Pharmaconutrition

Coining new terms is a robust enterprise in medicine.  Last week we had 'biosurveillance.'  Now there's 'pharmaconutrition.'  As Rick and I agree in this week's podcast, at least there's some intuitive understanding possible with such compound words, in contrast to that other medical addiction, acronyms.  Yay!

So what is pharmaconutrition?  Just as it sounds, it's the use of nutrition and nutritional supplements as pharmaceuticals, with the intention of improving an outcome or even curing a condition.  Lofty goal for things we  ingest!  In this study 'Enteral Omega-3 Fatty Acid, Y-Linoleic Acid, and Antioxidant Supplementation in Acute Lung Injury,' published in JAMA. investigators tried using these supplements, known in the common vernacular as fish oils, in people who were on ventilators. They were trying to improve lung function and wean these folks off mechanical ventilation sooner.  Alas, not only didn't fish oil help, it actually appeared to make things worse.

272 patients who required mechanical ventilation were enrolled in this study from a number of hospitals.  All of the patients received nutrition via a tube inserted into the stomach as due to the ventilation device, they couldn't swallow things orally.  About half received omega-3 fatty acids twice a day while the others got a placebo.  Blood tests on subjects demonstrated an 8-fold increase in a fish oil metabolite, but most disappointingly, folks who received the supplement stayed on the ventilator more days than those who did not, remained in the ICU longer, and experienced a higher rate of death, 25.1% versus 17.6%, compared with those who did not receive the supplements.  The study was stopped early.

Well.  As Rick opines in the podcast, yet one more demonstration of what observational studies seem to clearly show is a good idea is disproven when subjected to that gold standard, the double blind, placebo controlled, randomized, prospective study.  It reminds me of studies several years ago that seemed to suggest that vitamin E supplements, in light of their antioxidant capabilities, would benefit smokers in helping them avoid the inevitable lung inflammation and injury secondary to sucking in smoke.  Lo and behold, the supplements made things worse and simply reiterated a forgone conclusion:  don't smoke.

Seems like there are a variety of studies lately, though, not only disproving the benefits of supplements but actually showing their harmful nature.  I'm not only referring to things like ephedra as a weight loss aid but to that old standby, calcium.  Burgeoning evidence suggests that calcium supplements, especially in older women, may increase a woman's chance of heart disease and heart attack.  Yikes!  We've been touting these for years as a means to stave off osteoporosis,and now we're learning they may hasten heart disease.  So what's a woman to do?  Protect her bones or her heart?  Avoid that well worn path from falls to hip fracture to death, only to succumb to a fatal MI?

I'm not even going to attempt to wrestle that one to the mat, but here's the view from the cheap seats:  once again, moderation is key, and it appears that obtaining one's optimal nutrition is best achieved by consuming foods with all the right stuff.  Here's how to keep it simple:  if you can recognize a food, eat it.  If you can't, because it's been colored, processed, and packaged to a mere vestige of itself, don't. Eat way more veggies, fewer fruits, and even less meat, and only meats that once again, resemble the animal from which they came. 

Other topics this week include using social media to identify problems drinkers among college students in Archives of Pediatric and Adolescent Medicine, end of life advance directives and their impact on medical costs in JAMA, and surgery at the end of life in the Lancet.  Until next week, y'all live well.

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