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Nutritional Problems in Crohn’s and Colitis

Posted Aug 24 2008 1:49pm
ANNOUNCER: Two diseases of the digestive system-Crohn's disease and ulcerative colitis-together are called Inflammatory Bowel Disease, or IBD.

TOBY GRAHAM, MD: Inflammatory bowel disease is a disease which affects the intestine. It is a disease that as such can cause symptoms that are GI-related symptoms. Anything from impaired ability to eat, loss of appetite, to the most dramatic manifestation, which is the diarrhea and often hemorrhage, actual loss of blood in that diarrhea.

ANNOUNCER: Nutrition problems are common with IBD. One problem is that people with IBD often limit what they eat because they get cramps and experience nausea. Or, they may want to avoid a sudden episode of diarrhea in social situations.

TOBY GRAHAM, MD: There is actually a decrease in oral intake, and it's significant in both children and adults with inflammatory bowel disease. So overall prevalence of nutritional, serious nutritional problems in inflammatory bowel disease, is of the order to 80 to 85%.

ANNOUNCER: People with IBD also have intestines that fail to absorb the nutrients their bodies need.

STEPHEN McCLAVE, MD: Crohn's disease typically or most commonly affects the end of the small bowel where fat and fat-soluble vitamins are absorbed. So, A, D, E and K are the four fat-soluble vitamins. Because of the disease process, we have trouble absorbing them and so, typically, we have to watch for vitamin D deficiency, osteoporosis, vitamin A deficiency and breakdown of the skin and night blindness, vitamin E deficiency that can lead to some neuromuscular problems and vitamin K that could affect our clotting abilities.

ANNOUNCER: People with IBD also lose nutrients, as well as protein and important fluids, because of damage to intestinal tissue.

TOBY GRAHAM, MD: One of the things about inflammatory bowel disease is that protein is lost Inflammatory bowel disease affects the lining of the intestine in the colon of the surface area no longer is able to retard the leak of serum and protein, so there is a huge protein leak from the gut.

ANNOUNCER: Another factor that can contribute to malnourishment in people with IBD is the stress response. When the body kicks into to its disease-fighting mode, extra calories are needed, compounding nutritional problems. Medicines are usually the first line of therapy in treating people with IBD. But careful attention to diet, and even nutritional therapy, can help, too. Many people with IBD believe, for example, that flare-ups can be avoided if certain foods are avoided. Dairy products are a common problem, but other generalizations are difficult.

STEPHEN McCLAVE, MD: There are a lot of myths out there about diet and inflammatory bowel disease. There is no one specific diet, there's not a Crohn's disease diet or an ulcerative colitis diet that we put patients on automatically. But there are certain things that they typically get into trouble with. A surprising problem they have are food intolerances. Food intolerances are not food allergies, but intolerance means, when they eat this food, it increases their symptoms. And, if you are very careful and take a good diet history, you can figure out specific foods that cause symptoms.

ANNOUNCER: One type of food, fiber, is a double-edged sword for people with IBD helping some people and hurting others.

STEPHEN McCLAVE, MD: Fiber is good to help soak up excess fluid in patients that are prone to diarrhea, and that could be good for patients with Crohn's or ulcerative colitis. But with patients with Crohn's disease that tend to have partial obstruction, that big bolus of fiber could lead to partial obstruction and cause trouble. An interesting thing with ulcerative colitis is that fiber is broken down to short-chain fatty acids and short-chain fatty acids are a compound in the food that has a very healthy effect on the colon.

ANNOUNCER: Nutritional considerations are important in the management of IBD. Patients do best when they work with their doctors to make sure they take in the nutrients and fluids their bodies need. And people with IBD may be able to avoid some flair-ups by paying careful attention to their bodies' reaction to some of the foods they eat.

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