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Liver and intestine diseases

LIVER DISEASES

We should remember, that the right diet is very important not only in the treatment of liver diseases, but also in preventing them, so this topic should not be ignored.

Wrong nutrition (both deficiency of calories and their overabundance) causes numerous systemic diseases, including those of the liver. It is important to stress that the thing most especially damaging to the liver is an overabundance of easily-absorbable carbohydrates, contained in sugar, sweets, jams, etc. This is why, in order to maintain proper liver function, one should keep in mind proper daily nutrition and not abusing alcohol or medicines.

Chronic liver diseases encompass many conditions, among which the most important are: chronic liver inflammation, cirrhosis, fatty liver, toxic liver disease, and diseases associated with dysfunction of metabolism iron and copper (hemochromatosis and Wilson’s disease). During treating all of these ailments, nutrition is the basic element – all the more because pharmacotherapy in most cases does not address the causes, but instead stops particular links in pathogenetic mechanisms.

In chronic diseases of the liver, dysfunction of metabolism of particular nutrients occur. Usually they are not correlated with the clinical course of the disease. This is why it is important to approach each patient on a case-by-case basis.

In liver diseases, nutrition is generally not based on a particular diagnosis, but on the type of metabolic dysfunctions present. This is why choosing a diet is based on THE existence of liver failure, as well as deciding on the degree of malnutrition, and, possibly, a presence of jaundice.
The aim of nutrition is to provide all of the necessary nutrients in order to maintain metabolic balance, to balance nutritional deficiencies, provide materials for the regeneration of liver cells, and thereby improve the functioning of this organ.

Nutrition in chronic diseases often encounters problems associated with different symptoms of the disease and its chronic and progressing nature. Among these are: lack of appetite, feeling of satiation and bloating, thirst, temporary digestive dysfunctions, and monotony of the diet.

To put it simply, at the time of liver efficiency we use a high-protein diet. Using it during recuperation of the liver from hepatitis (or during liver cirrhosis), the destroyed liver cells will regenerate and disease-caused nutrient deficiencies will return to balance. In turn during diseases associated with liver failure, a low-protein diet is used.

Among general guidelines regarding diets in chronic diseases, it is important to mention:

  • Diet should provide all necessary nutrients, so as not to cause their deficiencies
  • Diet should not be formulaic, but individually adjusted for each patient (adjusted to both his state and the phase of the disease)
  • Changes done in nutrition, especially significant increase of a particular nutrient, should be performed gradually, with careful monitoring of patient’s condition.
  • The menu (as far as possible) should be varied.
  • Foods causing bloating should be avoided, due to production of gas (toxins).
  • With decreased appetite, one should eliminate such foods as sweets and fats in favor of products with high biological value.

INTESTINE DISEASES

INFLAMMATORY BOWEL DISEASE (IBD)

Inflammatory bowel disease is a group of chronic diseases of the digestive system, including Crohn’s disease, ulcerative colitis (UC) and non-specific inflammatory bowel disease.

The occurrence of diseases of this group is consistently rising, and their etiology, unfortunately, is unclear. They constitute a nonhomogeneous group of digestive system diseases. Inflammatory bowel disease cannot be cured, only treated. The aim of treatment is curing cyclical flare-ups and maintaining remission – a period where no symptoms occur.

As mentioned above, the etiology of these diseases is not fully known, however it is widely accepted that genetic as well as emotional factors play a major role. Infections can also be a contributing factor, yet as of now no particular microorganism has been isolated.

Inflammatory bowel diseases are a group of illnesses manifesting in many various ways, which makes giving a quick and accurate diagnosis difficult. And it is a prompt and correct diagnosis, and a following correct treatment that are crucial. Sometimes, this disease remains undiagnosed for many months or even years. Inflammatory bowel disease symptoms are very burdensome and sometimes awkward for the afflicted. Among the most important ones are: stomach aches, fever, weight loss, and feeling of satiation after a meal or rectal tenesmus.

In ulcerative colitis the effects are felt by mucosa of the large intestine, especially its terminal part connecting to the anus. The patient usually suffer from stomach aches, weight loss, rectal tenesmus, and chronic diarrhea with blood and mucus, and, in times of flare-ups, fever. Intestine examination shows inflammation and ulceration of colon mucosa and anus. Post-inflammatory polyps may also be present, and after many years, colon cancer.

Crohn’s disease, may develop in any part of the digestive tract, from oral cavity to anus. Usually it develops in the terminal part of the small or large intestine. Among its symptoms are: chronic diarrhea, stomach aches, and weight loss. The inflammation consumes the whole thickness of the intestinal wall, not only the mucosa, but it is limited only to its parts, between which there are stretches of healthy intestine.

All of these symptoms are rarely present at the same time, which causes the diagnosis to be given after the disease has made some progress (in the meantime the patient is treated for food poisoning, indigestion, or irritable bowel syndrome). This has drawbacks, because as the disease progresses, its treatment becomes difficult.

There are four ways of approaching the treatment of inflammatory bowel diseases: dietary, pharmacological, biological, and surgical.

While treating of inflammatory bowel diseases is symptomatic, it can lead to a temporary remission. In its mild form, medication may be sufficient. These are usually: sulfasalazine and mesalazine, as well as steroids. The patient treated with steroids should systematically perform densitometry (tests of bone density), control blood sugar and arterial pressure. In case of highly aggravated symptoms and raised body temperature, the treatment must take place in a hospital. Those suffering from inflammatory bowel diseases often require nutrition by drip feed, and transfusions of blood or other fluids. Surgery is performed in the most serious cases.

While consumed foods do not contribute to the occurrence of inflammatory bowel disease, proper nutrition is an important part of therapy. This is because symptoms of ulcerative coliosis and Crohn’s disease cause loss of appetite, disrupt nutrient absorption, while prolonged diarrheas lead to dehydration, and loss of minerals and vitamins. Dietary advice in both of these diseases is similar.

Among many goals of the diet, the most important are:

  • replenishing nutrient insufficiencies caused by the prolonged diarrheas and the existing inflammation
  • normalization of the amount and consistency of the stool by eliminating foods that aggravate diarrhea, as well as consuming constipation-causing foods
  • minimizing the irritating effect of chyme on the intestine.

One of the most important things to keep in mind is that the treatment is highly dependent of the stage of the disease and the level of symptoms.
During a flare-up a liquid diet, followed by semi-liquid is used.

At that time, the menu includes unsweetened tea, still mineral water, strained compote, gruel made from semolina, rice or grated oatmeal, or soggy hardtack. Consumption of milk is not advised, since many patients suffer from intolerance of it. This sort of diet is non-physiological, therefore it should not be continued longer than 2-3 days.

When diarrhea cannot be stopped, or the patient’s condition makes oral nutrition impossible, a complete exclusion of it is necessary, and a switch to full-time drip feed is performed (obviously, treatment using this kind of feeding can be performed only in hospital conditions).

As the condition improves and diarrhea subsides, the diet can be broadened. Such diet should be high-calorie, high-protein, and with limited refined sugar, fat, and insoluble fiber (especially raw).
Naturally, the diet should be adjusted to individual dietary needs and tolerances of the patient.

While preparing a dietary plan, one should also consider supplementing vitamins and minerals (especially vitamin B12, folic acid, fat-soluble vitamins, calcium, and iron).

Some of the more important guidelines regarding diet are:

  • Meals should be small in quantity, but eaten regularly and often (4-6 times a day)
  • It is important to chew the food thoroughly
  • During the day, in order to avoid dehydration, an adequate amount of liquids should be consumed (circa two liters, or up to three liters in a period of diarrhea flare-up)
  • Gas-inducing foods should be avoided, as well as products which may increase the stool mass due to incomplete digestion.
  • Foods containing simple sugars (lactose and fructose), since they may induce excess fermentation in the intestines.
  • Foods containing refined sugars should also be limited, since they can cause aggravation of symptoms.
  • Fats should be reduced. Hard to digest animal fats should be eliminated completely (lard, fatback, bacon), and easy to digest fats can be used in limited amounts (butter, cream, olive oil, plant oils).

It is also recommended to avoid food containing substantial amounts of insoluble fiber (brown bread, full grains, bran, raw vegetables and fruits (especially of the berry family, which contain large amounts of seeds and cause bloating)).

A well-balanced diet should contain sources of complete protein (lean meat, lean cold cuts, fish and meat, egg whites, whole eggs, but in limited amount). If we tolerate fermented milk products we can also consume them, again in limited amounts.

In a period of diarrheas it is recommend to consume foods which slow down bowel movements and have a constipating effect.
The method of preparation is also very important. Among the most important are: cooking, stewing without searing, and roasting.

CONSTIPATIONS

Constipations are basically a plague of the modern civilized society, since they constitute an important heath issue for millions of people.

We talk about a constipation when the stool consistency is very hard and compact, or when there is a difficulty in passing it. Conversely, we talk about chronicity when one of the below symptoms persists for a period longer than six months:

  • stool is passed less often than three times a week
  • with more than a quarter of defecations, there is an increased sensation of or rectal tenesmus
  • there is a sensation of incomplete defecation.

Many factors influence the frequency of bowel movements. The factors affect the rate of peristalsis, and thus on the time it takes to for the contents to pass thorough the GI tract. The time in which chyme passes through intestine is highly varied. In most people, the movement of chyme trough the large intestine takes 2-3 days, and a bowel movement happens once every 24 hours. If this time lengthens, the contents stay longer in the colon, and their water content decreases. This leads to stool not only being passed more rarely, but also becoming harder and more compact.

The reasons for constipation are varied. Sometimes constipations can be a significant symptom of a systemic GI tract disease, but they can also be aided by other diseases, e.g. diabetes, damage to the spinal nerve, hormonal imbalances, Parkinson’s disease, or multiple sclerosis. Constipations also happen during dehydration and electrolyte imbalance, e.g. after prolonged vomiting or diarrhea. They often affect pregnant women (usually caused by the uterus pushing on intestines and hormonal changes). Most often, however, constipations are caused by incorrect eating habits, too little physical activity, irregular routine, stress, and constant avoiding of a bowel movement, which disrupts the mechanisms signaling its necessity. In sensitive people, constipation arises during travels, when it is caused by change in food habits and by stress. It is also important to notice, that over-reliance on laxatives can also lead to constipation. This is why laxatives should only be taken when needed.

Among the most important constipation-causing dietary factors are:

  • consuming large amounts of animal fats and simple carbohydrates,
  • small amount of dietary fiber in diet.

Considering the mechanism of development, we can distinguish two forms of constipation: spastic and atonic.

ATONIC CONSTIPATIONS

Atonic constipation arises due to a slowdown of peristalsis, which causes excessive water absorption in the colon and increase in density of stool mass.

Among the reasons for its occurrence are:

  • irregular meals
  • improper menu composition, low-fiber diet
  • sedentary lifestyle
  • stopping defecation due to situational factors
  • over-reliance on laxatives and enemas
  • general reduction of body activity due to congenital weakness of the nervous-muscle system, anemia, previous serious illnesses (infectious and non-infectious) etc.

An atonic constipation is often accompanied by:

  • bloating
  • dull pain in the abdomen
  • loss of appetite
  • bad taste in mouth
  • headaches and restlessness
  • stools are passed as dry, long, small lumps or a thin “pencil”.

This makes proper dietary course of action necessary. In atonic constipation a high-fiber diet is used. The aim is it stimulates intestinal motor function, regulating their function without the need for pharmaceuticals.

In a high-fiber diet, the amount of dietary fiber is increased (its insoluble components – cellulose, hemicellulose, and lignin) and liquids. Insoluble fiber increases stool mass, binds water to a small degree, quickens peristalsis due to mechanical stimulation, slows hydrolysis of starch and absorption of glucose, reduces the energy content of diet and provides a sense of satiation. However, water is necessary to activate its functions.

Bran and full-grain products (including buckwheat groats, barley groats, graham, brown bread) have the biggest effect on defecation reactions.

It is recommended to eat 2-3 times a day one spoon of bran. Bran can be added to, e.g. salads, yogurt, or minced dishes. It is important to remember, that while consuming bran, one should not only increase the consumed liquids (to at least 2 liters per 24 hours), but also increase calcium by 10% (bran contains phytic acid, which inhibits absorption of calcium, magnesium, and iron).

In a low-fiber diet, very important components are: dried fruits (pears, raisins, or figs), as well as beetroot and red pepper (they contain around 5% lignins).
The diet needs to be introduced gradually. One should not start from large amounts of fiber (40-50g per day), because it may cause initial bloating and mild stomach aches.

Aside from the above-mentioned products, the foods having a beneficial effect on peristalsis are: honey, kefir, yoghurt, one-day old sour milk, true coffee, cream, carbonated water, dried pear compote, juices containing organic acids, butter, olive oil, oils, raw salads, flaxseed, bouillon, broths, spicy foods.

The temperature of consumed foods should be average.

On an empty stomach, it is useful to drink half a glass of boiled, cool water with honey, or eat soaked dried plums, or a spoon of butter or olive oil.
It is also important to eat five meals a day (at regular intervals). These cannot be too large, however they should contain a substantial amount of liquid.

In order to avoid constipation, it is best to avoid foods such as: strong tea, dried blueberries, dry red wine, dry foods, and foods causing bloating. It is also advisable to limit foods which slow down peristalsis, such as: white breadstuff, dumplings, white rice, semolina, potato flour, cream cakes, and bananas.

SPASTIC CONSTIPATIONS

They are a result of heightened activity of the large intestine, which in this case almost all the time is in a state of spasm, which in turn stops peristalsis and moving of the stool mass. Spasms usually occur during inflammation of the large intestine, or in case of irritable bowel disease. They are also common in depression, hysteria, and neurasthenia. This type of constipation appears also during irritation of the intestinal wall by foreign bodies: fecaliths, parasites, etc.

Some of the reasons of spastic constipation are:

  • cramp of the large intestine as a reflex in inflammation of abdominal organs, in case of stomach or duodenum ulcers, gall stones or kidney stones,
  • painful damage of the anus, e.g. hemorrhoid rupture, polyps,
  • intenstinal constriction or inflammation.

These constipations are characterized by:

  • strong thirst,
  • pains in the left hip area,
  • a sense of fullness in the abdomen,
  • false signals of need of a bowel movement,
  • bloating,
  • excreting hard lumps of stool,
  • often face is unnaturally red.

Spastic constipation may also be of psychological origin. During a depression, hysteria, and neurasthenia, they cause dysfunction of the defecation reflex, when there are no bowel movement, even in a full colon.

In case of spastic constipation, a high-fiber diet should not be followed, since it aggravates intestinal cramps. An easily digestible diet is recommended. Foods, which irritate the GI tract (be it mechanically, chemically, or thermally) should be reduced.

Fiber is served in the form of boiled fruits and vegetables (mixed). It is recommended to eat foods increasing the fermentation processes in the intestines, e.g. beetroot sugar, milk sugar, room-temperature water with honey, fruit and vegetable juices, sour milk, yogurt, kefir, and mineral water.

Soaked dried plums, eaten on an empty stomach are beneficial, as well as fats: olive oil, plant oils, butter all cause a better “slide” of the stool through the intestine.

Animal proteins originating from meats rich in connective tissue should be reduced, since they increase intestine spasms. Main sources of protein should be diary and plant products.
Foods that should be eliminated from the menu: brown breadstuff, un- or coarsely cut groats, bloating fruits and vegetables, unripe fruits with peel, ripening cheeses, fried and spicy foods.

The temperature of the consumed food should be moderate.

DIARRHEAS

The term “diarrhea” usually means liquid, semi-liquid, and more rarely mushy stool, more often than three times a day. Diarrhea is characterized by increased number of bowel movements, contents of water in the stool, and the volume of stool. Diarrheas are a more common symptom of diseases than constipation. It is important to remember, that basically any prolonged diarrhea is a clear indication too seek a doctor’s advice.

Among the most common causes of diarrhea are:

  • emotional, psychological, and neurovegetative factors, which, by increasing peristalsis, especially of the large intestine, cause on increased mucus generation by intestinal mucus membranes, which causes speeding up of intestinal content and prevents solidification of the stool
  • various diseases constituting so-called invalid digestion syndromes (e.g. chronic diseases of the pancreas, post-gastrectomy state, post-dysyntery state, hepatic failure, congenital enzyme defects, or hormonal, allergic, and immunological conditions)
  • chronic inflammation of intestines, primarily ulcerative colitis
  • various – usually chronic – bacterial, protozoan, or parasitic infections of the intestines.

Correct dietary measures toward diarrhea are vital.

Initially, our menu should only consist of salted gruel: rice, barley or semolina, possibly hardtack and stale buns (everything without sugar or fat). As the condition improves (after 2-3 days), we may add boiled meats (poultry, beef), potato puree (with milk and butter), low-fat chicken broth. For children, Carrot soup is recommended. Adults are usually encouraged to eat cooked carrot and pumpkin as far as vegetables are concerned, and as for fruits – roasted apples.

Our food should be freshly made (in order to minimize the chance of following poisonings at a time our body is weakened).

We must remember about replenishing liquids. During the day, we should drink at least two liters of them. It would be the best, if they were served in regular intervals and in small amounts (e.g. half a glass every half an hour). These should be moderate temperature, non-sweet liquids. Considering mineral loss, the best would be mineral water, boiled water (slightly salted), as well as electrolyte medicines, such as Gastrolit or Saltoral – especially for children and stronger symptoms of vomiting or diarrhea. We can also drink teas or herbs (mint, chamomile). Depending on our state, we may drink watered-down fruit and vegetable juices (1:4, and, on the following days, 1:1). However, the juices we consume should not contain sugar.

At that time we should abstain from fermentation-increasing foods, such as apple, grape, or pear juices, milk, sorbitol (added to “light” products, with reduced sugar content). It is also helpful to exclude coffee, strong tea, carbonated beverages, and alcohol. Keeping in mind that our diet should be easy to digest, we should avoid frying, searing, baking and grilling.

Some of the constipating food and drinks are:

  • tannin drinks, without sugar: tea, dried blueberry tea, chamomile tea, mint tea
  • pectins, which bind water and toxins and protect the intestinal mucosa: boiled carrot, apple, or pumpkin
  • thin cocoa, water-based, no added sugar

When diarrheas stop, and stools are properly formed again, it is advised to relieve the digestive system and refrain from hard to digest foods, fried food, or fast food, for a few days. It is recommended to eat more milk products (kefir, sour milk, yogurt, and buttermilk), so that the intestinal flora is regenerated and proper function is restored.