Enteral Nutrition

All people need food to live. Sometimes a person cannot eat any or enough food because of an illness. Others may have a decreased appetite, difficulties in swallowing, or some type of surgery that interferes with eating. Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes.

Why Reptides

Whey protein Hydrolysate or whey peptides are partially pre-digested by enzymes. They are easy on the digestive system and have a high absorption rate. They are better absorbed than intact proteins, they are by far the most digestible and have better nitrogen retention and utilization. Several investigators have noted improved absorption, greater nitrogen utilization, higher branched chain amino acid levels and increased insulin secretion with the use of peptide based formulas compared with intact protein. Critically ill patients suffering from severe hypoalbuminemia frequently develop a protein-losing enteropathy, which can be attenuated by the use of a peptide-based formula. Thus, peptide- based formula may attenuate albumin turnover in the intestine and thus be efficacious in patients with a protein-losing enteropathy from a variety of etiologies.

Medium-chain Triglyceride powder

Patients that have malnutrition or malabsorption syndromes are treated with MCTs because they do not require energy for absorption, utilization, or storage. Medium-chain triglycerides are generally considered a good biologically inert source of energy that the human body finds relatively easy to metabolize. They have potentially beneficial attributes in protein metabolism. Due to their ability to be absorbed rapidly by the body, medium-chain triglycerides have found use in the treatment of a variety of malabsorption ailments. MCT supplementation with a low-fat diet has been described as the cornerstone of treatment for primary intestinal lymphangiectasia (Waldmann’s disease). Several scientific studies have shown MCT to be effective in treating fat malabsorption, chronic diarrhoea and weight loss in patients.

Why protein and immunity

Whey has a high concentration of glutamic acid and branched- chain amino acids (BCAAs)- leucine, isoleucine and valine. BCAAs, particularly leucine are important factors in tissue growth and repair. Leucine has been identified as a key amino acid in protein metabolism during the transition-initiation pathway of protein synthesis. Whey protein concentrate is a rich source of cysteine. It contains a concentration of cysteine that is atleast four-fold higher than other high quality proteins. With a high concentration of these amino acids, immune function is enhanced through intracellular conversion to glutathione. Research has revealed that whey protein concentrate is an effective cysteine donor that maintains concentration of active glutathione. Glutathione stimulation is the primary immune-modulating mechanism as glutathione is the major endogenous antioxidant produced by the cells, participating directly in the neutralization of free radicals and reactive oxygen compounds, as well as maintaining exogenous antioxidants such as vitamins C and E in their reduced (active) forms.

Dietary RNA

Nucleotides increase protein synthesis and are involved in the regulation of several T-cell mediated immune responses. Immunonutrition formulae fed to head injured rats has been shown to prevent intestinal barrier function. Intestinal apoptosis, mucosal atrophy and bacterial translocation was found to be significantly reduced in the group fed immunonutrition as compared to the group fed standard enteral nutrition.


L-glutamine is an amino acid found in proteins of all life forms. It is classified as a conditionally essential amino acid. This means that under normal circumstances the body can synthesize sufficient L-glutamine to meet physiological demands. However, under certain diseased conditions the body cannot do so. L-glutamine has come to be regarded as one of the most important of the amino acids when the body is subjected to metabolic stress situations as trauma (including surgical trauma), cancer, sepsis and burns. Under such conditions, L-glutamine becomes an essential amino acid, and it is therefore very important to ensure adequate intakes of the amino acid in order to meet the increased physiological demands created by these situations. L-glutamine is a conditional amino acid, meaning in certain reported conditions the body is unable to synthesize (sufficient) glutamine from other amino acids. Glutamine is universally recommended for advanced nutritional programs. L-glutamine is the most abundant amino acid in the body and plasma glutamine levels are the highest of any amino acid. L-glutamine is a very versatile amino acid and participates in many reactions in the body. L-glutamine serves as the most important nitrogen shuttle, supplying nitrogen for metabolic purposes (from glutamine-producing tissues, such as skeletal muscle) to glutamine-consuming tissues. L-glutamine participates in the formation of purine and pyrimidine nucleotides, amino sugars (such as glucosamine), L-glutamate and other amino acids, nicotinamide adenine dinucleotide and glutathione. It also participates in protein synthesis, energy production and the production of D-glucose and glycogen. Importantly, L-glutamine can serve as the primary respiratory substrate for the production of energy in enterocytes and lymphocytes. L-glutamine is considered an immunonutrient, and supplemental L-glutamine is used in medical foods for such stress situations as trauma, cancer, infections and burns. There are numerous benefits of supplementing with this important nutrient: • Immune system & wound repair: Glutamine plays a major role in infection-fighting immune system. Many immune cells like lymphocytes, neutrophils, macrophages and fibroblasts associated with wound repair use glutamine as metabolic fuel even more than glucose. Glutamine is important for nucleotide synthesis which regulates cellular proliferation in wound or scar repair. Hence glutamine acts as an immune booster. • Inflammatory Bowel disease (IBD): Glutamine helps to protect the lining of the gastrointestinal tract, which is called the mucosa. Glutamine deficiency may play a role in the development of Inflammatory Bowel Disease (IBD), namely ulcerative colitis and crohn’s disease. These conditions are characterized by damage to the lining of the small or large intestine, which leads to inflammation, infection and ulcerations on the mucosal lining of small intestine. • Peritonitis/ sepsis/ Infection: Glutamine supplementation has been known to maintain the health of the mucosa of the gastrointestinal tract. Keeping the intestinal mucosa healthy and maintaining gut barrier may help prevent infections such as peritonitis, sepsis or septicemia which occur due to translocation of virulent strains of pathogens. • Cancer: Many cancer patients have abnormally low levels of Glutamine. For this reason, some experts speculate that glutamine ay prove to be a good addition to conventional treatment of cancer under certain conditions. Supplemental glutamine is often used as adjuvant therapy in malnourished cancer patients undergoing chemotherapy or radiation treatments and sometimes used in patients undergoing bone marrow transplants. • HIV/ AIDS: Individuals with advanced stages of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) often experience severe weight loss (particularly loss of muscle mass). Glutamine supplementation, along with other important nutrients may reduce severe weight loss associated with this condition. Causes of l-glutamine deficiency include severe trauma, infection or metabolic stress induced by a catabolic state or extreme physical exertion.


Selenium is a trace mineral that is essential for good health. Selenium is incorporated into proteins to make selenoproteins, which are important antioxidant enzymes. The antioxidant properties of selenoproteins help prevent cellular damage from free radicals. Free radicals are natural by-products of oxygen metabolism that may contribute to the development of chronic diseases such as cancer and heart disease. Other selenoproteins help regulate thyroid function and play a role in the immune system. Most cases of selenium depletion or deficiency are associated with severe gastrointestinal problems, such as Crohn’s disease, or with surgical removal of part of the stomach. These and other gastrointestinal disorders can impair selenium absorption. People with acute severe illness who develop inflammation and widespread infection often have decreased levels of selenium in their blood. Selenium affects cancer risk in two ways. As an anti-oxidant, selenium can help protect the body from damaging effects of free radicals. Selenium may also prevent or slow tumor growth. Certain breakdown products of selenium are believed to prevent tumor growth by enhancing immune cell activity and suppressing development of blood vessels to the tumor. Some studies indicate that mortality (death) from cancer, including lung, colorectal, and prostate cancers, is lower among people with higher selenium blood levels or intake. The body needs selenium for normal growth and health. Selenium is needed for certain enzymes that help with normal body functions. Selenium is a key component of a number of functional selenoproteins required for normal health e.g. glutathione peroxidase, which is responsible for destroying lipid-damaging peroxides. In this role selenium complements the anti-oxidant function of vitamin E.

Alpha Lipoic Acid

Alpha Lipoic Acid is a naturally occurring co-factor in the body. It exists in intracellular and extra-cellular tissue as well as in cell membranes. In addition to being the only antioxidant able to cross the blood-brain barrier, ALA is both water and fat soluble and thus highly bioavailable. Alpha Lipoic Acid enhances the activity levels of vitamins C and E, and increases levels of glutathione (also a powerful antioxidant) in cells.


The amino acid arginine, which is classified as a semiessential amino acid and conditionally as an essential nutrient for adults in injured or stressed states, is important in a number of biological and physiological processes. In trauma and sepsis states, its bioavailability is reduced. In clinical studies, arginine supplementation enhanced nitrogen retention and protein synthesis in animals and in healthy human subjects. Nutritional formulas with arginine can enhance immune parameters after stress and surgery. Arginine, an essential amino acid for adults in injured or stressed states, is less available in the body under these conditions. Arginine plays a role in protein synthesis, as a substrate for the urea cycle and the production of nitric oxide, and as a secretagogue for growth hormone, prolactin, and insulin. Whereas most amino acids are 16% nitrogen, arginine is 32% nitrogen. Arginine is synthesized primarily in the kidney from gut-derived citrulline via the urea cycle, which also detoxifies ammonia and facilitates excretion of nitrogen. Arginine supplementation significantly enhanced the amount of collagen and lymphocyte mitogenesis. The data suggested that arginine may be of clinical benefit in improving wound healing and immune responses. The beneficial effect of arginine on the immune system appeared distinct from its more moderate effect on nitrogen metabolism. Supplemental arginine significantly enhanced the mean T-Lymphocyte response and mean CD4 phenotype.


Zinc is such a critical element in human health that even a small deficiency is a disaster. Zinc supplementation is a powerful therapeutic tool in managing a long list of illnesses. Zinc, an essential trace mineral, is required for the metabolic activity of the body’s enzymes, and is considered essential for cell division and the synthesis of DNA and protein. These enzymes are involved with the metabolism of protein, carbohydrate, fat and alcohol. Zinc is also critical to tissue growth, wound healing, taste acuity, connective tissue growth and maintenance, immune system function, prostaglandin production, bone mineralization, proper thyroid function, blood clotting, cognitive functions, fetal growth and sperm production. The mineral zinc is present in every part of the body. Zinc has a range of functions. It helps with the healing of wounds and is a vital component of many enzyme reactions. Zinc is vital for the healthy working of many of the body’s systems. It is particularly important for healthy skin and is essential for a healthy immune system and resistance to infection. It plays a crucial role in growth and cell division where it is required for protein and DNA synthesis. As a component of many enzymes, zinc is involved in the metabolism of proteins, carbohydrates, lipids and energy. Zinc is found in all parts of our body, 60% is found in muscle, 30% in bone and about 5% in our skin. The first signs of zinc deficiency are impairment of taste, a poor immune response and skin problems. Other symptoms of zinc deficiency can include hair loss, diarrhoea, fatigue, delayed wound healing, and decreased growth rate and mental development in infants. Zinc functions as an antioxidant and is involved in many critical biochemical reactions. It also helps to protect DNA from damage and assists in its repair. The role of zinc in a wide range of cellular processes, including cell division and proliferation, immune function, and defense against free radicals, has been well established. In brief, zinc functions would be the following: • Supporting normal growth and development during pregnancy, childhood, and adolescence • Playing a role in tissue repair • Helping the body use carbohydrate, protein, and fat • Helping to maintain proper immune function, including promoting wound healing • Serving as part of enzymes that control body processes • Maintaining a sense of taste and smell • Maintaining normal vitamin A levels and usage Sufficient levels of zinc are essential for a properly functioning immune system. For example, zinc is required for the development and activity of T-lymphocytes, which are a type of white blood cell that helps fight infection. When people deficient in zinc are given zinc supplements, biological markers of immunity improve. These effects are most clearly seen among children in emerging nations—when given zinc supplementation, they experience shorter courses of infectious diarrhea and may have less serious problems from pneumonia.

Omega 3 Fatty Acid

Addition of n3 PUFAs limits the proinflammatory effect of omea-6 fatty acid, omega 3 fatty acid inhibit both omega-6 desaturase and omega-5 saturase, the former being rate limiting in the conversion of linoleic acid to arachidonic acid. Further, omega-3 fatty acid replace omega-6 fatty acid in cell membrabe phospholipids, which is associated with the production of prostaglandins and leukotrienes (3-and 5-series) with reduced proinflammatory potential. The cost of postoperative morbidity consumed a large amount of the diagnosis related group reimbursement rate. Preoperative nutrition supplementation with specialized enteral feeds with L-arginine and omega=3 fatty acid appears to be a cost-effective treatment. Supplemental enteral feeding with arginine and omega 3 fatty acid significantly increased plasma and peripheral white blood cell ω3/ ω6 ratios and significantly decreased PGE2 production and postoperative infectious/ wound complications compared with standard enteral feeding.
  • This email address is being protected from spambots. You need JavaScript enabled to view it.