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Recovery from an ICU stay Is tough. Could more protein help? - AGDAILY

Bodybuilding News

Bodybuilding News

Well-known member
Jul 17, 2013
Paul Wischmeyer was a teenage athlete when he learned firsthand just how devastating an intense illness can be. After spending the better part of a year severely sick and frequently hospitalized with undiagnosed severe inflammatory bowel disease, his colon perforated, landing him in the intensive care unit. When he finally recovered, he went from being a starter on his high school basketball team to being too weak to walk down the court — profoundly disabled from just being in the hospital.

He built back his strength over the next few years, and eventually worked his way through medical school as a personal trainer in a competitive bodybuilding gym, where he helped clients sculpt their physiques by providing them with targeted workouts and having them add protein and other nutritional supplements to their diets. But it wasn’t until his training in critical care medicine that Wischmeyer began to thread together his interest in bodybuilding with his interest in ICU recovery.

Critical care experts have long known that a stay in the ICU can lead to long-term weakness lasting months or even years after discharge, regardless of the specific illness. Wischmeyer was especially struck by his patients’ massive loss of muscle, which reminded him of his own experience.

“I’d watch people lose half their body weight in a short period of time and not be able to walk,” he says.

Today, Wischmeyer, a critical care and nutrition physician at Duke University, is a leading voice among clinicians and scientists investigating whether increasing protein intake during and after hospitalization could be an important and long-overlooked component of recovery. Lean muscle melts away startlingly quickly in ICU patients, and muscle-wasting is a predictor of long-term impairment after hospitalization, studies show. Proponents of the approach say that protein, a nutritional cornerstone for body builders, may help critically ill patients retain muscle or rebuild it as well.

“Protein is what everyone is interested in in right now,” says Zudin Puthucheary, a clinical senior lecturer in intensive care at Queen Mary University of London. (Wischmeyer, like many researchers in the nutrition field, has received funding from industry.)

But some question whether simply adding more protein to patients’ diets will translate into increased muscle mass and better functioning. While several studies suggest that boosting protein levels early on after critical illness or surgery may improve recovery, they have mostly been small, and other studies have not shown a benefit.

“Protein provision might be important, but there aren’t large studies to understand that yet,” said Renee Stapleton, a pulmonologist and critical care physician at the University of Vermont Medical Center.

A handful of such studies are currently underway, but whether they will bring clarity to the protein picture remains to be seen.

Clinicians have a name for the long-term disability some people experience after an ICU stay: ICU-acquired weakness. Critical care physician Margaret Herridge of Toronto General Hospital began quantifying the effect some two decades ago. More than half of people in their 40s and 50s who spend a week on a ventilator don’t return to work a full year after their hospital stay, she found, and a third never do. Even five years later, patients on average recover only three-quarters of the stamina and 6-minute walking distance of their age- and sex-matched peers.

The COVID-19 pandemic has highlighted this issue by bringing huge waves of patients to the ICU. People hospitalized with COVID-19 tend to stay in the ICU longer than other patients, and that, along with the drugs and sedation they receive, likely ratchets up the risk of disability afterwards. “I think COVID has highlighted for the general public a lot more about what happens in the ICU,” including the challenge of reaching a full recovery, says Leeanne Chapple, a critical care dietician at the University of Adelaide in Australia.

Researchers think that the massive muscle wasting that occurs during a critical illness deserves much of the blame for making recovery difficult.

“The first thing we do when anything bad happens is we stop making muscle,” says Puthucheary. Not only that, the body also breaks down existing muscle through a process called catabolism. During muscle catabolism, proteins stored in muscle tissue are broken down into smaller molecules called amino acids and energy is released. That breakdown happens quickly: A person who undergoes surgery or who spends time in the ICU can lose up to a kilogram, or 2.2 pounds, of muscle mass per day during the acute stages of their illness.

Theoretically, adding more protein to a patient’s diet can help minimize the muscle loss. Yet nutrition has traditionally gotten short shrift in medicine, some experts say; a 2019 report from researchers at Harvard University called for better education about nutrition during medical training. This is especially relevant to critical care, a specialty in which monitoring vital statistics, stamping out infections, and generally ensuring survival has been paramount, says Daren Heyland, a critical care physician at Queen’s University in Kingston, Canada.

But the mindset is shifting as physicians start considering nutrition as something that is “really modulating the underlying disease process,” rather than merely playing a supporting role, Heyland says. “It is a major paradigm shift.”

Ironically, this shift is driven by improvements in critical care. Today, doctors can save people from trauma and illnesses that would have led to death just two decades ago.

“With all this great technology, are we creating survivors — or victims?” Wischmeyer says. “There’s this epidemic of impaired quality of life that we have to address. And I think that is drawing a lot more attention to nutrition.”

Dietary guidelines recommend that a healthy adult should consume around 0.8 grams of protein per kilogram of body weight each day. Current intensive care guidelines, meanwhile, suggest that adults receive 1.2 to 2 grams of protein per kilogram per day, generally delivered through a feeding tube. Wischmeyer and other experts advocate for amounts at the high end of that range, depending on a person’s age and other factors.

Yet it’s not just a question of raising protein targets; clinicians need to ensure those targets are actually being met as studies in U.S. hospitals show that patients are often getting less than half the recommended amount. “We are not getting anywhere near the lowest level” of recommended protein, says Wischmeyer.

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