Starve before surgery???

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We’ve found that feeding the brain is critical to treating traumatic brain injury.  (Reported here.)  But, the opposite- cutting out foods- is the right preparation for some surgery.

Using mice, Drs. Peng, Robertson, Gallinetti, Mejia, Vose, Charlip, Chu, and Mitchell at the Harvard School of Public Health  (reported in Science Translational Medicine)  found that deleting protein from the diet for about a week prior to surgery served to protect the kidneys and livers.  This is critical for those longer operations, the complicated ones.  This protein depletion is similar to the actual conditions in the body post-heart attack or stroke- the blood flow is diverted from these organs after these events.  (That observation is from where this hypothesis derived.)  The provision of sugar and fat in the diet but no proteins greatly reduces the chances of inflammation.

Eight mice were allowed to eat as much as they wanted for six days.  Except the food was total protein-free.  The other animals had a normal diet.  On the seventh day (no rest, here), the artery and vein serving the kidney were clamped shut for 35 minutes.  This severance of blood flow and oxygen led to kidney failure in 60% of the mice on the normal diet- within a week of the procedure. Every protein-starved mice survived.

The researchers also tried the removal of  a single essential amino acid (there are eight of them); tryptophan.  This had a protective effect, as well.  Furthermore, the researchers provided halofuginone to the mice; this drug mimics proline deficiency (another essential amino acid, one critical during stress or illness).  Three days of the administration of this drug provided a protective effect, as well.

Up to now, folks have been told to not eat on the day of surgery.  However, that is not related to this phenomenon- but, instead, to insure that they have empty stomachs, precluding the chance of vomiting during the procedure.

This concept still needs to be tested in humans.  After all, this research was performed with healthy mice; we perform surgery on the ill and the infirm.    That is exactly what is in the plans at Peter Bent Brigham Hospital (one of the Harvard-affiliated hospitals).

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12 thoughts on “Starve before surgery???”

  1. Interesting progress and would be great to know if it works on humans. Surgery is such a traumatic event that any way to make it more protective would be more than helpful. Thanks Roy! ~ Suerae

    1. You know it. It’s hard to believe that before the invention of Colyte (the colon lavage system with which I was involved), how prone bowel surgery was towards severe complications. (An enema never fully cleanses the region.) That was a simple change- that led to a remarkable change in outcomes. One can only hope this does likewise, Suerae.

  2. Okay so the challenge is how to control patient’s diets before surgery. Never mind the test to see if it would work, how do you control people who are stressed?
    Roberta recently posted..It hurts……

    1. It’s easier than you think. First of all, you could provide them food- which is the “paternalistic fashion”. Secondly, you could provide them suggested diets or lists of foods they can’t eat.
      This works, albeit on a shorter time period, for people undergoing blood tests and the like. And, when folks know, it’s only a week (or six days) and it means their recovery from their impending surgery is upgrading significantly, they will comply.

  3. One of my rabbit is really active, she runs so fast and always struggle when people pick her up. I was told that it is a ‘she’, but according to her hehaviour, do u think that it could be a ‘he’ ?

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