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|Nutrition and You: Short Bowel Syndrome|
Quenching Your Thirst
We often think and talk about the heat, especially with picnics, baseball games, and all of the fun associated with being outside in warmer weather. But consumers with short bowel syndrome (SBS) and other types of malabsorption are at greater risk of dehydration at all times of the year, so it is important to know how to stay hydrated. Fluid intake and output is always important!
Water is the single largest component of the body, contributing between 50 and 70 percent of total body weight. Water is obtained by eating and drinking. The body also makes water.
We lose water in our urine and stool and through our skin and respiratory tract. If you have SBS, you can lose a lot of water in your stool or ostomy output. In warm weather, people tend to lose more water through increased sweating.
In order to be well hydrated, fluid intake must equal output. So, should you drink water, sports drinks, or oral rehydration solutions?
Selecting a BeverageBelieve it or not, water isn’t the best beverage for a person with SBS or other types of malabsorption. If your gastrointestinal tract has to try extra hard to absorb fluid—like in SBS—you should drink a beverage that is low in sugar and contains sodium, and sometimes one that contains potassium and bicarbonate. These drinks are called oral rehydration solutions (ORSs). You can buy these or make your own. Check the Oley Web site for some recipes and ideas.
Oral Rehydration SolutionsWhy an ORS? The consumer with SBS must consider the osmolarity of the beverage he or she has chosen. Osmolarity refers to the concentration of a liquid, or the number of particles in it. The more particles there are, the higher the osmolarity.
Hyperosmolar solutions contain many particles of glucose and little to no sodium. They are very concentrated and cause fluid to be pulled into the intestinal tract to dilute the concentration of the drink; this causes watery diarrhea. Examples of hyperosmolar beverages include: fruit juices, regular soda pop, lemonade, and fruit smoothies.
Hypoosmolar solutions contain little to no particles of glucose and sodium. They are not very concentrated and do not pull fluid into the intestinal tract. But they are not always absorbed entirely. Examples include: water, ice, decaffeinated coffee and tea, sugar-free soda pop, sugar-free powdered drinks, and sugar-free flavored water.
Isoosmolar solutions contain sodium, potassium, and glucose in the same concentration as blood and extracellular fluid. These will not cause fluid to shift into the intestinal tract and will therefore help to minimize stool output. An example of an isoosmolar solution is the World Health Organization ORS.
Working with your dietitian or physician, you can choose an appropriate oral fluid tailored to your bowel function and anatomy in order to best manage your fluid balance. If you have SBS and your colon is connected, you will most likely do best with isoosmolar or hypoosmolar fluids. If you have SBS ending in an ostomy, you will most likely tolerate isoosmolar, high-sodium ORSs.
Preventing DehydrationDrink an appropriate volume of fluid slowly throughout the day to meet both your baseline needs and to cover your losses. This means drinking no more than one cup over one hour—and take the hour to do it! Drinking oral fluids quickly will typically worsen dehydration by causing increased stool output and causing you to feel thirstier.
When in doubt, consult with your health professional as soon as you have identified the signs and symptoms of dehydration, which include thirst, dark-colored urine, decreased frequency of urination, lightheadedness (especially upon standing), fast heart rate (pulse), and sudden weight loss. Prevention is the best treatment. So stay well hydrated and enjoy the warm weather!
This column has been compiled and reviewed by Laura Matarese, PhD, RD, LD, FADA, CNSD; Carol Ireton-Jones, PhD, RD; Cheryl Thompson, PhD, RD, CNSD; and Marion Winkler, PhD, RD, CNSC.
LifelineLetter, July/August 2010