Re: Re: Full Liquid Diet? Evidence based?

June 16, 2011

Maybe the definition of the full liquid diet needs to be broadened...would

we consider pureed a full liquid?

>

> that diet isn't that useful to speech pathologists anymore since

> there are thickeners now that are amylase resistant and those products are

> alot better to train swallowing reflexes.

>

> Merav full liquid diet in hospital setting even if that is the only thing

> that the patient can tolerate it is unacceptably, a college of mine did a

> cost comparison with enteral nutrition products and it was alot cheaper

> using them. Apart from the monetary costs those diets hardly can give

> patients their nutritional needs.

> I was in an internship the last 2.5mo in an hospital were surgeons just

> left the patients with clear liquids for 10 days because of gastric

> bleeding. I just asked them directly what miracle they wanted me to perform

> when they called me to optimize the patient nutritional status before

> surgery after they made them save all those days. After talking to them for

> several hours and show them the evidences most of them realized how wrong

> was what they did. Nowdays with artificial nutrition support these kind of

> acts should be called malpractice.

>

> I advise you to read about ERAS program (Early recovery after surgery).

>

> Just a note, in the hospital that I did that internship they did

> bromatological analysis to the liquid diet and at max (even if optimized

> with energy dense liquids) it gave 800Kcal and 40g of protein. Don't ask me

> because they kept it, apparently the nutrition services director didn't want

> to bother to change ...

>

> Catia Borges

>

> >

> > >

> > > Pam,I am sorry to be the one who says that, but I am very surprised how

> > > harsh and " personal " your response was. these kind of responses hold

> many on

> > > the list from participating in active discussion. We are not all

> informed

> > > 100% on 100% of the topics, and no one should be expected to be an

> expert on

> > > every single topic. It is impossible and very unhealthy,

> professionally, to

> > > anyone,to assume they " know all " .Sometimes clear liquid or full liq

> diets

> > > are the only thing pts can tolerate and its better then NPO, and it

> should

> > > not be used more then few days bc it is nutritionally lacking. But with

> all

> > > do respect to EBM - textbook and studies are not case study and real

> > > practice. Pts are not textbook nor a study, and even in EMB there is a

> value

> > > to case studies. Respected journals publish them all the time. thats

> why

> > > they are called case studies. and to say that clear of full liq diet is

> just

> > > wrong all across the board is wrong too.

> > > Pam, your knowledge and experience are priceless and greatly

> appreciate,

> > > but we need to leave room for ppl to ask freely, without the fear of

> being

> > > scrutinized by others.

> > > Merav Levi, RD, MS, CDNA dietitian, not the food police.

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

> >

>

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

Check out my blog: mixture of deals and nutrition

Join me on Facebook <http://www.facebook.com/TheFrugalDietitian?ref=ts>

Join Crowdtap: Earn gift cards, try out products, support your charity…All

for FREE!!! <http://thefrugaldietitian.com/?p=21973>Polo Shirt with your

logo: $2.95 shipped Great Father’s Day

Gift<http://thefrugaldietitian.com/?p=20750>

* " Nutrition is a Science, Not an Opinion Survey " *

June 16, 2011

The facility where I am employed has fully liquids, runny puree, and

puree...

> Maybe the definition of the full liquid diet needs to be broadened...would

> we consider pureed a full liquid?

>

> >

> > that diet isn't that useful to speech pathologists anymore since

> > there are thickeners now that are amylase resistant and those products

> are

> > alot better to train swallowing reflexes.

> >

> > Merav full liquid diet in hospital setting even if that is the only thing

> > that the patient can tolerate it is unacceptably, a college of mine did a

> > cost comparison with enteral nutrition products and it was alot cheaper

> > using them. Apart from the monetary costs those diets hardly can give

> > patients their nutritional needs.

> > I was in an internship the last 2.5mo in an hospital were surgeons just

> > left the patients with clear liquids for 10 days because of gastric

> > bleeding. I just asked them directly what miracle they wanted me to

> perform

> > when they called me to optimize the patient nutritional status before

> > surgery after they made them save all those days. After talking to them

> for

> > several hours and show them the evidences most of them realized how wrong

> > was what they did. Nowdays with artificial nutrition support these kind

> of

> > acts should be called malpractice.

> >

> > I advise you to read about ERAS program (Early recovery after surgery).

> >

> > Just a note, in the hospital that I did that internship they did

> > bromatological analysis to the liquid diet and at max (even if optimized

> > with energy dense liquids) it gave 800Kcal and 40g of protein. Don't ask

> me

> > because they kept it, apparently the nutrition services director didn't

> want

> > to bother to change ...

> >

> > Catia Borges

> >

> > >

> > > >

> > > > Pam,I am sorry to be the one who says that, but I am very surprised

> how

> > > > harsh and " personal " your response was. these kind of responses hold

> > many on

> > > > the list from participating in active discussion. We are not all

> > informed

> > > > 100% on 100% of the topics, and no one should be expected to be an

> > expert on

> > > > every single topic. It is impossible and very unhealthy,

> > professionally, to

> > > > anyone,to assume they " know all " .Sometimes clear liquid or full liq

> > diets

> > > > are the only thing pts can tolerate and its better then NPO, and it

> > should

> > > > not be used more then few days bc it is nutritionally lacking. But

> with

> > all

> > > > do respect to EBM - textbook and studies are not case study and real

> > > > practice. Pts are not textbook nor a study, and even in EMB there is

> a

> > value

> > > > to case studies. Respected journals publish them all the time. thats

> > why

> > > > they are called case studies. and to say that clear of full liq diet

> is

> > just

> > > > wrong all across the board is wrong too.

> > > > Pam, your knowledge and experience are priceless and greatly

> > appreciate,

> > > > but we need to leave room for ppl to ask freely, without the fear of

> > being

> > > > scrutinized by others.

> > > > Merav Levi, RD, MS, CDNA dietitian, not the food police.

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

> > >

> >

>

> --

> Ortiz, MS, RD

> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

> Check out my blog: mixture of deals and nutrition

> Join me on Facebook <http://www.facebook.com/TheFrugalDietitian?ref=ts>

> Join Crowdtap: Earn gift cards, try out products, support your charity…All

> for FREE!!! <http://thefrugaldietitian.com/?p=21973>Polo Shirt with your

> logo: $2.95 shipped Great Father’s Day

> Gift<http://thefrugaldietitian.com/?p=20750>

> * " Nutrition is a Science, Not an Opinion Survey " *

>

June 16, 2011

I am still waiting to an answer to 's question: What would you have

instead?

Catia,

If you have read my first post I said that clear liq diet is lacking

nutritionally and should not be used more then few days, and to be specific, not

more then 3 days. No one , me included, ever said, it is a nutritionally

balanced, or a great support diet. But ...did you ever feel sick enough not to

be able to take anything in, other then apple juice and chicken broth??????

terrible nutritionally but soothing. what's better ? npo? TF? TPN? I don't think

so. as a transitional diet for SHORT, VERY short time - it could be utilized as

long as we proceed from it.

Merav Levi, RD, MS, CDNA dietitian, not the food police.

http://www.linkedin.com/in/meravlevi

" Life is not measured by the number of breath you take, but by the moments that

take your breath away. " - Carlin " People don't forget the truth, they just

become better in lying " (Revolutionary Road)

To: rd-usa

From: catiapb@...

Date: Thu, 16 Jun 2011 20:24:49 +0000

Subject: Re: Full Liquid Diet? Evidence based?

that diet isn't that useful to speech pathologists anymore since

there are thickeners now that are amylase resistant and those products are alot

better to train swallowing reflexes.

Merav full liquid diet in hospital setting even if that is the only thing that

the patient can tolerate it is unacceptably, a college of mine did a cost

comparison with enteral nutrition products and it was alot cheaper using them.

Apart from the monetary costs those diets hardly can give patients their

nutritional needs.

I was in an internship the last 2.5mo in an hospital were surgeons just left the

patients with clear liquids for 10 days because of gastric bleeding. I just

asked them directly what miracle they wanted me to perform when they called me

to optimize the patient nutritional status before surgery after they made them

save all those days. After talking to them for several hours and show them the

evidences most of them realized how wrong was what they did. Nowdays with

artificial nutrition support these kind of acts should be called malpractice.

I advise you to read about ERAS program (Early recovery after surgery).

Just a note, in the hospital that I did that internship they did bromatological

analysis to the liquid diet and at max (even if optimized with energy dense

liquids) it gave 800Kcal and 40g of protein. Don't ask me because they kept it,

apparently the nutrition services director didn't want to bother to change ...

Catia Borges

>

> >

> > Pam,I am sorry to be the one who says that, but I am very surprised how

> > harsh and " personal " your response was. these kind of responses hold many on

> > the list from participating in active discussion. We are not all informed

> > 100% on 100% of the topics, and no one should be expected to be an expert on

> > every single topic. It is impossible and very unhealthy, professionally, to

> > anyone,to assume they " know all " .Sometimes clear liquid or full liq diets

> > are the only thing pts can tolerate and its better then NPO, and it should

> > not be used more then few days bc it is nutritionally lacking. But with all

> > do respect to EBM - textbook and studies are not case study and real

> > practice. Pts are not textbook nor a study, and even in EMB there is a value

> > to case studies. Respected journals publish them all the time. thats why

> > they are called case studies. and to say that clear of full liq diet is just

> > wrong all across the board is wrong too.

> > Pam, your knowledge and experience are priceless and greatly appreciate,

> > but we need to leave room for ppl to ask freely, without the fear of being

> > scrutinized by others.

> > Merav Levi, RD, MS, CDNA dietitian, not the food police.

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

>

June 20, 2011

Aren't there several medical nutritionals that are considered appropriate

for clear liquids that can be included in the protocol and menu choices?

Even in SNFs I've been doing this for many years if needed.

Not every patient will accept, or is a candidate for invasive procedures

like TPN.

Digna

From: rd-usa [mailto:rd-usa ] On Behalf Of

catianutr

Sent: Monday, June 20, 2011 1:13 AM

To: rd-usa

Subject: Re: Full Liquid Diet? Evidence based?

Merav, Yahoo groups is acting weird and at the moment doesn't show some of

the answers. So I am sorry for the late reply.

In my opinion even 3 days with clear liquids is too much in patients with

high risk of malnutrition. Several studies prove that even 24 h fasting with

only clear liquids increase metabolic stress. Usually in those patients I

allow the liquids that they can eat but use some kind of nutritional support

as well, enteral or parenteral. Even though oral nutrition products don't

taste that great for some people (although I have tried all of them and and

most taste good)they are usually well tolerated if you use low osmolarity

ones. With the oral nutrition support I talk with the patient to check their

preferences if they don't like the taste of a product I usually change to

the other brand.

After GI surgery, if the patient is doing TPN I keep it until they can

fulfil around 60% of their energy needs PO. If they aren't doing TPN instead

of starting with clear liquids diet I start with an oral nutrition support

product. Patients usually tolerate well. I always talk with the patient

explaining that enteral nutrition is part of their treatment and will help

them in recovery. Never had any of them rejecting the products.

Catia Borges

>

> >

>

> > >

>

> > >

>

> > >

>

> > > Pam,I am sorry to be the one who says that, but I am very surprised

how

>

> > > harsh and " personal " your response was. these kind of responses hold

many on

>

> > > the list from participating in active discussion. We are not all

informed

>

> > > 100% on 100% of the topics, and no one should be expected to be an

expert on

>

> > > every single topic. It is impossible and very unhealthy,

professionally, to

>

> > > anyone,to assume they " know all " .Sometimes clear liquid or full liq

diets

>

> > > are the only thing pts can tolerate and its better then NPO, and it

should

>

> > > not be used more then few days bc it is nutritionally lacking. But

with all

>

> > > do respect to EBM - textbook and studies are not case study and real

>

> > > practice. Pts are not textbook nor a study, and even in EMB there is a

value

>

> > > to case studies. Respected journals publish them all the time. thats

why

>

> > > they are called case studies. and to say that clear of full liq diet

is just

>

> > > wrong all across the board is wrong too.

>

> > > Pam, your knowledge and experience are priceless and greatly

appreciate,

>

> > > but we need to leave room for ppl to ask freely, without the fear of

being

>

> > > scrutinized by others.

>

> > > Merav Levi, RD, MS, CDNA dietitian, not the food police.

>

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

>

> >

>

June 20, 2011