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|Nutrition and You: Dietary Management for Short Bowel Syndrome|
What You Eat Does Matter
LifelineLetter, September/October 2008
Laura Matarese, PhD, RD, LDN, FADA, CNSD
We eat both for the nutrients food provides and for the pleasure of eating. But if you have short bowel syndrome (SBS), the type of food you eat and the way you consume foods are especially important, as these factors will affect your absorption. This article will review the types of foods you should consume and the way you should consume them if you have SBS.
Short Bowel SyndromeWhat exactly is SBS? And what do we mean by “short”? The normal small bowel length in adults ranges from 300 to 800 cm. Loss of two-thirds or more of the small bowel is defined as SBS. However, as many of you know, it is not just the length that matters, but how well the remaining bowel functions. So you may not have much bowel, but what you have works pretty well. Or you may have plenty of bowel, but it is diseased and doesn’t function optimally.
DietDietary modification is the foundation of therapy for someone with SBS. This is one area where you, the home parenteral and/or enteral (homePEN) consumer, have total control. You can decide what you eat, how much, and when. Making small adjustments in your diet will help you manage your ostomy output or bowel movements. This, in turn, may allow you to reduce your dependence on parenteral nutrition (PN).
GI AnatomyLet’s start with a few basic concepts. Your diet must be based on your own gastrointestinal anatomy. If you have SBS and your colon is in circuit, you will maximize your absorption if you follow a diet that is low in simple carbohydrates and low in fat. If you have SBS and a jejunostomy, there is no need to restrict fat, but limiting the simple carbohydrates will help to decrease the ostomy output.
CarbohydratesWhat is a simple carbohydrate and what is a complex carbohydrate? A simple carbohydrate consists of two sugar molecules that are hooked together to form a disaccharide. Examples of these are sucrose (table sugar) and lactose (milk sugar). These are found in foods such as candy, cakes, cookies, pies, regular soda pop, jelly, jam, syrup, ice cream, sherbet, and sorbet. If you have SBS and you consume large amounts of these simple carbohydrates, you may experience more diarrhea.
Complex carbohydrates are composed of large starch molecules. When consumed, complex carbohydrates generally do not produce a lot of diarrhea. Complex carbohydrates are found in pasta, potatoes, breads, cereals, whole grains, fruits, and vegetables.
It might be tempting to consume foods that are “low carb.” However, these foods often contain sugar alcohols such as sorbitol and manitol instead of sugar. Sugar alcohols are not absorbed by the gastrointestinal tract. They tend to cause diarrhea and foods containing these “sweeteners” should be avoided. You may find these sugar alcohols in sugar-free mints and chewing gum, as well as in diabetic candies and cookies. Read the labels carefully.
Many people ask if they need to restrict milk and milk-containing products because milk contains lactose (the sugar found in milk) naturally. Many people lack the enzyme lactase, which is necessary to digest the lactose. If you cannot digest lactose, you will have gas, diarrhea, and bloating when you consume milk products. However, many people can tolerate small amounts of milk. For example, you may be able to tolerate milk on your cereal, even though you cannot drink a glass of milk.
You can get fiber
naturally through food (i.e., oatmeal, whole grains, fruits, and vegetables) or
get it through various fiber supplements (see Table 1). Even if your
colon is not connected, you can use fiber to help to thicken up your ostomy
output. This may give you a little more control over your output.
Oral rehydration solutions (ORSs) are used to enhance fluid absorption. These solutions vary widely in their content (see Table 2). The number and size of the dissolved particles in a solution determine the osmolality of the solution. The greater the number of particles and the smaller the size of those particles, the higher the osmolality. This is expressed as milliosmoles per kilogram of water (mOsm/kg). The optimal fluid to maximize absorption is isotonic (280 mOsm/kg H2O). Absorption of fluids is also maximized when the glucose content is 10 g/L, but even the best solutions have more glucose to increase their palatability.
Of the commercially prepared ORSs, the World Health Organization’s solution contains the best mixture of glucose and sodium, and it costs the least. It comes in packets of powder that can be mixed at home with water and a sugar-free flavoring such as Kool-Aid or Crystal Light. Other commercially prepared ORSs are available in over-the-counter premixed bottles and closely approximate the World Health Organization solution.
Sports drinks, sodas, and juices contain too much carbohydrate and not enough sodium, and will cause diarrhea to worsen. In table 2, note the levels of carbohydrate (CHO), sodium (NA+), and potassium (K+) in the sports drink in comparison to the ORSs. However, you can add additional water and salt to these drinks to make them more closely resemble an ORS (see Table 3).
Click here for updated ORS recipes (January, 2017).
Frequent, Small Meals
Is It Okay to Modify the Diet?Sometimes you just have to have that favorite food even though you know it is going to run right through you. Is this okay? Well, on occasion, it is acceptable to sample that favorite food. But it is best to just “sample” it, and to do it when you are close to a bathroom. If you do this too often, you are likely to lose too much fluid and too many electrolytes.
ConclusionWe eat for nutrition as well as for pleasure. If you have SBS, the type of food you eat and the way you consume food will affect your absorption. Small adjustments in the diet can give you more control over your output without you having to sacrifice nutrition or taste.
Dr. Matarese is the Director of Nutrition, Intestinal Rehabilitation and Transplantation Center, Thomas E. Starzl Transplantation Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. This article is based on a presentation Dr. Matarese gave at the Oley Annual Consumer/Clinician Conference in San Diego in June.
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