Nutrition of the critically ill - emphasis on liver and pancreas

About 25 million individuals undergo high risk surgery each year. Of these about 3 million willnever return home from hospital, and the quality of life for many of those who return is often significantlyimpaired. Furthermore, many of those who manage to leave hospital have undergone severe life-threateningcomplications, mostly infections/sepsis. The development is strongly associated with the level of systemicinflammation in the body, which again is entirely a result of malfunctioning GI microbiota, a conditioncalled dysbiosis, with deranged composition and function of the gastrointestinal microbiota from the mouthto the anus and impaired ability to maintain intact mucosal membrane functions and prevent leakage oftoxins-bacterial endotoxins and whole or debris of bacteria, but also foods containing proteotoxins gluten,casein and zein and heat-induced molecules such as advanced glycation end products (AGEs) and advancedlipoxidation end products (ALEs). Markedly lower total anaerobic bacterial counts, particularly of the beneficialBifidobacterium and Lactobacillus and higher counts of total facultative anaerobes such as Staphylococcus andPseudomonas are often observed when analyzing the colonic microbiota. In addition Gram-negative facultativeanaerobes are commonly identified microbial organisms in mesenteric lymph nodes and at serosal “scrapings”at laparotomy in patients suffering what is called “Systemic inflammation response system” (SIRS). Clearly theoutcome is influenced by preexisting conditions in those undergoing surgery, but not to the extent as one couldexpect. Several studies have for example been unable to find significant influence of pre-existing obesity. Theoutcome seems much more to be related to the life-style of the individual and her/his “maintenance” of themicrobiota e.g., size and diversity of microbiota, normal microbiota, eubiosis, being highly preventive.About 75% of the food Westerners consume does not benefit microbiota in the lower gut. Most of it, refinedcarbohydrates, is already absorbed in the upper part of the GI tract, and of what reaches the large intestine isof limited value containing less minerals, less vitamins and other nutrients important for maintenance of themicrobiota. The consequence is that the microbiota of modern man has a much reduced size and diversityin comparison to what our Palelithic forefathers had, and individuals living a rural life have today. It is theartificial treatment provided by modern care, unfortunately often the only alternative, which belongs to themain contributor to poor outcome, among them; artificial ventilation, artificial nutrition, hygienic measures,use of skin penetrating devices, tubes and catheters, frequent use of pharmaceuticals, all known to significantlyimpair the total microbiome of the body and dramatically contribute to poor outcome. Attempts to reconstitutea normal microbiome have often failed as they have always been undertaken as a complement to and not analternative to existing treatment schemes, especially treatments with antibiotics. Modern nutrition formulasare clearly too artificial as they are based on mixture of a variety of chemicals, which alone or together induceinflammation. Alternative formulas, based on regular food ingredients, especially rich in raw fresh greens,vegetables and fruits and with them healthy bacteria are suggested to be developed and tried.