Lect 10 MNT for lower GI (1).pdf

Disorders of the Lower GI Medical Nutrition Therapy Chapter 15 Lec # # 10 Diarrhea • Oral rehydration solutions can replace both fluids and lytes • Avoid high-sugar foods or beverages, sugar alcohols, caffeine, gas-producing foods, and alcoholic beverages • Soluble fiber and resistant starch to t...

Disorders of the Lower GI Medical Nutrition Therapy Chapter 15 Lec # # 10 Diarrhea • Oral rehydration solutions can replace both fluids and lytes • Avoid high-sugar foods or beverages, sugar alcohols, caffeine, gas-producing foods, and alcoholic beverages • Soluble fiber and resistant starch to thicken stool Goal = Alleviate symptoms or correct/prevent nutrient deficiencies Fiber Review Soluble Insoluble • Guar gum • Inulin • Fructooligosaccharide • Fructan • Galactans • Pectin Found in foods such as • Barley, legumes, nuts, seeds, oats, onion, garlic, rye • Cellulose • Lignin Found in foods such as • Fruits, vegetables skins, flax seed, and wheat bran Constipation • • • • • Increase whole grains, fruits, vegetables Fiber 25-38 grams/day =11 to 14g/1000 kcals Bulking agents Fluid – at least 2000 mL/day Lifestyle factors include exercise and plenty of fluids • Probiotics and prebiotics Goal = Increase fiber intake Malabsorption • Fat malabsorption – Restrict fat to 25 – 50 grams per day – MCT supplements (6-12 carbons) • 15 mLs provides 115 kcals • Enters circulatory system via the portal vein • Add to hot foods Goal = prevent nutrient deficiencies Malabsorption • Lactose – Lactase milk – Almond, rice or soy milk – Recommend other high sources of calcium • Sardines, kale, dried beans, canned salmon, collards, calcium fortified orange juice, broccoli ،‫ والكرنب‬،‫ والسلمون املعلب‬،‫ والفاصوليا املجففة‬،‫ واللفت‬،‫السردين‬ ‫ البروكلي‬،‫عصير البرتقال املدعم بالكالسيوم‬ Celiac Disease • Initially – Lactose and gluten free diet • No wheat, rye, or barley • Substitute w/corn, potato, rice, soybeans, tapioca, and buckwheat • Read labels very, very carefully including ‫الحنطة السوداء‬ – Medications, toothpaste, shampoo • Avoid cross contamination Correct nutrient deficiencies Celiac Disease • • • • MAJOR LIFESTYLE CHANGE Refer to qualified Dietitian Guide to support groups May still need medications – Steriods – anti inflammatory – Cyclosporine - immunosuppressant ww.glutenfreediet.ca www.glutenfreedietitian.com Goal = Prevent additional weight loss/encourage weight gain IBS • • • • Decrease anxiety, normalize dietary patterns Offending foods, elimination diets Nutritional adequacy Fiber ‫إزالة األطعمة التي تتعارض مع‬ ‫املرض والعالج من النظام الغذائي‬ – Use caution with insoluble fiber • Plenty of fluid and exercise • Pre & Pro “biotics” INDIVIDUALIZED FOR SPECIFIC SYMPTOMS FODMAPs for IBS Symptoms Low-FODMAP Diet Helps IBS patients Gas-Producing Foods Steps to Decrease Gas Production IBD • During Exacerbation – – – – Enteral preferred over parenteral Advancement from NPO as tolerated (individualize) Excessive feces Low-residue, lactose free initially Small, frequent meals IBD • During Exacerbation – MCT if steatorrhea present – Restrict gas forming, spicy, or fried foods – Increase fiber and lactose as tolerated IBD No need to memorise numbers only names • Supplementation – – – – – Vitamin D – 50,000 IU 1 X week X 8 weeks Calcium Citrate – 1200 – 1500 mg/d (÷ dose)\ Zinc – 12-15 mg/L of stool output Magnesium - 15-30 mEq/L Copper 0.5 – 1.5 mg/d IBD • Calculating Energy and Protein Needs • Adults – Energy needs + stress factor (1.3 to 1.5) – Protein 1.5 g/kg (ASPEN Guidelines) • Children Normal range is 0.8 But because in ammation we will give high dose of pro – Infants – 120 kcals/kg – Adolescents – 80 kcals/kg – Protein – 2.0 – 2.5 g/kg (ASPEN Guidelines) IBD • During Remission – – – – – – Maximize energy and protein Weight gain and physical activity Normalize dietary patterns Food sources of antioxidants, Omega 3s Limit foods high in oxalate Because high oxlate= stones in kidneys Pre & Pro “biotics” ‫تخفيف األعراض‬ Goal = Alleviate symptoms or Increase intake. Nutrition Therapy for Diverticular Disease • osis • itis – High fiber from food – Initially NPO – High fiber using – Advance as tolerated supplements – Gradually increase fiber – Fluid – Exercise – Foods to avoid??? Spicy food and low ber food Goal = Alleviate symptoms ‫ايش األطعمة التي يجب تجنبها؟‬ • • • • • • • Ostomies ‫فتحة في العضو بسبب عملية جراحية‬ After surgery, transition to oral diet Decrease risk of obstruction Maintain fluid and electrolyte balance Reduce excessive fecal output Produce appropriate consistency output Minimize gas and flatulence Multivitamin and B12 supplementation ‫إنتاج مخرجات متسقة مناسبة‬ TABLE 15.15 Goal = Proper hydration or prevent obstruction ‫‪SBS‬‬ ‫يمكن تستمر ملدة شهر‬ ‫بعد العملية الجراحية • اتباع نظام غذائي عن طريق الفم مع ‪• TPN‬‬ ‫انحسار اإلسهال • السوائل الصافية – خالية من السكر ومتساوية‬ ‫التوتر • التقدم إلى نظام منخفض الدهون وخالي من الالكتوز‬ ‫ومنخفض األكساالت • تجنب الكافيني والكحول وكحوليات السكر •‬ ‫األلياف القابلة للذوبان مفيدة؟ غير قابلة للذوبان ليس كثيرا‬ ‫‪TPN postoperatively‬‬ ‫‪Oral diet as diarrhea subsides‬‬ ‫‪Clear liquids – sugar free, isotonic‬‬ ‫‪Progress to low fat, lactose free, low oxalate‬‬ ‫‪Avoid caffeine, alcohol and sugar alcohols‬‬ ‫‪Soluble fiber beneficial? Insoluble not so much‬‬ ‫غير ذائب علشان املريض ما يعاني من اإلسهال‬ ‫‪Goal = Provide adequate energy, protein and‬‬ ‫‪fluid needs to meet needs‬‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ ‫•‬ Summary • Many diseases or syndromes of the lower GI tract will require Medical Nutrition Therapy • GI tract is important for motility, digestion, absorption and hydration • Always have a goal • Always individualize the intervention • Always know what resources you can access to know where to find the correct information.