Doctors, surgeons and health care practitioners from many disciplines clearly recognize that good to excellent nutritional support is essential to the best possible healing outcomes from the trauma induced by surgical procedures.

The question becomes, “What represents excellent nutritional support?”  At Top Doctors Labs, we have answered that question with our patent pending post surgery recovery product, Surgiplex MD.

There aren’t just one or two components to our formula but several in specific forms and doses targeted for faster, stronger and better healing.  Dr. Westerlund has authored an excellent whitepaper on the component parts of the formula referencing the detailed clinical research that is the foundation for its creation.

We are addressing each of the specific components in an ongoing series designed to educate patients and practitioners on why a specific vitamin, mineral or co-factor is critical to helping the body do its best job of tissue repair after surgery or accidental trauma.

This article on Vitamin A is the first in our series.  Comments or questions are welcome!

Vitamin A is the broad term that is commonly used to describe a large family of related compounds.  Retinol and retinal are often referred to as ‘pre-formed” vitamin A.  Other compounds in the family like beta-carotene and other carotenoids that can be converted by the body into retinol are referred to as “provitamin A carotenoids”.  Literally hundreds of different carotenoids are synthesized by plants, though only about 10% of these are actually pro-vitamin A carotenoids.  There is a substantial and compelling medical evidence-base to strongly support the role for vitamin A as a post surgery nutritional supplement. (JJ 1996)  It can be confusing to figure out not only what is the best dose of vitamin A to take, but equally confusing to figure out what forms (or combinations of forms) are best for healing.  These aspects are critically important in choosing the best vitamin A regimen.  Specific recommendations for vitamin A (as used in SurgiPlex MD) for the patient preparing and healing from surgery are summarized at the end of this article.

Retinoic acid and its isomers can act as hormones to affect gene expression, subsequently having a wide range of influences at a very important, baseline physiologic level.  It is likely that vitamin A, vitamin D and thyroid hormone interact dynamically to influence gene transcription.  Through the activation and suppression or the transcription of specific genes, retinoic acid plays a major role in:

• cellular differentiation, and
• facilitating the specialization of cells for highly specific physiologic roles.

These two complicated biologic processes are critically important during wound healing and for healing of all different tissue types.  These processes may well have a role in supporting true tissue regeneration (as opposed to more typical scar formation as a healing response). Many of the physiological effects linked to vitamin A function appear to result from this role in cellular differentiation.  Cellular differentiation is the process that helps a more basic precursor cell to evolve to become, for example, a skin cell, or muscle cell, or bone cell.  In this way, when vitamin A is taken in the proper balanced forms and doses, it has a very strong potential to support true tissue regeneration post surgery or injury.

Vitamin A is also commonly regarded by many experts as the “anti-infection vitamin”, because it is required for normal functioning of the immune system.  Retinol and its metabolites are well known to maintain the function and integrity of the skin and mucosa which serve as a first line of defense against infection.  Several studies in different testing models have documented the beneficial effects of optimal vitamin A intake on wound strength, skin strength, and strength of tendon repairs after surgery. Vitamin A and retinoic acid hold a central role in the differentiation of the lymphocytes, white blood cells that are critical for healthy immune response.  Activation of T-lymphocytes, the primary regulatory cells of the immune system, appears to require all-trans-binding of retinoic acid receptors.  Some authors have gone so far as to regard dietary deficiency of Vitamin A as a nutritionally-acquired immunodeficiency disease.  This is important, as a patient healing from surgery will have greater need for vitamin A, so even if they are getting enough vitamin A for day to day living, they may not be getting the necessary dose to help meet the increased demands of healing post surgery.

Vitamin A has a critical role in red blood cell production.  Red blood cells are the “railway box cars” that carry oxygen in the blood, picking up fresh oxygen in the lungs and then transporting oxygen in the blood to deliver it to all of the tissues of the body.  This includes the delivery of oxygen to injured, healing areas of the body that necessarily have increased need for oxygen, energy and protein and vitamins during the healing process.   The body’s precursor stem cells are dependent on vitamin A retinoids for normal differentiation into healthy red blood cells.  Vitamin A also appears to facilitate the mobilization of iron from body storage sites to forming red blood cells for incorporation into hemoglobin molecules (the oxygen-transporting molecule in all red blood cells).

Vitamin A has important and elegant interactions with vitamin D, zinc and iron in the patient healing from post surgery. Vitamin A deficiency may exacerbate iron deficiency anemia, which is clearly a potentially important issue from the standpoint of the surgical patient.  Vitamin A supplementation has definitive beneficial effects on iron deficiency anemia, and improves iron nutritional status in multiple groups, including children and pregnant women.  The combination of vitamin A and iron seems to synergistically reduce anemia more effectively than either supplemental iron or vitamin A alone.  In kind, animal studies have shown that iron deficiency adversely decreases available plasma and liver levels of vitamin A.

Many patients need to take long-term steroids for various medical conditions.  This is fairly common.  In these settings, steroids have beneficial effects, but they also have side effects that can slow a person’s ability to heal.  Ehrlich and Hunt’s work has shown that vitamin A has the ability to reverse or dramatically counteract the corticosteroid-induced inhibition of skin and facial (connective tissue) in wound healing. (H. T. Ehrlich HP 1968) (Hunt TK 1969) (T. H. Ehrlich HP 1973)  A number of animal studies well document the enhanced strength of skin wounds and bone with targeted vitamin A protocols. (Chen L 2009) (Gerber LE 1982) (Sela J 2000) (Seifter E 1975)  Levinson et al suggest that vitamin A benefits healing most by enhancing the early inflammatory phase, including increasing the number of monocytes and macrophages at the wound site, modulating collagenase activity, supporting epithelial cell differentiation, and improving localization and stimulation of the immune response. (Levinson SM 1984)  These are all complicated processes, but may be summarized as better, faster healing, with an improved immune system response to help prevent infection post surgery.

With the above cited research in mind, form-ratios and correctly targeted levels of vitamin A as optimized for the surgical patient will strongly support:

• normal gene expression,
• immune function, and
• iron / red blood cell / hemoglobin metabolism,
• mitigation of diabetes and (chronic) steroid use on wound healing
• ideal biomechanics, strength and compliance of integumentary tissue (skin, fascia, connective tissue)

As used in SurgiPlex MD by Top Doctors Labs, the Vitamin A forms and doses recommended for the surgical patient are:  5000 IU of vitamin A, though with 85% coming from beta-carotene, limiting required retinol (as retinyl acetate) to an optimal 750IU (15%), combined with 4250IU (85%) of beta-carotene. With vitamin A, the forms (and both quality and source of those forms) are as important as the actual dose.  Like many things in life, you get what you pay for and you only have one body and one chance to heal right – demand the good stuff to ensure your best health and healing.

Last time we launched our first blog, Ready To Go

References

Chen L, Chen LW, Chen H, Guo XS, Xu HZ, Ahang GY, Qi DS. “Skeletal biomechanical effectiveness of retinoic acid on induction of osteoporotic rats treated by alendronate.” Zhonguha Yi Xue Za Zhi, 2009: 89(27):1930-3.

Ehrlich HP, Hunt TK. “Effects of cortisone and vitamin A on wound healing.” Ann Surg, 1968: 167:324-328.

Ehrlich HP, Tarver H, Hunt TK. “Effectos for vitamin A and gluccocorticoids upon inflammation and collagen synthesis.” Ann Surg, 1973: 177:222-227.

Gerber LE, Erdman JW Jr. “Effect of dietary retinyl acetate, beta-carotene and retinoic acid on wound healing in rats.” J Nutr, 1982: 112(8):1555-64.

Hunt TK, Ehrlich HP, Garcia JA, Dunphy JE. “Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man.” Ann Surg, 1969: 170:633-641.

JJ, Petry. “Surgically significant nutritional supplements.” Plast Reconst Surg, 1996: 97:233-240.

Levinson SM, Gruber CA, Rettura G, et al. “Supplemental vitamin A prevents the acute raidation-induced defect in wound healing.” Ann Surg, 1984: 200:494-512.

Seifter E, Crowley LV, Rettura G, Nakao K, Gruber C, Kan D, Levinson SM. “Influence of vitamin A on wound healing in rats with femoral fracture.” Ann Surg, 1975: 836-841.

Sela J, Kauffman D, Shoshan S, Shani J. “Retinoic acid enhances the effect of collagen on bone union, following induced non-union defect in guinea pig ulna.” Inflamm Res, 2000: 49(12):679-83.

Hello all,

We just got our website up in March and put together all the many details required to run a business. In fact, that is a never ending process in a business as dynamic as ours. Nutrition has come into a much greater focus for obtaining best health results for patients than ever before.

We are happy to get most of those details out of the way so that we can work on getting our products out into the community to solve a pressing need that has never been adequately addressed: Nutritional support that is targeted and optimized for the peri-operative period.

Many doctors and nutrition experts realize that there are specific levels of vitamins and minerals that are critical to support healing after surgery, after a stroke, heart attack or other medical event. The scientific literature shows that the medically- preferred levels of these vitamins, minerals and co-factors are often significantly different than the recommended daily allowances used by the typical or average multivitamins.

Our research shows that at best, hospitals and doctors will give a hand-out to patients that will list various vitamins, minerals and co-factors that are helpful in the preparation for and the recovery from surgery. The handouts do not tell patients what specific forms and doses of each component should be taken. It is confusing at best.

Our research staff and countless doctors we interviewed recognized that if we could remove the confusion with an organized, medically-designed single supplement we could help all surgical patients optimize their nutrition to provide their best health and healing after surgery and other major medical events.

In response, the team at Top Doctors Labs has worked in step with doctors, surgeons and other health care professionals to create safe, natural, effective and pharmaceutically pure supplement formulations that remove the confusion and keep it simple.

Not only have we created a simple solution for what has been exceedingly confusing for patients to date but we have also made the best possible nutrition to support best surgical outcomes AFFORDABLE.

To individually purchase each of the critical components of our formula would be an excessive expense for patients. Not only expensive but incredibly confusing. How does an average patient adequately balance the many integrated nutritional components required while ensuring that there are no unsafe interactions with individual components or any of the drugs or anesthesia used for surgical procedures?

At best, it is a sort of Russian Roulette for a patient’s health and well being.

At Top Doctors Labs, we distinguish ourselves by maintaining research and clinical standards for our formulations that are simply unmatched. This demands the dynamic and dedicated input of US board –certified top medical doctors, surgeons, research PhD’s and other top health professionals.

The Top Doctors  Scientific Advisory Panel provides the cutting edge direction and insights needed to provide unique supplement solutions that are clinically formulated to act in collaboration with modern medical regimens. The clinical experts and top doctors that comprise our Scientific Advisory Panel are the intellectual core of our commitment to nutritional excellence. We are proud of our relationships and the great benefits it grants our customers.

We understand that even though the surgery or medical challenge may be the same, all patients are different. We don’t subscribe to the “one size fits all” program that is so abundantly practiced.

We are providing dynamic nutritional supplement solutions to address individual needs, demands and circumstances. The Top Doctors Labs family of advanced nutrition products has been developed to permit a ‘building block’ approach to our supplements so they can be mixed, matched and optimally organized to permit integrated, truly individual solutions. At the same time, we are keeping it simple enough to avoid the unnecessary confusion of dozens of bottles and handfuls of pills.

Our foundation product, Surgiplex MD, is a unique, evidence based formula employing specific components that address the critical aspects of a patient’s underlying nutritional status.

Clearly, there are a variety of different surgeries with different systems of the body and these require very specific approaches and supplements in order to optimize healing and improve the outcomes for patients.

Our approach was to develop Surgiplex MD as a foundational product that is excellent for enhancing recovery from all types of surgical and accidental traumas. There is a collection of medical evidence that identifies specific nutrients that are related to specific systems but until the creation of Surgiplex MD, the integration of that information into a comprehensive package for patients undergoing particular surgeries had not yet been undertaken.

There exists a substantial market for multivitamins and other nutritional supplements but most are generic in nature and not specifically designed with an evidence based approach or targeted to specific systems in the midst of substantial surgical stress.

The ability to provide a measured and highly effective supplementation regimen through the use of Surgiplex MD and other Top Doctors Labs products can have a profound impact on surgical outcomes for patients.

Currently, in addition to Surgiplex MD we have a product called Osteoplex MD that when coupled with Surgiplex MD creates what we call SurgiKit– Bone and Joint . This is our ‘building block’ approach to individualizing a nutritional regimen for patients.

Orthopedic surgeons report that it is quite common that many of their patients are clearly nutritionally deplete. In particular, many patients have a markedly limited supplementary approach to their skeletal system that substantially affects their ability to heal rapidly and optimize bone density recovery for their long-term skeletal health.

Based on such experience, there is a serious need for a targeted nutritional support for those patients that would undoubtedly result in more ideal outcomes than currently available with standard medical care.

We have several other products queued up to address a variety of other surgical events that will be available soon. We will let you know as soon as they are available.

In the meantime, we will be posting detailed information about our products. Starting next week we will be posting white paper excerpts for our foundational product, Surgiplex MD. We will be posting detailed information about the nutritional components that have been integrated together from 40 years of scientific and clinical research.

We will be providing the information on a weekly basis to not make the amount of information at one time overwhelming. We hope you find the information to be interesting as well as informative.

Surgiplex MD has a unique distinction amongst nutritional supplements besides the fact that to date there hasn’t been a single supplement, targeted solution to surgical recovery available. The formula is so unique that it is being patented. The overwhelming majority of available nutritional supplements cannot be patented because they are basically generic substances available through countless vendors.

Our research team has put together the best possible single source nutritional supplement for surgical preparation and recovery and we want you to have full details and references. We feel that knowledge is your first step towards taking control of your health and recovery from surgery. We want to help you take an active role in your recovery.

Please look for our first installment here next week!