Nutritional Therapies

Diet as therapy has been practiced for centuries. The father of medicine, Hippocrates, wrote extensively about the therapeutic use of diet, yet until relatively recently modem medicine has largely forgotten the overwhelming role of diet, except as related to such problems as obesity and diabetes. 

Nutrients are the chemical components of diet and are essential to life and health. Nutrients are classed as either macronutrients or micronutrients  

If micronutrients are absent or too low, illness results. Scurvy, for example, is a disease resulting from lack of vitamin C. It was once the curse of sailors who had to make long trips to sea with no access to fresh fruit or vegetables. Once the connection between scurvy and fresh fruit had been made and the sailors were issued lime juice to drink, scurvy virtually disappeared. 

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G. J. Dutton, ed., Glumronicyicid—Free and Combined Chemist, Biochemistry, Pharmacology andMedicine, Academic Press, Inc., New York 1966 B. L. Horecker in G. Rit2el and G. Bmbacher, eds.. Monosaccharides and Polyols in Nutrition, Therapy and Dietetics, Hans Huber, Bern, Swit2erland, 1967, p. 1. 

When normal enteral feeding in not possible or is inadequate to meet an individual s nutritional needs, intravenous (IV) nutritional therapy or total parenteral nutrition (TPN) is required. Products used to meet the IV nutritional requirements of the patient include protein substrates (amino acids), energy substrates (dextrose and fat emulsions), fluids, electrolytes, and trace minerals (see the Summary Drug Table Electrolytes). 

Phytochemicals have little nutritional value and do not get absorbed in the body, but they seem to turn on certain switches in the biochemical mechanisms, which signal the beneficial pathways to maintain health, and to turn off the switches which proceed to adverse biochemical pathways. Rice bran products have demonstrated significant benefits as nutritional therapies in diabetes, hyperlipidemia, cancer, fatty liver, hypercalcuria and heart disease. There is experimental and clinical evidence for the beneficial health effects of the following bioactives of rice bran ... 

Myo-inositol is one of the most biologically active forms of inositol. It exists in several isomeric forms, the most common being the constituent of phospholipids in biological cell membranes. It also occurs as free inositol and as inositol hexaphosphate (IP6) also known as phytate which is a major source from food. Rice bran is one of the richest sources of IP6 as well as free inositol. Inositol is considered to belong to the B-complex vitamins. It is released in the gastrointestinal tract of humans and animals by the dephosphorylation of IP6 (phytate) by the intestinal enzyme phytase. Phytase also releases intermediate products as inositol triphosphate and inositol pentaphosphate. Inositol triphosphate in cellular membrane functions as an important intra- and intercellular messenger, that merits its value as a nutritional therapy for cancer. 

King CK, Glass R, Bresee JS, et al. Managing acute gastroenteritis among children Oral rehydration, maintenance, and nutritional therapy. MMWR Morb Mortal Wkly Rep 2003 52(RR16) 1-16. 

In recent years, parenteral dosage forms, especially IV forms, have enjoyed increased use. The reasons for this growth are many and varied, but they can be summed up as (a) new and better parenteral administration techniques, (b) an increasing number of drugs that can be administered only by a parenteral route, (c) the need for simultaneous administration of multiple drugs in hospitalized patients receiving IV therapy, (d) new forms of nutritional therapy, such as intravenous lipids, amino acids, and trace metals, and (e) the extension of parenteral therapy into the home. 

Because the development of antibiotic resistance will continue to be a problem, the development of effective alternative treatments is imperative. Immunization, probiotics, antisecretory agents, improved oral rehydration and nutrition therapy and nonabsorbable antibiotics are being considered by clinicians and researchers. Novel... 

Lima AA, Carvalho GH, Figueiredo AA, Gi-foni AR, Soares AM, Silva EA, Guerrant RL Effects of an alanyl-glutamine-based oral rehydration and nutrition therapy solution on electrolyte and water absorption in a rat model of secretory diarrhea induced by cholera toxin. Nutrition 2002 18 458-462. 

Medical nutrition therapy is recommended for all patients. For individuals with type 1 DM, the focus is on regulating insulin administration with a balanced diet to achieve and maintain a healthy body weight. A meal plan that is moderate in carbohydrates and low in saturated fat, with a focus on balanced meals is recommended. In addition, patients with type 2 DM often require caloric restriction to promote weight loss. Bedtime and between-meal snacks are not usually needed if pharmacologic management is appropriate. 

Drug/Food interactions Several case reports and single-dose studies suggest that enteral nutritional therapy may decrease phenytoin concentrations however, this has not been substantiated. 

Hypomagnesemia For replacement therapy in magnesium deficiency, especially in acute hypomagnesemia accompanied by signs of tetany similar to those observed in hypocalcemia. When added to total parenteral nutrition therapy, to correct or prevent hypomagnesemia that may arise during the course of therapy. 

If possible, take with food. Patients may improve the taste of ritonavir oral solution by mixing with chocolate milk or enteral nutritional therapy liquids (eg, Ensure, Advera) within 1 hour of dosing. The effects of antacids on the absorption of ritonavir have not been studied. 

Hyperammonemia has occurred during parenteral nutrition as a component of therapy for renal insufficiency (905). The hyperammonemia presented as a change in mental status, developing about 3 weeks after initiation of parenteral nutrition therapy in most cases the episodes are of increasing duration and paroxysmal. In three of the patients, serum amino acid analysis in the acute phase showed reduced concentrations of ornithine and citrulline (the respective substrate and product of condensation with carbamyl phosphate at its entry into the urea cycle). Concentrations of arginine, the precursor to ornithine, were raised. 

Table 9.1 Summary of Discussed Single Nucleotide Polymorphisms, Including Their Influence on the Risk of Coronary Artery Disease and Some Possible Medical Nutrition Therapy Recommendations... 

Vakili S, Caudill MA. Personalized nutrition Nutritional genomics as a potential tool for targeted medical nutrition therapy. NutrRev. 2007, 65 301-315. 

Maxwell AJ, Anderson BE, Cooke JR Nutritional therapy for peripheral arterial disease a double-blind, placebo-controlled, randomized trial of Heart Bar. Vase Med 2000 5( I) I 1-19. 

Nutritional therapy for HMG-CoA lyase deficiency has two major goals. First, the prescribed diet aims to provide enough total protein and calories to achieve normal growth and maintain metabolic balance in the context of a leucine-restricted diet. Equally important, the nutritional therapy focuses on preventing excess catabolism, acidosis, and hypoglycemia, especially during times of acute illness. For these patients, it is particularly important to avoid fasting at any time. 

In summary, HMG-CoA lyase deficiency is a unique inborn error of metabolism with profound effects on both amino acid catabolism and metabolic homeostasis in the fasted state. Management of these patients is difficult and requires constant attention to daily nutrition and timely intervention during acute illness. Fortunately, nutritional therapy treatment that provides a diet adequate for growth but with limited intake of leucine and prevents fasting and hypoglycemia enables individuals with HMG-CoA lyase deficiency to live normal active lives. 

Optimal nutrition therapy requires defining the patient s nutrition goals, determining the nutrient requirements to achieve those goals, delivering the required nutrients, and assessing the nutrition regimen. 

Implement fluid/nutrition therapy, taking into account the nature of injuries and/or agents exposed to and monitoring hydration and fluid balance accordingly. 

H.L. Levy. 1989. Nutritional therapy for selected inborn errors of metabolism J. Am. Coll. Nutr. 8 54S-60S. (PubMed)... 

Schenker, S., Halff, G.A. Nutritional therapy in alcohohc hver disease. Semin. Liver Dis. 1993 13 196 - 209... 

Stickel, F., Hoehn, B., Schuppan, D., Seitz, H.K. Review article Nutritional therapy in alcoholic liver disease. Alim. Pharm. Ther. 2003 18 357-373... 

Nutritional therapy of liver diseases 850 6.1 Ascites in portal hypertension 869... 

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