Diet

Nutritional therapy for chronic inflammatory colon disease

introduction

introduction

Until recently it was assumed that im Large intestine mainly sodium and water ingested to prepare the intestinal contents for excretion. Today, however, there are findings that during a so-called "Post-digestion“Energy-rich food components that im Small intestine not used were broken down by intestinal bacteria and absorbed by the intestinal wall.

This aspect of the energy reserve or energy conservation plays a subordinate role in the industrial society with its abundance of food. In the third world, however, the uptake of high-energy compounds in the large intestine is estimated at 15-20% of total energy intake. In addition, it was previously assumed that dietary fiber is excreted unchanged from food and only increases the volume of stool by swelling. Today we know that they (varies in intensity depending on the species) are broken down in the colon. Short-chain fatty acids from the bacterial breakdown of carbohydrates and proteins also have a decisive influence on the internal environment of the large intestine and, together with sodium and water, are quickly and almost completely absorbed by the intestinal wall. Due to this fact, they work preventively against diarrhea. (See also Diet for Diarrhea)

Nutritional factors in the development and course of inflammatory bowel diseases

There are large differences in the incidence of both diseases between industrialized and third world countries. One can conclude that one too much sugar and a little too little Fiber are significantly involved in the development of diseases. At Crohn's disease Sick people could actually be shown an increased consumption of sugar, not with Ulcerative colitis. Fiber intake doesn't seem to play a major role here.

The possible disease-promoting intake of trans fatty acids (contained in chemically hydrogenated fats such as some margarines) and baker's yeast is also being discussed. People who were not breastfed as infants may also have a higher risk of developing the disease. In ulcerative colitis, there is so far no evidence of a connection between nutritional factors and the development of the disease. It was only observed that the absorption of a short-chain fatty acid (butyrate) in the large intestine is disturbed in ulcerative colitis.

All of these facts lead to the development of chronic inflammatory diseases Bowel disease however, nutritional factors cannot be proven beyond doubt.

General malnutrition and insufficient supply of vitamins and trace elements

Inpatients and outpatients with inflammatory bowel disease often show general malnutrition. In children and adolescents, this leads to reduced and delayed growth puberty. The following states contribute Malnutrition with: loss of appetite, one-sided nutrition, Failure to tolerate certain foods, vomiting, decreased absorption capacity of the diseased intestine, loss of bile acids and side effects of medication. This leads to weight loss, reduction of certain blood proteins (Albumins), Anemia and often to a reduction in the following Vitamins in the blood serum: vitamin B 12, vitamin D, folic acid, iron, calcium, potassium, magnesium, zinc. All of these vitamins and trace elements can be supplied in tablet form or by injection.

Nutritional therapy for chronic inflammatory bowel disease in an acute episode

The value of the artificial nutrition there is no doubt about the improvement of the nutritional status. Formula diets are therefore used in the acute episode. These are ready-to-drink or tube feedings. They are easy to digest, low in fiber and cover needs. At Crohn's disease it achieves a better nutritional status and positive effects on the intestinal mucosa. At Ulcerative colitis There is no reliable data on the value of a patient Formula diet in acute episode. Here minerals and fluids are supplied with the help of an infusion. The basis is therapy with cortisone. Additional artificial feeding via infusion improves the nutritional status, but has no influence on the course and inflammatory activity of the disease. The omega-3 fatty acids contained in fish oil apparently have an anti-inflammatory effect in the area of the intestinal mucosa. They can be in capsule form in a dosage of 5 g Omega-3 fatty acids are given a day. Results in this regard, however, have to be further verified before a corresponding recommendation can be made.

Nutritional therapy in between the acute attacks.

So far, when the Crohn's disease a low fiber and high sugar nutrition regarded as one of the contributing factors. However, there are also studies that show no difference to a normal mixed diet. In some cases, foods such as milk, wheat products and citrus fruits can make the symptoms worse. However, it is questionable whether a general avoidance of these foods will reduce the frequency of the acute attacks and extend the symptom-free time. At 15% of patients with Crohn's disease have been found to be intolerant to certain foods. A food allergy was excluded as the cause. This makes it clear that at the moment there are no reliable data on a certain type of diet that could be adhered to in the symptom-free period in order to prevent a new episode. We recommend a light, wholesome, varied whole diet that only takes individual intolerances into account.

Summary

In the acute episode:
Tube feeding effects in patients with Crohn's disease a considerable improvement in the nutritional status and in certain cases can have a positive effect on the healing of intestinal fistulas. Otherwise, artificial nutrition has no effect on the inflammatory activity in the intestinal mucosa.

In ulcerative colitis with impending complications and before operations in Crohn's patients, exclusively artificial nutrition via an infusion is necessary.

In the case of general malnutrition and lack of certain nutrients:

Artificial feeding through a nasogastric tube or, if not possible, an infusion.

For chronic oozing bleeding in the intestinal area, iron intake in tablet form.

If the lower part of the small intestine is more than 100 cm away, the administration of vitamin B 12 is necessary.

If zinc deficiency is proven, zinc must be given in tablet form.

For one Nutritional therapy that extends the symptom-free time between attacks, there is no clear evidence of its effectiveness. However, a light whole diet can be recommended, taking individual intolerances into account.