My doctor’s orders? Crisps, doughnuts and strictly no veg

*If we have a contest for worst medical advice EVER!!! I think we have a pretty good contender here – Engineering Evil

By Jo Waters

PUBLISHED:20:07 EST, 27  August 2012| UPDATED:20:07 EST, 27 August 2012

When Justin Hansen was told his gut condition  meant he’d have to follow a severely restricted diet for the rest of his life,  he was devastated.

But then he learned exactly how it would be  restricted.

‘Apparently, burgers, chips, chocolate,  full-fat milk, cakes, biscuits and sausage rolls are all ideal foods for me,’ says Justin.

Crohn's disease: Only half of the nutrients will be absorbed, so generally a patient needs to eat 50 per cent more food to make it upCrohn’s disease: Only half of the nutrients will be  absorbed, so generally a patient needs to eat 50 per cent more food to make it  up

‘The dietitian recommended I boost my calorie  intake with snacks such as sugary doughnuts, crisps and treacle  pudding.

‘I could hardly believe it. I’d have to eat  almost exclusively junk food to stay alive.’

Justin, a 51-year-old former IT consultant  who lives with his girlfriend in  Brighton, has Crohn’s disease, an inflammatory  bowel condition affecting 60,000 Britons.

Crohn’s  causes symptoms including pain,  diarrhoea, vomiting, weight loss and  fatigue, but in some cases, such as  Justin’s, it leads to a complication known as intestinal failure.

Here, the inflammation destroys the tissue of  the bowel so badly that surgeons must cut out sections of the intestine.

Patients can live without a complete bowel,  says Dr Simon Gabe, a consultant gastroenterologist at St Mark’s Hospital in  Harrow, London, who treats 300 intestinal failure patients a year.

‘The average gut varies in length between 3.5  and eight metres and the critical amount you need to stay alive is one metre,’ he says.

The problem is that when the intestine is  shortened, food passes through so quickly that its calories, nutrients, fluids  and electrolytes (salts) are not absorbed into the body.

Only half of the nutrients will be absorbed,  so generally a patient needs to eat 50 per cent more food to make it up. If the  bowel is very short, as Justin’s is, they must eat more.

What’s more, going against all received  wisdom about nutrition and health, patients must avoid high-fibre foods, which  pass through the gut quickly, and stick to carbohydrates, fat and sugar.

‘We recommend eating a high-calorie, but  low-volume diet,’ says Dr Gabe.

‘Fatty, high salt, refined carbohydrate foods  such as white bread and cakes are best because they are calorie dense and low in  fibre.

‘Patients can eat as much as they can manage,  and they certainly won’t develop a weight problem.

‘If they can’t consume enough calories, they  will lose dramatic amounts of weight and waste away, so they are also given  daily intravenous nutrition into a vein through a central line in their chest to  ensure that they are getting adequate calories.

‘The liquid food passes directly into their  bloodstream. Patients are taught to administer this and most do it overnight for  eight hours, sometimes every night.’

Going against all received wisdom about nutrition and health, patients must avoid high-fibre foods, which pass through the gut quicklyGoing against all received wisdom about nutrition and  health, patients must avoid high-fibre foods, which pass through the gut  quickly

Every year 4,000 people in Britain are put on  this diet as a result of a short bowel.

As well as Crohn’s, intestinal failure can be  caused by mesenteric infarction, where a blood clot blocks the gut and the colon  has to be removed by surgery.

Another cause is intestinal dismotility,  where the gut loses the ability to propel food and becomes blocked, sometimes as  a result of a stomach virus, or a complication of diabetes or stomach surgery.

Justin’s symptoms started in October 2001.

Over the following months he developed  swollen joints, mouth ulcers and infected nail beds.

‘I’d always been fit and healthy, but  suddenly it felt as if my body was packing up on me — I was struggling to walk a  short distance,’ he says.

‘At first, the symptoms were so random, no  one could work out why — I visited my GP umpteen times.

‘It wasn’t until 2003, when I had diarrhoea  and was vomiting, that anyone took it seriously.’

Justin’s sister Lou, a nurse, sent him to  A&E. An X-ray of his bowel showed his colon was in danger of  rupturing.

Further investigations revealed Justin had  Crohn’s disease.

He had an emergency operation to remove part  of his large intestine, and then an ileostomy to remove his bowel before being  fitted with a colostomy bag.

‘That was hard enough to deal with, but then  a week after surgery complications developed,’ says Justin.

‘My bowel became ulcerated — I was  desperately ill and spent nine months in hospital. I didn’t eat for five months — my bowel was falling apart.

‘At one stage my weight dropped from 11½st to  6st (I’m 5ft 11in). A few times I closed my eyes and hoped I’d never wake up.’

Doctors stabilised Justin’s condition and  after five months he began to eat and drink again.

It was then he was told about the diet he’d  have to follow for the rest of his life, with doctors advising he needed 4,000  to 5,000 calories a day.

‘It was funny that I had packets of crisps on  prescription,’ he says. ‘But at first I struggled to eat even one  bag.

‘Gradually, though, I began to eat more. I  always had one eye on the calorific content — I remember being so desperate to  top up my calories I’d mix milk with powdered milkshake and ice  cream.

‘Ironically, I don’t like junk food or  chocolate much. The foods I craved were things such as apples and salads, which  are bad for me.’

A typical breakfast would be cereal with  sugar, white toast with butter and jam and a full English of sausage, bacon,  eggs and hash browns.

Recommended snacks for mid-morning include  sugary doughnuts, crisps or a cream cake.

Lunch can be sausage rolls, pasties or a  sandwich with butter and/or mayonnaise.

In the evening, patients are encouraged to  eat meat, fish or chicken with potatoes, rice or pasta, lots of salt, few  vegetables and a creamy rice pudding, treacle pudding or tapioca with jam and  cream.

Patients are also given supplements to ensure  they get all the vitamins and minerals they need.

However, Justin struggled to maintain the  calorie intake and after more complications and surgery had a permanent  intravenous nutrition line fitted.

He is studying for an MSc in occupational  therapy and says his health has stabilised.

Alison Culkin, a specialist dietitian at St  Mark’s Hospital who advises Justin, says: ‘These patients can find it very  difficult to consume so many calories because they often have bowel problems,  feel nauseous, have a fluctuating appetite or a colostomy bag.’

Researchers at St Mark’s are developing a  grow-your-own bowel technique, which will potentially cure patients like Justin.

Scientists aim to be able to take tissue from  a patient’s bowel and use stem cells to grow new bowel tissue in laboratories — avoiding the problem of rejection.

Justin and a team of friends recently  completed a kayak trip from Manchester to London to raise money for  the hospital.

‘I want to highlight the problems intestinal  failure patients face and give hope to newly diagnosed patients that you can  lead a normal life.

‘I’m living proof you can do extraordinary  things. I just wish my GP had diagnosed Crohn’s disease earlier.

‘Maybe I might never have had to go through  this

Read more: http://www.dailymail.co.uk/health/article-2194464/My-doctors-orders-Crisps-doughnuts-strictly-veg.html#ixzz24zPaEtLc

Author: Ralph Turchiano

In short, I review clinical research on an almost daily basis. What I post tends to be articles that are relevant to the readers in addition to some curiosities that have intriguing potential. As a hobby, I truly enjoy the puzzle-solving play that statistics and programming as in the python language bring to the table. I just do not enjoy problem-solving, I love problem-solving and the childlike inspiration and exploration of that innocent exhilaration of discovering something new. Enjoy ;-)

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