Saturday, October 3, 2009
Factors in Wasting
Malnutrition and wasting can be caused by four general factors. Any of these problems should be addressed with your doctor, who should also refer you to a registered dietitian.
1. Low intake of calories and nutrients: There are many causes for low intake. Some people suffer loss of appetite from depression, infection, fever, medications, treatment with chemotherapy or radiation, fatigue, diarrhea, or nausea or have fear of eating. Other reasons are due to pain or difficulty chewing, tasting, or swallowing. Some people have financial problems or cannot get around easily and do not have access to food.
2. Malabsorption: This occurs when foods are not getting broken down into nutrients, or if they are, cannot be carried out of the gut into the circulation system. If you have diarrhea or vomiting, food and liquid is not completely being absorbed. Problems causing the malabsorption can be due to medication, malnutrition, or infection. Diarrhea or vomiting may be made worse when there is lactose intolerance or fat malabsorption.
3. Abnormalities in metabolism: Metabolism is the process of using nutrients to run the body. There may be an increased demand for calories protein, and nutrients.
4. The wasting of muscles from not being used: The “use it or lose it” concept is true. Changes in activity can occur when there are changes in work or social routines, or you just don’t feel mentally or physically well enough to keep up your usual physical activity or exercise.
Protein Breakdown
Without enough calories and nutrients from foods vital body tissue protein may be used for fuel. This protein breakdown process is called catabolism. The result is called wasting or cachexia with muscle “atrophy,” a decrease in the size of cells, tissues, and organs. Skeletal muscle loss may be visibly noticed and sometimes not. Weight may not change even though muscle mass has changed. Other body systems can be negatively affected, too. Other problems caused as a result of using protein for fuel include:
- A decreased in immune system competence,
- Increased risk of infections, like PCP,
- Atrophy of the small intestine villi, resulting in difficulty digesting, absorbing, and using nutrients.
Weight loss often occurs around the time of any infection, generally because that person feels too sick to eat or to eat enough. Along with weight lose there is the breakdown and loss of muscle. Muscle is also sometimes called lean body mass, tissue, or body cell mass.
If the weight loss is not stopped, continued loss of lean body mass with each infection can lead to malnutrition. During an infection, the body needs more fuel, calories, protein, and other nutrients to fight back.
Take aggressive action. Don’t wait and think it will pass. If you are not eating like you usually do for more than two days, call your doctor and insist on getting help. Ask for aggressive nutrition support. No one at home or in the hospital has to lose weight.
Get Your Nutrition Trip Together: A Five-Point Plan
1. The Diet
In general, practice eating high protein, high complex carbohydrates, and moderate fat foods, and drink plenty of fluids, 8-12 cups a day. Eat on a regular basis every few hours and whenever you are hungry. Take a general multiple-vitamin and mineral supplement daily and B complex daily. Attend to any nutrition concern. Individually, adjust this plan as conditions warrant.
2. Physical Activity
Practice getting some physical activity on a routine basis. Activity can make a physical and psychological difference. It can make you stronger, more alert and relieve stress.
3. Sleep
Set up a routine so that your sleep is steady and uninterrupted. Try not to sleep too few or too many hours each night. Get attention if there is a problem.
4. Stress Management
Do things that make sense and support your self-esteem. Correct the tasks or situations that hurt your self-esteem. Include ways to release stress and ways to relax.
5. Unconditional Love
Make decisions and do things for you out of self-love and self-respect. This is really the key point. When you are paying attention to loving yourself, everything else is easier.
