QUESTION ABOUT PROTEIN SHAKES

It is not uncommon for the patient to think the toilet is malfunctioning because several flushings are needed to remove the stool. A greasy character and truly rancid odor are indicative of increased stool fat, but are often absent until late. These complaints are often readily passed over by the busy physician. At such time, physical findings are usually absent, but hyperactive bowel sounds may be noted, especially in small intestinal disease. If symptoms are intermittent or if they progress slowly over many years, patients may exhibit vague, seemingly unrelated symptoms such as chronic fatigue and depression, long before the physician considers the possibility of serious organic disease.

Failure to digest or absorb fats results in a variety of clinical symptoms and laboratory abnormalities. These manifestations are the result of both fat malabsorption per se and a deficiency of the fat-soluble vitamins. In general, loss of fat in the stool deprives the body of calories and contributes to weight loss and malnutrition.

Failure to absorb the fat-soluble vitamins A, D, E and K also results in a variety of symptoms. Vitamin K deficiency presents as subcutaneous, urinary, nasal, vaginal and gastrointestinal bleeding. Deficiencies in factors II, VII, IX and X produce defective coagulation. Vitamin A deficiency results in follicular hyperkeratosis. Vitamin E deficiency is destructive to the central nervous system. Malabsorption of vitamin D causes rickets, osteopenia and osteoporosis.

Severe loss of body protein may occur before the development of laboratory abnormalities. Clinically, protein deficiency results in edema and diminished muscle mass. Since the immune system is dependent upon adequate proteins, protein deficiency can manifest as recurrent or severe infections. Protein deficiency in children results in growth retardation, mental apathy and irritability, weakness and muscle atrophy, edema, hair loss, deformity of skeletal bone, anorexia, vomiting and diarrhea. Protein-calorie malnutrition is known as marasmus, whereas protein malnutrition by itself is known as kwashiorkor.

Attempts have been made to classify malnutrition into a predominantly protein-depleted (i.e., kwashiorkor) or calorie- (energy-) starved (i.e., marasmus) state. In kwashiorkor, the subject ingests a moderate number of calories, usually as complex carbohydrate (e.g., rice), but very little protein. The liver is therefore supplied with inadequate amino acids. The liver becomes fatty and enlarged. Furthermore, the liver in kwashiorkor inadequately produces other proteins, including albumin, and serum albumin falls, with resulting peripheral edema. With marasmus the subject takes inadequate amounts of protein and calories. The low caloric intake means that only small amounts of carbohydrate are taken with adequate delivery of amino acids from muscle to the liver for protein production. Fatty liver does not occur, and serum albumin levels tend to be normal, with no peripheral edema. Often patients fall between these two extremes of nutritional states, but there are examples of kwashiorkor and marasmus in Western clinical practice. Anorexia nervosa is a classic example of marasmus. Marked muscle wasting and loss of subcutaneous tissue (adipose tissue****ur with normal-sized nonfatty livers and no peripheral edema. In contrast, the intensive care unit patient who has received intravenous dextrose (glucose) without amino acids for a prolonged period will often show a fatty liver and marked hypoalbuminemia (low albumin levels) and edema.

Clinical features of protein-energy malnutrition vary depending on the severity and duration of nutrient deficiency, age at onset and the presence or absence of other contributing or conditioning factors. With minimal deficiency, abnormalities may be subtle - particularly in adults, in whom there are no growth requirements. In these patients muscle wasting and loss of subcutaneous fat may be present. Weakness and minimal changes in psychomotor function may develop. Nontender parotid enlargement (glands in the face and neck) may occur, sometimes bilaterally. Patchy brown pigmentation, particularly over the malar eminences of the face, may occur. A lackluster appearance with thinning and increased shedding of hair from the sides of the head, particularly on combing or brushing, may develop. Bradycardia may occur. Variable degrees of hepatomegaly may result, sometimes with steatosis. In patients with protein-energy malnutrition following jejunoileal bypass a wide spectrum of histopathologic change has been observed, similar to findings frequently associated with alcoholic liver disease.

In adults with severe protein-energy malnutrition and in growing children, clinical features may be even more significant. Muscle wasting, subcutaneous fat loss, dependent edema and weight loss may be marked. Severe mental apathy and reduced physical activity may occur. Abnormalities in the hair, particularly of children, may be striking. Severe dyspigmentation may develop, especially distally; rarely, alternating strands of light and dark hair are observed. Hair may be removed without pain. Nails may become brittle, with horizontal grooves. An asymmetrical confluent pattern of skin hyperpigmentation may be seen, particularly over perineal and exposed areas, such as the face. Extensive desquamation may occur, leaving depigmented areas of superficial ulcers, particularly on the buttocks and backs of the thighs. Gastrointestinal symptoms are common but variable. These include marked constipation, diarrhea, anorexia or hyperphagia, nausea, vomiting and dehydration. Laboratory features are also variable. Serum proteins may be substantially reduced, including serum albumin and some higher-molecular-weight transfer proteins, such as transferrin, ceruloplasmin, lipoproteins, thyroxin and cortisol binding proteins. Serum amino acid analysis may show a decrease in essential amino acids (i.e., leucine, isoleucine, valine, methionine), and either normal or depressed levels of nonessentials (i.e., glycine, serine, glutamine). The urinary excretion of urea, creatinine and hydroxyproline may decrease. Severe electrolyte abnormalities develop, although serum levels may be normal.

What kind of protein is the best?

Eating a low calorie diet actually slows down your metabolism.