NUTRITIONDiet and Digestive Problems

PEGGY KLOSTER YEN

What's new about diet for gastroin­testinal problems? Don't we all knowthat milk is the best food for an ulcerpatient, that a low roughage dietsoothes the intestine in diverticulardisease? Aren't certain foods consti­pating and others gas forming?

The trouble with our knowledgeabout the effect of food on the GItract is that much of it is based onguesswork and personal prejudice.Even the dietary therapy for gastritisand ulcer is somewhat debatable.HereI will try to separate myth fromfact in the dietary treatment of di­gestive problems in the elderly.

Specific GI changes occur withage that can lead to functional prob­lems and may affect nutritional sta­tus. Aging causes cell loss and re­duces enzyme function. Stomachacid and intestinal motility decrease.Certain conditions are more com­mon in the aged than the young, in­cluding hiatal hernia and divertic­ular disease.

Probably no body system worriesolder adults on a daily basis morethan their GI tract. Many of themmistakenly believe a daily bowelmovement is necessary. for goodhealth.

In assessing bowel problems, ques­tion patients carefully. The numberof stools per week is less importantthan their consistency. Is the elderlyman or woman passing stools withgreat difficulty? Constipation is notthe lack of a daily stool but the pas­sage of hard, dry stools. Has therebeen a change in bowel habits? Thiscan be a sign of colon and rectal can­cer, and should be investigated.

Problems with constipation anddiarrhea can indicate various dis­eases, so do not dismiss them lightly.

Peggy Kloster Yen, RD, MPH, is the nutri­tion consultant. Aging and Chronic ·l1InessAdministration, Maryland Department ofHealth and Mental Hygiene, Baltimore.

Lactose intolerance is often over­looked as a cause of diarrhea, for in­stance, but it is prevalent in most ofthe world's population. Only Cauca­sians of European ancestry have alow incidence of this problem.

Swallowing difficulties may haveno apparent cause other than slowedesophageal motility. A complaint ofdiscomfort while lying down couldindicate hiatal hernia, a problemmore common in aged women. Obe­sity is often a complicating factor.

Assessment of GI problems in theelderly is complicated by the factthat they may present in an atypicalway. Dietary treatment is also com-

Advice to the Constipated

• Increase your fiber intake,especially whole grains, driedbeans, and dried peas.

• Consume at least two quartsof fluid daily.

• Use prune juice; it containsa natural laxative.

• Exercise regularly.

plica ted by the lack of a scientificbasis and by the prejudices and foodhabits of a lifetime.

Ulcer diet illustrates this point.Ask any adult what food is a majorpart of an ulcer diet and the answerwill most likely be milk. And yetthere is no good evidence to supportits use, and some evidence that it canbe harmful. The rationale for blanddiets is that they are chemically andmechanically nonirritating to the GItract. Milk would seem to fit this de­scription well, and it is a buffer forstomach acid. But milk is also a po­tent stimulator of acid secretion, asare all protein foods.

A review of peptic ulcer diet ther­apy claims that "the restrictions, ad­ditional milk, and frequent feedings"promoted for treating ulcer "have

not been proven to be ineffective, butneither have they been demonstratedto be superior to three regular mealsa day in promoting ulcer heal­ing."(l)

On the other hand, high fiberfoods, or roughage such as fruits andvegetables, have always beenthought to irritate the lining of thebowel. There is no proof, however,thatthese foods can scrape off muco­sal cells or otherwise harm an ulceror diverticulum.

Many elders can name foods thatare supposed to cause GI discomfort.Studies on people with and withoutGI disease have shown that bothgroups have food intolerances butthat food intolerances weren't re­lated to the presence of disease. De­spite controversy over dietary modi­fications, the following facts can bediscussed with older patients.

Peptic Ulcer

The objective of treating ulcers isto alleviate symptoms and heal theulcer by reducing gastric acid. Ant­acids are the cornerstone of ulcertreatment. Diet is less importantthan previously thought, but mostauthorities encourage frequent feed­ings as a way of lowering gastricacidity.

Some elderly people may confuseacid foods like tomatoes and citrusjuices with acid secretion by thestomach. There is no reason to re­strict acid-containing foods unlessthey cause discomfort, especiallysince they are such good sources ofvitamin C.

The proven gastric irritants shouldbe avoided: black pepper, chili pow­der, caffeine, cocoa, and alcohol.Even decaffeinated. coffee has beenshown to stimulate acid secretion.

Some physicians insist on the reg­ular use of milk in an ulcer diet, andthe psychological value of milk as a"soothing" food cannot be over­looked. However, for the older adultwho dislikes or doesn't tolerate milk,

Geriatric Nursing November/December 1982411

"Few foods actually have a harmful effect on adiseased bowel, but it is important to considerthe psychological aspects of food intake."

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NUTRITION

there is no harm in omitting it. Thereis a possibility of developing milk­alkali syndrome from excessive useof milk and antacids. Ulcer patientsshould also eliminate any food whichthey find causes them problems.

Diverticular Disease

The probable cause of diverticulardisease is increased intracolonic pres­sure, which forces out pouches of themucosa through defects in the intes­tinal muscle. About 30 percent of thepopulation over 60 years of age havethis problem. There is no reason tobelieve that seeds, nuts, or skins offood get "caught" in diverticularpouches and cause problems(2).

In a complete reversal of the tradi­tional low residue diet, the moderntreatment of diverticular disease is a

high fiber diet. Fiber ensures a larg­er, softer stool, which requires lesspressure to propel it through thebowel.

Gastritis

Gastritis is usually the conse­quence of disease, not age. Dietarytreatment is the same as for ulcer. Ifthere is diminished acid secretion, vi­tamin B12 will be absorbed lessreadily and may have to be supple­mented with injectable or oral prep­arations. Vitamin C also may be giv­en to aid iron absorption, which ismore efficient in an acid environ­ment.

Hiatal Hernia

A hiatal hernia is a pouch of stom­ach that protrudes through the dia­phragm. Theory about the cause in­dicts low fiber and constipation.There is no specific dietary treat­ment. Eating small meals, recliningafter eating, and elevating the headof the bed on blocks are helpfulmeasures. Surgical repair is oftendone but not always successful.

Even without hiatal hernia, some

elders may have esophageal reflux ofstomach contents. The same preven­tive measures apply, along withavoidance of alcohol and coffee.

Lactose Intolerance

Many older people avoid milk, notbecause they know they are lactoseintolerant but because they knowmilk bothers them. Eliminating allmilk and milk-containing productsshould alleviate symptoms of lactoseintolerance. Label reading will helpidentify foods that contain addedlactose. If the symptoms disappear,lactose-containing foods can then begradually reintroduced.

Sometimes, fermented dairy prod­ucts like yogurt are tolerated better.Buttermilk, however, contains asmuch lactose as regular milk. Occa-

sionally, chocolate milk is toleratedbetter, perhaps because it stays inthe stomach longer due to its highersugar content.

Lactose-hydrolyzed milk is avail­able as well as a lactase (enzyme)product to aid with the digestion ofmilk. Only a few people will requirea strict lactose-free diet. For thosewho do, calcium supplements will beneeded to replace the dairy source ofthis mineral.

In discussing GI problems withelders nurses can give them up-to­date information about the effect offood on the digestive tract. Fewfoods actually have a harmful effecton a diseased bowel, but it's impor­tant to consider the psychological as­pects of food intake. Emotional upsetcan trigger GI problems, so be sureto assess the older adult's environ­ment and life situation along with hisfood intake.

ReferencesI. Welsh, J. D. Diet therapy of peptic ulcer dis­

ease. Gastroenterology 72(4 Pt.I);740-745,Apr. 1977.

2. Yen. P. K. Why eat a fiber rich diet? Geriatr.Nurs. 2;436-438, Nov.-Dcc. 1981.