Réf. : Re: [Dysphagia] hyperosmolar fluids and yogurt

[dysphagiadude at mailcan.com (dysphagiadude@mailcan.com)]

Thanks, Irene and Benoit!  

I've been a periodic lurker and general non-contributor to the listserv
lately, but I can see that a lot has happened in my absence.  I shall
strive to behave more responsibly.

I was pretty sure that yogurt didn't represent any special hazard in
terms of aspiration, but the business about using probiotics in aerosol
form to inprove the status of the respiratory tract was a REAL eye
opener!  I followed up on Google and I found
http://www.hpb.cz/ang/cas/03-3/main.html, which seems to offer a few
more details on the topic.

The oral care at the SNF where I work is suboptimal.  I'm trying to
educate, but it seems like mouth care often takes a back seat to
everything else.  I inservice, talk with people, post articles on
bulletin boards and leave listserv email lying about with others might
find it.  I've had MDs write orders for it, and written it into my care
plans.  I'd be interested in learning how others approach this problem.

On Wed, 8 Sep 2004 10:26:28 -0400, nutrition.iugm@ssss.gouv.qc.ca said:
> 
> Hello everyone,
> 
> It seems that there is a misconception in the use of hyperosmalor /
> "bacteria" rich foods in people who aspirate. Although I understand both
> sides, I have to underline the fact that NO foods aren't hyperosmolar
> except water / tea / coffee and diet products that contains only water /
> artificial sweetners and flavor. As soon as you add sugar / salt or any
> other kind of short molecules, the osmolarity (or osmolality) of the
> product rises. For example, fruit juices are often higher than 600 mOsm /
> kg (and can go as high as 1000 mOsm / kg) as milk's osmolarity is around
> 275 mOsm / kg. To my knowledge, yoghurt osmolarity isn't know
> specifically.
> But as I said, as soon as you add sugar, you increase the osmolarity of
> the
> product. Eggnog has an osmolarity of about 700 mOsm / kg. My guest is
> that
> the osmolarity of yoghurt is close enough to egg nog (unless it's
> artificially sweetned). So, which one is better ? Juice or yoghurt ? My
> personal guess is neither... they're practically the same !
> 
> For the microbiological content of foods, one must be aware that
> everything
> is contaminated. Unless food is prepare in a "air thight sealed"
> environment with sanitize procedure (such as irradiation, use of chemical
> agents) and excrutious hygiene measures, none can say that what they're
> eating is "bacteria-free". Should we limit ground beef on the account
> that
> it may contain E. Coli ? Should we avoid all cheeses since they're all
> made
> with a fermenting agent ? Same goes for beer ! Where do we stop the line
> ??? As you all know, poor dental hygiene IS the main problem and does
> create a good environment for bacterial proliferation. We can't have a
> germ-free environment and it would be health hazardous if it was.
> 
> For commercially produced yoghurt, I have to say that Irene is right.
> Most
> yoghurt doesn't contain active agents. The life span of these bacteria
> are
> only a few days, leaving a very short shelf-life viability. A few years
> ago, major companies made claims that their yoghuts contained active
> agents
> but they were rapidily contested by consumers associations (the actual
> bacterial count wasn't significant enough to say so). You might haven't
> notice it, but these health claims dissapeared as fast as they had
> appeared
> ! The only yoghurt on the market known to contain an active agent is
> Activia from Danone (at least that's the reality in the province of
> Qu?bec,
> Canada) and it's only a recent product (less than a few months !).
> 
> To Irene's question about lactase, everyone should know that it's an
> enzyme
> which digest lactose (the sugar contained in milk and milk based
> products).
> Also, lactose is one of the prefered energy substrate for bacteria (since
> they have lactase !). But how can it promote pneumonia ? I looked around
> and haven't found any references proving that it can promote it. Any
> simple
> sugars would do the same. I did find a reference (but didn't read it all
> since I only had acces to the r?sum?) stating that the use of probiotics
> (friendly bacterias !) can be beneficial for the respiratory tract by
> introducing it by aerosols !. As for the mecanism for "clearing out" the
> lungs, it involves the scavenging system (mainly macrophages which eats
> everything they can get they're hands on !). It would be interesting to
> know your physiatrist suspected mecanism of action. But above all, you
> have
> to keep in mind that the main and utter most important thing to have is a
> good nutrition status to insure a well functionning immune system. Enough
> energy, proteins, micronutrients and hydration is the main focus here !
> 
> I also look for published cases of pneumonia with lactobacillus species.
> The only known and published cases of lactobacillus pneumonias are in
> immune-depressed patients ie AIDS and neutropenics patients. I don't
> think
> that it is the case here.
> 
> Hope that it cleared up some quesitons you may add.
> 
> Benoit Bertrand RD
> Clinical Registered Dietician
> Institut universitaire de g?riatrie de Montr?al
> 4565, Chemin Queen-Mary's
> Montr?al (Qu?bec)
> H3W 1W5
> 
> Phone: (514) 340-2800 poste 3109
> Fax: (514) 340-2819
> Email: nutrition.iugm@ssss.gouv.qc.ca
> 
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