Ch. 22: CHO and FatModified Diets for Malabsorption

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Ch. 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

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90-95 of Nutrient Absorption takes place in the
first half of the Small Intestine
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Malabsorption Syndromes affect Fat more
Frequently than Carbohydrate or Protein
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Fat 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

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Fat-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

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Possible Causes of Malnutrition in Malabsorption
Syndromes
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Carbohydrate 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

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MNT 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

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Hidden 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

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Typical Gastric Surgery Resections
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MNT 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

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The Dumping Syndrome
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Nutritional 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

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Gluten-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

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Gluten-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

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Fat 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

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Fat-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

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Summary 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.

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Summary - 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.

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Sample Test Question

• Which of the following is NOT eliminated on a
  gluten-restricted diet?
• A. Rye
• B. Barley
• C. Rice
• D. Wheat