The critically and chronically ill patient typically has several biochemical processes that are severely compromised. These aberrant pathways are the target of pharmacological intervention and are typically the only dimension of patient care associated with the outcome. Supporting the patient’s most fundamental nutrition needs are equally important, yet this dimension of care receives very little attention.
Over the past 4 decades, there have been considerable advances in medicine’s approach to a wide variety of critical situations. The primary focus of care has been to treat critically ill patients with intervention protocols that can improve the stability of one system or another. The patient’s other, non-compromised organ systems are rarely considered as essential components of the “plan”. Yet, a growing body of evidence suggests that we are more than the sum of these parts or individual systems and that a failure to address the totality of the patient is only acceptable in classic triage cases such as those encountered on a battlefield or in remote areas.
Most modern care facilities consider enteral support adequate when formulas provide calories, fats, protein, and micronutrients in the form of sugar, refined vegetable oils, and difficult-to-digest casein or soy protein isolates. Adequacy is defined by staying within a range of values for each macro and micronutrient rather than to have a formula offer biological compatibility or to nourish a patient’s micro biota. An increased reliance on highly refined and artificial foods in an effort to meet patient nutrient requirements is and continues to be illogical. This trend has not provided optimal support and has created additional imbalances as a result.
Much of the success of Functional Formularies products Liquid Hope and Nourish has come as a result of other enteral formulas failing. Almost all other enteral formulas have ingredient lists that read more like a candy bar than a meal replacement. This combination of inflammation-driving ingredients produces patient intolerances that in turn causes patients, their care providers, and/or loved ones to search for something that offers true support.
The calories and protein in an enteral formula are only helpful if they are tolerated. The fats are either inflammatory or have anti-inflammatory potential. The word nourishment must take into account more than what is on the label in the way of values. It must place emphasis on how physiologically acceptable the food or food-like formula is.
One major area of human physiology is tied to all others: the micro-biome. This ecosystem has very rapid responses to a variety of nutrition factors. Sugars, lack of fiber, highly refined omega 6 fatty acid-rich vegetable oils, and emulsifiers are all qualities of foods that cause gut-derived inflammation and a lack of microbe diversity in patients. These effects undermine the immune response of an individual. At the time they are in critical care, an individual receiving enteral support with a typical commercial formula may be losing ground in this critical area. This is mostly the result of a system that is not accustomed to thinking support-for-the whole-body.
Functional Formularies is hopeful that our exponential growth in the past year is indication of an increasing awareness: a heightened awareness around these key responses to the usually unmeasured qualities of our enteral formulas. We are pleased that more and more care providers appreciate our products for their wholeness, their organic certification, their use of cold-pressed organic flax and olive oil, and their diversity of gut-friendly plant fiber from a wide variety of plants.
To all those patients, patient families, and care providers who have found us, we thank you. The future is bright if we can see the new sense of true support that is emerging.
~ John Bagnulo MPH, PhD.