Nutrition following surgery

The type of surgery you have will determine what and when you can eat after surgery. Surgeries involving the mouth, throat, abdomen, or digestive tract will likely lead to more restricted diets.

Once you are able to progress beyond clear liquids, an anti-inflammatory, nutrient-dense diet high in vegetables, fruits, whole grains and sources of high quality protein for at least two weeks (but ideally six weeks) after surgery is recommended 

Pain control after surgery

Pain control not only promotes better quality of life, but can impact your body terrain. Pain increases insulin resistance after surgery

Optimising your body terrain at a glance

Your body terrain is the state of your inner environment. It includes your nutritional status, metabolism, immune function, microbiome, environmental exposures, and other factors. You can think of your terrain as your garden. The minerals, microorganisms, water, and other aspects of soil can promote healthy growth and bountiful outputs, or they can get in the way of healthy growth. Your inner body terrain can similarly promote healthy cell and organ function—or it can favour the unwanted “weeds” of cancer. 

Your body terrain can directly affect your tumour’s microenvironment—the noncancerous cells and tissues and their processes that directly interact with your tumour. Your tumour can change its microenvironment, and the microenvironment can affect how a tumour grows and spreads. 

We focus on seven terrain factors with known links to cancer development, growth and spread:

• Bleeding and coagulation imbalance
• Blood sugar and insulin resistance
• Hormone imbalance
• Immune function
• Inflammation
• Oxidation
• Your microbiome

Medications to manage pain

Opioids are an important option in pain management and recovery after surgery. Opioids including morphine, fentanyl, oxycodone, and codeine are often used to manage pain. Use may being on side effects such as these:

• Constipation
• Urinary retention 
• Sleepiness (somnolence)
• Nausea
• Vomiting
• Loss of appetite (anorexia) 
• Dry mouth
• Dizziness
• Some evidence suggests they may have a negative effect on inflammation and wound healing
• Opioids also have the potential to become addictive.

Impacts on immune function
Opioids impair immune function, a body terrain factor connected to cancer.

Preliminary evidence of disruption of the immune system from use or sudden withdrawal from opioids; we advise against withdrawing abruptly from opiates and urge you to seek medical supervision for weaning off any opioids.

Impacts on cancer outcomes
Minimising opioid use may also improve your long-term cancer outcomes.

Preliminary evidence of lower risk of recurrence among men with prostate cancer treated with epidural analgesia compared to opioids in addition to general anaesthesia

Opioids: bottom line
In light of both benefits and risks of opioid use, we recommend they be used when necessary but in the smallest amount and for the shortest period possible. We encourage you to consider non-opioid options such as ibuprofen (Motrin or Advil) or acetaminophen (Tylenol) when available. Other non-traditional options for pain control are available.

Managing pain without drugs
In experienced hands, most of these approaches present little risk and may be beneficial.  They may be a good substitute for or addition to conventional pain management options. 

• Acupuncture: good evidence: Less pain related to surgery among people with cancer treated with acupuncture (good evidence)

• Cannabis or cannabinoids: Less pain from physical damage with oral standardised cannabis extract (modest evidence); Insufficient (conflicting) evidence of an effect on pain among people treated with opioids when adding cannabinoids in combined analyses of studies

• Guided imagery: modest evidence: Less pain among people undergoing surgery not specific to cancer and treated with guided imagery, sometimes with music (modest evidence)

• Melatonin: modest evidence: Less pain from surgery not specific to cancer among people treated with melatonin (modest evidence)

• Reiki: modest evidence: Less surgical pain not specific to cancer among people treated with reiki (modest evidence).

Wound healing and infection
Morphine—and perhaps other opioids—may increase your susceptibility to infection. Alternatives to pain management (above) can reduce this risk. Several botanicals have strong evidence to improve wound healing and reduce infections.

Regaining mobility and self-care

Expert recommendations, based on a large body of research, all promote adding movement to every day. In addition to exercising with cancer, simply walking and putting more movement in your daily activities brings benefits.

Recommendations from medical groups in brief: 

• Many professional organisations recommend achieving at least 150-300 minutes per week of moderate intensity or 75-150 minutes of vigorous exercise—building up over a few weeks if you’re not already close to this level. 
• An exception is made for those with advanced illness, who may need to de-emphasise aerobic exercise and increase light resistance training such as weightlifting and isometrics. 
• Limit sedentary time and take regular breaks from sitting and sedentary activities to get up and move.
• Benefits include improved physical function, better quality of life, and less fatigue.
• Benefits are seen before, during, and after cancer treatment, including during palliative care.
• The goal is to be active as much as possible, recognising that at times you may need to adjust movement types and levels, such as during or immediately after treatments such as surgery, chemotherapy, or radiation. Gentle movements such as qigong may be available when aerobic exercise is not.
• Following your doctor’s advice is important, but even within restrictions most people can increase activity and receive benefits.
• Goals include improving your muscle mass and density, staying as active as comfortable during treatment, moving safely, and staying hydrated. 
• Finding ways to make Moving More enjoyable will not only improve your motivation, but may bring extra benefits such as more social time if you choose to move with another person or group.
• Moving More can also contribute to better body terrain, better sleep, better cardiovascular fitness, and lower markers of stress.