Short Bowel Syndrome: What Is It?

Find out all about short bowel syndrome, a complex digestive problem.

Written and verified by el nutricionista Saúl Sánchez.

Last update: 07 February, 2023

Short bowel syndrome is a pathology that occurs with insufficient absorption of nutrients due to the digestive tract being lower than normal. In general terms, it’s in the small intestine where the most important part of the absorption of the different food compounds takes place. If the bolus doesn’t spend enough time in contact with the walls of the intestine, then the use of the nutrients will be put at risk.

It should be noted that short bowel syndrome can occur due to different situations. For example, there are cases where the length of the digestive tract is reduced in surgery, for various reasons. Its shortness may be from birth, or some of its parts could be dysfunctional. Be that as it may, your diet will have to be adapted to avoid deficits that could negatively affect your health.

Symptoms of short bowel syndrome

The first thing to know is the symptoms of short bowel syndrome. These are reflected in a study published in the journal Digestive and Liver Disease. They are the following:

• Diarrhea
• Greasy feces and a very bad smell
• Fatigue
• Weight loss.
• Malnutrition
• Swelling and edema in the lower extremities

However, some of these symptoms are compatible with other intestinal-type pathologies, such as irritable bowel syndrome, Crohn’s disease, and even colon cancer. In fact, it’s possible that these problems could occur due to a surgical intervention in which part of the tube is removed, later causing short bowel syndrome.

Nutrition in short bowel syndrome

When short bowel syndrome is diagnosed, the first thing to do is adapt your diet. Otherwise, deficits could be experienced that will negatively affect your health. It’s good to consider a series of measures regarding food intake, sometimes supplemented with supplements in order to achieve a state of internal homeostasis.

One of the key points is the distribution of meals throughout the day. The recommended steps in these cases are to take between 6 and 8 intakes smaller than normal, always eating slowly, and chewing food well. It must be taken into account that digestion begins in the mouth and that this step becomes even more important when some part of the tube isn’t functional. Otherwise, the symptoms will increase.

Likewise, it’s good to consume sufficient amounts of liquid. Especially natural mineral water or a light broth with little fat. Thanks to this, you’ll achieve a better lubrication of the digestive bolus and a more efficient absorption of the nutrients it contains. Periods of constipation will also be prevented, which could appear when there’s an internal functional problem.

But, of course, one of the keys to managing short bowel syndrome at a nutritional level is in protein intake. These nutrients are decisive in ensuring that the structures of the human body remain active, preventing their catabolism and degradation. This is shown in research published in the journal Nutrients. But we aren’t only talking about muscle mass; all the tissues of the human body are made up of proteins.

It’s important to guarantee the consumption of at least 0.8 grams of protein per kilo of weight per day in sedentary people. If you exercise regularly, you should double these values. However, half of the protein in the diet must be of animal origin, that is, of high biological value. In this way, a sufficient intake of essential amino acids is ensured, among which leucine stands out.

Carbohydrates and fats

Having made the point of proteins clear, we must move on to talking about carbohydrates and fats. As for the former, it’s always best to prioritize those that don’t have very high fiber content, as otherwise absorption would be delayed. Don’t forget that fiber acts as an antinutrient, which isn’t positive in the context of short bowel syndrome.

It’s clear that a portion of soluble fiber is important for bacteria in the digestive tract, but the contribution of insoluble fiber must be moderated. This first substance is also called prebiotic and has been shown to positively influence the growth of the microorganisms that make up the microbiota. Thanks to this, the absorption of certain nutrients is improved and the development of digestive pathologies is avoided.

As far as fats are concerned, importance must be given above all to the presence of omega 3 in the regimen, in order to modulate the inflammatory mechanisms in the internal environment. However, it shouldn’t be forgotten that the body’s ability to absorb these nutrients is reduced during short bowel syndrome. For this reason, the intake must be moderate.

What should be totally avoided is the consumption of trans fatty acids. These compounds increase internal inflammation and oxidation, causing a greater risk of developing chronic and complex pathologies. This is evidenced by research published in the BMJ magazine. It would even negatively influence the function of metabolism and the composition of the microbiota.

Lactose in short bowel syndrome

Some people with short bowel syndrome have trouble digesting and absorbing lactose. For this reason, the most appropriate thing will be to avoid it, opting for lactose-free dairy products to cover the calcium and protein intake that are needed in the daily diet.

However, it will always be necessary to test your tolerance to the carbohydrate. Some patients may not suffer problems in their digestion, so they can consume it without any problem. If no significant symptoms are experienced after ingestion, it may be included in the diet on a regular basis.

What we do have to be more careful with is the presence of oxalates in the diet. These compounds partially block the absorption of some nutrients and can lead to kidney stones if consumed in excess or in conditions of low hydration. They’re present mainly in foods such as tea, coffee, cola drinks, chocolate, nuts, and green leafy vegetables.

If they appear regularly in your diet, the level of certain elements such as iron in the body could be conditioned. This would cause anemia in the medium term, which causes chronic tiredness and fatigue.

In general, and according to a study published in the European Journal of Gastroenterology & Hepatology , supplementation isn’t necessary in short bowel syndrome. However, if a nutrient deficit is detected, it would be necessary.

Be careful with the fiber intake

Fiber intake should be limited with short bowel syndrome. Otherwise, the symptoms could be aggravated, especially those related to diarrhea and gas. Even the absorption of certain nutrients would be limited, which would give rise to a deficit.

When there aren’t any diseases, dietary guidelines usually recommend the inclusion of at least 25 grams (1 oz) of fiber on a daily basis. In cases of digestive pathologies such as the one we’re dealing with, it could be positive to reduce the presence of said element by half, always giving priority to the soluble portion.

In fact, the insoluble fiber itself is capable of swelling with water, improving the composition of the microbiota and serving as a substrate for the genesis of short-chain fatty acids. These have been shown to have a strong anti-inflammatory component, which is why they’re able to maintain internal homeostasis in the internal environment.

Even the inclusion of fermented dairy products in the diet would be positive in order to promote the creation of these compounds. Through probiotics, a selective colonization is produced by bacteria in different areas of the intestine. This increases the richness in terms of microorganisms and improves the digestion and synthesis of different nutrients.

The inclusion of a probiotic supplement in your diet could even be considered to alleviate some of the intestinal-type symptoms, such as diarrhea. However, finding the right one isn’t always easy. It’s best to choose a strain that has sufficient evidence.

Short bowel syndrome, a complex digestive problem

Short bowel syndrome causes a series of changes in the digestive process which means you have to change your diet. In this way, an optimal nutrient supply will be achieved, thus preventing deficits that could negatively affect physiology.

Of course, on some occasions, it might even be necessary to include a supplement to prevent the levels of certain elements from falling below recommended levels.

Patients may undergo certain changes in food tolerance on an individual basis. The same issue that we discussed regarding lactose can occur with proteins such as gluten. In these cases, it’s best to consult an expert to assess an adaptation of the regimen so that the symptoms are reduced, thus increasing well-being.