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炎症性肠病的营养提示
炎症性肠病(IBD)是一个术语,用于两种特定的和独立的疾病:克罗恩病和溃疡性结肠炎. Nutritional recommendations are different for each disease and for each individual patient. 与注册营养师和十大赌博平台排行榜讨论适合你的治疗方法是很重要的.
疾病的定义
- 克罗恩氏病 克罗恩病是一种病因不明的慢性炎症性疾病,可累及消化道的任何部分. 炎症可以延伸到整个肠壁, 常导致腹泻, 狭窄(缩小), 瘘管(异常开口), malabsorption and the need for surgical resections of portions of the digestive tract.
- 溃疡性结肠炎 溃疡性结肠炎是一种结肠炎症性疾病, 或者是大肠, 哪一种常伴有带血腹泻. 这种炎症不会穿过整个肠壁,因此不会导致瘘管. 然而,广泛的炎症最终可能需要手术切除受影响的区域.
常见问题:IBD的饮食管理
关于IBD饮食治疗的信息常常令人困惑. 许多人收到的信息告诉他们要避免整个食物组或特定的食物. However, there is no need to avoid foods unless they worsen your symptoms. 最好是限制尽可能少的食物,以增加你获得平衡的机会, 营养的饮食. 这对维持消化道功能和整体健康非常重要.
饮食能控制IBD吗?
没有特定的饮食被证明可以预防或治疗IBD. 然而,一些饮食策略有助于控制症状. 下面的信息可能适合你的饮食策略.
我如何识别问题食品?
记录所吃的食物,然后注意症状何时恶化,这可以帮助你识别问题食物的模式.
What are dietary strategies for managing symptoms and when are they appropriate?
There are different approaches to diet during flares and in the absence of flares. 不管是什么疾病,都不要过度限制饮食. 生病期间充足的营养是很重要的. 具体建议见下文.
溃疡性结肠炎发作的饮食建议
- 遵循低残留饮食以减轻腹痛和腹泻.
- Avoid foods that may increase stool output such as fresh fruits and vegetables, 西梅和含咖啡因的饮料.
- 在你的饮食中减少浓缩的甜食, 比如果汁, 糖果和苏打水, 帮助减少进入肠道的水分, 哪些可能导致水样便.
- 减少饮酒量.
- 试着在你的饮食中加入更多的omega-3脂肪酸. 这些脂肪可能有消炎作用. 它们存在于鱼类中,包括鲑鱼、鲭鱼、鲱鱼和沙丁鱼.
- Patients often find that smaller, more frequent meals are better tolerated. This eating pattern can help increase the amount of nutrition you receive in a day.
- 如果食欲不佳和固体食物耐受不佳,可以考虑服用营养补充剂(参见推荐的液体补充剂部分)。.
克罗恩病发作的饮食建议
- 遵循低残留饮食以减轻腹痛和腹泻.
- 如果你有狭窄,避免坚果、种子、豆类和谷粒是特别重要的.
- Avoid foods that may increase stool output such as fresh fruits and vegetables, 西梅和含咖啡因的饮料. 冷食可能有助于减少腹泻.
- If you have 乳糖不耐受,遵循无乳糖饮食. 乳糖不耐症会引起胀气, bloating, 吃奶后30 ~ 90分钟抽筋、腹泻, 冰淇淋或大量的乳制品. 呼气氢测试可以证实乳糖不耐症的怀疑.
- If you have oily and foul-smelling stools, you may have 脂肪吸收不良. 通过低脂饮食治疗脂肪吸收不良. 与你的十大赌博平台排行榜或营养师讨论这些症状.
- Smaller, more frequent meals are better tolerated and can maximize nutritional intake.
- 如果你的食欲下降,不能很好地忍受固体食物, consider taking nutritional supplements (see section on recommended liquid supplements).
Diet Progression Following Flares for 溃疡性结肠炎 and 克罗恩氏病
- Continue to follow a low residue diet and slowly add back a variety of foods.
- 从耐受性良好的液体开始,逐步过渡到软固体, 然后是固体食物(液体和固体食物建议见下文).
- Introduce one or two items every few days and avoid any foods that cause symptoms.
- 在饮食中加入可耐受的纤维. 可耐受的纤维来源包括嫩熟的蔬菜, 罐装或煮熟的水果, 还有淀粉类食物,比如煮熟的谷物、全麦面条和玉米饼.
- 在爆发期间,在可容忍的范围内吃各种各样的食物. 这包括水果、蔬菜、全谷物、瘦肉蛋白、低脂和脱脂乳制品.
- 锻炼后增加卡路里和蛋白质的摄入量. Abdominal pain, diarrhea and decreased appetite may have caused poor food intake. 用于治疗耀斑的类固醇也会增加对蛋白质的需求.
耀斑后的第一个食物建议包括:
- 稀释果汁
- Applesauce
- 水果罐头
- Oatmeal
- 普通鸡肉、火鸡或鱼
- 煮熟的鸡蛋或鸡蛋替代品
- 土豆泥、米饭或面条
- 面包——酸面包或白面包
常见问题:治疗和营养副作用
有任何药物有营养副作用吗?
Moderate to severe flares of IBD are often treated with corticosteroids (prednisone), 胆甾胺和5-ASA化合物(磺胺嘧啶). 这些药物有营养副作用,应该加以解决. 如果你服用了这些药物, 向你的十大赌博平台排行榜或注册营养师咨询治疗建议.
- Prednisone causes decreased absorption of calcium and phosphorus from the small intestine. It also causes increased losses of calcium, zinc, potassium and vitamin C. 持续使用大剂量强的松, 其结果可能是骨质流失和骨病的发展. 服用强的松的人每天可能需要高达1200毫克. 服用强的松的人对蛋白质的需求也会增加,因为它会增加体内蛋白质的分解.
- 消胆胺 减少脂溶性维生素(A)的吸收,D, E and K), 还有叶酸, 维生素b - 12, 钙和铁.
- 柳氮磺胺吡啶 干扰叶酸的吸收. People taking this drug also should take a 1 milligram folate supplement each day.
手术会影响营养状况吗?
Some patients need surgery for severe inflammation, strictures, fistulas and abscesses. In 克罗恩氏病, the affected portion of the digestive tract is removed. 溃疡性结肠炎, 结肠通常被切除,回肠(小肠的底部)可以连接到肛门.
切除部分肠道会影响营养状况. 当小肠或大肠的部分被切除, 吸收营养物质的表面积减少了. 下面的图表说明了营养物质被吸收的地方. 如果肠道的某些部分严重发炎, 或者已经被移除, 营养的吸收可能会受到影响. 可能导致营养不良和营养缺乏.
如果你已经或正在计划做切除肠道的手术, 和你的十大赌博平台排行榜或注册营养师谈谈你需要服用哪些维生素和矿物质.
IBD的哪些副作用会导致营养不良?
There are several reasons why people with IBD may be at risk for malnutrition. The following list includes some side effects that contribute to malnutrition.
- 食物/液体摄入不足可能引起恶心, 腹部疼痛, 食欲不振食欲不振或味觉改变
- 损失增加-急性发作期间肠道炎症导致蛋白质损失增加, 瘘管液损失, 腹泻和出血
- Increased nutritional needs – inflammation or infection increases metabolic requirements
- Malabsorption with 克罗恩氏病 may be caused by severe intestinal inflammation, 切除小肠和药物治疗, 比如强的松和柳氮磺胺嘧啶
肠病患者的营养需求不同吗? 克罗恩病和溃疡性结肠炎患者的具体营养需求是什么?
营养需求因人而异,因疾病状况、体型和年龄而异. 营养师可以帮助你估计你的个人需求. Calorie and protein needs are similar for 克罗恩氏病 and 溃疡性结肠炎. 在这两种疾病中,需要在炎症期间和之后立即增加以恢复损失. The following are general statements about nutritional needs that may apply to you.
- Calories 除非希望体重增加,否则热量需求只会轻微增加. Weight loss can occur due to episodes of inflammation, poor appetite and decreased intake.
- Protein 患者在两次发作之间的蛋白质需求量等于你体重的克数(1千克等于2千克).2磅体重). 例如,120磅. 女性54岁.5 kg. 因此每天应该摄入大约55克蛋白质. 对于体重增加和恢复急性发作后的损失,需要增加50%. 如果服用皮质类固醇(强的松),需求也会增加。.
- 液体和电解质 喝足量的液体很重要. A good guideline for hydration is to drink half of your body weight in ounces of water (e.g. a 120 lb. 人应该喝60盎司的水). Fluid requirements increase during or after episodes of diarrhea and with exercise. 确保你补充了腹泻造成的电解质损失. Sodium, 氯和钾可以通过喝运动饮料来补充, 比如佳得乐和Powerade.
- 维生素和矿物质 每天可以服用一种含矿物质的标准复合维生素. 某些营养素缺乏的风险增加,应该通过额外补充这些营养素来治疗. 与你的营养师或十大赌博平台排行榜讨论维生素和矿物质的需求.
- People with 克罗恩氏病 由于广泛的炎症或消化道的大部分切除,是否有更大的维生素和矿物质缺乏的风险.
- People with 溃疡性结肠炎 have less risk for vitamin and mineral deficiencies but are more prone to iron, 液体和电解质流失并出血, 腹泻和/或大肠切除.
What can I do for periods of poor appetite and weight loss to prevent malnutrition?
有时,很少有食物能被很好地耐受. 在这段时间里,尽可能多地吃可忍受量的高热量食物是很重要的. During times when solid foods cause irritation or you have a poor appetite, 液体口服补充剂可能有助于提供营养. The following list includes liquid supplements for 克罗恩氏病 and 溃疡性结肠炎.
克罗恩病的液体补品
- 儿童用Peptamen或Peptamen Junior Contains protein that has been partially broken down, making it easier to absorb. This may be useful if portions of the digestive tract are inflamed 或者已经被移除. 这个配方还含有更容易被吸收的MCT油, 减少脂肪吸收不良(腹泻)的不良影响, 胀气和腹胀). This formula is not highly concentrated, which also may help decrease diarrhea. An 8 ounce ready-to drink can provides 240 calories, 10 grams protein; made by Nestle. 建议添加风味包,以提高适口性.
- Peptamen 1.5 与Peptamen成分相同,但每罐提供更多卡路里. An 8 ounce ready-to-drink can provides 360 calories, 16 grams protein; made by Nestle.
- Modulen IBD 温和配方,可能有助于控制腹泻. 它还含有一种生长因子,可以减少炎症. 它含有MCT油,可以更好地吸收脂肪. An 8 ounce serving made from powder provides 240 calories, 9 grams protein; made by Nestle.
- EnLive! 适用于术前营养,脂肪吸收不良,乳糖不耐症和麸质敏感. This is a clear liquid supplement that is a good source of protein and calories. An 8 ounce. ready-to drink box provides 300 calories, 10 grams protein; made by Ross.
- Lipisorb High in MCT oil, which is an easily absorbed form of fat -- useful for 脂肪吸收不良. An 8 ounce ready-to drink can provides 325 calories, 14 grams protein; made by Mead Johnson.
- Subdue 部分分解的蛋白质加上MCT油,可以更好地吸收脂肪. An 8 ounce ready-to drink can provides 240 calories, 12 grams protein; made by Mead Johnson.
- Vivonex 可能适用于严重的吸收问题. 这种配方脂肪含量很低,是“元素”或含有完全分解的蛋白质, 所以肠道可以很容易地吸收营养. An 8 ounce ready-to drink can provides 240 calories, 11 grams protein; made by Novartis
- Optimental 该产品也是元素(完全分解的蛋白质),并含有MCT油,更容易吸收. 它不含乳糖,含有高水平的抗氧化剂. An 8 ounce ready-to drink can provides 237 calories, 12 grams protein; made by Ross.
溃疡性结肠炎的液体补品
Because people with 溃疡性结肠炎 do not have malabsorption concerns, a supplement that contains partially broken down protein is not usually needed. 标准补充剂是好的,但如果它们是等渗的或低浓度的,则更容易耐受, 这有助于预防腹泻. Some formulas that may be helpful include Modulen IBD or Enlive (see above).
营养缺乏及治疗
溃疡性结肠炎
People with 溃疡性结肠炎 may have increased needs for the following nutrients. Deficiencies depend on medications used and the extent of blood loss and diarrhea. Consult your doctor or nutritionist if you have concerns about deficiencies. 通过补品和营养丰富的食物来纠正.
- Folate 使用柳氮磺胺吡啶增加风险
- Magnesium 慢性腹泻的风险增加
- Calcium 使用强的松增加风险
- Iron 结肠溃疡导致失血的风险增加和/或缺乏症的临床体征和症状(贫血)
- Potassium 慢性呕吐和腹泻的风险增加,强的松的使用 and/ or low blood levels of potassium
克罗恩氏病
患有克罗恩病的人缺乏以下营养素的风险可能会增加. A variety of factors affect risk for nutrient deficiency including medications used, 部分消化道被切除, degree of inflammation and the patient's ability to take adequate nutrition. Consult your doctor or nutritionist if you have concerns about deficiencies. Nutrient deficiencies are treated with supplements and nutrient-rich foods.
- Vitamin B12 回肠(下小肠)广泛炎症或切除回肠的风险增加.
- Folate 使用柳氮磺胺吡啶增加风险; extensive inflammation in the jejunum (middle portion of the small intestine) or removal of the jejunum.
- 维生素D, E和K Increased risk with 脂肪吸收不良; inflammation of large portions of the jejunum and/or ileum or removal of portions of the jejunum and ileum.
- Vitamin A Increased risk with 脂肪吸收不良; disease involvement of the duodenum (upper small intestine) and/or upper jejunum.
- Magnesium 广泛的炎症和/或切除大部分空肠和回肠的风险增加, 瘘管丢失和慢性腹泻.
- Zinc 伴有广泛炎症和/或空肠切除的风险增加, diarrhea, 瘘损失, 使用强的松或测量低血锌水平.
- Calcium 避免乳制品导致乳糖不耐症的风险增加, 脂肪吸收不良, 强的松使用, 整个小肠广泛的炎症或手术.
- Potassium 慢性呕吐和腹泻的风险增加,强的松的使用.
加州大学旧金山分校健康医学专家已经审查了这些信息. 它仅用于教育目的,并不打算取代您的十大赌博平台排行榜或其他医疗保健提供者的建议. We encourage you to discuss any questions or concerns you may have with your provider.