The Perioperative use of Nutraceuticals: Probiotics

Nutritional assessment is a critical step that inpatients have to go through before undergoing surgery. Unfortunately, even with the obesity pandemic, most patients fall into the category of malnourished or are at risk of malnutrition. A detrimental nutritional status reflects a slow recovery, increased hospital stay, risk of postsurgical infection, impaired wound healing, and pressure ulceration. Perioperative nutrition uses nutritional support through macro and micronutrients or nutraceuticals 7- 14 days before surgery, during, and after the procedure. In turn, the perioperative use of nutraceuticals improves surgical outcomes and ensures proper healing. Furthermore, combining orthomolecular medicine knowledge and acute care setting procedures can diminish the risk of hyperglycemia and refeeding syndrome. In addition, probiotics have an application in preoperative care with beneficial results in the preparation stage and postsurgical outcome.

Perioperative support: ERAS

Perioperative nutrition is an essential part of the enhanced recovery after surgery (ERAS) initiative. Indeed, ERAS’ priority is to assess nutritional status, correct or improve dietary deficiencies using oral supplementation (enteral nutrition) and bioactive components such as micronutrients, essential fatty acids, and probiotics. Consequently, this nutritional support results in a reduced hospital stay, leading to lower infection risk and wound dehiscence.

Probiotics

There are multiple reports about the gastrointestinal ecosystem and how the balance (symbiosis) between the host and microbiome plays a crucial role in health. Nevertheless, diseases and surgical procedures can disrupt this balance leading to dysbiosis. 

Dysbiosis has a close link with chronic and severe diseases. Also, infections, autoimmune disease, and increased inflammation are part of this dysbiosis ecosystem. Nevertheless, the use of probiotics as preoperative support has a shred of extensive supportive evidence. 

The rationale for the use of probiotics:

1. Perioperative use of probiotics ensures the reduction of mucosal damage during surgery and prevents medication dysbiosis.
2. Counteracts the use of antibiotics as prophylaxis: Antibiotics as preparation before surgery associate with “functional” diarrhea to severe conditions like pseudomembranous colitis.
3. Alleviates microbial disbalance caused by presurgical fasting: Previous studies report a loss of Firmicutes and elevated concentration of Proteobacteria and Bacteroidetes caused by the scarcity of available macronutrients. Additionally, the surgical injury intensifies the presence of postsurgical dysbiosis.
4. Probiotic supplementation is associated with a restored function of gastrointestinal permeability. Consequently, the protective probiotic effects on intestinal permeability translate to a modulated inflammatory and immune response.
5. Clinical evidence supports the use of probiotics in reducing infectious complications and reducing anastomosis dehiscence.

Clinical application:

In an experimental study using a probiotic nutraceutical composed of a mixture with Lactobacillus Plantarum LP01 (1 billion living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells) was put to the test after gastric surgery. 

The symptoms assessed in this study were: abdominal pain, abdominal bloating, flatulence, borborygmi, malaise, weakness, headache, and eructation. Furthermore, the presence of these symptoms was followed for eight weeks. This study reported positive outcomes in all of the symptoms mentioned above.

Orthomolecular medicine’s scope focuses on treating inflammation using nutraceuticals. As a nutritionist, I see the overlapping of conventional medicine in the acute setting and orthomolecular therapy in perioperative nutrition. The benefits associated with probiotics can be applied with positive outcomes in both environments, which enforces the modality of “is not this or that, is this and that.” – Ana Paola Rodríguez Arciniega, MS.

References:

Ali Abdelhamid, Y et al. “Peri-operative nutrition.” Anesthesia vol. 71 Suppl 1 (2016): 9-18. doi:10.1111/anae.13310

Bonavita, Luigi et al. “Postsurgical intestinal dysbiosis: use of an innovative mixture (Lactobacillus Plantarum LP01, Lactobacillus lactis subspecies cremoris LLC02, Lactobacillus delbrueckii LDD01).” Acta bio-medica : Atenei Parmensis vol. 90,7-S 18-23. 10 Jul. 2019, doi:10.23750/abm.v90i7-S.8651

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