Crohns & Colitis - 5 Flashcards
What is Crohn’s disease?
A type of inflammatory bowel disease (IBD) characterized by chronic inflammation of the gastrointestinal tract.
What symptoms did Sabrina experience after eating?
Abdominal bloating, cramping, and pain.
What dietary changes did Sabrina try to alleviate her symptoms?
Eliminating all vegetables, many fruits, red meat, and dairy.
Did Sabrina’s dietary changes successfully improve her condition?
No, her cramps and pain continued despite her efforts.
What type of diet was Sabrina advised to follow?
A low-fiber diet.
True or False: Foods can cause or cure IBD.
False.
What is the role of nutrition in managing IBD?
Maintaining general health, managing symptoms during disease flares, and contributing to quality of life.
What should individuals with IBD avoid in their diet?
Foods that are difficult to digest, such as corn and potato skins.
Who should individuals with IBD consult for dietary advice?
A registered dietitian (RD).
What is the difference between a registered dietitian and a nutritionist?
Registered dietitians have completed specific education and internship programs, while nutritionists may not have minimum qualifications.
What can happen if individuals avoid foods without scientific evidence?
It can affect their relationship with food and result in serious health consequences.
What does the term ‘anorexia’ mean in the context of IBD?
Loss of appetite and the inability to eat enough to maintain weight.
What are some common symptoms of malnutrition?
Weight loss, loss of appetite, muscle weakness, changes in skin, hair, nails, gums, eyesight, or mood.
What are the risk factors for malnutrition in individuals with IBD?
Inadequate intake of nutrients, increased nutrient requirements, malabsorption of nutrients, increased losses of electrolytes, minerals, trace elements, and proteins.
Fill in the blank: The most common indicator of malnutrition is _______.
significant loss of body weight.
What dietary guidelines should people with IBD follow?
Individualized diets that consider personal tolerances, preferences, and health goals.
What can contribute to systemic inflammation in IBD?
Cytokines produced in the inflamed intestine.
How can diet help prevent malnutrition?
By ensuring adequate intake of calories and essential nutrients.
What is the purpose of a nutrition plan for individuals with IBD?
To manage illness and achieve desired health outcomes.
What is the significance of individualized diets for IBD patients?
They are tailored to the unique needs, tastes, and health conditions of each individual.
What should individuals do if they experience symptoms associated with malnutrition?
Mention them to their doctor as soon as possible.
What is a key dietary recommendation from Canada’s Food Guide?
Make half your plate fruits and vegetables.
True or False: There is a single diet that works for everyone with IBD.
False.
What role does diet play in the prevention of long-term complications in IBD?
It contributes to maintaining nutritional status and overall health.
Fill in the blank: Diet can also help with _______ management during disease flares.
symptom.
What is the recommendation for the proportion of fruits and vegetables on your plate?
Make half your plate fruits and vegetables.
What type of grains should you aim to include in your diet?
Make at least half your grains whole grains.
What type of milk should you switch to according to dietary recommendations?
Switch to fat-free or low-fat (1%) milk.
What should you compare when choosing foods like soup, bread, and frozen meals?
Compare sodium in foods and choose the foods with lower numbers.
What is a healthier alternative to sugary drinks?
Drink water instead of sugary drinks.
If IBD is under control, what dietary guidelines should be followed?
Follow the USDA MyPlate Food Guidance System or Canada’s Food Guide.
What is the role of diet in relation to IBD symptoms?
Diet plays an important role in maintaining nutritional status and symptom management.
What questions should you ask to determine if you need to modify your diet?
- Is my disease active or under control right now? * What symptoms am I currently experiencing? * What part or parts of my bowel are affected? * Are there any complications from my disease? * What effect does my treatment have on nutrient requirements? * Do my medications interact with nutrients? * Has surgery affected the amount of remaining bowel available for absorption?
What are the specific goals of diet modifications?
- Normalize bowel function * Minimize GI intolerance symptoms * Maintain hydration and electrolyte balance * Maintain or improve nutritional status * Continue or resume social participation and enjoyment
What are elimination diets?
Elimination diets significantly restrict or exclude one or more foods or major food groups.
What is the scientific consensus on the value of exclusion diets in IBD?
The value of exclusion diets has not been scientifically proven in IBD.
What are potential long-term consequences of following exclusionary diets?
- Development of nutrient deficiencies * Weight loss * Malnutrition * Food phobias or obsessions * Loss of enjoyment of eating
What is lactose intolerance?
Lactose intolerance is when your body cannot adequately digest the milk sugar lactose.
What causes lactose intolerance?
Lactase deficiency, which is the lack of the enzyme needed to break down lactose.
What are the classic symptoms of lactose intolerance?
- Bloating * Cramping * Gas * Diarrhea
What factors can contribute to lactose intolerance?
- Genetics * Acquired factors
What is primary lactase deficiency?
A natural decline in lactase production as we age.
Which ethnic groups are more likely to experience lactose intolerance?
- African * Jewish * Asian
What is secondary lactase deficiency?
A deficiency in lactase enzyme due to external factors such as medical treatment or disease.
What test is commonly used to diagnose lactose intolerance?
A hydrogen breath test.
What is a dose-dependent effect in relation to lactose consumption?
Many individuals can still consume small amounts of dairy, just not as much as before.
What does the lactose ladder indicate?
It lists dairy products and their lactose content from lowest to highest.
What are some hidden sources of lactose?
- Processed meats * Gravies * Breads * Cereals * Salad dressings * Cake mixes * Margarine
What is the recommended daily intake of calcium for adults?
1000 to 1300 mg per day, depending on age and gender.
What are some important nutrients for bone health besides calcium?
- Vitamin D * Phosphorus * Magnesium * Fluoride
What should individuals with IBD consider if they restrict dairy?
They need to consider increasing calcium and vitamin D intake from other sources.
What are enzyme supplements used for?
To help break down lactose for individuals who are lactose intolerant.
What is the impact of oxalates and phytates on calcium absorption?
They bind to minerals like calcium, reducing their bioavailability.
What compounds reduce the absorption of calcium from plant-based sources?
Oxalates and phytates
Oxalates are found in dark green leafy vegetables, while phytates are found in whole grains, nuts, seeds, and legumes.
How many servings of milk products are recommended for adults to obtain enough calcium?
Two to four servings per day.
What is the calcium content in 1 cup of cow’s milk?
285–330 mg.
What should you consider if you cannot improve your calcium intake from food?
Calcium supplements with vitamin D.
What is the calcium content in fortified soy milk?
300 mg per 1 cup (250 mL).
What is the recommended maximum elemental calcium dosage at one time for optimal absorption?
No more than 500 mg.
What role does vitamin D play in calcium absorption?
Helps your body absorb calcium.
What factors can influence the body’s ability to produce vitamin D from sunlight?
Geographic location, time of year, age, skin color.
True or False: Cottage cheese is a good source of vitamin D.
False.
What is the revised recommended amount of vitamin D intake for adults according to the IOM in 2010?
600 to 800 IU.
What are some food sources of vitamin D?
- Cow’s milk
- Fortified soy milk
- Fortified orange juice
- Salmon
- Mackerel
- Sardines
What can excessive intake of water-soluble vitamins lead to?
Expensive urine.
What is a symptom of calcium and vitamin D deficiency in individuals treated with steroids?
Need for additional calcium and vitamin D.
What is the absorption location for vitamin B12?
Terminal ileum.
Fill in the blank: If you have Crohn’s disease affecting the terminal ileum, you most likely require _______ supplements.
Vitamin B12.
What should you do if you suspect you need to supplement specific nutrients?
Talk to your doctor.
What is the best way to determine if you need a multivitamin supplement?
Identify which food groups are not well represented in your diet.
What are some key micronutrients that may require supplementation?
- Calcium
- Vitamin D
- Iron
- Vitamin B12
- Folic acid
What type of calcium supplement should be chosen?
Those that also contain vitamin D.
What should you check on the labels of fortified foods?
Whether the fortification is with vitamin D3 and not vitamin D2.
What is the calcium content in 1 cup of fortified orange juice?
100 mg.
What is the recommended serving of salmon for vitamin D intake?
3 oz (90 g), cooked.
What is the role of vitamin K in the body?
Essential for blood clotting and bone health.
What should individuals on high-dose steroids consider regarding protein intake?
They may need extra protein.
What is a common source of vitamin D that should be avoided due to potential contaminants?
Cod liver oil.
What is the calcium content in 1 cup of cooked spinach?
130 mg.
What is the primary benefit of a well-balanced diet?
Good health and nutrient variety
A well-balanced diet can usually be eaten even if you have IBD.
What are standard adult multivitamins typically used for?
Meeting general nutrient needs
Special versions exist for specific groups, like prenatal or ‘silver’ for older adults.
True or False: Mega-doses of vitamins are usually more beneficial.
False
Excess vitamins are excreted or stored, which can be harmful.
What act regulates dietary supplements in the United States?
Dietary Supplement Health and Education Act (DSHEA) of 1994
Companies are responsible for the safety and claims of their supplements.
What should you look for in Canada to ensure a supplement is safe?
D.I.N. (Drug Identification Number) or G.P. (General Product) number
These indicate Health Canada approval.
What are the three types of liquid dietary supplements?
Polymeric, Semi-Elemental, Elemental
Each type has different levels of nutrient breakdown.
What is the purpose of polymeric liquid supplements?
Provide complete undigested molecules of nutrients
They are designed to mimic the form of nutrients found in food.
What are semi-elemental supplements?
Supplements with hydrolyzed protein into smaller molecules called peptides
These are easier to digest.
What distinguishes elemental supplements from other types?
Protein is hydrolyzed into free amino acids
They are designed for easier absorption.
What is the typical macronutrient distribution in most liquid supplements?
- 50% to 55% calories from carbohydrates
- 15% to 20% calories from protein
- Less than 30% calories from fat
What is a modular supplement?
A product designed to supplement a specific nutrient
Examples include Polycose (carbohydrate only) and MCT oil (fat only).
What can be a primary therapy for Crohn’s disease affecting the small bowel?
Nutritional supplements
They can help reduce inflammation and symptoms.
What is the recommended approach to taking fiber supplements?
Take them separately from other nutrients
Fiber may bind to some nutrients and interfere with absorption.
What are the two types of dietary fiber?
- Insoluble fiber
- Soluble fiber
What is the main function of soluble fiber?
Helps gel loose bowel movements and lowers cholesterol
It is fermented by bacteria in the large intestine.
What is the consequence of a long-term low-fiber diet?
Challenges in ensuring adequate vitamins and minerals
It may necessitate reliance on canned, cooked, or juiced fruits and vegetables.
What should you look for to avoid unhealthy juice cocktails?
Labels stating ‘100% fruit juice’ or ‘100% juice blends’
These provide more vitamins and natural antioxidants.
What is fiber?
Structural part of plants that human digestive enzymes cannot break down
Some bacteria can ferment it to produce short-chain fatty acids.
What is the effect of insoluble fiber on stool?
Bulks stool and relieves constipation
It increases fecal weight and speeds up intestinal passage.
What dietary changes may be recommended during an IBD flare?
Limit fiber intake
This helps recover and improve quality of life.
What foods can help increase soluble fiber in your diet?
- Oat bran
- Chickpeas
- Lentils
- Barley
- Applesauce
What are some sources of insoluble fiber?
- Skins of fruits and vegetables
- Whole wheat and whole-grain breads and cereals
- Brown or wild rice
What are some sources of soluble fiber?
- Oat products
- Pectin
- Pulp of fruits
- Legumes with outer skin peeled
What is a source of soluble fiber?
Oat bran
Soluble fiber is beneficial for digestion and can help thicken stool.
What type of flour contains the bran and germ but looks like refined flour?
White whole wheat flour
It provides the same fiber as whole wheat.
Which food product is an example of a high source of fiber?
Kellogg’s All-Bran Buds cereal
Contains 3 g of soluble fiber and 9.7 g of insoluble fiber.
What is the primary effect of wheat bran?
Promotes bowel regularity
It is a source of insoluble fiber.
What dietary change can help slow high stool output?
Increase soluble fiber
Soluble fiber can help thicken stool when included at mealtime.
Name two foods known to thicken stool.
- Cheese
- Smooth nut butters
Other examples include pretzels and potato chips.
What should be reduced to manage high stool output effectively?
Dairy lactose
Alternatives should be consumed for calcium.
What is a recommended strategy for gas reduction?
Try commercial enzyme products
Products like Beano help digest fiber without gas formation.
What is the aim of adjusting meal sizes and timing?
To reduce stool frequency
Eating smaller meals and snacks can help manage symptoms.
What is the purpose of oral rehydration solutions?
To improve fluid absorption
Examples include Gastrolyte for adults and Pedialyte for children.
What are common symptoms of dehydration?
- Fatigue
- Increased thirst
- Dry mouth
- Stomach cramps
A rapid weight loss can also indicate dehydration.
Which two electrolytes are critical for body fluid regulation?
- Sodium
- Potassium
They are essential for maintaining hydration and electrolyte balance.
List two food sources high in sodium.
- Bouillon cubes
- Canned fish
Processed foods also contain high sodium levels.
What is a potential challenge of a fluid diet?
Getting enough nutrition
Fluid diets often lack adequate vitamins, minerals, and protein.
What type of diet is better than a clear fluid diet?
Full fluid diet
It includes dairy products and is slightly more nutritious.
What should be avoided to reduce the risk of dehydration?
Caffeinated beverages
They can lead to increased urine production.
Fill in the blank: A __________ diet should generally be limited to no longer than several days.
clear fluid diet
It is not a balanced source of nutrition.
What is the role of the ileal brake mechanism?
To slow transit time of food through the bowel
It regulates how quickly the stomach empties.
What should be done if diet modifications do not yield desired effects?
Consult a doctor or dietitian
It may indicate that medical therapy is required.
What are the two types of nutrition support?
- Total enteral nutrition (tube feeding)
- Total parenteral nutrition (intravenous feeding)
They are used when there is a risk of malnutrition.
What is total enteral nutrition (TEN)?
A method of nutrition support where nutritional supplements are delivered via a feeding tube when a person cannot consume enough by mouth.
Particularly helpful in children with certain forms of IBD, especially Crohn’s disease of the small intestine.
What are the two types of nutrition support?
- Total enteral nutrition (tube feeding)
- Total parenteral nutrition (intravenous feeding)
Both types are used when there is a risk of malnutrition or progression of malnutrition.
What is the purpose of tube feeding?
To reduce inflammation in the intestine and avoid the need for medications like steroids, while also enhancing growth in children.
Tube feeding allows continued oral fluid intake.
What is total parenteral nutrition (TPN)?
A specialized form of nutrition delivered via an intravenous line, allowing the gut to rest by providing nutrients directly into the bloodstream.
TPN is used when a person cannot consume enough nutrition by mouth or tube feeding.
What are some risks associated with TPN?
- Higher risk of infection
- Blood clots
- Metabolic intolerance
- Liver or gallbladder problems
- Abnormalities in cholesterol, triglycerides, and sugar levels
TPN can also lead to psychological effects, such as missing the experience of eating.
What do synbiotics refer to?
Both prebiotics and probiotics that contribute to maintaining intestinal health.
They help keep a sufficient number of ‘good’ bacteria in the intestine.
What are prebiotics?
Nondigestible carbohydrates that are fermented by colonic bacteria, promoting the growth of ‘good’ bacteria and producing short-chain fatty acids.
Found in foods like onions, bananas, and garlic.
What are probiotics?
Live bacteria that confer health benefits when administered by mouth, promoting immune system balance and downregulating inflammation.
Commonly found in yogurts and kefir.
Fill in the blank: Omega-3 fats are ________, while omega-6 fats are ________.
anti-inflammatory; pro-inflammatory
What are the two important omega-3 fatty acids mentioned?
- Eicosapentaenoic acid (EPA)
- Docosahexaenoic acid (DHA)
EPA and DHA are primarily obtained from fish and seafood.
What is the optimal intake of omega-3 for cardiovascular disease?
1000 mg of EPA plus DHA per day.
General recommendations suggest 400 to 500 mg per day for the public.
What is immunonutrition?
A field of nutrition focused on modulating the inflammatory response through diet.
It is particularly relevant in diseases with an inflammatory component, such as IBD.
What are functional foods?
Conventional foods or those similar in appearance that demonstrate a physiological health benefit.
Examples include omega-3 eggs and fish.
What is a common concern when using fish oil supplements?
They may contain environmental contaminants.
It is advisable to check ingredient labels for safety.
What is the significance of VSL#3?
A pharmaceutical probiotic preparation that has shown promise in preventing recurrent pouchitis.
Contains eight different bacterial strains and three billion viable bacteria per gram.
What did James’s doctor suggest regarding diet and ulcerative colitis?
Diet alone cannot be relied on to prevent flares of colitis and should be combined with medication.
Consulting a registered dietitian was recommended for further diet therapy.
What are antioxidants?
Substances like vitamin E, vitamin C, carotenoids, glutathione, and selenium that may have beneficial effects on the immune system and inflammation.
Research is still at a biochemical level for specific recommendations.
What is often true about colitis flare-ups?
Colitis flare is not his fault and was not caused by a failure to stick with his diet
Flares often occur without apparent cause.
What are some examples of antioxidants relevant to IBD?
- Vitamin E
- Vitamin C
- Carotenoids
- Glutathione
- Selenium
The area of antioxidants and IBD looks promising, but studies are still at a biochemical level.
What potential benefits do antioxidants and fish oils have?
They may have beneficial effects on the immune system and inflammation
There may also be other foods or components that help maintain appropriate immune response.
What is an anti-inflammatory diet?
A dietary program recommendation that includes various foods to reduce inflammation
It ties the theory of food components into an overall dietary approach rather than single supplements.
List some foods included in an anti-inflammatory diet.
- Fish (especially higher in omega-3)
- Fruits (blueberries, blackberries, strawberries, raspberries)
- Vegetables
- Beans
- Nuts and seeds
- Olive oil
The diet avoids or limits processed foods.
What is currently being researched regarding the anti-inflammatory diet?
Whether following this type of diet will reduce inflammation in people living with IBD
As yet, there is no conclusive answer.
Is there a standard diet for IBD?
No, there is no standard diet for IBD
Diet modifications can help with symptom management.
When are diet restrictions usually applied for IBD patients?
During times of disease activity or postoperative recovery periods
Any diet modifications should be discussed with a doctor or dietitian.
What factors should be considered when making diet modifications for IBD?
- Religion
- Culture
- Ethnicity
- Beliefs
- Personal food preferences
- Tolerances
- Allergies
- Phobias
- Lifestyle
- Employment
- Sports
- Financial considerations
Diet modifications are individualized recommendations.
Fill in the blank: Any diet modifications should be discussed with your _______.
doctor or dietitian
True or False: Diet modifications for IBD are uniform for all patients.
False
They are individualized recommendations that work for each person.
