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Nutrition for PSC and IBD
Laura E. Matarese, MS, RD, LDN, FADA, CNSD
Director of Nutrition
Intestinal Rehabilitation and Transplant Center
Thomas E. Starzl Transplantation Institute
University of Pittsburgh Medical Center
Objectives
z Describe
the basic principles of healthy
eating
z Provide ideas for healthy snacks
z Provide suggestions for maintaining healthy
weight
z Review vitamin, mineral and electrolyte
supplementation
Are you a nutritional nightmare?
Do you consider ketchup to be a
vegetable?
Is your idea of a fruit serving a
banana split sundae with extra hot
fudge sauce?
Do you often use cola and potato
chips as a meal replacement?
If you answered yes to any of these questions,
you might be a nutritional nightmare!
The Importance of Good Nutrition
z Good
nutrition is essential for good health
and to prevent nutritional deficiencies
z A healthy diet will give you energy to do
the things you want to do
z Good nutrition does not mean you have to
sacrifice flavor and enjoyment
What is a "Healthy Diet"?
z
The Dietary Guidelines describe a healthy diet as
one that
z
Emphasizes fruits, vegetables, whole grains, and
fat-free or low-fat milk and milk products;
Includes lean meats, poultry, fish, beans, eggs, and
nuts; and
Is low in saturated fats, trans fats, cholesterol, salt
(sodium), and added sugars.
z
z
New Food Guide Pyramid
Simple vs. Complex CHO
LIMIT
z Sugar
z Candy
z Cakes, cookies, pies
z Regular soda pop
z Jelly, jam, syrup
z Ice cream, sherbet
z Sorbet
INCLUDE
z Pasta
z Potato
z Breads
z Cereals
z Whole grains as
tolerated
z Fruits and vegetables
as tolerated
What is low-carb?
Impact Carb Fact
Total Carb 26g
Fiber -1g
Sugar Alcohol -18g (sorbitol, mannitol)
Glycerine -3g
Total Net Carbs* = 4g
“The fiber and sugar alcohol have a
minimal effect on blood sugar. For
those watching their carb intake, count
only 4g”
www.Dr.Soy.com
But, sugar alcohols may cause
diarrhea so it is best to avoid these
Types of foods and the way
the food is consumed affects
absorption…
2400 kcal, 50% CHO, 20% Protein,
30% Fat
Breakfast
Breakfast
z 1 cup oatmeal
z 8 oz orange juice
z 2 oz lactose-free milk
z 1 cheese and fruitz 1 egg
filled Danish
z 1 English muffin
z 2 tsp margarine
z 1 tsp diet jelly
z 4 oz coffee
Morning Snack
z 1 bagel w/½ oz cheese
z 1 tsp margarine
z 1 small banana
Byrne et al., NCP 15:309, 2000
z 4 oz water
2400 kcal, 50% CHO, 20%
Protein, 30% Fat
Lunch
z 3 oz baked ham
z ½ cup cooked rice
z ½ cup carrots
z 2 small dinner rolls
z 2 tsp margarine
z 4 oz water or diet soda
Lunch
z 1 thin slice cheese
pizza
z 12 oz regular soda
Byrne et al., NCP 15:309, 2000
2400 kcal, 50% CHO, 20% Protein,
30% Fat
Dinner
z 4 oz roasted chicken
z 1 large baked potato
z 2 dinner rolls
z 2 tsp margarine
z 4 oz water or diet soda
Evening Snack
z 1 roast beef sandwich
z 2 slices bread, 1 oz meat,
1 tsp mayo
z 1 tsp mustard
z 1 oz pretzels
z 4 oz water or diet soda
Dinner
z 12 oz T-bone steak
z 1 large baked potato
z 1 cup spinach
z 12 oz beer
Evening Snack
z 3-4 cups popcorn
z 1 cup raspberry sorbet
z 12 oz diet soda
Byrne et al., NCP 15:309, 2000
Healthy Snacks
No Refrigeration Required
z Nutrigrain bars
z Fruit (e.g. banana w/peanut butter)
z Peanut butter and crackers
z Nuts (as tolerated)
z Pretzels
z ½ Peanut butter and jelly sandwich
Healthy Snacks
Refrigeration Required
z Half sandwich (with meat)
z Cheese and crackers
z Cottage cheese
z Yogurt
z Hard boiled egg
z Raw vegetables as tolerated (serve with humus or
low fat dressing)
Low-fat diet
z Use
non-stick pans and cooking sprays
z Bake, broil or boil
z Select the “heart-healthy” entrees in
restaurants
Does this mean an end to those
late night potato chips??
A few potato chips now and then are fine. But they
should not be used as a meal replacement!
Alcohol and caffeine
Alcohol
z Toxic to the liver in large amounts
z Inhibits folic acid absorption
z Irritant to the GI tract
z Best to avoid alcohol
Caffeine
z GI stimulant
z Causes calcium excretion
z Limit or avoid colas, coffee, some teas and chocolate
So what’s a person supposed to
drink?
z Oral
rehydration solution
z Fruit juice as tolerated
z Low fat milk as tolerated
z Bottled water
z Ice tea with sugar substitute, lemon, mint
z Diet soda pop
z Decaffeinated tea or coffee
Maintaining a Healthy Weight
z Eat
at least 3 times a day. Smaller meals
spaced throughout the day will reduce the
urge to snack.
z Don’t skip breakfast
z Bake, broil, grill, poach, or steam
z Choose, healthy low-fat snacks
z Pay attention to portion sizes
Watch those portions!
Cheating guidelines
Maintaining a Healthy Weight
z Eat
more fruits, vegetables and whole grains
z Limit fatty foods
z Remember “low-fat” does not necessarily
mean “low-calorie”
z Read labels
z Exercise more
Reading Labels
Duodenum
absorption of
amino acids
iron, mono and
disaccharides
Jejunum
absorption of
Ca, folate, D, E,
A, K, H2O & Na,
FFA,
monoglycerides
Ileum
absorption of
larger amts of
H2O & Na, B12,
intrinsic factor,
and bile acids
CMAJ 166(10): 2002
Colon
absorption small
amounts of
H2O, lytes, and
bile acids
Fat-soluble vitamins
z Vitamin
A: 50,000 IU daily for 1 month,
followed by a maintenance dose based on
serum levels of retinol
z Vitamin D: 25,000 to 50,000 IU two to
three times a week
z Vitamin E: 800 to 1200 mg of alphatocopherol daily
z Vitamin K: 5 mg/day by mouth
Calcium
z 1500
mg/day in divided doses and vitamin
D (800 IU/day) to prevent osteoporosis
Supplement Form
z Pill
or capsule
z Chewable
z Liquid
z Dose and type is individualized
Magnesium Supplements
Brand
Mag-Tab
SR
Magonate
Anion
% Mg Readily Calcium Strong
Absorbed Sparing Cathartic
L-Lactate
10
_
√
√
Dihydrate
Gluconate
6
_
_
√
Slow-Mag Chloride
12
√
_
√
MagOx
Oxide
60
_
_
√
UroMag
Oxide
60
_
_
√
Fluid and Electrolytes
Oral Rehydration Solutions
Sodium-glucose Co-transport
Oral Rehydration Solutions
Sodium Balance with Short Bowel Syndrome
Rodriguez CA et al. Clin Sci 1988;74(suppl18):69
Oral Rehydration Solutions
Na
mMol/L
WHO-ORS
90
Rice-based
90
Pediatric solution
50
Sports Drink
20
Ginger ale
3
Apple juice
3
Chicken broth
250
Carbohydrate *
g/L
20
40
20
60
90
124
0
Osmolality
mOm/kg
310
260
270
380
540
730
450
*All contain glucose except rice-based solution
Oral Rehydration Solutions
Company
Pediatric
oral
25
Na/L
(mEq)
45
Parent’s
Choice
Jianas (816- WHO 421-2880) ORS
Mead
Enfalyte
Johnson
Ross
Pedialyte
25
45
2.77
20
90
0.55
32
78
7.38
25
45
4.49
Cera
20
CVS
Product
Walmart
Ceralyte
CHO g/L
70 & 90
Approximate
Cost/L $
3.99
3.15
Oral Rehydration Solutions
How much?
z Oral intake must exceed ostomy output
z 1.5- 2 liters (50-66 oz) throughout the day
z Some people may require as much as 3
liters (99 oz)
Food is the best means of
nutrition support
z The
most nutritionally complete
z The most physiologically appropriate
z The most psychologically supportive
z The most socially acceptable
z The best
Eat, drink, and be healthy!
The University of Pittsburgh Medical Center