GERD nutritional therapy
avoid large, high fat meals avoid eating 2-3 hours befor lying down elevate head 6-8 inches while sleeping avoid smoking avoid alcohol avoid caffeine and carbonate beverages avoid acidic or spicy foods consume a healthy, nutritionally balanced diet with adequate fiber lose weight, if indicated
atrophic gastritis should be evaluated for?
B12, iron and calcium
natural eradication for H. Pylori?
green tea broccoli black currant oil kimchi probiotics (lactobacillus, bifidobacterium)
peptic ulcer avoiders
alcoholc, spicy foods, triggers
limit coffee and caffeine
gas producing foods
beans cruciferous veggies fruits whole wheat and bran high sugar beverages dairy sugar alcohols
constipation, how do we get it?
lack of fiber inadequate fluid low energy intake iron and calcium supplements lack of exercise immobility laxative abuse postponing urge to defecate
criteria for constipation
- must include or more of these for last 3 months
straining during 25% defecations
lumpy or hard stools in 25%
sensation of incomplete evacuations in 25%
sensation of anorectal obstruction for at least 25%
manual maneuvers to facilitate at least 25%
<3 defecations per week - loose stools are rarely present without use of laxitives
- there are insufficient criteria for diagnosis of IBS
separate hard lumps
severe constipation
lumpy and sausage like
mild constipation
a sausage shape with cracks in the surface
normal
smooth, soft sausage or snake
normal
soft blobs with clear cut edges
lacking fiber
mushy consistency with ragged edges
mild diarrhea
liquid consistency with no solid pieces
severe diarrhea
how can we help people with constipation?
increase consumption of whole grain products to 6-11 servings/d
increase veggies to5-8 servings/d
consume high fiber cereals to get at least 25 g of fiber/d for females and 38 g/d for males
increased fluid consumption to at least 2L/d
what could cause malabsorptive diarrhea
pancreatic insufficiency gastric acid hypersecretion imparied bile production or secretion bacterial overgrowth enzymatic deficiency celiac disease chron's disease allergy
what should you so for those with diarrhea?
replenish fluids
limit lactose, sugar alcohols, fructose and large amounts of sucrose
soluble fiber, like pectin, can slow GI motility
try probiotics
bacteriodetes (seen in healthy patients)
bacteroides
prevotella
xylanibacter
firmicutes (seen in obese patients)
clostridium eubacterium roseburia blautia ruminococcus faecalibacterium lactobacillus
actinobacteria
bifidobacterium
propionibacterium
proteobacteria
E. coli
verocomicrobia
akkermansia (none in autistic patients)
large intestine colonization can be affected by?
mode of delivery premature delivery feeding introduction of solid food siblings antibiotics
signs and symptoms of malabsorbed fat
pale, greasy, smelly stools, diarrhea without distention or gas
signs and symptoms of malabsorbed protein
edema
muscle atrophy
signs and symptoms of malabsorbed carbs
watery diarrhea, flatus, abdominal distention
signs and symptoms of malabsorbed fluid or electrolytes
tachycardia
dry mouth
signs and symptoms of malabsorbed bile salts
watery diarrhea
signs and symptoms of malabsorbed folic acid
macrocytic anemia
glossitis
signs and symptoms of malabsorbed B12
macrocytic anemia, glossitis, fatigue, nerve issues
signs and symptoms of malabsorbed B complex
cheilosis angular stomatitis glossitis dermatits ataxia sensory dysfunction
signs and symptoms of malabsorbed vitamin A
night blindness
follicular hyperkeratosis
signs and symptoms of malabsorbed vitamin D
muscle cramps
bone pain
signs and symptoms of malabsorbed vitamin E
decreased deep tendon reflex
signs and symptoms of malabsorbed iron
microcytic anemia
fatigue
koilonychia
signs and symptoms of malabsorbed zinc
taste atrophy
dermatits
hair loss
signs and symptoms of malabsorbed magnesium
tetany
signs and symptoms of malabsorbed selenium
muscle pain
signs and symptoms of malabsorbed copper
weakness
signs and symptoms of malabsorbed calcium
paresthesia
tetany
bone pain
trousseau sign
leaky gut
increated intestinal permeability
what could leaky gut be due to?
infections
medications
dysbiosis
who has leaky gut?
celiac chron's MS IBS SIBO
most common test for diganosis of leaky gut
lactulose-mannitol test
pathyphysiology of celiac disease
genetic susceptibility (35% have it, small percent present with it)
exposure to gluten
environmental trigger
autoimmune response
nutritional symptoms of celiac disease
anemia increased fracture risk clotting issues delayed growth lactase deficiency
extraintestina celiac symptoms
malaise arthritis dermatiits herpetiformis infertility hepatitis ataia psychiatric syndromes (depression, etc)
associated disorders with celiac
autoimmune cluster: T1DM, thyroiditis, hepatits
GI malignancy
IgA deficiency
celiac vs gluten sensitivity or intolerance
celiac: immune system involved, body attacks itself
gluten sensitivity/intolerance: no immune response, IBS, diagnose using elimination diet
nutritonal therapy for those with celiac
gluten free for life, avoid wheat, rye, barley and malt
up to 50g/day of oats may be tolerated
gluten free grains and flours
amaranth arrow root bean flours corn rice soybean potato quinoa flax tapioca
gluten free desserts
sorbet
popsicles
cheese, eggs, meat, fish, poultry for gluten free
all cheese
all eggs
all fresh untreated meat, fish or poultry
beans, legumes, nuts, seeds, fruits, veggies for gluten free
can have all these things
alcohol gluten free
wine
distilled liquor
gluten-free beer
hidden exposure to gluten
medications communion wafter toothpaste mouthwash lipstick cross contamination
nutritional defeicencies at diagnosis of celiac
calorie/protein fiber iron zinc, copper calcium, magnesium, vitamin D folate, niacin, riboflavin, B12
gluten free diet started nutritional deficiencies
fiber
iron
calcium, magnesium, vitamin D
folate, niacin, riboflavin, B12
long term gluten free diet
fiber
folate, niacin, riboflavin, B12
refractory celiac disease
patients who don’t respond to a gluten free diet
present with severe malabsorptive diarrhea and weight loss
gluten free diets are usually low in?
iron, fiber, folate
niacin
riboflavin
gluten free diets are usually high in?
saturated fat
starch
sucrose
nutritionally adequate gluten free diet
focus on foods taht are natrually gluten free
get at least 5 servings of fruits and veggies/day
add amaranth, quinoa and buckwheat
meat, fish and dairy
intestinal brush border enzyme deficiencies
lactose intolerance
fructose malabsorption
lactose intolerance
most common form of carb malabsorption
diagnosi with hydrogen breath test or a lactose tolerance test
most can consume up to 12 g of lactose a day without symptoms (=1 cup of milk)
fructose malabsorption
diagnosed with hydrogen breath test
75% of healthy people incompletely absorb large amounts of fructose
IBD
inflammation increases protein requirement
what supplements are necessary for IBD?
folate B6, B12, zinc, magnesium
if diarrhea: zinc, selenium, potassium
if steroids: vitamin D and calicum
what can help reduce flareups for IBD?
omega 3s
rome III criteria for IBS
recurrent abdominal pain or discomfort at elast 3 days/month in the last 3 months associated with 2 or more of the following:
improvement with defecation
onset associated with a change in frequency of stool
onset associated with chagne in appearance of stool
IBS with constipation (IBS-C)
<3 bowel movements per week
hard, lumpy stools
straining
IBS w/ diarrhea (IBS-D)
> 3BM/d
fecal urcency
loose, watery stools
mixed IBS (IBS-M)
mix of hard and loose stools over hours to days
unsubtyped IBS
insufficient evidence to meet criteria for other types
what should you check for those with IBS?
meds they are taking review of GIsymptoms assessment of nutritonal staus and food intake supplement intake use of mind-body therapies
IBS treatemnts for abdominal pain and discomfort
antispasmodic agent (antidepressants)
IBS treatment options for constipation
fiber, fluid, laxatives
IBS treatment options for diarrhea
antidiarrheals
IBS treatment options for small intestinal bacterial growth
antibiotics/probiotics
IBS treatment options for global symptoms
psychotherapy
peppermint oil
probiotics/prebiotics
FODMAP diets
limit fermentable foods (sugars, oligosacharides,sugar alcohols)
use as a guide to start with a very restictive diet and slowly add back foods to determine trigger
emerging as a useful diet for IBS peitnts
diary foods to limit with FODMAP
milk cottage cheese ice cream sweetened condensed milk evaporated milk soft cheese sour cream whipped cream yogurt chocolate
non dairy foods to avoid with FODMAP
coconut milk coconut cream beans black eyed peas hummus lentils pistachios soy
grains to limit with FODMAP
wheat
chicory root
inulin
rye
fruits to limit for FODMAP
avocado apples apricots dates canned fruit cherries dried fruit figs guava lychee mango nectarines pears papaya peaches plums pprunes watermelon
vegetables to limit with FODMAP
artichokes asparagus beets leeks broccoli brussel sprouts cabbage cauliflower green beans mushrooms summer squash
sweetners/seasonings to limit with FODMAP
agave honey high fructose corn syrup coconut jams jelly molasses garlic onions pickles relish sugar alcohols
diverticulosis
sac-like pouches that form within the colon due to weakeneed muscles
most often in sigmoid colon
diverticulitis
inflammation fo diverticula
etiology of diverticular disease
associated with obesity low fiber diet vitamin D insufficiency sedentary lifestyle NSAID use
nutritional therapy for diverticular disease
no longer recommended to avoid nuts, seeds, corn, popcorn or berries
high fiber diet can improve symptoms
probiotic studies suggest improvement with certain bacteria
SIBO
overproliferation of bacteria in the SI that are normally only found in LI
could be due to low stomach acidity, liver or gallbladder disease or pancreatitis
if probiotics are recommended, avoid lactobacillus acidophilus and ferminti
carbs serve as fuel for bacteria
what diet could be useful for SIBO?
FODMAP diet
fat lab test
72 hour fecal fat test
protein lab test
fecal nitrogen, serum albumin
carb lab test
hydrogen breath test
fluid/electrolyte lab tests
serum electrolyte panel, creatinine, urea nitrogen
bile salt lab test
serum 7alpha-hydroxy-4-cholesten-3-1
folic acid lab test
hemoglobin, MCV, serum, RBC folate
B12 lab tests
hemoglobin, MCV, serum, RBC B12
B complex lab test
serum vitamin levels
vitamin A lab tests
serum retinol, retainal esters
vitamin D lab test
serum 25-hydroxyvitamin D
vitamin E lab test
serum tocopherol
vitamin k lab test
prothrombin clotting time
iron lab tests
hemoglobin, MCV, serum ferritin, serum iron-binding capacity, total iron
zinc lab test
serum zinc
magnesium lab tests
serum magnesium, 24hr urinary Mg
selenium lab test
serum selenium
copper lab test
serum copper, cerulopalsmin
calcium lab tests
serum calcium, phsophorus, alkaline phosphatase, PTH
lactulose
non-absorbable disaccharide (leaky gut)
mannnitol
sugar alcohol (lack of indicates malabsorption)
is chron’s or ulcerative colitis more likely to show with malabsorption
chron’s because it involves the ileum
which is used to absorb B12 and bile