Digestive Health: Nutrition Guidelines for Patients wtih Short Bowel Syndrome HF#369

What is Short Bowel Syndrome?
Short bowel syndrome or SBS occurs when a person has lost a large portion of their bowel and is no longer able to absorb enough of the nutrients in the foods we eat.  This handout will help you choose foods and eat in a way that will allow your bowel to absorb more of the nutrients.

• Symptoms may include:

o Gas
o Cramps
o Diarrhea
o Fluid loss
o Weight loss

 

Does is matter what part of my bowel has been lost?
Yes.  There are two main sections of your bowel, the small intestine (small bowel) and the large intestine (colon).  The small bowel can also be broken down to 3 sections, the duodenum, jejunum, and the ileum.  In the “normal” bowel each section will absorb certain things.

 

Portion of the bowel	Where is it?	What is absorbed?
Duodenum	Right after the stomach	Calcium, magnesium, and iron
Jejunum	After the duodenum	Most things are absorbed here, including sodium, magnesium, and fluids.
Ileum	After the jejunum	Vitamins A, B12, D, E, and K, as well as bile salts which help absorb fat
Colon	Connects the small bowel and the rectum	Most fluids and electrolytes

 

Will the portions of the bowel that remain ever be able to absorb more fluids and nutrients?

Yes.  Over time the portions of the bowel that remain will be able to absorb more.  This will begin to happen 24-48 hours after the loss of the bowel and continue to increase for up to 1 year.  During this time it is common to have diarrhea.

 

What can I do to help my body absorb as much as it can?

• Eat 5 to 6 small meals a day.
o Eating small, frequent meals will put less stress on your shortened bowel. Small meals help control your symptoms, and will result in better digestion and absorption.
o Eat slowly and chew your food well
o Once your bowel has adapted, you can resume having 3 meals a day.

 

• Limit fluids with meals and avoid high-sugar beverages
o Only drink ½ cup (4 ounces) of fluid during each meal.  Drinking large amounts of fluid pushes your food through your bowel faster, giving it less time to digest or absorb nutrients.
o Drink fluids between meals and aim for at least 8 cups or 64 ounces of fluid per day.
o Limit or avoid drinking milk or dairy products if they cause bloating, gas, or diarrhea.
o Avoid high-sugar beverages, such as fruit juices and soda.
o Avoid caffeine and alcohol.
o If you have high stool output you should add extra fluids.  Oral rehydration solutions can be helpful to maintain fluids and electrolytes in your body.  Try Cera-Lyte®, Equalyte®, or Rehydralyte®,.

 

• Select high protein foods
o Eat foods high in protein at least 6 times per day.  Examples include meat, fish, poultry, egg, legumes, and dairy as you are able to handle it.

 

• Moderation with fats
o If you experience foul-smelling stools that appear oily and or frothy, decrease the amount of fat in your diet.
o High fat foods include oils, butter, margarine, high fat chips and crackers, and cookies.

 

• Choose complex carbohydrates
o Good choices are complex carbohydrates, such as those found in bread, cereal, pasta, potatoes, and rice.
o Poor choices are foods rich in simple sugars, such as regular soda, candies, frozen desserts, and fruit juice.

 

• Incorporate soluble fiber into your diet
o Soluble fiber may help slow movement through the bowels and result in a more formed stool.  Examples would include Benefiber® or guar gum, pectin, or foods such as oatmeal, oat bran, barley, and legumes.
o Insoluble fibers hold more fluid in the bowel and will increase diarrhea, so you may want to limit them.  Examples include bran from grains, woody vegetable stems, fruit and vegetable skins, and seeds.

 

• Be aware of oxalates
o Oxalates are organic acids that are found in food and are made by our bodies when breaking down some foods.
o Patients who have their ileum removed and have an intact colon may need to follow a low-oxalate diet.  This helps prevent kidney stones from forming.
o High oxalate foods include:

 

 

Beverages	Tea, coffee, cola drinks, juices, beer (Draft Lager, Stout, Guinness)
Meat/Meat Substitutes	Soybean products, peanut butter, baked beans (in tomato sauce)
Vegetables	Leafy green vegetables, sweet potatoes, celery, eggplant, leeks, okra, parsley and chives, green peppers, summer squash, watercress, beans, (green, wax, dried)
Fruits	Berries, tangerines, rhubarb, fruit cocktail, currants, citrus peels
Grains/Bread	Wheat germ, grits (white corn), soybean crackers, fruit cake
Fats/Oils	Peanuts and pecans

 

 

• Use of vitamins, minerals, and supplements
o Take a daily multivitamin.
o Take a 500mg calcium supplement (calcium citrate or Tums®) 3 times daily, for a total of 1500 mg per day.
o You may need vitamin B12 injections if the last part of your ileum has been removed.
o If you’re having a lot of diarrhea your doctor may prescribe a zinc supplement.
o Keep a salt shaker at the table and use it.

 

• May need a rehydration solution with increased diarrhea
o If you are having a lot of diarrhea, your body is losing fluid, sodium, and potassium.
o An oral rehydration solution is not the same as a sports drink (such as Gatorade).
o Below are drink recipes that will help maintain fluids:

 

Solution No. 1	Solution No. 2
½ teaspoon. salt	1 cup orange juice
¼ teaspoon salt substitute	8 teaspoons sugar
8 teaspoons sugar	¾ teaspoon baking soda
½ teaspoon baking soda	½ teaspoon salt
1 liter water	1 liter water

 

 

Teach Back:

 

What is the most important thing you learned from this handout?

 
 
 
What changes will you make in your diet/lifestyle, based on what you learned today?

 

If you are a UW Health patient and need more information please contact UW Health at one of the following locations:

 

 

UW Medical Foundation Nutrition  202 S Park St, Madison, WI 53705 appts: 608-287-2770 Appointments available at 12 locations uwhealth.org/nutrition

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 05/09/2013

Copyright © 03/01/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#369

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