Short bowel syndrome is a digestive system disorder that happens after some part of the small intestine has been cut off. People with this disorder usually come down with diarrhea and malabsorption, and these symptoms vary according to how much of the small intestine is removed. Consequently, they receive food through the veins, known as total parenteral nutrition (TPN), and anti-diarrhea medications like loperamide.
Small Intestine Credit: BruceBlaus.
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To reduce the need for TPN, scientists have developed an interest in treating short bowel patients on normal or high-carbohydrate diets with artificial growth hormone, either alone or in conjunction with glutamine. In humans, the intestines are known for their regenerative properties, and glutamine is an important nutrient that helps intestinal cells be strong, while carbohydrate diets improve energy absorption and intake.
Does carbohydrate absorption increase?
About two decades ago, scientists conducted a lot of research on this, and they kept on wondering if these effects were solely caused by a modification of their diet. It was also unclear to them how the synergistic effects of the growth hormone and glutamine facilitated intestinal absorption.
Some studies propose that patients with short bowel syndrome respond better to high-carbohydrate diets than to diets high in fat. Byrn and his colleagues researched this and implemented a high-carbohydrate diet with artificial growth hormone and glutamine. They discovered that most of their patients stopped taking TPN 1 year after the trial ended due to increased absorption and weight gain. This was a good outcome; however, the participants were not compared with people who did not take the regimen, making the study a little bit unreliable and unclear.
Thereafter, Szkudlarek and his team were of the opinion that a normal diet could still have the same effect or even better. They recruited 8 patients with short bowel syndrome who had been on TPN for an average of 7 years. They gave artificial growth hormone and glutamine to the active patients and normal saline and L-alanine to the control group all through the layer below the skin. They did not increase the carbohydrate intake. However, looking at the results, they found no improvement in intestinal absorption of macronutrients, energy, or other nutrients.
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A literature review done recently by Chen and others initially pointed out that the studies that were done so far and their subsequent results are inconsistent, but most of them show that the synergistic effect of glutamine and growth hormone on the intestine causes patients to abandon their TPN with time. This means that the intestines benefit from the regimen. Interestingly, they also suggest that the regimen has an effect on intestinal stem cells, causing them to grow and may even cause them to grow into goblet cells, which are mucus-secreting cells also found on the wall of the intestine.
Hope for patients
A life lived on TPN is not ideal, and most patients on it detest how unnatural it feels. If this regimen gains traction clinically, people who have short bowel syndrome and other forms of intestinal malabsorption no longer have to be confined to TPN forever. They can have hope of one day being able to eat and properly digest their food like every other person.
Clinical significance
The clinical application of growth hormone and glutamine to stimulate intestinal stem cells is one of those ideas that appear unthinkable at first, but once done appear inevitable. This management protocol may not be limited to short bowel syndrome, but could also be used to treat a variety of intestinal diseases as well as to plan future studies on this subject, particularly those that focus on the regulation of cellular proliferation and differentiation.
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Conclusion
The science on the glutamine and growth hormone regimen is not settled yet. Various scientists have both proven and disproven the fact that treatment of the intestine with this regimen promotes the absorption of carbohydrates. More results have tilted toward the positive than the negative. More clinical research, however, should be carried out to come to a definite conclusion.
References
Chen, Y., Tsai, Y. C., Tseng, B. J., & Tseng, S. H. (2019, August 17). Influence of Growth Hormone and Glutamine on Intestinal Stem Cells: A Narrative Review. Nutrients. Retrieved December 6, 2023, from https://doi.org/10.3390/nu11081941
