Nutrition therapy for chronic inflammatory colon diseases

Until some time ago it was assumed that the large intestine mainly absorbs sodium and water to prepare the intestinal contents for excretion. Today, however, there are findings that during a so-called “post-digestion” high-energy food components that were not utilized in the small intestine are broken down by intestinal bacteria and absorbed by the intestinal wall. This aspect of energy reserve or energy conservation plays a subordinate role in the industrial society with its food abundance.

In the Third World, however, the absorption of energy-rich compounds in the large intestine is estimated to account for 15 – 20 % of the total energy intake. Moreover, it was previously assumed that dietary fiber is excreted from the food unchanged and only increases the stool volume through swelling. Today we know that they are broken down in the large intestine (with varying intensity depending on the type).

Short-chain fatty acids from bacterial carbohydrate and protein breakdown also have a decisive influence on the inner milieu of the large intestine and are quickly and almost completely absorbed by the intestinal wall together with sodium and water. Due to this fact they have a preventive effect against diarrhea. There are great differences in the frequency of both diseases between the industrialized countries and the countries of the third world.

It can be concluded that too much sugar and too little dietary fiber are significantly involved in the development of the diseases. In Crohn’s disease patients, an increased consumption of sugar has indeed been demonstrated, but not in ulcerative colitis. Fiber intake does not seem to play a major role in this case.

The potentially disease-promoting intake of trans fatty acids (contained in chemically hardened fats such as some margarines) and of baker’s yeast is also being discussed. In addition, Betrofene, which were not breastfed as an infant, may have a higher risk of falling ill. In ulcerative colitis there is no evidence of a connection between nutritional factors and the development of the disease.

It has only been observed that the absorption of a short-chain fatty acid (butyrate) in the colon is disturbed in ulcerative colitis. All these facts for the emergence of chronically inflammatory intestine illnesses by nourishing factors are not however doubtlessly provable. Inpatients and outpatients with chronic inflammatory bowel diseases often show general malnutrition.

In children and adolescents, this leads to reduced length growth and delayed puberty. The following conditions contribute to malnutrition: Loss of appetite, unbalanced diet, failure to tolerate certain foods, vomiting, reduced absorption capacity of the diseased intestine, loss of bile acids and side effects of medication. This leads to weight loss, reduction of certain blood proteins (albumins), anaemia and often to a reduction of the following vitamins in blood serum: vitamin B 12, vitamin D, folic acid, iron, calcium, potassium, magnesium, zinc.

All these vitamins and trace elements can be supplied in tablet form or by injection. The value of artificial nutrition for improving the nutritional status is beyond doubt. Formula diets are therefore used in acute cases.

These are ready-prepared drinking or tube feeds. They are easily digestible, low in fiber and meet the requirements. In Crohn’s disease, this results in a better nutritional status and positive effects on the intestinal mucosa.

In ulcerative colitis patients, there are no reliable data on the value of a formula diet in acute phases. In this case, minerals and fluid are supplied by means of an infusion. The basis is the therapy with cortisone.

Additional artificial nutrition via infusion improves the nutritional status, but has no influence on the course and inflammatory activity of the disease. The omega-3 fatty acids contained in fish oil apparently have an anti-inflammatory effect in the area of the intestinal mucosa. They can be given in the form of capsules in a dosage of 5 g omega-3 fatty acids per day.

However, results in this respect must be further substantiated before a corresponding recommendation can be made. Until now, a diet low in fiber and rich in sugar has been considered one of the factors that promote the development of Crohn’s disease. However, there are also studies that show no difference to a normal mixed diet.Foods such as milk, wheat products and citrus fruits can in some cases aggravate the symptoms.

However, it is questionable whether avoiding these foods in general reduces the frequency of acute attacks and prolongs the period without symptoms. In 15% of patients with Crohn’s disease, intolerance of certain foods has been found. Food allergy was ruled out as the cause.

This makes it clear that there is currently no reliable data on a specific diet that could be followed during the symptom-free period to prevent the occurrence of a new relapse. We recommend a light, wholesome, varied whole food diet that only takes into account individual intolerances. Acute relapse: tube feeds lead to a considerable improvement in the nutritional status of patients with Crohn’s disease and in certain cases can have a positive effect on the healing of intestinal fistulas.

Otherwise, an artificial diet has no effect on the inflammatory activity in the intestinal mucosa. In ulcerative colitis with impending complications and prior to surgery in Crohn’s patients, exclusively artificial nutrition via an infusion is necessary. In cases of general malnutrition and deficiency of certain nutrients: Artificial nutrition via a stomach tube or, if not possible, an infusion.

In the case of chronic oozing bleeding in the intestinal area, iron intake in tablet form. If the lower part of the small intestine is removed by more than 100 cm, the administration of vitamin B 12 is necessary. In case of a proven zinc deficiency, zinc must be given in tablet form.

There is no clear evidence of the effectiveness of nutritional therapy that prolongs the pain-free period between attacks. A light full food with consideration of the individual incompatibilities can be recommended however.