Réf. : Re: [Dysphagia] hyperosmolar fluids and yogurt

[nutrition.iugm at ssss.gouv.qc.ca (nutrition.iugm@ssss.gouv.qc.ca)]

Hello everyone,

It seems that there is a misconception in the use of hyperosmalor /
"bacteria" rich foods in people who aspirate. Although I understand both
sides, I have to underline the fact that NO foods aren't hyperosmolar
except water / tea / coffee and diet products that contains only water /
artificial sweetners and flavor. As soon as you add sugar / salt or any
other kind of short molecules, the osmolarity (or osmolality) of the
product rises. For example, fruit juices are often higher than 600 mOsm /
kg (and can go as high as 1000 mOsm / kg) as milk's osmolarity is around
275 mOsm / kg. To my knowledge, yoghurt osmolarity isn't know specifically.
But as I said, as soon as you add sugar, you increase the osmolarity of the
product. Eggnog has an osmolarity of about 700 mOsm / kg. My guest is that
the osmolarity of yoghurt is close enough to egg nog (unless it's
artificially sweetned). So, which one is better ? Juice or yoghurt ? My
personal guess is neither... they're practically the same !

For the microbiological content of foods, one must be aware that everything
is contaminated. Unless food is prepare in a "air thight sealed"
environment with sanitize procedure (such as irradiation, use of chemical
agents) and excrutious hygiene measures, none can say that what they're
eating is "bacteria-free". Should we limit ground beef on the account that
it may contain E. Coli ? Should we avoid all cheeses since they're all made
with a fermenting agent ? Same goes for beer ! Where do we stop the line
??? As you all know, poor dental hygiene IS the main problem and does
create a good environment for bacterial proliferation. We can't have a
germ-free environment and it would be health hazardous if it was.

For commercially produced yoghurt, I have to say that Irene is right. Most
yoghurt doesn't contain active agents. The life span of these bacteria are
only a few days, leaving a very short shelf-life viability. A few years
ago, major companies made claims that their yoghuts contained active agents
but they were rapidily contested by consumers associations (the actual
bacterial count wasn't significant enough to say so). You might haven't
notice it, but these health claims dissapeared as fast as they had appeared
! The only yoghurt on the market known to contain an active agent is
Activia from Danone (at least that's the reality in the province of Qu?bec,
Canada) and it's only a recent product (less than a few months !).

To Irene's question about lactase, everyone should know that it's an enzyme
which digest lactose (the sugar contained in milk and milk based products).
Also, lactose is one of the prefered energy substrate for bacteria (since
they have lactase !). But how can it promote pneumonia ? I looked around
and haven't found any references proving that it can promote it. Any simple
sugars would do the same. I did find a reference (but didn't read it all
since I only had acces to the r?sum?) stating that the use of probiotics
(friendly bacterias !) can be beneficial for the respiratory tract by
introducing it by aerosols !. As for the mecanism for "clearing out" the
lungs, it involves the scavenging system (mainly macrophages which eats
everything they can get they're hands on !). It would be interesting to
know your physiatrist suspected mecanism of action. But above all, you have
to keep in mind that the main and utter most important thing to have is a
good nutrition status to insure a well functionning immune system. Enough
energy, proteins, micronutrients and hydration is the main focus here !

I also look for published cases of pneumonia with lactobacillus species.
The only known and published cases of lactobacillus pneumonias are in
immune-depressed patients ie AIDS and neutropenics patients. I don't think
that it is the case here.

Hope that it cleared up some quesitons you may add.

Benoit Bertrand RD
Clinical Registered Dietician
Institut universitaire de g?riatrie de Montr?al
4565, Chemin Queen-Mary's
Montr?al (Qu?bec)
H3W 1W5

Phone: (514) 340-2800 poste 3109
Fax: (514) 340-2819
Email: nutrition.iugm@ssss.gouv.qc.ca