Introducing Entry Level Clinical Nutrition™ -- Part V The New Age Of Sickness And Scarcity: An Overview of the Seven-Step Program
My last post reviewed the impressive work of Stig Bengmark, MD, PhD, an internationally recognized expert on critical care nutrition. In that post, I noted that Dr. Bengmark draws a direct linkage between the acute phase response - a response to a short, intense, traumatic stress - and what he calls the chronic phase response (CPR). He says that the CPR is the body's response to "long-lasting, continuous . . . mental and/or physical stress". He says that its effects resemble those of the acute phase response in many respects.
Bengmark also says - and I agree - that many chronic "diseases" such as chronic fatigue, depression and reduced muscle mass, are not diseases at all but are actually responses to long-term mental and physical stressors. Yet these "diseases" represent the chief complaints of many of our chronically ill patients.
This remarkable idea - that the CPR is the true reason for many chronic "diseases" - forms the biochemical and physiological basis for Entry Level Clinical NutritionTM. The prior post summarized what practitioners can do to help many chronic illness sufferers in terms of optimizing many of the metabolic imbalances associated with the CPR:
- Optimize muscle mass and amino acid levels
- Reduce inflammation
- Improve insulin sensitivity
- Optimize pH
- Optimize dietary carbohydrate / protein ratio
- Optimize gastrointestinal function
- Optimize key micronutrients such as vitamin D, iodine, and zinc
Now, I would like to present an overview of the seven specific modalities we use to address each of these aspects of Entry Level Clinical NutritionTM. This seven-step program is based on the vast amount of biochemical/physiologic/nutritional information available from critical care nutrition literature.
1. Optimizing muscle mass and amino acid levels
It's well known that muscle strength consistently predicts both morbidity and mortality. That's why preventing or reversing sarcopenia - which some consider "normal" muscle wasting associated with aging - is an essential component of age-related health promotion.
Substantial scientific literature shows that amino acid and protein supplementation stimulates muscular protein synthesis. These supplements also can directly improve energy performance by encouraging an anabolic shift. In addition, amino acid and fish oil supplements help counteract muscle wasting and cellular energy reduction. Studies also suggest that these supplements may improve cardiac function and muscle performance, enhancing the patient's quality of life.
2. Reduction of inflammation
While dealing with muscle issues is important, addressing inflammation shouldn't be very far behind. Inflammation's role in cardiovascular disease, obesity, and diabetes is becoming better understood; however, the importance of subclinical inflammation in chronic illness is less appreciated. Given what we know about the impact of long-term stress on the body, we must acknowledge that a constant systemic stressor like inflammation is a crucial issue in the chronically ill patient.
So we shouldn't be surprised when we read about dramatic improvement in cachetic patients when they take fish oil and herbs such as curcumin. Of course, there are many ways to reduce inflammation and I'll be giving this topic much greater attention in future posts.
3. Improvement of insulin sensitivity
Insulin is the major anabolic hormone. If we are serious about treating chronic illness, we must restore the anabolic condition as much as possible. Wise use of herbs and nutrients to enhance insulin activity and sensitivity is therefore an important part of our effort to reduce catabolism.
At the same time, given that most insulin receptors are found in muscle, increases in protein synthesis and ATP production are vital if we are going to be successful with insulin resistant patients. This, of course, brings us back to the importance of increasing muscle mass as an integral part of the Entry Level Clinical NutritionTM program.
4. Optimization of pH
Chronic, low-grade metabolic acidosis is remarkably important - yet poorly understood. Only now is the medical community beginning to recognize how important central acid-alkaline imbalance is in the creation of ill health for almost every patient you see each day. The problem starts with the overwhelmingly acidogenic modern diet. When we add the aging body's natural tendency toward more acidic status, it becomes clear that maintaining acid / alkaline homeostasis is a significant challenge.
Long-term acidosis is connected to bone loss and it can accelerate a shift toward muscle protein catabolism and proteolysis. Rebalancing toward an anabolic physiology can begin with simple dietary changes, plus magnesium glycinate and potassium bicarbonate supplementation. Together, these steps can help reverse the catabolic effects noted above.
5. Optimizing dietary carbohydrate / protein ratio
Simply put, diet is one of the most significant daily influences on our health. Providing the right fuel to the human system starts with ample quality protein sources, augmented by moderate consumption of high quality fats and less glycemic carbohydrates. Optimizing diet helps to create a desired anabolic trend. Protein-based drinks and bars should be judiciously considered when quality foods aren't available.
6. Optimization of gastrointestinal function
No matter what the chronic condition may be, catabolism typically leads to gut mucosal atrophy. What's more, poor dietary and sleeping habits also impact gut health. And if our food is not being digested properly, it goes without saying that we will be lacking in the benefits of proper nutrition.
So it's not surprising that GI symptoms such as gas, bloating, constipation, and/or diarrhea and findings of maldigestion and malabsorption often accompany many chronic illnesses. Betaine HCl and digestive enzymes are often a good place to start when addressing these situations.
7. Optimizing key micronutrients such as vitamin D, iodine, and zinc
A number of aspects of chronic illness, such as catabolism and inflammation, can interfere profoundly with micronutrient metabolism. When these interferences occur, key micronutrients are often unable to perform tasks that are critical to assure optimal function of intracellular mechanisms. In turn, the patient's physiology becomes more catabolic, with negative results.
This detrimental situation can be worsened by low dietary intake of such nutrients as vitamin D, iodine, and zinc. The use of micronutrient supplementation can make sense with these patients in the form of a quality multivitamin/mineral product. Addition of increased amounts of vitamin D, iodine, and/or zinc should also be considered.
Having reviewed these modalities, you can see that Entry Level Clinical NutritionTM is a sensible and remarkably easy-to-use approach. There is, of course, more to it than what I have just described and my next post will begin to explore this fascinating, practical program in more detail.
Meanwhile, if you'd like to pursue these ideas further, please click on the following link, which will take you to the Moss Nutrition web site and our section on Entry Level Clinical NutritionTM. There you'll see a chart I developed which gives an overview of the physiologic basis of the topic, plus general diagnostic and treatment parameters.
You can also learn more about Entry Level Clinical NutritionTM by calling us at 800-851-5444. You will be greeted by one of our clinical specialists who will be happy to talk with you.
Click Here to view the Entry Level Clinical Nutrition Training Series at FMTown!
