I remember a drug company advertisement this past year, which used the expression "strong medicine" to catch the eye of the wary and erudite doctors. I have already forgotten what the medication was—so much for advertising. What does matter is that the phrase did catch my eye and I thought the thought: "too bad that most patients and their doctors fail to realize that nutrients are also strong medicine." In fact, in treating deficiency diseases, the corrective nutrients are the strongest possible medicines. No matter how clever or powerful a new drug treatment may be, the fact is that sickness is not likely a result of medication deficiency. This is not to deny the benefits of pharmacology; and "strong medicine" can improve the odds of recovery and perhaps give some comfort or relief of symptoms. But there is no known disease that is caused by drug deficiency. On the other hand every nutrient deficiency is potentially fatal! That is one of the most persuasive arguments in favor of putting nutrition first. To correct a nutrient deficiency is "strong medicine."
What would you think about a treatment that could lower the rate of complications after major cancer surgery by 40 percent? Would you call that "strong medicine?" Well that is exactly what was reported by a surgical team from Hong Kong. By providing a two-week-long regimen of intravenous amino acids, medium-chain fats, simple sugars, vitamins and minerals, they actually cut the death rate by 40 percent after surgical removal of cancerous liver tissue. This was a comparison between 60 surgical patients with liver cancer treated by nutrient supplementation (intravenous) and 64 similar patients (control group) who did not get nutrient therapy. Nutrient support cut the number of infections in half and the impairment of liver function was also cut by 40 percent. The need for diuretics to control fluid retention was cut by fifty percent and weight loss in the nutrient support group was negligible, where the control group averaged 3 pounds weight loss in hospital.
The best results were in patients with normal liver function. In this group nutrition support was associated with a four-fold reduction in complications. On the other hand a sub-group of patients with active hepatitis were possibly made worse by the intravenous treatment, as their complications rate was double that of the untreated control group. It is information like this that highlights the practical importance of medical nutrition: physicians must be to be knowledgeable about the role of nutrient support because nutrition is strong medicine; it makes a big difference in outcome; and it must be used properly.
If the use of nutrient support could do so much for this group of seriously ill patients facing major surgery, how do you think it would work in other surgical situations, particularly in sickly patients? The question has already been answered in various ways by clinical studies. One of my favorites is a double-blind study of vitamin A supplementation. Treating with this single vitamin at megadoses for a week before surgery was sufficient to prevent the usual post-operative drop in white blood cells. This means that the immune system of the vitamin A-supplemented patients was stronger and presumably better able to resist infection. In fact, that is what seemed to be the most important advantage in the Hong Kong study: fewer infections.
Nutrient therapy has been repeatedly demonstrated to be strong medicine, life-saving medicine. But it works best if given early, before the patient is in a life-threatened state. Furthermore nutrient therapy works better if it is individualized. Just as the Hong Kong study showed, some patients seemed to be the worse for taking the extra amino acids and fats. Perhaps these molecules overloaded the liver or added to the condition of inflammation in some way that did not occur in cases of cirrhosis (scarred liver) or uncomplicated liver carcinoma, without extensive hepatitis inflammation. This may seem reasonable and even obvious to you now as you read this, but such answers are not at all obvious to newcomers in the field of medical nutrition.
 Fan ST, Lo CM, Lai, ECS: Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. New England Journal of Medicine 1994; 331:1547-52. (Both support and control groups received 25 grams albumin IV for five days post-operatively; but only the nutrient group received 1.5 grams amino acids per Kg of body weight and 30 kcal of dextrose and 50% MCT per kg in 1.75 liters IV daily).
©2007 Richard A. Kunin, M.D.