Transcript Fiber-Modified Diets for Lower GI Tract Disorders Chapter 18 Nutrition & Diet Therapy (7th Edition)

Fiber-Modified Diets for
Lower GI Tract Disorders
Chapter 18
Nutrition & Diet Therapy (7th Edition)
I. Modifying Fiber Intake
• Modification may require either increase or
decrease in dietary fiber; RDI is 38 g/day
– Insoluble fibers: increase fecal weight & promote rapid
passage of wastes through large intestine (aka dietary
fiber, found in whole grains)
– Soluble fibers: more viscous; slow passage of food
– Health recommendation: most people should increase
fiber intake by increasing consumption of whole grains
– Side effects of high-fiber diet: increased intestinal gas
(flatulence)—should be added gradually & portions
increased as tolerance improves
Nutrition & Diet Therapy (7th Edition)
Diets high in soluble
fibers can lower
blood cholesterol
levels
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II. Disorders of Bowel
Function
• Constipation
– Difficulty passing stools (straining) or
infrequent bowel movements; often diagnosed
when individual has fewer than 3 bowel
movements/week
– Causes:
• Food intake & activity-related causes: low fiber &/or
food intake, inactivity
• Medical & neurological conditions: diabetes mellitus,
chronic renal failure, hypothyroidism, Parkinson’s
disease, spinal cord injury, multiple sclerosis
• Pregnancy
• Some medications & dietary supplements
Nutrition & Diet Therapy (7th Edition)
Disorders of Bowel (cont’d)
• Constipation (con’t)
– Treatment
• Gradual increase in fiber intake, especially
– Wheat bran
– Fruits & vegetables
– Fiber supplements
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Adequate fluid intake
Foods with mild laxative effects: prunes & prune juice
Laxatives, enemas & suppositories
Medical treatment
– Medications to increase peristalsis
– Surgical intervention (colon resection, colostomy) as
last resort
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Disorders of Bowel (cont’d)
• Diarrhea
– Passage of frequent, watery stools
– Severe or persistent diarrhea can cause dehydration
& electrolyte imbalance
– Causes
• Complication of medical problems
• Infection, medications, dietary substances
– Treatment
• Correction of underlying medical disorder
• Change in medication or omission of offending
foods
• Bulk-forming agents to reduce liquidity of stool
• Antidiarrheal drugs for chronic diarrhea
• Parenteral nutrition for severe, intractable
diarrhea
Nutrition & Diet Therapy (7th Edition)
Disorders of Bowel (cont’d)
• Diarrhea (con’t)
– Nutrition therapy
• Depends on cause, severity & duration of
diarrhea & degree of fluid loss
• Rehydration therapy: replacement of fluid &
electrolytes for severe diarrhea
• Fiber restriction for some individuals
• Foods & beverages containing fructose, sugar
alcohols & lactose may aggravate symptoms
• Avoidance of caffeine-containing products
– Rehydration therapy
• The replacement of fluids and electrolytes
(water, salts, and glucose or sucrose) if diarrhea
is severe.
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Nutrition & Diet Therapy (7th Edition)
Disorders of Bowel (cont’d)
• Irritable bowel syndrome
– Characterized by chronic, recurrent & unexplainable
intestinal symptoms
– Symptoms
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Both diarrhea & constipation
Flatulence, bloating, distention
Mild to severe, often interfering in routine daily activities
Individuals may eventually become asymptomatic
– Possible Causes: May be associated with colonic response to
meals, GI hormones & stress
– Treatment
• Dietary adjustments
• Stress management & behavioral therapies
• Medications for management of symptoms
Nutrition & Diet Therapy (7th Edition)
Disorders of Bowel (cont’d)
• Irritable bowel syndrome (con’t)
– Medical nutrition therapy
• Complete diet history to reveal behaviors that
improve or worsen symptoms
• Dietary changes that help one symptom may
aggravate another
• Increase fiber intake to reduce constipation &
improve stool bulk
• Bulking agent
• Avoidance of milk products (if lactose intolerant)
• Caffeine & alcohol can exacerbate symptoms
• Small, frequent meals
• Possible low fat diet
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III. Inflammatory Bowel
Diseases (IBD)
• Crohn’s disease
– Involves small intestine & may result in
nutrient malabsorption
– Complications
• Can occur in any region of GI tract—usually affects
ileum &/or colon
• Deep inflammation, ulcerations, fissures & fistulas
• Intestinal obstruction, intestinal cancers
• Malnutrition
• Malabsorption of fat, fat-soluble vitamins, calcium,
magnesium, zinc
• Vitamin B12 deficiency, anemia
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Inflammatory Bowel
Diseases (cont’d)
• Ulcerative colitis
– Affects colon; always involves rectum & may
extend into additional segments of colon
– Complications
• Tissue erosion or ulceration (primarily affecting
mucosa & submucosa)
• Mild disease results in few complications, unless
colon involved
• Weight loss, fever, weakness
• Anemia
• Dehydration & electrolyte imbalance
• Protein loss
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• In Crohn’s, the mucosa has
a “cobblestone”
appearance due to deep
fissuring in the inflamed
mucosal tissue
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• In UC, the colon appears
inflamed and reddened,
and ulcers are visible
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Treatment of Inflammatory
Bowel Diseases
• Drug treatment
– Medications to control symptoms: reduce
inflammation & minimize complications
• Antidiarrheal agents
• Immunosuppressants
• Anti-inflammatory drugs
– Help to achieve remission but associated with
side effects (diet-drug interactions)
detrimental to nutrition status
Nutrition & Diet Therapy (7th Edition)
Inflammatory Bowel
Diseases
• Medical Nutrition
Therapy
– Crohn’s disease:
aggressive dietary
management
– Manage symptoms &
complications
• High-kcalorie, high-protein
• Liquid supplements
• Restriction of fiber &
lactose
• Vitamin & mineral
supplements
Nutrition & Diet Therapy (7th Edition)
– Ulcerative colitis:
requires little dietary
adjustment
– In severe illness, manage
symptoms & complications
• Restoration of fluid &
electrolytes (possible
intravenous replacement)
• Correct deficiencies
resulting from protein &
blood losses
• Low-fiber diet
• Bowel rest (withhold
foods)
• Parenteral nutrition
support
IV. Diverticular Disease of the
Colon
• Diverticulosis:
presence of pebblesize outpockets in
intestinal wall
(diverticula)
– Incidence increases
with age
– May remain symptomfree until complication
develops
– Increased fiber in diet
(increased stool weight
& bulk) may decrease
development
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• Diverticulitis: inflammation
or infection developing around
a diverticulum
– Common complication of
diverticulosis
– Spread of infection to
adjacent organs may result in
development of fistula
– Infection may spread to
peritoneal cavity (rare
occurrence)
– Symptoms: persistent
abdominal pain, fever,
alternating constipation &
diarrhea
Nutrition & Diet Therapy (7th Edition)
Treatment for Diverticular
Disease
• Focuses on symptom relief
– Reducing pain
– Alleviating constipation
– Increasing fiber to prevent disease progression
• Add wheat bran to meals
• Use bulk-forming agents
• Some recommend avoidance of nuts, popcorn & foods
containing seeds—no evidence that this will reduce
complications
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Antibiotics to treat infection
Clear liquid diet, progressed to solid foods as tolerated
Bowel rest when necessary; intravenous fluid treatment
Surgical intervention to treat complications, including
removal of colon
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V. Colostomies &
Ileostomies
• Ostomy: surgically created opening (stoma) in
abdominal wall for elimination of dietary waste;
may be permanent or temporary
– Colostomy: creation of stoma from section of colon
– Ileostomy: creation of stoma from section of ileum
– Dietary waste collected in disposable bag affixed to skin
surrounding stoma; or interior pouch may be surgically
constructed behind stoma
– Stool consistency varies according to functional capacity
of remaining length of colon
• Removal of small portion of colon: stools may continue to
be semi-solid
• Removal or bypass of entire colon: absorption of fluid &
electrolytes reduced substantially, resulting in liquid stool
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Nutrition & Diet Therapy (7th Edition)
Nutrition Therapy for Ostomies
• Gradual progression of diet following surgery
– Clear liquids, low in sugars, progressing to low-fiber diet as
tolerated
– Small, frequent meals better tolerated initially
– Addition of questionable foods slowly & one at a time
• Colostomy
– Dietary concerns depend on length of colon removed
– High-fiber diet to improve stool consistency & promote regularity
– Removal of large segment: recommendations may be same as
ileostomy
• Ileostomy
– Chew thoroughly to ensure adequate digestion & to prevent
obstruction
– Avoidance of insoluble fibers—reduce intestinal transit time & may
increase output
– Inclusion of at least 8 cups of liquid/day
Nutrition & Diet Therapy (7th Edition)
Nutrition Therapy for Ostomies
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Obstructions
A primary concern of ileostomy
patients
Cut food into small pieces,
carefully chew
Foods that may cause problems
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Corn
Celery
Coconut
Dried fruit
Grapes
Nuts & popcorn
Raw cabbage
Unpeeled apples
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Reducing gas & odors
A concern for all ostomy patients
Avoid foods that are gasproducing
Avoid foods that produce odors
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Fish
Eggs
Dried beans & peas
Onions & garlic
Asparagus & Brussels sprouts
Beer
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Smoking
Gum or tobacco chewing
Use of drinking straws
Eating quickly
Avoid practices that increase gas
production
Nutrition & Diet Therapy (7th Edition)
Nutrition in Practice—Probiotics
& Intestinal Health
• Shortly after birth, GI tract is colonized
with wide variety of bacteria (flora)
– Majority reside in colon
– Populations vary within different regions of GI
tract
– Benefits to health
• Degrade undigested or unabsorbed dietary
carbohydrate, including fibers resistant to digestion
• Stimulate immune defenses to prevent overgrowth of
pathogenic bacteria
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Probiotics
• Foods & supplements
supplying live,
nonpathogenic bacteria in
sufficient numbers to
benefit health
• Resistant to destruction
by stomach acid, bile,
other digestive
substances
• Alter intestinal
environment to benefit
human host
• Possible help for medical
problems:
- May prevent & treat some
gastric & intestinal disorders
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– Improve lactose digestion
– Improve availability &
digestibility of various
nutrients
– Alter susceptibility to food
allergens & alleviate some
allergy symptoms
– Help prevent or reverse
infections in urethra &
vagina
• Benefits to health not
conclusive in research—
therefore should be
considered adjuncts to
primary medical
treatment for illness
Probiotics
• Intestinal disorders helped by probiotics
– Shortened duration of diarrhea caused by
rotavirus in infants & children
– Decreased incidence of traveler’s diarrhea in
tourists visiting high-risk areas
– Prevent recurrence of infectious diarrhea in
hospitalized patients
– Reduced incidence & duration of antibioticassociated diarrhea in infants & children
– Reduced occurrence of pouchitis (inflammation of
surgical pouch created in patients with ileostomy
or colostomy)
Nutrition & Diet Therapy (7th Edition)
Probiotics
• Sources of probiotic bacteria
– Foods—provided mainly by fermented foods
• In U.S.—yogurt & acidophilus milk (produced using
species of Lactobacilli & Bifidobacteria)
• In Europe & Asia—yogurt, milk, ice cream, oatmeal
gruel, soft drinks
– Dietary supplements
– Prebiotics in foods that may stimulate growth in
large intestine
• Safety
– Infection in immune-compromised individuals
– Lack of industry standards for probiotics in foods &
supplements
Nutrition & Diet Therapy (7th Edition)