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

2. 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
Diets high in soluble fibers can lower blood cholesterol levels
Nutrition & Diet Therapy (7th Edition)

3. Nutrition & Diet Therapy (7th Edition)

4. 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)

5. Disorders of Bowel (cont’d)
Constipation (con’t)
Treatment
Gradual increase in fiber intake, especially
Wheat bran
Fruits & vegetables
Fiber supplements
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
Nutrition & Diet Therapy (7th Edition)

6. 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)

7. 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.
Nutrition & Diet Therapy (7th Edition)

8. Nutrition & Diet Therapy (7th Edition)

9. Disorders of Bowel (cont’d)
Irritable bowel syndrome
Characterized by chronic, recurrent & unexplainable intestinal symptoms
Symptoms
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)

10. 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
Nutrition & Diet Therapy (7th Edition)

11. 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
Nutrition & Diet Therapy (7th Edition)

12. 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
Nutrition & Diet Therapy (7th Edition)

13. In UC, the colon appears inflamed and reddened, and ulcers are visible
In Crohn’s, the mucosa has a “cobblestone” appearance due to deep fissuring in the inflamed mucosal tissue
In UC, the colon appears inflamed and reddened, and ulcers are visible
Nutrition & Diet Therapy (7th Edition)

14. Nutrition & Diet Therapy (7th Edition)

15. 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)

16. 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
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
Nutrition & Diet Therapy (7th Edition)

17. IV. Diverticular Disease of the Colon
Diverticulosis: presence of pebble-size outpockets in intestinal wall (diverticula)
Incidence increases with age
May remain symptom-free until complication develops
Increased fiber in diet (increased stool weight & bulk) may decrease development
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)

18. Nutrition & Diet Therapy (7th Edition)

19. 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
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
Nutrition & Diet Therapy (7th Edition)

20. 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
Nutrition & Diet Therapy (7th Edition)

21. Nutrition & Diet Therapy (7th Edition)

22. 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)

23. Nutrition Therapy for Ostomies
Reducing gas & odors
A concern for all ostomy patients
Avoid foods that are gas-producing
Avoid foods that produce odors
Fish
Eggs
Dried beans & peas
Onions & garlic
Asparagus & Brussels sprouts
Beer
Avoid practices that increase gas production
Smoking
Gum or tobacco chewing
Use of drinking straws
Eating quickly
Obstructions
A primary concern of ileostomy patients
Cut food into small pieces, carefully chew
Foods that may cause problems
Corn
Celery
Coconut
Dried fruit
Grapes
Nuts & popcorn
Raw cabbage
Unpeeled apples
Nutrition & Diet Therapy (7th Edition)

24. Nutrition & Diet Therapy (7th Edition)

25. 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
Nutrition & Diet Therapy (7th Edition)

26. 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
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
Nutrition & Diet Therapy (7th Edition)

27. 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 antibiotic-associated diarrhea in infants & children
Reduced occurrence of pouchitis (inflammation of surgical pouch created in patients with ileostomy or colostomy)
Nutrition & Diet Therapy (7th Edition)

28. Probiotics Sources of probiotic bacteria Safety
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)