DIETARY MANAGEMENT
OF GASTROINTESTINAL
DISEASES (ULCERATIVE
COLITIS)
Prepared by: 3rd year
medicine students in King
AbdulAziz University.
Yaser is a 35-year-old man who owns his own company.
He has been used to working long hours. He likes junk
foods, the hotter and spicier, the better. He loves Chinese
and Indian foods. Lately he has been having bouts of
diarrhea, especially after Chinese dinners. Besides the
diarrhea, he was nauseated and had cramps for two nights
in a row. He had a fever. On the second night, he saw
blood in the toilet. His doctor suggested that Yaser should
follow a low-residue diet to help prevent further episodes
of ulcerative colitis . The doctor requested a consult with a
registered dietitian to teach Yaser about his new diet.
CASE STUDY
Yaser is a 35 year old man.
He works for long hours.
He likes junk food, Indian food, Chinese food,
and spicier the better.
He had bouts of diarrhea, nausea, cramps, and
fever.
He saw blood in the toilet.
The doctor suggested a low residue diet to
prevent further episodes of ulcerative colitis.
CASE SUMMARY
Causes :
The exact cause of ulcerative colitis
remains unknown, but there are few
risk factors like:
1-Immune system malfunction
2-Heredity
3-Food
One possible risk factor is an immune
system malfunction. When the immune
system tries to fight off an invading virus
or bacterium, an abnormal immune
response causes the immune system to
attack the cells in the digestive tract, too
Heredity also seems to play a role in
that ulcerative colitis is more
common in people who have family
members with the disease.
However, most people with
ulcerative colitis don't have this
family history.
He loves to eat lots of junk food and he
likes it extra spicy, especially if it is
Chinese or Indian. Fatty foods make the
diarrhea worse, and spicy food may
irritate the colon.
1- Avoid and limit some food:
Limit dairy products: many people with
inflammatory bowel disease find that
problems such as diarrhea, abdominal pain.
LIFE STYLE FOR ULCERATIVE COLITIS
Try low-fat foods as high fat food make the
diarrhea worse (e.g. junk food).
LIFE STYLE FOR ULCERATIVE COLITIS
LIFE STYLE FOR ULCERATIVE COLITIS
Spicy foods, alcohol and caffeine may make
the signs and symptoms worse.
2-Avoid stress: although stress doesn't cause
inflammatory bowel disease (ulcerative colitis),
it can make the signs and symptoms worse and
may trigger flare-ups. (Yaser works for long
hours, so this can make him stressed).
LIFE STYLE FOR ULCERATIVE COLITIS
Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon. This condition causes diarrhea, belly pain, and bloody bowel movements. These symptoms happen because the colon becomes inflamed and gets sores, called “ulcers.”
WHAT IS ULCERATIVE COLITIS?
Symptoms of ulcerative colitis can be mild or
severe. They might happen just once, or they might
go away and come back over and over again.
Possible symptoms include:
Diarrhea
Bloody bowel movements
Loss of appetite
Belly cramps
Fever
Weight loss
SYMPTOMS OF ULCERATIVE COLITIS
Yes. the symptoms might improve if :
He avoids foods that make his symptoms worse
(e.g. Chinese food in the case).
He avoids (NSAIDs) such as ibuprofen for pain
relief. NSAIDs have been linked to flare-ups.
Instead, acetaminophen (Tylenol) is
recommended.
He follows a healthy diet.
CAN HE DO ANYTHING ON HIS OWN TO
FEEL BETTER?
Depending on the symptoms, the doctor might
prescribe:
Medicine placed directly into the rectum
(enema, suppository, or foam). They reduce
swelling in mild cases.
Medicine that taken in a pill. A common one is
called 5-ASA (5-aminosalicylic acid).
A brief course of glucocorticoid (also called
steroids) to reduce swelling.
HOW IS ULCERATIVE COLITIS TREATED?
When medicines and changes in diet don ’t work, surgery
can help. There are two types:
Removal of colon and reattachment of anus/rectum This
procedure is one of the most common surgeries used to
treat ulcerative colitis. During the procedure, the
surgeon removes the large bowel and most of the
rectum, but he saves the anal sphincter. The surgeon
then creates a tubular pouch out of the end of the small
intestine and sews it to the anal canal .
Removal of colon with permanent ileostomy: the
surgeon removes the colon, rectum, and anus. The
surgeon will attach the ileum to an opening in the
abdomen called ostomy.
CAN SURGERY BE AN OPTION?
It's important to self-manage ulcerative
colitis with healthy lifestyle habits and a
nutrient-rich diet. Paying attention to
nutrition is especially important with GI
diseases because the symptoms of
diarrhea and bleeding can lead to
dehydration, electrolyte imbalance, and
loss of essential nutrients.
THE MAIN ABNORMALITIES IN ULCERATIVE COLITIS PATIENT
THAT WILL AFFECT HIS NUTRITIONAL MANAGEMENT.
• Chronic bleeding from the
inflamed and ulcerated intestinal
tissue can cause a shortage of red
blood cells (anemia) in some
affected individuals.
• Malnutrition caused by ulcerative
colitis is rare because vitamins,
minerals, and proteins are
absorbed in the small intestine,
which isn't affected by ulcerative
colitis.
THE MAIN ABNORMALITIES IN ULCERATIVE COLITIS PATIENT
THAT WILL AFFECT HIS NUTRITIONAL MANAGEMENT.
There are several reasons why people with
ulcerative colitis may be at risk for poor nutrition,
including:
• Decreased food intake due to loss of appetite,
pain, diarrhea, or other symptoms, or fear of
these symptoms.
• Increased need for calories, protein, and some
vitamins and minerals.
• Dehydration due to diarrhea.
• So, people with ulcerative colitis should
follow a balanced diet and be sure to
get enough calories, protein, vitamins,
minerals, and fluid
SOME FOOD ITEMS ARE COMMON TROUBLEMAKERS
FOR PEOPLE WITH ULCERATIVE COLITIS, INCLUDING:
•Spicy foods.
•Caffeine.
•Carbonated drinks.
•Dairy products, if you ’re lactose intolerant.
•Dried beans, peas, and legumes.
•Foods high in fiber.
•Nuts, crunchy nut butters.
•Popcorn.
•Products that have sorbitol (sugar-free gum).
•Raw fruits and vegetables.
•Seeds.
•Alcohol.
SOME FOOD ITEMS ARE COMMON TROUBLEMAKERS
FOR PEOPLE WITH ULCERATIVE COLITIS, INCLUDING:
6WHAT DIETARY MODIFICATIONS
SHOULD BE INDICATED FOR THE
PATIENT TO MAINTAIN
ADEQUATE NUTRITIONAL
STATUS?
When you have ulcerative colitis :
you will avoid some types food because it
trigger some symptoms.
So, It’s hard to maintain a balanced diet
and get adequate calories and protein.
DIETARY MODIFICATIONS
1-Drink lots of water; at least 8 cups of water a
day can help to avoid dehydration that caused
by diarrhea.
2- Iron may be necessary for patients at risk
of anemia from blood loss in the diarrhea.
3-May need supplements due to loss of
vitamins and minerals in diarrhea
(dehydration)
DIETARY MODIFICATIONS
Try to eat less of:
Milk products: These foods can lead to bloating, gas, and diarrhea.
Caffeine: caffeine stimulate the intestines and intensifies diarrhea.
Fibers: diarrhea.
DIETARY MODIFICATIONS
VITAMIN D
Your body needs vitamin D to maintain strong bones.
It also plays a role in how your immune system
functions. Low levels of vitamin D are common
among the general adult population.
If you have ulcerative colitis, especially if you take
steroids, your risk of a vitamin D deficiency -- along
with the accompanying risk of osteoporosis -- is very
high. This risk is compounded by the fact that many
people with ulcerative colitis restrict the amount of
dairy products they consume to help reduce diarrhea,
yet dairy foods are good sources for vitamin D.
VITAMIN D
In this case he should ask his doctor if he should be
taking a vitamin D supplement. Experts differ in their
recommendations for vitamin D supplementation, so
he should talk to his doctor about his best option.
CALCIUM
Calcium is the mineral the body uses to build bones.
Your body also uses it in other ways, such as helping
muscles contract or sending messages through the
nervous system. If your system does not have enough
calcium, the body removes it from the bones, causing
them to become brittle and leading to the
development of osteoporosis.
Avoiding dairy products, along with the effect various
medicines have on calcium, makes a calcium
deficiency a strong possibility with ulcerative colitis. If
his doctor recommends taking a calcium supplement,
he’ll probably need 1,000 to 1,200 milligrams per day.
IRON
People with ulcerative colitis can lose iron through
bleeding from the sores in the colon. Not having
enough iron can lead to anemia. A lack of iron
means your body can't make enough healthy
red blood cells to transport an adequate supply of
oxygen throughout your body. With anemia you may
feel tired a lot, have a fast or irregular heartbeat,
dizziness, problems thinking, and other symptoms.
Your doctor can tell if you have an iron deficiency
with a blood test. If you do, the doctor will probably
recommend you take an iron supplement.
FOLATE OR FOLIC ACID
Folic acid is a B vitamin that your body needs to
make healthy new cells. In women, it also protects
against birth defects of the baby's spine or brain.
Folic acid can also reduce the risk of colon cancer,
which is elevated in people with ulcerative colitis.
People with UC often find it difficult to tolerate
folate-rich dark leafy vegetables and may end up
with low levels of the vitamin. Those levels can be
made even lower as a result of certain medications .
PROBIOTICS
Probiotics, often found in yogurt, are friendly
bacteria that can help balance the bacteria
community in your gut and may enhance the
production of mucous in your intestines. This mucous
serves as a barrier to the invasive, detrimental
bacteria. Though more scientific evidence is needed,
it’s believed that probiotics may help induce
ulcerative colitis remission and keep you in
remission longer. There are a few safety issues
regarding probiotics so he should speak to his doctor
before using it.
OMEGA-3 FATTY ACIDS
These healthy fats, found in fatty fish, may be helpful
in reducing inflammation. More research is needed
to determine whether omega-3s can help with
management of colitis, according to a review in the
British Journal of Nutrition, but he may want to ask
his doctor whether he or she recommends that he
includes fish like salmon and mackerel in his
ulcerative colitis diet or if you should try a
supplement.
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REFERENCES
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