Mitochondrial dysfunction and PICS, poor recovery after ICU.

Nestle Nutrition Institute CEU course. Polyphenols can help, magnesium, methyl B complex, Omega 3 fatty acids, etc.

People act like “going to the hospital” will make everything okay - it turns out that unless there is a rapid recovery, then it is more likely that the person will become part of the chronically ill post ICU population - who are underserved for their treatment needs. Mitochondrial dysfunction in ICU patients may be a factor in why patients either have a rapid recovery or a lack of recovery. Sadly, more than half are likely to have long term changes in physical, mental and cognitive function. Physical changes in pulmonary, neuromuscular, and physical function; Mental changes of anxiety, depression, or PTSD; and Cognitive changes in memory, attention, mental processing speed, and executive function.

*Post is too long for the email.

What is different between the people with rapid recovery and those who become a chronically disabled post ICU patient? My guess is untreated anemia of chronic inflammation. Iron chelators such as artemisinin can help, or citrus or pomegranate peel, etc.. There are many in the plant kingdom because the plants need to protect themselves against solar radiation and dehydration or excess water. MicroRNA direct events, changes in gene transcription in a way that helps our mitochondria too.

• CEU course, Pick Your PICS: Mitochondrial Changes, Inflammation and Nutritional Interventions, Nestle Medical Hub for Healthcare Professionals. Presented by Keith Miller, MD, FACS; Martin Rosenthal, MD, FACS; Beth Taylor, DCN, RD-AP, CNSC, FAND, FASPEN, FCCM. (Nestle Nutrition Institute) (the pdf),

Post-intensive care syndrome (PICS) - symptoms that persist after leaving intensive care. They may include mental/psychiatric symptoms, cognitive decline, and physical disabilities in function. If a rapid recovery does not occur, then the long-term PICS symptoms are likely to occur.

Pick Your PICS: Mitochondrial Changes, Inflammation and Nutritional Interventions | Nestlé Medical Hub for Healthcare Professionals *Available for 2 CEUs for some health practitioner specialties. (Nestle Nutrition Institute)

Post-ICU recovery services - I recommend a live-in resort or at least food sampling and preparation classes.

Services for the not fully recovered patients after they leave the hospital are currently inadequate according to the speakers’ discussion. This is a group of people similar to the brain fogged and fatigued group of histamine excess/hyperinflammation folks that I have been writing about. They need, ideally, in my opinion as a professional nutrition counselor and from personal experience as a brain fogged and fatigued person in my past, that a month at a live-in resort-like rehab facility is needed. Let other people spend the energy needed to make and serve the healthy food that is needed to heal and clear the foggy mind. Working along with the pros or having classes is needed to teach the skills to shop and prepare the new foods and teach the lifestyle changes. Tasting things helps to get over a hurdle of “I don’t want to try that recipe/plan, it looks weird or hard.” When people get a chance to taste new things a few times it can help adjust to appreciation for the new food or method of cooking.

The exhaustion and mental confusion are too great to expect people to handle it all on their own. Others need to help them get to first get healthy enough to be able to concentrate and learn new skills and have the energy to feel up to it. Gradually increasing exercise and moderate pacing on an ongoing basis to prevent relapse are needs. A nursing home does not provide that level of care and guidance.

How to provide this level of care or some substitute for less money than the live-in resort ideal? Providing really thorough written and video guidance materials for at-home use could be a start for motivated people who have some caregiver support or aren’t too debilitated.

Franchise guidance for deli/education centers that are set up independently.

Franchise-like Start-up guidance for a deli/soup kitchen, with an outpatient food and education center, could be another inexpensive start up to substitute for some of the goals of a live-in facility without the expense. Provide the education guides/start-up policy manuals, and local areas can set up their own versions of the deli/education center. Recipes, menu plans, shopping lists, would need to be included as when foods are restricted, other new foods need to be introduced to provide balance in macro and micronutrients. Like Alcoholics Anonymous clubs except for getting over the habit of modern inflammatory living. Spicy glutamates, sugar, salty fatty things, or sweet and fatty things are all fairly addictive. Processed foods often are made to encourage eating too much of them.

Food trucks could take the deli concept on the road and could have arranged education events as stops on its travels.

Food truck! could be another versatile way to reach more people in need without having a base rental budget. We are still waiting for the taco truck on every corner. Just make them healthier tacos - pom peel in the meat sauce and beans, and have more variety of choices to build a meal. Histamine folks have to pass on tomatoes but avocado and cilantro, cumin, coriander and garlic, onions, and zucchini are generally fine. Gentle on the cumin if too sensitive of a gut issue is present. The corn or wheat tortilla may be a problem for anyone with membrane breakdown/inflammation issues, so white rice is a standby on the sensitive gut diet. Bown rice can add to an oxalate burden and cause discomfort. Hot pepper can be a problem for people with inflammatory bowel symptoms.

Butyrate and colon microbiome counts, (and zinc).

Back to the webinar, or, first, the post webinar evaluation:

Evaluation question for the webinar: What is a gap in ICU care of patients?

My answer: Butyrate producing species are being ignored compared to the small intestine probiotic species that can be provided in supplements. The colon species are critically important to whole health and colon cells. Resistant starches and zinc is the need to support the anaerobic species of the colon and we need them to make butyrate and other short chain fatty acids for us. Education and treatment focus currently is focused too much on the small intestine instead of seeing both areas of the GI microbiome as essential for health. Zinc deficiency also leads to increased IL-6.

My basic pudding recipe is medicinal food that would help in recovery. I eat a spoonful (generous, like finger jello, it clings to itself ~ 1/8 cup) to settle my stomach and may have a 1/4 or 1/2 cup for breakfast or a late-night snack. Too large a serving is too much of a good thing, one cup may lead to gassiness. The potent licorice flavor makes a spoonful go a long way. The spoonful also has a nootropic, mind clearing effect. The cherry licorice pudding did too. Polyphenols can reduce neuroinflammation - and clear the brain fog.

My dad’s, now modified to increase protein, porridge recipe is also medicinal food. A Tale of Two Porridges - Translational Medicine? (substack.com) Note to self - only one Like on that post - a lot like throwing diamonds to swine. The recipe needs an update for my mom’s version. Seriously though, I cannot help people who don’t recognize value without it already being in a neat package with a pop-up ad and price tag. I work for that one person who is interested, so I will carry on. I’m changing the name of the porridge to “Dad’s 8 months on Hospice Porridge” and I will update the name as time progresses - goal “Dad’s 8 months off Hospice Porridge” *If a hospice patient lives too long, they get taken off the program; ~ 6-12 months or less, is the usual service provision.)

Anemia of chronic inflammation - ferritin and free iron are likely untreated problems.

~~ What is different between the rapid recovery patients and the PICS patients? The cells may have dysfunctional mitochondria - maybe they are giving off infected cell signals. They may have extra iron. Anti-malarials seem to help autoimmune or cancer recovery. Anemia of chronic inflammation may be part of the problem and is treatable with iron chelators - anti-malarials seek out iron rich cells. Artemisinin is a potent iron chelator. Excessive cannabinoid breakdown may be occurring which leads to more inflammation and more membrane breakdown. Lack of methyl B, niacin and other B vitamins, trace minerals, zinc and magnesium are likely factors, caused by the increase in oxidative stress/inflammation.

Endocannabinoid breakdown needs to be stopped.

Some bad news from endocannabinoid science, (Onaivi, Sugiura, Marzo, 2005), - the not rapid recovery folks, are likely in early stages of decomposition and need to turn that around before the body will cooperate with healing.

Inflammation is signaling to the body to ‘disintegrate’. Endocannabinoid membrane breakdown leads to further inflammatory changes and seems to be a natural part of a merciful death. When starving a person is first ravenous and seeks out anything and may be violent, and then as starvation worsens the endocannabinoid system kicks in euphoric anandamide which is blissful and pain relieving; appetite is gone, the desperation is gone - and it signals entry into a preliminary stage of decompositional changes in cells. (Onaivi, Sugiura, Marzo, 2005) For better quality of life, try not to enter decomposition before you are ready to die.

“In fact, disruption in the mitochondrial function and alterations in the number and shape of the organelles have been viewed in several types of human diseases and also in events of intoxication. Impaired ETC activity and decreased production of ATP have been observed in samples obtained from the brain of patients affected by neurodegenerative diseases as, for example, Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. Furthermore, mitochondrial dysfunction has been observed in metabolic (i.e., diabetes mellitus types I and II) and cardiovascular diseases. Mitochondrial collapse is also a central event during aging.

Inflammation, such as that observed after muscular lesion, may also damage mitochondria, affecting performance in sports. In that context, mitochondria-targeted molecules would be strategic to prevent or to treat mitochondrial impairment in several conditions.” (de Oliveira, 2021, from the Preface)

Plant polyphenols are a solution that works (and spermidine and urolithin A in particular).

“Mitochondrial impairment causes an increase in the production of ROS and RNS and initiates a vicious cycle that impacts the function of the organelles, leading to bioenergetics-related collapse and redox disturbances that can trigger cell death by different mechanisms.” […]

The solution: “It has been demonstrated that certain natural molecules, such those that are found in plants, exert antioxidant and anti-inflammatory actions in human cells and tissues. Moreover, some of those molecules may attenuate the effects of certain stimuli on the mitochondria. On the other hand, plant molecules can induce mitochondrial biogenesis, mitophagy, and fusion and fission, as evidenced in both in vitro (i.e., cell culture) and in vivo (i.e., animals) experimental models.” [*which is beneficial] […]

“Also, there is increasing interest in the redox and bioenergetics-related effects that plant molecules promote in the mitochondria. Certain plant molecules can prevent the chemically induced increase in the production of ROS by the mitochondria experimentally. Besides, plant molecules are able to improve the mitochondria-located defenses against ROS, such as Mn-SOD, GPx, and the nonenzymatic antioxidant agent glutathione (GSH). Collectively, these effects promote mitochondrial protection, reducing the impact of mitochondrial dysfunction on the cell fate.” […]

[Noteworthy, I now use Excedrin for caffeine as I can’t tolerate any coffee, sadface.] “In Chapter 19, S. Momtaz and contributors describe the effects of caffeine on the mitochondria of cells found in the central nervous system.” […]

“The utilization of ascorbic acid (which is commonly known as vitamin C) as a mitochondrial protectant agent is discussed by R.C. Vineetha and colleagues in Chapter 28.” (de Oliveira, 2021, from the Preface) (Index) *That looks really good, so I bought it, Merry Mitochondria to me! Currently on sale!

Tangent within a tangent: Germ/Terrain theory crowd - decomposition and virus is us, are us. It is our symbionts taking over as they sense their host is no longer functioning. Apoptosis signaling and viral budding and exosome budding all look fairly similar. Is a rose by any other name still a rose? I think we are both the germs and the terrain, so focus on building a good terrain and hosting beneficial ‘germs’. Additional thought - if dysfunctional mitochondria, that can no longer properly signal apoptosis, are an underlying causal factor in autoimmune conditions and cancer, than the shared mechanism of action of anti-malarial’s and Ivermectin against cancer or autoimmune disease may be reacting to the iron rich aspect of the cells from the anemia of chronic inflammation response. That is what I have thought of as the shared mechanism of action, maybe it involves the bacterial origin of mitochondria though. It is an interesting thought.

Iron is sequestered by the body from hemoglobin into intracellular storage in response to inflammatory signals. Infectious pathogens need iron too, so it is a defense mechanism that continues too long. Artemisinin is a very helpful iron chelator and anti-malarial that has shown effectiveness against cancer and for autoimmune disease. I used 200 mg am and pm for many months following CoV in March 2020 and it started helping reduce the extreme fatigue within a day or two.

How to turn around early stages of ‘decomposition’, endocannabinoid membrane breakdown? Niacin is important too, along with butyrate (both activate GP109 receptors).

See the work I’ve been working on - it is complex but doable if the person is not too far gone. Multiple organ failure is predeath though - sadly, sometimes saying good-bye maybe the best possible outcome, if cognitive loss is too great already.

This information matters, whether you like it or not, whether you like me or not. The simple explanation - modern life and modern diet promotes hyperinflammation which causes chronic brain and body illnesses. Niacin and polyphenol rich plants like pomegranate can help inhibit the inflammation but restricting the other causes of inflammation is really needed too. (And future dads - your drinking counts too - it takes 74 days to grow a healthy sperm or an alcohol and toxin damaged one with multiple gene mutations that may cause ADHD in your child.)

Plant polyphenols protect mitochondria and reduce inflammation, and so does niacin.

For review:

Just because your doctor doesn’t recognize pellagra, doesn’t mean it can’t kill you - it means that it likely will kill you unless SOMEONE recognizes that you need niacin supplementation STAT. The Role of Nutrition Care In Mitochondrial Health - ASPEN 2021 - YouTube.

Corollary - Just because your doctor doesn’t recognize scurvy (vitamin C deficiency) doesn’t mean it can’t kill you - it means that it likely will kill you unless SOMEONE recognizes that you need vitamin C supplementation (or good food sources) STAT.

Once health is critically impaired higher dose supplements (and many, not just one or two) are likely needed in addition to good food. Medical research too often treats nutrient research like medications - studying each individually only to find out that a single nutrient usually can’t solve all of the problem - unless the problem was something like pellagra or scurvy.

If you or a loved one are chronically ill following an illness or hospitalization, then you need a lot of nutrition care and months of it, years of it, for the rest of your life probably. Lifestyle changes may be needed to for better light/dark circadian habits and other factors like some minimal exercise daily.

I looked at all of the protocols on the FLCCC site and they would help, but it is not thorough enough for all the autoimmune/chronic inflammation issues that can occur. Early treatment helps but long treatment is needed for the hyperinflammation which causes brain fog and fatigue and often chronic pain of some sort.

Within the current censorship, I am not sure how I can best help. I try to reach those who are interested with an attitude of “When the student is ready the teacher will appear.” People who want a magic pill are not ready to be students of mine. I try to have web searchable info that may help whenever someone searches for it. Writing the menus, recipe examples, and shopping lists (avoid/beneficial/moderate use, for various inflammatory categories) is a goal, but is a big job.

A few more slides from the webinar (Nestle Nutrition Institute); *This video is not available without registration as a health professional on their site and sadly I can’t seem to rewatch it now that I completed the quiz.

“Mitochondial DYS-Function” Pick Your PICS: Mitochondrial Changes, Inflammation and Nutritional Interventions, Nestle Medical Hub for Healthcare Professionals. (Nestle Nutrition Institute)

“Do ICU COVID Patients Suffer from PICS-S?” Pick Your PICS: Mitochondrial Changes, Inflammation and Nutritional Interventions, Nestle Medical Hub for Healthcare Professionals. (Nestle Nutrition Institute) - Yes, combining ICU patients who stayed in ICU for an average of 13 days, with a group who stayed an average of 19 days - and had worse long-term changes: 25-29% experienced memory/cognitive impairment post discharge; 37-53% had insomnia; 33% extreme fatigue; 46% muscle weakness; 44% anxiety; 85% neuropsychological dysfunction; 87% required pulmonary rehab.

“ICU COVID PICS-S patients’ symptoms over time?” With a group of 50 ICU patients, from baseline there was a significant increase in negative changes at 1-month post discharge that improved somewhat by 3-months post d/c fo personal care function and pain or discomfort but there was no change in the increased anxiety/depression. Pick Your PICS: Mitochondrial Changes, Inflammation and Nutritional Interventions, Nestle Medical Hub for Healthcare Professionals. (Nestle Nutrition Institute) *NOTE that magnesium deficiency is a cause of both anxiety and depression and is more likely to occur during inflammatory conditions - and then provide topical sources or chelated supplements please as GI malabsorption may be likely to be an underlying issue too.

~~

ICU anecdote - patient was failing, getting skin sluffing symptoms - bizarre, what an unusual case, they don’t know what is wrong! Turned out someone forgot to order the B vitamins with the other drip feed nutrients, or some error led to no B vitamins for too long. We need B vitamins and C daily, and in increased amounts for any condition with inflammation. It was a case of medical negligence rather than a new mystery disease as it was initially considered. The patient recovered, but that could have led to death by B vitamin deficiency.

Food is fuel. Food can taste good, but that isn’t the main point. How does it leave you feeling later? Good fuel leaves you energized and clear-headed. Bad fuel can have an initial stimulatory effect followed by a crash and irritation, anxiety, or brain fog. Any mold exposure is still a fairly immediate trigger for brain fog for me, followed by a migraine later. When a person’s diet contains things causing inflammation then even the best ‘fire-fighting’ team of phytonutrients may not do more than reduce the negative symptoms somewhat. Identifying and restricting problem chemicals from the diet and living environment is a critical need if a more complete recovery is the goal.

“P. granatum [pomegranate] and its constituents have shown protective effects against natural toxins such as aflatoxins, and endotoxins as well as chemical toxicants for instance arsenic, diazinon, and carbon tetrachloride. The protective effects of these compounds are related to different mechanisms such as the prevention of oxidative stress, and reduction of inflammatory mediators including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), cyclooxygenase-2(COX-2) and nuclear factor ĸB (NF-ĸB) as well as the modulation of apoptosis, mitogen-activated protein kinase (MAPK) signaling pathways and improvement of liver or cardiac function via regulation of enzymes.” (Hosseini, Razavi, Hosseinzadeh, 2022)

Spermidine and urolithin A promote mitophagy - safe removal of dysfunctional mitochondria. See this post: Mitochondrial dysfunction, continued, & an ASPEN webinar. (substack.com)

**This post wandered a bit and there is more to learn about mitochondria, microRNA, and will likely have a follow up.

Trivia, I need a new keyboard for my laptop. Too many letters are losing their function.

I tend to get omegante currently.

Disclaimer: This information is being provided for educational purposes within the guidelines of Fair Use it is not intended to provide individual health care guidance. Please seek a functional health professional for individualized health care.

Reference List

(de Oliveira, 2021) Editor(s): de Oliveira, M.R., ‘Mitochondrial Physiology and Vegetal Molecules’, Academic Press, 2021, ISBN 9780128215623, https://doi.org/10.1016/B978-0-12-821562-3.00012-5. https://www.sciencedirect.com/book/9780128215623/mitochondrial-physiology-and-vegetal-molecules The Preface, Pages xxxvii-xli: https://www.dropbox.com/s/tht30zprg7dfl3h/ScienceDirect_articles_11Dec2022_15-58-25.011.zip?dl=0

(Hosseini, Razavi, Hosseinzadeh, 2022) Hosseini, A., Razavi, B.M., Hosseinzadeh, H., (2022). Protective effects of pomegranate (Punica granatum) and its main components against natural and chemical toxic agents: A comprehensive review, Phytomedicine, 2022, 154581, ISSN 0944-7113, https://doi.org/10.1016/j.phymed.2022.154581. https://www.sciencedirect.com/science/article/pii/S0944711322006699

Miller, K., Rosenthal, M., Taylor, B., (2021) Pick Your PICS: Mitochondrial Changes, Inflammation and Nutritional Interventions, Nestle Medical Hub for Healthcare Professionals. March 21, 2021, (Nestle Nutrition Institute) (the pdf)