Colon & Lower Gastro-Intestinal Conditions, Crohn’s, IBS, Ulcerative Colitis, Constipation

The lower gastrointestinal tract (GIT) is defined as the jejenum and ileum of the small intestine, and the large intestine or colon.

Lower GIT conditions for which Medical Nutrition Therapy is indicated, may include:

• Constipation:

Causes of constipation may include unhealthy fibre-poor DIET,  disturbed microbiome, lifestyle (lack of exercise), dysmotility disorders ( for eg hypothyroidism; diabetes ), neurologic diseases (for eg Parkinsons), chronic use of Opiates   ( for eg for chronic pain ), IBS ( irritable bowel syndrome). A thorough and meticulous dietary history is most helpful in identifying which causes are present, and to manage these appropriately. Sufficient dietary fibre and hydration, microbiome support, elimination of additives, identification of possible allergens or irritants, and physical activity, when applied effectively, could have a profound and long term positive effect.

• Diarrhea:

Diarrhea is defined by the WHO as the passage of 3 or more loose stools / day. Because diarrhea is a symptom, and not a disease the first step in medical treatment is to identify and treat the underlying condition. Increase in antibiotic use, has led to an increase in antibiotic – associated diarrhea (AAD) and over growth of Clostridium Difficile with resultant C.Diff Infection CDI. Supplementation with probiotics and prebiotics shows promise to prevent AAD and CDI.  Currently the best treatment for CDI is fecal microbiota transplantation(FMT).  Nutrition interventions must be viewed within the context of the underlying pathology. Replacement of fluids and electrolytes is the first step. Minimal fibre is rarely indicated. In fact, the metabolism of soluble fibre by colonic bacteria leads to production of short-chain fatty acids (SCFA’s) which feed the colonocytes, facilitate the absorption of fluid and help regulate the GI motility.

• Gastro Intestinal Obstruction:

Gastroparesis, adhesions, hernias, metastatic cancers, volvulus, and dysmotility may result in obstruction. Careful dietary adjustment is essential as the GIT may be compromised with narrowed segments. Surgery may be necessary and enteral feeding (tube feeding) beyond the point of obstruction may be feasible. Parenteral nutrition (intravenous) may be needed.

• Coeliac Disease (CD) (Gluten-Sensitive Enteropathy):

True CD may be characterized by genetic susceptibility, exposure to gluten, an environmental “trigger” and autoimmune response. Gluten refers to specific peptide fractions of proteins: glutenin and gliadin found in wheat, secalin found in rye, and hordein found in barley. Only a very small % of CD patients may react to the avenin protein in oats.     Untreated CD over time, results in damage to the intestinal mucosa, leading to impaired digestion and absorption of nutrients. Conditions such as anaemia, osteomalacia, osteopenia, dental enamel hypoplasia, vit K deficiency, lactase deficiency,  and autoimmune diseases, may develop. In close collaboration with your Gastroenterologist, I obtain your medical records, and blood results, to most accurately plan your nutrition care.

• Lactose and Fructose intolerance:

This condition may be associated with diarrhoea, abdominal pain, flatulence, or bloating after lactose consumption. It may be a primary condition, or secondary as a consequence of infection. Diagnosis may be confirmed by an abnormal hydrogen breath test or an abnormal lactose tolerance test. Management requires dietary therapy, with exclusion, as well as appropriate replacement.

Consumption of fructose, from fruit juice, high-fructose corn syrup, in soft drinks and confectionery, has increased significantly in recent years. The human small intestine has a limited ability to absorb fructose, as compared to glucose. Fructose coexists in foods with other carbohydrates which have been given the umbrella term FODMAPs.  In a recent published study, restriction of FODMAPs demonstrated symptom relief in those with lactose of fructose intolerance.

• Irritable Bowel Syndrome (IBS):

IBS is the most common disorder diagnosed by Gastroenterologists.

IBS is defined as:  “ abdominal discomfort associated with altered bowel habits “  Several factors may play a role in the etiology of IBS, such as abnormal GI motility, gut flora alterations, genetics and psychosocial stress.  The first goal of nutrition therapy is to ensure adequate nutrient intake, from most tolerable individually selected food options. Excessive FODMAPs in the diet, may cause gas production and intestinal dysmotility,  which should be eliminated.  However, this approach may lead to nutritional deficiencies of folate, thiamine, vitB6 and fibre and needs to be used as part of an individualised and balanced approach, by the skilled dietitian.

• Diverticular Disease: (DD)

Diverticular disease is one of the most common medical conditions among industrialised societies.  Most individuals with diverticulosis remain asymptomatic. The sac-like outpouchings, when colonic mucosa and submucosa herniate through weakened areas in the muscle, may become inflamed, associated with acute pain, and requiring hospitalisation for intravenous antibiotic therapy.

Acute diverticulitis may include abscess formation, bleeding, obstruction, and sepsis from perforation. An inverse relationship between fibrous foods and the risk of diverticulitis was demonstrated. A high fibre diet, contributing a minimum of 25g/day or more, preferably from foods, is advocated to reduce the likelihood of disease progression. During an acute episode of DD, bowel rest and Intravenous nutrition may be needed.

• Inflammatory Bowel Disease (IBD): Crohn’s Disease (CD) and Ulcerative Colitis (UC):

IBD is a chronic and relapsing disorder of the GIT.

It is characterised by chronic intestinal inflammation, and is categorised into 2 mayor forms: CD and UC.  These conditions share some clinical characteristics, such as diarrhoea, fever, weight loss, anaemia, food intolerance, malnutrition, and extra-intestinal manifestations ( for eg arthritic ) The onset of IBD occurs most often in patients aged 15-30years. The cause of IBD is still poorly understood. The most widely accepted pathogenesis involves complex interaction of the GI immunologic system, genetic and environmental factors. Emerging research is investigating the role of the Microbiome. The Western diet may be a contributing factor for development of IBD.  I intend to work in close collaboration with your Gastroenterologist, to understand the stage of your disease and to support you to achieve remission with the best nutrition care.