The low residue diet is used for people with intestinal disturbances. This diet restricts the intake of dietary fiber and of milk which has medium residue. If the purpose of the diet is only to reduce the amount of residue in the lower bowel and to decrease fecal output, milk and milk products are not restricted. Highly seasoned and fried foods are generally omitted but individual tolerances should be considered. Foods should be well chewed and meals should be eaten slowly. Dietary fiber is reduced by using refined cereal grains, certain whole, well-cooked tender vegetables, cooked or canned fruits (without any seeds or skins), and tender meats.
Adequacy: The low residue diet is planned to meet the Recommended Daily Dietary Allowances.
to avoid the problem of absorption. Folic acid can be taken in pill form and iron can be replaced either by tablets or, if need be, in exceptional cases, by injection. In my experience many patients with IBD have abdominal distress if they take iron by mouth, especially cramps and constipation. Their stool may turn black and be confused with rectal blood. It may be necessary to try a few preparations of iron before finding one that agrees with you.
What Is the Role of Trace Elements?
Several vital substances circulate in the blood in very small amounts. Called “trace elements,” these substances are essential for the healthy functioning of the body’s tissues.
The trace element we know most about is zinc. Researchers have found that some patients with skin and mouth problems, as well as intestinal problems, may have low stores of zinc. These patients have been nutritionally deprived through failure to absorb this substance or by starvation, given inadequate food, or intravenous fluids that lack the proper amount of zinc. For these patients, zinc should be given in a pill form.
Another trace element, selenium, can cause heart trouble if it is absent from the diet, but it is a rare deficiency. It is usually seen in individuals who receive all their nutrition intravenously, a procedure called total parenteral hyperalimentation. This deficiency has now been corrected by including selenium in all solutions given to sick people.
Because patients with IBD may have a capricious appetite or because of poor eating, some individuals may be given food supplements to increase both calories and nutrients. Some of those fluid preparations are high in calories and pleasantly flavored, but they are meant as supplements, not as replacements for real food not unless there is a mechanical blockage that prevents food from passing through the gut. Ensure, Sustical, or Flexi-Cal, are among the popular brand-name supplements you may be prescribed. The limitations in other “elemental diets,” as they are called, are their expense and unpalatable flavors. Patients are not happy to take them.
Another way of increasing calories even in patients who have had some of the intestine removed or in those with an inflamed bowel is to give them fat in a form that does not require the formation of micelles by bile salts and pancreatic juice which occur normally in digestion. What we give these patients is fat in the form of medium-chain triglycerides, which are shorter chains of fatty acid than we find in our normal diets. Corn oil, for example, is a long-chain fatty acid, but is not easily absorbed. The medium-chain triglycerides are digestible and are described at length in the article titled on malabsorption.
This term means supplying the patient’s nutrition by mouth in a liquid form that can be easily absorbed by the small intestine. With this approach, the diet is reduced to its essential chemical elements, a procedure recommended especially by our British colleagues in the treatment of Crohn’s disease. In some studies, elemental diets taken by mouth have reduced the complications of Crohn’s disease of the intestine.
These elemental diet preparations contain the smallest elements of the diets amino acids, sugar, triglycerides or fatty acids, vitamins, and trace elements. It is difficult to persuade patients with Crohn’s disease to take adequate amounts of these preparations because they are often so unpalatable. Even the astronauts rebelled against taking the elemental diet. But elemental enteral diets do appear to have a place in acute ulcerative colitis before surgery or as a way of treating inflammation in Crohn’s disease.
Prevention of Oxalate Kidney Stones:
At first glance, the title of this section may seem far afield from the dietary approaches we have been considering in this article. But patients with inflammatory bowel disease, both Crohn’s and ulcerative colitis, can and do often suffer from kidney stones, some of which are oxalate kidney stones. So it is important for us to understand how intestinal disease can contribute to the formation of oxalate stones.
Oxalate, which is the same as oxalic acid, is an organic compound that occurs naturally in food, especially in foods of plant origin. It is not essential for life and is excreted in the urine.
What are the foods that contain the high amounts of oxalate? The highest concentrations are found in green leafy vegetables, beans, cereals, beets, rhubarb, chocolate, tea, coffee, and peanuts.
What happens when oxalate is eaten by normal people? The ordinary diet contains between 80 and 100 milligrams of oxalate a day, and in most people, it is not absorbed, but forms insoluble calcium salts in the small intestine, which are excreted in the stool. In hyperoxaluria, on the other hand, excessive amounts of oxalate are excreted in the urine, and this leads to stones. For most individuals, an increased amount of oxalate in the urine stems from an increased absorption of the oxalate eaten.
How does the increased absorption take place in individuals with intestinal disease whose small intestine has been affected by disease or surgery, or by bypass surgery? Two mechanisms seem to be very important. First, patients with small bowel disease absorb fatty acids poorly. Calcium in the intestine forms soaps with the fatty acids rather than with the oxalate. The oxalate thus remains in solution, allowing for increased absorption. Moreover, patients with intestinal disease, especially if the ileum is affected, have trouble absorbing their bile salts. That results in the passage of bile salts into the colon, which normally functions to absorb water and solidify the feces. The presence of increased bile salts in the colon enhances the absorption of oxalate in the colon.
What is the best way to prevent the formation of oxalate stones? You must restrict your oxalate intake in the diet, limit your fat intake, increase fluid each day to dilute the urine of its oxalate contents, and avoid vitamin C supplements. This last point is important since vitamin C is converted into oxalate in the body of some individuals.
If your kidneys function normally, then you can supplement your diet with calcium in the form of calcium gluconate or calcium carbonate, which can block the absorption of oxalate. For some individuals, aluminum hydroxide will also block the absorption of oxalate, but not as effectively as calcium.
Rich fatty foods should be avoided, particularly butter, margarine, fried foods, and rich creams and sauces. On the other hand, cereals, meat, and some dietary products are low in oxalate. Your goal should be to eat no more than 40 to 50 milligrams of oxalate a day.
Oxalate Content by Food Groups:
Cereal and Cereal Products
|Egg noodle (Chow Mein)||1.0|
|Grits (white corn)||41.0|
|Spaghetti in tomato sauce||4.0|
|Milk and Milk Products|
Meats and Eggs:
|Bacon, streaky fried||3.3|
|Beef, canned corned||0.0|
|Beef, topside roast||0.0|
|Beans, green boiled||15.0|
|Beans in tomato sauce||19.0|
|Oxalate mg/100 gm|
|Brussels sprouts, boiled||0.0|
|Potatoes, white boiled||0.0|
|Watercress, early fine curled||10.0|
|Fruit salad, canned||12.0|
Bartlett, canned 1.7
Pineapple, canned 1.0
Golden Gage 1.1
Green Gage 0.0
Red plum jam 0.5
Strawberry jam 9.4
Prunes, Italian 5.8
Stewed, no sugar 860.0
Peanuts, roasted 187.0
Chocolate, plain 117.0
Jelly, with allowed fruit 0.0
Plain candies 0.0
Barley water, bottled 0.0
Coffee (0.5 g Nescafe/100 ml) 3.2
Lemon squash drink (lemonade) 1.0
Lucozade, bottled (soda) 0.0
Orange squash drink (orangeade) 2.5
Ovaltine drink, 2 grain 100 nil 10.0
Ribena, concentrate (black currant drink) 2.0
2 rain. infusion 55.0
4 Mill infusion 72.0
6 rain. infusion 78.0
Tea, rosehip 4.0
Apple juice trace
Cranberry juice 6.6
Grape juice 5.8
Grapefruit juice 0.0
Orange juice 0.5
Pineapple juice 0.0
Tomato juice 5.0
Beverages, alcoholic Beer
Lager draft, Tuborg Pilsner 4.0
Stout, Guinness draft 2.0
Sherry, dry trace
Cocoa, dry powder 623.0
Coffee powder (Nescafe) 33.0
Chicken noodle soup 1.0
Lemon juice 1.0
Lime juice 0.0
Ovaltine, powder canned 35.0
Oxtail soup 1.0
Tomato soup 3.0
Vegetable soup 5.0
100 grams = 1/z cup, usually
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