells are not permanently damaged in type 2 diabetes, but are merely inhibited. They report reversal of diabetes up to 28 years after diagnosis.

So, diabetics motivated enough to starve themselves can regain normal health. This information should be available to all people with type 2 diabetes, even though it is unlikely many will be motivated enough to escape from the disease. It’s not easy to not eat. Diabetics should know that if they don’t reverse their diabetes, their future health is in jeopardy, although the serious consequences must be balanced against the difficulties and privations associated with starvation diets. For many people, this may prove too high a price to pay. It’s hard to voluntarily restrict food intake that much. Okay, how about involuntary food restriction? That’s what stomach stapling surgery is. When you essentially remove someone’s stomach, they’re forced into compulsory food restriction.

Of course, major surgery carries major risks, both during the operation and afterwards. There can be bleeding, leakage, infections, erosions, herniation, and severe nutritional deficiencies. Surgery or starvation? There’s got to be a better way. 

To see any graphs, charts, graphics, images or studies mentioned here, please go to the Nutrition Facts podcast landing page.  There, you’ll find all the detailed information you need, plus links to all the sources we cite for each of these topics.

Be sure to check out my new How Not to Die Cookbook. It’s beautifully designed, with more than 120 recipes for delicious, plant-based meals, snacks, and beverages. All the proceeds from the sales of all my books all go to charity.  I just want you to be healthier. 

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Thanks for listening to Nutrition Facts.  I’m Dr. Michael Greger.

This is just an approximation of the audio content, contributed by Allyson Burnett.