Nutrition in the ICU

By Ryan Heeney / February 7th, 2024

In the summer of 2022, my home away from home was the ICU at Sarasota Memorial Hospital visiting my brother who had been in a car accident (he’s doing much better now). But I was there everyday visiting for almost 7 straight weeks. After a few weeks of visiting, you can begin to get a bit restless (and curious too). Among the many machines, wires, IV’s and other things which looked very complicated, I could see what looked his formula tube for feeding. It was a carton that sat above the bed and had a tube that ran all the way down to inside his stomach.

Out of curiosity one day, I decided to check out what exactly they feed you through a tube in the ICU. Just like any other package you would find at the supermarket, the nutrition label and ingredients were right there on the label. The staff had mentioned this formula was nothing like “Ensure” and what they use in the ICU was extremely high quality.

After seeing the label and learning the each 1 liter bottle of formula was around $80, I was a bit surprised at what I saw.

 Here are the ingredients:



Water, Corn Maltodextrin, Whey Protein Hydrolysate, Hydrolyzed Sodium Caseinate, Structured Lipid (Interesterified Marine Oil [Contains One or More of the Following: Anchovy, Menhaden, Salmon, Sardine, Tuna], Medium-Chain Triglycerides), Medium Chain Triglycerides. Less than 1% of: Canola Oil, Soy Oil, Short-chain Fructooligosaccharides, Natural & Artificial Flavor, Cellulose Gel, DATEM, Magnesium Phosphate, Calcium Carbonate, Sodium Phosphate, Potassium Chloride, Calcium Phosphate, Potassium Citrate, Ascorbic Acid, Choline Chloride, Potassium Hydroxide, Magnesium Chloride, Acesulfame Potassium, Carrageenan, Cellulose Gum, Sucralose, L-Carnitine, Taurine, Zinc Sulfate, Ferrous Sulfate, Niacinamide, d-Alpha-Tocopheryl Acetate, Calcium Pantothenate, Manganese Sulfate, Thiamine Hydrochloride, Pyridoxine Hydrochloride, Copper Sulfate, Riboflavin, Vitamin A Palmitate, Folic Acid, Chromium Chloride, Sodium Molybdate, Potassium Iodide, Sodium Selenate, Phylloquinone, Biotin, Vitamin B12, and Vitamin D3.

As you can see, for the bulk of the macronutrients (where the calories came from) the formula consisted of: Corn maltodextrin for the carbohydrate, whey and casein for the protein, and then fish oil and MCT oil for the fat. Then some general vitamins, minerals and other additives.



The main things I found unfavorable about the formulation of the product were:

1. The carbohydrate source being purely from corn maltodextrin. Corn maltodextrin has a GI of about 110 which is high, but considering the slow drip of the formula I’m guessing it keeps blood sugars level enough and when you’re in a critical state I learned they like to keep your blood sugar high. Since pure sucrose has a GI of 65 maybe it could keep blood sugars even more level? Ideally sucrose could be added to the formula has part of the carbohydrate source for many of it’s beneficial properties including antiviral properties, anti-stress properties and pro-thyroid properties (improving the organism as a whole including immune function).

  • https://www.sciencedaily.com/releases/2020/01/200129143339.htm

  • https://pubmed.ncbi.nlm.nih.gov/11963830/


  • https://www.youtube.com/watch?v=jQw1SJ3UFww&t=85s&ab_channel=RayPeatClips

2. Marine oil should be eliminated completely due to the many negative aspects PUFA

  • https://pubmed.ncbi.nlm.nih.gov/1690007/

  • http://www.ncbi.nlm.nih.gov/pubmed/22033707 (study used fat comprised of 70% PUFA)

  • https://academic.oup.com/ajcn/article/84/6/1277/4649361?login=false

3. Eliminate all PUFA from the "less than 1%" list.



4. Eliminate carrageenan and cellulose gum for digestive issues

.

  • https://pubmed.ncbi.nlm.nih.gov/395492/

  • https://pubmed.ncbi.nlm.nih.gov/2676614/

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242073/

  • https://pubmed.ncbi.nlm.nih.gov/7020378/

  • https://pubmed.ncbi.nlm.nih.gov/359059/

  • https://pubmed.ncbi.nlm.nih.gov/17095757/

Could there by a reason why it’s formulated the way that it is? Could certain ingredients be necessary for someone in very poor health? That’s certainly possible and I’d be curious if so. Emergency medicine in the U.S. is very impressive and I would definitely leave the door open to alternative explanations.