Review by Tamzyn Murphy Rd, MSC
“Knowing what I know, I just can’t stand back and say nothing.” – Dr. Manjunath Markandaya
When we think of a critical illness, diet is rarely top. And yet, as Dr. Manjunath Markandaya A critical care neurologist based in Gainesville, Georgia, what we feed our most sick patients could make the difference between life, death or recovery. In an interview with the eyes of Tamzyn Murphy RD MSC of Nutrition Network, Dr. Markandaya (with love known as “Dr. Manju”) challenged the outdated protocols of the ICU, shared extraordinary cases of patients and gave clinicians, carers and families a look at the nutritional therapy that could be seen if driven by science instead of the mamm.
This is more than a food conversation, it is a call to radically review critical care.
From survival to recovery: Review of ICU Example
Dr. Manju has spent more than 20 years of treatment for patients in neurotragling care, where he manages cases such as traumatic brain damage, severe strokes, intracerebral hemorrhage and epileptic condition. For most of his early career, the diet was not even on the radar.
“When I started … diet was the last thing in my mind. It didn’t matter, you didn’t think about it at all, ” confessed. “We were good at keeping people alive. But we don’t give them good functional results.”
This changed when younger patients some in 30, 20 years old, and even teenagers began to fill ICU beds. The question that began to haunt him was this:
“What can we do to improve the neurological effect … so they return to being functional members of society?”
The answer, discovered, was not in more machinery or medicines but in by supplying the brain differently.
The brain runs to ketones: and we get it starving it
The brain is a uniquely metabolically active organ and one that thrives in ketones, especially during the injury. “The brain runs so well in the ketones … not only feeds the brain well. It activates a whole cataract of events that allows the brain to repair and heal” explained by Dr. Manju.
However, the typical ICU diet, either orally or through pipe supply, could not be more than support.
“It’s a heavy carbohydrate, heavy oil seed, full of margarine diet.
Even the so -called “ketogenic” medical feeds are often built on refined vegetable oils such as Kats and Sunflower. The irony? While trying to cause ketosis, they simultaneously introduce pre-inflammatory fats that can aggravate the results.
Case: Guillain-Barré Syndrome and the first flow of real food pipes
Faced with these restrictions, Dr. Manju took things in his hands literally by feeding a patient in a critical manner with one Homemade Diet Keno-Karveri through gastrostomy tube. His case reporting, Feasibility of a real keto-carnivore food supply to a neurobid therapy unitdescribes a 61 -year -old man Serious Guillain-Barré syndromewhich was quadriplegic and dependent on the respirator after autoimmune nerve damage.
The standard commercial feeds offered to him were full of Maltodextrin corn, Canola oil and isolation of soy protein. So Dr. Manju intervened.
“We came with a formula using 70/30 ground beef, four to six egg yolks, full fat fat and sardines.
Over time, they were transported from four small foods a day to two larger feed. The patient reported it well “There are no gastrointestinal issues. There are no new infections.” Dr. Manju said. Indeed, The operation of the patient’s kidneys improved and his neurological recovery began.
“He was able to tolerate spontaneous breathing, swing his toes, lift his shoulders.
Because it matters: ICU as a metabolic battlefield
Patients with ICUs are often hyperglycaemic due to hormone stress, infections and rights with right -wing. In fact, the standard blood sugar target is 140-180 mg/dl (7.8-10 mmol/l)-well in the diabetic range.
“We get punishment if we don’t keep blood sugar so tall. It’s the standard” said Dr. Manju.
This high glucose environment is not just harmful Actively prevents ketosis. Even when clinical doctors try to cause ketosis for neurological benefit (as in the resistant epilepsy), the Excessive use of dextrose in iv drugs and feed makes it almost impossible to get patients in a therapeutic metabolic condition.
This is where the real food strategy of Dr. Manju breaks the mold. Replacement of processed carbohydrates and oils with animal density products, It creates a metabolic environment that favors treatment.
The exogenous ketone solution
When the real food is not feasible, Dr. Manju turns exogenous ketones especially ketone for financial access and accessibility.
“We give them three to four times a day … Patients who were coma start smiling and interacting with their families. I have seen happening repeatedly.”
In one case, a woman coma for 21 days was alert and responded within 24 hours of completion of ketones. ‘Her husband was over the moon’ Recall.
It is not a magical treatment, but it is a powerful metabolic tool, especially in a change -resistant system.
Heart failure and ketogenic heart
Dr. Manju’s research does not stop at Neurology. Also applies ketogenic interventions congestive heart failure (CHF) And by questioning the deeply established belief that fat and cholesterol cause heart disease.
“Most heart failure instructions still push low -fat, high carbohydrate diet diets, but the truth is that the heart prefers fatty acids and especially ketones when failing.”
He shared an amazing insight: the failed heart really signifies the body to produce ketones. Some researchers now use acetone breathing levels in diagnose Heart failure in patients with non-kettle.
Dr. Manju described several ICU patients with implanted heart pumps (LVAD) who received exogenous ketones for neurological support – only to experience dramatic heart improvement.
“Few had their heart failure completely reversing. The LVADs were removed.”
This unpublished proof leads its lecture to the upcoming Nutrition Network, starting in August 2025.
Real obstacles, real courage
Applying these protocols is not easy. Dr. Manju faces significant resistance from the Nutrition Departments, Cardiologists, Nephrologists and Administrative Gatekeepers. Even when providing supportive bibliography, he said, “This contradicts the guidelines.”
“I had to go to multiple meetings, show the rationale and even then they won’t approve it, so I talk to families directly, if they suddenly insist and threaten legal action, people back.”
Tamzyn summoned it better:
“You’re incredibly. Incredibly brave. It shouldn’t even be a struggle to serve real food in patients with critically patients – but make it and make the difference.”
What can we do? Practical suggestions by Dr. Manju
If you or a loved one ends up in the ICU, Dr. Manju offers these critical knowledge:
- Ask what is in the flow.
“Most standard pipe supply is simply processed corn and soy oils. Request the list of ingredients.” - Ask for elementary types if you can’t access real food.
“They are not ideal but contain less inflammatory ingredients.” - Avoid continuous feeding.
“Falling the bell gives the intestinal time to rest, reduce inflammation and improve recovery.” - Consider exogenous ketones.
“It is one of the few ways to support brain metabolism in ICU.” - Train the healthcare team.
“Provide literature. Ask respectable questions. Press for change when you can.”
For clinical doctors: training that converts practice
Dr. Manju’s approach did not come out of nowhere. He is proud of his graduate Nutrition for Medical Certification Nutrition-A rigorous, clinical program guided by the clinician, who authorizes doctors, dieticians and allied professionals to apply a therapeutic restriction of carbohydrates to clinical environments.
“It was definitely one of the hardest lessons I’ve taken – and so it’s worth it” He shared.
If you are ready to question the contract and change lives like Dr. Manju, that’s where to start:
👉 Nutrition for Medical Certification Nutrition
For more information on a ketogenic diet and metabolic treatments for neurological diseases, register for food networks Neurology.
In addition, the work of Dr. Manju appears on the upcoming Network Network Cardiovascular education (Starting August 2025) -Email Support@nutrition-network.org for pre-registration or ask for early bird offers
Final thoughts: from doctrine to data based on data
If there is a message that Dr. Manju wants to get clinicians and carers, this is:
“I would rather get no food than to get this food.”
In a world where patients with critical disease are systematically powered pre-inflammatory mud under the pretext of “full nutrition”, Dr. Manju pioneered real food, real science and real treatment.
His stories remind: Change does not come from waiting – it comes from action, education and brave professionals who wish to ask harsh questions.
📢 Take action today
Let’s restore fuel, not just survival.
