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Surgery and Nutrition

Your illness does not define you. Your strength and courage does.

Nutrition is an important aspect of cancer treatment at all levels. Eating well, during and after surgery, allows the body to cope better and stay stronger throughout further course of treatment. Good nourishment reduces recovery times. At times, if the patient is underweight, she is put on a diet with more caloric and protein content prior to the surgery, in particular for stomach, mouth and throat cancers.

Post-Surgery Diet and Recovery

Once the surgical part of the treatment is completed, the patient gets a little respite from further treatments till the stitches are removed and the wound has healed. During this period, the food requirements of the patient are adequate proteins, vitamins and minerals to enhance healing, to replenish the blood lost during surgery, and to rebuild the immunity and provide the building blocks for tissue repair. In other words, first healing, and then preparing the body for the further onslaught of chemotherapy and/or radiation therapy.

The additional food requirements to hasten repair and healing after surgery focus on increased intake of proteins for repair; vitamin C and other vitamins for wound healing; iron, B12 and folic acid for blood replenishment; carbohydrates and fats for the body's normal energy requirement; and foods for proper functioning of the immune system.

Proteins

Surgery places a considerable burden on the body and an increased demand for certain foods. Proteins provide amino acids--the building blocks for tissue repair and for keeping the immune system healthy. After surgery, other treatment modalities like chemotherapy and radiation therapy also require extra protein intake. These can be derived from fish. egg whites, chicken, lean meat, low fat dairy products, legumes like beans and peas and lentils, and protein supplements, Animal sources of protein are rich in vitamin B12, an essential ingredient for the formation of red blood cells.

Vitamin C

Perhaps the most important nutrients post-surgery are vitamins and minerals. Vitamin C or ascorbic acid is a water soluble vitamin found in a variety of vegetables and fruits. It is a potent antioxidant that protects against free radical injury to the cells. Surgical wounds heal by scar formation. Scar tissue is rich in collagen, which over time matures into fibrous tissue. Vitamin C has a distinct role in collagen synthesis and in the strengthening of the freshly-laid-down fibrous tissue. Deficiency of Vitamin C is associated with delay in wound healing, rupture of the wound and late recovery.

Good sources of Vitamin C are amla, guava, green leafy vegetables, broccoli, tomatoes, sweet potatoes, berries, citrus fruit, mangoes, red bell peppers, fortified cereal, and the freshly blended fruit juice of any of the above fruits. The daily requirement for this vitamin goes up from 90 mg for men and 75 mg for women to 500mg or more after surgery. Vitamin C also protects against heart disease by decreasing bad cholesterol, aiding absorption of iron, and supporting the health of the immune system.

Juicing and Blending

The basic principle of juicing or blending is drinking what you cannot eat and giving a headstart to your day with a  natural burst of vitamins and minerals. Unlike juice from freshly-pressed fruits and vegetables, packaged juices bought over the counter have exorbitant amounts of sugar and no fibre. Blending is even better than juicing-it pulverizes the fruit or vegetable at high speed so that it retains all the fibre content of the original fruit or vegetable. However, it is important to remember that absorption is quicker after juicing (because of lower fibre content) when compared to a blended drink.

Juice Recipes

For each of the following, blend the ingredients and add 6090 ml of water, if necessary.

Vegetable Juice (Green Juice)
  • 2 carrots
  • 10-15 roughly chopped spinach leaves
  • 2-3 celery stalks/2-3 amla
  • 1 cucumber
  • Juice of half lime
  • 1/4 teaspoon olive oil
  • 1/4 cm ginger
Fruit Juice
  • 2 carrots/12 cucumber/1 small beetroot
  • 2 oranges
  • 1 apple
  • 1/4 cm ginger
Other Vitamins

Other vitamins that play an important role are:

  • Vitamin A: Found in oranges, green vegetables and carrots, it promotes wound healing.
  • Vitamin D: Found in milk, fish, eggs and sunlight, it is a mood elevator and essential for bone repair.
  • Vitamin E: Found in vegetable oils, nuts, liver, mill and eggs, it protects the body from free radical injury.
  • Vitamin K: Found in green leafy vegetables, fish liver, and oils, it is necessary for blood clotting
 Iron- and Folic Acid-Rich Food

Surgery is invariably accompanied by some blood lose which varies with the type of procedure. Haemoglobin is the protein in the red blood cells that carries oxygen to the tissues. The oxygen is necessary for cellular metabolism and healing after surgery. Since cancer cells thrive in anaerobia conditions, adequate oxygenation of blood is anti-cancerous Consuming iron-rich foods like liver, meats, clams and green leafy vegetables like spinach, optimizes the haemoglobin levels and replenishes the iron stores.

Red blood cell formation or erythropoiesis requires iron, folic acid, and vitamin B12. The deficiency of folic acid and vitamin B12 impairs DNA synthesis in the red cell precursors, causing them to self-destruct (apoptosis). This is often referred to as 'ineffective erythropoiesis'. Folic acid is poorly stored in the body and needs constant replenishment. Many foods contain folic acid, like spinach, sprouts, broccoli, beans, peas, chickpeas, kidney, liver and potatoes. These should be consumed in adequate quantities after surgery.

Carbohydrates and Fat Requirements

Carbohydrates are the body's major source of energy, providing the fuel for physical activity and for proper organ function. The best sources of carbohydrates are whole grains, fruits and vegetables. These foods also supply vitamins, minerals, fibre and phyto-nutrients to the body. Adequate carbohydrate intake in the form of whole grain bread or roti, brown rice, oatmeal and unpolished rice should be ensured. Complex carbohydrates provide nutrients and fibre. Sugar and refined flour should be avoided or restricted. Surgery is accompanied by inactivity, which promotes constipation. Sufficient fibre intake increases the bulk of the intestinal content and reduces constipation. Healthy fats from olive oil, low fat butter, nuts and seeds provide the energy levels required after surgery.

 Food for Proper Functioning of the Immune System

A properly functioning immune system prevents wound infection and enhances healing. Foods rich in antioxidants, essential fatty acids, vitamins and minerals keep the immune system in good health. Foods that provide us with our daily requirement of these substances are eggs, fish, tofu, nuts, leeks and green vegetables.

Food for Mood Elevation

Surgery and hospitalization can be depressing. Engaging the patient in all types of activities keeps them occupied and helps them deal better with their situation. Mood elevators in foods are fish, flax seed, beans, broccoli, nuts, cereals and banana. Daily exposure to sunlight also helps in keeping the mood uplifted.

Wheatgrass

Wheatgrass is the stem of wheat seven to ten days after germination. It is believed to possess therapeutic, healing properties. Like most green plants, it is rich in chlorophyll, amino acids, minerals, vitamins and enzymes, and is gluten free. It can be consumed as a drink.

Wheatgrass is an antioxidant and has anti-inflammatory properties. Other effects include combating anaemia, detoxification by easing constipation through its high fibre content, and stimulation of the thyroid.

Wheatgrass Juice: For fresh wheatgrass, blend 3-4 tablespoons of chopped grass in one glass of water. One can also use dried wheatgrass powder mix one tablespoon in enough whole-wheat flour to make two rotis

Proponents of wheatgrass support its use during nemotherapy. However, there are those who believe that fresh sprouts are far more beneficial than wheatgrass. Sprouts are better tolerated by some patients who have an altered tastema side-effect of medication. Green juicing-using a range of fresh vegetables-is considered superi to wheatgrass by some. To maximize benefit, wheatgrase could be alternated with green juice.

 Suggested Menu to Promote Healing after Surgery

Once oral feeds are permitted, and there is no restriction on diet, regular food with normal quantities, as per the patient's taste can be provided:

Begin the Day with a Juice

For juicing, a mixture of two fruits and a vegetable is ideal (try 3 oranges, 1 apple and 2 carrots). The consistency is that of a smoothie. It should not be strained and should be drunk with no additional additives.

Breakfast

1.One whole egg and white of second egg (scrambled) with two slices of multigrain bread OR 2-3 cheelas (6") OR 2-3 dosas (6") OR a bowl of cereal with milk, 1 teaspoon of ground flax seed, 1 tablespoon of chopped walnuts and a sprinkling of cinnamon
2.One cup of tea/coffee with no additives.

Lunch
  • Start with mixed vegetable salad.
  • Dal
  • Two vegetables (for methods of cooking see p. 74 in Using the Beneficial Effects of Food in Cancer'). It is recommended that potatoes not be eaten along with rice or chapatis, since that doubles the starch intake and increases the risk of cardiovascular disease.
  • Two chapatis (approximately 40-50 gms of wheat flour each) OR rice.
  • Curd (60-80 ml), and a fruit.
Tea
  • A cup of tea and a tablespoon of a mixture of nuts (almonds, pine nuts, cashew nuts and pumpkin seed).
  • Fruit if desired.

Dinner (Vegetarian/non-vegetarian versions of Indian/Western diets are both possible)

  • Start with a salad
  • Meat/fish/chicken/dal (for methods of cooking see p. 74)
  • Vegetables (no potato)
  • Roti/rice/bread.
After Dinner

A cup of tea.