Gerontology and GERD - What's the latest?
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® eNews is a monthly e-newsletter shared with the global PEN Community and created to help dietitians position themselves as leaders in evidence-based nutrition practice. In addition, users of the PEN System will find articles on the new evidence, resources and features available and how to maximize one's use of PEN.
What is the Latest on GERD and the need for B12?
The Question
What are the considerations related to vitamin B12 status in individuals with gastroesophageal reflux disease (GERD)?
The Recommendation
Although individuals with GERD who take proton pump inhibitor (PPI) medications may have lower vitamin B12 levels than individuals not taking PPIs, evidence is not strong enough to warrant routine advice to increase vitamin B12 intake. Similarly, routine monitoring of vitamin B12 levels is not warranted in asymptomatic individuals without other risk factors for vitamin B12 deficiency.
Evidence Summary
A 2022 systematic review of seven observational studies (one cross-sectional, one case-control, five prospective cohort) concluded that chronic PPI use can lower vitamin B12 levels. Further high quality research is required to elucidate this effect.
Clinical guidelines for GERD management recommend that individuals who take PPIs should not be routinely advised to increase their vitamin B12 intake or routinely monitored for vitamin B12 deficiency.
Grade of Evidence C
Remarks
PPIs inhibit gastric acid production, which is necessary for vitamin B12 absorption in humans. Gastric acid converts pepsinogen into pepsin, which allows vitamin B12 to be released from proteins in food.
There is no “gold standard” test for vitamin B12 deficiency, which makes research on the topic heterogeneous.
To see the full practice question, including the Evidence Summary, Evidence Statements, Comments, Rationale and References, click here.
Wondering what else is new or updated? Click here.
Post-cholecystectomy – Is a Low Fat Diet Needed?
The Question
Is a fat-restricted diet needed for individuals with gallbladder disease after cholecystectomy for symptom management?
The Recommendation
Evidence does not support prescribing a fat-restricted diet after cholecystectomy.
Evidence Summary
The authors of a 2020 prospective cohort study (n=83) concluded that dietary fat intake did not affect gastrointestinal symptoms following cholecystectomy.
A 2013 RCT (n=40) found no significant difference in digestive symptoms following cholecystectomy in participants prescribed a low fat or regular post-surgical diet.
The 2014 National Institute of Health and Care Excellence (NICE) guidelines recommend that it is unnecessary for individuals with gallstones to avoid food triggers, including dietary fat, following cholecystectomy.
Grade of Evidence C
To see the full practice question, including the Evidence Summary, Evidence Statements, Comments, Rationale and References, click here.
Interested in more GI content? Did you know that the PEN System has 26 GI Knowledge Pathways! Here are the other 25:
Thank you to our dietetic students Alexandra and Nadina!
For the last two months, the PEN Team has been fortunate to welcome two dietetic students from Toronto Metropolitan University (TMU) in Toronto, Canada. Alexandra Breau and Nadina Villacis are both graduate students completing a Master of Health Science in Nutrition Communication and practical training to qualify to become registered dietitians in Canada.
Nadina and Alexandra assessed the PEN System’s current social media strategy and identified opportunities to promote user engagement. The recommendations were summarized into a social media toolkit and an annual plan to showcase new and updated PEN content, feature PEN staff and PEN users, and also connect PEN content with calendar days of significance. Have you checked out our PEN socials lately? Many of their suggestions and recommendations have already been implemented!
Learn more about our fabulous dietetic students on Instagram (@pennutrition). You can also follow our new hashtag #PENNutrition.
Thank you, Alexandra and Nadina, for all of your amazing work!
PEN eNews
July 2023 Volume
13 (7)
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