Nutrition to prevent weight loss in stroke patients - Essay Example

?NUTRITION TO PREVENT WEIGHT LOSS IN STROKE PATIENTS Table of Contents Introduction I. A Case of Recovery from Stroke Without Complications: Determine Nutritional Requirements. II. Basic Rules For A Lean, Healthy Body III. In Case of Poor Appetite: Situation A. Stroke Patient lost normal ability to chew and swallow. IV. In Case of Poor Appetite: Situation B. Stroke patient has poor taste and smell. V. In Case of Poor Appetite: Situation C. Stroke patient has untimely emotional issues. VI. Cleansing Therapy to Facilitate Better Absorption of Nutrients: Background Reason VII.Lifestyle Change Has an Impact on Nutrition Conclusions Introduction Undernourishment among stroke patients is very common. James D. Geyer and Camilo R. Gomez (2009, p.282) reported that about 50% of those who survived an acute stroke will experience dysphalgia or the impairment of normal ability to swallow. To prevent or overcome malnutrition, qualifications about the patient must be known. Different stroke patients have different combinations of problems. Then the question of what to feed, when to feed, and how to feed that stroke patient will need to be answered. Some cases will allow for the simple determination of nutritional ingredients. Many others are not as easy to deal with. In this essay, an attempt to present corresponding solutions to meet nutritional requirements will be done given the most common scenarios of stroke patients facing the risk of losing weight. Aside from the simple case, the following other situations will be considered: (1) stroke patients with poor appetite due to a damaged ability to chew and swallow normally; (2) poor taste and smell; (3) emotional issues preventing normal food intake; (4) the need for lifestyle change; and (5) stroke patients with chronic conditions. The purpose of including all these is to provide a ready set of guidelines for use when any of these situations are encountered. This essay is taken from the viewpoint of Nurses, Caregivers, and Nutritionists. A Case of Recovery from Stroke Without Complications: Determine Nutritional Requirements. There should be a periodic attempt to determine the stroke patient’s energy requirements in order to achieve a desirable weight. Of course, this is aside from taking BP before and after meals, and whenever there is a need to do so. Knowing the energy requirements will reveal how much calories are needed. Freda Myco (1983, p. 94) noted that “the energy needs of stroke patients…should be assessed in relation to body weight, body build, age, sex, health status, and physical activity levels.” For those who are normal, energy requirements would be about 2000 kcals/24 hours for men and 1,800 kcals/24 hours for women. A stroke patient should take the right amount of calories to maintain weight. The consequence of too much calories will be weight gain, while lack of calories will turn the patient into a malnourished person with lack of energy to exercise. Since the topic of this paper is about nutrition to prevent weight loss of stroke patients, it should be worth mentioning that Freda Myco (1983, p.95) also clarified that “Malnutrition is not caused by simply taking too few calories, rather it is the result of a deficiency in the correct mixture of food constituents, vitamins, and minerals.” Basic Rules For A Lean, Healthy Body What stroke patients will need is a good eating habit of the right diet containing adequate calories without the unwanted cholesterol. At Body Art, Tanya Lee Sheehan recommends (2008, p. 11) that a person should eat just enough every 3 hours. And the recipe should be “more lean protein, veggies, fruit and nuts”. There is a reason for eating more often but with less quantity. It gives time for food to be digested first before a new set will need digestion. But her ideas are for people who can still exercise and burn the food they eat through exercises. In the FAO (Food and Agriculture Organization) of the UN, along with Ann Burgess, Peter Glasauer (2004, p.83), there is a guideline about “How to help sick people eat more”. The very first guideline recommends that the sick be offered food every 1-2 hours and should be given snacks in between meals. Second, they should be encouraged to eat more per meal in order to recover. For stroke patients, this means eating nutritious meals which will not lead to an increase in blood pressure or another stroke. Third, FAO recommends giving the sick “easy-to-eat foods that the person likes, but includes energy-rich and nutrient-rich foods” (p.83). Fourth, it is better to feed them after they have been washed and cleaned. Fifth, feed the sick while he is sitting up properly. Sixth, keep food nearby the sickbed. 7th, never force a person to eat. And so, the FAO of UN also advised more frequency for food intake of sick people. Another reference book by Beth Ann Schariff Pusey (2006, pp. 254-258) showed the calories content per type of food. These are found in the Appendix Section Figures 1-5. In Case of Poor Appetite: Situation A. Stroke Patient lost normal ability to chew and swallow. Poor appetite could be due to loss of normal ability to chew and swallow food. If this is the case, the required nutrients may have to be taken mostly through a liquefied diet rich in calories. Soft diets will do away with the problem of mastication or chewing. However, the recipe should be rich in calories to meet the recommended amount of the body. This can be done by osterizing (using a Blender to grind a recipe with the calorie requirements). If there is still difficulty in feeding with soft diet, the next alternative is a “Full Liquid Diet”. In the book on basic nursing, Caroline Bunker Rosdahl and Mary T. Kowalski (2008, p.341) classifies “Full Liquid Diet” as the alternative than may be for a long time. It may not be a “Clear Liquid Diet” because of lack of nutrients, calories, protein which would necessitate intravenous feeding of the missing ingredients. And even if it is a “Full Liquid Diet”, they advise adding food supplements like Ensure. Essentially, what goes into the osterizer should be controlled to meet the needs of a stroke patient. Calories have to be estimated. According to the same authors, Caroline and Mary, (p.345), “a high calorie diet generally contains over 3,000 calories and 130 grams of protein.” Swallowing exercises may resume after a stroke patient has recovered from malnutrition. Stein, Joel et.al. (2009, p. 193) said “A basic tenet of dysphagia rehabilitation is that the best exercise for swallowing is swallowing.” However, they also gave the condition which says, “Prior to initiation of dysphagia therapy, the stroke patient must be stabilized medically. This includes providing recurring stroke prevention, minimizing or preventing complications, and ensuring proper management of general health functions.” (p.193) Cleveland Clinic (2008) gave valuable tips to deal with stroke patients experiencing dysphagia. These are found in Figure 6 under the Appendix section. Poor nutrition in post-stroke patients may be partially due to the loss of ability to self-feed or with difficulties with chewing or due to poor appetite. Bales, C. and Ritchie. C.S. reported a study of Kumlien, et. al. (2009, p. 481) which involved 40 stroke patients, and said: “Thirty percent were assessed as having poor food intake or poor appetite. Reasons for poor food intake included difficulties due to chewing problems (15%), difficulties handling food on the plate (17.5%) and the need for assistive feeding devices such as tools, plates, or mugs (27.5%).” Those who cannot self-feed will have to be patiently assisted until they are able to consume the desired amount of calories per meal. Difficulty in chewing would mean having to prepare easy-to-chew, oftentimes soft food with the required calories. In Case of Poor Appetite: Situation B. Stroke patient has poor taste and smell. If the poor appetite is not because of any impairment of the functions to chew and swallow, another reason could be the loss of taste and smell. Melissa Bernstein and Ann Schmidt Luggen wrote (p.94) that from the age of 50 and above, “the number of taste buds begin to diminish”. It leads to “agenusia” or loss of taste if not just “hypogeusia” or diminished taste. A similar problem can be true when a patient already has a poor sense of smell. In these instances, Bernstein and Luggen recommended (p.97) responding by appealing to the other means of increasing appetite, like presenting an attractive appearance of the food to be taken and stimulating an increase of appetite. Phyllis Balch (2006, p. 210) reminded about the power of vitamins B-Complex to stimulate appetite. In Case of Poor Appetite: Situation C. Stroke patient has untimely emotional issues. Assume further that the patient’s idiosyncrasies have been considered (e.g. some religious don’t eat pork-based recipe, or a bloody viand even if cooked), and the problem of poor appetite is not an impairment of the chewing or swallowing functions, and not a loss of taste and smell, it could be due to an emotional state which stroke patients manifest. These would show in changes of mood from being happy, hopeful, feeling great to suddenly becoming frustrated, angry, shocked, depressed. Something else is taking up the stroke patient’s attention such that there is no interest to eat any food. Roger Cicala stated ( 1999, p.138) “Depression and mood changes occur in 2/3 of all stroke patients and in all patients with strokes that involve the frontal lobe on the left side. Emotional problems are severe in about 1/3 of stroke patients, at least during the first year. For most patients the mood change encompasses depression only…Generally, situational depression will clear up within a year after the stroke, but some patients require antidepressants for a longer period of time.” In such a condition, therefore, the patient will not be able to receive his nutritional requirements except after the anti-depressant will have taken effect and he can focus on eating. The nutrition of a stroke patient will also depend on the alertness of a nurse to administer preparations for meal time not only in the form of the needed calorie requirements but also in terms of the timing of medication prior to eating. Ruth A. Roth and Carolynn E. Townsend (2003) detailed the ingredients needed in terms of vitamins, minerals, carbohydrates, protein per body weight and showed the acceptable weights for adults as per USDA (US Dietary Advisory) (p.298). To stimulate appetite, one should understand the difference between hunger and appetite. Hunger refers to a physiological need to take in some food that is usually “felt four to six hours after eating a full meal”, according to Roth and Townsend (2003, p. 303). On the other hand, “Appetite is a learned psychological reaction to food caused by pleasant memories of eating it.” (p.303) This raises the importance of supplying the stroke patient with vitamin B-Complex because of its property for mental alertness. The importance of B-Complex for the nutrition of stroke patients is further explained in Appendix Figure 14. Cleansing Therapy to Facilitate Better Absorption of Nutrients: Background Reason Prevention against further stroke is the best way to treat stroke patients as they are being nourished with the right amounts of calories, vitamins, minerals, and other food supplements. Due to the many risk factors such as “atrial fibrillation, smoking and hypertension… homocysteinemia and the paradoxical role of alcohol” (Norris, J.W. & Hachinski, V. 2001) in the treatment of stroke, John W. Norris and Vladimir Hachinski recommended prevention as the best way to avoid occurrence this cerebrovascular disease. These two authors “recruited an international group of experts to provide a comprehensive, critical review of the primary and secondary prevention” of stroke. Included were “lifestyle changes, diet, exercise, and estrogen” among the primary ways to protect against recurrence of stroke, and “aspirin, antiplatelet therapy, surgical measures” for secondary ways. The elderly also have slower digestion, and absorption of nutrients may be impaired or weakened by “plaques” along the lining of blood vessels which are oftentimes caused by accumulation of excess cholesterol. Delay in the bowel movement results in growth of bacteria and toxins in the system. In turn, these unwanted pollutants of the body can damage tissues and cells. They also weaken the immune system causing an alteration in the normal body response. First of all, the objective should be towards rehabilitation until the stroke patient has fully recovered. Thereafter, he should be fed with food that will prevent further strokes even after he has fully recovered. The ability to recover needs the support of an individual’s immune systems or the ability to revitalize the body so that it will become normal. For some stroke patients, healing of the brain blood vessels can either take some time or the damaged nerve can no longer give back a lost function of the body. At best, prevention of further strokes should be done with the help of good nutrition. One of the sources of stroke is obesity which results in high blood pressures and later stroke. Why obesity facilitates stroke is explained in Appendix Figure 13. Stroke patients need cleansing therapy. Cleansing therapy is aimed at detoxifying patients, especially those who have been under chemical medications, like stroke patients. Detoxification, says Linda Page (2008, p. 10) can help resolve the problem of chronic fatigue syndrome, a situation wherein people would avoid exercises or activities to burn those fats. It is best administered when a patient appears to be normal after taking in chemical drugs and not taking them would only afford some time for the cleansing therapy to take effect. Unfortunately, chemical drugs can accumulate and be the toxins of the body in the sense that they prevent the immune system from giving out its positive effects. And chemical drugs are not the only sources of toxins. Pollutants in the air, pesticides of fruits and vegetables that cannot be eliminated by cooking, and other sources accumulate with chemical drug toxins in the already weakened body. Also according to Linda Page (2008, p. 9), “Naturopaths have used detoxification therapies to achieve health and wellness for over 100 years! In Europe, detoxification has long been an integral part of the flourishing spa industry.” Organic grown apples can detoxify the system, according to Bruce Fife (1997, p. 161) because they are “rich in vitamins, minerals, and complex carbohydrates” and they also contain “protein, fiber, organic salt and acids. Therapeutically, it is a purifier, vitalizer, cleanser, antiseptic, disinfectant, germicide, respiratory stimulant, brain and nerve stimulant, and tonic.” Detoxification is intended to remove these toxins altogether. Appendix Figure 11 explains more about the meaning of detoxification. This is done using natural food alternatives. One good example would be in a situation wherein a stroke patient is observed to be having difficulties with digestion of food. The Papaya fruit can supply the system with adequate “natural papaine” which provides for a more regular daily discharge, and more. It has a little protein that is easily digested, about “4-6 grams per kilo”. Protein from animal meat has cholesterol, protein, and difficult-to-digest fats. In contrast, based on the documentation of Harold W. Tietze (2003, p. 40), “Papaya, the super enzyme, can digest 35 times its own weight in meat!” How then is this useful to stroke patients? When a person experiences indigestion of too much protein consumed, the situation can lead to high blood pressures (p.41). Papaya can prevent that problem. More supporting authoritative information about the Papaya is in the Appendix Figure 12. Roberta L. Duyff (2011, p.135) emphasized the value of phytonutrients found in most fiber-rich foods. They are capable of healing damaged cells. Furthermore, some fruits like bananas and apples are relatively high in both calories and fibres. Malnourished stroke patients need both. Another author, Earl Fee (2011, p. 75) distinguishes food supplements from fruits and vegetables. Since supplements are processed products, they do not have phytonutrients although they may have the vitamins and minerals. Additional benefits of phytonutrients are found in the Appendix Section. Lifestyle Change Has an Impact on Nutrition. Nutrition can become a problem among the affluent. Because some people can afford to buy whatever food delights the taste, and no amount of teaching can prevent them from developing the habit of consuming sources of hypertension, heart ailments, cancer, diabetes, stroke and other diseases, the body eventually gets one of these diseases. In 1971, according to WHO (World Health Organization) (Gariballa, S.. 2004, p. 3), “stroke is defined as rapidly developing clinical signs of focal and, at times, global loss of cerebral function with symptoms lasting more than 24 hours or leading to death and with no apparent cause other than that of vascular origin”. One of the usual impact on the victim is the failure to live independently for a time if he recovers or a disability connected to the brain. According to the Department of Health and Social Security 1992 which was cited by Salah Gariballa (2004, p.6), “there is no doubt that good nutrition contributes to the health and well-being of elderly people and to their ability to recover from illness”. But there would have to be a lifestyle change. Better health consciousness would mean avoiding what the doctor says should be avoided, keeping the system clean by undergoing cleansing therapy, and eating only those which will be needed to keep the body healthy. Conclusions Nutrition for malnourished stroke patients will require great patience on the part of a nurse or caregiver, due to various problems like difficulties in chewing, swallowing, loss of taste and smell, emotional experiences, loss of appetite, lack of energy, and the effects of other diseases. They lead to unintentional weight loss. Thus, the challenge is to overcome obstacles and become successful in providing the stroke patient with adequate calories to meet daily requirements in order to maintain the right weight. Regular monitoring of BP, weight, food intake, discharge, and behaviour will be necessary. Providing B vitamins, calories, protein, minerals, adequate liquids, aside from the medications will require calculations. Cleansing therapy should be given everytime there are signs of dirty discharge or when there is constipation. It will improve absorption of nutrients and get rid of toxins, excess fats, and give many other benefits. Feeding with fresh fruits and vegetables is highly recommended for the phytonutrients that cooked food cannot provide. Beyond meeting calorie requirements, vitamins, minerals, phytonutrients for adequate weight maintenance, and resorting to cleansing therapy for better absorption of nutrients, higher resistance to diseases, and for faster recovery, the nutrition needed should be in conjunction with a stroke patient’s medication. Patrick Davey (2010, p.46) considers unintentional weight loss that may be either caused by anorexia or another source inspite of normal appetite. His schematic diagram showed that anorexia could be (1) due to organ failure of the “heart, renal, and the lungs”, (2) Dementia / depression which involves a neurological disease, (3) an infection like HIV, TB, (4) cancer, and (5) Gastro-intestinal tract inflammation. If there seems to be normal appetite and yet the patient remains malnourished or underweight, he says it could be due to (6) poor absorption of food nutrients, (7) hyperthyroidism or diabetes. The occurrence takes places in 1.3% to 8% of the elderly. Weight loss can turn into a more morbid scenario and may end up in death. The recommended procedure to overcome loss of weight has been to first identify the cause of that weight loss. Behind all the different difficult situations of stroke patients is the caregiver who must be alert, creative, and accurate in responding to the nutritional needs of a stroke patient. As Ellen M. Barker (2008, p. 555-556) had written, “…care must include every possible prevention strategy to help the patient avoid a future stroke catastrophic, depressive response.” References: Balch, Phyllis A., 2006. Prescription for Nutritional Healing, 4th Edition. Penguin Group Ltd, USA. Balch, Phyllis A ,2002 . Prescription for Herbal Healing: An Easy-To-Use A-Z Reference to Hundreds of Common Disorders and Their Herbal Remedies. Penguin Putnam Inc. Bales, Connie W. and Ritchie, Christine Seel ,2009. Handbook of Clinical Nutrition and Aging. Humana Press, Springer Science + Business Media, Barker, Ellen M. 2008 . Neuroscience Nursing: A Spectrum of Care, 3rd edition. Elsevier Health Sciences. Berkson, Burt and Berkson, Arthur J. , and Challem, Jack, ed.,2006 . User’s Guide to the B-Complex Vitamins. Basic Health Publications. Burke Rehabilitation Hospital, 2010. Study Impact of Nutritional Supplementary Treatment of Undernourished Stroke patient on Functional Outcome Measures. BioPortfolio Clinical Trials, July 15, 2010. Available online @ http://www.bioportfolio.com/resources/trial/107219/Study-Impact-Of-Nutritional-Supplementary-Treatment-Of-Undernourished-Stroke-Patient-On-Functional.html . Accessed July 28, 2011. Burgess,Ann, Glasauer, Peter, and FAO-UN, 2004. Family Nutrition Guide. FAO of the United Nations, Rome. Caras, Nick, 2008. Detoxify Your Lifestyle. Nick Caras 2008. Cicala, Roger, 1999 . The Brain Disorders Sourcebook. Lowell House, NTC/Contemporary Publishing Group, Inc. Cleveland Clinic, 2008. The Role of Nutrition in the Prevention and Treatment of Stroke. The Cleveland Clinic Foundation, Sept. 5, 2008. Available online@ http://my.clevelandclinic.org/disorders/stroke/hic_the_role_of_nutrition_in_the_prevention_and_treatment_of_stroke.aspx . Accessed July 28, 2011. Davey, Patrick, 2010. Medicine At A Glance. John Wiley and Sons. Duyff, Roberta Larson, 2011. American Dietetic Association Complete Food and Nutrition Guide. John Wiley and Sons. Fee, Earl, 2011. One Hundred years Young the Natural Way: body, Mind, and Spirit Training. Trafford Publishing 2011. Fife, Bruse, 1997. The Detox Book: How To Detox your Body To Improve Your Health, Stop Disease, and Reverse Aging. Piccadilly Books Ltd. Finestone, Hillel M. and Greene-Finestone, Linda S., 2003. Rehabilitation Medicine: 2. Diagnosis of Dysphagia and Its Nutritional Management for Stroke Patients. CMAJ, 169 (10) 1041-1044. Gariballa, Salah MD., FRCP , 2004. Nutrition and Stroke: Prevention and Treatment. Blackwell Publishing Ltd. Geyer, James D. and Gomez, Camilo R.,2009. Stroke: A Practical Approach. Lippincott, Williams & Wilkins and Wolters Kluwer. Marshall, Collin, 2003. Obesity Epidemic: The Marshall Plan Natural Diet-Free Solution. iUniverse Inc. Myco, Freda ,1983 . Nursing Care of the Hemiplegic Stroke Patient. Harper & Row Ltd. London. Nip WF, Perry L., McLaren S., and Mackenzie, A., 2011. Dietary Intake, Nutritional Status, and Rehabilitation Outcomes of Stroke Patients in Hospital. Journal of Human Nutrition & Dietetics, the British Dietetic Association Ltd.. PubMed Articles. Available online @ http://www.bioportfolio.com/resources/pmarticle/187442/Dietary-Intake-Nutritional-Status-And-Rehabilitation-Outcomes-Of-Stroke-Patients-In-Hospital.html . Accessed July 28, 2011. Norris, John W. and Hachinski, Vladimir, eds, 2001. Stroke Prevention. Oxford University Press, June 1, 2001. Ostfold Hospital Trust, 2010. Nutritional Therapy for Stroke Patients. BioPortfolio Clinical Trials, July 15, 2010. Available online @ http://www.bioportfolio.com/resources/trial/116298/Nutritional-Therapy-For-Stroke-Patients.html . Accessed July 28, 2011. Page, Linda, 2008. Healthy Healings Detoxification: Programs to Cleanse, Purify, and Renew. Healthy Healing LLC. Pusey, Beth Ann Schaff, 2006. You Are What You Eat: Nutrition for the Beginner. Xlibris Corporation, USA. Rosdahl, Caroline Bunker and Kowalski, Mary T., 2008. Textbook of Basic Nursing 9th Edition. Walters Kluwer Health, Lippincott Williams and Wilkins. Roth, Ruth A. and Townsend, Carolynn E., 2003. Nutrition and Diet Therapy, 8th Edition. Thomson Delmar Learning. Sharma, Dr. Rajiv, 2006. Improve Your Health with Papaya, Bengal, Quince. The Book Factory. Stein, Joel M.D., Harvey, Richard L., Macko, Richard F., Winstein, Carolee J. and Zorowitz, Richard D., Eds., 2009. Stroke Recovery and Rehabilitation. Demos Medical Publishing. Sheehan, Tanya Lee, 2008 . Fitness Food Cookbook and Inspirational Nutrition Guide, Version 5. Body Art Motion. Tietze, Harald W. , 2003. Papaya (Pawpaw): The Medicinal Tree. Harald W. Tietze Publishing. Appendix Figure1. Fruit Calories Contents ( Source: Pusey, Beth Ann Schaff, 2006. You Are What You Eat: Nutrition for the Beginner. Xlibris Corporation, USA). Figure 2. Dairy Calories Content ( Source: Pusey, Beth Ann Schaff, 2006. You Are What You Eat: Nutrition for the Beginner. Xlibris Corporation, USA.) Figure 3. Fats, Oils, Sugars, Sweets (Source: Pusey, Beth Ann Schaff, 2006. You Are What You Eat: Nutrition for the Beginner. Xlibris Corporation, USA. ) Figure 4. Carbohydrates, Bread, Pie, Cakes, Cookies, Cereals, etc. Unit Calories Unit Calories (Source: Pusey, Beth Ann Schaff, 2006. You Are What You Eat: Nutrition for the Beginner. Xlibris Corporation, USA.) Figure 5. Protein, Meat, Beans, Fish, Eggs, Nuts (Source: Pusey, Beth Ann Schaff, 2006. You Are What You Eat: Nutrition for the Beginner. Xlibris Corporation, USA) Figure 6. Acceptable Weights for Healthy Adults Given a Height ( Source: “Nutrition and Diet Therapy” p. 298, by Ruth A Roth and Carolynn E. Townsend 2003) Figure 7. Acceptable Body Mass Index Given the Height ( Source: “Nutrition and Diet Therapy” p. 297, by Ruth A Roth and Carolynn E. Townsend 2003) Figure 8. Common Fast Food Nutrients ( Source: “Nutrition and Diet Therapy” p. 256, by Ruth A Roth and Carolynn E. Townsend 2003) Figure 9. Tips For Eating Well With Swallowing Problems (Source: http://my.clevelandclinic.org/disorders/stroke/hic_the_role_of_nutrition_in_the_prevention_and_treatment_of_stroke.aspx ) Figure 10 – Additional Benefits of Phytonutrients For stroke patients and others who need to prevent the onset of various diseases, Earl Fee (2011, p. 77) said: “The remarkable phytonutrients work with the vitamins, minerals, enzymes, and fiber to protect against disease. These natural compounds are associated with the prevention and treatment of at least the four leading causes of death: cancer,diabetes, cardiovascular disease, and hypertension. In addition, phytonutrients help prevent stroke, cataracts, arthritis, atherosclerosis, osteoporosis, and urinary tract infections…DNA repair due to toxic exposure…increases immune activity: antibacterial and antiviral properties…helps excrete toxins and harmful chemicals…reduces blood pressure, strengthens and protects blood vessel walls, strengthens capillaries that carry oxygen and nutrients to cells, helps regulate the correct hormone balance: alters estrogen metabolism…increases energy levels…reduces LDL cholesterol.” Figure 11. What Detoxification Means In the book entitled “Detoxify Your Lifestyle”, Nick Caras (2008, p.81) clarifies what is meant by detoxification. His very first advice is “Stop feeding sugar to the bad bacteria in your gut.” One might say not much sugar is given to the patient. In reality, most of the food consumed gets converted into glucose which also means sugar in layman’s language. His second advice is to utilize probiotic food supplement. For the third advice in detoxification, he says that yogart and sauerkraut should be made part of the regular diet. Remember what had been mentioned earlier about the benefit of yogurt in that it can give provide good bacteria that produces B vitamins. The 4th advice was to flush out and clean the colon so that the intestinal tract can be cleaned. Although he did not mention Papaya for that purpose, such a fruit performs the purpose of flushing out excess food from the colon. His 5th and final advice is to avoid toxins. They come from pesticides, pollution of the air, cigarette smoking, antibiotics and other chemical medications. The last source is unavoidable at times. However, once a treatment is completed after a regimen of antibiotics, flushing out the excess toxins and reviving the good bacteria with unprocessed yogart will revive the system within. He warned (p.91) about GMO (genetically modified products) sold in the market because their DNA of GMO seeds were injected with pesticides, herbicides, and fungicides to help farmers minimize work in spraying farm products. Those sprayed with chemicals can be washed. GMO products have the toxins inside and they cannot be washed out. Figure 12 – Benefits and Proper Use of the Papaya for Stroke Patients This fruit also contains Amino Acids like (1) Isoleucine which contributes to growth, mental health, nitrogen balance, and the synthesis with other amino acids, (2) Leucine which is said to provide energy for the muscles as well as stimulate the brain; (3) Lysine which helps in the formation of blood antibodies and “improves the circulatory system and promotes cell growth” (p.37); (4) Methionine which “metabolizes fats and lipids that maintain a healthy liver. calms the nerve ; (5) Phenylalanine which is needed by the thyroid that has an impact on the metabolic rate of the person; (6) Threonine which improves digestion in the intestines; (7) Tryptophane which helps in the utilization of vitamins B-complex and builds better nerve fibres, and then allows patients to have better emotional stability, calmness, appetite; (8) Valine which improves mental capacity and muscle coordination; (9) Arginine which helps keep the blood clean by the action of papaine on protein to break it down; (10) Histidine which can improve hearing ability through the benefits gained by the nerve relay; (11) Alanine which can strengthen cell walls; (12)Aspartic Acid which transforms carbohydrates into energy; (12) Cystine which improves Pancreas performance in stabilizing blood sugar and eliminating allergic response to some food; (13)Glutamic Acid which joins the glucose to provide better energy for the brain cells; (14)Glycine which promotes the generation of more energy; (15)Proline, “a precursor of Glutamic Acid”; (16) Serine which covers and protects the nerve fibres; and (17) Tyrosine which is an anti-aging amino acid that regulates the hunger satiety, helps in the production of hair color pigments, and protects the skin against sunburns. Dr. William L. Mayo supported the common sense articulations of Harald Tietze (2003, p.6-7) about the benefits of Papaya. Other authors who have written about Papaya confirmed the positive effects of Papaya for people with high blood pressures. Dr. Rajiv Sharma (2006, p.19) recommended Papaya diet for high blood and also included the same many benefits of its amino acids (p. 12). He said (p.15), “The ripe fruits are rich in vitamins. They contain vitamins A, C, and B-complex, amino acids, calcium, iron, enzymes, and so on. The protein in Papaya is not only digestible food but it also helps to break up hard-to-digest-protein.” Therefore, it must be good for the nutrition of stroke patients with difficulty chewing and who encounter digestion problems as a result. However, Papaya should be only in regulated amounts due to its power to also cause loose bowel movement. It is best used to overcome constipation. The common sense procedure would be to observe the pattern of discharge aside from the pattern of eating. If the stroke patient is unable to excrete normally at least once a day, there is either a poor digestion or there has been lack of food intake during the day or the previous day. This goes back to the earlier situation wherein the patient does not eat enough for any of the possible reasons already given. Assuming he was able to gain adequate weight, it is not enough to wait for the blood pressure to rise suddenly. The preventive measure is to keep the internal system clean or free from toxins, excess fats, and unwanted bacteria – since nourishment includes cleanliness. A body may be considered infected and malnourished if the internal system of the body is polluted with substance that should not be there. For example, too much sodium can lead to stroke. Polluted internal systems release discharge that will look dirty and that will give a foul scent. If the discharge is too soft, perhaps due to liquefied food intake, too much oily and/or fibrous food, and lack of solid food intake, the recommended procedures (for adults) by Phyllis A. Balch (2002, p. 260) are as follows: (1) stop giving all sources of soft bowel discharge or diarrhoea, namely, coffee, fibrous food, high dosage of Vitamin C (3,000 mg.), lactose rich milk; (2) drink plenty of liquids (not hot or cold); (3) shift to BRAT recipe (Bananas, Rice, Applesauce, Toasted bread) or cooked potatoes; (4) If the “diarrhoea is chronic (lasting more than three days), consult a doctor. Papaya should be avoided because of its enzymes and fibres, whenever a discharge is too soft. Take the recommended anti-diarrhoea medications. There are many herbal or alternative medications against loose stool. But unless the doctor allows their use, patients should stick to the prescribed medications. The best way to regulate the intake of a combination of food to meet the daily required calories without inducing prolonged loose bowel and constipation is by (a) recording food intake in terms of time, volume or quantity, (b) recording medications given at a determined time and dosage, and (c)taking the blood pressure before meals and after meals, and by (d) monitoring the pattern and results of discharge. This is very much what hospital nurses do for purposes of tracing problems with patients. Figure 13. Why Obesity Will Facilitate Stroke According to Marshall, Colin ( 2003, p. 2), it is a known fact “that obesity or its fundamental causes can lead to atherosclerosis, high blood pressure the silent killer, arthritis and type II diabetes. These conditions…can result in heart attack, stroke, congestive heart failure, a degraded immune system and vulnerability to many diseases.” It presupposes excess fats which will cling to the walls of the vessels and then narrow the passage of blood. The fats can eventually block food nutrients from being received by the body through the blood. Then the vessels will become malnourished until they are weak. With high blood pressure, those weak vessels lose their flexibility so that a high blood pressure can result in the bursting of a part of the blood vessel somewhere in the brain. It is possible for the stroke patient to be among those who used to be obese prior to a stroke, but suddenly lost weight soon after a stroke. Those who love to eat fatty meat products will have to change their lifestyle by giving up whatever will lead to excess cholesterol. And the caregiver will have to educate a stroke patient about the reasons why he is being given not what he wants but what he needs to eat in order to have normal weight. Figure 14. Why B Vitamins Are Critical To Good Nutrition of Stroke Patients According to doctors Burt Berkson and Arthur J. Berkson (2006, p.5), vitamin B-Complex “are essential to the proper functioning of your blood and entire immune system.” Because they are water soluble and most are released through urination, B vitamins should be supplied to the body on a daily basis. These vitamins are found in liver and kidney parts of meat products, in green leafy vegetables, in beans, peas, peanuts, and other legumes. They are NOT found in most carbohydrate products like cereals, bread, and pasta. Severe deficiency can result in Pellagra Disease and Beriberi. Symptoms of inadequate B-complex can be early fatigue, “tingling in the fingers and toes”(p. 7), or inflammation of the tongue. Those who do not take multivitamin preparations with B-Complex are most likely deficient in the B vitamins simply because cooking eliminates them. Patients who take antibiotics kill the beneficial bacteria that produce vitamin B-Complex. Unprocessed yogurt can re-supply the body with beneficial bacteria that naturally produces the B vitamins. Having adequate supply of B vitamins protects against “mood disorders”(p.9) and sharpens mental functioning (p.17). It is also said to be capable of protecting against stroke. Both doctors said (p. 9) “One way in which B vitamins protect you from heart disease is tied to the amino acid homocysteine, which is produced by the body during breakdown of protein. Research has repeatedly shown than an increased level of homocysteine in the blood is an important risk factor for serious damage to arteries, which can lead to heart disease and strokes. Several studies illustrate the beneficial effects of B vitamins on homocysteine levels. For example, in one study, homocysteine levels were significantly lowered in more than 600 patients with B-vitamin supplementation. The three key B vitamins that were shown to effectively reduce homocysteine levels are folic acid, vitamin B6, and vitamin B12.” Vitamin B1 has anti-stress properties. Doctors observed (p.17) that those who took B1 regularly for 3 months became “clear-headed, energetic, and self-composed”. 50-100 mg. of Thiamine (B1) per day was the recommended dosage although the required daily amount for adults is only 1.5 mg. per day. Thus, one way to improve appetite is by ensuring the daily intake of vitamins B-complex whether in tablet form, syrup, or from natural sources like fresh fruits and vegetables. Read More