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Food as Medicine - Nutrition for Digestive Disorders

DK PublishingDK Publishing 2/07/2014 DKBooks
Photo: High-fiber breakfast - To increase your fiber intake and keep your digestive tract active, start your day with a bran or whole-wheat cereal, topped with dried or fresh fruit. © Provided by DKBooks High-fiber breakfast - To increase your fiber intake and keep your digestive tract active, start your day with a bran or whole-wheat cereal, topped with dried or fresh fruit.

Peppermint tea - A great alternative to normal tea or coffee, peppermint has anti-spasmodic properties, and can ease IBS symptoms by calming the intestinal tract.

Photo: Eat dried fruit - Soak dried fruits in juice or water for a nutritious fruit salad. Apricots, figs, and raisins are high in soluble fiber, and raisins are also high in magnesium. © Provided by DKBooks Eat dried fruit - Soak dried fruits in juice or water for a nutritious fruit salad. Apricots, figs, and raisins are high in soluble fiber, and raisins are also high in magnesium.

High-fiber breakfast - To increase your fiber intake and keep your digestive tract active, start your day with a bran or whole-wheat cereal, topped with dried or fresh fruit.

Photo: Peppermint tea - A great alternative to normal tea or coffee, peppermint has anti-spasmodic properties, and can ease IBS symptoms by calming the intestinal tract. © Provided by DKBooks Peppermint tea - A great alternative to normal tea or coffee, peppermint has anti-spasmodic properties, and can ease IBS symptoms by calming the intestinal tract.

Healthy high-fiber dish - Tuna and bean salad and a hunk of whole-grain bread make a low-fat, high-fiber meal that can help prevent the formation of gallstones.

© Provided by DKBooks

Eat dried fruit - Soak dried fruits in juice or water for a nutritious fruit salad. Apricots, figs, and raisins are high in soluble fiber, and raisins are also high in magnesium.

Photo: Make time for regular meals - It is very important not to skip meals, including breakfast, if you suffer from a peptic ulcer. © Provided by DKBooks Make time for regular meals - It is very important not to skip meals, including breakfast, if you suffer from a peptic ulcer.

High-fiber sweet potato - A baked sweet potato served with arugula is a high-fiber dish that is nutritious, easy to prepare, and will help in the treatment of diverticulosis.

Photo: Healthy high-fiber dish - Tuna and bean salad and a hunk of whole-grain bread make a low-fat, high-fiber meal that can help prevent the formation of gallstones. © Provided by DKBooks Healthy high-fiber dish - Tuna and bean salad and a hunk of whole-grain bread make a low-fat, high-fiber meal that can help prevent the formation of gallstones.

Checking ingredients - If you or your child has a lactose intolerance, it is important that you check food labels carefully and learn to spot ingredients that contain lactose.

Photo: Checking ingredients - If you or your child has a lactose intolerance, it is important that you check food labels carefully and learn to spot ingredients that contain lactose. © Provided by DKBooks Checking ingredients - If you or your child has a lactose intolerance, it is important that you check food labels carefully and learn to spot ingredients that contain lactose.

Low-fiber pasta bake - A white-pasta bake with tuna, topped with low-fat hard cheese, is a great low-fiber option for people suffering from diverticulitis.

Photo: High-fiber sweet potato - A baked sweet potato served with arugula is a high-fiber dish that is nutritious, easy to prepare, and will help in the treatment of diverticulosis. © Provided by DKBooks High-fiber sweet potato - A baked sweet potato served with arugula is a high-fiber dish that is nutritious, easy to prepare, and will help in the treatment of diverticulosis.

Make time for regular meals - It is very important not to skip meals, including breakfast, if you suffer from a peptic ulcer.

Photo: Low-fiber pasta bake - A white-pasta bake with tuna, topped with low-fat hard cheese, is a great low-fiber option for people suffering from diverticulitis. © Provided by DKBooks Low-fiber pasta bake - A white-pasta bake with tuna, topped with low-fat hard cheese, is a great low-fiber option for people suffering from diverticulitis.

What you eat and how you eat can have a major impact on digestive problems.

Nutrition plays a big role in many digestive disorders because what you eat has an important effect on your gastrointestinal (GI) tract.


The role of nutrition

If your GI tract is abnormal in any way, your doctor will suggest specific dietary changes to help alleviate some of your symptoms.

Some of these dietary changes may help correct and prevent the problem. For example, increasing the amount of fiber in your diet and drinking more water will help prevent constipation, and excluding gluten, a specific type of protein, may be required for the rest of your life if you have celiac disease. Although this may sound difficult, it could save your life and you will be grateful to be able to enjoy your meals again without suffering from painful symptoms afterward.

Your doctor may advise you to change your lifestyle. For example, if you have reflux disease, you should avoid lying down after eating; and, if you have a peptic ulcer, you may need to limit foods and drinks containing caffeine.


Changing your diet

Making the appropriate changes to manage your digestive disorder requires patience and a trial-and-error period. You may find it helps to write down the offending foods that give you gas or cause you to feel bloated. If this continues to happen over and over again, then eliminating these foods may be beneficial to you. But remember, if you eliminate food groups from your diet you may need to take supplements. For example, those who avoid dairy products will need a calcium supplement to prevent osteoporosis from developing.

A lot has changed over the years with regards to nutrition for digestive disorders and we have provided the most up-to-date advice in this chapter.


Tips to treat indigestion

The following suggestions can help relieve mild attacks of indigestion—pain or discomfort in the stomach or upper abdomen that usually comes on after eating a meal. The complaint may be accompanied by nausea, belching, and bloating. It is caused by eating or drinking too much, or stress, or may be a symptom of an underlying disorder such as a peptic ulcer .

Avoid foods that may irritate the stomach, such as caffeine, spearmint, peppermint, citrus fruits, spicy foods, high-fat foods, and tomato products.

Some people find that an herbal tea, such as peppermint, fennel, or chamomile, provides relief.

Eat small, low-fat meals and snacks, such as fruits, pretzels, crackers, and fat-free yogurt frequently, and at regular times during the day.

Always eat slowly and chew your food thoroughly.

Have drinks between meals, rather than with meals.

Take a walk after meals, but do not do any strenuous exercise for at least one hour after eating.

Avoid lying down for at least two hours after eating a meal.

Try having a warm milk drink before bed, and use extra pillows to raise your head.

If stress might be a cause of your indigestion, try to include relaxation techniques in your life, such as yoga or meditation.

If you smoke, you should try to quit, since smoking may worsen the symptoms.

Try an antacid medication, which can relieve the symptoms of indigestion by neutralizing stomach acid.

Do not take aspirin or ibuprofen for pain relief since these medications can irritate the stomach.

If you are overweight, which may worsen symptoms, try to lose weight.

See your doctor if your symptoms become worse or do not improve after two weeks or if your indigestion recurs.


Treating constipation

A diet that is high in animal fats, such as meat, cheese, and eggs, and refined sugar but low in fiber from vegetables, fruits, and whole grains is a common cause of constipation.

The infrequent and difficult passage of stools is particularly common in older people. This is because gut motility decreases with age, resulting in food and waste taking longer to pass through the intestine. Stimulant laxatives can make the intestine sensitive to their effects, so you should avoid taking them regularly. It is far more effective to treat constipation through changes to your diet.

In addition, regular exercise will help stimulate intestinal activity and improve the motility of the intestinal tract.


Increase your fiber intake

Dietary fiber in food traps water and adds bulk to the stool, making it move through the gut more quickly.

Gradually increase your fiber intake to 28g per day by eating more whole grains, vegetables, fruits, and legumes. Aim to eat six servings of grains and grain products daily.

Make sure that you eat lots of fresh fruits and vegetables. Include foods with a natural laxative effect, such as prunes or prune juice, apricots, and apples.

Eat a high-fiber breakfast cereal. Bran cereals are particularly high in fiber and can be livened up with toppings, such as sliced banana, raisins, or strawberries.

Switch from white bread, pasta, and rice to whole-wheat varieties.

Avoid eating processed or highly refined foods, which are high in sugar and carbohydrates and low in fiber.


Increase your fluid intake

If you suffer from constipation, increase your fluid intake. Aim to drink about 4 pints (2 liters) of water a day. Dry stools are more difficult and painful to pass, but drinks add bulk and fluid to the stool, making it easier to expel. Limit alcohol and caffeine because they can lead to dehydration, creating stools that are hard and more difficult to pass.


Magnesium and exercise

Magnesium can help loosen stools, so increase your intake of magnesium-rich foods, such as spinach, almonds, Brazil nuts, raisins, and artichokes . Alternatively, you can take a magnesium supplement .


When should I see my doctor?

If you have recently become constipated and the problem has lasted for more than two weeks—even after increasing your intake of fiber and fluids and your level of activity—you should make an appointment to see your doctor.

In addition, if you notice blood in your stool, consult your doctor, because bleeding from the intestine can be a symptom of a serious disorder such as colorectal cancer.


Treating diarrhea

Diarrhea is the frequent passage of loose, watery stools, and is often caused by infections from contaminated food or water. The following suggestions will help ease your symptoms:

Replace lost fluid and electrolytes (minerals dissolved in fluids) with water, fruit juices diluted with water, rehydration drinks, or sports drinks. Try to drink at least 16floz (500ml) of fluid every one to two hours to prevent dehydration.

Avoid very hot or very cold liquids, coffee, alcohol, or caffeinated soft drinks, all of which can irritate the intestine.

Read product labels and check with your pharmacist about sorbitol- or lactulose-containing medications or diet products, which can cause diarrhea; discontinue taking them if possible.

If you can tolerate food, eat yogurt with live cultures (to replace gut flora) and avoid insoluble fiber (whole grains) until the diarrhea has resolved.

Eat bland, nonfatty foods that are easily digested, and avoid milk, red meats, and highly seasoned food.

If the diarrhea is a short-term problem, avoid high-fiber foods, such as whole grains and fresh fruits and vegetables, which can be difficult for the irritated intestine to digest. If the diarrhea lasts for more than two weeks, increasing soluble fiber intake may help, but you should see your doctor.


Tips to prevent diarrhea

Good hygiene and awareness of the sources of food contamination will help you to avoid diarrhea:

Wash your hands after using the toilet and changing diapers.

Frequently wash bathroom and food preparation surfaces.

When traveling overseas, drink only bottled water, carbonated soft drinks, and drinks made with boiled water, such as tea and coffee. Do not drink tap water or ice that has been made from tap water.

Avoid meat or fish that is raw or rare, or that is not served hot.

Peel fruits and vegetables.


Treating irritable bowel syndrome

Doctors believe that in people with irritable bowel syndrome (IBS) the colon (the major section of the large intestine) is abnormally sensitive to stimuli such as excess gas, stress, high-fat or fiber-rich foods, caffeine, and alcohol. These stimuli can irritate the colon and cause pain, cramps, and diarrhea. Women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can aggravate the condition. Many people state that the symptoms occur after they eat or when they are under stress.


Identify problem foods

A balanced diet can help alleviate IBS symptoms. You may find it helpful to keep a food diary to identify which foods cause the most discomfort and try to eliminate these from your diet. These foods may be different for each person; for example, some people may find onions and mushrooms cause gas, bloating, and discomfort; while others may find relief from omitting wheat.


Choose dairy products

Even if you find that most dairy products are difficult to tolerate , do not rule out yogurt. Yogurt may be better tolerated because it contains organisms that supply lactase, the enzyme needed to digest lactose (the sugar in milk). Lactose-free milk is also an option. Since dairy products are an important source of calcium, consider drinks enriched with calcium or take a calcium supplement if your body cannot tolerate dairy products.


Other dietary factors

High-fiber foods, such as whole-grain breads and cereals, legumes, fruits, and vegetables help avoid intestinal cramps and spasms, and constipation—although, if you suffer from diarrhea, a low-fiber diet is better. It is also best to avoid caffeinated drinks such as tea, coffee, and cola, which stimulate the colon. Many find herbal teas, especially peppermint and fennel, soothing. Fruit juice contains a lot of fructose, which can aggravate symptoms of IBS and contribute to diarrhea. It is best to stick to drinking mineral water to help flush out your system. In addition, smoking can exacerbate the symptoms of IBS, so it is important to quit if you smoke.


Young woman with irritable bowel syndrome (IBS)

Name Megan

Age 25 years


Problem

Five years ago, Megan was diagnosed with irritable bowel syndrome (IBS). She complains of crampy abdominal pain, which is relieved by a bowel movement. She often has loose stools or diarrhea followed by no bowel movements for several days. Her movements are irregular and her symptoms worsen when she is stressed. Her weight is stable and she does not have a fever or bleeding when going to the toilet.


Lifestyle

Megan is a lawyer and is always busy and often stressed out. Her symptoms occur several times a week and affect her work. She has two meals a day (pizza or a sandwich for lunch and pasta or take-out for dinner), often on the run. Because of the diarrhea, she is not sure what to eat, but she drinks apple juice to prevent dehydration. She does not take a multivitamin supplement and does not exercise.


Advice

Several factors contribute to Megan’s IBS. She is stressed at work and would benefit from yoga and exercise. She should eat breakfast—such as whole-grain toast or wheat cereal—to encourage more regular bowel movements and to help increase the fiber in her diet.

Megan also experiences cramping and gas from certain foods, the most common being legumes, onions, prunes, and cruciferous vegetables, such as cabbage and broccoli. Megan could try to eliminate these foods one by one to determine any associations. She could also temporarily eliminate dairy products, since an intolerance to lactose (milk sugar) can cause symptoms similar to IBS. She may find, however, that she can tolerate yogurt, which is also high in calcium.

Increasing dietary fiber will help relieve Megan’s symptoms, and she should have regular, firmer bowel movements. However, it can be hard to get enough dietary fiber, particularly if she eliminates fiber-rich foods that cause gas. She would benefit from taking a psyllium or methylcellulose fiber supplement.

Megan should make sure she drinks plenty of water with the supplements to reduce the symptoms of excessive gas, which may occur initially. The fructose in the apple juice can also contribute to diarrhea, so drinking water instead could help.


Treating and preventing peptic ulcers

The goals of nutritional treatment for peptic ulcers—damage to the stomach lining (stomach ulcer) or the first part of the small intestine (duodenal ulcer)—are to reduce and neutralize stomach acid and to maintain the stomach lining’s resistance to the acid. Reducing stomach acid helps alleviate symptoms and allows sores to heal.

There is no specific diet for ulcers—each person must discover which foods cause discomfort and avoid them. You may find the following tips helpful:

Eat three meals daily, avoid skipping meals, and limit your intake of spicy, fatty, or other foods that cause discomfort.

Avoid bedtime snacks, since symptoms often occur in the night.

Limit caffeine intake by reducing your intake of coffee, tea, cola, and chocolate.

Limit alcohol intake and avoid drinking on an empty stomach.

Avoid smoking and passive smoking as smoke may increase the secretion of stomach acid, increase the frequency of duodenal ulcers, and delay healing.


Helicobacter pylori infection and peptic ulcers

Peptic ulcers are commonly associated with Helicobacter pylori infection. The infection is thought to be spread by unsanitary living conditions. It infects the stomach and releases substances that reduce the effectiveness of the layer of mucus that protects the stomach lining from its own acidic juices. The acidic juices then erode the lining of the stomach or the duodenum, allowing a peptic ulcer to develop. A combination of antibiotics and ulcer-healing drugs will usually clear up the ulcer.


Preventing and treating gallstones

Gallstones are formed from bile, a cholesterol-rich liquid made by the liver and stored in the gallbladder, that aids the digestive process. Gallstones are more common in women, in people over the age of 40, and those who are overweight and eat a high-fat diet. A family history of gallstones is a risk factor.


Low-fat, high-fiber diet

Avoiding fatty foods and increasing your consumption of fiber by eating more high-fiber foods, such as bran, soy, guar gum, and pectin, which is found in many fruits and vegetables, can help prevent gallstones and relieve the discomfort caused by existing stones. Regular exercise may also decrease the risk of developing gallstones.

If you are obese, you are at increased risk of developing gallstones. Therefore, following a low-fat diet and increasing your exercise level will not only help you lose weight but also reduce your risk of developing gallstones. However, rapid weight loss can cause the formation of gallstones in some people, so you should lose weight gradually.


Gallbladder surgery

Surgical removal of the gallbladder is the most effective means of curing gallbladder disease—the effects are immediate. Once the gallbladder has been removed, however, there is no reservoir of bile, and fat absorption may be affected. In this case, following a low-fat diet may be helpful.


Dealing with lactose intolerance

Normally, the enzyme lactase breaks down lactose (a natural sugar found in milk and other dairy products) in the intestine to form the sugars glucose and galactose. These are then easily absorbed through the intestinal wall into the bloodstream.

If this enzyme is absent or its levels are low, the unabsorbed lactose ferments, producing painful symptoms, such as abdominal bloating and cramping, diarrhea, and vomiting. The condition usually develops in adolescence or adulthood and is uncommon in babies and young children. No treatment can improve the body’s ability to produce lactase, but symptoms can be easily controlled through diet.


Limit or avoid lactose

Some people can benefit from just reducing the amount of foods they eat containing lactose, such as milk, yogurt, cheese, cream, and butter, and most are able to tolerate a small amount of lactose without symptoms. However, some people will develop symptoms from just a tiny amount of lactose. For those who cannot tolerate even small amounts of lactose, lactase enzymes are available, which will help them digest foods that contain lactose.


Read food labels

If you are lactose-intolerant, check food labels for hidden dairy products. Small amounts of lactose may be hidden in breads, cereals, soups, margarine, lunch meats, dressings, candies, pancake mixes, cookies, and many other foods.


Lactose-free foods

There are lactose-free forms of milk, cheese, and yogurt available, but if you find that you cannot tolerate these, try soymilk products, which are naturally lactose-free yet supply many of the same nutrients that are in cow’s milk. Different brands of soymilk have different tastes, so try a few until you find one that you like.


Watch your calcium intake

Dairy products are our prime source of dietary calcium, which is important for maintaining bone health. You should therefore try to include some lactose-free dairy or soy products in your diet every day. Other calcium-rich foods include salmon, spinach, and collard greens . If you fall short on calcium, a supplement of 800–1,200mg per day is advisable to maintain recommended daily calcium levels.


Coping with Crohn’s disease and ulcerative colitis

People with an inflammatory bowel disorder, such as Crohn’s disease or ulcerative colitis, cannot absorb nutrients properly and are at risk of nutrient deficiencies and becoming underweight.


Getting enough nutrients

If you have an inflammatory bowel disorder, make sure you get enough nutrients. A dietitian can help you in dealing with deficiencies, which can develop because the damaged intestine is not absorbing nutrients effectively. This is very important for children, who are growing and developing.

Symptoms such as nausea, diarrhea, and recurrent abdominal pain can occur at mealtimes, which often leads to decreased appetite and food intake. In Crohn’s disease, inflammation of the intestine can result in overgrowth of bacteria. This, combined with the effects of any previous surgery to remove diseased sections of the bowel, can decrease the absorptive surface area of the intestine and reduce the absorption of essential nutrients. People who have undergone surgery may have problems absorbing fats and this, coupled with frequent bouts of diarrhea, may also cause deficiencies to develop.

It is crucial to increase the amount of protein you eat since inflammatory bowel disorders can cause excessive intestinal secretion of protein-rich fluids through the inflamed wall of the intestine. Good sources include lean meat, poultry, oily fish, and legumes .


Protective foods

Various foods can help relieve as well as prevent the troublesome symptoms of an inflammatory bowel disorder.

Complex carbohydrates from whole grains, vegetables, and fruits are a good source of fiber, which helps the intestine function properly. If the extra fiber causes gas, take an over-the-counter product to reduce gas.

Drink lots of fluids, mainly water, but avoid caffeinated drinks. Green tea is thought to be beneficial.

Eat plenty of foods containing omega-3 fatty acids, such as canola oil, flaxseed, soybeans, and oily fish.

The herb sage may be helpful too.


Foods to avoid

Certain foods may cause symptoms. Common things to avoid are alcohol, sugary foods, including sweet fruit such as grapes and pineapple, and caffeine, as they can all cause inflammation; foods containing gluten, which is found in wheat, oats, and barley; milk and dairy products; foods that are common causes of allergic reactions, such as soy, eggs, and peanuts; and vegetables of the brassica family, such as Brussels sprouts, cabbages, and broccoli.


Taking supplements

People who have Crohn’s disease or ulcerative colitis are advised to take a multivitamin supplement. Deficiencies of the fat-soluble vitamins (A, D, E, K), vitamin B12, and folate are common. A folate supplement is vital for anyone taking sulfasalazine (a drug prescribed for chronic inflammation), which can interfere with folate’s absorption. Some patients may need injections of vitamin B12. Persistent, watery diarrhea may require supplementation with the minerals zinc and magnesium.


Diverticular disorders

Diverticulosis is the presence of small pouches (known as diverticuli) in the wall of the colon, which occur when parts of the intestine bulge outward through weak areas. The increase in pressure in the colon is commonly caused by constipation due to lack of fiber in the diet.

From time to time, one or more of these “pouches” may become inflamed. This condition is known as diverticulitis, and it is possible to treat it with a low-fiber, “soft” diet.


High fiber for diverticulosis

Diverticulosis is very common among older people and, although it often does not produce specific symptoms, some people may develop cramps, bloating, and irregular bowel movements, with no sign of fever or infection.

Treating and preventing diverticulosis through nutrition often involves just increasing insoluble fiber in the diet; this helps keep stools soft and easy to pass and prevents constipation, and therefore prevents the development of diverticulosis.

The recommended daily amount of fiber is 25g for a woman and 38g for a man. Fruits, vegetables, and grains are good sources of dietary fiber, and can easily be incorporated into your daily diet .

If you suffer from diverticulosis, it is important that you follow a high-fiber diet, and make sure that you also drink plenty of fluids (preferably water)—about 4 pints (2 liters) a day. It is important that you avoid becoming constipated, since hard stools or straining when you go to the toilet will cause more diverticuli (pouches) to form and make your symptoms worse.


High-fiber meal planner

Breakfast

Muesli with chopped fruit, and whole-wheat toast


Lunch

Baked sweet potato with a side salad of arugula

Fresh orange

Glass of low-fat milk


Dinner

Chicken and vegetable stir-fry with brown rice

Baked apple with vanilla yogurt


Snacks

Six or seven dried apricots

Low-fat fruited yogurt


Low fiber for diverticulitis

Diverticulitis is an acute infection or inflammation of the diverticuli that may flare up if a stool gets caught in one of the “pouches.” Symptoms can include abdominal pain, fever, and nausea. An infection usually lasts for about a week.

When someone with diverticulosis develops diverticulitis, the nutritional advice changes. Rather than following a high-fiber diet, you should instead follow a low-fiber one, which allows the passage of stools through the inflamed, typically narrowed segment of the colon.

In addition, you should eat a soft diet, which means that you should eat things that do not require much chewing, such as soup, mashed potatoes, well-cooked pasta, and bananas. Once the infection has cleared up, patients should go back to their high-fiber diet.


Low-fiber meal planner

Breakfast

Puffed rice with low-fat milk

Banana

Glass of apple juice


Lunch

Omelet with ham, and a bagel

Apple sauce

Water or low-fat milk


Dinner

White pasta bake with tuna topped with low-fat cheese

Low-fat chocolate mousse


Snacks

Vanilla low-fat yogurt

Rice cakes with low-sugar jam


Eating seeds and nuts

In the past, doctors recommended that people with diverticulosis should avoid eating nuts and seeds because they could lodge in the diverticula and lead to diverticulitis. There are no known cases of such a blockage, however, and so there is no proven benefit in avoiding seeds and nuts. If you have suffered rectal bleeding, your doctor may still advise you to avoid seeds and nuts, but otherwise you can safely enjoy these items as part of a high-fiber diet.

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