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Recovery from an ICU stay is tough. Could more protein help?

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Paul Wischmeyer was a teenage athlete when he learned firsthand just how devastating an intense illness can be. After spending the better part of a year severely sick and frequently hospitalized with undiagnosed severe inflammatory bowel disease, his colon perforated, landing him in the intensive care unit. When he finally recovered, he went from being a starter on his high school basketball team to being too weak to walk down the court — profoundly disabled from just being in the hospital.

He built back his strength over the next few years, and eventually worked his way through medical school as a personal trainer in a competitive bodybuilding gym, where he helped clients sculpt their physiques by providing them with targeted workouts and having them add protein and other nutritional supplements to their diets. But it wasn't until his training in critical care medicine that Wischmeyer began to thread together his interest in bodybuilding with his interest in ICU recovery.

Critical care experts have long known that a stay in the ICU can lead to long-term weakness lasting months or even years after discharge, regardless of the specific illness. Wischmeyer was especially struck by his patients' massive loss of muscle, which reminded him of his own experience. "I'd watch people lose half their body weight in a short period of time and not be able to walk," he says.

Today, Wischmeyer, a critical care and nutrition physician at Duke University, is a leading voice among clinicians and scientists investigating whether increasing protein intake during and after hospitalization could be an important and long-overlooked component of recovery. Lean muscle melts away startlingly quickly in ICU patients, and muscle-wasting is a predictor of long-term impairment after hospitalization, studies show. Proponents of the approach say that protein, a nutritional cornerstone for body builders, may help critically ill patients retain muscle or rebuild it as well. "Protein is what everyone is interested in in right now," says Zudin Puthucheary, a clinical senior lecturer in intensive care at Queen Mary University of London. (Wischmeyer, like many researchers in the nutrition field, has received funding from industry.)

But some question whether simply adding more protein to patients' diets will translate into increased muscle mass and better functioning. While several studies suggest that boosting protein levels early on after critical illness or surgery may improve recovery, they have mostly been small, and other studies have not shown a benefit. "Protein provision might be important, but there aren't large studies to understand that yet," said Renee Stapleton, a pulmonologist and critical care physician at the University of Vermont Medical Center. A handful of such studies are currently underway, but whether they will bring clarity to the protein picture remains to be seen.

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