On the unit I work on we get lots of babies who have "short gut syndrome" due to a variety of causes who have to be on parenteral nutrition to supplement their nutrition while their GI system grows and hopefully heals fast enough. The big problem (among many) with TPN (total parenteral nutrition) is that it destroys the liver and kids get horribly jaundiced (which also causes brain damage) and often they die of liver failure or need a liver transplant before their GI system grows enough to take them off TPN.Babies born with short gut syndrome can't absorb nutrients properly due to their unusually short small intestine. They're temporarily fed intravenously (total parenteral nutrition; TPN), until their intestines can develop enough to digest food normally.
Boston Children's has done some amazing work showing that this is largely due to the fact that the lipids part of the TPN was a soybean based oil so they started using Omegaven instead which is a fish oil based IV lipid solution. So far the results have been amazing and reversed the damage in lots of kids livers and prevented it in those started on Omegaven at birth.
The typical TPN formula contains soybean and safflower oils as the fat, both of which are over 50% omega-6 linoleic acid. Soybean oil also contains 7% omega-3 alpha-linolenic acid. You can't get the kids started too early on a "heart-healthy" diet!
The solution was to replace the vegetable oil with fish oil, which prevents or rapidly reverses the severe liver damage caused by TPN rich in omega-6 vegetable oils. I don't think this is a great solution, but it certainly beats vegetable oil. The ideal solution would be to replace the vegetable oil with a fat that approximates the composition of breast milk: mostly monounsaturated and saturated fat, with a little bit of linoleic acid, alpha-linolenic acid and long-chain fats such as AA and DHA. You could do this pretty easily with a mix of lard and fish oil; or palm oil and fish oil; or coconut oil, olive oil and fish oil. Breast milk composition varies with diet, and the amount of linoleic acid in the breast milk of Western populations is unusually high.
Excess linoleic acid, particularly when combined with excess fructose and insufficient omega-3 fat, is toxic to the liver. Modern Western nations are experiencing an epidemic of non-alcoholic fatty liver disease (NAFLD), which animal studies indicate is probably the result of replacing animal fats with polyunsaturated vegetable oils and increasing sugar intake (see links below for more detail). Fatty liver was seen primarily in alcoholics three decades ago. An estimated 1/4 of Americans now have NAFLD. It's the number one cause of liver damage in the U.S.
Where the liver goes, the rest of the body follows.
How to Fatten Your Liver
Nonalcoholic Fatty Liver Disease
The Liver: Your Metabolic Gatekeeper
More Liver Functions
18 comments:
Excellent post Stephan! I look forward to reading your links when I get back to town!
Sounds like a job for coconut oil.
Stephan,
Do you think this info might be of use to a mom with a child with Rett Syndrome fed mostly with a feeding tube? I'll forward the post link if you think so.
I told her about MCT oil about two years ago and she got the doctor's "disinterested OK" to supplement with MCT, and the daughter had some improvements as a result. One of their therapists ( a PT?) was impressed enough with the MCT results to suggest it for other RS patients, who also saw some improvement.
I've read that alcohol is essentially a long-chain sugar, that the body uses water to split the alcohol into sugars. So is the damage done to a liver by alcohol the result of the excess sugar?
Well Sel,
I think you got it backward; you might consider some sugars as long chain poly-alcohols.
Yeesh! Enlightening -- and disturbing -- info on veggie oils, Stephan. Very sad that lives barely born into this world get such an onslaught of poor medical treatment. The little tykes aren't even given a chance to be optimally healthy. :-(
What are the causes of short gut syndrome?
In nutrition courses they teach you that alcohol is like "liquid fat" because of the similarities in metabolism. I don't see how alcohol could be chemically related to sugars. Most alcohols are very similar to fatty acids in structure, a simple hydrocarbon chain with an OH at the end (alcohol) or a COOH at the end (fatty acid). Sugars are usually hydrocarbon rings with a bunch of OHs and Os at various positions.
I believe much of the damage done by alcohol consumption is blamed on acetaldehyde, a substance produced during the breakdown of ethanol by the body.
Dave,
Yup. I think it's been used in TPN before if I recall.
Anna,
Could be, but it sounds like she's got things pretty well under control.
Sel,
I don't know the mechanism behind alcoholic liver damage.
Sue,
It can be congenital or caused by the removal of part of the small intestine due to several conditions. I'm not sure what causes congenital short gut.
Sadly, the WIC program at which I used to be a dietitian provided free baby formula, and just looking at a nutritiondata.com breakdown of the Enfamil AR (with DHA and ARA!) type that was most popular, has about a 9:1 ratio of omega-6 to omega-3 and 44% of calories from sugar. Oh dear, and then their first food is usually some grain cereal, follow by those nice wheat and corn biscuits.
Thought you would be interested in this short omega-3 video: http://www.youtube.com/profile?user=queenoffats
Tom says:
"In nutrition courses they teach you that alcohol is like 'liquid fat'"
Wow, does that ever explain a lot.
:)
My son is a patient at Children's Hospital Boston and is part of the Omegaven program. He is 100% TPN dependant and before Omegaven he was suffering from severe liver damage, presumably caused by the standard lipid formula provided intravenously. If you would like to see first hand what this change from Omega-6 to Omega-3 fats can do, visit our site and view his before and after pics.
www.samoconnor.com
Re: alcohol
There seems to be a similarity between alcohol metabolism and fructose metabolism. Both have to go through the liver. Both may cause similar liver damage such as "fatty liver" and cirrhosis.
Jason,
Very cool! Thanks for the link.
"The typical TPN formula contains soybean and safflower oils" -- is it the Omega 6 that damages livers, or is it the fact that they're being fed grain oils intravenously? Are the lectins that induce adults to avoid grains likely to be present in this formula? The formula might be 'purified' but my understanding is that just means "less other stuff than normal," it doesn't mean protein-free.
Andrew,
I can't rule out that IV lectins could be a contributing factor. However, given the fact that excess n-6 can cause liver damage when ingested as well, I suspect that's a simpler explanation.
That's it. I'm taking my 6 year old off of her prescribed 2-cans per day of Pediasure Enteral Formula. She is supplementally fed as her kidney medications are administered through her gasterostomy button. I've had enough of this crap in a can. This post just confirmed my concerns about giving her these processed oils (in combo with corn maltodextrin and sucrose).
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