Overfeeding, overhydration, elderly patients & the LCP – Clinical Medicine article

Article published in the Royal College of Physicians journal Clinical Medicine 2013;13(3):248-251

Overfeeding and overhydration in elderly medical patients – Lessons from the Liverpool Care Pathway.

Eleni Tsiompanou; Caroline Lucas; Mike Stroud

‘If a convalescent while taking nourishment remains weak, it is a sign that the body is being overnourished’ Hippocratic Aphorism – 4th century BC

Abstract 

This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. Artificial nutrition and hydration were stopped. They quickly improved and the LCP was discontinued. Two of the patients deteriorated again on reintroduction of enteral feeding and/or intravenous fluids, only to improve a second time following withdrawal of feeding and fluids. Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.

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“Toxicity in Chemotherapy — When Less Is More”

Slide1

An exciting article in the world’s most prestigious journal, the New England Journal of Medicine,

 

analysing recent research on how fasting before, during and/or after chemotherapy can improve

 

the anti-cancer effect of the chemotherapy and reduce the side effects from the treatment.

 

Why does this happen?

 

Because normal cells can protect themselves better during fasting, but cancer cells cannot.

 

A word of caution from the authors that:

  1. these are preliminary results, done in cell cultures and animals and only in small numbers of human beings 
  2. fasting should not be applied in malnourished patients and malnutrition must be prevented and
  3. re-feeding after fasting is extremely important and may need to be done very slowly and carefully 

In conclusion, this is an exciting area of on-going research.

What and how we eat can affect us in profound ways. 

Article by: Alessandro Laviano and Filippo Rossi Fanelli. New England Journal of Medicine 2012; 366:2319-2320 http://www.nejm.org/doi/pdf/10.1056/NEJMcibr1202395

“Recent research that short-term fasting before or after chemotherapy, or at both times, induces differential stress resistance in normal and cancer cells.

In normal cells, fasting activates protective metabolic pathways that confer resistance to oxidative stress (Panel B).

In contrast, yeast transformed with an activated oncogene is unable to turn on the protective response and thus remains sensitive to oxidative stress.

Additional experiments using mouse models of human cancer showed that fasting specifically augments levels of oxidative stress and sensitivity to oxidative damage (e.g., that inflicted by chemotherapeutic agents) in cancer cells and that these effects are accompanied by DNA damage and apoptosis.“