Mitigating the impact of anaesthetic on brain health

Brain support: from left to right: Natures Own High Potency  Brahmi complex, Vitamin C, Thompsons B-complex, Westgold butter, Melrose Cod Liver Oil, Celtic sea salt, coconut butter, Melrose MCT oil, Blooms MSM

Hat tip to this episode and this episode of Bulletproof Radio for bringing up the impact of anaesthetic on brain health.

In the episode with JJ Virgin, they discuss how she helped her son recover from a hit and run and how she recovered quickly from knee surgery.

In the other episode, Steven Fowkes and Dave Asprey discuss, amongst other things, anti-trauma compounds like DMSO that can be protective to the spine in case of a car accident for example.

The effects of anaesthetic on brain health

The administration of general anaesthetic during surgery can also have serious long-term effects on the neural systems in the body, especially the brain. In this post I'm going to investigate what I can about how to mitigate the impact since I've got some surgery coming up. It'll also be interesting to see what I manage to uncover because I've just heard of a friends' daughter who had an accident and was in surgery for 3 hours. Should we be concerned for post-anaesthetic impact and is there anything that she can do now to mitigate the effects?

Severity of anaesthetic

There are different severities of anaesthetic depending on the procedure. The most harmful to brain health is full general anaesthetic.
I believe for my procedure (total hip replacement) that a less severe anaesthetic regime is used, likely spinal block plus sedative. I have heard of people having this done without sedation but I'm not that game!

Bulletproof intermittent fasting

First things first. The brain runs really well on ketones which are produced by the breakdown of fatty acids. You can find plenty of information out there about ketogenic diets so I won't go into the details. Since I've been on a low carb high fat diet for a couple of years now I am fat adapted, so adopting a high-fat ketogenic diet post-surgery should work well. 

To get the maximum benefit will mean an extended 'fasting' period. In this case, I'll be looking at a 'fat fast'. That'll mean that I won't 'eat' until lunchtime and will just have coffee-plus-butter/coconut/MCT for breakfast. Maybe with some collagen powder mixed in.

Coconut oil

Coconut oil is well known for it's positive benefits for brain health. Look for an organic cold-pressed variety. There are plenty. Work your way up to 3-5 tablespoons a day (but do start slowly to avoid gastro upset and disaster-pants!)

[Link to podcast on coconut oil for treating dementia. ]

MCT oil

In addition to raw coconut oil I use MCT oil for mental performance. It's a fraction of coconut oil but is metabolised directly to ketones (and thence energy) and is included in Bulletproof Coffee. I use Melrose MCT oil.
There is a further refinement of MCT which isolates the C-10 fatty acids, most popular brand is Bulletproof Brain Octane which I've heard good things about. I may well give this a try beforehand to see if it's worth using over and above 'standard' MCT oil.

Omega-3

As we all 'know', fish oil is good for you. In fact it's DHA for the brain is the particular form. I'm using cod liver oil to help manage my osteoarthritis since it is also high in vitamin D. 

l-glutamine

 - phosphoserine [3 heaped teaspoons]
[More info to be figure out...]
L-glutamine is the main component of muscle. It's commonly used as a bodybuilding supplement to support muscle preservation when 'cutting'. May be useful post-op to keep muscle tone but doesn't look like it would have much of a brain-support function.

DMSO and MSM

MSM is a somewhat unproven supplement but is popping up as a remedy for arthritis pain. I use it along with my glucosamine/chondroitin supplement. The neuro-protective aspects of MSM are definitely controversial, however it is suggested that DMSO is beneficial in mitigating spinal trauma [DMSO is a solvent related to MSM]. From wikipedia:

The spectrum of biological effects of dimethyl sulfoxide (DMSO) and MSM differ, but those of DMSO may be mediated, at least in part, by MSM.^[

Choline

From wikipedia:

Choline is the precursor for acetylcholine, a neurotransmitter involved with memory; it’s an integral component of two important phospholipids; and the liver uses it to process fats and package lipids.

Dietary sources include liver, eggs, shellfish. Choline may also be used as a dietary supplement in the form of Alpha-GPC / Glycerol Phosphocholine. Suggested dosing (by JJ Virgin) is 3 times a day before and after surgery @ 2000 uGrams.
Will look at e.g. http://www.amazon.com/Now-Foods-Alpha-Veg-Capsules-60-Count/dp/B001RYKA3U/

Smart drugs

I'll do some more digging into this. Suggestion by Dave Asprey is:

piracetam or aniracetam protects your brain from low oxygen states.

and so can have a neuroprotective effect during anaesthetic. Obviously you'd want to know how you react to such substances before dropping them into the mix.

Herbal supplements

I've been enjoying improved mental function by taking a herbal compound of Ginkho,Ginseng, Brahmi once every few days and I shall continue to do so before and after the operation.

Pain relief

After major bone surgery, pain relief is essential. I'm not sure if any of the hard-core meds have any lasting neural impact. My thinking is that I won't be shy about using the pain medication but I won't take them for any longer than I have to and I'm going to do what I can to maximise my recovery post-operation to minimise my exposure to hard pain medications.

Anti-oxidants

If you're having anaesthetics then you're in a hospital environment. You may well be having x-rays and other imaging done, lots of oxidative stress. So a good supply of anti-oxidants is essential - Vitamin C, Co-Q10, alpha-linoleic acid, glutathione.

Vitamin B12

Vitamin B12 is essential for good neural condition so make sure to include a good vitamin B complex.

Others

An operation is a major stress on the body so your adrenals will be working hard. Make sure you're taking a good quality salt to support the adrenals to cope with the stress.

Physical therapies

Saunas and heat exposure can increase levels of Prolactin levels by 10-fold. Prolactin is involved in the process of myelination of nerve cells. Heat stress from a sauna increases brain-derived neurotrophic factor when combined with exercise. BDNF increases the growth of new brain cells and increases the survival of existing brain cells.

For further thought

Will GABA help? https://www.upgradedself.com/bulletproof-gabawave 

Changelog

2-Aug-2014: First published.

17-Aug-2014: Added note on the potential use of sauna.