Clinical Nutrition Dilemma

As high as 85 percent of patients with cancer are suffering from malnutrition. Malnutrition has been associated with longer length of hospital stay, higher mortality rate, increased re-admission rate, increased risk of infection and poorer outcome in general. Many of my cancer patients rely on oral nutritional supplement to sustain their lives. However, according to the Centers for Medicare and Medicaid Services (CMS), oral nutritional supplement and tube feed formula are not covered by insurance unless it is a sole source of nutrition. Therefore, once a patient has a gastrostomy feeding tube placed, doctors are hesitant to let their patients eat by mouth again because the patient may have lost insurance coverage for the tube-feeding supplies. In fact, multiple randomized controlled trials (RCT), a highly respected clinical research method, have demonstrated the cost effectiveness, improvement of health outcome and increased survival rate of an oral nutritional supplement. These...

Corn syrup and maltodextrin... just to name a few ingredients of a typical oral nutritional supplement. A bottle of oral nutritional supplement typically contains about 20 to 23 grams of sugar. Sounds terrible, right? Yes, making fruit smoothies with yogurt may be a great substitution for conventional liquid oral nutritional supplement. All the fresh ingredients and probiotics in one drink. Imagine all of your patients getting one of these smoothies everyday. It would take three extra full-time equivalents just to make smoothies all day. In reality, it's not economical, it's ideology. The idea of telling my acutely sick patients to only eat healthy food seems to be the equivalent of telling my patient who did not eat well for days to just eat a celery stick because it's healthy. When one is sick, they often lose his/her appetite and eat inadequately. A high protein, high calorie liquid oral nutrition supplement becomes a quick fix to such patient. But an experience...