Mineral Supplements. Supplements of calcium, magnesium, zinc, selenium, and iron may be needed to offset deficiencies in patients with severe IBD.
- Calcium and magnesium are critical for health and strong bones. Many patients with IBD suffer from calcium and vitamin D deficiencies, which cause low bone density. Studies indicate that calcium and vitamin D supplements may be adequate to increase bone density without drugs.
- Selenium is a potent antioxidant.
- Zinc is important for wound healing, and deficiencies may promote fistulas in Crohn's disease.
- Iron supplements may be required for anemia. However, iron overdose is very dangerous. As few as three adult iron tablets can poison children, even fatally. No one, even adults, should take a double dose of iron if one is missed. A doctor should advise patients on correct dosage.
Diets as Primary Treatment for Severe Malnutrition
Enteral Nutrition. Enteral nutrition uses a feeding tube that is inserted either through the nose and down through the throat or directly through the abdominal wall into the gastrointestinal tract. It is the preferred method for feeding patients with malnutrition who cannot tolerate eating by mouth. The nutritional formulas used in enteral administration include:
- Polymeric diets (containing a balance of standard nutrients).
- Elemental diets (predigested nutrients that are absorbed in the first meter of the small intestine). These diets are used less commonly than polymeric diets.
In children, enteral nutrition is given for 6 - 8 weeks. Simple foods are then introduced (chicken, potato, rice), and more complex foods (milk, fiber, wheat-based foods) are then added gradually. However, relapse is still common.
A major 2002 analysis did not confirm any advantages of enteral feedings over corticosteroids, nor did it find any additional benefits from elemental diets compared to polymeric diets. Still, they may be helpful for specific patients. For example, in a 2001 study of children with steroid-dependent Crohn's disease that was already in remission, elemental supplements allowed many of them to withdraw from the medication. Further research is needed to determine if there is an optimal balance of nutrients in the enteral diet formula for IBD that might improve their effects.
Total Parenteral Nutrition. Total parenteral nutrition (TPN), or hyperalimentation, is the intravenous administration of nutrients through an indwelling catheter (tube). It is used for very severe IBD when patients cannot tolerate any nutrition by mouth or with a feeding tube, and may even be useful as a primary therapy for patients with Crohn's (although not for those with fistulas). It is usually administered in the hospital, although increasingly people are self-administering it at home. The procedure carries a risk for complications, some serious, including infection, blood clots, and liver failure.
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