IBD Effects on General Nutrition
Many nutritional complications occur during the course of IBD. Because nutritional complications have a great influence on IBD patients, and his/ her mortality, we must ensure OPTIMAL nutritional status. A decreased food intake is the primary cause of a patients nutritional deficit. It most certainly is the most common cause of patients needing hospitalization. Weight loss is prevalent
in 65% (sixty-five percent) to 75% (seventy-five percent) of IBD patients. Malabsorption can be anticipated in patients with extensive involvement of the small intestine and in patients who had surgical procedures of segments of the small intestine. Fat malabsorption, and its resulting caloric loss and also loss of fat soluble vitamins and minerals are specifically commonplace. Bile acid malabsorption is very common.
The laxative effect of bile acids on the colon may be the result of chronic watery diarrhea. Such patients may develop electrolyte and trace mineral deficiency, while chronic fat malabsorption may result in calcium and magnesium deficiency. The increased loss of tissue components such as the great loss of blood proteins across the damaged mucosa may overtax the ability of the liver to replace these proteins. Anemia and low iron count generally accompany IBD. The most common drugs used in treatment of IBD are corticosteroids and sulfasalazine, both increasing the need for adequate nutrition. Corticosteroids have an invigorating effect on protein break down; depress protein synthesis; decrease absorption of calcium and phosphorus, increase urinary excretion of vitamin C, calcium, potassium and zinc; increase levels of blood glucose, serum triglycerides, and serum cholesterol, increase the requirements for vitamin B6, ascorbic acid, folate, and vitamin D; decrease bone formation; and impair wound healing. Sulfasalazine inhibits the absorption and transport of folate, decreases serum folate and iron, and increases the urinary excretion of ascorbic acid.
Another way IBD leads to nutritional deficit is by way of the increased nutritional needs. Patients with IBD might require as much as 25% (twenty-five percent) more protein than the usual RDA. Especially if protein is being lost as described above. (1-3)
Correcting Nutritional Deficiencies
How important it is to correct the nutritional deficiencies of patients with IBD can not be emphasized enough. These deficiencies lead to different gastrointestinal function and structure, resulting in the patient entering a viscous cycle. Meaning, the secondary effects of malnutrition on the gastrointestinal tract may cause further malabsorption, further increasing the nutritional deficit. The most important part of nutritional therapy is to provide adequate caloric intake. This may be achieved through the use of and Elemental Diet or and Elimination Diet.
Next: The Elemental Diet
1. Rosenberg L.H., Bengoa J.M., Sitrin M.D. Nutritional Aspects of Inflammatory Bowel Disease. Ann Rev Nutr 5 (1985):463-84
2. Heatley H.V. Review: Nutritional Implications of Inflammatory Bowel Disease. Scand J Gastroenterol 19 (1984):995-8
3. Motil K.J., Grand R.J. Nutritional Management of Inflammatory Bowel Disease. Ped Clinics North Amer 32 (1985):447-69