Itʼs been an exceptional past few weeks, mostly because I continue to hear from people who are desperate for something, anything, to help a loved one in a coma from a brain injury, traumatic or anoxic. However, there have been a couple situations recently that have really upset me, mainly because of the use of science by doctors as a roadblock not to do anything for their patients. In one case in particular, the doctor told the mother of a patient that he would not do anything because he didn’t believe the son would ever live any meaningful life so why bother. That type of attitude expressed by someone in my profession makes me sad and angry. Even worse is that the mother of this patient is also a physician trained in nutrition and the attending doctor refuses to listen to her pleas for basic nutrition for her son.
The more common roadblock is almost always a claim by doctors that omega-3s may cause internal bleeding. This is the common ignorance that they choose to believe. If you ask them to show a single study in which internal bleeding was documented as a problem, they could not do it because there has never been a study that has shown bleeding to be a clinical concern. There are studies that show the effectiveness of using omega-3s, so much so that the Society of Critical Care Medicine published 34 recommendations for the care of critically ill patients and only two of the recommendations were rated as GRADE A and they both were concerning using immune enhancing enteral formulations including omega-3s. See:
McClave et a. Journal of Parenteral and Enteral Nutrition / Vol. 33, No. 3, May/June 2009, page 296.
E. Selection of Appropriate Enteral Formulation E1. Immune-modulating enteral formulations (supplemented with agents such as arginine, glutamine, nucleic acid, ω-3 fatty acids, and antioxidants) should be used for the appropriate patient population (major elective surgery, trauma, burns, head and neck cancer, and critically ill patients on mechanical ventilation), with caution in patients with severe sepsis.
(For surgical ICU patients, Grade: A)
While this does not address dosage, it speaks to the importance of using the proper nutrition to allow patients the best chance of healing. It is also interesting to me that the same doctors who will tell you they won’t use omega-3s because of the risk of bleeding also have their ICU patients on one of the pharmaceuticals they use to prevent the blood from clotting. They are using either Heparin, Coumadin, or Warfarin (a rat poison). These pharmaceuticals completely block the enzymes responsible for allowing the blood to clot. Yet concerning omega-3s, a natural substance in which the brain is comprised and essential for development of the fetal brain, they express concern about bleeding when omega-3s promote the body’s natural anti-inflammatory processes including excessive clotting.
It will be a big start to get ICU doctors to adhere to a basic published standard-of-care of feeding critically ill patients. To not do so is counter to published enteral feeding guidelines. No one has more at stake in patientsʼ healthcare than the family. The doctors and nurses all go home at the end of their shift. Their ignorance of the science is not an adequate excuse. The family has to stand up for what they believe is right and correct.