Protein calorie malnutrition is devastating for patients [PODCAST]

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“My practice consisted of patients who suffered from serious injuries and illnesses. Concerning the latter, a significant number had cancer, especially breast cancer. The issue all patient groups have in common to a certain degree is protein calorie malnutrition (PCM). The most dramatically affected are those stricken with a malignancy. PCM leads to increased morbidity, mortality, complications, length of hospital stays, and hospital readmissions. As physicians, we must bring awareness to this devastating problem and offer solutions based on education and new product innovation.”

Steve Snodgrass is a surgeon and founder, Dr. Steve’s Nutri Snax. He can be reached on Instagram @drstevesurgeon.

He shares his story and discusses his KevinMD article, “Protein calorie malnutrition is devastating for patients.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Steve Snodgrass. He is a surgeon and scientific entrepreneur, and he wrote the KevinMD article “Protein calorie malnutrition is devastating for patients.” Steve, welcome to the show.

Steve Snodgrass: Thank you very much for having me. I appreciate the opportunity to talk with you and your followers.

Kevin Pho: So we’ll get into the article a little bit, but first off, can you share your story and journey to where you are today?

Steve Snodgrass: Sure. I was chief of surgery at HCA Greenview Hospital in Bowling Green, Kentucky, also a member of the American Medical Association, a fellow of the American College of Surgeons, and an author. I’ve written several scientific papers and books, both fiction and nonfiction. And then I stepped out of the operating room to go to the boardroom to create a product to help patients overcome protein calorie malnutrition.

Most of my patients were very sick and/or injured. Concerning those who had illnesses, many had cancer, especially breast cancer. And one of the things that it seemed like all patients, especially cancer patients, have in common is some degree of protein calorie malnutrition. As physicians, I don’t think that we pay quite enough attention to it, because, especially as a surgeon, you’re so busy you just think about what’s at hand and what’s before you.

But I looked at it, especially in my cancer patients. I had one patient in particular who had breast cancer, and we had a mastectomy that went perfectly. We followed treatment protocols to the letter, and then that patient died because she had pneumonia and couldn’t eat enough protein to sustain her immune system. So we went through all of that only to lose the patient, and I said that something has got to be done. Using our backgrounds as physicians, we must have new product innovation and education to overcome protein calorie malnutrition, because without a question it increases morbidity, mortality, complications, length of hospital stays, and hospital readmissions.

Kevin Pho: So take us through that journey. You said you created a product to address protein calorie malnutrition. What were some of the challenges that you faced in making that transition from a surgeon to an entrepreneur and creating this product?

Steve Snodgrass: Well, as a surgeon, you’re used to fixing everything yourself, right now. Whatever you’re going to be doing, you do it, and then you go on to the next thing. It’s an immediate fix and an immediate reaction. Obviously you have people helping you in the operating room, but for the most part, we’re very independent thinkers.

During this transition, you become aware that you are dependent on so many different factors and so many different people, and that was a shock to me. You say, “Well, I want to get this done,” and somebody says, “Well, we’re not going to be ready to do that for several weeks, if not months.” So it comes down to even the whole thing about simple boxes for the product and things like that, how delays along the line happen, and you’re just not used to that. And you’re not really used to answering to anybody, because you’re trained to do what you do best in the operating room, and then when you get out in the real world, you find it’s extremely.

Kevin Pho: So we’re going to get into your article shortly, but for those nonclinicians who are out there, can you just define what protein calorie malnutrition is, as well as elucidate some common reasons why patients have it?

Steve Snodgrass: Yes. Well, the main thing is they’re just not getting enough protein. Most of it is because they’re not taking in enough protein, especially quality protein, or they’ve got problems with absorption of the protein. So that’s where protein is at the center. It’s the most important macronutrient that we have, because it’s involved in literally everything in body homeostasis and just every cellular reaction, enzymatic reaction, tissue building itself. So protein is at the very foundation of, realistically, humanity.

Kevin Pho: All right, so let’s talk about your article now. It’s titled “Protein calorie malnutrition is devastating for patients.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Steve Snodgrass: Well, the reason I wanted to share the story is because I think there are a lot of misconceptions, and there are a lot of people who are just not aware of how important it is. Some of the literature says that around 50 percent of patients are already protein malnourished. I focused on cancer patients in particular, because I think 80 percent of cancer patients present with weight loss as a primary symptom. So we’re already starting behind. And patients have a compromised GI tract, if not the disease itself, it could be due to inactivity, pain, pain medication. Just everything slows down.

Liquid forms of protein supplementation are the most commonly recommended, yet the National Cancer Institute states that protein calorie malnutrition is the number one secondary diagnosis in cancer patients. I thought it was interesting, because I called my colleagues around the country and I said, “What do you think the most common secondary diagnosis in cancer patients is?” And they all said, “Oh, wound infection, pneumonia, atelectasis, urinary tract infection.” No one knew it was protein calorie malnutrition. So I think that’s how prevalent it is, and so we must be aware of that, and we need to fix that. As soon as the patient is diagnosed, they need to up their protein content and intake.

So I tried to make that as easy for them as I could by making a product that had a familiar mouthfeel, taste, and crunch they were used to eating, and they could eat it on the go. It’s a solid food. It’s kind of like a Cheeto, if you will. We make it in French toast flavor and pizza flavor, and it’s been tested all over the country, and not one patient has gotten sick from eating this product. So I’m very, very pleased with that, because there’s intolerance of liquid. If you take a liquid and you throw it on top of an already compromised GI tract, that excess volume will make people sick. So liquids have their place, but they’re all not tolerated well.

And so I wanted to give something that people could eat without getting sick. We’ve done studies, again, all over the country, and even patients who had advanced cancers of the head and neck would take the product, just dissolve it under their tongue, and take a sip of water, thus avoiding all that volume, and they wouldn’t get sick. So we’ve been extremely pleased with the results that we’ve had.

Kevin Pho: So from a surgical standpoint, can you just briefly talk about some of the surgical complications that can arise in patients who are protein malnourished?

Steve Snodgrass: Well, one of the things, obviously, and for us as surgeons: To heal the wound, you’ve got to be protein stable, because the whole thing of wound healing is dependent upon protein stability as the very core foundation. Plus, you don’t want patients who have an incision to get pneumonia, cough, and all of a sudden now they have a wound hernia, something like that. So we want to avoid all these different kinds of complications that are associated with protein calorie malnutrition.

And especially when you start losing lean body muscle mass, a lot of times patients have to stop their chemotherapy because they’re just too weak to handle it, because they’ve lost so much lean body muscle mass. According to the literature, I’m going to say, even conservatively, around 50 percent of cancer patient deaths are attributed to protein calorie malnutrition in some form or fashion.

Kevin Pho: For those patients who are undergoing surgery, what are some of the things that they can do to prevent becoming protein malnourished during and after the procedure?

Steve Snodgrass: Well, I think there’s a thing now that’s coming out called prehabilitation. Normally, when I had a patient who was diagnosed with cancer, or any patient for that matter, we looked at their nutritional status, and we started upping their protein intake from day one. Sometimes cancer patients require 2 to 2.5 times the normal amount of protein, depending on their situation. So we would continue that increased protein intake up to six to eight weeks after the surgery. As soon as they’re diagnosed, we would up their protein content or intake, and we would continue that to around eight weeks post-op.

Kevin Pho: We’re talking to Steve Snodgrass. He is a surgeon and physician entrepreneur, and he wrote the KevinMD article “Protein calorie malnutrition is devastating for patients.” Steve, you mentioned you did create a product that solves this issue. Outside of your product, what are some other options patients have? You did mention some liquid options. Is there anything else?

Steve Snodgrass: Oddly, some of the things that are most recommended as being convenient forms of protein are like tuna or salmon on a cracker, quinoa, things like that. And while they have their place, they’re certainly not convenient. A lot of those things I couldn’t eat or drink, and I don’t have cancer, so it’s very tough. And you know, you don’t have to take a cooler with you. A lot of patients travel to get their chemo, and so it’s inconvenient to carry some sort of cooler or something like that.

A lot of times the real thick protein bars are just not well tolerated. A lot of patients have mouth ulcers and a lot of different issues in their oral cavity, with a dry mouth and things like that, so it’s very tough for them sometimes to take in adequate amounts of protein.

I can give you one story. My sister-in-law had a friend of hers who had breast cancer, and she was so bad she went to her doctor and she said, “You know, I just have no appetite. I can’t eat anything.” And then his answer was, “I don’t understand why you just can’t eat more beans and taters.” And we just have to realize that these patients just are not normal.

I recommend that they eat multiple small meals during the day when they can tolerate it and avoid getting full. That’s one of the main things about my product, that you can eat it without getting full and getting sick. And so some of these other choices, while they have their place, are certainly not convenient.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Steve Snodgrass: Well, I think number one is that we need to be aware of nutrition, especially as it relates to protein, for any of our patients, especially surgery patients as well as cancer patients. And I think also there’s been a misconception about soy protein being a bad thing for cancer patients, when just the opposite is the truth. The studies that have been done most recently have shown that soy protein intake decreases recurrent rates and decreases death rates in breast cancer patients. I wrote a 30-page paper on it because I wanted to know why, and I’m convinced more than ever that all of us, I feel, need to take in soy protein, because it’s heart-healthy and has a lot of healthy benefits.

Obesity is associated with like 13 forms of cancer, so we must develop healthier lifestyles to prevent. But once we do get sick, we have to start taking care of ourselves, because we don’t want to risk a secondary primary cancer or something like that. So soy protein is great for the human body, and if I’m a breast cancer patient, I’m going to eat it every single day.

Kevin Pho: And how can people reach you?

Steve Snodgrass: People can reach me through, I’m going to give you my direct email, if anybody wants to communicate with me: It’s [email protected]. Or you can go to my product site, which is www.drstevesnutrisnax.com, that’s N-U-T-R-I, S-N-A-X, dot com. Or Instagram, you can see me at Dr. Steve Surgeon.

And one of the other things I’m doing, I’ve become an artist here lately, and this has been an interesting journey for me as well. My paintings are doing so well I was featured in Modern Luxury magazine. And what I’m doing is some auctions for cancer patients. The first one we did was the University of California San Francisco Helen Diller Comprehensive Cancer Care Center, and I’m going to be doing one for OneOncology in the spring. So I really am mixing the medicine as an art and a science.

Kevin Pho: Wonderful. Steve, thank you so much for sharing your time and insight, and thanks again for being on the show.

Steve Snodgrass: Thank you. I really appreciate it, Kevin.

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