Pre-surgery diet and supplements

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Chuck C

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My aortic valve replacement surgery is coming up in 4 days. I’d love to have input from others as to what recommendations they were given prior to surgery. I’ve reviewed the limited guidance that they gave me for diet and supplements prior, took a look at what some medical sites recommend and looked for some supporting literature on the recommendations. Also, there is such an incredible wealth of knowledge on this forum pertaining to coagulation, that hopefully some with experience and knowledge of the literature can weigh in with their views and perhaps dispel some of the myths that might be being perpetuated out there. Just as much of the guidelines regarding diet and warfarin are riddled with misinformation, I suspect that much of the guidance for pre-surgery diet may also be misleading.

My Clinic:

Aside from instruction to not eat after midnight the day before surgery, my clinic has given very little guidance in their pre-surgery hand out.

“If you are taking blood-thinning medications, including aspirin, and have not received instructions about when to stop them, please contact your surgeon’s office immediately.”

And

“Please discontinue taking any herbal supplements unless instructed by your physician.” - Note, that no time frame is given- 3 days before? 1 week? 2 weeks?

Various medical sites online indicate to avoid the following:

“Green tea, cayenne, ginkgo, garlic, ginger, flaxseed, tomatoes, potatoes, and eggplant may have a negative effect on anesthesia or bleeding time.”

“Avoid all fish and flaxseeds 2 weeks prior to surgery, as these are high in Omega 3 which can affect clotting time.”

“Foods high in refined sugar should be avoided as they can suppress immune function.”

“The following food items that contain salicylates that can affect blood clotting: Almonds, Apricots, Berries (All), Cherries, Cucumbers, Grapefruit, Grapes, Lemons, Limes, Nectarines, Oranges, Peaches, Plums, Prunes, Raisins, Tomatoes, Vinegar, White carbohydrates, bagels, rice, pasta”

Almost all indicate to avoid turmeric, fish oil and aspirin and usually they say to discontinue one week prior to surgery.

My suspicion is that most of the above is not based on the literature. I did look for literature to support discontinuing fish oil, fish, flaxseed and chia seed, all of which are discouraged because they are high in Omega 3, which many claim negatively impacts clotting.

The literature does not appear to support this, at least for fish oil:

“Higher achieved n-3-PUFA levels were associated with lower risk of bleeding.”

https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004584

And this study:

“Fish oil supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior to surgery or other invasive procedures.”

No impact of fish oil supplements on bleeding risk: a systematic review - PubMed

And some found a benefit from omega 3s:
“The authors found that omega-3 supplementation was associated with fewer post-surgical infections, as well as a shorter hospital stay.”

Is it Safe to Take Fish Oil Before Surgery & Medical Procedures?

My surgeon ordered extensive blood work which was done yesterday. I eat a big Mediterranean salad every day, which contains many of the foods that many sites warn about: loaded with garlic, onions, tomatoes and chia seeds. I also put a good chunk of salmon in each salad. As I have not yet discontinued this salad, perhaps I will bleed to death in surgery. But, my coagulation baseline bloodwork perhaps suggests otherwise, and I was even on 81mg aspirin and fish oil supplements the day they took my blood.

Two of the tests done, I believe, were to establish my baseline coagulation:

INR: My INR was 1.1 which is in the normal range for baseline.

APTT- This looks at the other coagulation pathway, which heparin interferes with.

My APTT level 24.1 seconds. The reference range is 24.4 to 36.2 seconds. So, if anything, I am clotting a little faster than normal, although I doubt this is a reason for concern.

What action I have taken based on the hand out from my clinic: I stopped aspirin 2 days ago. I stopped my turmeric supplements yesterday. I stopped fish oil supplements and fish yesterday as well, but after reading the literature I resumed again today. Holding off on garlic and onions for now, but curious what others think. It sounds like there may be some literature to suggest stopping garlic prior to surgery.

I’d love any input on what advice others were given before surgery and for those with knowledge and experience on coagulation, how much of the above pertaining to diet and supplements is baloney?
 
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Two of the tests done, I believe, were to establish my baseline coagulation:

INR: My INR was 1.1 which is in the normal range for baseline.
interesting that they're doing that now, and yep .. that's normal

Dunno if you know it but INR = International Normalised Ratio

not everyone is normal but you now have evidence you're pretty close.

I’d love any input on what advice others were given before surgery and for those with knowledge and experience on coagulation, how much of the above pertaining to diet and supplements is baloney?

I was given nothing only told to stop aspirin. This is prior to:
  • OHS in 2011
  • debridement 1 in 2012
  • debridement 2 in 2013
supplements are an industry that exists on the back of lack of knowledge and personal views. I have good friends in pharmacy, pharmacology and pathology and nobody says much nice about the industry.

Its a free world in many places so everyone can believe what they like.
 
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Hello Chuck - You have alot of detailed questions! You may be over thinking this. My Clinic advised to stop taking ALL supplements & 81mg aspirin a minimum of 5 days before surgery. Only exception was the blood pressure med..
I would suggest stop eating all of the "exotic" foods listed above and just eat plain light healthy food. High protein, low fat etc.. Start drinking lots of water daily with a little lemon juice to flush your system. The day before surgery is the most important as far as what you choose to eat and when.
My pre-surgery INR was 1.1 and APTT was 27.9 but the stated standard range was 23.0 to 32.4
Sorry I could not offer more. But, now is the time to enjoy some wine or beer and not worry about INR!!
 
interesting that they're doing that now, and yep .. that's normal

Dunno if you know it but INR = International Normalised Ratio

not everyone is normal but you now have evidence you're pretty close.



I was given nothing only told to stop aspirin. This is prior to:
  • OHS in 2011
  • debridement 1 in 2012
  • debridement 2 in 2013
supplements are an industry that exists on the back of lack of knowledge and personal views. I have good friends in pharmacy, pharmacology and pathology and nobody says much nice about the industry.

Its a free world in many places so everyone can believe what they like.

Hi Pellicle,
As always, your input is extremely valued, especially on this issue. I did stop aspirin 6 days prior to surgery.

"
supplements are an industry that exists on the back of lack of knowledge and personal views. I have good friends in pharmacy, pharmacology and pathology and nobody says much nice about the industry."
I would agree that the supplement world is based on lack on knowledge and mostly BS. I take a few, but try to make sure that those I take have RCT published data to justify.

Your knowledge and wisdom has been priceless to me pre-surgery, and I am certain that I am going to be communicating with you regarding INR management, among other things, post surgery.
 
Hello Chuck - You have alot of detailed questions! You may be over thinking this. My Clinic advised to stop taking ALL supplements & 81mg aspirin a minimum of 5 days before surgery. Only exception was the blood pressure med..
I would suggest stop eating all of the "exotic" foods listed above and just eat plain light healthy food. High protein, low fat etc.. Start drinking lots of water daily with a little lemon juice to flush your system. The day before surgery is the most important as far as what you choose to eat and when.
My pre-surgery INR was 1.1 and APTT was 27.9 but the stated standard range was 23.0 to 32.4
Sorry I could not offer more. But, now is the time to enjoy some wine or beer and not worry about INR!!
Hi Unicusp,
That sounds like good advice. Interesting that our INR was the same and APTT was similar.

"You have alot of detailed questions! You may be over thinking this"

I am a detailed kind of guy. It may seem that I am overthinking and more anxious about this than I truly am, due to the level of detail in my post. But, my post was made somewhat to expose how far reaching and out there some of the pre-surgery advice is, and hoping that folks with real world experience on the matter can help give clarity. This may benefit me and others who encounter the mountain of pre-surgery advice, which I think in some cases is misleading.

Personally, I am disregarding most of the diet recommendations I find out there on the web, except those that are specifically recommended by my surgeon, or seem to have some evidence to back them. I am also paying close attention to posters here who have given advice: kimchi anyone? Just bought a big tub at Costco today, lol! So, per my surgeon's guidelines, the supplements are out, as well as aspirin. Still taking fish oil and eating fish, after reading several published studies, but did cut it back a little. I usually eat enough garlic to repel any vampire that would even consider entering my neighborhood, but, as there may be a little evidence for this one, I will reduce it to a moderate level. I think that the nurses might appreciate this as well. I love nuts and tomatoes too much to stop eating those unless I can see some actual literature to convince me not to and, as my surgeon has not advised against them, they are still on the menu.

I appreciate all of the information that you have shared about your recent surgery. We'll soon be comparing notes on post surgery life.
 
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It looks like dessert is still okay
tiramisu a scoop of vanilla icecream with a side of brandy?
1616121308138.png
 
My aortic valve replacement surgery is coming up in 4 days. I’d love to have input from others as to what recommendations they were given prior to surgery. I’ve reviewed the limited guidance that they gave me for diet and supplements prior, took a look at what some medical sites recommend and looked for some supporting literature on the recommendations. Also, there is such an incredible wealth of knowledge on this forum pertaining to coagulation, that hopefully some with experience and knowledge of the literature can weigh in with their views and perhaps dispel some of the myths that might be being perpetuated out there. Just as much of the guidelines regarding diet and warfarin are riddled with misinformation, I suspect that much of the guidance for pre-surgery diet may also be misleading.

My Clinic:

Aside from instruction to not eat after midnight the day before surgery, my clinic has given very little guidance in their pre-surgery hand out.

“If you are taking blood-thinning medications, including aspirin, and have not received instructions about when to stop them, please contact your surgeon’s office immediately.”

And

“Please discontinue taking any herbal supplements unless instructed by your physician.” - Note, that no time frame is given- 3 days before? 1 week? 2 weeks?

Various medical sites online indicate to avoid the following:

“Green tea, cayenne, ginkgo, garlic, ginger, flaxseed, tomatoes, potatoes, and eggplant may have a negative effect on anesthesia or bleeding time.”

“Avoid all fish and flaxseeds 2 weeks prior to surgery, as these are high in Omega 3 which can affect clotting time.”

“Foods high in refined sugar should be avoided as they can suppress immune function.”

“The following food items that contain salicylates that can affect blood clotting: Almonds, Apricots, Berries (All), Cherries, Cucumbers, Grapefruit, Grapes, Lemons, Limes, Nectarines, Oranges, Peaches, Plums, Prunes, Raisins, Tomatoes, Vinegar, White carbohydrates, bagels, rice, pasta”

Almost all indicate to avoid turmeric, fish oil and aspirin and usually they say to discontinue one week prior to surgery.

My suspicion is that most of the above is not based on the literature. I did look for literature to support discontinuing fish oil, fish, flaxseed and chia seed, all of which are discouraged because they are high in Omega 3, which many claim negatively impacts clotting.

The literature does not appear to support this, at least for fish oil:

“Higher achieved n-3-PUFA levels were associated with lower risk of bleeding.”

https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004584

And this study:

“Fish oil supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior to surgery or other invasive procedures.”

No impact of fish oil supplements on bleeding risk: a systematic review - PubMed

And some found a benefit from omega 3s:
“The authors found that omega-3 supplementation was associated with fewer post-surgical infections, as well as a shorter hospital stay.”

Is it Safe to Take Fish Oil Before Surgery & Medical Procedures?

My surgeon ordered extensive blood work which was done yesterday. I eat a big Mediterranean salad every day, which contains many of the foods that many sites warn about: loaded with garlic, onions, tomatoes and chia seeds. I also put a good chunk of salmon in each salad. As I have not yet discontinued this salad, perhaps I will bleed to death in surgery. But, my coagulation baseline bloodwork perhaps suggests otherwise, and I was even on 81mg aspirin and fish oil supplements the day they took my blood.

Two of the tests done, I believe, were to establish my baseline coagulation:

INR: My INR was 1.1 which is in the normal range for baseline.

APTT- This looks at the other coagulation pathway, which heparin interferes with.

My APTT level 24.1 seconds. The reference range is 24.4 to 36.2 seconds. So, if anything, I am clotting a little faster than normal, although I doubt this is a reason for concern.

What action I have taken based on the hand out from my clinic: I stopped aspirin 2 days ago. I stopped my turmeric supplements yesterday. I stopped fish oil supplements and fish yesterday as well, but after reading the literature I resumed again today. Holding off on garlic and onions for now, but curious what others think. It sounds like there may be some literature to suggest stopping garlic prior to surgery.

I’d love any input on what advice others were given before surgery and for those with knowledge and experience on coagulation, how much of the above pertaining to diet and supplements is baloney?

You are over thinking it all. Just enjoy life for the next couple of days. Eat food that makes you happy. Time for some chocolate :)
 
I appreciate all of the information that you have shared about your recent surgery. We'll soon be comparing notes on post surgery life.
No problem. Glad I could assist as others have done for me. You will be fine. Enjoy the ride. Yes, there are interesting & enjoyable moments. In the meantime I'm sure tomatoes and nuts are fine. Enjoy what you like, in moderation. Stay active until surgery and hydrate!
 
Hey, Chuck C -

Great, useful thread idea, thank you. I’ve been researching so much other stuff (trying to find a good PCP and cardiologist mostly) that I forgot about diet and supplements.

Time to use up this bottle of Ginkgo extract while I still can - & hope there’s enough in my system in two weeks to help with pump head.
 
Hey, Chuck C -

Great, useful thread idea, thank you. I’ve been researching so much other stuff (trying to find a good PCP and cardiologist mostly) that I forgot about diet and supplements.

Time to use up this bottle of Ginkgo extract while I still can - & hope there’s enough in my system in two weeks to help with pump head.
I suggest stopping the Ginkgo now. It's a blood thinner and can cause uncontrollable excessive bleeding during surgery. You definitely want all of it out of your system before surgery. I have no idea how long that may take. May want to ask your surgeon.
 
i also started having second thoughts after I typed that ^

phew! That was close.

Somebody really needs to write a comprehensive book about all this - it’d be super helpful to have everything all in one place, instead of us each having to reinvent the wheel. I get the value of personal experience, but not for every single aspect.
 
It's great that you're doing research! In general, prior to an aortic valve replacement surgery, it's recommended to maintain a healthy diet that includes plenty of fruits and vegetables. For this, the guys from medicalweightlosslehighvalley.com may help. In terms of supplements, it's important to talk to your healthcare provider before taking any new supplements. Some can interact with medications and affect blood clotting. Vitamin K, for example, can interfere with the action of blood thinning medications such as warfarin. So it's important to be mindful. It's also essential to stay well-hydrated prior to surgery and to avoid alcohol.
 
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It's great that you're doing research! In general, prior to an aortic valve replacement surgery, it's recommended to maintain a healthy diet that includes plenty of fruits and vegetables. For this, the guys from medicalweightlosslehighvalley.com may help. In terms of supplements, it's important to talk to your healthcare provider before taking any new supplements. Some can interact with medications and affect blood clotting. Vitamin K, for example, can interfere with the action of blood thinning medications such as warfarin. So it's important to be mindful. It's also essential to stay well-hydrated prior to surgery and to avoid alcohol.
I was never put on a special diet before surgery. I ate what I always did. it was after surgery when I got on Warfarin when I had to watch the intake of vitamin k.
 

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