The other day I had been to a reputed hospital of Bhubaneswar, where a relative of mine was admitted. The treating doctor and ICU in-charge were more concerned about antibiotics, central line, sodium, potassium level but had no time to instruct the nurses or the attendants about the food to be given through mouth or nasogastric tube. The human body needs 1,200 to 1,500 kilocalories per day to survive doing nothing whereas a burn case may require three to four thousand calories. An asthmatic or heart failure case may need high calories. One gram sugar, one gram oil and one gram protein provide four, nine and four calories, respectively whereas one gram of alcohol provides seven calories. Along with calories, high-class protein, vitamins, trace elements and electrolytes are essential to sustain life.
A sick person requires more calories depending on the type of illness. If sick people do not eat enough, they use their own body fat and muscles for energy and nutrients. They lose weight and become undernourished. Their immune systems may become less effective and they are less able to fight infections. The tissue healing and repair work depends on the nutritional aspect of the patient not on antibiotics or MRI or CT or tumor markers. But the modern medical men are more concerned about all those and leave this important part ‘nutrition’ to a person who has least knowledge on the subject.
Sick people may have used up their stores of vitamin B complex, Vitamins A & C, iron and other micronutrients. They need a variety of nutrient-rich foods to refill these stores. People can eat more during recovery if they eat extra food at each meal and/or more meals and snacks each day. Breastfeeding children who are recovering from illness should be breastfed more often. Avoid foods that require a lot of chewing. Puree or grind foods like meat and vegetables make them easier to eat. liquid foods such as soups and dal are also good options. "Real ethnic foods are always the best choice,"
Diet requirement of a liver disease patient is different from a kidney or a heart failure patient. Our modern doctors did their graduations and superspecialities reading books written by foreign authors, who have no idea about what Odia, Bengali, Maharashtrian or a Telugu eats. They wrote Western type of food for the patients! Neither our smart doctors are interested to know or read these boring topics called nutrition in health and disease. At best, they prescribe some powders or liquids without knowing what they contain. Recently, a cancer relative of mine had gone to Mumbai spending his hard-earned retirement money and getting bankrupt purchasing some fruits whose name I did not know -- Dragon Fruits (Pitya), Qi (Quie Ying), Avocado, Chinese red meat redish, Miracle Berry with a belief that these fruits would cure him of his aliment. When I asked him why you are eating such unknown, imported costly fruits, his wife answered, “The Mumbai doctor had advised to consume these fruits.” I did not interfere in their imported fruit ideas and the soya protein costing two thousand rupees for nine hundred grams!
I thought that ‘commissions are known in drugs but fruits’IJ People of other countries have started following our ancient system of medicine, but you have fallen into a trap like many Indians. lucky that you have not gone to any mataji or babaji, I commented with a smile. There are lots of misconceptions on diet among educated and uneducated public. The health drink powders are a billion dollar businesses in India. Parents purchase costly health drinks for their children with the hope that they will be a six-footer, muscular like Mr India. Some firms catch hold of celebrities and sportspersons and campaign for drinks as meant for pregnant women, lactating mothers, senior citizens, memory expanders and for fair complexions. lots of myth surrounds the food and fruits which Indian sick persons consume. Earlier days, no one used to take almond, but now you go to any low or middle income group relatives or friends they would serve almond and salted cashew nuts! I know many relatives of mine losing memory fast after consuming almonds and germinating cereals!
Coming to nutrition in hospital, it is seen that very many patients die due to improper nutrition, inadequate calories, protein and vitamins. Water-soluble vitamins are not stored in body; hence, they have to be supplemented through tablets or food every day. No other country in the world has so much of variety of choice in food during health and diseases as in India. The doctor must know the food habits of Indians of different regions. Hope our ICU and critical care medicine doctors take care of the nutritional aspect of their patients for quick recovery provided they are interested. We must remember that nursing care and nutrition is the cornerstone of patient management, be it in hospitals or at homes. The diet part should not be left for the untrained persons to decide regarding the intake of calories, protein, fats, carbohydrates, minerals, vitamins, sodium, potasium, iron and other trace elements in the diet of the hospitalised patients.
Bhubaneswar is unique in one way that most of the hospitalised senior citizens have low sodium level, reasons best known to our research scholars. This problem could be due to too much salt loss in hot and humid condition or medicines for their high blood pressure and salt restrictions. One should never try to correct low sodium and low potassium level quickly or else the patient will become worse. Everyone should remember it’s the nutritional aspect which plays a major part on the outcome of patients, not the costly antibiotics and unnecessary investigations. Medical men should remember patients suffering from different diseases need different food supplements and calories. Adequate rest, drinking fluids and getting proper nutrition are some of the most important things one can do to feel better and recover faster when sick. But some foods have benefits that go beyond just providing your body with nutrients. While food alone cannot cure sickness, eating the right foods can support your body's immunity system and help relieve certain symptoms. Always consider age factor, associated diseases and the financial aspect of patients before starting a treatment in a newly-admitted patient in a hospital.
(Dr Satpathy is an ex-Joint Director, SAIl, Consultant Internal Medicine, Diabetologist. Bhubaneswar)