Comprehensive modified diet simplifies nutrition management of adults with short-bowel syndrome.
Lykins TC. Stockwell J.
Tallahassee Memorial Regional Medical Center, Marriott Corporation, Fla, USA.
Short-bowel syndrome (SBS) is a complex condition resulting from massive surgical resection of the intestinal tract. Nutrient malabsorption and metabolic alterations occur as a function of the portions of bowel removed and the length of remaining bowel segment. The nutrition management of SBS is challenging; many dietary restrictions are described, but inconsistently, throughout the literature. We compiled the restrictions and developed a comprehensive diet to reestablish adult patients with SBS on oral intake after surgery. Our purpose was to simplify the task of instructing patients with SBS in a diet that restricts all categories of food substances that may be poorly absorbed: fat, lactose, insoluble fiber, oxalates, and concentrated sweets. Suggestions to increase the transit time of ingested foods are included with the diet. Patients are taught the SBS diet after surgery and have bimonthly contact with the dietitian after leaving the hospital. Categories of restricted food substances, such as lactose, may be attempted and added back to the diet if they are tolerated. Bowel adaptation enhances tolerance to various dietary components over time. If sufficient bowel adaptation occurs, some patients are eventually able to return to an unrestricted diet.
Allaying fears and fallacies about lactose intolerance.
McBean LD. Miller GD.
National Dairy Council, Rosemont, Ill., USA.
Public awareness and misunderstandings of lactose intolerance are at an all-time high. Many people erroneously believe they are lactose intolerant or develop gastrointestinal symptoms after intake of lactose. Consequently, lactose-containing foods such as milk and other dairy foods may be eliminated unnecessarily from the diet. Because these foods are a major source of calcium, low intake of them can compromise calcium nutriture. This, in turn, can increase the risk of major chronic diseases such as osteoporosis (porous bones) and hypertension. This review is intended to help dietetics professionals alleviate clients' fears about lactose intolerance and recommend dietary strategies to improve tolerance to lactose. Scientific findings indicate that the prevalence of lactose intolerance is grossly overestimated. Other physiologic and psychologic factors can contribute to gastrointestinal symptoms that mimic lactose intolerance. Scientific findings also indicate that people with laboratory-confirmed low levels of the enzyme lactase can consume 1 serving of milk with a meal or 2 servings of milk per day in divided doses at breakfast and dinner without experiencing symptoms. Several dietary strategies are available to help lactose maldigesters include milk and other dairy foods in their diet without experiencing symptoms.