Being a dietitian on the ICU is not always the easiest of jobs. There is a certain confidence one has to have to work with doctors to be respected. The theme this week has been confidence indeed.
On Monday morning I was rounding, as part of a multidisciplinary team, on a patient that had multiple medical problems including Acute Respiratory Distress Syndrome (ARDS) and Acute Renal Failure (ARF). As an ICU dietitian a big part of my job is nutrition support, specifically enteral nutrition, that which goes through the gut, and parenteral nutrition, that which bypasses the gut. Different formulas are specifically formulated for specific conditions. This patient was appropriately placed on a formula specific to ARDS and had been on it for about a week. In rounds it was evident that the patient’s renal failure was becoming more of an issue and my professional experience was that a formula specifically formulated for renal would have been better at this time. I proceeded to ask the attending physician if he thought the renal problems were a bigger issue at this time. His response to me was that no one should ever be placed on the formula the patient was on because a study had shown that it could be harmful.
Certain situations lend themselves better to discussions than others. Rounding on the ICU is not one of them. I asked the doctor what reference he was speaking of and continued on with rounds. Later that day I got the study the doctor was referring to. It was completed in a way that was completely different from other studies on this topic. The study had tried to separate the pieces of nutrition to see if “parts” of it were helpful. The part that was separated out was the omega-3 fats, which were given in higher amounts than would be given in the formula as a whole. The fats were also given whether or not the accompanying formula was administered. As a result, the study showed that the separate parts, the fats, were harmful.
This, of course, brings me to one of my main tenets in nutrition, which is, the whole is greater than the sum of its parts. Sometimes we cannot isolate the active ingredient(s) because they don’t work (or don’t work as well) unless they are part of the whole. Such is the case here. (More on this in another blog.)
Another issue to consider here is that one study does not guidelines make. The doctor was basing his response on one study done two years ago. Reviews by several societies of critical care have been done since then and the guidelines for nutrition support were revised last year all agreeing that the formula in question is still appropriate and indicated in the treatment of ARDS.
You may not be looking for information on how to treat ARDS, but you may be looking for information on the safety of supplements, or how to lose weight safely and effectively, or treatments for other diseases.
How can you avoid this mistake while making sure the nutrition information you are getting is accurate? Follow these simple tips and feel confident that you have the right information.
When you look for nutrition information, first consider the source. What does that mean? The source of information should be reliable. Legitimate sources are well-known organizations such as the American Diabetes Association, American Heart Association, Academy of Nutrition and Dietetics, etc. There are many organizations that focus on specific areas of nutrition for example the Celiac Sprue Association. The Environmental Working Group provides information to the public about the safety of pesticide-free foods and sustainably raised fish. If the source is an author, what are their credentials and background?
Next, consider the content. Is the site trying to sell you something? Is the information trying to sway you to believe or not believe in something? Is the site trying to advertise a product? What is the purpose of the information? Is it poorly written with grammar and spelling mistakes? Good quality information should be balanced and allow the reader to make up their mind about the usefulness of the information.
Is the information current? Reputable websites usually have a date at the bottom of when the content was last updated. If the website doesn’t have a date, beware…..the information could be outdated or simply not true.
Accuracy of information is important as well. How does the information presented compare to other pieces of information on the same topic?
Finally, if references are listed do they show good use of evidence? Are the references of good quality? Are they trusted sources of information?
I wish you well on your search for quality nutrition information.
In good health,
Regina
