Intestinal Failure - Short Bowel Syndrome following a jejunocolic anastomosis (Low fat and low oxalate diet)

You have been provided with this leaflet as you have undergone surgery resulting in a jejunocolic anastomosis.

The information contained will explain what this means and will give advice on some dietary changes which you may need to consider.

What is a jejunocolic anastomosis?

A jejunocolic anastomosis is a procedure whereby a part of the small bowel, called the ileum, is removed through surgery and the jejunum is then joined to the colon (also called the large bowel).

How does this affect what I eat?

This type of surgery removes a large part of your small bowel called the ileum; this is the part where fat is usually absorbed. Therefore, following this surgery, fat from the food that you eat is not absorbed well.

This means that fat particles stay in your bowel and move into the colon (large bowel), which can lead to loose stools or diarrhoea.

What are oxalates and why do I need to limit them?

Oxalates occur naturally in some of the foods we eat. Usually during digestion, they bind to calcium and are then passed out of the body in our stool.

However, following a jejunocolic anastomosis, if there are excess fat molecules in the colon (large bowel) then the calcium will bind to these instead of the oxalate, meaning that the oxalate particles are left in the colon.

This oxalate is then absorbed into the blood and travels to the kidneys, where it is passed out in the urine. However, too much oxalate can start to form crystals in the kidneys, which can then grow into bigger kidney stones. Kidney stones differ in size.

Although small kidney stones may pass out of the body in urine, causing only minor discomfort, larger kidney stones can be painful and may need further intervention to remove them.

Can I still eat fat?

We recommend you limit the amount of fat in your diet. Below are some tips which can help you to do this.

• Avoid eating too many fatty foods, for example butter, oils, spreads, salad dressings, cream, fried foods, cakes, biscuits, pastry and take-aways
• Choose low fat options where possible e.g. low fat cheese and low fat yoghurts
• Consider changing your cooking methods; avoid frying and using large amounts of oil/fat
• Remove visible fat and skin from meat products
• Read the labels on food packaging. Foods which are ‘low in fat’ will have 3g of fat or less per 100g, or 1.5g of fat per 100ml for liquids (1.8g of fat per 100ml for semi-skimmed milk)

What foods do I need to choose and avoid?

There are certain foods and drinks that contain high amounts of oxalate, and whilst these don’t need to be completely avoided, they should be limited as much as possible to reduce the risk of developing kidney stones. These foods and drinks are:

Fruit: Beries, including strawberries, gooseberries, blueberries, raspberries, cranberries. Figs, tangerine, plums and currants.

Vegetables: Rhubarb, beetroot, spinach, parsely, leeks, celery, okra.

Miscellaneous: Chocolate, nut spreads (including peanut butter), cocoa, carob, soy products (tofu, soy milk, soy cheese and soy ice cream), sesame seeds.

Drinks: Tea, black tea, instant coffee, soy milk. Ovaltine, cocoa, hot chocolate drinks, chocolate milk, cocoa cola, draught beer. Limit all tea (including herbal and fruit) to 1 to 2 weak cups per day. 

Calcium

Very high, or very low calcium intake may actually increase your risk of stone formation. We therefore recommend that you aim to have a moderate intake of calcium, as this will bind to the oxalate in your gut and reduce the risk of stone formation.

Try to include 2 to 3 servings of dairy foods or high calcium foods every day, for example:

• Yoghurt
• ½ pint milk
• 50g cheese

Supplements

It is important to tell your doctor or dietitian if you are taking over the counter vitamin/mineral tablets otherwise you may overload your system.

Vitamin C supplements in high doses (over 1000 mg a day) are not recommended unless directed by your doctor. This is because vitamin C is converted to oxalate inside the body and therefore high amounts of vitamin C will increase your risk of developing kidney stones.

Vitamin D supplements should also be avoided unless directed by your doctor. This is because vitamin D aids calcium absorption.

Calcium supplements are also not recommended unless directed by your doctor.

Fish oil supplements (containing vitamin D) and multivitamin preparations should only be taken under the guidance of your doctor.

Do not discontinue any prescribed vitamin/mineral tablet without discussing with your doctor/dietitian first as this may be a daily lifelong treatment to prevent vitamin or mineral deficiencies.

Fluid intake

The amount you drink each day can affect your risk of developing kidney stones. Urine that is more dilute (paler in colour) will have a reduced concentration of waste products.

Therefore, aiming to produce at least 2 litres of urine per day reduces the risk of developing kidney stones.

To achieve this, drink 3 to 3.5 litres of fluid per day.

The following urine colour chart is a useful guide to help you know if you are dehydrated:

Tips to increase your fluid intake:

• Take a large bottle of water when you are out so that you can sip it throughout the day
• Have a glass of water every hour
• Have 1-2 drinks of fluid before going to bed and take a drink to sip throughout the night to dilute your urine overnight.
• Have two drinks at each mealtime - one before and one after your meal
• Eat foods that have a high fluid content i.e. soups, jellies, fruit and vegetables

For further information or advice, please contact your dietitian:

Name
Tel no:

Contact Information - Intestinal Failure Unit - 0161 206 2845