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Biomedical subjects

M H Floch

Publications and source records attributed to M H Floch.

At least 37 records · Page 2Linked to original sources
PubMed1993

Using enteral nutrition formulas.

A review of enteral tube feeding formulations is presented. When choosing an enteral formula product for a patient one must first determine the calorie and protein needs of the patient. Then one must determine the level of gastrointestinal tract function. First ask, to what degree is the small bowel functioning: totally, partially, or not at all? Has the small bowel lost surface area because of atrophy, inflammation, or surgical removal? Is the gut edematous because of hypoalbuminemia or congestive heart failure? Is bowel motility impaired by opioids, anticholinergics, or mechanical ileus? Is digestion limited by pancreatic or bile acid insufficiency? Has absorption been decreased by intestinal ischemia or gastrointestinal bleeding? Decreased surface area, bowel edema, and diminished digestive juices are only partial losses of small bowel function. An elemental formula should be tried first in these situations. Any of the other problems alone or in combination probably preclude the use of the small bowel and the patient will need total parenteral nutrition. If gastrointestinal function is adequate, then other organ failures that result in specific nutrient intolerance must be ruled out. If gastrointestinal function is adequate and no other organ failures preclude the use of a polymeric formula, then one must decide if stress and hypermetabolism are present. Enteral feeding is the preferred method of providing specialized nutrition support. Bowel rest reduces the barrier functions of the gut and malnutrition reduces cell-mediated immunity. The indications and relative contraindications for enteral tube feeding are also reviewed. The rationale for the formula design and the evidence for formula efficacy are presented. Polymeric, elemental, organ-specific, and immune-modulating formulas are discussed. Guidelines for formula selection are suggested.

Enteral Nutrition↗
PubMed1991

Diet and nutrition in ulcer disease.

In this era of H2-inhibitors, the available evidence does not support the need to place peptic ulcer disease patients on restrictive diets. The major goal of diet is to avoid extreme elevations of gastric acid secretion and the direct irritation of gastric mucosa. In view of this, only slight modifications in the patient's usual diet are recommended. Table 1 depicts a sample menu for chronic peptic ulcer disease. Frequent milk ingestion as previously prescribed is not encouraged. This is owing to the transient buffering effect and significant gastric acid secretion effect of milk. The fat content of milk has no influence on these effects. Spices, in particular black pepper, red pepper, and chili powder, may produce dyspepsia. One study shows red chili powder to have no detrimental effect on duodenal ulcer healing. It has also been proposed that daily pepper ingestion may have a beneficial adaptive cytoprotective response. While still controversial and under evaluation, peptic ulcer patients should avoid any spice that causes discomfort, especially during exacerbation of peptic disease. Currently, studies indicate that it is prudent to avoid alcohol. This is especially true for the concentrated forms, such as 40% (80 proof) alcohol. Coffee should be avoided on the basis of its strong acid secretagogue property. Coffee can induce dyspepsia. Whether noncoffee caffeine-containing beverages (tea, soft drinks) induce peptic ulcer is unknown, but they are acid secretion stimulators. Decaffeinated coffee has an acid stimulating effect as well. It is reasonable to have peptic ulcer patients restrict decaffeinated coffee and all caffeine-containing beverages. There appears to be no evidence to restrict dietary fiber. Some fiber-containing foods may possess factors that are protective against ulcer disease. According to the Mayo Clinic Diet Manual, previously recommended small frequent feedings have not been shown to be more effective than three meals per day in the treatment of chronic peptic ulcer disease. This reference cites authorities advising against extra feedings because of increased acid secretion and unnecessary complication of eating patterns. However, some patients claim to be relieved of symptoms with more frequent feedings, especially during acute phases. Citric acid juices may induce reflux and cause discomfort in selective patients. Stomach distention with large quantities of food should be discouraged. Although there is now little role for dietary therapy, one should note that bland and ulcer diets probably are not detrimental to most persons if they are used for a short time and may have some psychological benefit.(ABSTRACT TRUNCATED AT 400 WORDS)

Alcohol Drinking↗
PubMed1989

Dietary therapy of steatorrhea.

The dietary treatment of steatorrhea requires knowledge of the cause of the disease associated with the steatorrhea. Once the cause is established, then an approach to the dietary management can be adopted. Guidelines for treatment are reviewed in this article. Recommendations for either the treatment of the primary disease, limitation of fat intake, nutritional support, or pancreatic-enzyme replacement are made depending on the disease process. The most common disease entities causing steatorrhea are discussed in detail. Specific recommendations are made for the treatment of steatorrhea in cystic fibrosis of the child and adult, pancreatic insufficiency caused by chronic pancreatitis, gluten enteropathy, and the short-bowel syndrome. Emphasis is placed on the fact that each patient must be managed by correlating the cause of the steatorrhea with specific modalities of therapy.

Celiac Disease↗
PubMed1986

Digestion and absorption of fiber carbohydrate in the colon.

Most dietary carbohydrates are digested and absorbed in the small bowel. However, fiber carbohydrate and other carbohydrates can be metabolized by the normal flora of the colon. The substrate for bacterial fermentation includes compounds for which small bowel digestive and absorptive mechanisms may, or may not, exist and soluble and some insoluble fiber. Products of fermentation include gases and volatile fatty acids which may be absorbed or nourish the colon mucosa. Total body nutrition and metabolism may also be affected by the products digested and absorbed in the colon.

Animals↗
PubMed1986

Practical aspects of implementing increased dietary fiber intake.

Two hundred twenty dietitians participated in a workshop conference on Health Implications of Dietary Fiber. They were given lectures to increase their knowledge base, and then in group sessions answered questions and wrote concensus opinions. The results are the content of this paper. The topics covered and responses are reported in four categories, diabetes and obesity, hyperlipidemia, hypertension and coronary heart disease, gut function and gastrointestinal disease, and cancer. Specific recommendation for implementing high fiber diets are made in each category. However, the dietitians expressed caution on accepting all of the conclusions expressed in the literature on the value of fiber and believed much education and instruction is needed in order to increase dietary fiber intake.

Colonic Neoplasms↗
PubMed1985

Colonic bacterial flora and serum cholesterol: alterations induced by dietary citrus pectin.

The influence of dietary pectin on blood lipids and stool bacterial flora, enzyme activity, and physical properties was investigated. Fifteen grams of citrus pectin were added to the normal diets of 10 subjects. A decrease in serum cholesterol was observed after 2 wk of dietary supplementation, but was not statistically significant after the 3rd wk. Fecal bacterial flora was modified by pectin; anaerobic bacteria increased and aerobic bacteria increased. No change in stool bacterial 7 alpha dehydroxylase or cholesterol dehydrogenase activity was observed. The daily stool output, pH, and water content were not influenced by the addition of pectin to the diet.

Adult↗