Clinical Nutrition & Dietetics In Patient Recovery, Fitness & Sleep

Kalpana Rangraj, Senior Nutritionist, Portea Medical, BangaloreHeadquartered in Bangalore, Portea Medical is one of India's pioneer home healthcare service provider, offering world-class services in the areas of Physiotherapy, Doctor Consultations, Nursing, Counselling Lab Tests and many others.

Clinical nutrition plays an important role in improving and maintaining the health of patients. Some of these include outpatients at clinics and community health settings or inpatients in hospitals who may suffer from diabetes, kidney diseases, old age conditions, heart diseases, accident related complications, and a plethora of other chronic conditions. Hence, clinical nutritional programs may either be preventive or therapeutic.

Patients normally tend to lose about 5-10 percent of their total body weight after a surgery. Under such circumstances, nutrition becomes vital to aid recovery. After surgery, the body needs more calories to heal. Good nutrition after surgery helps promote surgical wound healing. Protein needs are also increased to aid in tissue repair, slow down muscle catabolism, and decrease the inflammatory phase. Thus, for elective surgery, 1.5gram of protein per kilogram of body weight is recommended, while the requirement increases to 2gram per kilogram of body weight if a major surgery has been conducted on a patient.

Primary care, hospitals, nursing, and homecare must appreciate the importance of dietary intake, and arrange enteral or parenteral feeding when appropriate. In addition, explicit protocols and standards must be created and adhered to in terms of nutritional management of patients.

Nutrition & Fitness
Nutrition is as crucial as workout regimes for fitness aficionados and athletes. A lack of nutritional support usually leads to poor recovery between workouts including injuries, hormonal imbalances, and adrenal fatigue. Hence, nutrition and fitness go hand-in-hand for athletes as they strictly keep track of calories, drink the right amount of fluids, and eat the right amount of macro and micronutrients.

Nutritionists have deemed that athletes do not get stronger while training. They do so when the body is at rest, and while sleeping or eating. Exercise can also be stressful for the body as it breaks it down for stronger rebuilding. This is when the window of opportunity arises to rebuild the body with proper nutrition. Hence, athletes require a combination of high quality protein and carbohydrates before and after exercise.

Complete proteins like milk, whey, casein, soy, egg, or combinations of proteins are instrumental in building lean muscle. They contain all the 20 essential amino acids that the body requires for stronger and leaner rebuilding. On the other hand, a combination of carbohydrates work best to prolong endurance for athletes whose workout lasts over an hour. Depending on the workout intensity, they consume 30-70grams of carbs per hour. These two macronutrients play a crucial role in
the synthesis of new muscles and muscle glycogen replacement, that is, the fuel burned during exercise. Carbohydrates avoid sluggishness and fatigue later in the day or during a following workout. Healthy carbohydrate sources include fruits, whole grain cereals. Dietary fats also are equally important in meeting energy needs & maintaining hormonal balance.

A strong patient nutrition program helps replenish and strengthen the body to assure effective and timely recovery

Weekly dinners typically comprise lean meats like chicken, pork, and fish(such as salmon); complemented with plenty of vegetables. Most fitness aficionados prefer to consume majority of their carbohydrates during the day, and increase protein and fat while reducing carb intake at night.

Hence, it becomes vital to choose the right type, amount and timing of food intake, fluids, and supplements for athletes. It is the planning done on attaining adequate energy and nutrients, consuming fluids and electrolytes, keeping the body hydrated, and the right balance between food and supplements that helps in attaining peak performances. Adequate hydration is a key element in sports performance. Most athletes benefit from a personalized hydration plan.

Nutrition & Sleep
Adequate sleeping patterns are linked to eating patterns. This depends on the body’s cortisol rhythms. Cortisol is the hormone produced by the adrenal glands above the kidneys. It oversees the regulation of body functions like resistance to infection, cancer, and auto immune diseases; activation of thyroid hormone; bone resorption; muscle strength; energy production; and intensity of allergic reactions. Hence, cortisol becomes a strong factor in rejuvenating sleep.

Melatonin is another hormone, which is affected by darkness and light. This important hormone is produced by the pineal gland in the brain, retina, lens, and the gastrointestinal system. Several studies have shown that melatonin regulates other hormones in the body. Melatonin secretion also helps regulate the sleep/wake cycle. These two hormones regulate the 24-hour pattern of the body function and response. If the hormone-production cycle is disturbed by staying awake at night or sleeping during the day (as in shift working), it may lead to mood changes, dizziness, irritability, depression, and metabolic disorders, such as type-II diabetes. The body's immune system may also be damaged.

Cortisol is produced in a cycle called the circadian rhythm highest levels are released in the morning while lowest at night. An abnormal rhythm can result in fatigue, migraine headaches, abdominal bloating, and either low or high blood pressure. A cortisol disruption at night will invariably affect our sleep quality regardless of the number of sleep hours. Our rapid eye movement(REM) sleep, that is, the stage of sleep when we dream, will in turn disrupt leaving us unrefreshed in the morning. Hence, rejuvenating sleep requires normal levels of cortisol levels at night, which must be maintained during the day.

It is the glycemic index(GI) of a meal that affects the cortisol level for the following five hours. The GI of a food portrays how our blood sugar levels are affected by particular foods. For instance, foods containing high sugar and low fibre would comprise high GI index causing wild fluctuations in insulin levels in comparison to foods with low GI.

Thus sugar and refined starches included in white bread, donuts, bagels, and french fries cause cortisol levels to rise. Apart from this, having no meal at all is worse than consuming food with high GI because cortisol levels rise after five hours of the previous meal or snack, thereby disrupting our REM sleep. Hence, low GI foods like eggs, meats, fish, and most vegetables tend to lower the cortisol levels. A continuous consumption of such foods throughout the day, every five hours, is required to maintain the cortisol on its normal downward track.

In Conclusion
Nutrition is an extremely vital com¬ponent of patient recovery program. A strong patient nutrition program helps replenish and strengthen the body to assure effective and timely recovery. In patients, even a small nutrition deficiency can impede the normal recovery process and reduce chances for optimal recovery. Thus, the focus laid on clinical nutrition becomes decisive in quick or lengthy recoveries and also in reducing associated costs.