Protein .. Why we truly need it ..
This session is from last nights Chapter Leader Training . I wanted you all to have a copy as well . Enjoy .
Why protein supplementation?
It¡¯s about Absorption
Proteins form the body¡¯s main structural elements and are found in every cell and tissue. Take away the water, and about 75 percent of your weight is protein.
Your body uses proteins:
¡Ü for growth
¡Ü to build and repair
bone
muscles
hair
connective tissue
skin
internal organs
blood
virtually every other body part or tissue
Besides building cells and repairing tissue, proteins form antibodies to combat invading bacteria & viruses; they build nucleoproteins (RNA & DNA). They make up the enzymes that power many chemical reactions. They also carry oxygen throughout the body and participate in muscle activity.
At least 10,000 different proteins make you what you are and keep you that way.
Hormones, antibodies and enzymes that regulate the body¡¯s chemical reactions are all made of protein. Without the right proteins, blood won¡¯t clot properly and cuts won¡¯t heal.
Each protein is a large complex molecule made up of a string of building blocks called amino acids. The 20 amino acids the body needs can be linked in thousands of different ways to form thousands of different proteins, each with a unique function in the body.
Your body can¡¯t use food protein directly. So after protein is ingested, digestive enzymes break the protein into shorter amino acid chains, and then into individual amino acids. In the gastric bypass patient, this normal digestive process is bypassed. These digestive enzymes are not available until they meet with the food protein in the common channel of the small intestine, and then have only about 5 - 7 ¨ö ft (compared to 20 ft in a ¡°normal¡± digestive tract) to do their job. The amino acids then enter the blood stream and travel to the cells where they are incorporated into proteins the body needs.
Nine of the 20 amino acids required by human beings are considered ¡°essential¡± because they come only from the diet; the other 11 are considered ¡°nonessential¡± because the body can make them.
The average*** person (the ¡°normal¡±, NON-gastric bypass patient) needs 50-65 grams*** of protein each day. Considering malabsorption of at least 50%**, the RNY patient will need 100-140 grams per day minimum, which cannot be eaten as food because of the small size of the pouch.
**Note: Depending on the length of bypass, the RNY patient may absorb as little as 25% or less. But it is normally agreed that even a short proximal will not absorb more than 50%.
***Note: Adults need a minimum of 1 gram of protein for every kilogram of body weight per day to keep from slowly breaking down their own tissues. That¡¯s about 8 grams of protein for every 20 lbs. Malnourished, septic, pregnant, injured or burned patients will require more protein, in the order of 1.5-2.0 g/kg daily. Extra protein is also required after surgical procedures and illness.
Carbohydrate malabsorption will result in symptoms of diarrhea and excessive flatus (gas). Malabsorbed carbohydrates that enter the colon are fermented by colon bacteria into gases. Stools seem to float on the water because of their increased gas content (not because of their fat content). This often happens when the gastric bypass patient begins to eat more carbohydrates, instead of protein. Given sufficient time, fat and muscle will be catabolized. Physical examination may reveal signs of weight loss from both fat stores and lean body mass. The patient will be weak and will easily develop fatigue. Fat loss will generally be noted as sunken cheeks and flat buttocks, with wrinkled or loose skin indicative of loss of subcutaneous fat stores. There may be direct evidence of a reduced metabolic rate. The patient will often be mentally slowed.
Protein malabsorption
Severe loss of body protein may occur before the development of laboratory abnormalities. Clinically, protein deficiency results in edema and diminished muscle mass. Since the immune system is dependent upon adequate proteins, protein deficiency can manifest as recurrent or severe infections. Protein deficiency in children results in growth retardation, mental apathy and irritability, weakness and muscle atrophy, edema, hair loss, deformity of skeletal bone, anorexia, vomiting and diarrhea. Protein-calorie malnutrition is known as marasmus, whereas protein malnutrition by itself is known as kwashiorkor.
Protein/Energy Malnutrition
Attempts have been made to classify malnutrition into a predominantly protein-depleted (i.e., kwashiorkor) or calorie- (energy-) starved (i.e., marasmus) state. In kwashiorkor, the subject ingests a moderate number of calories, usually as complex carbohydrate (e.g., rice), but very little protein. The liver is therefore supplied with inadequate amino acids. The liver becomes fatty and enlarged. Furthermore, the liver in kwashiorkor inadequately produces other proteins, including albumin, and serum albumin falls, with resulting peripheral edema. With marasmus the subject takes inadequate amounts of protein and calories. The low caloric intake means that only small amounts of carbohydrate are taken with adequate delivery of amino acids from muscle to the liver for protein production. Fatty liver does not occur, and serum albumin levels tend to be normal, with no peripheral edema. Often patients fall between these two extremes of nutritional states, but there are examples of kwashiorkor and marasmus in Western clinical practice. Anorexia nervosa is a classic example of marasmus. Marked muscle wasting and loss of subcutaneous tissue (adipose tissue****ur with normal-sized nonfatty livers and no peripheral edema. In contrast, the intensive care unit patient who has received intravenous dextrose (glucose) without amino acids for a prolonged period will often show a fatty liver and marked hypoalbuminemia (low albumin levels) and edema.
Clinical features of protein-energy malnutrition vary depending on the severity and duration of nutrient deficiency, age at onset and the presence or absence of other contributing or conditioning factors. With minimal deficiency, abnormalities may be subtle - particularly in adults, in whom there are no growth requirements. In these patients muscle wasting and loss of subcutaneous fat may be present. Weakness and minimal changes in psychomotor function may develop. Nontender parotid enlargement (glands in the face and neck) may occur, sometimes bilaterally. Patchy brown pigmentation, particularly over the malar eminences of the face, may occur. A lackluster appearance with thinning and increased shedding of hair from the sides of the head, particularly on combing or brushing, may develop. Bradycardia may occur. Variable degrees of hepatomegaly may result, sometimes with steatosis. In patients with protein-energy malnutrition following jejunoileal bypass a wide spectrum of histopathologic change has been observed, similar to findings frequently associated with alcoholic liver disease.
In adults with severe protein-energy malnutrition and in growing children, clinical features may be even more significant. Muscle wasting, subcutaneous fat loss, dependent edema and weight loss may be marked. Severe mental apathy and reduced physical activity may occur. Abnormalities in the hair, particularly of children, may be striking. Severe dyspigmentation may develop, especially distally; rarely, alternating strands of light and dark hair are observed. Hair may be removed without pain. Nails may become brittle, with horizontal grooves. An asymmetrical confluent pattern of skin hyperpigmentation may be seen, particularly over perineal and exposed areas, such as the face. Extensive desquamation may occur, leaving depigmented areas of superficial ulcers, particularly on the buttocks and backs of the thighs. Gastrointestinal symptoms are common but variable. These include marked constipation, diarrhea, anorexia or hyperphagia, nausea, vomiting and dehydration. Laboratory features are also variable. Serum proteins may be substantially reduced, including serum albumin and some higher-molecular-weight transfer proteins, such as transferrin, ceruloplasmin, lipoproteins, thyroxin and cortisol binding proteins. Serum amino acid analysis may show a decrease in essential amino acids (i.e., leucine, isoleucine, valine, methionine), and either normal or depressed levels of nonessentials (i.e., glycine, serine, glutamine). The urinary excretion of urea, creatinine and hydroxyproline may decrease. Severe electrolyte abnormalities develop, although serum levels may be normal.
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