DIETARY MANAGEMENT

OF GASTROINTESTINAL

DISEASES (ULCERATIVE

COLITIS)

Prepared by: 3rd year

medicine students in King

AbdulAziz University.

Yaser is a 35-year-old man who owns his own company.

He has been used to working long hours. He likes junk

foods, the hotter and spicier, the better. He loves Chinese

and Indian foods. Lately he has been having bouts of

diarrhea, especially after Chinese dinners. Besides the

diarrhea, he was nauseated and had cramps for two nights

in a row. He had a fever. On the second night, he saw

blood in the toilet. His doctor suggested that Yaser should

follow a low-residue diet to help prevent further episodes

of ulcerative colitis . The doctor requested a consult with a

registered dietitian to teach Yaser about his new diet.

CASE STUDY

Yaser is a 35 year old man.

He works for long hours.

He likes junk food, Indian food, Chinese food,

and spicier the better.

He had bouts of diarrhea, nausea, cramps, and

fever.

He saw blood in the toilet.

The doctor suggested a low residue diet to

prevent further episodes of ulcerative colitis.

CASE SUMMARY

1WHAT DO YOU KNOW ABOUT

YASER THAT PUTS HIM AT

RISK FOR ULCERATIVE

COLITIS?

Causes :

The exact cause of ulcerative colitis

remains unknown, but there are few

risk factors like:

1-Immune system malfunction

2-Heredity

3-Food

One possible risk factor is an immune

system malfunction. When the immune

system tries to fight off an invading virus

or bacterium, an abnormal immune

response causes the immune system to

attack the cells in the digestive tract, too

Heredity also seems to play a role in

that ulcerative colitis is more

common in people who have family

members with the disease.

However, most people with

ulcerative colitis don't have this

family history.

He loves to eat lots of junk food and he

likes it extra spicy, especially if it is

Chinese or Indian. Fatty foods make the

diarrhea worse, and spicy food may

irritate the colon.

2GIVEN HIS LIFESTYLE

HABITS, HOW WILL THE

DISEASE AFFECT HIS

LIFE?

1- Avoid and limit some food:

Limit dairy products: many people with

inflammatory bowel disease find that

problems such as diarrhea, abdominal pain.

LIFE STYLE FOR ULCERATIVE COLITIS

Try low-fat foods as high fat food make the

diarrhea worse (e.g. junk food).

LIFE STYLE FOR ULCERATIVE COLITIS

Fibers: may make the symptoms worse

LIFE STYLE FOR ULCERATIVE COLITIS

LIFE STYLE FOR ULCERATIVE COLITIS

Spicy foods, alcohol and caffeine may make

the signs and symptoms worse.

2-Avoid stress: although stress doesn't cause

inflammatory bowel disease (ulcerative colitis),

it can make the signs and symptoms worse and

may trigger flare-ups. (Yaser works for long

hours, so this can make him stressed).

LIFE STYLE FOR ULCERATIVE COLITIS

3WHAT MAJOR TOPICS ABOUT

ULCERATIVE COLITIS DOES

YASER NEED TO UNDERSTAND?

Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon. This condition causes diarrhea, belly pain, and bloody bowel movements. These symptoms happen because the colon becomes inflamed and gets sores, called “ulcers.”

WHAT IS ULCERATIVE COLITIS?

Symptoms of ulcerative colitis can be mild or

severe. They might happen just once, or they might

go away and come back over and over again.

Possible symptoms include:

Diarrhea

Bloody bowel movements

Loss of appetite

Belly cramps

Fever

Weight loss

SYMPTOMS OF ULCERATIVE COLITIS

Yes. the symptoms might improve if :

He avoids foods that make his symptoms worse

(e.g. Chinese food in the case).

He avoids (NSAIDs) such as ibuprofen for pain

relief. NSAIDs have been linked to flare-ups.

Instead, acetaminophen (Tylenol) is

recommended.

He follows a healthy diet.

CAN HE DO ANYTHING ON HIS OWN TO

FEEL BETTER?

Depending on the symptoms, the doctor might

prescribe:

Medicine placed directly into the rectum

(enema, suppository, or foam). They reduce

swelling in mild cases.

Medicine that taken in a pill. A common one is

called 5-ASA (5-aminosalicylic acid).

A brief course of glucocorticoid (also called

steroids) to reduce swelling.

HOW IS ULCERATIVE COLITIS TREATED?

When medicines and changes in diet don ’t work, surgery

can help. There are two types:

Removal of colon and reattachment of anus/rectum This

procedure is one of the most common surgeries used to

treat ulcerative colitis. During the procedure, the

surgeon removes the large bowel and most of the

rectum, but he saves the anal sphincter. The surgeon

then creates a tubular pouch out of the end of the small

intestine and sews it to the anal canal .

Removal of colon with permanent ileostomy: the

surgeon removes the colon, rectum, and anus. The

surgeon will attach the ileum to an opening in the

abdomen called ostomy.

CAN SURGERY BE AN OPTION?

ileostomy

CAN SURGERY BE AN OPTION?

4LIST THE MAIN ABNORMALITIES

IN THIS PATIENT THAT WILL

AFFECT HIS NUTRITIONAL

MANAGEMENT.

It's important to self-manage ulcerative

colitis with healthy lifestyle habits and a

nutrient-rich diet. Paying attention to

nutrition is especially important with GI

diseases because the symptoms of

diarrhea and bleeding can lead to

dehydration, electrolyte imbalance, and

loss of essential nutrients.

THE MAIN ABNORMALITIES IN ULCERATIVE COLITIS PATIENT

THAT WILL AFFECT HIS NUTRITIONAL MANAGEMENT.

• Chronic bleeding from the

inflamed and ulcerated intestinal

tissue can cause a shortage of red

blood cells (anemia) in some

affected individuals.

• Malnutrition caused by ulcerative

colitis is rare because vitamins,

minerals, and proteins are

absorbed in the small intestine,

which isn't affected by ulcerative

colitis.

THE MAIN ABNORMALITIES IN ULCERATIVE COLITIS PATIENT

THAT WILL AFFECT HIS NUTRITIONAL MANAGEMENT.

There are several reasons why people with

ulcerative colitis may be at risk for poor nutrition,

including:

• Decreased food intake due to loss of appetite,

pain, diarrhea, or other symptoms, or fear of

these symptoms.

• Increased need for calories, protein, and some

vitamins and minerals.

• Dehydration due to diarrhea.

• So, people with ulcerative colitis should

follow a balanced diet and be sure to

get enough calories, protein, vitamins,

minerals, and fluid

5WHAT TYPES OF FOOD ARE

GOING TO BE A PROBLEM FOR

YASER?

SOME FOOD ITEMS ARE COMMON TROUBLEMAKERS

FOR PEOPLE WITH ULCERATIVE COLITIS, INCLUDING:

•Spicy foods.

•Caffeine.

•Carbonated drinks.

•Dairy products, if you ’re lactose intolerant.

•Dried beans, peas, and legumes.

•Foods high in fiber.

•Nuts, crunchy nut butters.

•Popcorn.

•Products that have sorbitol (sugar-free gum).

•Raw fruits and vegetables.

•Seeds.

•Alcohol.

SOME FOOD ITEMS ARE COMMON TROUBLEMAKERS

FOR PEOPLE WITH ULCERATIVE COLITIS, INCLUDING:

6WHAT DIETARY MODIFICATIONS

SHOULD BE INDICATED FOR THE

PATIENT TO MAINTAIN

ADEQUATE NUTRITIONAL

STATUS?

When you have ulcerative colitis :

you will avoid some types food because it

trigger some symptoms.

So, It’s hard to maintain a balanced diet

and get adequate calories and protein.

DIETARY MODIFICATIONS

1-Drink lots of water; at least 8 cups of water a

day can help to avoid dehydration that caused

by diarrhea.

2- Iron may be necessary for patients at risk

of anemia from blood loss in the diarrhea.

3-May need supplements due to loss of

vitamins and minerals in diarrhea

(dehydration)

DIETARY MODIFICATIONS

Try to eat less of:

Milk products: These foods can lead to bloating, gas, and diarrhea.

Caffeine: caffeine stimulate the intestines and intensifies diarrhea.

Fibers: diarrhea.

DIETARY MODIFICATIONS

7WOULD DIETARY SUPPLEMENTS

HELP IN HIS CASE? AND WHY?

VITAMIN D

Your body needs vitamin D to maintain strong bones.

It also plays a role in how your immune system

functions. Low levels of vitamin D are common

among the general adult population.

If you have ulcerative colitis, especially if you take

steroids, your risk of a vitamin D deficiency -- along

with the accompanying risk of osteoporosis -- is very

high. This risk is compounded by the fact that many

people with ulcerative colitis restrict the amount of

dairy products they consume to help reduce diarrhea,

yet dairy foods are good sources for vitamin D.

VITAMIN D

In this case he should ask his doctor if he should be

taking a vitamin D supplement. Experts differ in their

recommendations for vitamin D supplementation, so

he should talk to his doctor about his best option.

CALCIUM

Calcium is the mineral the body uses to build bones.

Your body also uses it in other ways, such as helping

muscles contract or sending messages through the

nervous system. If your system does not have enough

calcium, the body removes it from the bones, causing

them to become brittle and leading to the

development of osteoporosis.

Avoiding dairy products, along with the effect various

medicines have on calcium, makes a calcium

deficiency a strong possibility with ulcerative colitis. If

his doctor recommends taking a calcium supplement,

he’ll probably need 1,000 to 1,200 milligrams per day.

IRON

People with ulcerative colitis can lose iron through

bleeding from the sores in the colon. Not having

enough iron can lead to anemia. A lack of iron

means your body can't make enough healthy

red blood cells to transport an adequate supply of

oxygen throughout your body. With anemia you may

feel tired a lot, have a fast or irregular heartbeat,

dizziness, problems thinking, and other symptoms.

Your doctor can tell if you have an iron deficiency

with a blood test. If you do, the doctor will probably

recommend you take an iron supplement.

FOLATE OR FOLIC ACID

Folic acid is a B vitamin that your body needs to

make healthy new cells. In women, it also protects

against birth defects of the baby's spine or brain.

Folic acid can also reduce the risk of colon cancer,

which is elevated in people with ulcerative colitis.

People with UC often find it difficult to tolerate

folate-rich dark leafy vegetables and may end up

with low levels of the vitamin. Those levels can be

made even lower as a result of certain medications .

PROBIOTICS

Probiotics, often found in yogurt, are friendly

bacteria that can help balance the bacteria

community in your gut and may enhance the

production of mucous in your intestines. This mucous

serves as a barrier to the invasive, detrimental

bacteria. Though more scientific evidence is needed,

it’s believed that probiotics may help induce

ulcerative colitis remission and keep you in

remission longer. There are a few safety issues

regarding probiotics so he should speak to his doctor

before using it.

OMEGA-3 FATTY ACIDS

These healthy fats, found in fatty fish, may be helpful

in reducing inflammation. More research is needed

to determine whether omega-3s can help with

management of colitis, according to a review in the

British Journal of Nutrition, but he may want to ask

his doctor whether he or she recommends that he

includes fish like salmon and mackerel in his

ulcerative colitis diet or if you should try a

supplement.

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REFERENCES

THANK YOU

Prepared by: 3rd year

medicine students in King

AbdulAziz University.