Tagged with 'constipation'

Do you feel sleepy or tired? Are you less active than usual? Do you have a dry, sticky mouth? Headache? Dizziness? If so, chances are you need to drink more water.

Why are probiotics important during pregnancy? Our dietitian covers that and more.

A low-FODMAP diet may just cure your digestive issues.

If you live in the Northern Hemisphere, you’re in the midst of winter and your body more than likely can’t make enough vitamin D from the sun because the sun is at too low an angle in the sky. Along those lines, isn’t it interesting a vitamin D deficiency is common in people with Inflammatory Bowel Disease (IBD)? Inflammatory bowel disease encompasses two independent but related entities: ulcerative colitis and Crohn's disease. In the Northeastern part of the United States, known for their lengthy, overcast winters, rates of ulcerative colitis and Crohn’s disease are highest, with rates in the Midwest and West not far behind.

The Link Between Vitamin D and Autoimmune Disease

Inflammatory bowel diseases are chronic, inflammatory, autoimmune disorders of the GI tract. It is now proven vitamin D is an important regulator of the immune system which may have implications for the development, severity and management of immune related disorders such as IBD. Particularly if someone with IBD has any malabsorption of dietary vitamin D, and/or has less exposure to the sun due to living in a climate suboptimal for vitamin D synthesis in the skin.

Ulcerative Colitis vs. Crohn’s Disease

The symptoms of these two diseases are quite similar, but the areas affected in the gastrointestinal tract (GI tract) are different.

Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, also called the large intestine, but it may affect any part of the gastrointestinal tract, from the mouth to the anus. Ulcerative colitis is limited to the large intestine.

Crohn’s disease can also affect the entire thickness of the bowel wall, while ulcerative colitis only involves the innermost lining of the colon. Another difference is in Crohn’s disease, the inflammation of the intestine can “skip”— leaving normal areas in between patches of diseased intestine. This does not occur in ulcerative colitis. For more details about Crohn’s disease, visit my blog here.

Absorption of Dietary Vitamin D

Absorption of dietary vitamin D occurs in the upper small intestine, so if a person has had an intestinal resection due to some form of inflammatory bowel disease, they should be considered at risk of malabsorption of vitamin D, thus a low vitamin D status.

Vitamin D, IBD, and Bone Health

Vitamin D deficiency has been linked to bone loss among people with IBD, and bone loss is a problem for up to 50% of people with IBD. As a result, people with IBD are at risk of developing osteoporosis. To prevent bone disease, there are clear guidelines that recommend vitamin D supplementation for people with IBD, especially when undergoing steroid treatment. However, despite these recommendations, vitamin D deficiency is still common with IBD.

How Much Vitamin D?

The Vitamin D Council recommends adults with ulcerative colitis keep their serum vitamin D levels in the high-natural range, about 70-80 ng/ml. Your primary care physician can perform a simple blood test to determine current levels. The Vitamin D Council also advises children with ulcerative colitis should be given 2,000 IU per 25 pounds of body weight per day.

For Crohn’s disease, one study gave patients 2,000 IU per day and after 3 months, they had significantly less fatigue, increased muscle strength and an overall improvement in their quality of life.

Bottom Line: Vitamin D seems to play in integral part in overall well-being for those with some form of irritable bowel disease. Consult with your gastroenterologist and have your vitamin D levels checked.

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

References:

1. Andreassen H, Rungby J, Dahlerup JF, Mosekilde L. Inflammatory bowel disease and osteoporosis. Scand J Gastroenterol 1997;32:1247–55.

2. Andreassen H, Rix M, Brot C, Eskildsen P. Regulators of calcium homeostasis and bone mineral density in patients with Crohn's disease. Scand J Gastroenterol 1998;33:1087–93.

3. Margherita T Cantorna, Yan Zhu, Monica Froicu, and Anja Wittke. Vitamin D status, 1,25-dihydroxyvitamin D₃, and the immune system. Am J Clin Nutr. December 2004; vol. 80, no. 6:1717S-1720S.

4. Crohn’s and Colitis Foundation of America.

5. Holick MF. Vitamin D. In: Shils ME, Olson JA, Shike M, Ross CA, eds. Modern nutrition in health and disease. Baltimore: Williams & Wilkins, 1999:329–99.

6. Compston J, Creamer B. Plasma levels and intestinal absorption of 25-hydroxyvitamin D in patients with small bowel resection. Gut 1977;18:171–5.

7. Vitamin D Council: Inflammatory Bowel Disease.

8. Blanck S, Aberra F. Vitamin D deficiency is associated with ulcerative colitis disease activity. Dig Dis Sci. 2013 Jun;58(6):1698-702.

9. Vitamin D Council: Does vitamin D deficiency contribute to inflammatory bowel disease?

10. Walsh N. Vitamin D boosts quality of life in Crohn’s. MedPage Today. Mar 20, 2013.

Let’s face it, constipation happens. We don’t like to talk about it, but if you’ve ever been constipated it is certainly uncomfortable and your mission becomes to fix it…stat!

The Difference between Soluble and Insoluble Fiber

Fiber comes in two types, soluble and insoluble. Soluble fiber dissolves in water and helps regulate cholesterol and blood sugar. Soluble fiber is commonly found in beans and fruits.

Insoluble fiber doesn’t dissolve in water. It acts as a scrubber in your digestive tract. Insoluble fiber is found in vegetables and whole grains.

How Much and What?

A diet rich in both types of fiber is crucial. According to the Academy of Nutrition and Dietetics, men under 50 need 38 grams of fiber each day and women need 25 grams. Adults over 50 require less fiber (30 grams for guys and 21 grams for ladies) due to decreased food consumption. To understand what that amount looks like, check out the sample meal below, which contains 37 grams of fiber. The key is eating a couple fiber-containing foods at every meal, particularly vegetables, fruit, nuts, legumes, beans and whole grains. As you can see, meats, dairy, and eggs do not have protein. This is why eating a variety of foods and adding many different colored foods is an important and beneficial rule of thumb.

A Real Life Example of Enough Daily Fiber

Water To Keep Things Moving

While focusing on fiber, don’t forget water, and lots of it! If you’re eating plenty of high-fiber foods but not getting enough fluid to help flush it through your system, you can make matters worse. Drink at least 8 to 10 glasses of decaffeinated fluids every day to assist in keeping your stools soft. Have a water bottle available wherever you are. A large water bottle that holds a lot of water may be more convenient because you don’t have to keep refilling it. My husband recently received this Klean Kanteen as a gift and now drinks about 2-3 bottles per day at work--all because it’s more convenient.

Sneaky Tips to Boost Your Fiber Intake

• Add flaxseeds to oats, smoothies, and yogurt. Flaxseeds assist with constipation as these have the action of lubricating the bowel. Two tablespoons will boost your daily fiber by 3.8 grams.

• Chia seeds have a whopping 5.5 grams of fiber per tablespoon.

• Coffee is an old-fashioned remedy that helps millions to avoid constipation. In fact, it is one of the main reasons people choose coffee in the morning. Coffee irritates the intestines a little and can stimulate bile flow from the liver. Avoid the fashionable cappuccinos and lattes. They are too strong, contain less water, which is bad, and they contain more caffeine, which is also worse and more irritating. If you use coffee, limit it to one cup of regular coffee daily.

• Another remedy you may consider is 1 teaspoon of apple cider vinegar mixed with 3 oz of water and juice from a lemon wedge (1 tsp of lemon juice). Do this before meals to help stimulate digestion. Also do upon rising in the morning to stimulate a bowel movement.

• Consider a potent Probiotic—something like ProBiota 12. Balancing and supporting beneficial bacteria in the digestive tract is critical for many functions: immune, digestive, neurological, dermatological and others. Take 2 capsules about 5-10 minutes after dinner.

• Consider a fiber supplement to add bulk to your stool, such as this one.

• Avoid refined carbohydrate foods, such as white sugar, white bread, white rice, white pasta, sugary cold cereal, and other poor quality, low-fiber, and highly processed foods.

• Stick to whole grain foods, such as 100% whole wheat bread, quinoa, oats, brown rice, wild rice, amaranth, and millet. To check out more whole grains, visit the Whole Grains Council website.

• Eat the fruit rather than drinking the juice. The peel and pulp are where the majority of the fiber is located. Whole fruit is more filling than juice, so don't cheat yourself.

• While spinach isn’t as high in fiber as other veggies, it can easily be sliced and snuck into many dishes without adding much taste or hassle. I add organic baby spinach to so many things, such as soup stock, eggs, smoothies, protein shakes, and pasta sauce.

• Everyone always thinks of vegetables, fruits, and whole grains when they think of high-fiber foods, but nuts are very impactful. As you can see from the example above, only ¼ cup provides 4 grams of fiber. Find a trail mix you like and include it regularly as a snack.

One final tip, don't forget exercise. Exercise most days of the week. It increases muscle activity and the speed which food travels through your intestines.

Bottom Line: If you're constipated, get really serious about boosting the fiber in your diet. Pack in the salads and fruit at a couple meals, beans, and whole grains--all in one day. Drink a lot of water, and if you do this everyday, you'll be regular in no time.

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

Crohn's is the pits and anyone who has it would agree with me and probably say "the pits" is an understatement! I don’t have Crohn’s, but know people with it, and I remember thinking treating it was so difficult, complicated, and sort of a crap shoot because different treatments worked for some people but not others. There was no clear cut answer. There is no magic pill. There’s no way around it and people with Crohn’s have to learn to live with it and manage it day-to-day.

What is Crohn’s Disease?

It’s a form of Inflammatory Bowel Disease (IBD) that causes chronic inflammation and irritation of the digestive tract. There isn’t a known cause, but it is known to run in families. A person’s immune system and environment appear to also play a role in developing Crohn’s. A recent study published in October 2013, claims scientists have discovered Crohn’s disease can originate from a specialized intestinal cell type called Paneth cells. This is great news and provides a possible new target for treatment.

What happens with Crohn’s Disease?

In a majority of patient’s, Crohn’s starts in early adulthood, and involves cramping pain, diarrhea, weight loss, low grade fever, and has a profound impact on quality of life. Crohn’s disease is often associated with maldigestion and malabsorption of dietary protein, fat, carbohydrates, water, and a wide variety of vitamins and minerals. As a result, much of what a person with Crohn's eats may never truly get into the body.

What is Nutrition’s Role?

Nutrient deficiency is a common concern since inflammation from this condition interferes with nutrient absorption. As a result, people with Crohn’s disease need a nutrient-rich diet with adequate calories, protein and healthy fats. Current science also advocates nutrition to enhance the body's immune system, provide antioxidants to reduce inflammatory stress, and improve a patient's feeling of strength, stamina, and well-being.

Eat to Reduce Inflammation

• Let fruits and vegetables make up at least half your plate at meals. Make a point to regularly fit in fresh, frozen or dried berries and cherries. Be sure to eat a variety of vegetables, including leafy greens like kale, chard, spinach, and Brussels sprouts.

• Select more plant-based sources of protein like beans, nuts and seeds.

• Choose whole grains instead of refined ones. Avoid the ingredient, “Enriched.” Swap brown, black or wild rice for white rice; whole oats or barley for instant oatmeal and cream of wheat; and 100% whole-wheat bread instead of white. For some individuals, eliminating wheat may reduce inflammation. Talk to your doctor before going gluten-free and a registered dietitian can help you accomplish this.

• Swap heart-healthy fats for not so healthy ones. Olive oil, avocados, nuts and seeds are a few delicious choices.

• Choose fatty fish like salmon, sardines and anchovies to get a heart-healthy dose of omega-3 fatty acids.

• Season your meals with fresh herbs and spices. They pack a flavorful and antioxidant-rich punch.

• Free your diet of processed foods, artificial sweeteners, added sugars, and unhealthy fats are always very important.

Eat to Improve Strength and Stamina

• Vitamin D supplements may help overcome fatigue and decreased muscle strength associated with Crohn’s. Besides boosting bone growth and remodeling, vitamin D is thought to improve neuromuscular and immune function, reduce inflammation and help with other bodily tasks. Discuss your vitamin D status with your primary gastroenterologist to determine whether or not vitamin D supplementation is indicated in your particular situation. It’s an easy blood test to measure your levels.

• Eat small meals or snack every 3 to 4 hours.

Other Tips and Guidelines for Crohn’s disease 

• Stay hydrated. Drink small amounts of water throughout the day. Remember to avoid plastic bottles and choose stainless steel or glass instead.

• During times when you don’t have symptoms, include whole grains and a variety of fruits and vegetables in your eating plan. Start new foods one at a time, in small amounts.

• When you have symptoms, such as diarrhea or abdominal pain, foods to avoid may include high fiber foods, raw and gas-producing vegetables, most raw fruits and beverages with caffeine.

• Some common symptom-provoking foods are dairy, high fiber grains, alcohol and hot spices.

• Discuss with your doctor about the possibility of experimenting with a gluten free diet. It may improve your symptoms slightly.

• Consider taking a probiotic. Seventy percent of your immune system is based in your intestines so you want a very strong immune system to keep your body functioning efficiently. I highly recommend ProBiota 12. Because of the potency, start by taking 1/4 tsp., about 5-10 minutes after dinner for one week. After that, increase to 1/2 tsp. until the bottle is gone. Once the bottle is gone, continue taking the probiotics, but consider changing to the capsule form and take 1 capsule/day after dinner. 

Your gastroenterologist may recommend dietary supplements such as iron, calcium, vitamin D, folate, zinc and vitamin B12 to prevent or treat deficiencies. 

Crohn’s Patients at Higher Risk for Stroke, Heart Attack

In an analysis of over 150,000 patients with IBD in nine studies, researchers estimated the risk of stroke and heart disease in patients with IBD, as compared to the general population. The results of the comparison pointed to a 10-25 percent increased risk of stroke and heart attacks in patients with IBD. The increased risk was especially more prominent in women.

Nutrition seems to be the cornerstone of Crohn's disease and the effort put into following the correct diet is well worth it. Have meaningful conversations with your gastroenterologist and seek help from a registered dietitian nutritionist.

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

References:

Adolph, TE et al. Paneth cells as a site of origin for intestinal inflammation. Nature. Oct. 2013.

Academy of Nutrition and Dietetics. Inflammation and Diet. Aug. 2013.

Academy of Nutrition and Dietetics. Crohn’s Disease and Diet. July 2013.

Mayo Clinic. Patients with inflammatory bowel disease at higher risk for stroke, heart attack. Science Daily, 14 Oct. 2013. Web. 6 Jan. 2014.

REDUCED STROKE RISK

A new meta-analysis of eight observational studies suggests another possible benefit for dietary fiber—reducing your danger of suffering a stroke.  British scientists reported in the journal Stroke that each additional seven grams of daily fiber intake was associated with a significant 7% lower risk of the two main types of strokes (ischemic and hemorrhagic). 

Seven grams of fiber is about the equivalent of an extra serving of beans or two servings of fruit such as apples or oranges.

WHAT FOODS HAVE FIBER? 

Most people get their fiber from vegetables, fruit, legumes, beans, and whole grains (oatmeal, 100% whole wheat bread, etc.) 

FIBER SUPPLEMENT

It is definitely possible to get enough fiber from supplements.  The amount of fiber in a fiber supplement varies from brand to brand, but usually ranges from 6-10 grams per serving.  With that said, I suggest using a fiber supplement as just a way to top off your fiber intake in order to meet the daily recommendation.

WHAT’S THE DAILY FIBER RECOMMENDATION? 

Per the Institute of Medicine, here are the numbers:

Men over 50:  30 grams

Men under 50:  38 grams

Women over 50:  21 grams

Women under 50:  25 grams

SOLUBLE VS. INSOLUBLE FIBER

Soluble fiber forms a gel in the stomach and small intestine, slowing the rate of nutrient absorption and slowing gastric empting.  This effect increases your feeling of fullness and influences the overall amount of food eaten, resulting in lower levels of overweight.

Bacterial fermentation of soluble fibers in the large intestine produces short-chain fatty acids, which inhibit cholesterol synthesis by the liver, consequently lowering serum cholesterol levels.

Insoluble fiber adds bulk to our stool, preventing constipation and reducing risk of hemorrhoids. 

Insoluble fiber helps our gut bacteria, or gut flora, to grow.  Our gut bacteria are living organisms that eat sugars and fiber, and prevent bad bacteria from living in our gut and making us sick.  Insoluble fiber is a strong fiber that takes a lot longer for our gut bacteria to break down, which helps them grow and multiply.  

Bottom Line:

There are many reasons to eat your favorite high fiber foods everyday…not only reduced risk of gastrointestinal disorders and diverticular disease, but also better cholesterol levels and blood pressure, and reduced risk of stroke.

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

Reference:  Health & Nutrition Letter, Tufts University, The Friedman School of Nutrition Science and Policy