Nutrition – The Solution for Improved Post-Surgery Recovery

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In 1974, Dr. Charles Butterworth used the phrase “The Skeleton in the Hospital Closet” to  raise awareness of physician and hospital induced malnutrition (iatrogenic malnutrition) in patients.1  The premise was that patients came into the hospital and became malnourished because of a variety of reasons including fluid and food withdrawal prior to surgery or diagnostic tests, failure to assess the patient, failure to monitor food intake, and others. Failure to maintain the nutritional stature of the patient through hospitalization and after are causes of longer length of stay, poor outcomes, and early return to hospital.

With the new enhanced recovery protocols post-surgery, “patients still can’t eat after midnight before an early morning surgery, but two or three hours before surgery they do get a carbohydrate-loaded drink fortified with electrolytes, minerals and vitamins. They are pretreated for pain with non-narcotic painkillers and epidurals that are kept in place postoperatively. With careful monitoring, patients receive only necessary levels of IV fluid during surgery. Soon afterward they get out of bed to walk and may ingest solid food, and they are discharged earlier with careful instructions for home care.”

Another surgeon, Dr. Hedrick, who is the co-author of a study published online in February in the Journal of the American College of Surgeons, “found that the new protocol, used in colorectal-surgery patients at the UVA health system, helped reduce the length of hospital stay by 2.2 days compared with a control group who had conventional treatment. It also reduced complications by 17% and increased patient satisfaction with pain control by 55%. There was a cost savings of $7,129 per patient.”

Dr. Butterworth also noted that nutrition education is critical to physicians understanding the risk to their patients.  It has taken quite a few years, but, finally it appears that the lessons may have been learned. An article in the Wall Street Journal (March 31, 2015) by Laura Landro discusses the concept of “enhanced recovery” which is a method to reduce the stress on patients while reducing the potential for “surgery procedure induced malnutrition.”  Shortening the fasting time before surgery and feeding as soon as tolerable after surgery are hallmarks of the enhanced recovery process.   Many studies have shown that proper nutrition during hospitalization shortens length of stay, improves patient outcome, and helps prevent readmissions.

It is too bad that it has taken such a long time for the implementation of the holistic approach to patient care.

Sources:
1 Butterworth C. The skeleton in the hospital closet. Nutr Today. 1974;9: 4-8.
2 Thiele, RH, et al., 2015. Standardization of Care: Impact of an Enhanced Recovery Protocol on Length of Stay, Complications, and Direct Costs after Colorectal Surgery.  J. Am. College of Surgeons, 220:4 430–443.  http://www.wsj.com/articles/patients-bounce-back-faster-from-surgery-with-hospitals-new-protocol-1427739292
MARCH IS NATIONAL NUTRITION MONTH

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Designated by the Academy of Nutrition and Dietetics (AND), the 2015 theme for National Nutrition Month is “Bite into a Healthy Lifestyle.” Choosing tasty and nutritious foods in proper serving sizes along with adequate physical activity is important in staying healthy and avoiding chronic disease. This month, let’s focus on “food bites” containing calcium and its role in keeping us active and healthy — no matter our age or activity level.

A mineral found in many foods, calcium is known for its storage in bones and teeth where it supports their structure and hardness. But, we also need calcium for muscle movement and for effective nerve transmission between the brain and every part of the body. In addition, calcium is used to help blood vessels move blood through the body and assists in the release of hormones and enzymes affecting many functions. The amount of calcium needed varies with age, but the current guideline for women and men over 70 years of age is 1200 mg/day. Certain groups of people are more likely to have trouble getting enough calcium. Those groups include:

  • Postmenopausal women
  • Those with lactose intolerance who cannot digest lactose
  • Vegans (vegetarians who eat no animal products)
  • Ovo-vegetarians (vegetarians who eat eggs but not dairy)

The best advice: choose a variety of foods that provide calcium including:

  • Milk, yogurt and cheese – 8 oz. of milk = 300 mg calcium
  • Kale, broccoli, Chinese cabbage and dark green leafy vegetables
  • Fish with edible soft bones such as canned sardines and salmon
  • Legumes including black-eyed peas and white beans
  • Some breakfast cereals, fruit juices, soy and rice beverages, and tofu have calcium added. Check labels for calcium

Other factors affecting the amount of calcium absorbed in the digestive tract include:

  • Age because efficiency of calcium absorption decreases with age.
  • Vitamin D intake, present in some foods and produced in the body when skin is exposed to sunlight, increases calcium absorption.
  • Other components in food such as oxalic acid and phytic acid can reduce calcium absorption.

There are no obvious symptoms to indicate low calcium levels since the body maintains these levels in the blood by taking it from bones. Long term impact of calcium intake below recommended levels can cause low bone mass (osteopenia) and increased risk of osteoporosis (bones becoming porous, fragile and prone to fracture), a major health problem for more than 10 million adults over age 50 in the US.

Calcium dietary supplements vary depending on type and amount of calcium used, along with the use of other nutrients such as vitamin D. Before considering a supplement, consult with your doctor, pharmacist or registered dietitian as it may interact or interfere with prescribed medications.

Information source for this article: “Eating Well as You Get Older: Benefits of Eating Well” (National Institutes of Health. Senior Health) Topic last reviewed: November 2014.

BENEFITS OF EATING WELL

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According to the National Institute of Health (NIH) Senior Health website, healthy food choices make a difference in our health and quality of life. In an article, “Eating Well as You Get Older”, staff at NIH stress the impact food choice has on your health and how you look and feel. So, if you are a person who sets New Year’s Resolutions, maybe this will motivate you.

Eating Well Promotes Health

Eating a well-planned, balanced mix of foods every day has many health benefits such as reducing the risk of heart disease, stroke, type 2 diabetes, bone loss, some cancers, and anemia. If you already have one or more of these chronic diseases, eating well and being physically active may help you better manage them. Healthy eating may also help you reduce high blood pressure and lower high cholesterol. Eating well gives you the nutrients needed to keep your muscles, bones, organs and other parts of your body healthy throughout your life. These nutrients include vitamins, minerals, protein, carbohydrates, fats, and water.

Eating Well Promotes Energy

Eating well helps keep your energy level up, too. By consuming enough calories, you give your body the fuel it needs throughout the day. The number of calories needed depends on how old you are, whether you’re a man or woman, your height and weight, and how active you are.

Food Choices Affect Digestion

Your food choices also affect your digestion. For instance, not getting enough fiber or fluids may cause constipation. Eating more whole-grain foods with fiber, fruits and vegetables or drinking more water may help with constipation.

Too much of a good thing…becomes a slice of trouble

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I like pizza. My kids like pizza. I bet you like pizza too. It sounds as if we all like pizza too much. A recent study in the journal Pediatrics showed that when pizza is eaten by kids and teens they eat 84 and 230 calories more in the day, respectively. Importantly, sodium intake increases also with almost 400 milligrams higher intake per day when pizza is eaten. Now you might not think that sodium intake is a concern for kids, but, rethink – we are training their palette to prefer high sodium foods. Consumption of high sodium foods over time can lead to hypertension, which is a factor for developing further chronic conditions including diabetes, renal disease, heart disease and others.  Costs associated with hypertension are estimated to be over $40 billion each year with half of this going to medication to help reduce fluid build-up. It is interesting to hear heart docs talk about patients that they release from the hospital with orders to consume a low sodium diet but who wind up back in the hospital. The patient gets home and has nothing to eat so they call the local pizza place for takeout or delivery. Wham, high sodium results in fluid retention and a trip back to the hospital. This will cost the hospital for the readmission.

Does pizza or any food need to be high in sodium to taste good? NO. One of the hardest parts of going on a lower sodium diet is adjusting to the taste of food that is much lower in sodium. Mom’s Meals Nourishcare dietitians and chefs work to develop meals with low to moderate amounts of sodium while being highly flavored by herbs and other seasonings…and supportive of heart health.

Powell LM1, Nguyen BT2, Dietz WH3 2015.  Energy and Nutrient Intake From Pizza in the United States Pediatrics. 2015 Jan 19. pii: peds.2014-1844. [Epub ahead of print] Davis, K. Expenditures for Hypertension among Adults Age 18 and Older, 2010: Estimates for the U.S. Civilian Noninstitutionalized Population. Statistical Brief #404. April 2013. Agency for Healthcare Research and Quality, Rockville, MD.

DASH Rated #1 Best Overall Diet

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Recently, U.S. News and World Report did a comprehensive review of the 35 leading diet programs using input from health experts.  Surprisingly, they ranked the DASH Diet (Dietary Approaches to Stop Hypertension), a lesser known diet developed to fight high blood pressure, as the #1 Best Diet Overall  for people to use in trying to maintain a healthy lifestyle.  The experts felt it offered the most “nutritional completeness, safety, ability to prevent or control diabetes and support heart health.”  We applaud this finding.  The evidence from Dr. Scott Hummel a cardiologist at the University of Michigan Hospitals shows that a low sodium diet has significant beneficial effects on the heart muscle itself.  Improvements in heart function are apparent in certain cardiac patients when they consumed a modified DASH diet.  Mom’s Meals is proud to be a part of the on-going clinical trial of Dr. Hummel and the teams at University of Michigan and Columbia University.  For more on the DASH diet, go to dashdiet.org.  To see the complete diet reviews and rankings at US News and World Report go to:  http://health.usnews.com/best-diet.

Type 2 Diabetes…Sugar’s Unsweet Results

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Over the years, the United States has addressed several important public health issues through social marketing avenues.  An example is the anti-smoking campaigns “Cancer cures smoking” where educational materials were both graphic and impactful.  The recent “truth®” campaign is estimated to have avoided around $1.9 Billion in health care costs because 1.6% (approximately 300,000) fewer youths were smoking over the course of the campaign (Holtgrave et al., 2009).  The costs of smoking to society are immense and these types of campaigns are cost effective.

Another area that is ripe for a social marketing campaign is the escalating epidemic of Type II diabetes.  Data shared by the International Diabetes Foundation shows that diabetes affects over 380 million people worldwide.  In the United States alone, diabetes affects over 29 million people and costs over $69 Billion in medical bills, disabilities and early death.  It is not getting better as 1.7 million people are diagnosed with diabetes yearly and a third of our citizens are pre-diabetic.  Picture this, 73,000 foot and leg amputations occur in this country each year.  Most of these are preventable because they are caused by a failure of individuals to know how to take control of their diabetes.

For the most part Type II diabetes is preventable and controllable.  (Agree and changed to controllable.  Although there is information regarding pre-diabetes relatively few on actual diabetics although Jenny Craig did fund a study that showed A1C drops.  Diet and exercise being the most successful prescription.  A recent article by Dr. Robert Pearl (http://www.forbes.com/sites/robertpearl/2014/12/18/type-2-diabetes/), suggests that it is time for a marketing campaign to help people take control and understand the impact that their diet has on their condition.  Dr. Pearl suggests that it may be useful to begin labeling high fat, high sugar products with graphic illustrations of what happens when diabetes is uncontrolled (see his article in Forbes Magazine for a very graphic concept).

Mom’s Meals believes that consumption of adequate and appropriate nutrition can be an important part of helping control various chronic conditions including diabetes.  If you look at other places on this website you will find testimonials from individuals who have documented an improvement in their control of Type II diabetes.  Prepared, ready-to-eat meals like Mom’s Meals can be the convenient solution in the first step to an alternative lifestyle that supports health and combats chronic disease.

Source:  Holtgrave DR, Wunderink KA, Vallone DM, Healton CG. Cost-utility analysis of the National truth campaign to prevent youth smoking. Am J Prev Med. 2009;36(5):385–8.

Americans Become Heavier

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Almost one-third of all Americans are now obese according to the American Public Health Association.    According to the study, Americans are gaining weight and are less active than ever before.  Last year the obesity rate of adults in the United States increased from 27.6% to 29.4%.There has been an increase in obesity rates while at the same time a significant decline in adults activity levels. The study shows nearly 24% of adults have not exercised in the past 30 days.

Obesity is a serious health concern tied to many chronic and costly diseases. The good news … while obesity and its related health issues are serious, they are, in many cases, also preventable and reversible. High blood pressure and diabetes are among the few diseases that are directly correlated to diet and exercise. Those impacted by these diseases are encouraged to increase their activity level and boost their consumption of fruits and vegetables along with eating more lean meats. Read the full story and to see how your state ranked on the health scale. http://www.usatoday.com/story/news/nation/2014/12/10/public-health-obesity-inactivity-state-rankings/20095261/

Nutrition Support Helps lower Health Care Cost

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A recent “What’s Hot” from the Gerontology Society of America focused on elder malnutrition, a topic that Mom’s Meals has been very involved with for a couple of years.  Malnutrition in this population has been identified for many years.  However, it has taken until now for the realization that elder malnutrition may impact health care costs and that by simply feeding people an adequate and appropriate diet may have positive effects.  Interestingly, one of the articles mentions that current models of Transition Care (moving the patient from hospital to home) may have over emphasized the medico-pharma aspects of patient care.  A more holistic approach that includes nutritional care is recommended.  Mom’s Meals has recognized and been preaching that nutrition support is critical to the well being of the elderly population.  It is encouraging that policymakers are finally seeing that feeding people is good for them and good for the health care system.

Sam Beattie, Ph.D.

What you can do about malnutrition

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We understand that seniors want to continue to live independently yet may not know all the steps they can take to help avoid malnutrition.  Even small dietary changes can make a big difference in an older adult’s health and well-being. For example:

Engage doctors. If your loved one is losing weight, work with his or her doctors to identify — and address — any contributing factors. This might include changing medications that affect appetite, suspending any diet restrictions until your loved one is eating more effectively, and working with a dentist to treat oral pain or chewing problems. Request screenings for nutrition problems during routine office visits, and ask about nutritional supplements. You might also ask for a referral to a registered dietitian.

Encourage your loved one to eat foods packed with nutrients. Spread peanut or other nut butters on toast and crackers, fresh fruits, and raw vegetables. Sprinkle finely chopped nuts or wheat germ on yogurt, fruit and cereal. Add extra egg whites to scrambled eggs and omelets and encourage use of whole milk. Add cheese to sandwiches, vegetables, soups, rice and noodles.

Restore life to bland food. Make a restricted diet more appealing by using lemon juice, herbs and spices. If loss of taste and smell is a problem, experiment with seasonings and recipes.

Plan between-meal snacks. A piece of fruit or cheese, a spoonful of peanut butter, or a fruit smoothie can provide nutrients and calories.

Make meals social events. Drop by during mealtime or invite your loved one to your home for occasional meals. Encourage your loved one to join programs where he or she can eat with others.

Encourage regular physical activity. Daily exercise — even if it’s light — can stimulate appetite and strengthen bones and muscles.

Provide food-savings tips. If your loved one shops for groceries, encourage him or her to bring a shopping list, check store fliers for sales and choose less expensive brands. Suggest splitting the cost of bulk goods or meals with a friend

Remember, identifying and treating nutrition issues early can promote good health, independence and increased longevity. Take steps now to ensure your loved one’s nutrition.

How to spot malnutrition

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Over the last few weeks, we have been focusing on how to prevent and detect malnutrition in seniors. The signs of malnutrition in older adults can be tough to spot, especially in people who don’t seem at risk — but uncovering problems at the earliest stage can help prevent complications later. To detect malnutrition:

Observe your loved one’s eating habits. Spend time with your loved one during meals at home, not just on special occasions. If your loved one lives alone, find out who buys his or her food. If your loved one is in a hospital or long term care facility, visit during mealtimes.

Watch for weight loss. Help your loved one monitor his or her weight at home. You might also watch for other signs of weight loss, such as changes in how clothing fits.

Be alert to other red flags. In addition to weight loss, malnutrition can cause poor wound healing, easy bruising and dental difficulties.

Know your loved one’s medications. Many drugs affect appetite, digestion and nutrient absorption.

In the final excerpt of how to prevent and detect malnutrition in seniors we will discuss what steps you can take to help avoid malnutrition.