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Short bowel syndrome: What the RDN needs to know

Active in competitive sports, 16-year-old Sara was headed to volleyball practice when the abdominal pain became too much. A bowel obstruction related to undiagnosed Crohn’s disease led to her first small bowel resection. A little more than a year later, adhesions from the first surgery along with progression of her inflammatory bowel condition led to a second bowel obstruction. This time the significant necrotic tissue required removal of more than 60% of her remaining intestine. Beyond recovery from surgery, a diagnosis of short bowel syndrome signifies that the way Sara’s body processes nutrition may be permanently effected.

Calcium and meal planning: Simple reminders from RDNs to patients

Editor’s note: This post is brought to you by Creamy Bites.

As RDNs, we know that the benefits of calcium are many. This becomes so obvious to us that we sometimes neglect to remind patients that calcium cannot act alone. We teach patients that it is good to eat a variety of calcium-containing foods, from both plant and animal sources, but they must keep in mind that bioavailability differs between the two. Fundamentally, plant foods are rich in nutrients (potassium, magnesium, vitamin C) that aid calcium absorption, but also contain those that actually hinder it, such as oxalates and phytates.1-3 Patients need to understand this paradox, as it means it takes more plant sources than animal sources to net the same amount of calcium absorbed.4

Fortunately, there are simple and easy measures patients can take to increase calcium intake and absorption simultaneously. For instance, eating calcium-rich foods in combination with foods that enhance absorption, such as those high in vitamin D, potassium and protein.1,5

Consider the simple mix-and-match approach in the table to combine high-calcium foods with high-vitamin D foods. This helps patients optimize intake and absorption of both nutrients.6-9
Good Sources of Calcium
(~300 mg)

Milk, 1 cup
Cheese (cheddar, mozzarella), low fat, 1-1⁄2 oz.
Tofu, calcium fortified, 1 cup

(~200 mg)

Canned salmon or sardines (with soft bones), 3 oz.
Cereal, calcium fortified, 1 cup
Kale or collard greens, 1 cup cooked

(~50 mg)

White beans, canned, 1⁄2 cup
Corn tortilla, 1 medium
Broccoli, 1⁄2 cup cooked
Almonds, 2 tablespoons

Good Sources of Vitamin D

Egg yolks
Fatty fish such as salmon, mackerel
Cheese
Fortified milk, orange juice, cereals
Beef liver
Tuna

Simple meal ideas might include:

Breakfast tacos: 1 corn tortilla, 1 egg, 1 1/2 ounces 2% milk cheese, and salsa (380 mg)
Pasta: 1⁄2 cup white beans, 1⁄2 cup cooked kale, 1⁄2 cup pasta and 1⁄2 cup feta […]

Are your patients confused about calcium?

Editor’s note: This post is brought to you by Creamy Bites.

For a long time, we’ve been told that calcium consumption is not only good, but necessary: to build strong bones when we are growing, maintain them as we grow older, and reduce fracture risk. We’ve empowered ourselves by eating well, and counseling others to do the same. We’ve acquired the knowledge we need to keep our bones strong and make sure our children grow up strong. We’ve followed the advice of the U.S. Surgeon General (last updated in 2012) and learned some pretty interesting facts about calcium:

Most people don’t get enough calcium, especially young people between ages 9 and 18, post-menopausal women, and men over 70, according to the National Institutes of Health.
There are a lot of different sources of calcium supplements, and not all of them are the same.
Calcium should be taken with vitamin D, because vitamin D facilitates absorption.
The body can typically only absorb up to 500 mg of calcium at a time, so it’s a good idea to take calcium supplements twice a day.

NIH Recommendations for Adequate Calcium Intake from All Sources

 
Diet, Supplements, or Both?
Conventional wisdom suggests that consuming foods and beverages high in calcium is the best way to meet the body’s calcium needs. In general, including calcium-rich foods and beverages as part of a healthy, balanced, nutrient-diverse diet is prudent. However, all evidence shows that Americans, on average, do not even meet the lower end of the RDA requirement. In fact, the average woman over the age of 40 has a calcium intake of less than 50% of the RDA (Blank). Equally alarming, 60% of 6-to-11-year-olds and 70% of 12-to-19-year-olds don’t get enough calcium (Greer).

Besides the fact that people […]