1. Lecture 11b 25 MARCH 2013 Colitis, Migraine and Respiratory

2. Colitis Inflammation of the colon Diarrhea is an issue since the inflamed colon is incapable of its normal water management function- i.e. removing water from the faeces Complete bowel rest helps

3. Ulcerative colitis Treatment Complete resection (removal) of colon No nutritional implications but may be diarrhea initially This diarrhea is transient and apparently self- correcting Evening primrose oil may have some limited success for this type of colitis in terms of stool consistency but this contradicts self-correcting diarrhea

4. Diversion colitis Surgical diversion process by which the distal colon is left intact but without the stool stream This results in abdominal cramping with mucoid or bloody diarrhea Infusion of salt solution containing short chain fatty acids(scfa) (2-4 carbon fatty acids) into rectal remnant is a remedial measure but complete reanastomosis is the only complete cure Conclusion from scfa treatment?

5. Migraine Dural blood vessels become dilated and the pulsatile blood flow through these vessels distends and irritates the highly pain sensitive dura mater -this would explain the throbbing nature of migraine headaches -inflammatory component to migraine headache has been proposed

6. Nutritional management of migraine Riboflavin administration Metabolites of riboflavin participate in overcoming the mitochondrial defect that that plays a role in migraine pathogenesis Avoiding foods Certain foods in certain persons trigger migraines -however this is highly individual with one food or group of foods affecting a particular person but not another

7. Nutritional management of migraine However dietary restriction of a food or food groups may upset the principles of adequacy, moderation, variety, nutrient density, energy control, and balance

8. Migraine Foods contributing to migraine: Citrus foods Tea(flavonoids) Coffee Pork Chocolate Milk Nuts Vegetables Cola

9. Migraine -food components affecting vascular tone and causing migraine (highly individual): tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate), aspartame, caffeine

10. Migraine -foods thought to trigger migraines subsequent to hypoglycemia are: chocolate, cheese, citrus fruits, bananas, nuts, cured meats, dairy products cereals, beans, hot dogs, pizza, food additives coffee, tea, cola drinks, alcoholic drinks such as red wine, beer or whiskey distilled in copper stills

11. Migraine -solution to all this is trial and error elimination of foods including meticulous record keeping -problems with this approach?

12. Respiratory Acute respiratory failure Need sufficient energy and protein to support lung function and prevent infections without overtaxing the compromised respiratory system Fluid and sodium restrictions may be necessary to ease pulmonary edema

13. Respiratory Acute respiratory failure Overfeeding causes increased carbon dioxide which results in additional respiratory requirement- therefore reduce kcal to an appropriate level(energy to support lung function and prevent infections without overtaxing the compromised respiratory system)

14. Respiratory Aspiration pneumonia Potentially lethal lung infection Nasogastric feeding or gastrostomy or jejunostomy which allows the lower esophageal sphincter to remain closed -all this helps to reduce aspiration risk

15. Respiratory Chronic obstructive pulmonary disease (COPD) Emphysema and chronic bronchitis are the two most common examples of chronic obstructive diseases COPD patients frequently experience: weight loss, protein energy malnutrition PEM and infections due to anorexia poor food intake, high energy expenditure due to laboured respirations

16. Respiratory Chronic obstructive pulmonary disease Nutritionally Weight loss (caloric restriction combined with appropriate exercise levels) Malnourishment- gradual refeeding as tolerated -easy to eat foods in small meals to improve food tolerance- enteral feeding may help -need fewer kcal from carbohydrate due to carbon dioxide issue Avoid overfeeding –carbon dioxide load issue

17. Respiratory Cystic fibrosis Laboured breathing- increased kcal and protein and do not restrict fat Enzyme replacements for pancreatic impairment Multivitamin including fat soluble vitamins Table salt to overcome electrolyte losses due to sweating Additional fluids to liquefy thick secretions and prevent dehydration Maintain appropriate height to weight ratio