Nutritional support for patients with diarrhoea

Question 1

Functions of the microbiome

Answer 1

• assists with breakdown of food and nutrient digestion
• production of metabolites including short chain fatty acids, bile acids, nutrients and vitamins
• resident intestinal microflora provides an environment that favours the growth and functioning of beneficial bacteria which supports the normal functioning of the immune cells and controls inflammatory processes -> prevents dz

Question 2

How can we maintain a healthy microbiome or rebalance gut microbes after a disruption?

Answer 2

• dietary manipulation: food is a substrate for GI microbes, so it has a direct impact on microbiome healthy and diversity
• any diet must be species specific and life-stage appropriate and selected depending on the cause of d+
• dietary changes may be short, or long-term
• prebiotic or probiotic therapy
• helminth therapy
• FMT

Question 3

Prebiotic - definition, functions and clinical uses

Answer 3

= non-digestible food ingredients that selectively stimulate the growth and activities of specific bacteria in the GIT and exert beneficial effects on the host = food for bacteria

Functions
- food for bacteria and produce energy for intestinal cells

Clinical use
- modulation of GALT
- maintaining healthy microbiota or rebalancing the gut microbes after disruption

Question 4

Probiotic - definition, functions and clinical uses

Answer 4

= living microorganisms which when administered in adequate amounts confer a health benefit on the host = live bacteria

Functions
- to adjust intestinal bacterial population
- helps digest food, maintains intestinal mucosal integrity, helps metabolism and stimulates systemic immune function

Clinical use
- modulation of GALT
- maintaining healthy microbiota or rebalancing the gut microbes after disruption
- control d+ caused by bacterial overgrowth or parasitic infection via competitive exclusion, competition for nutrients and binding sites, and an increase in specific and non-specific immune response

Question 5

Small vs large intestinal d+

Answer 5

SI:
- frequency: 2-4x daily
- urgency uncommon
- tenesmus rare
- increased volume of faeces
- mucus rare
- melaena possible
- steatorrhoea possible
- weight loss possible

LI:
- frequency: 4+x daily
- urgency common
- tenesmus common
- no increase in volume of faeces
- mucus common
- fresh blood possible
- no steatorrhoea
- no weight loss

Question 6

What are the 4 broad categories of available diets when picking a diet for a pt with d+?

Answer 6

Low fat diets
- typically have fat contents between 18-25g/1000kCal
- not to be confused with weight loss diets which may not contain the correct formulation of nutrients and fibre for pts with d+
- e.g. to treat pancreatitis

Fibre-enhancing diets
- soluble fibre dissolves in water to form a thick gel -> this slows the movement of ingests through the intestines
- insoluble fibre doesn’t dissolve in water and has low fermentability -> provides bulking of stool and water absorption
- ideal fibre enhancing diets contain both forms of fibre to provide a balancing effect
- e.g. to treat colitis

Low residue diets
- high protein digestibility (>85%)
- high fat and carb digestibility (>90%)
- low in fibre (<5%)
- speed movement through the stomach
- aid absorption in a compromised intestine
- e.g. to treat EPI

Hypoallergenic diets
- hydrolysed proteins reduce the chance of allergic reaction as they are too small to bind with immunoglobulins -> less likely to elicit a response from the pts immune system
- e.g. to treat nutritional allergy