Nutrition Guidelines for People With Short Bowel Syndrome

This information will help you maintain your nutrition after your bowel surgery.

About Your Bowels

Your bowels are your small intestine and large intestine (colon). They help your body absorb nutrients from the foods you eat and liquids you drink.

• Your small intestine absorbs carbohydrates, proteins, fats, vitamins, and minerals. It’s about 15 to 20 feet long and is divided into 3 sections. The first section is the duodenum, the second is the jejunum, and last section is the ileum. Each section has a specific role in how your body digests and absorbs nutrients.
• Your colon absorbs water and minerals. It’s about 5 feet long.

When a part of your bowel is removed, the part that’s left can adapt. It does this by absorbing the nutrients and liquids that would’ve normally been absorbed by the part that was removed. This means that parts of your bowel can be removed without having a major impact on your nutritional health.

However, it takes time for your remaining bowel to adapt. For some time after your surgery (typically a few months), your body may not absorb nutrients, liquids, vitamins, and minerals as well as it did before your surgery. It’s important to remember that everyone’s body heals differently so recovery time can be different from person to person

Short Bowel Syndrome

Short bowel syndrome is a set of symptoms that happen while your remaining bowel adapts after your surgery. You can reduce these symptoms by following the guidelines in this resource.

People with short bowel syndrome may have:

• Gas
• Cramps
• Diarrhea (loose or watery stools)
• Fluid Loss
• Weight loss

Dietary Guidelines

Follow these guidelines while your bowel is recovering. You can also use the sample menu, located at the end of this resource.

Eat 6 to 8 small meals a day

Eating small, frequent meals will put less stress on your shortened bowel. Small meals help control your symptoms and are easier for your body to digest and absorb.

• Eat slowly and chew your food well.
• Once your bowel has adapted, you can go back to having 3 meals a day.

Chew Foods Well

Chewing foods well will help break down food for easier absorption (the way a substance enters your body) by your body. It will also help prevent foods from causing a blockage as they pass through your intestine.

Only drink ½ cup (4 ounces) of liquids during each meal

Drinking large amounts of liquids with meals pushes your food through your bowel more quickly. This means that you may not digest or absorb enough nutrients.

• Drink most of your liquids between meals, at least 1 hour before or after a meal.

Include enough nutrients in your meals to help you heal.

Your meals should be:

• High in proteins. Examples of protein-rich foods include:
  • Fish
  • Poultry (chicken, turkey)
  • Meat (beef, pork, lamb)
  • Eggs
  • Tofu
  • Dairy products (milk, cheese, yogurt)
  • Smooth peanut butter and other nut butters, such as almond butter
   
• High in refined or low-fiber complex carbohydrates (starches). Examples include:
  • White bread
  • Cereals such as Rice Krispies® and corn flakes
  • Potatoes without skin
  • White rice
  • White pastas
• Moderate in fats. Examples of fatty foods are:
  • Oils
  • Butter
  • Margarine
  • Mayonnaise
  • Gravies
  • Cream sauces
  • Gravies
  • Cream sauces
  • Regular salad dressings
  For example, it’s okay to have butter on toast or mayonnaise on a sandwich, but it’s better to avoid very high-fat foods such as deep fried foods. If you had a large section of your ileum removed, you may be able to eat larger amounts of fat at breakfast time better than later on in the day.
• Low in sugary foods. Examples of sugary foods are:
  • Sugar (cookies, cakes, candies, chocolate, soda, instant teas, fruit drinks)
  • Corn syrup
  • Molasses
  • Honey
  • Pancake syrup
  You can use artificial sweeteners like Splenda® or Sweet N’ Low®. However, limit your intake of sugar-free candies or cough drops that contain sugar alcohols such as sorbitol, xylitol, mannitol, and isomalt. Taking large amounts of these may have a laxative effect (make you have a bowel movement).

Include enough liquids in your diet

• Try to drink at least 8 (8-ounce) glasses of liquids each day.
• Avoid very hot or cold drinks.
• Choose drinks that don’t have a lot of sugar. This will keep you from getting dehydrated. Examples include water, coffee, tea, milk, or juices diluted with water. Be careful: coffee may have a laxative effect on some people.

If you’re lactose intolerant, follow a low-lactose diet

Sometimes, having part of your bowel removed can make you lactose intolerant.

Lactose is a sugar that’s found in dairy products. It can cause symptoms such as gas, cramps, and diarrhea. These symptoms usually begin within the first 30 minutes of eating or drinking a dairy product.

• To see if you can tolerate lactose, drink ½ cup of milk. If you have any symptoms, try lactose-free dairy products, such as Lactaid® milk or almond, rice, or soy milk. You can also use Lactaid® tablets or Lactaid® drops before you eat dairy items to help you digest them.
• Some foods have less lactose than others. If you can’t drink dairy milk, you can still try cultured yogurt and aged cheeses (for example, hard cheeses such as cheddar and Swiss). If you can eat those, try soft cheeses (for example, cream cheese and cottage cheese). If you’re still having symptoms, you may want to avoid all dairy products for 1 or 2 months and then try them again.

Limit high oxalate foods

If you had your ileum removed and have an intact colon, you may need to limit high oxalate foods in your diet. Oxalate is a substance found in many foods and can cause kidney stones. If instructed by your healthcare provider or dietitian, limit foods and drinks that are high in oxalates, such as:

• Tea
• Coffee
• Cola drinks
• Chocolate
• Carob

• Nuts
• Soy products
• Beans
• Dark leafy greens
• Sweet potatoes
  • Beets
  • Celery
  • Berries
  • Kiwi
  • Dried figs
• Rhubarb
• Whole wheat flour
• Wheat germ
• Wheat bran

Your doctor or dietitian will discuss this diet with you, if it’s necessary.

Fiber

After your surgery, you may find that fiber, especially insoluble fiber, is hard to digest. Insoluble fiber is found mainly in whole-grain and bran products. It doesn’t break down in water and your body can’t break it down, so it makes stool (poop) more bulky.

Soluble fiber is usually tolerated better because it breaks down in water and can be broken down by your body. It also helps slow digestion. Foods with soluble fiber include:

• Oatmeal
• Oat bran
• Barley
• Soy
• Nut butters
• Fruit
• Fruit Pectin
• Psyllium (fiber supplement)*
• Legumes
  • Chickpeas
  • Lima beans
  • Kidney beans
  • Lentils

*Check with your doctor before taking any fiber supplements.

Many foods contain a mixture of both soluble and insoluble fibers. Use the list below as a guide.