Medtrition, Inc. blog

Can You Be Overweight & Malnourished? What GLP-1 Users And Caregivers Should Know

Medtrition Inc. — Fri, 11 Sep 2026 10:00:01 GMT

Body size alone shouldn't rule out nutrition risk. Food intake, pace of weight loss, strength, and mobility tell a more complete story than the scale does.

That's because a person can be overweight and still be malnourished. It seems contradictory, but body weight alone doesn't show whether someone is getting the protein, vitamins, and minerals needed to maintain health and physical function.

That distinction matters more as GLP-1 medications, including semaglutide and tirzepatide, become mainstream weight-loss tools. These drugs sharply reduce appetite and food intake, but eating less raises the stakes on what a person does eat.

During Malnutrition Awareness Week, led by the American Society for Parenteral and Enteral Nutrition, health care professionals, patients and caregivers are encouraged to question a common assumption: that malnutrition affects only people who look thin. It doesn't. Malnutrition happens when the body doesn't get or absorb enough nutrients, whether from eating too little, illness or an unbalanced diet, and it can affect people of any body size. Someone can carry excess weight while getting too little protein or too few vitamins and minerals, or lose weight on purpose while dealing with nutritional problems the scale doesn't reveal.

Why GLP-1 Medications Raise the Stakes on Nutrition

GLP-1 medications reduce appetite, increase fullness, and slow digestion. Those same mechanisms that make them effective can also make it harder to eat enough, especially for people dealing with nausea, vomiting or constipation.

A 2026 review in the Journal of Nutrition found that the rapid adoption of GLP-1 therapies has outpaced the nutrition support built around them, and that sharp reductions in food intake can raise the risk of inadequate protein, fiber, fluid, and micronutrient intake, along with loss of lean tissue. Proper assessment and monitoring can address much of that risk, which is why nutrition care belongs in treatment from the start.

What About Muscle Loss?

Significant weight loss almost always includes some loss of lean tissue along with fat. A 2026 meta-analysis of 20 randomized controlled trials, covering nearly 16,000 participants, found that lean mass made up a meaningful share of weight lost with incretin-based therapies(also known as GLP-1 medications), similar to what's seen with intensive lifestyle-based weight loss, and that resistance training helped preserve more of it. In the SEMALEAN study, lean mass in adults taking semaglutide declined early and then stabilized, while handgrip strength improved over 12 months. Losing some lean mass doesn't automatically mean a person is getting weaker.

Signs that Deserve Attention

People taking GLP-1 medications, and those caring for them, should watch for:

Eating much less than usual or skipping meals regularly
Feeling full after only a few bites
Persistent nausea or vomiting that interferes with eating or drinking
Trouble getting enough protein or variety in the diet
Unintended or unusually rapid weight loss
New or worsening fatigue, weakness or loss of stamina
Trouble getting up from a chair, climbing stairs or completing daily tasks
Dizziness or other signs of dehydration
A noticeable decline in strength, mobility or independence

None of these signs necessarily mean someone is malnourished, and none mean a medication should be stopped, a decision that belongs with the prescribing clinician. What they do is start a conversation with a physician or dietitian, who can evaluate food intake and history to determine whether more support is needed. Severe or persistent vomiting or signs of significant dehydration require prompt medical attention.

Making Limited Appetite Count

When appetite drops sharply, the makeup of meals matters more. Strategies worth raising with a clinician include:

Include protein in every meal and snack
Eat smaller, more frequent meals if full portions are difficult
Choose low-volume, nutrient-dense foods
Sip fluids throughout the day, separate from meals if necessary
Plan simple foods for days with higher nausea
Eat diverse foods for vitamins, minerals, and fiber
Ask if a nutritional supplement is appropriate

There's no single protein target that fits everyone, and needs vary, particularly for older adults and people managing kidney disease or other conditions. Individualized guidance from a clinician beats a number pulled off the internet.

Strength and Caregiving Matter Too

Nutrition is only half of protecting muscle during weight loss. Resistance activity, which doesn't require heavy lifting, helps the body hold onto muscle: bands, light weights, chair exercises or body-weight movements, depending on ability. Anyone who is inactive or manages a health condition should check with a clinician first. Everyday function often says more than a body-composition number: rising from a chair, carrying groceries and climbing stairs without unusual fatigue.

Caregivers often notice reduced appetite first, especially in older adults, who already face gradual muscle loss with age. A person may not realize how little they're eating, especially if they're pleased with the weight loss itself. Watch for:

Unfinished meals or a refrigerator that isn't being restocked
Growing fatigue or difficulty preparing food
Reluctance to eat driven by nausea or early fullness

Asking "Are you able to eat enough to feel strong?" tends to open more useful discussion than commenting on weight lost.

A Broader Definition of Successful Weight Loss

GLP-1 medications remain valuable tools for treating obesity. The research on lean-tissue loss isn't an argument against using them. It's an argument for pairing treatment with real nutrition care and physical activity. A person doesn't have to be underweight to need help, and a lower number on the scale doesn't tell the whole story.

Explore Medtrition's website for practical information regarding product offerings to bridge the nutritional gaps often encountered in the GLP-1 journey.

Related Products
ProSource^® Cup | ProSource^® NoCarb | Gelatein^®

Sources

American Society for Parenteral and Enteral Nutrition, Malnutrition Awareness Week
Mogna-Peláez, P., & Guasch-Ferré, M. (2026). Avoiding Malnutrition in the Era of Glucagon-Like Peptide-1 Medications: Emerging Evidence and Opportunities for Integrated Nutrition Care. The Journal of nutrition, 156(8), 101684. https://doi.org/10.1016/j.tjnut.2026.101684
Eisa, N., & Barood, O. (2026). Lean Mass Changes With Incretin Therapy Versus Lifestyle Intervention: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Diabetes, obesity & metabolism, 28(6), 4818–4827. https://doi.org/10.1111/dom.70666
Alissou, M., Demangeat, T., Folope, V., Van Elslande, H., Lelandais, H., Blanchemaison, J., Cailleaux, P. E., Guney, S., Aupetit, A., Aubourg, A., Rapp, C., Petit, A., Godin, M., Vignal, L., Grigioni, S., Déchelotte, P., Colange, G., Coëffier, M., & Achamrah, N. (2026). Impact of Semaglutide on fat mass, lean mass and muscle function in patients with obesity: The SEMALEAN study. Diabetes, obesity & metabolism, 28(1), 112–121. https://doi.org/10.1111/dom.70141

NCP October Journal Review: A 10-Year Review of Enteral Misconnection Adverse Events

Karen Sudders MS, RD, CNSC, LDN — Thu, 19 Sep 2024 16:00:00 GMT

In healthcare, safety protocols are essential for ensuring the well-being of patients. However, even with the best systems in place, errors can occur that can have serious consequences. An article recently published in the Nutrition in Clinical Practice (NCP) journal shines a light on one such issue—enteral misconnections. The article titled “The Lingering Safety Menace: A 10-Year Review of Enteral Misconnection Adverse Events” discusses enteral misconnections which refers to errors where feeding tubes are connected to the wrong port, such as intravenous lines, leading to the delivery of nutrients or medication in the wrong location. This can cause serious harm, including infection, organ failure, or even death. Despite advancements in medical technology and protocols aimed at preventing these errors, they continue to occur.

Over the course of ten years, the study reviewed numerous reports of adverse events resulting from enteral misconnections. The results were alarming: despite awareness campaigns and safety improvements, such events continue to occur.

One of the most significant insights from the narrative review was the role that standardization in medical equipment could play in reducing these errors. The introduction of safer, standardized connectors, such as the ENFit system, was hailed as a step in the right direction, but its adoption has been inconsistent across healthcare facilities.

The authors advocate for wider adoption of standardized enteral feeding connectors, which are designed to prevent cross-connections. However, they also stress the importance of ongoing education and training to ensure that healthcare professionals are well-versed in their use. Despite technological advancements, the review emphasized that human factors remain at the heart of enteral misconnections. Fatigue, stress, understaffing, and miscommunication were all cited as contributing factors.

The 10-year review offers a tough reminder of the challenges in healthcare safety, particularly in the context of enteral feeding management. While progress has been made, the persistence of adverse events stresses the need for ongoing attention and systemic changes. The article serves as a call to action for healthcare institutions, urging them to not only adopt safer technologies such as ENFit connectors but also to prioritize a culture of safety through education, training, and better communication.

Ultimately, as the article highlights, eliminating enteral misconnections requires a multifaceted approach, combining technological innovations with human-centered strategies. Only through this combination can healthcare providers hope to protect patients from this preventable, yet still prevalent, safety menace.

References

Ethington, S., Volpe, A., Guenter, P., & Simmons, D. (2024). The lingering safety menace: A 10-year review of enteral misconnection adverse events and narrative review. Nutrition in Clinical Practice, 39(5), 1251–1258. https://doi.org/10.1002/ncp.11191

Nutrition Intervention for Patients with Wounds and Dysphagia

Dr. Nancy Collins, PhD, RDN, LD, NWCC, FAND — Tue, 05 Mar 2024 14:00:00 GMT

Dysphagia, commonly known as a swallowing problem, can lead to significant health issues, such as dehydration, malnutrition, fatigue, aspiration, pneumonia, and a general decline in functional status.¹ These factors often contribute to skin breakdown and prolonged wound healing.

Patients with both dysphagia and wounds are challenging to treat because typical oral nutrition supplements for wound healing require the patient to consume 8-fluid ounces/twice daily. This amount of fluid may not be practical for these patients who are frequently prescribed thickened liquids to compensate for swallowing difficulties. Diet modification of food texture and/or fluid consistency is a nutritional approach commonly utilized for dysphagia management. Swallowing thin liquids, such as water, juice, coffee, or tea, requires muscle coordination and control because these fluids are aspirated easily into the lungs, which may lead to pneumonia. A patient who has difficulty consuming thin liquids sometimes is given a liquid with greater viscosity, meaning it is thickened by adding nonfat dry milk powder, cornstarch, or commercial thickeners. This approach requires measuring, mixing, and preparation by the staff only to have many patients consume very little of it or refuse it entirely.

Medtrition® offers a different solution called Expedite™ Cup. This product is currently the only available therapeutic nutrition supplement to support wound healing designed with the dysphagia patient in mind. It is a gelatin consistency that is IDDSI Level 4, extremely thick or spoon/pudding thick and served in a 2-ounce daily portion. Expedite Cup requires no preparation and is served by simply removing the foil lid and eating it right out of the plastic cup. Since the serving size is a small, 2-ounces/day, it is very easy for patients to adhere to this intervention until their wound is fully healed.

Expedite Cup contains a highly concentrated blend of the collagen dipeptides Prolyl-Hydroxyproline (PO) and Hydroxyprolyl Glycine (OG) plus L-citrulline. These highly active ingredients were carefully selected based on current research to support wound healing. These specific collagen dipeptides stimulate fibroblast activity to help build new tissue² while L-citrulline is an efficient and more powerful way to stimulate nitric oxide production when compared to supplemental arginine.³

Visit medtrition.com for more information and to request samples.

Reference:

Niedert, K. C., & Carlson, M. P. (Eds.). (2016). Nutrition care of the older adult: A handbook of nutrition throughout the continuum of care (3rd ed.). Academy of Nutrition and Dietetics.
Sugihara, F., Inoue, N., & Venkateswarathirukumara, S. (2018). Ingestion of bioactive collagen hydrolysates enhanced pressure ulcer healing in a randomized double-blind placebo-controlled clinical study. Scientific Reports, 8, 11403. https://doi.org/10.1038/s41598-018-29831-7
Agarwal, U., Didelija, I. C., Yuan, Y., Wang, X., & Marini, J. C. (2017). Supplemental citrulline is more efficient than arginine in increasing systemic arginine availability in mice. The Journal of Nutrition, 147(4), 596–602. https://doi.org/10.3945/jn.116.240382

Citrulline Unveiled: a Key Ingredient in Expedite Explained.

Dr. Nancy Collins, PhD, RDN, LD, NWCC, FAND — Tue, 20 Feb 2024 14:00:00 GMT

You may have noticed that one of the major ingredients in Expedite™ is the amino acid citrulline. While you probably are familiar with arginine, you might not be as familiar with citrulline. Citrulline is a nonessential amino acid, meaning the body can synthesize it endogenously. The function of citrulline is to produce arginine, which is why it is linked to wound healing and why it is added to the Expedite formulation.

A simple way to think of it is that citrulline is a precursor to arginine. The only function of citrulline is its conversion to arginine. A study comparing the relative efficiency of arginine and citrulline supplementation conducted in mice concluded that citrulline supplementation may increase arginine availability even more than arginine supplementation itself.¹ Outside of wound healing, healthy people take citrulline supplements for a variety of reasons, including improved athletic performance, lowering blood pressure, and alleviating erectile dysfunction.²

Arginine supplementation has some drawbacks. The primary challenge is the loss of arginine during the first-pass metabolism. The first-pass effect, also known as pre-systemic metabolism, refers to the metabolism of drugs or chemicals in the liver or intestine prior to their reaching the systemic circulation.³ Approximately 40% of dietary arginine is lost during this first-pass effect,⁴ while citrulline undergoes limited degradation. Arginine is largely metabolized by the liver, whereas citrulline is not taken up by the liver and therefore nearly all the citrulline absorbed from the small intestine bypasses the liver and enters the systemic circulation.⁵

Other reported challenges with chronic arginine supplementation include gastrointestinal problems and diarrhea.⁶ This effect is dose dependent, with studies varying from 3 g/day to more than 100 g/day. While the daily dose provided by typical wound supplements probably will not provoke any stomach issues, patients often complain that they believe the nutritional supplement affected them. If a patient believes this is true and stops consuming the supplement, the practitioner is back to square one and must find another intervention.

Finally, the controversy regarding use of arginine in hemodynamically unstable patients and critically ill patients persists. While this controversy should no longer exist,⁷ it is still brought up at every major wound meeting, indicating that it is still an unanswered question in practitioners’ minds. The conversion of citrulline to arginine occurs continuously if citrulline is circulating in the bloodstream.⁸ This will maintain a steady release of nitric oxide, which may help answer this issue.

Expedite contains ingredients that reflect the most current science to improve patient outcomes, and this includes citrulline.

Visit medtrition.com for more information and to request samples.

References

Agarwal, U., Didelija, I. C., Yuan, Y., Wang, X., & Marini, J. C. (2017). Supplemental citrulline is more efficient than arginine in increasing systemic arginine availability in mice. The Journal of Nutrition, 147(4), 596–602. https://doi.org/10.3945/jn.116.240382
RxList. (n.d.). L-citrulline. https://www.rxlist.com/l-citrulline/supplements.htm
Kenyon, E. M., & Hughes, M. F. (2010). Oral exposure and absorption of toxicants. In Comprehensive toxicology (2nd ed.). Elsevier. https://doi.org/10.1016/B978-0-08-046884-6.00103-2
Wu, G. (1998). Intestinal mucosal amino acid catabolism. The Journal of Nutrition, 128(8), 1249–1252. https://doi.org/10.1093/jn/128.8.1249
Morris, S. M., Jr. (2002). Regulation of enzymes of the urea cycle and arginine metabolism. Annual Review of Nutrition, 22, 87–105. https://doi.org/10.1146/annurev.nutr.22.110801.140547
Grimble, G. K. (2007). Adverse gastrointestinal effects of arginine and related amino acids. The Journal of Nutrition, 137(6 Suppl. 2), 1693S–1701S. https://doi.org/10.1093/jn/137.6.1693S
Rosenthal, M. D., Rosenthal, C., Patel, J., Jordan, J., Go, K., & Moore, F. A. (2016). Arginine in the critically ill: Can we finally push past the controversy? International Journal of Critical Care and Emergency Medicine, 2(2), 017. https://doi.org/10.23937/2474-3674/1510017
Maric, S., Restin, T., Muff, J. L., Camargo, S. M., Guglielmetti, L. C., Holland-Cunz, S. G., Crenn, P., & Vuille-dit-Bille, R. N. (2021). Citrulline, biomarker of enterocyte functional mass and dietary supplement: Metabolism, transport, and current evidence for clinical use. Nutrients, 13(8), 2794. https://doi.org/10.3390/nu13082794

Sarcopenia and the Importance of Protein Intake

Karen Sudders MS, RD, CNSC, LDN — Thu, 25 Jan 2024 13:00:00 GMT

Sarcopenia, from the Greek word meaning “poverty of flesh,” is the degenerative loss of skeletal muscle mass and strength associated with aging. It is a component of the frailty syndrome and can be debilitating and even fatal for the elderly, especially in the face of other co-morbidities such as wounds. Age-related muscle atrophy begins in the third decade of life and accelerates with advancing age; it really speeds up after a person’s 75th birthday.

At the root of the problem with sarcopenia is the issue of body composition. For simplicity, lean body mass (LBM) is defined as “the mass of the body minus the fat.” LBM is crucial for wound healing, immunity, organ function, and muscle strength. Loss of LBM occurs with aging, immobilization, acute injury or surgery, poor diet, lack of activity, and chronic health conditions. If a person who already has a deficiency of muscle mass suffers an additional insult from trauma or a chronic disease process, recovery of normal independent function is very difficult if not unlikely but proper nutrition can help, particularly protein intake.

It is recommended that protein intake be spread evenly throughout the day as opposed to consuming most of the protein at a single meal. Simply put, a breakfast of tea and toast is not the ideal meal to maximize protein synthesis. Protein should be included at every meal. Patients should be encouraged to consume protein throughout the day as shown in the sample menu below. For patients who have a poor appetite or are not eating well for any reason, liquid protein supplements can help meet protein intake goals in a convenient way. For example, Medtrition’s ProSource Plus Liquid Protein provides 100 calories and 15 grams of protein in a small 30 mL dose. ProSource is available in a variety of formulations to meet a variety of patient needs including a no carb version, a variety of flavors, and even one complete with an ENFit® connector to facilitate administration in tube fed patients. Visit www.medtrition.com for more information and to request samples.

Sample Menu with Thirty Grams of Protein* at Each Meal

Breakfast:
½ cup of cholesterol free egg product – 10 grams of protein
1 oz. of cheddar cheese – 7 grams of protein
2 slices of turkey bacon – 7 grams of protein
1 cup of milk – 8 grams of protein
Lunch:
2 slices of whole wheat bread – 7 grams of protein
3 oz. tuna, canned in water – 23 grams of protein
1 extra-large banana – 2 grams of protein
Dinner:
3 oz. boneless pork tenderloin, cooked – 20 grams of protein
1 medium baked potato with peel – 4 grams of protein
2 tablespoons reduced fat sour cream – 2 grams
½ cup cooked peas – 4 grams of protein

*Nutritional analysis performed using ESHA Food Processor.

References

Coelho-Junior, H. J., Calvani, R., Azzolino, D., Picca, A., Tosato, M., Landi, F., Cesari, M., & Marzetti, E. (2022). Protein intake and sarcopenia in older adults: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(14), 8718. https://doi.org/10.3390/ijerph19148718

Meeting Protein Requirements in the ICU

Karen Sudders MS, RD, CNSC, LDN — Tue, 09 Jan 2024 19:00:00 GMT

Meeting protein requirements in the Intensive Care Unit (ICU) is crucial for patient recovery, and there are multiple benefits associated with it. These benefits include, but are not limited to, improved wound healing, increased muscle mass and strength, prevention of muscle wasting, enhanced immune function, and overall improved recovery and survival rates.

Improved Wound Healing: Proteins are the building blocks of tissue. Adequate protein intake can help promote wound healing, especially in patients who have undergone surgery or have pressure ulcers (Stechmiller, 2010).
Increased Muscle Mass and Strength, Prevention of Muscle Wasting: In critically ill patients, muscle mass can rapidly decline due to inactivity and the body’s increased metabolic rate. Providing sufficient protein can help mitigate this loss and improve functional outcomes (Puthucheary et al., 2013).
Enhanced Immune Function: Protein malnutrition can impair the immune response, making patients more susceptible to infections. Adequate protein intake can help enhance immune function and reduce infection risk (Bistrian, 1990).
Improved Recovery and Survival Rates: Numerous studies have shown that meeting protein requirements in the ICU can improve patient outcomes, including reduced length of hospital stay and improved survival rates (Weijs et al., 2014).

Please note that individual protein needs vary, and it’s important to individualize nutrition therapy based on the patient’s condition, nutritional status, and tolerance. Also, overfeeding calories can have potential negative effects and should be avoided. It’s always recommended to consult with a registered dietitian or a nutrition support team for appropriate nutritional management in the ICU.

References

Stechmiller, J. K. (2010). Understanding the role of nutrition and wound healing. Nutrition in Clinical Practice, 25(1), 61–68. https://doi.org/10.1177/0884533609358997
Puthucheary, Z. A., Rawal, J., McPhail, M., Connolly, B., Ratnayake, G., Chan, P., Hopkinson, N. S., Phadke, R., Dew, T., Sidhu, P. S., Velloso, C., Seymour, J., Agley, C. C., Selby, A., Limb, M., Edwards, L. M., Smith, K., Rowlerson, A., Rennie, M. J., Moxham, J., Harridge, S. D. R., & Hart, N. (2013). Acute skeletal muscle wasting in critical illness. JAMA, 310(15), 1591–1600. https://doi.org/10.1001/jama.2013.278481
Bistrian, B. R. (1990). Role of the systemic inflammatory response syndrome in the protein-calorie malnutrition of critical surgical illness. Surgical Annual, 22(Pt. 2), 93–111.
Weijs, P. J. M., Looijaard, W. G. P. M., Beishuizen, A., Girbes, A. R. J., & Oudemans-van Straaten, H. M. (2014). Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Critical Care, 18(6), 701. https://doi.org/10.1186/s13054-014-0701-z

Did you know: Amino Acids vs Protein?

Karen Sudders MS, RD, CNSC, LDN — Wed, 04 Oct 2023 12:00:00 GMT

Amino acids are the building blocks of protein. They assist in many different bodily functions, but the two are not interchangeable, especially when it comes to nutrition declarations. While amino acid contribution will impact nitrogen load, they are not part of the total protein content on a nutrition label. This is important when reviewing products with protein claims and contribution.

Both amino acids and protein have roles in medical nutrition therapy and supporting the body; however, as stated, they are different. The addition of amino acids does not increase the whole protein content of a product, and protein sources can have different amino acid profiles depending on the actual source of protein. This is important when selecting a protein modular.

When reviewing products, it's important to understand what they are and what they are not. Products with protein cannot list the additional amino acid (such as arginine) as part of the protein contribution. Looking at all aspects of product provision is a necessity when selecting the best option for your patients.

Remember to read and evaluate your labels and ingredient profiles before you choose your modular protein.

Banatrol Plus White Paper Summary

Karen Sudders MS, RD, CNSC, LDN — Tue, 07 Jan 2020 21:00:00 GMT

Diarrhea is an important problem in critically ill patients.^1,2 Enteral feeding and medications are common causes of diarrhea in the hospital setting. Fiber-free enteral nutrition can induce diarrhea through abnormal colonic responses and disruption of the colonic microbiota.^{3, 4, 5, 6} Antibiotics can also disrupt the gut microbiota, resulting in dysbiosis and diarrhea.^{7, 8, 9}

Dietary fiber has been shown to have a positive impact on diarrhea in acute care patients.^{2, 10, 11} In 2016, the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (JPEN) published clinical guidelines which included expert consensus that a fermentable soluble fiber additive (module) be considered for routine use in all hemodynamically stable medical and surgical intensive care unit patients placed on a standard enteral formulation.¹² In addition, a dose of 10 – 20 g divided over 24 hours was recommended as adjunctive therapy when there was evidence of diarrhea was while the routine use of a soluble fiber additive (module) was suggested for all ICU patients as a prophylactic measure to help maintain commensal (colonic) microbiota and promote bowel health through the delivery of short-chain fatty acids (SCFA).

Soluble, fermentable dietary fiber plays a key role in the management of diarrhea in acute care through the restoration/modulation of the colonic microbiota and serving as a substrate to produce SCFAs. The colonic microbiota is a complex and diverse microbial ecosystem [13]. Beneficial colonic microbiota suppress enteropathogenic organisms through a process called colonization resistance.^{14, 15} Mechanisms for colonization resistance include: 1) competition for niches and nutrients, 2) metabolic exclusion by SCFA production, O2 consumption and bacteriocins, and 3) modulation of the host immune system [15]. Disruption of the gut microbiota via antibiotics^{8, 16} or enteral tube feeding^{17, 18} can reduce colonization resistance and increase the risk of infection by organisms such as Clostridium difficile.

Anaerobic fermentation of dietary fiber by the resident microbiota in the large bowel leads to the production of SCFAs, primarily acetate, propionate and butyrate.^{19, 20} SCFAs play an important role in colonization resistance^{15, 21} and are a source of energy for the host^22, with butyrate being a preferential energy source for the colon [23]. Another key benefit, as it relates to diarrhea, is the effect of SCFAs on water absorption in the colon.²⁴ SCFAs are absorbed by colonic epithelial cells and stimulate Na-dependent water absorption via a cyclic AMP- independent process involving apical membrane Na-H, SCFA-HCO3, and Cl-SCFA exchanges.²⁴ Nasogastric tube feeding of fiber-free formulas induce abnormal secretion of fluid and electrolytes in the ascending colon.²⁵ However, this effect is reversed when SCFAs are infused into the ascending colon.²⁶ A reduction in SCFA production during antibiotic use may be the primary reason for antibiotic-associated diarrhea²⁷ as the mechanism by which the colon absorbs water is compromised. Fermentable dietary fiber, by serving as an indirect source of SCFAs, helps restore the level of these important organic acids in the colon through the fermentative activity of the resident microbiota.

Banatrol Plus is a unique combination of banana flakes that provide dietary fibers such as pectin and resistant starch,^{28, 29} and Bimuno GOS (B-GOS). Bananas have a long history of use in the management of diarrhea. In 1950, Fries³⁰ published a paper on the effect of dehydrated banana flakes on infant diarrhea. Infants treated with dehydrated banana flakes recovered more quickly than did the infants in the control group. Banana flakes have also been shown to control diarrhea in enterally fed patients.³¹ Results from treatment with banana flakes were comparable to the control group receiving routine care (ie., antidiarrhea medication and tube feeding rate adjustment). Bimuno GOS is a novel galactooligosaccharide produced by a strain of Bifidobacterium bifidum NCIMB 41171.³² B-GOS is highly fermentable and bifidogenic.³² Clinical studies in healthy elderly volunteers demonstrated a significant increase in the number of beneficial bacteria, especially bifidobacteria, as well as a positive effect on immune response.^{33, 24} Also, B-GOS has been shown to reduce diarrhea episodes in healthy subjects at risk of travelers’ diarrhea.³⁵

Bimuno GOS and the dietary fiber in banana flakes are highly fermentable serving as an energy source for the microbiota in the large bowel [36] [37] [38]. Bimuno GOS is a highly effective prebiotic serving as preferential energy source for bifidobacteria. These ingredients help maintain/restore the colonic microbiota and subsequently colonization resistance during enteral feeding and following antibiotic therapy. In addition, the SCFAs produced through fermentation drive water and electrolyte absorption in the colon and represents a key mechanism by which soluble, fermentable fiber helps manage diarrhea in hospitalized patients.

There is expert consensus for the routine use of a soluble, fermentable fiber module in all hemodynamically stable medical and surgical intensive care unit patients placed on a standard enteral formula to help maintain commensal microbiota and promote bowel health through the delivery of SCFA. Also, the literature confirms that dietary fiber has a positive impact on diarrhea in acute care patients. The use of a module to deliver dietary fiber represents an approach that allows for a more controlled and consistent dose of dietary fiber to meet the unique needs of the individual patient. Banatrol Plus, a unique combination of banana flakes and B-GOS, represents the ideal soluble dietary fiber module for use in hospitalized patients at risk of or experiencing diarrhea.