I. Why we should pay attention to the diet and nutrition of inflammatory bowel disease Patients with inflammatory bowel disease are often malnourished, underweight, and even malnutrition with cachexia is most directly caused by inadequate intake, excessive loss, and impaired absorption of dietary nutrients.
The relationship between inflammatory bowel disease and dietary factors is still controversial. It has been suspected that certain foods or the dietary intake of certain harmful components, such as macromolecular compounds, bacteria or other pathogenic organisms and their antigenic components, trigger an abnormal response of the intestinal immune mechanism, causing immune damage to the gastrointestinal mucosa that is difficult to abort. Animal experiments have confirmed that even if the genetic background for the development of inflammatory bowel disease is clearly present, it does not develop as long as it does not pass through the gastrointestinal diet. However, without eating, there is no nutritional intake and the patient has no way to recover. Clinically, many patients are often afraid of “eating” because of stenosis, obstruction, ulcers and bleeding in the digestive tract, abdominal pain, diarrhea, blood in the stool, etc., after eating. They think that “it is better to eat less or not to eat rather than to eat harmful”. In some cases, due to surgery, partial removal of the intestine, or fistula, the amount and speed of diet is limited, and the food eaten is not completely digested and absorbed. On the other hand, during the acute activity of inflammatory bowel disease or in patients with more than moderate activity of the disease, the intestine is constantly losing blood and tissue fluid components, in addition to the reduction of the absorption area due to the extent of the lesion, which affects the absorption of nutrients and vitamins and minerals, and the exudation and bleeding from the lesion. This is significantly exacerbated during active disease in Crohn’s disease patients.
The similarities and differences between the dietary nutritional management of Crohn’s disease and ulcerative colitis Crohn’s disease may invade various parts of the digestive tract, mainly the small intestine, but most commonly the distal part of the small intestine, the terminal ileum, followed by the large intestine immediately adjacent to the terminal ileum. Ulcerative colitis, on the other hand, invades essentially only the colon. Also in Crohn’s disease or ulcerative colitis, the extent of the lesion varies, as does the size of the invasion and the impact on the patient’s nutritional metabolism. In mild cases, the difference may be less than normal, while in severe cases the patient’s life may be at risk. Both Crohn’s disease and ulcerative colitis can present with impaired absorption and excessive loss of nutrients, but because small bowel lesions are seen primarily in the former, malabsorption is significantly more severe in patients with Crohn’s disease than in the latter.
The small intestine is the main site of nutrient absorption. Enzymes secreted by the small intestinal mucosa mainly break down carbohydrates, such as lactose into galactose and glucose, which are then absorbed into the bloodstream to be used by tissues and organs such as the liver. Protein is mostly digested and broken down into amino acids in the small intestine, while fat becomes fatty acids, triglycerides and cholesterol. The small intestine also secretes some proteases and lipases to break down the corresponding nutrients. All these small molecules are absorbed in the small intestine and then transported to the whole body. Iron is absorbed mainly in the upper part of the small intestine. The final small intestine is responsible for the absorption of vitamin B12, folic acid and other important hematopoietic factors. In contrast, the large intestine has a relatively simple function, mainly absorbing water that has not been absorbed by the small intestine. Therefore, it is not difficult to understand that in inflammatory bowel disease, especially those with lesions in the small intestine, the digestion and absorption of the above-mentioned nutrients can be serious.
Third, the dietary management and nutritional support of patients with different conditions In order to ensure the nutrition of patients with inflammatory bowel disease, but also to avoid overloading the gastrointestinal tract digestion and absorption and exacerbating inflammation, various dietary formulas and nutritional support treatment measures have been studied and designed. For patients with extensive lesions, severe disease, and complications that cannot be addressed by a gastrointestinal diet for nutritional intake, a special diet, or total parenteral nutrition, is required. The latter is a nutritional support treatment that does not go through the gastrointestinal tract at all and relies only on intravenous input.
1. Diet and nutrition for patients in remission or mild disease The so-called patients in remission or mild disease mainly refer to those who have no fever, diarrhea only 3 times a day or less, no or little blood in the stool, and basically normal hematocrit, hematocrit and C-reflective protein on blood tests. Nonetheless, their dietary management should be taken very seriously. It is important to have adequate nutritional intake to ensure the repair of intestinal lesions, but also to avoid an inappropriate diet that promotes disease activity. Patients should doctors and dietitians often communicate information and obtain guidance on diet and nutrition, and should not think that the disease is recovered and the diet can be carefree.
2, the acute activity of the nutrition should pay special attention to reduce the load of the intestinal tract. For patients who can take orally, they should be encouraged to take orally to meet the basic nutritional intake, from less to more, and gradually achieve adequate nutritional supply. Liquid nutrition of different flavors should be provided to suit the requirements of different patients. In addition, patients should be ensured to have adequate daily fluid (water) intake. The amount and rate of nutritional fluid intake and changes in abdominal symptoms and urine output should be monitored and recorded in detail. It is also important to choose a liquid diet with a certain limit on fat for a certain period of time, depending on the situation, and later, depending on the condition, medium-chain fat can be added gradually. If a high-molecular liquid diet is not tolerated, a low-molecular liquid diet is substituted. If diarrhea and blood in the stool are very severe, or if the symptoms worsen after oral liquid nutrition, total parenteral nutrition must be implemented. Patients should also have the opportunity to discuss with their physician and dietitian to develop a diet that is appropriate for them.
Fourth, patients need to do a few things 1, keep a good course diary and diet diary management of inflammatory bowel disease requires long-term cooperation between patients, doctors and dietitians. Since most patients do not live in the hospital or occasionally stay in the hospital for an episode. Therefore, it is important that patients and their families monitor their condition during the time they are away from the hospital, and that they have records that truly reflect objective changes in their condition. Only when this is done can the doctor fully grasp the changes in the patient’s condition and propose just the right individualized and rational treatment for the patient’s disease.
2.The significance and method of accurate weight measurement Weight is an important indicator reflecting nutritional status and development. Patients with good nutritional status are more able to tolerate the damage brought by disease and inflammation to the organism. If the weight is insufficient, during acute relapse, the affected will lose more weight, making the lesion more difficult to repair. Therefore, patients with inflammatory bowel disease should maintain a normal or near-normal weight (calculated as the ratio of height to weight) as much as possible, and not less than 20% of the standard weight. Some patients may exceed the normal weight standard. If they are mildly overweight (e.g., 10%), they do not need to lose weight through a restrictive diet. These patients are more fortunate and can have more energy stores conducive to repair or cope with more exertion.
3. Find the cause and address the food intolerances Improper diet can promote or exacerbate inflammatory bowel disease. The problem is that it is not possible to identify and tell which food or its preparation is intolerant to a particular patient and which food causes discomfort such as abdominal pain, bloating and diarrhea. Some articles will list a number of foods that may be intolerant. Every patient reacts differently to food, but it is important not to fear and resist certain foods without basis. This is not conducive to nutritional intake. Therefore, the solution is for the patient to be attentive and to look for and identify the foods that he or she cannot tolerate. Reduced doses of corticosteroids may cause discomfort of one kind or another. At this point, do not mistake it for food intolerance.
4. Be proactive in keeping in touch with your own physician and dietitian Patients with inflammatory bowel disease have different conditions. Even for a specific patient, the condition changes from period to period. This requires constant adjustment of the patient’s medication and dietary management. There should be open and frequent contact between the patient and the physician, including the dietitian, to exchange information in a timely manner. Patients should accurately and promptly report their condition and diet management to the physician without fear of hassle, and regularly or irregularly monitor relevant indicators; the physician should constantly guide the patient’s diet management, nutritional intake and medication according to the changing condition.