When fever shuts down the appetite.

“Like a faith war”

Physicians have yet to agree on whether – and how – to deal with appetite loss in hospitalized patients, Schuetz explains. While there have been some indications that tailored nutrition strategies can improve patients’ condition, evidence-based studies are lacking, he says. The result is that debate on the issue has turned into something of a faith war. According to Schuetz, some experts believe that the best approach is to concentrate on treating the underlying illnesses, upon which the patient’s appetite would return of its accord, while others argue that nutrition plays a crucial role in the healing process, and should therefore be the primary focus. On the other hand, in the last few years in particular physicians have come to realize that an excess of additional calories can cause a substantial deterioration, particularly among acutely ill patients in intensive care. “It is a contradictory situation overall,” Schuetz concludes. “Fundamentally, people need more calories when they are ill, as the body needs more energy to recover. At the same time, however, it shuns food, which seems paradoxical.”

A complex – and not very profitable – issue

Does this complexity explain the scarcity of large-scale studies? “Nutrition is a complex and highly specific area,” Schuetz replies. However, he believes other factors are at play too – not least among them funding. “Research is invariably expensive, and the pharmaceutical industry is obviously not going to be very interested in studies about food that don’t lead to patents and  expensive products. Nutrition is often regarded as a complement to therapy, not a form of therapy in its own right.”

The results of Schuetz’s study could now mark the beginning of a shift in mindset. By examining data from around 2,000 subjects, he succeeded in showing that tailored nutrition has a beneficial impact on chronically ill patients in hospital. “The study was very well received in expert circles,” he reports. In concrete terms, it showed that malnutrition is a modifiable factor in the course of an illness. In other words, “the study taught us that tailored nutrition strategies are an effective tool to combat dangerous weight loss and some of the associated complications and mortality.”

Inflammation as a key factor

Since the study, Schuetz has gone a step further with his research: “We asked ourselves whether there might be subgroups within the study that responded particularly well to nutrition therapy,” he explains. His conclusion was that not all patients benefit equally from tailored nutrition. “For those with very high levels of inflammation, this form of treatment didn’t help much. Meanwhile, we observed significant positive effects among patients in which inflammation was less severe, or had already subsided.”

These results might also explain why earlier studies yielded partially contradictory results, as they failed to take this distinction into account. In any case, Schuetz is quite certain that inflammation is one of the primary factors influencing the effectiveness of nutrition therapy. He hopes that his results will ultimately lead to increased acceptance for therapy based on tailored nutrition, and help it to become more widely established. “Of course, it is also a question of resources,” the physician points out, “which makes it all the more important to know whom this kind of therapy can benefit.”

Empowering patients

The therapeutic approach studied by Schuetz has a key advantage: It does not involve medication. He explains that his patients often ask what steps they can take to support their recovery. Their options are not limited to popping pills: “Nutrition is something that patients can take charge of themselves,” he explains, adding that it is also a way for relatives to become involved in the healing process.

Schuetz predicts that “the problem of malnutrition is likely to become more serious as society ages.” Considering that we have known about it for thousands of years, and the fact that food is a relatively simple matter, we know remarkably little about it, he observes. Accordingly, he believes that nutrition therapy has a great deal of untapped potential for dealing with deficiency symptoms. “Once we have a better understanding of how this therapy works, we can even apply it preventively – before weight loss sets in. After all: An ounce of prevention is worth a pound of cure.”