Nutrition Management of Gastrointestinal Conditions

Raising awareness about Gastrointestinal (GI) Diseases and conditions is vital, in part because the stigma around talking about GI symptoms such as diarrhea, constipation, or gas keeps people from having open conversations about them. Without open conversations, people often feel alone and isolated with what they are experiencing. In reality, 40% of people in the U.S. have felt that GI symptoms interrupt their daily lives1, and around 25% of people in the U.S. have a diagnosed digestive disease(2). Thus, if you have a digestive disease or experience chronic GI symptoms, you’re not alone!

Review other blog posts from this series here:

Part 2: Helpful Tips for Living with Digestive Disorders

Part 3: 99 Problems but a Colon Ain’t One: Health Testimony

Part 4: Gut-Brain Connection in Gastrointestinal Conditions

Nutrition management of GI conditions can take many forms.

Three things to consider when it comes to managing a Gastrointestinal Condition:

1. Addressing nutrient deficiencies and getting adequate energy
2. Addressing the gut microbiome
3. Managing GI symptoms with the diet

Addressing Nutrient Deficiencies and Getting Adequate Energy

First, people with digestive diseases are at higher risk of having micronutrient deficiencies, malnutrition, or unintentional weight loss. This is due to frequent episodes of diarrhea, decreased intake of food (especially during times of flare-ups), and malabsorption in the gut. Some micronutrient deficiencies could also be contributing to GI symptoms, as well. Ask your doctor about checking for possible nutrient deficiencies if you believe this may be a concern.

Digestive disease-associated micronutrient deficiencies include the following:

• Inflammatory Bowel Syndrome (IBS): vitamin B2, vitamin D, calcium, and iron (3)
• Irritable Bowel Disease (IBD): calcium, folic acid, iron, zinc, vitamin B12, vitamins D, A, E, K (4)
• Celiac Disease (on gluten free diet): vitamin B6, B12, vitamin D, iron, folic acid, copper, zinc (5)
• Chronic constipation: vitamin D and possibly magnesium (6, 7)
• Exclusionary diets in attempts to managing GI symptoms may also lead to deficiencies in: vitamin B1, vitamin B2, calcium, iron, zinc (3)

The best way to prevent micronutrient deficiencies is to, first, manage your GI symptoms to the best of your ability using medication, as prescribed, as well as dietary and lifestyle modifications to prevent intestinal lining damage or inflammation. Eat small, consistent meals with a variety of proteins and plant foods, as your diet allows, to ensure you are getting adequate nutrients. Utilize supplements as needed to help you meet your needs.

Addressing the Gut Microbiome

Second, the gut microbiome can play a significant role in overall health, and especially in gut health. But first, what is the gut microbiome? Many of us are familiar with the fact that there are bacteria in our gut, in part due to the recent rise in popularity of probiotics and prebiotics. There are, in fact, many different types of bacteria in our gut, but also fungi, viruses, and even some parasites. We can collectively call these groups microbes. The community, as a whole, make up what is called the microbiome. The microbiome can change based on environment, food, and medications. There is more and more evidence that the microbiome in our gut plays a major role in our health, even outside of our gut. Our gut microbiome helps prevent infections, interacts with and influences our immune system, and impacts mental health (8,9).

Our gut microbiome seems to play a role in digestive diseases as well. As one well-known example, a specific harmful bacteria called Helicobacter pylori (H. pylori) can contribute to stomach ulcers, gastritis (infection and inflammation of the stomach), and stomach pain. Changes in the gut microbiome have also been found in patients with IBD (11), and alterations to the gut microbiome are being researched as a treatment for IBS (12). How does this contribute to GI symptoms? The network of nerves in the lining of the gut make up what is called the enteric nervous system (ENS), also sometimes called the “little brain” of the gut. This interacts with food and regulates motility of the gut, secretions, and absorption of food. Dysregulation of this “little brain” in our gut can lead to many of the GI symptoms that we are familiar with, like diarrhea, constipation, and pain or discomfort. The gut microbiome plays an important role in regulating the ENS, or “little brain”, although we are still learning just how this happens (13). Therefore, the gut microbiome can contribute to these GI symptoms too.

The good news is that we can also influence our gut microbiome, and you do not have to be taking probiotics to do it. The microbes in our gut feed off the foods that we eat and are impacted by our lifestyle as well. A variety of plant foods high in fiber tend to contribute to a rich and healthy microbiome, while a diet high in refined carbohydrates or sugar or high in saturated fat can contribute to an unhealthy gut microbiome. Other foods like yogurt, kefir, sauerkraut, tempeh, kimchi, and kombucha are rich in microbes and therefore can directly provide the gut microbiome with these microbes. Other factors influencing the gut microbiome include stress, medication, exercise, geographic location, and more (9). Therefore, a healthy diet, rich in high fiber foods, paired with exercise and stress management techniques will contribute to healthy and happy gut microbiome, and, in doing so, can also help manage GI symptoms.

Managing Gastrointestinal Symptoms with Diet

Lastly, management of gastrointestinal symptoms can take many forms, including nutrition approaches of elimination diets, exclusion of trigger foods, or promoting optimal gut health with food. Diet recommendations can change depending on the digestive disease. For example, a low FODMAP diet is recommended for IBS and SIBO (small intestine bacterial overgrowth). For constipation, a diet high in fiber and fluids paired with exercise is recommended. An anti-inflammatory food pattern also tends to work best for this. For Celiac Disease or lactose intolerance, gluten or lactose, respectively, should be eliminated from the diet. Not all digestive diseases have such a clear answer, however, in part because each person’s GI tract and response to food is different. There is not one diet that works for everyone with IBD, but there are a variety of diets that work for different people to manage the disease (14). Also, some people with IBS do not respond as well to a low FODMAP diet and could benefit from trialing a different diet.

Therefore, some other diet approaches to managing GI symptoms to consider could include:

• Anti-inflammatory food pattern
• Low FODMAP diet
• Auto-immune protocol (AIP) diet
• Specific carbohydrate diet
• Gut and psychology syndrome (GAPS) diet
• Low fermentation diet
• No yeast diet

These diets address different aspects of gut health including targeting the permeability of the gut lining (leaky gut), inflammation in the gut and the body, or elimination of foods that tend to be digested by the gut microbiome and thus cause gas, and more.

Specifically during periods of GI flare-ups, a “low ruffage” or low fiber (less than 10 to 15 grams) diet can also help alleviate symptoms. This typically focuses on eliminating raw or tough vegetables, fruits with peels or seeds, dried fruits, nuts and seeds, beans, as well as tough meats. Other gastric irritants that could contribute to GI symptoms include high fat foods (especially when high in saturated fat), spicy foods, highly acidic food, peppermint, chocolate, caffeine, coffee, and alcohol. Set up an appointment with your dietitian to discuss which diet could be the best fit for you.

If you have a digestive disease or deal with GI symptoms interrupting your daily life and would like more support, Avance Care is starting a free, quarterly support group for people with a variety of GI conditions. Join the support group email list by filling out the interest form below and someone will be in touch soon to get you started.

Avance Care Support Group Interest Form 

References:

1. American Gastrointestinal Association. (2022). New Survey finds forty percent of Americans’ daily lives are interrupted by digestive troubles. Retrieved from https://gastro.org/press-releases/new-survey-finds-forty-percent-of-americans-daily-lives-are-disrupted-by-digestive-troubles/#:~:text=New%20survey%20finds%20forty%20percent,digestive%20troubles%20%2D%20American%20Gastroenterological%20Association
2. Mathews, SC, Izmailyan, S, Brito, FA, Yamal, JM, Mikhail, O, Revere, FL. (2022). Prevalence and Financial Burden of Digestive Diseases in a Commercially Insured Population. Clinical Gastroenterology and Hepatology.
3. Bek S, Teo YN, Tan XH, Fan KHR, Siah KTH. (2022). Association between irritable bowel syndrome and micronutrients: A systematic review. J Gastroenterol Hepatol.
4. Crohn’s and Colitis Foundation. (2022). Vitamin and Mineral Supplementation. Retrieved from https://www.crohnscolitisfoundation.org/diet-and-nutrition/supplementation
5. Celiac Disease Foundation. (2019). Dietary Supplementation Advice for Celiac Patients on a Long-Term Gluten-Free Diet. Retrieved from https://celiac.org/about-the-foundation/featured-news/2019/08/dietary-supplementation-advice-for-celiac-patients-on-a-long-term-gluten-free-diet/
6. Panarese, A, Pesce, F, Porcelli, P, Riezzo, G, Iacovazzi, PA, Leone, CM, De Carne, M, Rinaldi, CM, Shahini, E. (2019). Chronic functional constipation is strongly linked to vitamin D deficiency. World J Gastroenterol.
7. Zhang, L, Du, Z, Li, Z, Yu, F, Li, L. (2021). Association of dietary magnesium intake with chronic constipation among US adults: Evidence from the National Health and Nutrition Examination Survey. Food Sci Nutr.
8. Harvard T.H. Chan School of Public Health. (2023). The Microbiome. Retrieved from https://www.hsph.harvard.edu/nutritionsource/microbiome/
9. Tenchov, R. (2022). How Your Gut Microbiome is Linked to Depression and Anxiety. Retrieved from https://www.cas.org/resources/cas-insights/emerging-science/how-your-gut-microbiome-linked-depression-and-anxiety
10. About IBS. (n.d.). IBS and Your Gut. Retrieved from https://aboutibs.org/what-is-ibs/ibs-and-your-gut/
11. Glassner, KL, Abraham, BP, Quigley, EMM. (2020). The microbiome and inflammatory bowel disease. J Allergy Clin Immunol.
12. Pittayanon, R, Lau, JT, Yuan, Y, Leontiadis, GI, Tse, F, Surrette, M, Moayyedi, P. (2019). Gut Microbiota in Patients with Irritable Bowel Syndrome- A Systematic Review. Gastroenterology.
13. Vicentini, FA, Keenan, CM, Wallace, LE, et al. (2021). Intestinal microbiota shapes gut physiology and regulates enteric neurons and glia. Microbiome.
14. Crohn’s and Colitis Foundation. (2022). Special IBD Diets. Retrieved from https://www.crohnscolitisfoundation.org/diet-and-nutrition/special-ibd-diets?gclid=CjwKCAiA3pugBhAwEiwAWFzwdUVj8jKvvzfX5RbSB7PMa84ueGAafJ9dspGr82PQZJU5MJC1W7Zw0hoClM4QAvD_BwE