A complete information guide to Medical Nutrition Therapy of Upper and Lower Gastrointestinal Disorders

1. Gastrointestinal Diseases (Upper
& Lower) and their Medical
Nutrition Therapy
Presented By ;
 Alishba Saleem
Clinical and Community Learning Nutritionist

2. Gastrointestinal Disorders
 Gastrointestinal disorders is the term used to refer to any
condition or disease that occurs within the gastrointestinal
tract.
 The gastrointestinal tract (also called the GI tract) is a
series of hollow organs that form a long continuous
passage from our mouth to our anus. The organs that make
up our GI tract are our mouth, esophagus, stomach, small
intestine, large intestine, and anus.

3. Types
 There are 2 types:
1) Upper GI tract
2) Lower GI tract
 Upper GI tract:
It consist of structures that’s aids in ingestion and digestion of
food.
It includes:
 Peptic ulcer
 Gastritis
 Hiatal hernia
 Gastroesophaegal reflux disease

4. Peptic ulcer
 Peptic ulcers are open sores that develop on the inside
lining of your stomach and the upper portion of your small
intestine.
 They're usually formed as a result of inflammation caused
by the bacteria H. pylori, as well as from erosion
from stomach acids

5. Epidemiology
• Ulcers can develop at any age
• They most often occur from early middle age onwards ( 30 -
50), with gastric ulcers being more common in elderly people (
> 60).
• Affect both men and women.
• May be acute or chronic
Acute ulcers are often multiple, produce no symptoms and
usually heal without scarring.
Chronic ulcers are deeper, usually occur individually and
usually produce symptoms. They leave a scar when they heal.

6. Types of Peptic Ulcer
 There are 2 types of peptic ulcer:
1. Gastric ulcers
2. Duodenal ulcers
 Gastric ulcers:
which form in the lining of the stomach.
 Duodenal ulcers:
which form in the upper small intestine.

8. Symptoms
 Burning stomach pain
 Feeling of fullness, bloating
 Fatty food intolerance
 Heartburn
 Nausea
 vomit that’s bloody or looks like coffee
grounds
 Dark blood in stools, or stools that are
black or tarry
 Trouble breathing
 Feeling faint
 Unexplained weight loss

9. Diagnosis of Peptic Ulcers
 Your doctor will use information from your medical history, a
physical exam, and tests to diagnose an ulcer and its cause. The
presence of an ulcer can only be determined by looking directly
at the stomach with endoscopy or an X-ray test.
 Medical history
 To help diagnose a peptic ulcer, your doctor will ask you
questions about your medical history, your symptoms, and the
medicines you take.
 Be sure to mention medicines that you take without a
prescription, especially nonsteroidal anti-inflammatory drugs
(NSAIDs), such as
 aspirin (Bayer Aspirin)
 ibuprofen (Motrin, Advil)

10. Physical Exam
 A physical exam may help a doctor diagnose a peptic
ulcer. During a physical exam, a doctor most often
 checks for bloating in your abdomen
 listens to sounds within your abdomen using a stethoscope
 taps on your abdomen checking for tenderness or pain

11. Upper Gastrointestinal
Endoscopy
 An endoscope, a thin tube containing a tiny camera, is
inserted through your mouth and down into your stomach
to look at the stomach lining. The doctor will check
for inflammation and may perform a biopsy, a procedure
in which a tiny sample of tissue is removed and then sent
to a laboratory for analysis.

12. Lab tests
 To see if you have a Helicobacter pylori (H.
pylori) infection, your doctor will order these tests:
 Blood test
 Urea test
 Stool test

13. Medical Nutrition Therapy
 According to Marrota and Floch, calories distribution for
patients with peptic ulcer should be normal, with values
ranging from
 50-60% of carbohydrates
 10-15% of proteins
 and 25-30% of lipids

14.  To accelerate the healing process, in addition to protein,
there are specific micronutrients such as
 zinc:
It is essential to maintain the immune system function, as
a response to oxidative stress, and to heal wounds.
 Selenium
It may reduce infection complications and improve
healing.
 vitamin A:
It may be used as a supplement, but the research that
supports this practice is of limited effectiveness, because
very high dosages do not promote cure, and excessive
intake may be toxic

15.  Vitamin B12
Deficiency of vitamin B12 is common in patients with
peptic ulcer due to the prolonged use of antacids.
Deficiency of this vitamin causes impaired cell division
and megaloblastic anemia.
 2.4 µg/day is recommended, which can be obtained
from animal foods, such as meat and eggs.

16. Foods With Probiotics
 Foods like yogurt, miso, and tempeh are rich in
“good” bacteria called probiotics. They may help
ulcers by fighting an H. pylori infection or by helping
treatments work better.
Fiber-Rich Foods
 A diet rich in fibers for individuals with peptic ulcer
is advisable.

17.  According to WHO 20 to 30 g/day of fiber is
reccomended because it act as buffers, reducing
concentrations of bile acids in the stomach and the
intestinal transit time, resulting in less abdominal bloating,
thus decreasing discomfort and pain in the gastrointestinal
tract
 Fiber-rich fruits include: bananas, oranges, apples,
mangoes, strawberries, raspberries.
 Sweet Potato
It’s high in vitamin A, and there’s evidence that this
nutrient can help shrink stomach ulcers and may also play
a role in preventing them. Other foods with a good dose of
vitamin A include spinach, carrots and beef liver.

18. Food groups Allowed Use with caution Prohibited
Dairy low-fat cheeses,
yogurt, fermented
milk
Fatty cheeses
(cream cheese)
-
Oilseeds Flaxseed, Brazilian
nut, walnuts
- -
Oils and olive oils Vegetable oils, olive
oil
- Fried foods
Fruits Apple, papaya,
melon, banana
Orange, pineapple Lemon
Vegetables Leafy dark green
vegetables, carrot,
green bean,
spinach, kale,
radish, zucchini
Broccoli,
cauliflower,
cabbage, cucumber,
onion, red pepper
Spicy peppers (black
pepper, chilies)
Legumes Bean soup, lentils,
chickpeas, soybean
Beans -
Meats Lean meat (beef,
pork, chicken, fish)
Fatty meats, organ
meats and sausages
-

21. Gastritis
 Gastritis is a condition in which the stomach lining known
as the mucosa is inflamed, or swollen.

22.  Gastritis may be acute or chronic
 Acute gastritis
It starts suddenly and lasts for a short time.
 Chronic gastritis
It is long lasting. If chronic gastritis is not treated, it may
last for years or even a lifetime.

23. Types of Gastritis
 Erosive gastritis:
 Erosive gastritis is gastric mucosal erosion caused by
damage to mucosal defenses. It is typically acute,
manifesting with bleeding, but may be sub acute or
chronic with few or no symptoms.
 Non erosive gastritis:
It refers to a variety of histologic abnormalities that are
mainly the result of Helicobacter pylori infection.

24. Causes
Gastritis can be caused by:
 Due to excessive alcohol use
 vomiting
 stress
 the use of certain medications such as aspirin or other
anti-inflammatory drugs.

25. It may also be caused by
 Helicobacter pylori (H. pylori):
 A bacteria that lives in the mucous lining of the stomach
without treatment, the infection can lead to ulcers, and in
some people, stomach cancer.
 Bile reflux:
 A backflow of bile into the stomach from the bile tract
(that connects to the liver and gallbladder)
 Infections:
 caused by bacteria and viruses.
If gastritis is left untreated, it can lead to a severe loss
of blood and may increase the risk of
developing stomach cancer.

26. Symptoms
Symptoms of gastritis vary among individuals:
 Nausea
 Abdominal pain
 Vomiting
 Indigestion
 Burning or gnawing feeling in the stomach between meals or at night
 Hiccups
 Loss of appetite
 Vomiting blood or coffee ground-like material
 Black, tarry stools
 shortness of breath
 dizziness or feeling faint

28. How is gastritis diagnosed?
 A health care provider diagnoses gastritis based on the
following:
 medical history
 physical exam
 upper GI endoscopy
 other tests
 Medical History
 Taking a medical history may help the health care provider
diagnose gastritis. He or she will ask the patient to provide a
medical history. The history may include questions about
chronic symptoms and travel to developing countries.

29.  Physical Exam
 A physical exam may help diagnose gastritis. During a
physical exam, a health care provider usually
 examines a patient's body.
 uses a stethoscope to listen to sounds in the abdomen.
 taps on the abdomen checking for tenderness or pain.
 Upper Gastrointestinal Endoscopy
 An endoscope, a thin tube containing a tiny camera, is
inserted through your mouth and down into your stomach
to look at the stomach lining. The doctor will check
for inflammation and may perform a biopsy, a procedure
in which a tiny sample of tissue is removed and then sent
to a laboratory for analysis.

30. Other tests
 blood tests
 urine tests
 evaluations of kidney and liver function
 checks for anemia
 gallbladder and pancreas function tests
 pregnancy tests
 stool evaluation

31. Treatment
 Treatment for gastritis is dependent on several factors. These
include the cause of the condition and whether the presentation
of gastritis is acute or chronic.
 Treatment options for gastritis involve a range of medications,
such as:
 Antibiotic medications:
 A 10 to 14 day course of antibiotics can directly attack H.
pylori. Regimens may include clarithromycin and
metronidazole.
 Histamine (H-2) blockers:
 Histamine blockers, such as ranitidine and famotidine, can
decrease acid production.
 Antacids:
 These can neutralize stomach acid.

32. Medical Nutrition therapy
 Dietary choices for gastritis can help to manage the severity of
symptoms and prepare the body to get rid of H. pylori bacteria.
 Foods to Eat:
 Both broccoli sprouts and probiotic yogurt have demonstrated
helpful effects that counter H. pylori.
 Eat high-fiber foods such as apples, oatmeal, broccoli, carrots,
and beans.
 low-fat foods such as fish, chicken, and turkey breast
 foods with low acidity, or are more alkaline, like vegetables
such as Brussels sprouts, carrots,cabbage, broccoli, artichokes,
asparagus, green peppers, green beans, and onions.

33. Foods to avoid
 Some foods and beverages can aggravate the symptoms of gastritis,
and should not be eaten while the disease is active these include:
 caffeinated drinks
 regular and decaffeinated coffee
 mint, green, and black teas
 orange and grapefruit juices
 alcohol beverages
 spicy foods, such as chili powder, hot peppers, and black pepper
 dairy foods made from whole milk and strong or spicy cheeses
 tomato products
 chocolate

34.  Other foods that are safe to consume are following:
 celery
 berries
 olive oil
 honey
 herbal teas

35.  Eat 5 to 6 small meals a day, as this can reduce the impact
of stomach acids.
 Hydrate often by frequently consuming water.
 Add omega 3 supplements to the diet, as they may play a
role in resolving gastritis such as fish oil.

36. Home remedies for gastritis
 Follow an anti-inflammatory diet. A diet to
prevent gastritis should include broccoli and olive oil.
 Take a garlic extract supplement.
 Try probiotics.
 Drink green tea with honey.
 Eat lighter meals.
 Avoid smoking and overuse of painkillers.
 Reduce stress(massage, yoga,breathing exercises)

37. Gastroesophageal reflux disease
 Gastroesophageal reflux disease, or GERD is a digestive
disorder that affects the lower esophageal sphincter (LES),
the ring of muscle between the esophagus and stomach.
Many people, including pregnant women, suffer
from heartburn or acid indigestion caused by GERD.
 Doctors believe that some people suffer from GERD due
to a condition called hiatal hernia.

38. What Is the Role of Hiatal
Hernia in GERD?
 Some doctors believe a hiatal hernia may weaken the LES and
increase the risk for gastroesophageal reflux. Hiatal hernia
occurs when the upper part of the stomach moves up into the
chest through a small opening in the diaphragm (diaphragmatic
hiatus). The diaphragm is the muscle separating
the abdomen from the chest. But having a hiatal hernia may
allow stomach contents to reflux more easily into the
esophagus.
 Coughing, vomiting, or sudden physical exertion can cause
increased pressure in the abdomen resulting in hiatal
hernia. Obesity and pregnancy also contribute to this condition.

40. Causes
 Low stomach acid
 Obesity
 Cigarette smoking
 Haital hernia
 Pregnancy
 Too much gas
 H.pylori
 Magnesium deficiency
 Wrong posture
 Low chloride diet
 Eating certain foods (triggers) such as fatty or fried foods
 Drinking certain beverages, such as alcohol or coffee
 Taking certain medications, such as aspirin

41. Symptoms of GERD
 Common signs and symptoms of GERD include:
 A burning sensation in your chest (heartburn), usually after
eating, which might be worse at night
 Chest pain
 Difficulty swallowing
 Sensation of a lump in your throat
 If you have nighttime acid reflux, you might also experience:
 Chronic cough
 New or worsening asthma
 Disrupted sleep

42. Diagnosis
 There are several possible tests to diagnose GERD, including:
 Esophageal pH and impedance monitoring: This measures
the amount of acid in the esophagus while the body is in
different states, such as while eating or sleeping.
 Upper gastrointestinal (GI) endoscope: This is a tube with a
camera attached, which is used to inspect the esophagus. A
small sample of tissue may also be taken at the same time in a
biopsy.
 Upper GI series: This is a type of X-ray that shows up certain
physical abnormalities that might cause GERD

43.  Esophageal manometry: This measures muscle
contractions in the esophagus during swallowing. It can
measure the strength of the sphincter.
 Bravo wireless esophageal pH monitoring: In this test, a
small temporary capsule is attached to the esophagus. This
measures the acidity continuously for around 48 hours.

44. Treatment
 GERD will often be treated with medications before attempting
other lines of treatment.
 Proton pump inhibitors are one of the main pharmaceutical
treatment options for people with GERD. They decrease the
amount of acid produced by the stomach.
 Other options include:
 H2 blockers: These are another option to help decrease acid
production.
 Antacids: These counteract the acid in the stomach with
alkaline chemicals. Side effects can
include diarrhea and constipation.

45.  Prokinetics: These help the stomach empty faster. Side
effects include diarrhea, nausea, and anxiety.
 Erythromycin: This is a type of antibiotic that also helps
empty the stomach.

46. Medical nutrition therapy
 Milk and milk products
 Fat-free, low-fat, and reduced-fat milk, low-fat or fat-free
yogurt, soy milk.
 Breads and cereals
Plain (with or without whole grain flour) bread, cereals,
rolls, and crackers, pancakes, waffles, muffins made with
low-fat ingredients

47.  protein from low-cholesterol
sources, such as salmon, trout,
almonds, lean poultry, beans, and
lentils
 Vitamin C rich foods like fruits such
as orange, kiwi, lemon, guava,
grapefruit,
 fruits high in fiber, magnesium,
and potassium, especially berries,
apples, pears, avocados, melons,
peaches, and bananas.

48.  eggs, in spite of their
cholesterol content
 Eat green leafy vegetables, such
as broccoli, spinach, kale,
asparagus, and Brussels sprouts.

49. Foods to avoid
 Avoiding the following foods may help with reducing symptoms:
 Caffeine (regular coffee, regular tea, chocolate)
 Citrus fruits/juices
 Carbonated beverages
 Alcohol
 Mints (peppermint, spearmint)
 Tomato products
 Fried, greasy foods
 Spicy foods
 Garlic and onions
 Chocolate
 meat, as it tends to be high in cholesterol and fatty acids
 oils and high-fat foods
 high quantities of salt

50. Home Remedies
 Chew Gum: People experiencing GERD can get some relief
by chewing sugar-free gum for 30 minutes after they eat.
Chewing a piece of gum stimulates the salivary glands, which
increases saliva. The saliva helps wash away any acid. Chew
one piece after you eat and note the difference.
 Don’t Lie Down After Eating: When you eat a meal and then
lie flat, the contents of your stomach can more easily be pushed
back up, as it puts pressure on your esophageal sphincter. It’s
best to eat three to four hours before you know you’ll be lying
down to allow time for your food to fully digest.

51.  Eat Fruit:
 Bananas have natural antacid properties that counteract acid
reflux. Eat a fully ripened banana each day to reduce the
discomfort of acid coming back up. Another great fruit to try is
an apple. To prevent discomfort at night, slice up an apple and
enjoy it a few hours before bedtime. Other fruits that can
reduce instances of GERD are and watermelon. Be sure to
avoid fruits with high acidic content such as oranges, grapefruit
and pineapple.
 Ginger Tea:
 Ginger tea is great for many stomach ailments, from the
common stomachache to nausea to chronic acid reflux. For full
flavor, simmer slices of ginger root in water for 30 minutes.
For maximum benefit, drink the tea before a meal to maximize
the impact of GERD.

52.  Other lifestyle and behavior changes can help relieve
GERD include:
 Eat moderate amounts of food and avoid overeating.
 Stop eating 2 to 3 hours before sleeping.
 Quit or avoid smoking.
 If a person is overweight, losing weight can help prevent
symptoms.
 Do not wear clothing that is tight around the abdomen.
 Sleep at a slight angle with the head slightly elevated.

54.  Many of the intestinal diseases occur because of the
target tract itself or because of the organs closely
related to the digestive process – liver, gallbladder and
pancreas.
 Depending on the disease, there may be disturbances
in motility, adequacy of enzyme production or release,
integrity of mucosal surface, transport mechanism and
so on.

55. Factors affecting the GI Motility
 Eating a low fiber diet
 Sedentary lifestyle
 Travelling or change in routine
 Resisting the urge to have a bowel movement
 Taking certain medication (anti depressants,
antibiotics, narcotics, antacids)
 Overuse of bowel laxative

56. What is Diarrhea?
 WHO defines diarrhea as passage of three or more
loose or liquid stools per day
 It occurs when there is rapid transit of intestinal
content, decreased enzymatic digestion, decreased
absorption of fluids and nutrients, increased secretion
of fluids into the GIT.
 It is not a disease, rather a symptom

57. Types of Diarrhea
 Exudative diarrhea is associated with mucosal
damage which leads to a discharge of mucus, fluid,
blood and plasma proteins along with the stool.
Crohn’s disease and Ulcerative colitis is mostly
exudative
 Osmotic diarrhea occurs when osmotically active
solutes are present in intestinal tract and are poorly
absorbed. It occurs mostly in patients consuming
simple sugar feedings after gastrojejunostomy

58.  Secretory diarrhea occurs because of active intestinal
secretion of electrolytes and water by the intestinal
epithelium resulting from certain bacterial and viral
actions and increased hormonal secretion
 Malabsorptive diarrhea results when a disease
impairs digestion or absorption to a point that
nutrients appear in stool. E.g, steatorrhea

59.  Medication induced diarrhea are most prevalent in
hospitalized and long term care patients. Medication
such as lactulose (used in hepatic encephalopathy),
sodium polystrene sulonate with sorbitol (used to treat
hyperkalemia) create increased bowel movements as
part of their mechanism of action

60. Medical Nutrition Therapy
 In order to avoid/treat dehydration which is a
common underlying factor of diarrhea, replacement of
necessary fluids and electrolytes is the first step
 Consumption of beverages and foods containing
sodium and potassium should be increased. These
may include ORS, broth, pedialyte, bananas and
mashed potatoes

61.  A low fiber diet is so far highly consumed and
beneficial diet for diarrheal patient
 Modest intake of prebiotic components and soluble
fibers such as pectin or gum slows transit through the
GI tract
 Foods containing prebiotics include bananas, oatmeal,
garlic, yogurt, whole wheat foods
 Foods containing soluble fiber include rice, apple,
beans, peas, lentils

62.  If diarrhea is accompanied by prolonged infectious or
inflammatory disease, malabsorption of vitamin,
mineral, fat or protein may also occur and nutrients
may have to be replaced parenterally or enterally.
 Loss of iron from severe GI bleeding may even cause
anemia
 Vitamin B12, folic acid and niacin deficiency is also
seen in some diarrheal patients

63. Low Fiber Diet
Foods Allowed
 All beverages – except for carbonated drinks
 Bread & Cereal foods containing rice, oatmeal, white bread,
corn flakes
 Eggs – all except fried
 Fruits – bananas, papaya, apricots, plums, peaches (all
without seeds and peels), strained fruits juice
 Meat – tender, minced or ground
 Vegetables – potato without skin, carrots, pumpkin, tender
chopped greens, strained cooked vegetables
 Lentils, beans, chickpeas.
 Yogurt is a good dairy option in diarrhea

64. Foods to limit in low fiber diet
 Excessive consumption of lactose
 Insoluble fiber including barley, whole wheat, bran
 Sugar alcohol, fructose and large amount of sucrose
worsen osmotic diarrhea
 Caffeine should be avoided till condition is stable
 Fried food should be avoided
 Strong flavored vegetables and fruits with tough peels
and certain flatulance causing foods should be avoided

65. Constipation
 It is defined as difficulty with defecation, characterized
by painful, hard or incomplete evacuation
 Causes of constipation are varied and may be multi
factorial
 It is one of the most prevalent healthcare issue
worldwide

66. Causes of Constipation
 Lack of fiber in diet
 Sedentary lifestyle
 Low total calorie intake and fluid intake
 Laxative abuse
 Certain gastrointestinal diseases
 Neurologic disorders, pelvic floor disorders,
dysmotility disorders

67. Medical Nutrition Therapy
 Primary nutrition therapy for constipation includes
consumption of adequate amounts of fluids and
dietary fiber (soluble and insoluble)
 Fiber increases colonic fecal fluid, microbial mass,
stool weight and frequency, and the rate of colonic
transit
 With adequate fluid intake, fiber softens the fluid and
makes it easier to pass

68.  DRI recommends fiber consumption of 25 g for adult
women and 38 g for adult males
 Fiber includes cellulose, hemicellulose, pectins, gums,
legnins, starchy material and oligosaccharide. Fiber
can be provided in the form of whole grains, fruits,
vegetable, legumes, seeds and nuts
 Moderate physical activity for atleast 20 – 30 minutes
per day is necessary

69.  A high fiber diet may have to exceed 25 to 38 g/day
 Bran and fiber supplements are necessary for patients
who can not meet the recommended intake of fiber
 Consumption of atleast 2 liter of fluids daily is
necessary to facilitate the effectiveness of a high fiber
diet

70. High Fiber Diet
 Increase consumption of whole grain breads cereals,
and other products to 6 to 11 servings
 Incorporate foods including whole wheat, oatmeal,
nuts and seeds, legumes and beans in diet
 Consume at least 4 to 5 servings of fresh fruits and
vegetables including apples, melon, apricot, peach,
pear, mango, banana, orange, dates, figs, green leafy
vegetables, dark colored vegetables, tomatoes, sweet
potato
 Include fruit juices with pulp

71.  Incorporate bran in diet. Start by consuming one
tablespoon of bran and increase the amount gradually
 Add dairy products in diet. Prefer milk based desserts
 Keep handful of nuts and dried fruits with you and
consume them as snacks

72. Foods that may cause Flatulence
 Beans
 Vegetables such as broccoli, cauliflower, capsicum,
cabbage, onions, mushroom
 Fruits such as pear, apple, peaches
 Soda fruit drinks
 Milk and milk products
 Packages food such as bread, cereal, salad dressing

73. Irritable Bowel Syndrome
 It is a condition characterized by unexplained
abdominal discomfort or pain that is associated with
changes in bowel movement
 Common symptoms include bloating, flatulence,
abdominal discomfort, GI distress, diarrhea and
constipation

74.  Rome 3 criteria for IBS and its subtypes are used to
define the diagnosis
 Criteria consists of recurrent abdominal pain or
discomfort for at least 3 days per month in the last 3
months with following conditions ;
1. Pain with defecation
2. Change in stool frequency at onset
3. Change in stool form or appearance at onset

75. Medical Nutrition Therapy
 Initial steps during nutritional counseling for IBS must
include review of current medication for IBS and other
medications, review of GI symptoms, assessment of
nutritional status and food intake, review of
supplement intake.
 Large meals and certain foods may be poorly tolerated
such as excess quantity of caffeine, dietary fat, lactose,
fructose.

76.  A combination of soluble and insoluble fiber is
targeted for constipation management. Increasing the
amount of insoluble fiber in patients without
constipation may worsen IBS
 Consumption of adequate fluid is recommended
especially when powdered fiber supplements are used

77. FODMAPs Diet
 There is an emerging research that a diet low in
FODMAPs may be an effective therapy in management
of GI symptoms in IBS
 The low FODMAPs diet (Fermentable Oligo-, Di-,
Monosaccharides and Polyols) limits foods that
contain lactose, fructose, fructo-oligosaccharides,
galacto-oligosaccharides, and polyols or sugar
alcohols.
 These short chain CHO are poorly absorbed in small
intestine, are highly osmotic, and are rapidly
fermented by bacteria in large intestine

78.  Nutrition intervention begins with elimination of all
high FODMAPs foods from the diet for a trial period of
6 to 8 weeks. The challenge phase begins with a slow,
controlled reintroduction of one FODMAPs diet
category at a time to observe for symptoms

79. High FODMAP Food
 Excess Free Fructose – fruits (apples, pears, mango,
watermelon, cherries, figs), vegetables (asparagus, peas,
zucchini), sweeteners and condiments (honey, high fructose
corn syrup, fruit juice concentrate)
 Lactose - milk (cow, goat & sheep), ice cream, soft cheeses
 Oligosaccharides (fructans & galacto-oligosaccharides) –
Fruits (nectarines, persimmon, watermelon, peaches), vegetable
(garlic, onions), cereals (wheat, barley, rye based products in
large amount), Legumes (chickpeas, lentils, beans), nuts
(cashew & pistachio)
 Polyols – fruits (apples, apricot, pear, nectarine, peaches, plums,
prune, watermelon, blackberries), vegetables (cauliflower,
mushroom), sweetener (sorbitol, mannitol, xylitol)

80. Low FODMAP Diet Instructions
 If any of the all the high FODMAP foods are
consumed, try cutting them out first
 If symptoms do not improve, avoid all FODMAP foods
for 6 to 8 weeks
 Avoid foods that contain significant free fructose in
excess of glucose
 Avoid foods that contain significant amount of FOS
and GOS as they are not well absorbed
 Restrict lactose containing foods

81. Diverticulosis
 Diverticulosis is characterized by the formation of sac
like pockets within the colon that form when colonic
mucosa herniate through weakened muscles
 The prevalence of diverticulosis is difficult to
determine as most of the patients remain
asymptomatic
 This condition becomes more common as people age,
particularly in people older than 50

82.  Diverticulitis is a condition that indicates
inflammation of one or more diverticulum
 Low fiber diet is a prominent cause of diverticulosis as
it reduces stool volume, predisposing individuals to
constipation and increased intracolonic pressures
hence inducing pressure to the colon

83. Medical Nutrition Therapy
 During an acute episode of diverticulitis, oral intake is
generally reduced until symptoms subside
 Complicated cases may necessitate bowel rest and
require parenteral nutrition support
 Once oral intake has been resumed, begin with a low
fiber diet (10 to 15 g/day), followed by a gradual return
to high fiber diet

84.  A high fiber diet in combination with adequate
hydration promotes soft, bulky stools that pass more
swiftly and require less straining with defecation
 Fiber intake should be increased gradually as it may
cause bloating or gas

85. THANK YOU