How Do I Maintain a Healthy Diet with Short Bowel Syndrome?

Patients with short bowel syndrome have unique dietary constraints because they have trouble absorbing nutrients. Kwai Lam, RD, clinical nutrition coordinator at the Mount Sinai Intestinal Rehabilitation and Transplantation Center, provides advice on how to obtain optimal nutritional intake with this difficult condition.

Kwai Lam, RD

In the United States, it is estimated that 10,000 to 20,000 people suffer from short bowel syndrome, a rare condition that occurs when an extensive length of the intestine is removed, typically during surgery to treat diseases, injuries, or birth defects.  It has debilitating effects, often contributing to poor quality of life and a greater chance of disease or death.

Dietary modifications aim to optimize nutrient and fluid absorption, and reduce diarrhea, malnutrition, and dehydration. What a patient can consume will depend on the anatomy of their remaining intestine. For example, the diet for someone with a colon will differ from someone without a colon. (See chart below.)

For all short bowel syndrome patients, foods with high sugar content should be avoided as they can exacerbate diarrhea. Meal planning should focus on including more complex carbohydrates such as bread, rice, pasta, and potatoes. Whole-grain products, raw vegetables, fruit peels, and nuts should be excluded due to their high fiber content and propensity to aggravate diarrhea. Dietary fat should be eaten in moderation, especially in individuals who have their colons since mal-absorbed fat in the colon along with a diet high in oxalate increase the risk of forming kidney stones.

Fluids with high sugar content, like juice and soda, cause an influx of water into the intestine, resulting in a laxative effect. Ideally, patients should consume fluid known as oral rehydration solution, which has a balanced ratio of sugar to sodium. Contrary to common beliefs, most sport drinks are not the best choice for this population, due to their high sugar and low sodium contents. Water and other fluids with no sodium or sugar, may be tolerated in some individuals who have their colon. However, these beverages tend to promote sodium and fluid loss, leading to further dehydration in individuals who have their colon removed. Oral rehydration solutions are recommended for all who have short bowel syndrome. They can be purchased commercially or made at home using three common household ingredients: water, table salt, and sugar.