Lecture 6: Nutrition Therapy for Lower GIT

Nutrition Therapy for Lower GIT and Malabsorption Disorders

Disorders of Bowl Function

• Irritable Bowel Syndrome (IBS)
  • Characterized by chronic and recurring intestinal symptoms with no specific physical abnormalities
  • Symptoms: disturbed defecation, flatulence, abdominal discomfort or pain, sudden change in appearance after a meal, and low-grade intestinal inflammation
  • Causes: psychological stress, post-infectious, changes in microflora, idiopathic
  • Diagnosis: difficult due to nonspecific symptoms and lack of laboratory tests
• Diarrhea
  • Characterized by frequent, watery stools
  • Causes: inadequate fluid reabsorption, increased intestinal secretions, osmotic and secretory diarrhea
  • Types: osmotic diarrhea (unabsorbed nutrients attract water to the colon), secretory diarrhea (fluid secreted by the intestines exceeds reabsorption)
• Constipation
  • Characterized by defecation frequency of fewer than three bowel movements per week
  • Symptoms: hard stools, excessive straining during defecation
  • Causes: low-fiber diet, low food intake, low fluid intake, low physical activity, medical conditions, neurological conditions, pregnancy, medication side effects

Nutrition Therapy for Disorders of Bowl Function

• Irritable Bowel Syndrome (IBS)
  • Dietary adjustments: try and error, peppermint oil, probiotics, psyllium supplementation, gradual increase in fiber intake
  • Avoid foods that aggravate symptoms: fried or fatty foods, gas-producing foods, milk
• Diarrhea
  • Nutrition care: depends on cause and severity of diarrhea
  • Dietary recommendations: low-fat, lactose-free diet, apple pectin or banana flakes to thicken stool consistency
  • Avoid foods that exacerbate symptoms: gas-producing foods, caffeine
• Constipation
  • Nutrition therapy: gradual increase in fiber intake, adequate fluid intake, adding prunes or prune juice to the diet
  • Avoid foods that exacerbate symptoms: low-fiber diet, dairy products, processed foods

Inflammatory Bowel Disease

• Crohn's Disease and Ulcerative Colitis (UC)
  • Characterized by chronic inflammatory illnesses with abnormal immune responses to the GI tract
  • Causes: autoimmune disease, genetic and environmental factors
  • Symptoms: malabsorption, diarrhea, blood in stool, weight loss, fatigue
• Nutrition Therapy for Inflammatory Bowel Disease
  • Dietary measures: high-kcalorie, high-protein diet, oral supplements, fat-soluble vitamins and mineral supplements
  • Medical treatment: aminosalicylates, corticosteroids, immunomodulators, biologic therapies, surgery

Colostomies and Ileostomies

• Colostomy
  • Surgical removal of the rectum and anus
  • Stools with high water content
  • Nutrition therapy: clear liquids, high-soluble fiber diet, vitamin B12 injections
• Ileostomy
  • Surgical removal of the damaged part of the ileum
  • Waste material in fluid form
  • Nutrition therapy: high-kcalorie, high-protein diet, vitamin B12 injections, extra fluid and electrolyte replacement

Malabsorption Disorders

• Cystic Fibrosis
  • Affects the cells that produce mucus, sweat, and digestive juices
  • Causes: defective gene
  • Complications: lung damage, pancreatic insufficiency, salt losses in sweat
  • Nutrition therapy: high-kcalorie, high-protein diet, pancreatic enzyme replacement therapy, liberal use of table salt
• Celiac Disease
  • Autoimmune disorder characterized by an abnormal immune response to gluten
  • Causes: immune reaction to gluten
  • Consequences: damage to intestinal mucosa, malabsorption of nutrients
  • Nutrition therapy: gluten-free diet### Malabsorption Disorders
• Lactase deficiency can result from mucosal damage, and milk products may exacerbate gastrointestinal symptoms.

Nutrition Therapy for Celiac Disease

• The treatment for celiac disease involves lifelong adherence to a gluten-free diet.
• Symptoms often improve within several weeks, but mucosal healing can take years.
• If lactase deficiency is suspected, patients should avoid lactose-containing foods until the intestine has recovered.
• A gluten-free diet eliminates foods containing wheat, barley, and rye.
• Patients should be instructed on food preparation methods to prevent cross-contamination from utensils, cutting boards, and toasters.
• Most people with celiac disease can safely consume moderate amounts of oats, but most oats grown in the United States are contaminated with wheat, barley, or rye.
• Some oat manufacturers produce oats in dedicated facilities and test products to ensure they are gluten-free.