Integrative medicine can significantly impact health and wellness before, during, and after surgery. Although the impact of integrative medicine is significant, I'm particularly interested in the effects of food and the microbiome in the perioperative period.

Surgery is common. The average person in the United States, over their lifetime, will have approximately nine surgical procedures. Surgery places stress on the body and mind. Before surgery, there is often anxiety or depression over the planned procedure, the anticipation of pain and nausea, and fear of the unknown. The surgical procedure and a visit to the hospital have additional effects. A few examples of the impact of hospitaliztion include sleep disturbances, interruptions in routines and activity, changes in diet, and the introduction of new medications. The surgery itself includes blood loss, tissue trauma, hemodynamic and fluid shifts, inactivity, and many other effects.

The body is composed of many diverse yet interconnected systems. As we unwind the complicated role of the microbiome in physical and mental health, one thing is growing increasingly clear; the microbiome has widespread influence over many facets of our physical and mental health.

A healthy microbiome is a diverse microbiome. Few things alter the microbiome more than antibiotics. Although good for preventing surgical site infections, broad-spectrum antibiotics have many unintended consequences. Antibiotics are often thought of innocuous, even by physicians. They are not. Antibiotics have their place in the medical armamentarium, but their overuse has led to a host of problems, as I discussed in my article in the Huffington Post. Since the gut microbiome is made up primarily of bacteria, it makes sense that antibiotics have a profound effect on the gut. Both oral and intravenous antibiotics influence the delicate microbial balance.

Perioperative changes in the gut microbiome are not limited to the effects of medication. Other influential factos include sleep disruption, anxiety, and a whole host of other factors.

I've been asked what individuals might do to rebuild their gut flora following surgery. I've included a short list of things you can do on your own. Please check with your healthcare provider to make sure these recommendations work for you.

Food:

• concentrate on whole plant-based foods--fiber is a source of prebiotics to nourish the good bacteria of the gut
• adopt an anti-inflammatory diet (e.g., Mediterranean)
• eat fermented food - things like unsweetened yogurt, kefir, saurkraut
• I'm not a fan of probiotics--but the jury is still out concerning their use in the perioperative period

Food is only one variable in the quest to rebuild your microbiome. There is emerging evidence of bidirectional interaction between the microbiome and many seemingly independent components of wellness, including sleep, exercise, and stress management.

Other things you can do to speed your recovery include:

• pay attention to sleep hygiene (including timing and quality of sleep)
• minimize stress (meditate, get a massage, spend time with friends or family)
• spend time in nature
• exercise

Although you will inevitably receive antibiotics during an invasive procedure, armed with the knowledge above, you can help overcome the negative impact of hospitalization and begin rebuilding your microbiome following surgery.

For more, see my slide deck on perioperative integrative medicine.