Title: Ch. 22: CHO and FatModified Diets for Malabsorption
1Ch. 22 CHO and Fat-Modified Diets for
Malabsorption
- Take Handouts of Diets
- Malabsorption Syndromes
- Which nutrients and degree of malabsorption
dependent on amount and location of the intestine
that is affected. - Multiple nutrients can be affected by
malabsorption - Restrictive diets add to risk of nutrient
deficiencies
290-95 of Nutrient Absorption takes place in the
first half of the Small Intestine
3Malabsorption Syndromes affect Fat more
Frequently than Carbohydrate or Protein
4Fat Malabsorption
- Caused by multiple disorders
- Nutritional results of fat malabsorption
- Loss of kcalories weight
- Loss of fat soluble vitamins and EFA
- Loss of calcium and magnesium
- Increases nutrient needs
- Kidney stones from Ca malabsorption
5Fat-modified Dietsfor Malabsorption Syndromes
- The Four Fs of Steatorrhea
- Pancreatic Enzyme Replacements
- Medium-chain triglycerides (MCT) portal vein
absorption - Refer to Handout on Low Fat Diet
6Possible Causes of Malnutrition in Malabsorption
Syndromes
7Carbohydrate Restricted Diets - Lactose
- More of the Worlds population are Lactose
intolerant than not - Deficiency of enzyme lactase
- Lactase activity decreases with age
- Temporary r/t ABT therapy, surgery, etc.
- Undigested Lactose draws in water to the gut
results in - Cramping
- Distension
- Diarrhea
- Flatulence
8MNT for Lactose-Restricted Diets
- Check medications - they may contain lactose!
- Give milk with other foods
- Rx for Lactaid
- Use of Commercial Products sweeter
- Some foods may be better tolerated chocolate
milk, ice cream hard cheeses - Fermented milk products - yogurt
- Refer to Handout on Low Lactose Diet
9Hidden Sources of Lactose
- Clients unable to tolerate even small amounts of
lactose need to avoid foods containing any of the
following ingredients - Buttermilk
- Cheese flavors
- Curds
- NFDM
- Lactose
- Malted milk
- Milk or milk solids
- Sweet or sour cream
- Whey but not Whey Protein Concentrate
10Typical Gastric Surgery Resections
11MNT s/p Gastrectomy
- Immediately following surgery NPO
- NCS Clear Liquid Diet - broth, unsweetened
decaff coffee or tea, sugar-free gelatin water - Stage 1 NCS Puree Diet blenderized foods, no
bread, focus on protein fluid needs - Stage 2 NCS Soft Diet soft grains, canned
fruits, cooked vegetables, soft moist meats,
limited fats - Stage 3 NCS Regular Diet focus on nutritious
foods that are tolerated avoid soda, sugars
fats
12The Dumping Syndrome
13Nutritional SEs of Gastrectomy
- Dumping Syndrome
- Reactions after eating foods high in sugar
- Sweaty, shaky, nauseated, cramps, diarrhea
- Prevention - pg. 549
- Possible Nutrient Deficiencies
- Vitamin B-12
- Iron
- Calcium
- PCM
14Gluten-Free Diets
- Celiac (SEE-lee-ack) disease a sensitivity to a
part of the protein gluten that causes flattening
of the intestinal villi and malabsorption also
called gluten-sensitive enteropathy or celiac
sprue. - Gluten (GLUE-ten) major protein found in wheat.
- Gliadin (GLY-ah-din) the fraction of gluten that
causes the toxic effects in celiac disease. - Other grains - B.R.O.W. not tolerated
15Gluten-free Diet
- Disorder had been underdiagnosed
- Blood test vs. biopsy now available
- Several specialty products available in stores
on-line - Can have potatoes, corn, tapioca
- Review handout on Gluten-free diet
16Fat Malabsorption
- General modifications
- Treat underlying cause surgery, drugs
- Fat modificationlow-fat products
- Enzyme replacement
- MCT replacement
- Small meals
- Water soluble forms of fat-sol vitamins
- Limit foods high in oxalates
- Modify for increased acceptability
17Fat-Modified Diets Surgery
- Intestinal Surgeries and Short-Bowel Syndrome
- Removal of part of small intestine resulting from
inflammatory bowel, cancer, obstructions,
diverticulitis, etc. - Short-bowel or short-gut syndrome
- Remaining portion gets longer, thicker and wider
to increase absorptive surface and becomes more
efficientmay take up to a year - High carbohydrate50--60 and limited in simple
sugars - lower in fat20 at first
- Blind Loop Syndrome
- Bacterial Overgrowth
18Summary CHO Restricted Diets for Malabsorption
- Diets used to treat malabsorption include the
lactose-restricted diet, the postgastrectomy
diet, and the gluten-free diet. - Lactose-restricted diets, help control the
diarrhea and pain associated with lactose
intolerance. - Postgastrectomy diets limit simple carbohydrates
to minimize malabsorption following gastric
surgery. - Gluten-free diets eliminate wheat, barley, rye,
and possibly oats. - Strict adherence to a gluten-free diet reverses
the intestinal damage that leads to malabsorption
in celiac disease.
19Summary - Fat Restricted Diets for Malabsorption
- Fat-modified diets can help minimize fat
malabsorption and its consequences. - For extra kcals, some of the fat can be supplied
as MCT, which are easier to digest and absorb
than LCT. - Bacterial overgrowth leads to fat malabsorption
by altering the bile salts necessary for their
absorption. - Fat malabsorption is more likely to occur from
intestinal surgery when the ileum and ileocecal
valve must be resected.
20Sample Test Question
- Which of the following is NOT eliminated on a
gluten-restricted diet? - A. Rye
- B. Barley
- C. Rice
- D. Wheat