The problem turned out to be far more subtle. It was not caused by her recent bone marrow transplant or her cancer. Rather, she was deficient in carnitine. Dr. Graham prescribed oral supplements of the betaine derivative, and the patient improved markedly. It's a story that highlights a fairly common situation.
Most physicians have only a rudimentary knowledge of nutrition, particularly micronutrients.
But making sure patients get the nutrition they need can reduce mortality and morbidity, improve the quality of a patient's life and increase the effectiveness of treatment. These points were central themes at the 25th clinical congress of the American Society for Parenteral and Enteral Nutrition, held last month in Chicago. Unfortunately, we still provide so little education for medical school students that they can't even write a good tube-feeding prescription, let alone counsel a patient in some of the details. But, warn experts, knowledge of nutrition is crucial to treatment success. The most effective treatments can fail if a patient's system is starving and can be even more successful if a patient is well-nourished.