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The Short Story on Short Gut/Bowel Syndrome
Call it what you want: the gut, intestines, bowels - it’s the system of organs are comprised of the small and large intestine (aka the colon). Most people don’t know that key nutrients are digested and absorbed in the gut, not in the stomach. The stomach is useful, don’t get us wrong, but the gut is where most of the action happens.
Short Bowel Syndrome, or SBS, can affect a person’s ability to digest and tolerate certain foods as well as the ability to absorb nutrition. A bowel resection, or removal of portions of the intestine, usually creates a situation for SBS to occur. Different types of bowel resection can have a variety of different nutritional consequences, each described below.
Type of Bowel Resections
Removal of a portion of the duodenum, one of the three major sections of the small intestine (the other sections being the jejunum and the ileum). The duodenum is where folate, iron, and zinc are absorbed.
Removal of a part of the jejunum can impair nutrient absorption. Although the ileum can adapt to take on the role of the jejunum, food maymove through the bowels too quickly resulting in loose stools and reduced absorption of fat, carbohydrates, and certain vitamins and minerals.
Removal of part of the ileum can cause major concerns, such as loose stools (causing electrolyte and fluid imbalance) and malabsorption of fat-soluble vitamins A, D, E, and K, as well as other nutrients. Ileal resection may increase the risk of kidney stones. If too much of the colon is removed, an ileostomy may be created, which is a surgical opening in the abdominal wall from the ileum to allow fecal matter to be excreted.
Removal of a portion of the colon. Colectomy types are named based on how much of the large intestine was removed (example: a sigmoid colectomy indicates the sigmoid was removed, the region closest to the rectum). If too much of the colon needs to be removed, such as in certain types of colon cancer, a colostomy may be created, which is a surgical opening in the abdominal wall from the colon to allow fecal matter to be excreted.
Symptom Management is Key
The most common symptoms from short bowel syndrome are bowel movement changes (typically diarrhea), bloating, gas, and cramps. Unintentional weight loss may occur from not eating enough and/or poorly absorbing nutrients. Having a grasp of tips and tricks for short bowel can minimize your chances of experiencing these symptoms.
Managing fiber and hydration become key in promoting bowel movements, hydrating the gut, and reducing fermentation of foods that can cause gas/bloating/cramps. In the case of diarrhea, soluble fiber (such as the fiber found in bananas, peeled fruit/vegetables, and white grains (such as rice and pasta) can help slow down gut motility and create more formed stools. In the case of constipation, insoluble fiber (found in whole grains (brown rice and pastas), fruit/vegetables with the skin, and nuts/seeds can help promote gut motility to move stool through faster.
Either way, adequate hydration with water (there is no replacement for water, in case you are curious) is key. Most people should aim for at least 4 (16.9oz) bottles of water per day (equivalent to 2 Liters or 64oz), but water recommendations are truly more individual than this blanket recommendation.
A Registered Dietitian can help you create a sustainable plan to enjoy the foods you eat while managing short bowel and minimizing complications. For more questions regarding short bowel and other nutrition topics, contact us and we’ll be happy to help!
Kamran Ahmad, MS, RDN, LDN
Zachari Breeding, MS, RDN, LDN, FAND
Kevin Klatt, PhD/RD Candidate