Care and nutrition for patients with short bowel syndrome

The article was professionally consulted by Doctor Department of Medical Examination & Internal Medicine - Vinmec Hai Phong International General Hospital.

Nutrition for patients with short bowel syndrome is extremely important, how to ensure enough energy for the body but still help the rest of the intestine to recover and adapt after surgery. While waiting for the bowel to recover, you should follow the following nutrition guidelines for patients with short bowel syndrome:

When you have short bowel syndrome, it means that the rest of your intestines have not yet adapted to ensure the function of the digestive system. Therefore, you need to divide meals, so that the intestines can absorb nutrients from food.
You should divide into 6-8 small meals during the day. Eating small, evenly spaced meals throughout the day will help relieve pressure on the remaining bowel and not strain the anastomosis.
At the same time, meals with less food are also easier to digest and absorb faster, thereby reducing the symptoms of food stagnation in the intestinal lumen. In the process of eating, you should eat slowly and chew thoroughly, so that digestion and absorption in the intestines are easier.
Once your gut has adapted, meaning that the symptoms of short bowel syndrome are reduced, you can slowly return to the 3-meal-a-day diet.

Eating and drinking lots of liquids at the same time as meals will cause food to pass through the intestines faster, which means your intestines may not be able to digest or absorb all of the nutrients. Therefore, the best way is that you should not drink more water during meals, because you also eat broth or water from other dishes such as pho, vermicelli, noodles,...
Total amount of water you use in each meal. Meals other than dry food should not exceed 120ml (equivalent to about 1/2 a bowl of rice). If you drink soup or soup with a meal, you should divide this amount of liquid evenly during the meal time, do not drink it all at once.

MORE: How is short bowel syndrome treated?

3.1. Protein The average amount of protein for a person is 1 - 1.2g/kg body weight/day.
For example, a patient weighing 50kg will need 50-60g of protein/day. Of which, about 25-30g (50%) has been provided from cereals such as rice, bread,... So you need to provide about 25-30g more protein from protein-rich foods. On average, each 100g of protein-rich foods will provide 17-20g of protein. Thus, a patient weighing 50kg needs to eat about 150-200g of lean meat or fish per day.
Some foods rich in protein such as:
Fish Poultry: Chicken, duck Beef, pork, sheep Eggs Tofu Dairy products such as milk, cheese Pureed peanut butter and other nut butters such as almond butter ..... 3.2. Carbohydrates are low in fiber or refined Carbohydrates usually make up about 50% of the calories in a daily diet. As a patient weighing about 50kg will need about 750kcal from carbohydrates, equivalent to about 3 bowls of rice per day. If the patient eats 6 small meals a day, then 1/2 bowl of rice is enough for each meal.
Some foods contain carbohydrates such as:
White bread Cereals Peeled potatoes, sweet potatoes White rice Noodles, noodles, vermicelli. SEE ALSO: Consequences of short bowel syndrome

3.3. Moderate fat In case you have had your ileum removed, you should eat more fat in the morning and gradually reduce it at lunch and dinner.
Some foods contain fat such as:
Cooking oils Butter Mayonnaise Dipping sauces Cream sauces Salad dressings Example: You can add a little butter on top of bread or add mayonnaise to a salad . You shouldn't eat fried foods.
3.4. Eat less sugar You should practice the habit of eating not too sweet, and should not abuse artificial sweeteners in food processing.
Some foods contain sugar, including:
Sugar: Crackers, cakes, candy, chocolate, tea, milk tea, fruit juices Syrups Malt Honey 3.5. Choose fiber Fiber, especially insoluble fiber, doesn't digest and make stool bulkier, which can be dangerous when you're suffering from short bowel syndrome. Insoluble fiber is found in whole grains, brown rice, and vegetables.
Soluble fiber is usually safer, because when entering the digestive system, they will form a moderate mucus solution, which helps slow digestion, less pressure on your intestines.
Some foods contain soluble fiber such as:
Oats Barley Soy

Dried nuts Fruits Beans and seeds Jute Vegetables Spinach Fiber supplements - psyllium Foods low in soluble fiber such as:
Wheat nuggets, rice nuggets, corn cereals and other grains. White rice White bread, whole grain bread. Potatoes in water or mashed with skins removed Foods containing insoluble fiber to avoid include:
Whole wheat bread, whole grain crackers, whole grains and other whole grain products. Wheat Whole grains. Fruit peels and seeds Dried fruits.

A person's daily water requirement is calculated by multiplying weight by 40ml. If you weigh 50kg, your daily water requirement will be 50 x 40ml = 2,000ml, equivalent to about 8 glasses of 250ml water per day.
This is the total amount of water taken into the body, including water provided through drinks and liquid foods such as soup, porridge. So you need to subtract all the water from the food to know the amount of filtered water you need to drink every day.
At the same time you also need to avoid drinks that are too hot or too cold. These types of drinks are not good for your digestive system, especially when you are experiencing short bowel syndrome.
You should also choose low-sugar drinks, this will help you reduce the risk of dehydration.

5.1. Limit lactose when lactose intolerant Lactose is a type of sugar commonly found in milk and dairy products. Symptoms of lactose intolerance such as bloating, gas, cramps, loose stools, pain in the anus, etc. These symptoms usually appear within 30 minutes of eating or drinking dairy products. milk.
If you have this condition, you should use dairy products that have had lactose removed. If you can eat yogurt, you can eat about 100ml/day.
5.2. Limit oxalate during ileostomy For patients who have had an ileostomy and with their large intestine intact, a low oxalate diet is recommended. Oxalates are found in many different foods and can cause kidney stones.
You need to avoid high oxalate foods and drinks such as:
Tea Coffee Carbonated soft drinks Chocolate Nuts Soybean products Green leafy vegetables Sweet potatoes Celery Strawberries Tangerine Rhubarb Wheat germ 5.3. How to eat vegetables After surgery to remove part of your intestines, you will have difficulty digesting undercooked vegetables. You should eat soft cooked vegetables and at first you should only eat about 1/2 bowl, then gradually increase, when eating, you need to chew thoroughly.

If your digestive symptoms are not getting worse, you can gradually increase the amount of cooked vegetables in your diet. Once your gut is stable, you can try some raw vegetables.
Vegetables that are generally well tolerated, you should choose such as:
Carrots Spinach, spinach Red beets Peeled potatoes Asparagus tops Lettuce Peeled, seeded cucumbers Sauce seeds and peeled tomatoes Pumpkins, gourds and seeds removed Vegetables that can cause bloating or discomfort you should avoid include:
Onions Broccoli, broccoli Cabbage Beans like lentils, chickpeas, red beans, lima beans Corn Kale Peas. >>See more: Nutrition therapy for short bowel syndrome in adult patients - Posted by Doctor Mai Vien Phuong - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

After surgery, your ability to eat decreases, so you may need to take an extra multivitamin a day to make sure you get enough micronutrients for your body. You should use a supplement with the right amount of micronutrients according to your needs.
Depending on your specific condition, your doctor may recommend using a higher dose of certain vitamins and minerals, such as:
When most of the ileum is removed, vitamin A, D and E should be supplemented, so use water-soluble form. When removing the terminal ileum and colon, vitamin B12 should be supplemented in the form of injections within 1-3 months.

When the ileum is removed, with the large intestine intact, the patient needs calcium supplements. Potassium is often deficient when the patient has severe diarrhea. The best way to supplement potassium is through foods such as potatoes, bananas, tomatoes, etc. Potassium supplements can cause side effects such as increased heart rate and cardiovascular risk, so Use only when prescribed by a doctor and under close supervision.

When you have loose stools several times a day, in addition to dehydration, your body may lose additional electrolytes such as sodium and potassium. At this point, you can buy rehydration and electrolyte solutions, then mix them according to the instructions, without a prescription. The total amount of water to be replenished is equal to the amount of fluid lost.
Note that this rehydration solution is not the same as sports rehydration solution.

If you are losing weight, you can take a high-calorie nutritional supplement. You need to consult your doctor or nutritionist before doing this. Since nutritional formulas have different ingredients, the choice must depend on the type of surgery, the type of metabolic disorder, and the type of malnutrition.
You may be advised to take a special supplement that is low in sugar and has pre-digested ingredients to make it easier for your body to absorb. Your doctor or dietitian may recommend medium-chain triglycerides (MCT), which is a type of fat that's easily digested and has extra calories.
If you can't eat or drink nutritional formulas, try fortified milk. It helps increase the amount of calories and protein in your diet. How to make fortified milk:
Mix 960ml fresh milk with 130 powdered milk (any milk like whole milk, 1%, 2% fat, skim milk). Mix the above ingredients thoroughly, then place in the refrigerator.

The above mixture makes 4 servings of fortified milk, each time you drink 240ml. The nutritional value you get for each drink is:
Whole milk: 230 calories and 16g protein 1% fat milk: 180 calories and 16g protein 2% fat milk: 200 calories and 16g protein Skimmed milk: 160 calories and 16g protein.

Keeping a daily food diary is very important, it is useful to find out what foods are best for you. The food diary should contain the following information:
Time of meals, snacks or drinks. Name of food and drink Amount of food and drink used. Symptoms encountered (if any). In case you have an ileostomy or have an ostomy, you need to record the amount of stool you pass for 1 week. When the amount of stool is stable, there is no longer a difference between the days, then only need to record once a month, each time checking 1-2 days. This information you need to bring with you when you return for a check-up.