Oatmeal interventions in severe insulin resistance on the intensive care unit: A case report.

OBJECTIVES: To report on the potential effectiveness of hypocaloric, plant-based short-term dietary oatmeal interventions in the treatment of insulin resistance in critically ill patients on the intensive care unit. CLINICAL FEATURES AND OUTCOME: A 67-year-old female with type 2 diabetes was admitted to our hospital with suspected pneumonia. The patient developed acute hypoxemic respiratory failure and was diagnosed with pneumogenic sepsis requiring invasive ventilation and an immediate transfer to our medical intensive care unit. Within 48 h the patient developed severe to extreme insulin resistance and required more than 200 units of insulin per day. Based on the "Noorden diet" described in 1903, a modified hypocaloric (700 kcal) and plant-based dietary oatmeal intervention was performed to "break" insulin resistance and to improve glycaemic control. For two days, the patient received a low-fat diet that restricted carbohydrates to whole-grain oats (180 g) and included small amounts of vegetables (60 g). Enteral feeding was done via nasogastric tube. During and after the intervention, glycaemic control improved significantly. A significant reduction in total daily insulin requirements was achieved during and after the intervention. CONCLUSIONS: Hypocaloric, plant-based short-term dietary oatmeal interventions significantly reduced mean blood glucose levels and mean required daily insulin doses in a critically ill and septic patient on the intensive care unit.

Atrial fibrillation risk factor management with a plant-based diet: A review.

Atrial fibrillation is the most prevalent cardiac arrhythmia in the clinical setting affecting approximately 34 million individuals worldwide. The disease is associated with a significant burden of morbidity and mortality resulting from stroke, heart failure, and acute coronary syndrome. Atrial fibrillation is now a major public health problem with tremendous implications on the economy and the world's healthcare systems. Numerous risk factors and clinical conditions that are associated with the development and progression of atrial fibrillation have been identified in the past. Within the last decades, a shift in awareness toward modifiable conditions has been observed and risk factor management has gained significant momentum. In light of this, dietary approaches are of paramount importance. Whole-food plant-based diets emphasizing grains, legumes, vegetables, fruits and nuts and excluding most (or all) animal products have recently experienced a significantly increased interest. The purpose of this review is to present evidence suggestive of a plant-based diet being a valuable tool in atrial fibrillation risk factor management. The effects of a plant-based diet on both established and emerging risk factors, such as inflammation and subclinical atherosclerosis, are reviewed in this article. A special focus is put on cardiovascular and metabolic risk factors including hypertension, coronary artery disease, diabetes, and obesity.

Deceleration capacity as a risk predictor in patients presenting to the emergency department with syncope: A prospective exploratory pilot study.

Syncope is a common cause for admission to the emergency department (ED). Due to limited clinical resources there is great interest in developing risk stratification tools that allow identifying patients with syncope who are at low risk and can be safely discharged. Deceleration capacity (DC) is a strong risk predictor in postinfarction and heart failure patients. The aim of this study was to evaluate whether DC provides prognostic information in patients presenting to ED with syncope.We prospectively enrolled 395 patients presenting to the ED due to syncope. Patient's electrocardiogram (ECG) for the calculation of DC was recorded by monitoring devices which were started after admission. Both the modified early warning score (MEWS) and the San Francisco syncope score (SFSS) were determined in every patient. Primary endpoint was mortality after 180 days.Eight patients (2%) died after 180 days. DC was significantly lower in the group of nonsurvivors as compared with survivors (3.1 ±â€Š2.5 ms vs 6.7 ±â€Š2.4 ms; P < .001), whereas the MEWS was comparable in both was comparable in both groups. (2.1 ±â€Š0.8 vs 2.1 ±â€Š1.0; P = .84). The SFSS failed at identifying 4 of 8 nonsurvivors (50%) as high risk patients. No patient with a favorable DC (≥7 ms) died (0.0% vs 3.7%; P = .01, OR 0.55 (95% CI 0.40-0.76), P < .001). In the receiver operating characteristic (ROC) analysis DC yielded an area under the curve of 0.85 (95% CI 0.71-0.98).Our study demonstrates that DC is a predictor of 180-days-mortality in patients admitted to the ED due to syncope. Syncope patients at low risk can be identified by DC and may be discharged safely.