Favor whole foods over anything heavily processed, and learn to make most of your meals at home using the foods that fall within your diet plan.

Avoid sweets

One of the most important dietary recommendations for patients with short bowel syndrome is to avoid sweets.  Candy, fruit juices and sodas are high in simple sugars, which pull water into the gastrointestinal (GI) tract and lead to fluid and nutrient loss (1).

Eat the right kinds of carbs

Complex carbohydrates, which are made of many sugar molecules strung together like a necklace, are the best types of carbs to eat for short bowel syndrome.  Unlike the simple sugars found in sweets, complex carbs are more easily digested and absorbed.  They are also high in vitamins and minerals and should be a primary calorie source regardless of your bowel anatomy.  A variety of grains and vegetables are great sources of complex carbs.

Pay attention to fiber type

Fiber is found in whole plant foods.  For the average person, eating a diet high in fiber from whole foods is important for staying healthy and preventing disease.  For short bowel syndrome patients, the quantity and type of fiber you can tolerate depends on your intestinal anatomy and individual condition.

Fiber can be soluble or insoluble.  Soluble fiber absorbs water and turns into a gel-like substance.  This contributes to fecal bulk and ability to hold water.  Insoluble fiber, or “roughage,” doesn’t change much when combined with water.  But it too adds bulk to stool and absorbs water as it moves through the digestive system, stimulating bowel movements.  While both types of fiber are important for health, soluble fiber is better tolerated by short bowel syndrome patients because it helps slow digestion.  Soluble fiber is also fermented by gut bacteria in the colon to produce beneficial by-products like short-chain fatty acids (2), which can nourish the gut barrier and help prevent inflammation. Absorbing and using short-chain fatty acids can generate another 500-1000 calories per day for short bowel syndrome patients (1).

If your colon is intact, get more than half of your calories from complex carbs and less than a third of your calories from fat.  Make sure you include foods with soluble fiber in your diet to take advantage of the extra calories generated by bacterial fermentation.  If you don’t have a colon, or if you have a jejunostomy or ileostomy, get around half of your calories or less from complex carbs and at least 30-40 percent of your calories from fat (3). If you can tolerate fiber, focus on soluble fiber from whole foods.  All short bowel syndrome patients should add any fiber-containing foods slowly in order to let the GI tract adapt.  You can cook vegetables to decrease the fiber content, or eat refined grains if you can’t tolerate whole grains.

Rethink dairy, wheat and other FODMAP foods

FODMAPs are carbohydrates and sugar alcohols that are poorly absorbed in the small intestine.  They can increase intestinal water content, gas production and cause more GI symptoms like stomach pain, bloating and motility changes.  FODMAP foods include dairy, wheat, legumes and certain fruits and vegetables.  They are also found in many processed foods, especially those with added sweeteners.  A low-FODMAP diet is appropriate for patients with specific GI diseases like irritable bowel syndrome.  FODMAPs have not been well-studied in short bowel syndrome patients, but if typical dietary advice doesn’t help your symptoms, it may be worth considering a low-FODMAP trial, or at least paying attention to the amount of FODMAP foods you eat (3).  Limit yourself to a couple of small portions (1/4 cup) of these foods initially per week.  If they are not well tolerated, you may want to avoid these foods.

Drink hydrating liquids

Short bowel syndrome patients, especially those with no colon and very high ostomy outputs, need to stay hydrated.  Water isn’t the best way to stay hydrated.  In patients with high output ostomies, water and other hypotonic fluids like tea, coffee, fruit juices and alcohol can actually make the output worse.  For this reason, some patients need limits on the amount of oral hypotonic fluids they can drink.  Instead, short bowel syndrome patients can sip on hydrating drinks like commercially prepared oral rehydration solutions.  These beverages include ideal proportions of both sugar and salt to keep you hydrated.  A variety of homemade oral rehydration solutions can be prepared.  Here is one recipe from the World Health Organization:

• 8 teaspoons sugar
• ½ teaspoon salt
• ½ teaspoon potassium chloride
• ½ teaspoon sodium bicarbonate (baking soda)
• 1 liter water
• Combine and stir until well mixed

And another one:

Many short bowel syndrome patients receive supplemental hydration with their tube feeds or through an IV.  Total intake and output including ostomy and urine output, heart rate, blood pressure, weight and laboratory values need to be regularly monitored.

Salt is not your enemy

Patients with short bowel syndrome are at risk for losing too much sodium, especially those with no colon and high ostomy outputs.  You can be generous with the salt shaker or with eating salty snacks.  Unless you have another disease that requires salt restriction, salt is not your enemy (1).

Pay attention to how you eat

Eat small, frequent meals, around 5-6 or more per day.  Patients with short bowel syndrome usually need to increase their dietary energy intake by approximately half to compensate for malabsorption and maintain weight (4).  Chew your food well.  Separate food and drinks by sipping beverages between meals.  Don’t forget to enjoy your food.

Watch out for kidney stones 

If you have part or all of your colon intact, you may be at risk for getting kidney stones.  The best way to prevent this is to make sure you are well hydrated, with good urine output.  Some patients may need to avoid foods high in oxalates as well (3).  Talk to your doctor to see if you need to avoid these foods.

Diet is an important part of treatment for short bowel syndrome.  You can eat tasty, nutritious meals made up of whole foods that can help improve symptoms.  While the guidelines above are general recommendations, every patient with short bowel syndrome is unique.  It is important to work with both your doctor and a nutritionist for specific guidance.

References:

1. Parrish, Carol R. “The Clinician’s Guide To Short Bowel Syndrome.” Practical Gastroenterology (2005): 67-106. Print.
2. Byrne, T. A., L. Veglia, M. Camelio, S. Cox, S. Anderson, J. Wilson, and H. Bennett. “Clinical Observations: Beyond the Prescription: Optimizing the Diet of Patients with Short Bowel Syndrome.” Nutrition in Clinical Practice 15.6 (2000): 306-11. Web.
3. Parrish, Carol R. “Nutrition Therapy for Short Bowel Syndrome in the Adult Patient.” Practical Gastroenterology (2014): 40-51. Print.
4. Sundaram, Aparna, Polyxeni Koutkia, and Caroline M. Apovian. “Nutritional Management of Short Bowel Syndrome in Adults.” Journal of Clinical Gastroenterology 34.3 (2002): 207-20. Web.