Surgery – The AIP Way, Part I

I’ve had four abdominal surgeries in my lifetime. One emergency Caesar section and three laparoscopic surgeries to diagnose and treat endometriosis. Of my four surgeries, two were performed since I adopted the Autoimmune Protocol as my primary autoimmune disease management tool. Being able to compare the first two surgeries, to the last two surgeries, noting positive differences in my research, preparation, and recovery, has inspired me to write a small blog series about “AIP surgery” for all of you.

While not every autoimmune disease is aggressive enough to require surgical intervention, some are. For instance Crohn’s disease, among others, can be this serious. Even outside of our autoimmune diseases, the possibility of surgery for minor and major reasons is something many of us will need to navigate at some point in our lives. I felt having some practical guidance on this could benefit the community. Part I of this series will focus on the research and pre-surgery preparation process (be aware that all my guidance here is based on a planned procedure).

Let’s begin with the research process. I find that there are three broad categories of research you’ll need to conduct if a planned surgery is in your future:

  1. Making the decision to have surgery
  2. Learning about the procedure
  3. Learning about costs and healthcare coverage

When making your decision to have surgery, here are the areas to investigate:

  • Guidance from your primary care provider, specialist, and surgeon
    • While your primary care provider may not have expertise in the specific medical issue or surgery, they likely know you well and can discuss the procedure with that in mind.
  • A second opinion from another qualified surgeon
  • Timing
    • Is it possible to delay or better to act quickly?
  • Discussing implications with family members and/or support network
    • It’s important to consider how this will impact them and clarify what support you will need.

When learning about the procedure, here are the areas to investigate:

  • Surgeon selection
    • You will want to discuss their skill level. Questions to ask are:
      • What is your training and background?
      • How often do you perform the procedure?
      • What are your success rates in treating this issue?
      • What is your experience with very complex or chronic cases?
    • You will also want to evaluate their bedside manner, ask about the follow-up care they give, assess how busy their schedule is, and whether should you travel for greater expertise.
  • Risks/benefits
  • Basic understanding of the techniques used
    • Your surgeon should be able to communicate clearly in lay-person terms how the surgery will be performed.
  • In or out-patient
    • Is this procedure relatively simple or will you require a hospital stay as part of recovery?
  • Average length of hospital stay for in-patient
    • This is important for your own planning on many levels.
  • What is considered a full recovery and average time frame to reach it
    • It’s important to understand what your surgeon will consider a full recovery and what kind of milestones are involved in reaching recovery.

When learning about costs and healthcare coverage, here are the areas to investigate:

  • Average total costs for the procedure
    • It’s often difficult to get hard numbers in our healthcare system, but try to get estimates on the surgeon, anesthesia, operating room, pathology, and hospital stay costs. This can be an anxiety-producing exercise, but in the long-run having a grasp on financial matters pertaining to your surgery will ease stress.
  • Health insurance coverage
    • Let’s be honest, the often purposely inconsistent nature of the health insurance system makes it very complex to navigate, but you will want to do your best to understand your coverage for major medical expenses, like surgery. You will want to ask the following questions of your insurance company:
      • Is prior-authorization required?
      • Are the surgeon, anesthesiologist, laboratories, and hospital in or out-of-network? If out-of-network, how is coverage handled?
      • Are there any aspects of the procedure that may not be covered?
  • Reduced prices or payment plans
    • Ask the providers involved about reduced prices or payment plans for any charges not covered after insurance or if you are a “cash” patient.
  • Explore leave from work, if necessary
    • Your employer might have short term and long term disability policies, which are paid or unpaid. If you will need that recovery time, make sure you understand what the policies cover and what you need to do to qualify.
  • Possible travel expenses
    • In some cases, traveling for expert care is the right decision. You’ll want to explore travel costs, like airfare or fuel, lodging, and food, and create a budget for those expenses. Be sure to keep track of them too, because they may be tax-deductible.

Let’s move to the pre-surgery preparation process. In general, there are four broad categories of preparation that most will tackle when facing surgery:

  • Nourishing the body
  • Arranging support
  • Planning with the medical team
  • Preparing for the procedure

When it comes to nourishing your body to be in the best possible shape for surgery itself and to aid recovery later, these are the steps to consider:

  • Return to elimination phase of AIP for a few weeks to 30 days prior (depending on level of invasiveness)
    • If you are still in elimination phase, this is an unnecessary step, but either way give significant focus to nutrient-density. You will be helping to bring inflammation down and load your body with the vitamins and minerals necessary for major wound healing.
  • Add targeted supplements 30-90 days prior to procedure
    • Supplements to consider are those that aid wound healing, decrease inflammation, and/or support detoxification. However, do not take this step without discussing it in detail with your medical team, since some supplements are contradicted prior to surgery (for instance, if they decrease clotting ability, etc.)
  • Adjust your schedule a few weeks to 30 days prior to allow maximum time for rest
    • It is very tempting to work like crazy right up until a surgery in anticipation of the time off following, but resting as much as you can will help your body be in an ideal state for quick healing, rather than already depleted going in.
  • Begin working on mindset and stress management a few weeks to 30 days prior
    • Try things like positive visualization for successful outcomes, prayer, meditation, etc. Again, the idea is to go into the surgery in an ideal state to support quick healing. If you are working from an already depleted state, you will take longer to recover.
  • Incorporate gentle movement into your pre-surgery routine
    • Again, you don’t want to tax your body ahead of time, but having some gentle routines in place is especially important since you may be somewhat restricted temporarily following the procedure.
  • Prepare and freeze AIP meals or ask others to help you with AIP food during recovery
    • Having a plan in place for post-surgery food will reduce a lot of anxiety and allow you to focus on rest.

Next, you’ll be arranging support for yourself. Surgery is not a small undertaking, having help in place is necessary. You’ll want to consider these steps:

  • Arrange for recovery time and support roles
    • This seems obvious, but can get overlooked. Be sure that you’ve scheduled enough time off and addressed any responsibilities at work, so you won’t need to think about it while you are out. Also, try to anticipate what you’ll need help with and arrange ahead of time with your family and extended support network to have specific people filling those roles.
  • Add a counselor, health coach, or other complementary care person to your team
    • Especially if you are feeling very overwhelmed about surgery preparation or extremely anxious or upset about the procedure itself, it can be helpful to have professionals to bolster you.
  • Assess gaps in your support
    • Once you’ve arranged most of the support necessary, re-evaluate to be sure you don’t have any gaps in both practical and emotional support. Again, surgery is not a small undertaking, the right help and care around you is vital. If there are any unmet needs, reach out for help.

As surgery gets closer, you will want to do some detailed planning with your medical team. You’ll want to consider these steps:

  • Discuss any concerns, questions, or requests you have
    • You might want to discuss any conditions that may affect procedure outcomes (like clotting issues) or make requests on how things will be handled once you are under anesthesia. For instance, I asked that my surgeons discuss with my husband beforehand if they feel an organ should be removed (it is not uncommon for endometriosis to irreparably damage ovaries, fallopian tubes, the appendix, etc.).
  • Discuss your dietary plan during recovery
    • If you can follow an AIP template post-surgery, that is ideal, but it is not what will be offered in the hospital. You will need to plan to bring in your own food and it is important that it progresses as your surgeon requires. For instance, they may have milestones for progressing to solid foods or wish for you to avoid certain foods.
  • Discuss how pain management will be handled post-surgery
    • Ask your doctors to explain the risks and benefits of the drugs they will be giving you to manage pain. If you’d prefer alternatives, ask about those options, but (and I cannot emphasize this enough) DO NOT be a martyr. Pain management is critical to a smooth recovery and a little planning can help you and your doctors approach it thoughtfully.
  • Get an advanced care directive and will in place
    • This sounds a bit scary, but this is a very wise step. All surgeries carry some risk and having these documents in place could dramatically decrease suffering for your loved ones should a worst-case scenario arise.

Finally, in the last 48 hours or so before surgery you’ll start preparing for the procedure. You’ll want to consider these steps:

  • Navigate bowel prep
    • If bowel prep (completely cleaning the intestines of stool to minimize risks) is required, ask about alternatives where possible for the formula. Sometimes more gentle options might be possible, however, don’t underestimate the importance of this process. If you must take harsh medications to cleanse the GI tract, the benefits outweigh the risks here! Keep in mind that you can replace things like Gatorade (encouraged for electrolyte replacement) with coconut water, broth, ginger tea with collagen, and other AIP-friendly options.
  • Hospital bag and storage
    • Decide on what you’ll be taking to the hospital with you, pre-pack, and arrange for storage of valuables with staff or family members.
  • Transportation and after-care
    • If this is an out-patient procedure, make sure you have transportation to and from arranged and that you and a caretaker understand after-care.

Surgery can be scary and overwhelming, but hopefully this guide helps you feel more targeted about making the decision and getting ready. I have found over my many surgeries, that the more research and careful preparation I do, the less anxious I am and the better my healing on the other side. Continue reading Part II on surgery recovery!

About Angie Alt

Angie Alt is a co-founder here at Autoimmune Wellness. She helps others take charge of their health the same way she took charge of her own after suffering with celiac disease, endometriosis, and lichen sclerosis; one nutritious step at a time. Her special focus is on mixing “data with soul” by looking at the honest heart of the autoimmune journey (which sometimes includes curse words). She is a Certified Health Coach through the Institute for Integrative Nutrition, Nutritional Therapy Consultant through The Nutritional Therapy Association and author of The Alternative Autoimmune Cookbook: Eating for All Phases of the Paleo Autoimmune Protocol and The Autoimmune Wellness Handbook. You can also find her on Instagram.


  • Karin says

    Thank you for all this very informative advice. Theee months ago I had a fall resulting in surgery on my ankle. I have 10 screws and plates now. I have been on AIP diet for MS for 2 years. I find I am still having to take aspirin or Tylenol most nights. I know that’s not great for leaky gut. Are there foods that act as pain killers? Or any other options?
    Thanks again for all your great info.

    • Angie Alt says

      Karin, I wouldn’t say that there are foods that specifically act as pain killers per say, but if you are eating an AIP template already, many of the foods you are eating are contributing to pain mgmt. For instance, some of the fats you are consuming are converted by your body into anti-inflammatory prostagladins. With pain, it is often inflammation specifically that needs to be treated to help decrease pain (that’s how aspirin & Tylenol work).

      There are three kinds of prostaglandins (hormone-like substances made from essential fatty acids) necessary for our bodies to function, prostaglandin 1, 2, and 3. PG1 and 3 helps us anti-inflame and PG2 helps us inflame when necessary. To help control inflammation, it makes sense to focus on sources of essential fatty acids to help form the anti-inflaming PG1 and 3. This is where the grass-fed beef comes in with AIP and can potentially help reduce pain . . . it has four times as much Omega-3 as conventional beef, which helps form PG3. It is also one of the richest source of linoleic acid, which contributes to forming PG1. It is a mistake to think we only concentrate on grass-fed beef though. AIP also encourages lots of wild-caught fish, like salmon, again very high in omeg-3s. In terms of saturated fats, there are many, many health benefits, but directly related to inflammation you have to view it in larger context of the overall AIP diet. We basically eliminate refined carbohydrates on AIP and research shows that when saturated fat intake is high, but carb intake low, there is a dramatic decrease in inflammation. Concentrate here & hopefully you can taper those painkillers more quickly.

  • Thank you so much for all of the great information you are sharing! I was diagnosed with Celiac Disease last summer, but only found out about AIP this month. I have been doing AIP about a week, and I’m so thankful for the community you are creating to keep people going. I’m obsessively listening to your podcast, and I really appreciate all of the info!

  • Pam Carmichael says

    I recently went through a total hip replacement and had a very bad time in the hospital. I became extremely nauseated by the pain medication. Next time I will try to arrange for someone to bring all of my meals into the hospital and take the pain meds with meals. Not sure how to get 3 meals a day brought in though. The meals in the hospital were terrible!!! And they gave the pain meds before meals on an empty stomach (no wonder I was sick) I asked for gluten free and lactose free meals but uggg! One day for breakfast I had a rice cake and juice (in a plastic cup sickly sweet). So if I need any other surgery I will have to do major planning ahead.

    • Mickey Trescott says

      Hi Pam! I was there with Angie and brought her meals. It really isn’t too complicated, we just made sure the medical team knew what food was being brought in and made sure it complied with the “type” of food she was supposed to be eating (clear liquid, opaque liquid, soups, etc.). You’ll need someone to stay nearby and bring you the food that was prepped beforehand, but it totally can be done!

  • MarlaM says

    This article is spot-on, Angie. Very informative – even for those not on the AIP.
    One needs to ‘plan’ for hospitalization (at some point) just as one ‘plans’ for retirement, and eventually death (medical and financial houses in order).
    No on wants to face the possibility, but the likelyhood is there.
    Angie, you and Mickey, what true friends! What a relationship to treasure!
    Angie, thank you for stating the obvious, and presenting invaluable advice in this article.
    Mickey, thank you for putting flesh on servanthood.
    Blessings on you both!

    • Angie Alt says

      Thanks Marla! We are lucky to have our partnership & friendship & both value it. And yes, I thought it was important for the community to be as prepared as possible for something like surgery.

  • Hi, Angie! I hope you are recovering well from your surgery! Thank you so much for your incredible work. You’ve been an unbelievable help. As I am also celiac and also have endometriosis, I follow your work since 2 years ago, when I was operated on for endometriosis for the last time. Since then I have a very restricted AIP diet, since I also have intolerance to FODMAP. I know that endometriosis is still developing by the tests I’m doing, but I’ve managed to live almost pain free, which makes me think I should continue to eat in this way. But I have a question. Since the adhesions caused by endometriosis are made of collagen, taking collagen or consuming gelatin or beef broth, could develop more endometriosis? What is your opinion? Thank you so much again for your work and I wish you an excellent recovery! Lots of love from Portugal!

  • Andrea Linton says

    Thank you for this article. It was needed, I had a surgery in July and was looking for something like this. Everything ran smoothly though. Something I did ahead of time was to have my doctor work with my pharmacist to compound a anti inflammatory and a more heavy duty pain killer just in case. My plan was not up take them but in case pain got too bad and it was too much for my system I wanted a medication without fillers that could aggravate the problem.
    Just something you might want to add as a suggestion to your part 2 🙂

  • Cheryl says

    Which supplements for healing before and after and what are the alternatives to the strong meds post op?

  • Shantam says

    I’m almost 56 years old and have never had a colonoscopy. I had a FIT test a few years ago and it was clean. I’ve read that those of us with Hashimoto’s have an increased risk for colon cancer and my Dr is pushing me to have a colonoscopy. I’m curious to hear opinions about that if anyone cares to chime in. Thank you.


    Great advice for anyone planning future surgery. Unfortunately I suffered with ulcerative colitis for 25+ years and was completely unaware that it was an AI disease and was “cureable”. I had been told that I would eventally need a colostomy bag and I accepted that that was my future. I developed a cancer and was operated on 10 days later. Tthe only planning I managed was to sort out respite care for my mother and ensure there were adequate services in place for my parents-in-laws. I no longer have colitis as the surgery removed my colon and anus so have a pemanent illiostomy. I have gone on to develop further 4 AI diseases but, thanks to my daughter- in- law, I am now 9mths AIP compliant and much healthier. Keep up your excellent work.

  • […] written two great articles on her blog: Surgery – The AIP Way, Part 1 and Part […]

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