Nutrition of the Critically Ill — A 21st-Century Perspective

Abstract

Health care-induced diseases constitute a fast-increasing problem. Just one type of these health care-associated infections (HCAI) constitutes the fourth leading cause of death in Western countries. About 25 million individuals worldwide are estimated each year to undergo major surgery, of which approximately 3 million will never return home from the hospital. Furthermore, the quality of life is reported to be significantly impaired for the rest of the lives of those who, during their hospital stay, suffered life-threatening infections/sepsis. Severe infections are strongly associated with a high degree of systemic inflammation in the body, and intimately associated with significantly reduced and malfunctioning GI microbiota, a condition called dysbiosis. Deranged composition and function of the gastrointestinal microbiota, occurring from the mouth to the anus, has been found to cause impaired ability to maintain intact mucosal membrane functions and prevent leakage of toxins—bacterial endotoxins, as well as whole bacteria or debris of bacteria, the DNA of which are commonly found in most cells of the body, often in adipocytes of obese individuals or in arteriosclerotic plaques. Foods rich in proteotoxins such as gluten, casein and zein, and proteins, have been observed to have endotoxin-like effects that can contribute to dysbiosis. About 75% of the food in the Western diet is of limited or no benefit to the microbiota in the lower gut. Most of it, comprised specifically of refined carbohydrates, is already absorbed in the upper part of the GI tract, and what eventually reaches the large intestine is of limited value, as it contains only small amounts of the minerals, vitamins and other nutrients necessary for maintenance of the microbiota. The consequence is that the microbiota of modern humans is greatly reduced, both in terms of numbers and diversity when compared to the diets of our paleolithic forebears and the individuals living a rural lifestyle today. It is the artificial treatment provided in modern medical care—unfortunately often the only alternative provided—which constitute the main contributors to a poor outcome. These treatments include artificial ventilation, artificial nutrition, hygienic measures, use of skin-penetrating devices, tubes and catheters, frequent use of pharmaceuticals; they are all known to severely impair the microbiomes in various locations of the body, which, to a large extent, are ultimately responsible for a poor outcome. Attempts to reconstitute a normal microbiome by supply of probiotics have often failed as they are almost always undertaken as a complement to—and not as an alternative to—existing treatment schemes, especially those based on antibiotics, but also other pharmaceuticals.

Intestinal alkaline phosphatase promotes gut bacterial growth by reducing the concentration of luminal nucleotide triphosphates

“…Probiotics are live organisms that provide health benefits and mostly include Lactobacillus species, Bifidobacterium species, Escherichia coli, Saccharomyces boulardii, and Trichuris suis (10,38,50,52,53). Although clinical trials of probiotics in some instances of dysbiosis have shown promising results, the efficacy of these live organisms appears to be quite limited and there is concern about occasional harmful side effects (3,5,43,46,57). 1 Prebiotics are defined as nondigestible food ingredients that promote the growth of bacteria, stimulate host immunity, prevent pathogenic infections, and facilitate host metabolism and mineral absorption (10,11,13,30,47,51,52).…”

Cortisol, alpha amylase, blood pressure and heart rate responses to food intake in men aged 50–70 years: importance of adiposity

“…This suggests that even moderate levels of carbohydrates can elicit a significant HPA axis response in overweight/obese men. The notion that even moderate levels of carbohydrates can elicit significant HPA axis activity is of particular significance, especially in the context of the modern day western diets including large quantities of refined carbohydrates [25]. This could even be more relevant to individuals who are already overweight/obese and are on a high carbohydrate diet because regular elevations of cortisol may further complicate metabolic anomalies that may already exist.…”

Die Paläoernährung und ihr Stellenwert für die Prävention und Behandlung chronischer Krankheiten

“…Nach Meinung der Autoren könnte das erweiterte Paläokonzept als "Lebensphilosophie" zur Bekämpfung der nicht übertragbaren Krankheiten und damit zur Sanierung der "Zivilisationsschäden" der Menschen beitragen. Auch für die Patientenversorgung und klinische Ernährung ließe sich das Konzept sehr gut anpassen und böte Chancen zur Verbesserung der Prognose [133].…”