Short Gut Syndrome Patient, Family & Professional Support Groups

Q: Is there a recommended diet for short bowel syndrome?

There is no one short gut diet. The best diet for you depends on your body's anatomy and tolerance and that varies person to person. You'll learn best by trial and error under the guidance of a medical team.

There are a few principles that apply to most short bowel syndrome patients.

It helps to eat several small meals and snacks throughout the day so that the gut can work on absorbing small amounts of food all day. Eating a lot at once can overwhelm the gut. Taking time to eat and chewing food well can also help with digestion.

Choosing the right foods matters, too, and there are a few guidelines that are pretty consistent for most people.

  1. Sugars. Limit sugars, including those found in many fruits, and be cautious with the lactose in dairy products. Sugar alcohols should also be avoided.
  2. Carbs. Carbs are a staple of most SBS diets. Choose refined complex carbohydrates like pasta, potatoes, rice, white breads, and cereals.
  3. Fats. Fats are another great source of calories. Restricted lipids in TPN can also cause fatty acid deficiencies, so it's especially important for children to eat essential fats. Eat healthy fats, focusing on essential fats, including vegetable oils, fish oil, margarine, etc. MCT oils can also be eaten in moderation.
  4. Protein. A healthy protein is recommended with every meal and snack. Focus on proteins like lean meats, eggs, and nut butters. Some patients tolerate minimal amounts of lactose. However, the use of dairy products is debated.
  5. Fiber. Choose soluble fibers such as oatmeal, green beans, apples, and bananas. Limit insoluble fibers such as whole grains, seeds, peels, fibrous vegetables, nuts and seeds.
  6. Salt and other electrolytes. Replenish electrolytes lost in stool through food and drink. While salt is unhealthy in typical diets, many people with SBS, especially those who are missing some or all of their colon, are deficient in sodium and need to eat more salt.
  7. Hydration. It's easy to get dehydrated with SBS, so drinking is critical. Choosing the right drink is essential. Your body absorbs fluids best when the balance of water and minerals in them (osmolarity) is the same concentration as your cells (isotonic). Oral rehydration solution (ORS) and some formulas prescribed for SBS are easily absorbed because of their osmolarity. They are the best choice for hydration. Other drinks like juice and soda pull fluid out of your cells, dehydrating you even more. Water won't dehydrate you, but it still isn't an ideal concentration and is hard to absorb. ORS, or an isotonic formula or nutrition shake, are the best drinks for hydration.

There are a couple of things you'll want to consider, depending on your anatomy.

Suppose you lost your colon or have an ostomy, so your colon is not connected to the rest of your intestine. Since fluid and electrolytes are absorbed in the colon, you'll need to drink more and add extra salt to your diet to compensate for those losses.

Suppose you do have a colon attached to your remaining small intestine. In that case, you won't need as many fluids or electrolytes. However, if your small bowel doesn't absorb a mineral called oxalate and it is instead absorbed in the colon, you can develop kidney stones. This affects diet in two ways. First, you'll also want to cut back on foods that contain oxalate, like green veggies, chocolate, coffee, and tea. Second, because malabsorbed fats tie up the calcium that usually binds oxalates, keeping them from being absorbed in the colon, you'll want fewer fats and more carbs in your diet if you have a colon.

, though, the goal of a short gut diet is to include as many different foods as you can tolerate. The best diet is one that is tailored to your specific needs.

That's a daunting task on your own. No wonder most intestinal rehabilitation teams include a registered dietitian. This person can be an invaluable resource to you.


References

  1. Byrne, T. et al; Beyond the Prescription: Optimizing the Diet of Patients with SBS; NCP 15:306-311, 2000 e+Epi">https://www.researchandmarkets.com/reports/5345917/short-bowel-syndrome-epidemiology-forecast
  2. Iyer, K., et al; AGA Clinical Practice Update on Management of Short Bowel Syndrome: Expert Review, Gastroenterology,DOI: https://doi.org/10.1016/j.cgh.2022.05.032, 2022
  3. Matarese LE. Nutrition and fluid optimization for patients with short bowel syndrome. JPEN J Parenter Enteral Nutr. 2013 Mar;37(2):161-70. doi: 10.1177/0148607112469818. Epub 2012 Dec 21. PMID: 23264168.
  4. Medico, T., et. al "A Kids Guide to Short Bowel Syndrome". 2020.
  5. Parrish, Carol R. The Clinician's Toolkit for the Adult Short Bowel Patient Part I: Nutrition and Hydration Therapy. Practical Gastroenterology (2022).https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2022/06/June-2022-Parrish-SBS-Nutrition-and-Hydration.pdf
  6. Parrish, C., Nutrition Therapy for Short Bowel Syndrome in the Adult Patient. Practical Gastroenterology, 2014 https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-October-14.pdf





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