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Nixing protein before surgery may cut complications

Study: Semi-starvation before procedure may prevent complications

Topics: Quality, Performance Improvement, Readmissions

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January 26, 2012

Eliminating protein from a patient's diet in the days before surgery may prevent certain surgical complications, according to a Science Translational Medicine study performed on rats.

Patients have long been instructed not to eat within a day of surgery to keep their stomachs empty and reduce the risk of vomiting, the Washington Post reports. However, recommending prolonged periods of semi-starvation instead would reverse the general belief that well-fed patients will do better in surgery.

For the study, Harvard School of Public Health researchers split a group of of test rodents into two cohorts—one that consumed unlimited protein-free food for six days prior to the procedure, while the other remained on a regular diet. They then clamped the artery and vein serving the rats' kidneys, cutting off blood flow for 35 minutes.

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Within one week of the procedure, researchers found:

• That 60% of the animals that had maintained a normal diet experienced kidney failure and died;
• All of the animals that had maintained the protein-free diet survived.

The researchers produced similar results when they removed only one essential amino acid from the rats' diets and when they administered three days of halofuginone, a drug that mimics deprivation of an amino acid critical during illness and stress.

But is it applicable to humans?
According to the researchers, protein deprivation triggers "metabolic triage," where the body shuts down certain production lines when it no longer has enough to make all the proteins the body wants. They say that inflammatory and immune response may be one of the first suspended production lines. By triggering the triage, the body thus limits damage to cell membranes, DNA, and enzymes caused when an influx of white blood cells returns to the oxygen-deprived tissue, causing inflammation. "What's surprising is that you can [eliminate proteins] for a really short time and still get a benefit," says lead author James Mitchell.

However, the authors did caution that "our studies were performed in young, healthy rodents. ...Whether this approach will work when needed most, such as in elderly or obese individuals" remains to be seen.

Mitchell and Brigham and Women's Hospital researchers are planning a study of patients who complete a three-day juice fast prior to surgery. "I think it will be very interesting to see how quickly and effectively it can be applied to patients," says University of Southern California molecular geneticist Valter Longo (Brown, Post, 1/25).