Lecture 11b

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Lecture 11b 28 MARCH 2011   Colitis, Migraine
and Respiratory
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Colitis Inflammation of the colon Diarrhea is
an issue since the inflamed colon is incapable of
its normal water management function- ie removing
water from the faeces Complete bowel rest helps
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Ulcerative colitis Treatment Complete
resection (removal) of colon No nutritional
implication but may be diarrhea initially This
diarrhea is transient and apparently
self- correcting Evening primrose oil may have
some limited success for this type of colitis
in terms of stool consistency but this
contradicts self-correcting diarrhea
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Diversion colitis Surgical diversion process by
which the distal colon is left intact but without
the stool stream This results in abdominal
cramping with mucoid or bloody diarrhea Infusion
of salt solution containing short chain fatty
acids (2-4 carbon fatty acids) into rectal
remnant is a remedial measure but complete
reanastomosis is the only complete
cure. Conclusion from scfa treatment?
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Migraine Dural blood vessels become dilated and
the pulsatile blood flow through these vessels
distends and irritates the highly pain sensitive
dura mater -this would explain the throbbing
nature of migraine headaches -inflammatory
component to migraine headache has been
proposed
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Nutritional management of migraine Riboflavin
administration Metabolites of riboflavin
participate in overcoming the mitochondrial
defect that that plays a role in migraine
pathogenesis   Avoiding foods Certain foods in
certain persons trigger migraines -however this
is highly individual with one food or group of
foods affecting a particular person but not
another
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However dietary restriction of a food or food
groups may upset the principles of adequacy,
moderation, variety, nutrient density, energy
control, and balance
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Migraine Foods contributing to this
problem Citrus foods Tea(flavonoids) Coffee
Pork Chocolate Milk Nuts Vegetables C
ola
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Migraine -food components affecting vascular
tone and causing migraine (highly
individual) tyramine, phenylalanine, phenolic
flavonoids, alcohol, food additives (sodium
nitrate, monosodium glutamate), aspartame,
caffeine
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Migraine -foods thought to trigger migraines
subsequent to hypoglycemia are chocolate,
cheese, citrus fruits, bananas, nuts, cured
meats, dairy products cereals, beans, hot dogs,
pizza, food additives coffee, tea, cola drinks,
alcoholic drinks such as red wine, beer or
whiskey distilled in copper stills
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Migraine -solution to all this is trial and
error elimination including meticulous record
keeping -problems with this approach
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Respiratory  Acute respiratory failure Need
sufficient energy and protein to support lung
function and prevent infections without
overtaxing the compromised respiratory
system Fluid and sodium restrictions may be
necessary to ease pulmonary edema  
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Respiratory  Acute respiratory failure Overfeedin
g causes increased carbon dioxide which results
in additional respiratory requirement-therefore
reduce kcal to an appropriate level(energy to
support lung function and prevent infections
without overtaxing the compromised respiratory
system)  
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Respiratory  Aspiration pneumonia Potentially
lethal lung infection Nasogastric feeding or
gastrostomy or jejunostomy which allows the
lower esophageal sphincter to remain
closed -all this helps to reduce aspiration
risk
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Respiratory  Chronic obstructive pulmonary
disease Emphysema and chronic bronchitis are
the two most common examples of chronic
obstructive diseases Frequently
experience weight loss, PEM and infections due
to anorexia and poor food intake, high
energy expenditure due to laboured
respirations
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Respiratory  Chronic obstructive pulmonary
disease Nutritionally Weight loss (caloric
restriction combined with appropriate exercise
levels) Malnourishment- gradual refeeding as
tolerated -easy to eat foods in small
meals to improve food tolerance- enteral
feeding may help -need fewer kcal from
carbohydrate due to carbon dioxide
issue Avoid overfeeding carbon dioxide load
issue
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Respiratory  Cystic fibrosis Laboured breathing-
increased kcal and protein and do not restrict
fat- Enzyme replacements for pancreatic
impairment Multivitamin including fat
soluble vitamins Table salt to overcome
electrolyte losses due to sweating Additional
fluids to liquefy thick secretions and prevent
dehydration Maintain appropriate height to
weight ratio