Welcome to the Nutrition Section.

The nutritional and herbal medicine information is collected from clinical trials and research, as well as traditional uses. It will be regularly updated via seminars. For more information go to Colleges, the National Centre for Naturopathic Medicine and Seminars pages.

This section contains information on Nutrition and Herbal Medicine that reflects current trends and information being presented to the general public. This section is currently and continuously being updated - Stay tuned.

Vitamins

Minerals

Amino acids

Immunonutrition

Nutrition and Infection

Herbal Medicines

For information on herbal medicines, visit the Herbal Page.

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New Books

New books by Brad McEwen are soon to be published in December 2007. One of these books is "Clinical Applications of Amino Acids". For more information on this book go to the Products page.

Amino acids

Immunonutrition--supplementary amino acids and fatty acids ameliorate immune deficiency in critically ill patients

Immunonutrition with omega-3 fatty acids and the “conditionally essential” amino acids arginine, glutamine, cysteine, and taurine can enhance the immune response in critically ill patients. This is due to the immunomodulating properties of these nutrients.
Immunonutrition is especially important when a patient’s immune response is compromised, as is the case post-operatively or after trauma. Immune deficiency is severely aggravated in sepsis and the systemic inflammatory response syndrome (SIRS). The resulting metabolic stress is characterised by glycolysis, lipolysis, and proteolysis, which may escalate to a hypercatabolic response or “autocannabilism”. Catabolic metabolism results in insufficiency of both specific and unspecific immunocompetent cells.
Immunonutrition should be started early in such patients for an optimal beneficial effect, preferably via the enteral route. It should include medium chain and long chain triglycerides, polyunsaturated omega-3 and omega-6 fatty acids (in the ratio 1:2), olive oil, and conventional amino acid preparations supplemented with the conditionally essential amino acids arginine, glutamine, cysteine, and taurine.

(Grimm H and Kraus A 2001, Immunonutrition--supplementary amino acids and fatty acids ameliorate immune deficiency in critically ill patients, Langenbecks Arch Surg, Aug; 386(5): 369-76.)

Metabolic changes after polytrauma: an imperative for early nutritional support

Severe trauma induces massive changes of the physiological state by alteration of metabolic pathways and activation of the innate immune system. The post-traumatic metabolic changes are characterized by hypermetabolism with increased energy expenditure, enhanced protein catabolism, insulin resistance associated with hyperglycaemia, failure to tolerate glucose load, and high plasma insulin levels (“traumatic diabetes”). The alterations of the physiological metabolic pathways leads to the development of hyperglycaemia and metabolic acidosis with hyperlactataemia. The increased oxygen demands of the polytraumatised patient further aggravate the hypermetabolic state by enhanced mitochondrial oxygen utilisation

The state of hypercatabolism after severe injury can lead to severe complications associated with posttraumatic hyperglycaemia, hypoproteinaemia, lactate acidosis, and immunosuppression.

The post-traumatic catabolic state requires an adjusted energetic balance with early protein substitution and hypercaloric nutrition. Patients with major injuries who receive no nutrition during the first few days after trauma can develop cumulative caloric and protein deficits which contribute to the risk of increased complications, such as infections and organ failure.

The concept of “immunonutrition” has been established in recent years and exemplified by the enteral supplementation of glutamine, one of the most promising new nutritional concepts for severely injured patients in recent years.
Glutamine is an essential amino acid which exerts metabolic benefits beyond its nutritional value by mediating immunological effects, such as induction of neutrophil phagocytic activity and oxidative burst. Glutamine was also shown to protect neutrophils from undergoing apoptosis in vivo. In addition, glutamine is a precursor to the reducing agent glutathione and thus contributes to antioxidant effects and cellular protection from ischaemia/reperfusion-mediated injury. This protective effect of glutamine has been demonstrated in different experimental models of ischaemia/reperfusion injury. Also, models of experimental starvation have shown the important nutritional effect of glutamine for enterocytes and intestinal mucosa. Furthermore, glutamine has been shown to restore cellular energy reserves to normal levels after haemorrhagic shock and to attenuate the extent of shock-induced cellular apoptosis. This finding is supported by reduced bacterial translocation in rat guts and improved gut immune function after diet supplementation with glutamine.
A prospective, randomised, double-blind controlled clinical trial demonstrated that glutamine supplementation reduces the incidence of multiple organ failure and death attributed to infections in critically ill patients.

In addition to glutamine, Ω-3 fatty acids have become an important nutritional supplementation for severely injured patients in recent years. These long-chain polyunsaturated fatty acids derived from fish oil were shown to exert potent anti-inflammatory properties in trauma patients, such as attenuation of arachidonic acid-derived metabolites like prostaglandin PGE2 and leukotriene LTB4, inhibition of leukocyte activation and chemotaxis, and attenuation of pro-inflammatory gene expression levels.

(Hasenboehler E, Williams A, Leinhase I, Morgan SJ, Smith WR, Moore EE, Stahel PF 2006, Metabolic changes after polytrauma: an imperative for early nutritional support, World Journal of Emergency Surgery, Oct 4; 1: 29-35.)

Nutrition and Infection

It is now apparent that nutritional status has a profound impact on immune function and that the immune system may be modulated by the use of specific modes of nutritional support.
In selected malnourished or severely injured patients, early nutritional support has been shown to improve outcome and decrease the incidence of infectious complications following major surgery or trauma. Enteral feedings appear to support the immune system better than parenteral feedings. TPN, although a potentially life-saving modality, should not be used indiscriminantly and should be limited to those severely malnourished or injured patients who are incapable of tolerating enteral feedings. The patient's metabolic needs should be assessed as accurately as possible, and the appropriate combination of substrates should be provided according to the patient's level of hypermetabolism. Overfeeding should be avoided.

A number of nutritional substrates have been identified which may potentially modulate specific aspects of immune function. Among these, glutamine, arginine, and omega-3 fatty acids have demonstrated potential clinical usefulness. Iron deficiency appears to be a normal host defence response to infection or trauma and should not be compromised by attempts at iron replacement therapy.
In summary, optimal nutritional support of the surgical patient supports the immune system and reduces the morbidity and mortality associated with severe malnutrition or injury.
(Mainous MR and Deitch EA 1994, Nutrition and Infection, Surg Clin North Am, Jun; 74(3): 659-76.)

This information is presented for your personal educational purposes only. It does not replace or substitute medical advice, nor is it intended to diagnose or treat, and should not be used so. Always consult a health care professional. Use only as directed. If symptoms do persist, or if you are unsure, consult your Health Care Professional. Please read labels carefully. Do not stop taking your medications. Speak to your doctor.