Fwd: FW: Hospital chain, under scrutiny, reports rare illness

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BTW, Pam, Thank you for your hard work and contribution to this list

and our profession!

Sent from my iPhone

Begin forwarded message:

>

> Date: February 21, 2011 3:36:59 PM EST

> To: " rd-usa " <rd-usa >

> Subject: Re: FW: Hospital chain, under scrutiny, reports

> rare illness

>

> Pam, I agree with what you are saying! PubMed is the best source but

> it also had been influenced by money and politics. There has been

> some positive changes in the science publishing community and

> journals since now most disclose funding. Science is sometimes

> backwards or after the fact. The example is HIV. First it did not

> exist and was missed Dx as other diseases since 1950s or longer,

> then it was a syndrome, then a virus and then labeled HIV/AIDS. Gulf

> War syndrome is similar and when there is no money or explanation it

> stays a syndrome. These viruses and syndromes cause hypermetabolic

> conditions and slow malabsorption leading to malnutrition. Medical

> nutrition is an art and a science! Today's science, medicine,

> definitions and more change all the time! Your giving an example of

> it. Big business is in everything now, including academia! Special

> interests trumps what is best for the patient or student. Bottom

> line is that if Americans are not given the opportunity to see a RD

> and a MD for regular check ups and care, healthcare cost shall rise

> and rise bankrupting our country. Time needs to be spent on basic

> care. My opinion, more than 90% healthcare starts with medical

> nutrition! This message is not getting to Americans!

>

> Sent from my iPhone

>

>

>

>> ,

>>

>> The research is not backwards, although I'm not sure what you mean by

>> that. Research is what is it. I'm in complete agreement with you

>> regarding the connection between nutrition and chronic illness,

>> however, kwashiorkor is not malnutrition as we have been taught in

>> the

>> past.

>>

>> When I talk about increased mortality with refeeding folks with

>> kwashiorkor, I am not talking about the " refeeding syndrome " (that is

>> really an iatrogenic complication, not a condition) that most of us

>> might have seen in hospitals. That " refeeding syndrome " is an acute

>> hypophosphatemia, hypokalemia, and not quite as severe hypomagnesemia

>> along with pulmonary and cardiac complications seen when one provides

>> carbohydrates in excess of capacity for cellular uptake and

>> utilization.

>>

>> Malnutrition does not equal malabsorption, nor does it equal

>> hypermetabolism. All are separate but can interact when present

>> concurrently. I think it behooves us to approach this from a science-

>> based perspective. The National Library of Medicine (NLM) offers the

>> free search engine, PubMed that can be used to search for literature

>> that has been peer-reviewed.

>>

>> Pam Charney, PhD, RD

>>

>> Pamela Charney and Associates, LLC

>> consultants in nutrition informatics

>> Transforming Nutrition Care With Informatics

>>

>> pcharney@...

>> http://www.linkedin.com/in/pamcharney

>>

>>

>>

>> > Pam, The research is backwards and not pure science. Like you

>> stated,

>> > it is money or politics at play here. Malnutrition is a slow

>> occuring

>> > process in which once it gets to a certain point, it starts the

>> slow

>> > cycle of illness leading to chronic illness and organ failure.

>> You are

>> > right, when illness due to this malnutrition occurs, refeeding

>> could

>> > be dangerous and even deadly. As with everything in life, timing is

>> > everything. It is really the denial of malnutrition,

>> malabsorption and

>> > hypermetabolism that is the problem!

>> >

>> > Sent from my iPhone

>> >

>> >

>> >

>> > > ,

>> > >

>> > > With all due respect, one should not use Today's Dietitian as the

>> > > place to learn the latest science. The information published

>> there

>> > is

>> > > not peer reviewed, nor is it systematic. It's what we call a

>> > > " journalistic review " . That's not a bad thing, I've written for

>> them

>> > > myself, it's just that you should know the difference.

>> > >

>> > > I know you like magnesium as the perpetrator for a number of

>> health

>> > > conditions, based on your recent posts here. However,

>> kwashiorkor is

>> > > not protein and electrolyte imbalance, at least not at the root

>> > cause.

>> > > In fact, in some research, when you give folks with (real)

>> > kwashiorkor

>> > > protein and electrolytes without considering co-morbid

>> conditions,

>> > you

>> > > often end up increasing mortality, which we really don't want

>> to do.

>> > >

>> > > What's going on here is much more complex; it's a mix of

>> facilities

>> > > trying to pull as much medicare money their way and RDs not

>> stepping

>> > > up with evidence to show what is and what is not truly a

>> nutrition

>> > > problem.

>> > >

>> > > I'd urge you to search PubMed for some of the more recent

>> papers on

>> > > kwashiorkor. Golden from the UK had published some that

>> are

>> > > very readable. There are others in the tropical medicine journals

>> > that

>> > > also talk about some other purported etiologies for kwashiorkor.

>> > >

>> > > Regards,

>> > > pam

>> > >

>> > > Pam Charney, PhD, RD

>> > >

>> > > Pamela Charney and Associates, LLC

>> > > consultants in nutrition informatics

>> > > Transforming Nutrition Care With Informatics

>> > >

>> > > pcharney@...

>> > > http://www.linkedin.com/in/pamcharney

>> > >

>> > >

>> > >

>> > > > Marasmus is starvation, kwashiorkor is protein starvation and

>> > > > electrolyte

>> > > > imbalance. A Today's Dietitian article a few months age

>> directed

>> > me

>> > > > to B1 for

>> > > > refeeding anorexia - it worked - I was so disoriented, and my

>> > heart

>> > > > was fluttery

>> > > > and weird. The magazine had flipped open to that page and it

>> was a

>> > > > life saver.

>> > > > When you are that underfed, there really is no appetite - zinc

>> > > > deficiency

>> > > > worsens appetite I believe. The magnesium deficiency adds to

>> the

>> > > > edema problem

>> > > > that the lack of albumin causes. Loss of muscle tone, alopecia,

>> > and

>> > > > dermatologic

>> > > > symptoms would all relate to protein deficiency. Getting

>> > rehydrated

>> > > > was

>> > > > necessary before I could swallow much food. When one or two

>> bites

>> > > > feels like

>> > > > sawdust it is easy to give up eating and not figure out how to

>> > start

>> > > > again.

>> > > > Rehydration requires magnesium as well as sodium and potassium.

>> > Many

>> > > > major

>> > > > electrolyte brands don't even have magnesium - it was regulated

>> > out

>> > > > sometime in

>> > > > the 20's - 30's.

>> > > >

>> > > > I think that that doctor and hospital system is recognizing the

>> > > > problem I've

>> > > > been working on - we can't heal and regenerate tissue if we

>> don't

>> > > > have the

>> > > > nutrients. As for increased Medicare billing I hope the

>> hospital/

>> > > > doctor is

>> > > > figuring out how to use that money to actually nourish the

>> > starving

>> > > > seniors and

>> > > > isn't just bonusing it out to executives.

>> > > >

>> > > > Kwashiorkor was more prevalent in starving children countries -

>> > > > edamatous belly

>> > > > - but I just saw that in my father-in-law. I couldn't find a

>> > formula

>> > > > that didn't

>> > > > have the high calcium level that throws off absorption. Our

>> > enteral

>> > > > feedings

>> > > > are not based on ratios that the chronically ill can absorb.

>> The

>> > > > feeding made

>> > > > him worse, 40 pounds edamatous. So painfully swollen with water

>> > and

>> > > > skin

>> > > > integrity you could poke a fingernail through (it seemed). He

>> is

>> > > > getting better

>> > > > finally.

>> > > >

>> > > > Providing " Health Shakes " and supplemental formulas that are

>> > high in

>> > > > calcium

>> > > > isn't helping. The problem is not that there is no protein in

>> the

>> > > > diet or even

>> > > > in the body - the problem is keeping the protein in the cells

>> and

>> > > > blood vessels

>> > > > where it can do some good. Magnesium is what is needed to

>> prevent

>> > > > the leaky

>> > > > membranes and in the chronically ill calcium is being

>> > preferentially

>> > > > absorbed.

>> > > >

>> > > > I want to make sweet potato ginger smoothies boosted with

>> garbanzo

>> > > > bean puree

>> > > > for everybody.

>> > > >

>> > > >

http://www.nutritionmd.org/health_care_providers/general_nutrition/protein_malnu\

trition.html

>> > > >

>> > > > Protein-Calorie Malnutrition: Overview and Treatment

>> > > > Protein-calorie malnutritionresults in 2 similar but distinct

>> > > > diseases, marasmus and kwashiorkor.

>> > > >

>> > > > Marasmus is defined simply as chronic deprivation of energy

>> needed

>> > > > to maintain body weight. Its extreme form is characterized by

>> > severe

>> > > > weight loss and cachexia.1 Marasmus is further characterized by

>> > > > subnormal body temperature, decreased pulse and metabolic rate,

>> > loss

>> > > > of skin turgor, constipation, and starvation diarrhea,

>> > consisting of

>> > > > frequent, small, mucus-containing stools.2

>> > > > Kwashiorkor is a somewhat more complex disease. It is

>> > characterized

>> > > > by edema, low capillary-filtration rate, hypoalbuminemia, and

>> > > > dermatitis.

>> > > >

>> > > > Derived from an African term meaning " the disease that occurs

>> when

>> > > > the next baby is born " , kwashiorkor was initially thought to

>> > result

>> > > > from a diet high in calories (mainly carbohydrates, such as

>> > maize),

>> > > > yet deficient in protein. However, infection, aflatoxin

>> poisoning,

>> > > > and oxidative stress may also play causative roles.1,3 Edema, a

>> > > > defining

>> > > > characteristic of kwashiorkor, resolves with treatment, despite

>> > > > continuing hypoalbuminemia, suggesting that the edema is due to

>> > > > leaky cell membranes, low capillary filtration rates, high

>> > > > concentrations of free iron, and free radicals that increase

>> > > capillary

>> > > > permeability.4 Kwashiorkor is further distinguished from

>> > marasmus by

>> > > > the following findings:

>> > > > * Massive edema of the hands and feet.

>> > > > * Profound irritability.

>> > > > * Anorexia.

>> > > > * Dermatologic symptoms (desquamative rash, hypopigmentation).

>> > > > * Alopecia or hair discoloration.

>> > > > * Fatty liver.

>> > > > * Loss of muscle tone.

>> > > > * Anemia and low blood concentrations of albumin, glucose,

>> > > potassium,

>> > > > and magnesium.5,6

>> > > > Kwashiorkor may also involve severe, life-threatening

>> > > hypophosphatemia

>> > > > (<1.0 mg/dL), which has been found to triple the mortality rate

>> > when

>> > > > compared with children who have normal phosphorus levels.7

>> > > > Treatment

>> > > > Individuals treated for protein-energy malnutrition are at risk

>> > for

>> > > > refeeding syndrome, in which hypophosphatemia, hypokalemia, and

>> > > > hypomagnesemia may lead to disturbances in the cardiac,

>> > neurologic,

>> > > > gastrointestinal, respiratory, hematologic, skeletal, and

>> > endocrine

>> > > > systems. Guidelines have been developed to help prevent these

>> > > > complications

>> > > > and to establish a transition to normalcy. Treatment consists

>> of 2

>> > > > phases: stabilization and rehabilitation.

>> > > >

>> > > > The initial (stabilization) phase proceeds from days 1 through

>> > 7. It

>> > > > consists of treatment and prevention of hypoglycemia,

>> hypothermia,

>> > > > dehydration, and infection; correction of electrolyte imbalance

>> > and

>> > > > micronutrient deficiencies; and a cautious feeding regimen.

>> > > >

>> > > > http://www.wrongdiagnosis.com/k/kwashiorkor/book-

>> diseases-7a.htm

>> > > >

>> > > > Protein-calorie malnutrition: Excerpt from Professional Guide

>> to

>> > > > Diseases

>> > > > (Eighth Edition)

>> > > > " Both kwashiorkor (edematous PCM) and marasmus (nonedematous

>> PCM)

>> > > > are common in

>> > > > underdeveloped countries and in areas in which dietary amino

>> acid

>> > > > content is

>> > > > insufficient to satisfy growth requirements. Kwashiorkor

>> typically

>> > > > occurs at

>> > > > about age 1, after infants are weaned from breast milk to a

>> > protein-

>> > > > deficient

>> > > > diet of starchy gruels or sugar water, but it can develop at

>> any

>> > > > time during

>> > > > the formative years. Marasmus affects infants ages 6 to 18

>> > months as

>> > > > a result

>> > > > of breast-feeding failure, or a debilitating condition such as

>> > > chronic

>> > > > diarrhea.

>> > > >

>> > > > In industrialized countries, PCM may occur secondary to chronic

>> > > > metabolic

>> > > > disease that decreases protein and calorie intake or

>> absorption,

>> > or

>> > > > trauma that

>> > > > increases protein and calorie requirements. In the United

>> States,

>> > > > PCM is

>> > > > estimated to occur to some extent in 50% of elderly people in

>> > > > nursing homes.

>> > > > Those who aren’t allowed anything by mouth for an extended

>> > period

>> > > > are at high

>> > > > risk of developing PCM. Conditions that increase protein-

>> calorie

>> > > > requirements

>> > > > include severe burns and injuries, systemic infections, and

>> cancer

>> > > > (accounts

>> > > > for the largest group of hospitalized patients with PCM).

>> > Conditions

>> > > > that cause

>> > > > defective utilization of nutrients include malabsorption

>> syndrome,

>> > > > short-bowel syndrome, and Crohn’s disease.

>> > > >

>> > > > Read more at

>> > > >

http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm?ktrack=kcplink

>> > > >

>> > > > Signs and symptoms

>> > > > Children with chronic PCM are small for their chronological age

>> > and

>> > > > tend to be

>> > > > physically inactive, mentally apathetic, and susceptible to

>> > frequent

>> > > > infections. Anorexia and diarrhea are common.

>> > > >

>> > > > In acute PCM, children are small, gaunt, and emaciated, with no

>> > > > adipose tissue.

>> > > > Skin is dry and “baggy,†and hair is sparse and dull brown

>> or

>> > > > reddish-yellow.

>> > > > Temperature is low; pulse rate and respirations are slowed.

>> Such

>> > > > children are

>> > > > weak, irritable, and usually hungry, although they may have

>> > > > anorexia, with

>> > > > nausea and vomiting.

>> > > >

>> > > > Unlike marasmus, chronic kwashiorkor allows the patient to

>> grow in

>> > > > height, but

>> > > > adipose tissue diminishes as fat metabolizes to meet energy

>> > demands.

>> > > > Edema

>> > > > often masks severe muscle wasting; dry, peeling skin and

>> > > > hepatomegaly are

>> > > > common. Patients with secondary PCM show signs similar to

>> > marasmus,

>> > > > primarily

>> > > > loss of adipose tissue and lean body mass, lethargy, and edema.

>> > > Severe

>> > > > secondary PCM may cause loss of immunocompetence.

>> > > >

>> > > > Diagnosis

>> > > > CONFIRMING DIAGNOSIS Clinical appearance, dietary history, and

>> > > > anthropometry

>> > > > confirm PCM. If the patient doesn’t suffer from fluid retent

>> ion,

>> > > > weight change

>> > > > over time is the best index of nutritional status.

>> > > >

>> > > > The following factors support the diagnosis:

>> > > > â‘ height and weight less than 80% of standard for the

>> > patient’s

>> > > > age and sex,

>> > > > and below-normal arm circumference and triceps skinfold

>> > > >

>> > > > â‘ serum albumin level less than 2.8 g/dl (normal: 3.3 to 4.3

>> g/

>> > dl)

>> > > > â‘ urinary creatinine (24-hour) level used to show lean body

>> mass

>> > > > status by

>> > > > relating creatinine excretion to height and ideal body

>> weight, to

>> > > > yield

>> > > > creatinine-height index.

>> > > >

>> > > > R Vajda, R.D.

>> > > > www.GingerJens.com

>> > > >

>> > > > ________________________________

>> > > >

>> > > > To: rd-usa ; dhcc@...

>> > > > Sent: Sun, February 20, 2011 8:50:58 PM

>> > > > Subject: FW: Hospital chain, under scrutiny, reports

>> rare

>> > > > illness |

>> > > > Local News | PE.com | Southern California News | News for

>> Inland

>> > > > Southern

>> > > > California

>> > > >

>> > > > This is a very interesting article. Aside from the fact that

>> our

>> > tax

>> > > > $$ are

>> > > > now going to our neighbor to the North, what is the accurate

>> > > > definition of

>> > > > Kwashiorkor IYO? And how is it diagnosed?

>> > > >

>> > > > Digna

>> > > >

>> > > > Hospital chain, under scrutiny, reports rare illness |

>> > > > Local News |

>> > > > PE.com | Southern California News | News for Inland Southern

>> > > > California

>> > > >

>> > > >

http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.h

>> > > > tml

>> > > >

>> > > >