Category: glycocalyx

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Glycocalyx – What’s Mucous All About?

*This post was written in 2010 as the second chapter of a book that I had started writing about nutrition and my own struggles with health. I’ve shared other sections from the book but I had never shared the following chapter because of the taboo nature of nasal mucous — common sense suggested that it is just too controversial a topic to write about nasal congestion — but snot’s all right, we need it to help stabilize the thin layers of membranous cell walls that surround all of our cells and organs.

A more recent article from Harvard.edu: All About That Mucus: How it keeps us healthy.

“Good behavior is attained at a young age.”                            – Burkino Faso proverb

[1, African wisdom desk calendars, Annetta Miller]

To sniff or blow? When is nasal discharge too much of a good thing? When allergies cause thin watery discharge that continually drips or causes congestion and difficulty breathing. Nasal discharge does typically drain to the back of the throat where it may be swallowed naturally. Childhood is too often filled with shaming about runny noises and dirty faces or sleeves or fingers. Is picking it and eating it a disgusting and filthy habit or an oral vaccination boost to the immune system? Traditional Eskimo cultures conserved fluid and heat by picking and eating it. [3] My mother tried to teach me good manners, as mothers do in Africa and all around the world, but I had allergies and wasn’t good at always having a fresh tissue with me.

Just what is snot, or more politely – mucus/mucous? It may be described as a freeform gelatinous matrix of glycolipids and glycoproteins that covers our internal surfaces and is known as the glycocalyx.

Good snot, bad snot, it’s not all the same. Healthy mucous layers are two millimeters thick — about the same width as a piece of thread or single strand of hair. Obviously we can produce a lot more than that in response to sickness or allergies. Over the course of my life I have had a lot of experience with nasal mucous and congestion. Most of my childhood was spent breathing through my mouth because I was so congested, so often. On a good day I would be able to breath through one or the other nostril but usually both were congested – and messy. Eventually I learned how to tell whether I needed antibiotics or more antihistamine based on the color, texture, and smell of my nasal mucous.

Gross yellowish-green mucous that had a rotten smell and a stringy, sticky texture meant go to the doctor and get antibiotics because the congestion has become a lung infection.

Thin, watery, clear or whitish mucous is produced in large amounts during allergy attacks. Mucous produced due to allergies didn’t have smell associated with it in my experience. The thin fluid mucous produced in such large amounts during allergies may be helping the body carry the allergen debris up and out of the lungs. Constantly suppressing this response with medications may produce short term symptom relief, however in the long run using medications that dry up mucous may be allowing the allergens full access to deeper lung tissue made accessible through the artificially opened airways. The mucous is part of our body’s defense system.

Coughing and sneezing and moving the mucous out may be better for your health than regularly using an over the counter medication. Cleaning up the environment and removing dust and allergens would also probably be better for your health, when possible, ie: you can stop smoking but you have little control over smog alert days beyond wearing a face mask and voting for environmental protection; or you can vacuum and wash your bedding weekly but you may not be able to give away the family pet as easily.

I tried a nasal steroid spray for the first time recently and discovered myself producing a brand new type of mucous. My airways felt more open than usual but I also developed a new cough that felt like I had something stuck in my throat that I was choking on, like a cat with a hairball. When I successfully cleared the mucous, it appeared a typical whitish color but the texture was much stickier and slimier — more like my childhood toy can of Slime. I stopped using the steroid nasal spray fairly quickly; free flowing snot’s all right — sticky, slimy snot is not — it isn’t able to be expelled as easily. Free flowing mucous allows the body to carry allergens and pathogens up and out of the lungs when the mucous is thin enough to allow productive coughing.

Occasionally I would blow my nose and find little round globule of clear semi-solid mucous — fascinating for an easily amused and not easily disgusted child — they looked just like a gelatin dessert without the bright food coloring. The chemical structure of mucous is similar to a gelatin dessert or fruit jams and jelly. Fruit jams and jelly thickens when the pectin fiber is cooked. Heating the pectin fibers cause them to change shape and form the semi-solid structure of the jam or jelly. Gelatinous mixtures are all fairly chemically unstable and minor changes in acidity or hydration may cause changes in the structure or cause the gelatinous mixture to dissolve back into a fluid.

Chemical mixtures are made when we cook food. Tiny chemical changes can produce big changes in a “free-form gelatinous matrix.” You could experiment by adding a little lemon juice or carbonated beverage to a bowl of a gelatinous dessert or scoop of jam. The acidity should cause the gelatinous structure to break apart and get watery looking again.

The glycocalyx may act a little like glue between cells or like a sealant coating pipes in a plumbing repair. The jelly-like glycocalyx helps protect our inner surfaces around cells and in the lining of blood vessels and throughout the intestinal tract. A healthy glycocalyx layer may help prevent allergens from leaking through the intestinal lining into the bloodstream. Pectin is important for making jam or jelly and eating fiber rich foods everyday is probably just as important for maintaining a healthy glycocalyx. Good sources of fiber include any whole plant foods such as: vegetables, fruits, mushrooms, whole grains, beans, nuts and seeds, and herbs and spices. There is also a healthy type of fiber in edible insects called chitin.

Happy dining!

— on fiber rich foods of course.     ;-)

Read more about which types of fiber are beneficial within the GI tract and which types of foods and fiber might help with nasal congestion:  Nasal congestion and fiber; a glycocalyx clarification, 

A gelatin dessert.

*Having enough water every day is also important for healthy mucous. And the electrically active minerals sodium, potassium, calcium, and magnesium are also important in fluid balance and healthy mucous .

Read more: Electrolytes are essential, magnesium helps protect brain cells 

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Bioslime is another word that is used specifically to describe the gelatinous glycocalyx layer produced by pathogens on the surfaces of transplant devices and tubing used in patient’s wounds for drainage or tube feedings.

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Fringe Report: The glycocalyx, fiber rich produce, and intestinal health

The term glycocalyx may be used to refer to the surface area of membranes that surround a single human or bacterial cell, or to the surface area of the membranes that form the interior or exterior of an organ, blood vessel, or the gastrointestinal tract. The fiber found in fruits, vegetables, nuts, seeds, beans, whole grains, mushrooms and a few other foods helps us form the glycocalyx. Pectin in fruit is a type of fiber that thickens into gelatin when the fruit is cooked. The fiber works together in our intestines to form a jelly like layer that lines and helps stabilize the intestinal walls. White blood cells can move around in the jelly layer patrolling for allergens or infectious agents.

Some of the fibers that are found in the glycocalyx layer are electrically active. The electric charge coating the interior of vessels and the intestine help to keep the area open because it acts like two magnets that are held together so the repel each other instead of joining – the electrically  active chemicals lining the intestine push each other away rather than attracting each other and it helps keep the interior of the vessel wide open and flowing freely. Adequate fiber and water helps prevent constipation. See  “Neuraminic acid was known first as sialic acid” (8/21/2013) for more information about electrically active sugars.

 

[The Glycocalyx, Our Jelly Filling, ]

[Glyco-compounds – essential sugar building blocks, ]

[We are what we eat., ]

[Alp Luachra, an old name for edematous malnutrition, ]

And four posts that lost their paragraph breaks when I copied them onto one page:

Sugars give energy and structure to life (July 16, 2013)

Neuraminic acid was known first as sialic acid (8/21/2013)

To termites, trees are kind of like giant sugar cubes (8/21/2013)

GPI anchors are cell membrane glycoproteins (8/27/13)

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

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Glyconutrient posts

Title: Sugars give energy and structure to life (July 16, 2013)
/This is the first of a few posts about glycocompounds. //second one: Neuraminic acid was known first as sialic acid// third one: To termites, trees are kind of like giant sugar cubes/
Carbohydrates are formed from carbon and water molecules. The name means ‘hydrate of carbon.’ Individual carbohydrate molecules are called simple sugars or monosaccharides. They are commonly found in the diet as disaccharides, pairs of two monosaccharides, and as long chain polysaccharides in the form of the energy rich starches and the indigestible fiber found in cell walls of plants. The individual monosaccharides may be found as a straight chain of linked carbon atoms or as closed rings. The ring form is more stable chemically. A glass of sugar water made with pure glucose would only have ~0.0026% of the glucose molecules in the straight chain formation, the rest would be in some variation of the the ring form.
The juice of the sugar cane gives us sucrose or table sugar, which is made up of two 6 carbon monosaccharides, one molecule of glucose and one of fructose. The disaccharide lactose is better known as milk sugar and is made up of one molecule of galactose and one of glucose.
Mannose and fucose are monosaccharides that are less common in unprocessed foods but are very useful as food additives in mixtures such as ice cream or pudding. Fucose is commonly found in brown seaweeds. About forty percent of the dry weight of brown seaweeds is the commercially useful alginate polysaccharides. Alginates are used as food additives to help stabilize mixtures and act as emulsifiers which help keep the mixture well mixed while standing on the grocery shelf. Mannans are the polysaccharide of mannose. Mannans are found in red algae which is useful for its agar and carrageenan content. They are used as food additives for their gelatinous properties and as thickeners. Carrageenan may be a health risk and has been shown to cause inflammation, impaired glucose tolerance and increased insulin resistance in lab animals at levels that might be found in comparable amounts in an average day’s food for a person.
Mannans are also the main type of energy storage starch in the seeds of the oil palm trees. One variety of the tree species, the ivory nut tree, is also known as ‘vegetable ivory.’ The mannan within the ivory like seeds resembles the overlapping long polysaccharide chains of cellulose, which is the type of fiber more commonly found in plant cell walls.

Other uses of the oil palm:  There are two types of oil produced from the seed of oil palm trees. Palm kernel oil is paler in color than the reddish color, beta-carotene rich, palm oil. Palm kernel oil contains a higher percentage of saturated fat than palm oil. It may increase the risk of high blood cholesterol but is an inexpensive cooking oil. Palm kernel oil is also frequently used in the production of soap because some of the saturated fatty acids produce good lather, even in salty sea water. Fibrous seed pulp that is left after oil production is used as animal feed.

The monosaccharide mannose may be the active factor that gives cranberries a reputation for helping prevent urinary tract infections (UTIs). The monsaccharide is thought to help make the lining of the bladder more resistant to infectious bacteria. More research is needed though to prove health benefits from cranberries or from more concentrated supplemental doses of D-Mannose.
(To be continued later – Glyconutrients are essential for helping protect cell surfaces from infectious agents – so fans of cranberries are probably onto a good thing.)
/Disclaimer: Information presented on this site is not intended as a substitute for medical care and should not be considered as a substitute for medical advice, diagnosis or treatment by your physician./
References:

  1. S.A. Brooks, M. V. Dwek, U. Schumacher, Functional and Molecular Glycobiology, (BIOS Scientific Publishers, Ltd., 2002), Amazon.
  2. “Out of One Many, or How to Use Agar Agar,” (Dec. 17, 2008) by chocolatecoveredKatie.com.
  3. “Palm Kernel,” Wikipedia (Warning: this Wikipedia entry contains an old war propaganda poster about harvesting palm seeds which may offend some people and for that very reason should never be forgotten.)
  4. “Palm Kernel Oil,” Wikipedia.
  5. “Palm Oil,” Wikipedia.
  6. “D-Mannose Offers Great Protection Against Urinary Tract Infections,”  SmartPublications.com.
  7. “Scientific Opinion on the substantiation of a health claim related to a Uroval® and urinary tract infection pursuant to Article 14 of Regulation,” (EC) No 1924/20061, EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA), European Food Safety Authority (EFSA), Parma, Italy
    pdf: efsa.europa.eu.
  8. L. Johnston, “Natural Urinary Tract Health: The D-Mannose Solution,” healingtherapies.info.
  9. A Weil, “Is Carrageenan Safe?” (Oct. 1, 2012), drweil.com.

Title: Neuraminic acid was known first as sialic acid (8/21/2013)
Neuraminic acid, or sialic acid as it was first called, is a monosaccharide with nine carbons. It has a negative electric charge which gives compounds containing it a negative charge. This is useful for keeping molecules like red blood cells from getting to near to each other. The negative charge on the surface glycoproteins repels the red blood cell from each other or from the walls of blood vessels which also have compounds containing sialic acid.
Mature red blood cells have an active life for about seven days.  White blood cells remove older red blood cells and de-sialylation of the surface proteins is one way the older cells are identified. Cancer cells with the ability to produce excess surface sialyation may have an increased chance to metastasize and turn up somewhere else in the body. [1, 3]
Our bodies need to be healthy and well enough nourished overall to keep the whole system working. The neuraminic acid is produced within our cells from other chemicals in a series of membranous channels called the endoplasmic reticulum and the golgi apparatus. The channels have embedded enzymes along the way somewhat like an assembly line in a factory.
Therapeutic glycoproteins are being developed and the problem of just the right amount of sialylation is one of the hurdles being studied. [2] In addition to the negative charge sialic acid tends to stabilize and stiffen the protein portion of the compound.  The proteins that line vessels were described to be somewhat like bottle-brushes; the protein being somewhat like the wire handle with the negatively charged sialic acid acting as bristles. [1]
/Disclaimer: Information presented on this site is not intended as a substitute for medical care and should not be considered as a substitute for medical advice, diagnosis or treatment by your physician./
References:

  1. S.A. Brooks, M. V. Dwek, U. Schumacher, Functional and Molecular Glycobiology, (BIOS Scientific Publishers, Ltd., 2002), Amazon.
  2. Bork K, Horstkorte R, Weidemann W., “Increasing the sialylation of therapeutic glycoproteins: the potential of the sialic acid biosynthetic pathway.” J Pharm Sci. 2009 Oct;98(10):3499-508. doi: 10.1002/jps.21684.  [ncbi.nlm.nih.gov]
  3. R. T. Almaraz, et. al., “Metabolic Flux Increases Glycoprotein Sialylation: Implications for Cell Adhesion and Cancer Metastasis.” Mol Cell Proteomics. 2012 July; 11(7): M112.017558. Published online 2012 March 28. doi:  10.1074/mcp.M112.017558 [ncbi.nlm.nih.gov]

Title:  To termites, trees are kind of like giant sugar cubes (8/21/2013)
Sugar cubes contain the disaccharide sucrose which contains the monosaccharide fructose in addition to glucose. The cellulose portion of trees is made of long fairly straight chains of glucose with no fructose, so trees and sugar cubes aren’t really alike. The bonds between table sugar and tree fiber are at slightly different angles but different enzymes are needed to break them down during digestion. The straighter angle between the simple sugars of plant fiber allow the linked chains of glucose to line up with each other. The lined up fibers then can form layers a little like sheets of paper stacked in a book, except it would be a doughnut shaped book. Cellulose or other types of plant fiber is found in the cell walls of the leaves, stems and roots.
Chitin is similar strong chain of the simple sugar N-acetylglucosamine. The simple sugars in chitin and cellulose both have the slightly straighter beta angle than the bonds found in energy storage starches or polysaccharides. Termites [3] and the bacteria found in the stomach of grazing animals are able to digest the stronger beta bonds of cellulose. Humans and most other animals can’t digest them because a specific enzyme is needed.
Energy starches have alpha type bonds between the simple sugars. Alpha bonds connect at an angle that might twist into a spiral chain similar to the double helix spiral of DNA. The angled alpha bonds are also found in branching shapes of storage starches like glycogen or amylose. The sugar molecule at the end of each ‘branch’ is available for rapid digestion. Glycogen is the energy storage polysaccharide of glucose in animals and humans and amylose is the form of glucose storage used in plants. Glycogen is slightly more branched than amylose.
Tree bark and tree sap both contain glucose but the bark contains cellulose and the sap would have amylose or a similar alpha bonded energy storage starch. A shiny insect shell or seashells also are a type of sugar but not glucose. Shells contain N-acetyl-glucosamine in the form of chitin.
Supplements of glucosamine may be helpful for reducing joint pain. Studies have used 1500 mg/day. [2]
/Disclaimer: Information presented on this site is not intended as a substitute for medical care and should not be considered as a substitute for medical advice, diagnosis or treatment by your physician./
References:

  1. S.A. Brooks, M. V. Dwek, U. Schumacher, Functional and Molecular Glycobiology, (BIOS Scientific Publishers, Ltd., 2002), Amazon.
  2. “Questions and Answers: NIH Glucosamine/Chondroitin Arthritis Intervention Trial Primary Study,” National Institutes of Health, National Center for Complementary and Alternative Medicine [nccam.nih.gov]
  3. Nakashima K, Watanabe H, Saitoh H, Tokuda G, Azuma JI.,”Dual cellulose-digesting system of the wood-feeding termite, Coptotermes formosanus Shiraki.” Insect Biochem Mol Biol. 2002 Jul;32(7):777-84. [ncbi.nlm.nih.gov]

Title: GPI anchors are cell membrane glycoproteins (8/27/13)
Glycosylphosphatidylinositol (GPI)-anchored proteins have one end that stays embedded firmly within the cell membrane and the other end can attach to a variety of important molecules such as enzymes and antigens. The enzyme or antigen is held above the cell membrane in a position that makes it available to be activated on the cell surface. The phosphatidylinositol end is lipid based and dissolves well in the fatty acid rich environment within the membrane. The glyco- or sugar part of the molecule is able to dissolve in water or form bonds with other proteins or carbohydrates.
GPI anchor proteins are essential for life. Mice that were experimentally made to lack the gene thought to encode for GPI anchor proteins did not survive. Experimental ‘knockout’ mice are usually observed to see what types of function the knocked out gene might have performed. The experiment showed that GPI anchors were necessary for survival. (Ref. 1, Brooks, Dwek, Schumacher, 2002, p 225)
GPI anchors are found in some types of G-protein couple receptors and may have importance within the cannabinoid receptor system.

  1. Brooks SA, Dwek MV, Schumacher U., Functional and Molecular Glycobiology, (Bios, 2002, Oxford, UK)
  2. Landry Y, Niederhoffer N, Sick E, Gies JP., Heptahelical and other G-protein-coupled receptors (GPCRs) signaling., Curr Med Chem. 2006;13(1):51-63. [ncbi.nlm.nih.gov/pubmed/16457639]
  3. Maccarrone M, Bernardi G, […], and Centonze D., Cannabinoid receptor signalling in neurodegenerative diseases: a potential role for membrane fluidity disturbance., Br J Pharmacol. 2011 August; 163(7): 1379-1390 [ncbi.nlm.nih.gov/pmc/articles/PMC3165948/]

Additional note:

GPI anchors

  1. Fujita M, Kinoshita T. “GPI-anchor remodeling: potential functions of GPI-anchors in intracellular trafficking and membrane dynamics.” Biochim Biophys Acta. 2012 Aug;1821(8):1050-8. doi: 10.1016/j.bbalip.2012.01.004. Epub 2012 Jan 11.  Abstract: [http://www.ncbi.nlm.nih.gov/pubmed/22265715] “and discuss how GPI-anchors regulate protein sorting, trafficking, and dynamics.”

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

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Alp Luachra, an old name for edematous malnutrition

Alp Luachra is a Celtic fairy with a pet newt. It was considered dangerous to fall asleep near a stream. Alp Luachra might climb into the victim’s mouth along with his pet newt. They would live in the stomach and gobble up nutrients while the rest of the accursed person shriveled away. No matter how much the victim would eat they would eventually starve – because Alp Luachra leeches all the nutrition away. I learned of him from my new book, Tarot of the Celtic Fairies. The picture on the Tarot card does resemble edematous malnutrition with a very round belly and thin, starved looking arms and legs. Maybe it does exist outside of the tropics. (The 9 of Cauldrons card from  Tarot of the Celtic Fairies 14)

Kwashiorkor, (that rare tropical form of malnutrition in toddlers weaned from breast feeding too rapidly, and/or from lack of introduction of insects to the diet at the appropriate stage), has been in the news. An insurance billing watch dog group found an increased use of the diagnosis code for kwashiorkor/malnutrition in a group of California hospitals. Prime Healthcare Service’s response to the allegations that a diagnosis of malnutrition was used to increase reimbursement states that the facts were distorted in order to mislead the public and gain concessions. It continues that the “relevant (i.e., where the diagnosis affected reimbursement) malnutrition rate at all Prime Healthcare hospitals was 3.6%,which is much less than the rates referenced in the article. For example, their relevant malnutrition rate at Huntington Beach hospital was 5.3% rather than the 39% reported by California Watch.”

That seems reasonable to me. It continues to review the disturbing prevalence of malnutrition and their screening program that Prime Healthcare hospitals use for improving patient care and decreasing morbidity and mortality rates a nutritional screening for their elderly patients is part of their routine care.

Published studies estimate that up to 15% of ambulatory elderly patients, up to 44% of homebound elderly patients, up to 65% of hospitalized elderly patients, and up to 85% of nursing home patients are malnourished. Hajjar, R.R., Kamel, H.K., Denson, K., Malnutrition In Aging, The Internet Journal of Geriatrics and Gerontology, Volume 1, Number 1 (2004); Chen, C.C-H, Schilling, L.S., Lyder, C.H., A Concept Analysis of Malnutrition In The Elderly, Journal of Advanced Nursing, Volume 36(1) (2001).

** Prime Healthcare sounds like a good place for dietitians to work. A nutrition screening by a Registered Dietitian is vital for quality preventative health care. A multidisciplinary team allows a thorough assessment from multiple viewpoints – a stethoscope or a microscope or a little Celtic sparkle – who knows the health solutions that teamwork can bring. However, I was just reading about albumin on RD411, an information website, today [16]. I learned that low albumin is not considered useful to tell if a patient is malnourished because it is easily influenced by many factors besides dietary protein intake. However, at the same time I learn that it is associated with increased mortality and morbidity – so I am left to assume that  I needn’t consider the elderly person with an albumin of 7 or 8 as ‘malnourished’ but just to consider them at increased risk of morbidity and mortality instead. The recommendation is to continue dietary calculations as normal, but instead of pouring another Health Shake to add to the malabsorbtion mess I would rather consider what is causing the shift in fluid and what might be better absorbed than what we already have been trying.

In research by Yi-Chia Huang et al, the elderly Taiwanese population had an intake range of 573.9 to 3191.9 kcal/day and no association between functional status and intake could be made.  Intake of at least 55 grams protein per day was associated with better function but higher levels of protein intake again could not be correlated to improved status. [7] In cases of malabsorption we can pour in 3000 calories per day and there will be no guarantee that it will be more helpful than 573. It would probably be more harmful than low intake. Anything that passes through the body has to be brought into safe balance with the chemical needs of the intestinal lining. Magnesium is a buffer that is taken from the bones to “fix” over acidic conditions. High protein, dairy and sugar intakes add to acidic conditions and coffee, carbonated beverages, black tea, and fruit juices can be very acidic. For strong bones try choosing an herbal or green tea and pass on the extra large glass of pop or milk and the triple shot of alcohol too probably.

There is controversy over using just the albumin level for a diagnosis of malnutrition and it is true that short term edema – puffiness – will cause low albumin levels while puffy. With less fluid in the blood and more fluid in the spaces between cells and organs there will be less albumin. It is a blood protein that acts a little like a sponge to attract and keep fluid around it but where the fluid goes it is also attracted to follow. Circular paths are the way of nature. The albumin level that remains low for months – rather than during an acute week of an illness – I would strongly consider the possibility that an underlying malnutrition problem is the cause of puffiness and low albumin, the reasons for the initial malnutrition can vary but once the poor absorption starts the problems picks up pace and the body deteriorates from feeding on itself – there isn’t a newt but there is a brain, heart and lungs as long as the fingers, toes and remaining peripherals hold out (reminder Buerger’s vasculitis disease [15]).

One lab test can be supported by other labs and observed signs and symptoms of health or weakness. Several studies have found that assessing frailty factors seems more correlated with a variety of quality of life factors and improved surgical recovery rates than BMI. More than 3 of 5 of the following – unintentional weight loss, weakness, self-reported poor energy, slow walking speed, and low physical activity  was found associated with risks of falls and fractures. Hand grip strength, and calf muscle to fat area, mid arm circumference, sarcopenia were mentioned as measurements of improved muscle mass with improved health status. Sit ups and leg lifts or just a walk in the woods – better muscle mass is associated with longer life.

Based on the sensitivity of the autoimmune gut and my review of kwashiorkor research, I would surmise that a gluten free, lactose free, low calcium to magnesium ratio with an increase in glucosamine and other essential sugars (super starches) and plenty of B vitamins, C, A, zinc, selenium might help the catabolic patient with edema. We need to provide building blocks that readily make a strong glycocalcyx to reduce the leakiness of the intestinal lining.

I am glad that Prime Healthcare has had to stand up for malnourished patient’s rights – the right to a diagnosis that is accurate. An albumin of 7 or 8 is tragic and just because it is from excessive dilution due to malabsorption/mal-retention and not due to lack of protein in the diet – doesn’t mean it isn’t leading to cell starvation. Just because we don’t quite understand edematous malnutrition and don’t seem to know how to stop it, doesn’t mean that it doesn’t exist and isn’t killing people in a very costly and agonizingly slow way.

Names matter and the tropics and kwashiorkor is simply where the problem was studied most. Edematous malnutrition is a better name for the condition in my opinion than protein calorie malnutrition. Over the long term edema means that the cells aren’t being well fed or well detoxified. During edema the movement of fluid is reduced and the movement of nutrients and toxins is slowed. Over the long term edema leads to dysfunction and malnourishment. If the fluid in our toilets backed up regularly we would expect the plumber to repair it not just measure the dysfunction. Puffy abdomen and ankles = overflowing waste = better call a doctor on the Prime Healthcare team in case malnutrition is involved (and remember to ask for a referral to a Registered Dietitian); maybe repair is still in the future but recognition is at least a first step.

Kwashiorkor occurs on the same diet as marasmus malnutrition but the children have different metabolic reactions. Recent infection may be associated with the kwashiorkor susceptible population. Their intestinal lining lacked glucosamine and excess fluid movement both directions was the result. An enzyme deficiency for the conversion of glucose or galactose into glucosamine seemed to be a significant difference between the two groups of children and aldosterone levels were also abnormal in the kwashiorkor children but not the maramus group. Edematous malnutrition exists outside of the tropics.
Glucosamine supplements may be crucial for heart disease and other leaky membrane problems (dementia). Zinc and selenium are low in heart disease and B6 and all of the B vitamins are essential for cell growth and energy demands. Vitamin C is also depleted rapidly. Our “health supplement shakes” and complete feeding formulas are not based on ratios that the critically ill can tolerate – they are more harmful than helpful. We need research and development of an isotonic formula with high levels of beneficial nutrients and low levels of a few things that add to the body burden .

In the meantime more magnesium, B complex, zinc, selenium, iodine, glucosamine, taurine, vitamin C, and beta carotene rich dark green and deep orange fruit and vegetables may be helpful to the chronically ill and obese. Mushrooms, aloe vera, fenugreek, slippery elm powder and ginger also have essential sugars – super fiber for building a strong glycocalyx. The intestinal lining is an organ that protects and nourishes our bodies for miles – literally – do we want junk food littering the way or a strong yet fluid, free-form matrix of super starches, trace mineral ions lighting up the place and plenty of strong white blood cells patrolling for trouble.  Cancer wouldn’t stand a chance – or at least reduced chance.

***11-7-11 BTW I figured out what’s happening with the leaky membrane problem – its complicated – call me or read the [bazillion words, “Cantaloupe, listeria, and sea squirts, oh my,” Oct. 5, 2011]

__________________________________________________________________________

 /Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./
  1. Olubukola O. Nafiu et al., “The Association of Body Mass Index to Postoperative Outcomes in Elderly Vascular Surgery Patients: A Reverse J-Curve Phenomenon,” Anesthesia & Analgesia 112, no. 1 (January 1, 2011): 23 -29.
  2. Ian M Chapman, “Obesity paradox during aging,” Interdisciplinary Topics in Gerontology 37 (2010): 20-36.
  3. S L Miller and R R Wolfe, “The danger of weight loss in the elderly,” The Journal of Nutrition, Health & Aging 12, no. 7 (September 2008): 487-491.
  4. Ian Janssen, “Morbidity and mortality risk associated with an overweight BMI in older men and women,” Obesity (Silver Spring, Md.) 15, no. 7 (July 2007): 1827-1840.
  5. Kristine E. Ensrud et al., “Frailty and Risk of Falls, Fracture, and Mortality in Older Women: The Study of Osteoporotic Fractures,” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 62, no. 7 (July 1, 2007): 744 -751.
  6. Meei-Fang Lou et al., “Nutritional status and health outcomes for older people with dementia living in institutions,” Journal of Advanced Nursing 60, no. 5 (December 2007): 470-477.
  7. Yi-Chia Huang et al., “Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan,” J Am Coll Nutr 20, no. 2 (April 1, 2001): 135-142.  (free article)
  8. Matteo Cesari et al., “Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study,” The American journal of clinical nutrition 83, no. 5 (May 2006): 1142-1148.  (free article)
  9. H K Vincent, K R Vincent, and K M Lamb, “Obesity and mobility disability in the older adult,” Obesity Reviews: An Official Journal of the International Association for the Study of Obesity 11, no. 8 (August 2010): 568-579.
  10. Heppenstall, et al, “Frailty: dominos or deliberation?,” N Z Med J. 2009 Jul 24;122(1299):42-53. http://www.nzma.org.nz/journal/122-1299/3710/.
  11. Fred Chau-Yang Ko, “The clinical care of frail, older adults,” Clinics in Geriatric Medicine 27, no. 1 (February 2011): 89-100.
  12. Stephane M Schneider et al., “Lack of adaptation to severe malnutrition in elderly patients,” Clinical Nutrition (Edinburgh, Scotland) 21, no. 6 (December 2002): 499-504.
  13. Lilian Liang et al., “Nutritional issues in older adults with wounds in a clinical setting” 1: 63-71.
  14. McElroy, Mark, Tarot of the Celtic Fairies, artwork by Eldar Minibaev, (2010, Lo Scarabeo, Via Cigna 110 – 10155 – Torino- Italy _www.loscarabeo.com_ (I hope this will be viewed as a brief extract and recommendation rather than copyright infringement.  I find Tarot cards a meditative cognitive therapy aid – solitaire for the brain.)
  15. http://www.hopkinsvasculitis.org/types-vasculitis/buergers-disease/ ***I discussed it in my article Vasculitis – Withering from Within.The main cause of this type is smoking and the best treatment is to quit smoking. Smoking depletes oxygen and antioxidants and magnesium – malnourishment from within – second best to quitting smoking would be of course to replenish with extra vitamin C and magnesium supplements and foods and some oxygen would help also vitamin A foods – supplements have not been helpful but the food has helped . . . carrots, peaches, sweet potatoes, tomatoes, broccoli and V8, mangos, apricots and cantalope.
  16. http://www.rd411.com/index.php?option=com_content&view=article&id=393:albumin-as-an-indicator-of-nutritional-status&catid=105:professional-refreshers&Itemid=400
  17. see my previous blogs Angelina please don’t risk the knife, and We are what we eat, for more Bibliography on kwashiorkor, insects and perimenopause.
  18. see my previous blogs on the glycocalyx and Electrolytes R Us, for more on leaky membranes and hydration.
  19. http://www.highbeam.com/doc/1G1-250812435.html . “Prime Healthcare Services Review of State Health Data Confirms Normal Malnutrition Rates Among Its Medicare Patients; Recent Studies Debunked.(Clinical report).” PR Newswire. PR Newswire Association LLC. 2011. HighBeam Research. 9 Apr. 2011 http://www.highbeam.com.

From a different list of reading:
7. Yi-Chia Huang et al., “Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan,” J Am Coll Nutr 20, no. 2 (April 1, 2001): 135-142.  (free article)

Excerpt from Conclusions section:
“There were approximately 36% of functionally dependent subjects who consumed energy less than 75% of the Taiwan RDNA in our study. The elderly with functional dependence might have more difficulties in accessing food. However, we could not find an association between energy intake and functional status. This might be due to large variations of energy intake among individuals ranging from 573.9 to 3191.9 kcal/day.
Consistent with Payette and Gray-Donald [24], the elderly had sufficient mean protein intake, but these authors’ association between protein intake and serum albumin concentration was not found. Morgan et al. [6], however, indicated a positive relationship between protein intake and serum albumin concentrations. It is worth noting that the association was valid only up to protein intake of 55 g/day. Since our subjects had a varied protein intake ranging from 23 g/day to 122 g/day and half of the subjects had a protein intake .55 g/day, the dietary protein intake might no longer have an effect on serum albumin concentration. Another possibility was that chronic conditions play a determinant role in affecting the albumin concentration.”

***Note on vitamin D – The chronically ill may have depressed 25-D levels because they have elevated 1,25 D levels resulting in more than enough of the active hormone for preventing fractures even though the vitamin level seems insufficient for the average person.

The enzyme to activate the vitamin to the steroidal hormone is made by white blood cells as part of the stress/inflammation response and in some cancer cell strains. An active D level above 45 means the bones are losing calcium stores. My five year 1,25-D average, while actively avoiding vitamin D foods, supplements and much time in the sun, was 59 pg/ml and my five year average 25-D was 20 ng/ml. The range was 51-71 pg/ml, 1-25-D and 8.0-26.7 ng/ml for 25D. Ex: 3-31-2009 25-D of 9.0 and 1-25D of 53 pg/ml. If I spend a day on the beach I am hurting two days later from the calcium that is drawn out of the bones – muscle spasms, fatigue and irritability symptoms primarily for me but ringing in the ears and a twitching eyelid have been reduced with magnesium. B vitamins and zinc tend to be involved to – magnesium rich foods would provide those as well as iron and iodine only if it was grown in iodine rich soil.

Kwashiorkor Bibliography

  1. http://www.ajcn.org/content/89/2/592.long ***Reduced production of sulfated glycosaminoglycans occurs in Zambian  children with kwashiorkor but not marasmus also good –
  2.  http://www.icmr.nic.in/ijmr/2009/November/1128.pdf  Tahmeed Ahmed, Sabuktagin Rahman and Alejandro Cravioto, Oedematous malnutrition,  Indian J Med Res 130, November 2009, pp 651-654
  3.  http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.htmlWilliams, L., Jewett, C., and Doi, S. K., Hospital chain, under scrutiny, reports rare illness (The Press Enterprise Local News)
  4. http://www.pe.com/localnews/opinion/editorials/stories/PE_OpEd_Opinion_D_op_27_ed_primehealth.1816fbc.html  Shady billing? (The Press Enterprise)
  5. http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illness.html
  6. “Prime Healthcare Should Be Denied New Hospital Licenses Until Federal, State Investigations into Extraordinarily High Septicemia, Malnutrition Rates and Risk to Patients are Complete.” Business Wire. Business Wire. 2011. HighBeam Research.
  7. http://online.wsj.com/article/SB10001424052748703293204576106072340020728.html  Marcel Dicke, Arnold Van Huis are professors of entomology at Wageningen University in the Netherlands.  (2-19-11, The Wall Street Journal, pC3)  “The Six-Legged Meat of the Future“
  8. http://onlinelibrary.wiley.com/doi/10.1111/j.1525-139X.2010.00705.x/abstractEffect of Diabetes Mellitus on Protein–Energy Wasting and Protein Wasting in End-Stage Renal Disease, Nazanin Noori1, Joel D. Kopple1,2Article first  published online:13 APR 2010DOI: 10.1111/j.1525-139X.2010.00705.x
  9. http://www.ncbi.nlm.nih.gov/pubmed/19121473  Semin Nephrol. 2009 Jan;29(1):39-49. Causes and prevention of protein-energy wasting in chronic kidney failure. Dukkipati R, Kopple JD. Division of Nephrology and Hypertension, Los Angeles Biomedical  Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
  10. http://www.ncbi.nlm.nih.gov/pubmed/19121477 Semin Nephrol. 2009 Jan;29(1):75-84. Nutrition support for the chronically wasted or acutely catabolic chronic kidney disease patient.Ikizler  TA.Department of Medicine, Division of Nephrology, Vanderbilt University School of  Medicine,Nashville, TN 37232-2372, USA.
11. http://www.ncbi.nlm.nih.gov/pubmed/16129200Am J Kidney Dis. 2005 Sep;46(3):387-405. Multinutrient oral  supplements and tube feeding in maintenance dialysis: a systematic review and meta-  analysis. StrattonRJ, Bircher G, Fouque D, Stenvinkel P, de Mutsert R, Engfer M, Elia  M.Instituteof Human Nutrition, University of Southampton, UK.

12.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891019/?tool=pubmed New Insights into the Role of Anabolic Interventions in Dialysis Patients with Protein Energy Wasting Jie Dong and T. Alp Ikizler1 Curr Opin Nephrol Hypertens. Curr Opin Nephrol Hypertens. 2009 November; 18(6): 469–475.doi: 10.1097/MNH.0b013e3283 31489d.

 “Economic Implications of Nutritional interventions It is also important to assess the impact of nutritional supplements not only in terms of changes in nutritional parameters, but to extrapolate these observations to potential improvements in hospitalization, mortality, and cost-effectiveness. In a recent study, Lacson et al showed that a hypothetical increase in serum albumin concentration in the order of 2 g/L in 50%  of the United States dialysis population would be associated with  projections of approximately 1400 lives saved, approximately 6000 hospitalizations  averted, and approximately $36 million in Medicare cost savings resulting  from a reduction of approximately 20,000 hospital days over one year[68]. This is a reasonable estimation since 2 g/L increase in serum albumin is the average improvement reported in most nutritional intervention studies.”

***The above paper is suggesting that giving them growth hormones  and other anabolic steroids along with protein will help them to stop catabolizing and start building albumin. They have had success with the strategy, but wouldn’t magnesium plus protein (ideally combined within the same magnesium foods) be cheaper than hormones and protein?