What to Take After Surgery

Medicine is messy. One of reasons researchers experiment on animals is they can create uniform, standardized injuries to test potential remedies. It’s not like you can just cut open 50 people and see if something works better than a sugar pill. But, wait a second, we cut people open all the time. It’s called surgery.

In my video Speeding Recovery from Surgery with Turmeric, I discuss a double-blind, randomized, placebo-controlled study that investigated the efficacy of turmeric curcumin in pain and post-operative fatigue in patients who had their gall bladders removed. Fifty people were cut into and given either curcumin or an identical-looking placebo, along with rescue analgesics—i.e., actual painkillers to take if the pain became unbearable. Even though it’s just laparoscopic surgery, people don’t realize what a toll it can take. (You can be out of commission for a month!) In India, turmeric—found in curry powder—has traditionally been used as a remedy for traumatic pain and fatigue, so the researchers decided to put it to the test.

According to the study, in the weeks following surgery, there was a dramatic drop in pain and fatigue scores in the turmeric curcumin group, with p-values of 0.000. Those are my kind of p-values! The “p-value” refers to a measure of the strength of evidence. The smaller it is, the stronger the evidence is that the result they found didn’t just happen by chance. By convention, a p-value under 0.05 is considered small enough for a result to be considered statistically significant. This means that you’d only expect to find a result that remarkable simply by coincidence 5% of the time, or in 1 out of 20 cases. So a p-value like the one in the study, <0.000, suggests you’d have to run the experiment thousands of times before you’d come up with such a dramatic result just by chance.

It’s hard to come up with objective measures of pain and fatigue, but drug-wise, the curcumin group was still in so much pain they were forced to take 7 of the rescue painkillers. In the same time period, though, the control group had to take 39 pain pills. Of course, it’s better not to get gallstones in the first place, which you can learn more about in my video Cholesterol Gallstones, but the researchers’ conclusion was like no other I’ve ever read in a drug trial.

“Turmeric is a natural food ingredient, palatable, and harmless.” Okay, so far so good. It continued: “It proves to be beneficial as it may be an ecofriendly alternative to synthesized anti-inflammatory drugs which have a definite carbon footprint due to industrial production.” Since when do surgery journals care about the greenhouse gas emissions from drug companies? I just had to look up the reference in the journal Surgical Endoscopy entitled “Journey of the Carbon-Literate and Climate-Conscious Endosurgeon Having a Head, Heart, Hands, And Holistic Sense Of Responsibdlity.” I don’t know what’s stranger, seeing the word “holistic” in a surgical journal or the name of this guy’s practice: “Dr. Agarwal’s Surgery & Yoga.”

The benefits of turmeric are clear—and not just as a remedy for pain. The spice also serves as a potent treatment against cancer, as I explain in these videos:

Turmeric is effective at fighting many other health conditions, too, as is evident in these videos:

Finally, you may be wondering whether turmeric is best taken as a supplement or in whole food form. I invite you to watch Turmeric or Curcumin: Plants vs. Pills and find out.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Optimal Bowel Movement Position

Compared to rural African populations eating traditional plant-based diets, white South Africans and black and white Americans have more than 50 times more heart disease, 10 times more colon cancer, more than 50 times more gallstones and appendicitis, and more than 25 times the rates of “pressure diseases”—diverticulitis, hemorrhoids, varicose veins, and hiatal hernia.

As I discussed in my Should You Sit, Squat, or Lean During a Bowel Movement?, bowel movements should be effortless. When we have to strain at stool, the pressure may balloon out-pouchings from our colon, causing diverticulosis; inflate hemorrhoids around the anus; cause the valves in the veins of our legs to fail, causing varicose veins; and even force part of the stomach up through the diaphragm into our chest cavity, causing a hiatal hernia (as I covered previously). When this was first proposed by Dr. Denis Burkitt, he blamed these conditions on the straining caused by a lack of fiber in the diet. He did, however, acknowledge there were alternative explanations. For example, in rural Africa, they used a traditional squatting position when they defecated, which may have taken off some of the pressure.

For hundreds of thousands of years, everyone used the squatting position, which may help by straightening the “anorectal angle.” There’s actually a kink at almost a 90-degree angle right at the end of the rectum that helps keep us from pooping our pants when we’re just out walking around. That angle only slightly straightens out in a common sitting posture on the toilet. Maximal straightening out of this angle occurs in a squatting posture, potentially permitting smoother defecation. (I remember sitting in geometry class wondering when I’d ever use the stuff I was learning. Little did I know I would one day be calculating anorectal angles with it! Stay in school, kids 🙂

How did they figure this out? Researchers filled latex tubes with a radiopaque fluid, stuck them up some volunteers, and took X-rays with the hips flexed at various angles. They concluded that flexing the knees towards the chest like one does when squatting may straighten that angle and reduce the amount of pressure needed to empty the rectum. This idea wasn’t directly put to the test until 2002, when researchers used defecography (which are X-rays taken while the person is defecating) on subjects in sitting and squatting positions. Indeed, squatting increased the anorectal angle from around 90 degrees all the way up to about 140.

So should we all get one of those little stools for our stools, like the Squatty Potty that you put in front of your toilet to step on? No, they don’t seem to work. Researchers tried adding a footstool to decrease sitting height, but it didn’t seem to significantly affect the time it took to empty one’s bowels or decrease the difficulty of defecating. They tried even higher footstools, but people complained of extreme discomfort using them. Nothing seemed to compare with actual squatting, which may give the maximum advantage. However, in developed nations, it may not be convenient. But, we can achieve a similar effect by leaning forward as we sit, with our hands on or near the floor. The researchers advise all sufferers from constipation to adopt this forward-leaning position when defecating, as the weight of our torso pressing against the thighs may put an extra squeeze on our colons.

Instead of finding ways to add more pressure, why not get to the root of the problem? “The fundamental cause of straining is the effort required to pass unnaturally firm stools.” By manipulating the anorectal angle through squatting or leaning, we can more easily pass unnaturally firm stools. But why not just treat the cause and eat enough fiber-containing whole plant foods to create stools so large and soft that you could pass them effortlessly at any angle?

Famed cardiologist Dr. Joel Kahn once said that you know you know you’re eating a plant-based diet when “you take longer to pee than to poop.”

In all seriousness, even squatting does not significantly decrease the pressure gradient that may cause a hiatal hernia. It does not prevent the pressure transmission down into the legs that may cause varicose veins. And this is not just a cosmetic issue. Protracted straining can cause heart rhythm disturbances and reduction in blood flow to the heart and brain, resulting in defecation-related fainting and death. Just 15 seconds of straining can temporarily cut blood flow to the brain by 21% and blood flow to the heart by nearly one-half, thereby providing a mechanism for the well-known “bed pan death” syndrome. If you think you have to strain a lot while sitting, try having a bowel movement on your back. Bearing down for just a few seconds can send our blood pressure up to nearly 170 over 110, which may help account for the notorious frequency of sudden and unexpected deaths of patients while using bed pans in hospitals. Hopefully, if we eat healthy enough, we won’t end up in the hospital to begin with.

Wondering How Many Bowel Movements Should You Have Every Day? Watch the video to find out!

The “forcing part of your stomach up through the diaphragm into our chest cavity” phenomenon is covered in my video Diet and Hiatal Hernia. The “ballooning of out-pouchings from our colon” is called diverticulosis. There’s a video I did about 6 years ago (Diverticulosis & Nuts), but I have some new and improved ones available: Diverticulosis: When Our Most Common Gut Disorder Hardly Existed and Does Fiber Really Prevent Diverticulosis?

 More on that extraordinary African data here:

So excited to be able to slip in a plug for Dr. Kahn’s work. His brand of “interpreventional cardiology” can be found at www.drjoelkahn.com.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: