Today we had a joint class day that included interns from Howard University and NIH. The Children’s National Medical Center was our host and we heard a diverse set of lectures including:: Infant Formula and Enteral Nutrition, Critical Care and Parenteral Nutrition, Introduction to GI: IBD, Celiac, and Allergies, Cystic Fibrosis, Neonatal Nutrition, Oncology and Bone Marrow Transplants, and Metabolics and Genetics. That’s a lot of information! This was to prepare us for our two week rotation at Children’s. We each get to work in two departments, so by having this class day, we were exposed to the work done in seven of them.
One lecture that I found especially interesting was given by Allison Becker MS, RD, CDE on cystic fibrosis. She began by explaining what the disease is, a layer of thick, sticky, mucus that builds up in the lungs and other parts of the body. Because of this, patients are prone to lung infects and constantly struggle when breathing. This leads to a very specific diet plan: eat as many calories as you can and choose foods high in fat and salt. Sounds pretty counter-intuitive, doesn’t it?
Cystic Fibrosis increases a patients energy expenditure, requiring them to consume sometimes more than double the calories of a healthy individual. In order to do this, fat is a huge ally. It has 9 calories per gram compared to 4 calories per gram from both carbohydrate and protein. By adding fat to meals and snacks, you get more bang for your nutrition buck. In order to get enough calories, some of Allison’s recommendations included adding:
- Cheese on sandwiches, salads, veggies, and meat
- Heavy cream in milk, mashed potatoes, gravy, and milkshakes
- Butter or margarine to all foods
- Bacon or sausage to breakfast
These are all simple ways to add more calories into a diet. Another recommendation is to consume high levels of salt. Part of the condition involves sweating, resulting in sodium losses. Children and adults can choose high salt foods, but for infants, 1/8 - 1/4 tsp (1-2 small packets from a fast food restaurant) should be added to breast milk, formula, or baby food.
Patients with cystic fibrosis currently have an average life expectancy of 37, up from 25 in 1985. Even with this dramatic increase in life expectancy, chronic heart disease does not appear in these people, despite the increased fat and sodium intake. Considering that the message to reduce these nutrients is predominant in our society, it can be hard to accept this. This case does demonstrate the difference between the needs of a healthy person and the needs of someone with a condition like cystic fibrosis. It was great to hear about this and understand just how varied the advice in this field can be, and still be appropriate.