Quotes, notes and references

"Up-to-date, practical information from dynamic, knowledgable speakers; overall, a valuable learning experience worth the trade-off of being indoors on a rare sunny Saturday in October; I feel inspired, challenged and better informed."

This was my evalution of the recent Education Day I attended. Listening to expert speakers in a supportive, collegial atmosphere boosted my morale as well as knowledge. The next step: translate this into daily practice.

So this week I've been reviewing my handouts. I thought I'd post some quotes, notes and key references pertaining to best practice in nutrition support (enteral and parenteral feeding) and vitamin-mineral supplementation.

Session: Enteral feeding: the practice vs the evidence (Carol Rees Parrish, MS, RD)

"To date, adequately powered studies have not been conducted to demonstrate a significant relationship between GRV [gastric residual volume] and aspiration pneumonia."

"Good evidence exists for maintaining a backrest elevation of greater than 30 degrees to decrease gastric reflux and aspiration events."

Parrish CR, McClave SA. Checking Gastric Residual Volumes: A Practice in Search of a Science? Practical Gastroenterology 2008; XXXII(10):33-47 (PDF)

Session: Parenteral feeding: passé in patients with pancreatitis? (Carol Rees Parrish, MS, RD)

"Jejunal feeding is safe, effective, low risk; best route (NJ, N-G-J vs PEG/J, surgical J) has yet to be determined by a prospective controlled trial."

Krenitsky, J., Makola D., Parrish, C. Parenteral Nutrition in Pancreatitis is Passé: But Are We Ready for Gastric Feeding? A Critical Evaluation of the Literature-Part I (PDF)

Krenitsky J, Makola D, Parrish CR. Pancreatitis Part II - Revenge of the Cyst: A Practical Guide to Jejunal Feeding (PDF)

"In patients with predicted severe acute pancreatitis, probiotic prophylaxis with this combination of probiotic strains did not reduce the risk of infectious complications and was associated with an increased risk of mortality.

Probiotics can no longer be considered to be harmless adjuncts to enteral nutrition, especially in critically ill patients or patients at risk for non-occlusive mesenteric ischemia."

Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial Lancet 2008; 371(9613):651-9.

Session: Drug-induced nutrient depletion and supplementation -- Literature picks (Liz da Silva, RD)

Bardia A, et al. Efficacy of antioxidant supplementation in reducing primary cancer incidence and mortality: a systematic review and meta-analysis. Mayo Clin Proc;83(1)23-34. (PDF)

Bjeklakovic G, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various disease. Cochrane Database of Systematic Rev 2008 Apr 16;(2):CD007176

Expert Group on Vitamins and Minerals. Safe upper levels for vitamins and minerals, food standards agency, London. 2003 (PDF)

Mulholland CA, Benford DJ. What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? Theoretical basis for harm. Am J Clin Nutr 2007;85(suppl):318S-322S. (PDF)

Wildish ED. An evidence-based approach for dietitian prescription of multiple vitamins with minerals. J Am Diet Assoc 2004;104:779-86.

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Complete schedule and speakers' biographies (PDF)

Paying more attention to those "subtle pieces"

Image: Steel Cut Oats 011 *

Quite effortlessly (or perhaps with subconscious intent), I am discovering more Web resources on mental health and diet. Today's ADA Daily News feed included a link to Feel-good foods.

I liked this excerpt that describes the subtle, supportive (and I think necessary) role food plays in mental health:

Nutritional changes aren't a magic bullet; they're subtle pieces of a treatment plan that might also include therapy, exercise--one of the most effective depression busters--and stress-reduction techniques.

But "diet can help with virtually any chronic condition" including depression, said registered dietitian Wendy Bazilian, who holds a doctorate in public health. Just remember that major depression might require an integrative approach that uses food in conjunction with other therapies, including medication and counseling. And never abruptly stop taking medication even if you're experiencing side effects such as weight gain and sexual dysfunction; talk to your doctor about tapering down.

The article also quotes a psychiatrist and author (Dr. James S Gordon), other physicians and a couple of diet book authors (including a registered dietitian) who share research findings, opinions and recommendations on foods to eat more often and foods to limit or avoid.

Link: Feel-good foods

*(Image credit: Photo by Baha'i Views/Flitzy Phoebe. Reproduced under a Creative Commons Licence. "This wonderful hot oatmeal is made with steel cut oats, ground flaxseed, and a generous sprinkling of brown sugar and cinnamon."

Nutrition & Mental Health (part 3)...and an Oops

I like, read and acknowledge all comments.... but I don't get very many comments (hint -- please don't be shy).  So recently I stopped checking for feedback daily and switched to weekly...and  missed seeing until now Kathryn's comment on this post. Kathryn Elliot is the nutritionist-herbalist behind Limes & Lycopenes, a well-written, informative and delightful-to-read blog "dedicated to cutting through the rubbish, misinformation and downright silliness about health, diet and food."

Be sure to check out her Mental and Emotional Health archives and this series of posts on foods and eating habits that nourish the mind. Thank you, Kathryn, for writing on this often-overlooked topic.

Recent additions to the Nutrition Practice Resources page

You may not visit this page regularly so I thought I'd mention a few recent additions in case they're pertinent to your practice and/or interests:

• Canadian Diabetes Association 2008 Clinical Practice Guidelines
  

• Healthy Eating at School
  

• Obesity & the Impact of Marketing on Children -- Chronic Disease Prevention Alliance of Canada (CDPAC)'s position statement
  

More resources on nutrition and mental health

I'm continuing to search for and read resources on nutrition and mental health. I feel like I'm just scratching the surface. Here are some links with my comments.

• Nutrition and the Brain -- This entry in the Encyclopedia of Mental Disorders covers the role of macronutrients and key vitamins in brain structure and function. The information is accurate and clearly explained and could easily be adapted for patient/client education. A dietitian's name (Nancy Gustafson, M.S., R.D., F.A.D.A., E.L.S) is listed at the end but it's not clear if she is the author of this entry.
• Household Food Insufficiency is Associated with Poorer Health (HTML version) (PDF version) -- A Canadian study that examined the relationship between  food insufficiency and physical, mental and social health.  "Individuals in food-insufficient households had significantly higher odds of rating their health as poor or fair, of having restricted activity, of having poor functional health, of suffering from multiple chronic conditions, of having major depression and distress, and of having poor social support compared with those in food-sufficient households" (boldface text added for emphasis). A  valuable evidence-based reference on the impact of food insecurity on health.
• Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women -- Unfortunately the full-text article is not available free online (cost is US$31.50) but you may have access to it through your workplace, library or educational institution.
• Food for Thought (PDF) from The National Alliance on Mental Illness  and Food and Mood (PDF) from the Depression and Bipolar Support Alliance -- Practical, empathetic patient/client eating guidelines.