Good nutrition is essential to manage the effects of Crohn’s disease, which can wreak havoc on your digestive system and leave you with a loss of appetite and chronic diarrhea. It’s even more important for people who have the Crohn’s complication called short bowel syndrome following surgery.
Short Bowel Syndrome: What Is It?
Your body absorbs most nutrients when food travels through the small intestine. When Crohn's treatment includes surgery to remove half or more of this section of your colon, a side effect can be short bowel syndrome — the inability to get the nutrients you need from the foods you eat.
Short Bowel Syndrome: What Are the Symptoms?
Chronic diarrhea is the main obvious symptom of short bowel syndrome and can cause dehydration, weight loss, and even death if not properly treated. Heartburn, cramping, bloating, and fatigue may also occur as well as food sensitivities.
What you might not realize at first is the general malnutrition, along with specific nutrient deficiencies, that results from short bowel syndrome. If the first section of the small intestine is removed, you might develop an iron deficiency; if the mid-section is taken out, you're more likely to have problems absorbing carbohydrates, fat, proteins, and vitamins. Vitamin B12 and bile acids are digested in the final part of the colon, so you'll have associated difficulties if you're missing that section.
Short Bowel Syndrome Treatment With Diet and Supplements
Preventing dehydration along with getting adequate nutrition, including vitamins and minerals are key to treating short bowel syndrome. As an initial treatment or in severe situations, you might need to get nutrition through an IV.
“Slow re-introduction of food is important,” says Adam Barrison, MD, a gastroenterologist at Summit Medical Group in Berkeley Heights, N.J. If you're able to eat food, Dr. Barrison adds that small, well-balanced, frequent meals are best.
Other important strategies to keep in mind include:
- Chew your food slowly. “There are enzymes, such as amylase found in the saliva, which break down starch and carbohydrates into smaller units as you chew,” says Karen Langston, CNCP, a certified holistic nutritionist in Phoenix, Ariz., and author of The Healthified Pantry. “If you do not chew enough, this process cannot happen properly.” It also triggers the production of hydrochloric acid in the stomach in anticipation of the food’s arrival. Chewing the food carefully allows for a better chance of vitamin and mineral absorption in the parts of the small bowel that remain.
- Avoid caffeine, alcohol, and sugar, which can contribute to the loss of vital nutrients.
- Work with a health care professional to develop the right combination of foods for you. Diet guidelines vary by what part of the bowel has been removed. For instance, explains Robyn Moss, MS, RD, in private practice in Newport Beach, Calif., and member of the Crohn’s & Colitis Foundation of America Orange County Medical Advisory Committee: If you've had a colonic segment removed, a low-fat, high-carbohydrate diet (50-60 percent carbohydrate, 20-30 percent protein, and 20-30 percent fat), plus 10 grams of soluble fiber a day is recommended. If you've had a jejunostomy, or shorter length ileostomy, a high-fat, low-carbohydrate diet (40-50 percent carbohydrate, 20-30 percent protein, and 30-40 percent fat), plus higher salt intake is recommended.
- Follow the recommendations of your nutrition professional for taking supplements. In generally, you'll likely have a chewable multivitamin twice a day, but you may also need more individualized, specific supplements, such as electrolyte replacements based on blood tests, says Jill D. Brown, MS, RD, a clinician in the Center for Gut Rehabilitation and Transplantation in the Digestive Disease Institute at the Cleveland Clinic in Cleveland, Ohio. “Vitamin, mineral, and essential fatty acid levels are routinely assessed and treated as necessary. Probiotics, which increase beneficial bacteria in the gut, can help decrease malabsorption. Some patients also find that the addition of a clear soluble fiber supplement helps to thicken and slow output.”
When Medication and Surgery Are Necessary
Some medications may help with the symptoms of short bowel syndrome including anti-diarrheal or anti-motility medications, gastric acid reducers, and bile acid/salt resins. Other possibilities include L-Glutamine powder, which can help maximize absorption, somatropin for intestinal adaptation and movement of water and nutrients, and GLP-2 to assist with absorption. It is crucial to always check with your health care provider before taking any medications, including those sold over-the-counter.
There are several surgical procedures that can help improve absorption as well. Both serial transverse enteroplasty (STEP) and the Bianchi Procedure use different methods to accomplish the same goal of making the bowel longer and narrower. Intestinal transplantation involves receiving part or all of a donated small intestine, bowel, and/or liver, though this is usually done only when other treatments have failed.
Treating Short Bowel Syndrome With Time and Patience
Research has shown that, over time, the bowel can adapt and compensate in its absorption to some extent. This process begins immediately after surgery and can take up to two to three years to see full results.
Last Updated: 6/21/2013