Bowel Rest for Crohn’s Disease

Decades ago, if you had Crohn’s disease that was difficult to control or if you couldn’t tolerate steroids, your doctor may have suggested an approach called bowel rest.

Today, thanks to better and safer treatments for Crohn’s, bowel rest is far less common — but it may be used as a last recourse, says James Marion, MD, director of education and outreach at the Susan and Leonard Feinstein Inflammatory Bowel Disease (IBD) Clinical Center at Mount Sinai Hospital in New York City.

Bowel rest involves giving your digestive system a break from eating any food by mouth, according to the Crohn’s & Colitis Foundation (CCFA). The idea is similar to staying off your foot to give a sprained ankle time to heal, Dr. Marion explains.

With bowel rest, your body still receives nourishment — just “through means that don’t require active digesting and processing of nutrients,” explains Sunanda V. Kane, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota.

This typically involves taking in liquid nutrition through a tube that runs from your nose to your stomach or small bowel, an approach called enteral nutrition. Or you might have nutrients delivered into your bloodstream through a large vein in your chest or arm via a process called parenteral nutrition. The mixture that’s used contains protein, carbohydrates, fats, vitamins, and minerals, Dr. Kane explains.

“Enteral feeding is typically done at home, where parenteral often starts off in the hospital until the right formula is configured, and is then continued at home,” she says.

When Bowel Rest May Be Effective

“If you’re not a good candidate for surgery or if your Crohn’s has caused a small bowel obstruction, which means a blockage prevents your small bowel from functioning well enough to provide the nutrition you need, you may be a candidate for bowel rest,” Marion says. Your doctor might also suggest it if, when eating, an obstruction in your small bowel causes you to vomit, or if the obstruction may perforate your bowel, he adds.

One advantage of bowel rest is that it doesn’t involve medications, Kane says. This may be why it was more common in the past, when steroids — with their numerous side effects — were the main treatment for Crohn’s disease, Marion explains. Long-term use of steroids can have negative consequences, including bone thinning, weight gain, and increased blood pressure.

But bowel rest has some drawbacks, too. If you’re being fed through an IV line, there is a risk for infection at the injection site as well as risk for clotting. In addition, long-term tube feeding can cause damage to your liver. It can also be unpleasant to have a feeding tube in your nose for an extended amount of time, Marion adds.

How to Cope With Bowel Rest

You shouldn’t be hungry or dehydrated on tube feeding, Kane says. “Sometimes what’s perceived as hunger is really just the desire to eat in the company of others. Hydration shouldn’t be a problem either, because there is adequate fluid in the preparations you will be given. ”

Here are some tips for getting through bowel rest and recovery:

Ask about the big picture. If you’re prescribed bowel rest, it’s important that your doctor is very clear on what’s required and what the next steps will be, Marion says. Be sure to ask questions: How long will you be on bowel rest? What happens if it doesn’t work? “It’s not something that should be open-ended,” he says. And Kane agrees, adding that understanding why you’re doing it and for how long can help you get through it.

Chew gum. “I always encourage my patients to have gum to chew on or hard candies to suck on, which can give you something to savor,” Marion says. “It’s a little thing, but it can help.”

Slowly reintroduce solid food. When you’re done with bowel rest and ready to reintroduce food, it’s important to do so gradually. “Don’t go to a steakhouse for your first meal,” Marion says.

Start with clear liquids and then progress to full liquids, such as gelato or ice cream, if you can tolerate milk products. Add soft, mushy foods such as porridge, scrambled eggs, and overcooked pasta. If you can tolerate these, you can add chopped meats like chicken — and ultimately cooked vegetables, too. “You can add more foods once you find you can tolerate the progression,” Marion says.

Low Fiber Foods to Rest the Colon | Healthy Eating

By Janet Renee Updated November 28, 2018

Your doctor may recommend a low-fiber diet after bowel surgery or for flareups of conditions such as ulcerative colitis, Crohn’s disease and diverticulitis. These conditions cause bowel inflammation, which often results in digestive discomfort. A low-fiber diet reduces the amount of roughage in your colon and slows down bowel movements to ease symptoms. Your goal for this type of diet is to limit fiber and focus on low-fiber food choices when planning your meals.

General Guidelines

Normally, women and men age 50 and younger need to aim to get 25 to 38 grams of fiber per day. On a low-fiber diet, aim for less than 10 to 15 grams daily. Limit milk and milk products to 2 cups per day and drink juices without the pulp. Cook allowed vegetables well to help break down the fiber. Avoid all dried beans and peas, and eat your meat tender and well-cooked. Limit meat to 1-ounce servings and a total of 4 to 6 ounces per day.

Bread, Cereal and Pasta

Low-fiber breads include refined white bread and light rye bread without seeds. You can have pancakes and waffles made with refined flour as well. Include refined cereals such as grits, cream of wheat and cream of rice. When choosing pasta and grains, go for white rice and refined pastas. Limit breads, cereals and pastas to no more than six servings per day. One slice of bread, 1/2 cup of cooked cereal and six crackers is one serving.

Vegetable Limitations

Limit vegetables to two servings daily. A serving consists of 1/2 cup of cooked or raw vegetables, or 1 cup of vegetable juice. Avoid lima beans, green peas, broccoli, parsnip and corn. You can have all other vegetables. You are allowed to eat cucumber, green pepper, romaine, tomatoes and zucchini raw, but cook all other vegetables. Recommended juices include carrot and tomato, according to Northwestern Memorial Hospital.

Forbidden Fruit

You’ll want to avoid all dried fruits on this diet. Limit your fruit intake to two servings per day. A fruit serving consists of 1/2 cup of cooked or canned fruits or 1/2 cup of raw fruit without skin. You can eat most cooked or canned fruits, except figs, prunes and berries. When choosing raw fruits, stick to apricot, banana, cantaloupe, honeydew, nectarine, papaya, peach, plum and watermelon. Choose bananas that are well-ripened and cantaloupe and honeydew that are soft.

Give Your Gut a Rest with an Elemental Diet

Psychologists and performance coaches recommend taking a break from the daily grind to rest and recuperate. However, for all the work a human gut does, does it not deserve a break as well?

Each and every bit of food ingested by an individual must go through the rigorous and well-defined process of the body breaking the food down into usable nutrients, absorbing these nutrients, and ultimately excreting out the waste products for which the body has little to no use. Challenges arise when any of the steps in the digestive process begin to lose efficiency and the body is forced to deal with the sequela of the disturbance.

Bacteria can be translocated or overgrown in various parts of the small bowel. The clinical manifestations of this can range from an annoyance to small intestinal bacterial overgrowth (SIBO). Moderate to severe gastrointestinal (GI) dysfunction – including SIBO, IBS and Crohn’s, requires medically supervised intervention. Other moderate to severe GI dysfunction may be affected by the loss of efficient digestion.¹ As this occurs, the concept of “gut rest” for the distal GI tract is important to support the healthy balance of bacteria.

Cases typically managed by gastroenterologists also have a dietary management component. Part of the dietary management is to allow the gut to heal by removing interferences to healing as well as simply adding the tincture of time without excessive work. Fasting is an example of gut rest, but unfortunately, it also starves the body of both micronutrient and macronutrients.

When resting the gut, it is important to employ a strategy which uses caloric sources that are readily absorbed in the proximal small bowel and hypoallergenic, allowing the rest of the digestive tract to rest and focus on maintaining a healthy balance within the microbiome. The challenge with pursuing this path is in providing adequate levels in the appropriate ratio of macronutrients, vitamins, and minerals which provide adequate nourishment.²

The good news is that the elemental diet has been specifically designed to support this unit combination of goals. It has been employed in the hospital setting since the 1940’s as a source of readily digestible calories. The elemental diet provides calories attained from carbohydrates, fats, and proteins in readily assimilated forms which allows the proximal small bowel to easily absorb the nutrients ingested, while requiring very little effort from the rest of the digestive tract. The macronutrient sources must be carefully chosen to provide both the proper ratio and adequate calories. Protein is generally provided in the elemental, free-form of amino acids, while fat is provided through easy to digest medium chain triglycerides, and partially hydrolyzed carbohydrates are also easy to digest in the initial portion of the small intestine.³

Significant support of the delicate gastrointestinal function and environment is provided when using the elemental diet and ensuring adequate calories, vitamins, minerals and nutrients are provided. Gut rest can be a useful option for many people and can be achieved with excellent results through its efficient application in combination with an elemental diet.

Gut rest and the elemental diet are not for everyone, but for those with moderate-to-severe gastrointestinal dysfunction, it should be an option given serious consideration, and used under close medical supervision. The elemental diet carries a high level of efficiency and effectiveness in maintaining gut health, which also requires a high level of responsibility. Patients should always consult their healthcare practitioner for guidance in determining what option will best fit their needs and should not begin use of an elemental diet without the help of a qualified healthcare practitioner

REFERENCES

1. Müller MJ et al. Dig Dis Sci. 1993 Nov;38(11):2001-9.
2. Rezaie A et al.Curr Gastroenterol Rep. 2016;18(2):1-11.
3. Russel RI et al. Gut. 1975;16(1):68-79.

Following a Low-Fiber Diet | Michigan Medicine

Topic Overview

What is a low-fiber diet?

A low-fiber diet contains foods that don’t create much waste (stool). This diet slows down your bowels and gives them a chance to rest.

Fiber is the part of plants that your body can’t digest. It gives bulk to your diet and helps you feel full. It also helps you have regular bowel movements.

But a low-fiber diet is often needed after bowel surgery or when you have a flare-up of a bowel problem. You might be asked to follow this diet if you have Crohn’s disease, ulcerative colitis, diverticulitis, or another condition that can cause swelling, pain, or narrowing of your bowels.

In some cases, you may start with a liquid diet (no solid food) and then add low-fiber foods.

Depending on your health problem, you may eat low-fiber foods for just a short time. Or you may need to follow this diet for the rest of your life.

You may need to take extra vitamins and minerals while you’re on this diet. Your doctor will let you know if you need these supplements.

What foods are okay to eat on a low-fiber diet?

You can eat most types of food on a low-fiber diet, including meats, white breads, and many fruits and vegetables. Your doctor can tell you how much fiber you can eat each day.

Here are some examples of low-fiber foods:

• Cooked red meat, fish, or poultry
• Eggs
• Dairy products, such as milk, ice cream, cheese, cottage cheese, and yogurt (as long as they don’t contain fruits or nuts)
• Well-cooked fresh or canned vegetables that don’t have skins or seeds.
• Lettuce
• Canned or cooked fruit with no skin or seeds
• Ripe bananas, melons, and peaches without skin
• Fruit juices without pulp
• Applesauce
• Refined white breads
• White rice or white pasta
• Saltine crackers

What foods should you NOT eat?

Here are some foods you should not eat while on a low-fiber diet:

• Whole grains, such as bran, oatmeal, and brown rice
• Whole wheat pasta
• Whole wheat or whole-grain breads
• Any foods that have seeds or nuts
• Any raw vegetables (except for lettuce)
• Foods that cause gas, such as brussels sprouts, broccoli, and cauliflower (raw or cooked)
• Corn
• Granola
• Lentils, split peas, and beans such as black or red beans
• Berries
• Dried fruit, such as prunes, raisins, or figs
• Raw fruit, except for ripe bananas, melons, and peaches without skin
• Popcorn

Credits

Current as of:
December 17, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Kathleen Romito MD – Family Medicine
Peter J. Kahrilas MD – Gastroenterology

Current as of: December 17, 2020

Author:
Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Kathleen Romito MD – Family Medicine & Peter J. Kahrilas MD – Gastroenterology

Understanding an Intestinal Obstruction | Johns Hopkins Medicine

An intestinal obstruction means that something is blocking your intestine. Food and stool may not be able to move freely. 

When your intestine works normally, digested food moves from your stomach to your rectum. Along the way, your body breaks food down into usable parts and turns the rest to feces (stool). You eventually eliminate it through a bowel movement.

An intestinal obstruction may partially or completely block this natural process. A complete blockage is an emergency and needs medical attention right away.

Among the many possible reasons for an intestinal obstruction are:

• Abdominal adhesions. These are growths of tissue in bands that may force your intestines out of place.

• Hernia. A hernia is a split in the muscle wall of your abdomen. Hernias can cause bulges and pockets. These may block your intestine.

• Volvulus. A volvulus happens when part of your intestine twists around itself. This creates a blockage.

• Intussusception. This condition means that a segment of your intestine slides into another segment. This narrows but may not block your intestine.

• Scarring. When your body heals small cuts (wounds), scar tissue forms. This can happen inside your intestine as well. These scars can build up and create partial or total intestinal blockages. Scarring can result from tears in your intestinal wall, belly (abdominal) or pelvic surgery, or infections.

• Inflammatory bowel disease.  Crohn’s disease and ulcerative colitis are 2 examples.

• Diverticulitis. Tiny pouches (diverticulae) can grow off the large intestine lining. These may become inflamed.

• Tumors. Growths may be cancer or harmless (benign). Either way, they can block your intestine completely or partially.

• Foreign objects. Nonfood objects that you swallow on purpose or accidentally may cause partial or complete intestinal obstruction.

• Meckel diverticulum. About 2 in 100 people are born with this additional small pouch inside the intestine.  

Symptoms

Symptoms of intestinal obstruction are:

• Severe pain in your belly

• Severe cramping sensations in your belly

• Throwing up

• Feelings of fullness or swelling in your belly

• Loud sounds from your belly

• Feeling gassy, but being unable to pass gas

• Constipation (being unable to pass stool)

Who’s at risk

You may be at risk of an intestinal obstruction if you have:

• Abdominal surgery. This can increase the risk for scar tissue or other growths. They also increase the risk for hernias.

• Diverticulosis. This condition means that something irritates the lining of the intestine. It may cause inflammation, infection, and scarring, which can lead to blockage.

• Cancer

• Inflammatory bowel disease

• Swallowed foreign objects

• Chronic constipation

Diagnosis

To diagnose your condition, your healthcare provider will consider your overall health and health history. He or she will ask you about your symptoms. Tell your provider where your pain is and how strong it is. Also tell your provider if you have had changes in your bowel movements or appetite. Tell your provider if you have any other unusual symptoms, such as digestive sounds or a feeling of being bloated.

Your provider will give you a physical exam. You may also need certain tests. These may include:

• Abdominal X-ray

• Barium contrast study

• CT scan

• MRI

• Contrast fluoroscopy

Treatment

The treatment your healthcare provider recommends will depend on what is causing the blockage. For a simple blockage you may need to have only fluids and no solids to eat. Your provider will work to fix any metabolic problems. You may have an intestinal decompression. This is usually done with a nasogastric tube. You may also have bowel rest.

You will need surgery right away if your intestinal obstruction is more complicated. This could be from a tear (perforation) in the intestine or a problem with blood flow. You may also need surgery if other treatment does not remove the blockage. The goal is to remove the blockage and repair your organs.

Your provider also might recommend using a small, flexible tube to keep your intestine open, instead of having more invasive surgery.

Complications

Complications are problems caused by your condition. Complications of intestinal obstruction include:

Prevention

Abdominal adhesions that occur after surgery may be prevented if your medical team takes certain measures. These include keeping the incision site moist instead of dry. Discuss in advance what steps your medical team can take to reduce your risk for adhesions after surgery.

When to call the doctor

Get medical help right away if you have symptoms of intestinal obstruction. These include severe abdominal pain, vomiting, and inability to pass stool.

How to manage or live with this condition

Follow your doctor’s instructions. If he or she has told you to change your diet as part of your treatment, stick to the new plan. The goal of the diet is to reduce the work that your digestive tract has to do, while still giving you the nutrition you need. 

Diet After Small Bowel Obstruction

Diet After Small Bowel Obstruction

Image Credit: virusowy/iStock/GettyImages

During small bowel obstruction, the normal flow of the contents of the digestive system are completely or partially blocked. Most blockages resolve once the small bowel has had time to rest. A nasogastric tube may be inserted through the nose and into the stomach to remove fluid. During this time, eating and drinking are prohibited, and fluids are administered intravenously. When the blockage is cleared, you can begin to eat an intestinal blockage diet consisting of easily digested foods.

Liquid and Full Liquid Diet

Once you’re able to have a bowel movement, the nasogastric tube will be removed to allow you to eat and drink. You will likely first be provided sips of clear fluids to see if you can tolerate it. If you can, you will move on to a full liquid bowel obstruction diet and remain on that for a day or two. A liquid diet will put less pressure on the bowel so it can continue healing while still giving you crucial nutrition.

On a full liquid diet, you can continue to drink clear fluids, and you can add:

• Fruit and vegetable juices and nectars
• Milk products, including cow’s milk, rice, soy and almond milks; buttermilk; milkshakes; frozen yogurt; pudding; smooth ice cream; and yogurt without fruit
• Cooked, refined cereals, including farina, cream of rice and cream of wheat
• Butter and oil
• Gelatin and fruit Popsicles without fruit, sugar and honey
• Broths, strained tomato soup and strained cream soups
• Formulated nutritional drinks.
• Tea and coffee

Avoid anything that requires chewing and anything with fiber. Fiber is hard to digest and will put too much stress on your digestive system. Although the main goal now is to heal your bowel, which sometimes means eating anything your system will tolerate, it’s a good idea to stick to healthier liquid options such as fruit and vegetable juices; unsweetened milk products; formulated nutritional drinks; refined cereals; and low-sodium nutrient-rich strained soups.

Full Liquid Sample Meal Plan

You will probably still be in the hospital while you are on the full liquid diet, so your meals will be designed for you. A typical daily meal plan might include a variety of low-fiber foods:

• Breakfast: Fruit juice, coffee or tea, cream of wheat with milk, pureed pears
• Lunch: Strained tomato soup, milk, fruit juice, Popsicle
• Snack: Nutritional drink
• Dinner: Strained cream of vegetable soup, pureed peaches, Popsicle

Read more: List of Foods High in Soluble Fiber

Low-Fiber Diet

If you tolerate the full liquid diet well, you will be able to transition to solid foods. However, you should still continue to eat easily digested foods that are low in fiber. Typically a low-fiber diet contains less than 10 to 15 grams of fiber per day. Your doctor will tell you to what extent you need to limit your fiber and how long you will remain on this diet.

A few tips make it easier to follow this diet:

• Read labels to choose foods low in fiber.
• Cook your foods well.
• Chew your foods completely before swallowing.
• Avoid any food that is fibrous or stringy, including gristly meat.
• If foods are not well-tolerated, try pureeing them.

There is a long list of foods to avoid on a low-fiber diet, and the main categories include:

• Bran (wheat, rice and corn).
• Fruit and vegetable skins.
• Nuts and seeds.
• Whole-grain foods.

These foods are rich in insoluble fiber, the type of fiber that moves through your digestive system relatively intact and provides bulk to your stool. While that’s healthy in your regular diet, it puts too much strain on your bowel while you are recovering.

Low-Fiber Bowel Obstruction Diet Sample Foods

As long as you stick within the main guidelines for foods not to eat, you can eat anything your digestive system will tolerate.

• White toast or English muffin with butter
• Scrambled egg
• Peach and banana smoothie

• Chicken breast
• Tomato soup
• Canned fruit without added sugar

• Well-cooked white fish
• Sweet potato
• Well-cooked zucchini, carrots and cauliflower

Stick to the low-fiber diet until you are healed and the doctor gives you the go-ahead to add more fiber-rich foods into your diet. Ultimately, you want to get the daily recommended amount of fiber, which is 38 grams for men and 25 grams for women. Eating a diet rich in fiber can help prevent another bowel obstruction in the future.

Read more: 19 High-Fiber Foods — Some May Surprise You!

Bowel rest in acute gastroenteritis

Acute infectious gastroenteritis, stomach flu, is caused by viruses, bacteria or parasites. Bowel rest, when patients with infectious diarrhoea are prescribed a restricted diet or fasting, is sometimes used to reduce stool output and protect the small intestine.

Question

What systematic reviews are there on use of bowel rest in acute gastroenteritis?

Identified literature

References

1. Gregorio GV, Dans LF, Silvestre MA. Early versus Delayed Refeeding for Children with Acute Diarrhoea. Cochrane Database Syst Rev 2011;7.

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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90,000 Seven easy ways to improve bowel health

British nutritionists have named seven simple rules for bowel health. What to eat and drink and what other measures can be taken, says Gazeta.Ru.

There are seven simple rules for gut health, writes British edition The Telegraph , citing advice from nutritionists from the University of Reading.

“The gut plays an important role in maintaining overall health, and the trillions of bacteria that live in it are key to this,” explains Professor Glen Gibson.

– 70% of our immune system depends on the gut and 90% of our serotonin is produced in it.

As you can imagine, good bacteria should prevail over harmful ones. ”

The first tip is to eat plenty of fiber, which keeps your intestinal cells healthy. “An imbalance between good and bad bacteria in the gut can affect not only intestinal health, but also cause a number of other chronic diseases – inflammatory bowel disease, arthritis and metabolic diseases such as obesity and diabetes,” says nutritionist Matt Perkins.

Another tip is to cut back on sugary and fatty foods. “Sugar feeds fungi like Candida albicans normally present in the intestines. These fungi do not cause any problems, but their overgrowth can inhibit the “friendly” gut flora, leading to symptoms such as fatigue, skin problems, thrush, nail fungus, ”says nutritionist Jenny Bodenham.

Adequate water intake also helps to cleanse the intestines.

“Water aids digestion by ensuring the proper supply of minerals and nutrients to the body.Start your day with a glass of water to invigorate your body ”,

– advises dietitian Kais Ernestam.

Also, experts advise consuming foods with probiotics, such as yoghurts. Miso soup also contains a large amount, according to Ernestam. It is recommended to drink such products with cold drinks.

It is worth noting that, according to the American Gastroenterological Association (AGA), there is currently not enough scientific evidence as to which particular probiotic is appropriate for ameliorating certain conditions or treating specific diseases.

Nutritionists recommend and prebiotics – food components that are necessary to stimulate the growth and vital activity of microflora. They are found in onions, garlic, beans, chicory, but in order to benefit the body, you will need to eat a huge amount of them. Therefore, you can simply use dietary supplements.

Not all advice is nutritional – for example, Dr. Harald Stossier recommends a special massage.

Soft movements should stretch the area from the epigastrium to the pubic bone, and then proceed to circular movements clockwise around the navel.After this movement, it is necessary to extend also to the ribs and the pelvic area. According to the doctor, it will benefit the large intestine. Each stage of the massage should consist of approximately 50 movements.

Dr. Joe Travers also advises avoiding stress – it promotes the production of the hormone cortisol, which does not have the best effect on digestion. The release of cortisol, according to Travers, leads to changes in blood flow and secretion in the intestine, suppressing the growth of beneficial microflora and promoting the growth of harmful ones.

Improper bowel function can cause problems more serious than diarrhea or constipation.

Thus, a change in the balance of bacteria is associated with chronic fatigue syndrome.

A research team from Cornwell University has identified a series of blood and gut biomarkers that can be used to diagnose chronic fatigue syndrome. 87 patients – 39 healthy and 48 with CFS – were examined for the presence of inflammatory biomarkers such as lipopolysaccharides and C-reactive protein, as well as for the intestinal microflora.It turned out that in sick patients the microflora is much less diverse, the content of anti-inflammatory bacteria in it is reduced, and the content of pro-inflammatory bacteria is increased. Also, the level of biomarkers indicated an inflammatory process in the body. Researchers believe it could be caused by bacteria entering the bloodstream. This clinical picture was observed in more than 80% of patients.

However, it is impossible to say for sure whether changes in microflora cause CFS or, on the contrary, the disease leads to these changes.

90,000 HOW TO BECOME YOURSELF AFTER A LONG BUTTING. GASTROENTEROLOGIST’S TIPS

If you are feeling overeating, it is important to quickly return your body from “stress” to “normal”. Indeed, when overeating, not only the gastrointestinal tract is overloaded, but also the hepatobiliary system (liver, bile ducts, gallbladder). When you receive an excess amount of “junk” food that we like the most (as a rule, these are multicomponent dishes: for example, cabbage rolls, gravy with flour and various salads with mayonnaise), the digestive system is not able to do its job efficiently.If this overeating continues for more than one day, the food stays in the intestines and is not digested.

Why is there an overload?

Each section in the digestive tract performs its own task. For example, the stomach and duodenum are mainly responsible for protein food, they break it down, so that later in the small intestine it gives up its valuable trace elements and components to the body. The gallbladder and liver are responsible for the digestion of fats. And the pancreas – for carbohydrates.Of course, the functions of these organs are much broader in the digestion of valuable components, but in general, each organ has its own key function. And when the usual amount of food comes in, the body works “in a chain”: after, for example, the stomach has completed its task, it can rest, and the next section begins to work.

When food comes in continuously, work goes on constantly, the gastrointestinal tract becomes exhausted, over time it does not find the resource to do its job well and does not complete it by 25-50%.If at the same time there are concomitant chronic diseases, impotence comes faster. As a result, most of the food passes from one section to another only partially digested. In the end, it enters the large intestine in an incompletely processed manner.

The large intestine is a very important part of the gastrointestinal tract, which is responsible not only for proper cleansing of the body, but also for the production of essential vitamins (in particular B vitamins), a number of enzymes, and compounds necessary for healthy life.When unprocessed food gets into it, it cannot extract all the useful elements from it, and also is not able to advance it at the usual speed, and the movement of masses through the intestines is inhibited. Untreated food masses begin to “ferment” in the alkaline environment of the intestine. This leads to bloating and disruption of the microbiocenosis (the ratio of the number of beneficial and harmful bacteria). Pathogenic bacteria (fungi and opportunistic flora) subsequently lead to a violation of the integrity of the intestinal walls and the ingress of toxic elements into the bloodstream, which causes the development of an inflammatory process in the body.Thus, systematic overeating leads to irreversible changes.

What to do after overeating?

The answer is to help the body regain its shape on its own. To do this, on the days following overeating, first of all, you must drink at least 1.5 liters of ordinary (still) water. If you overeat with fatty foods, add lemon juice (half a lemon to 1 liter of water) to the water. If carbohydrate food is abused, water should be with honey or ginger (1 tbsp.a spoonful of honey and 1 tbsp. a spoonful of grated raw ginger in 1.5 liters of water). If the food was proteinaceous, you will need water with turmeric (1 tablespoon of turmeric per 1 liter of water) or with a cucumber (cut 1 medium cucumber into 0.5 liters of water). Plain water, without additives, will also be auxiliary. After all, the body must first be cleansed of undigested food, give the cells water, which they did not receive during poor bowel function, and also increase the outflow of lymph (many lymph nodes are located just near the large intestine).

Also, the day after overeating, the day you should not arrange unloading, it is better to adhere to a normal diet. As already noted, all undigested food residues are in the intestines, and a fasting day will only slow down their excretion.

To help the intestines recover faster, it is necessary to introduce fiber into the diet. It is found mainly in vegetables (in particular, zucchini, broccoli, cauliflower, cabbage and Beijing cabbage, tomatoes, cucumbers, all types of lettuce, celery, pumpkin, as well as beets and carrots).Fiber will act as a prebiotic – nutrition for the microflora of the large intestine, necessary for the formation of an integral microflora and good motor function of the gastrointestinal tract. Also, fiber will create additional volume, which, when interacting with receptors in the large intestine, will remove the remnants of undigested food from the body. The addition of any vegetable oil to vegetables will enhance this function by additional release of bile and speed up the cleansing of mucus from the intestinal walls.

What can you eat?

At least for a few days, it is necessary to exclude gluten-containing products from the diet (wheat products (bread, semolina, pasta, couscous, bulgur), breadcrumbs, foods containing food additives E150, E160, E411, E471, sausages products, chips, french fries, beer, bouillon cubes, cocoa, instant coffee, products with sugar, sweets, milk (except for fermented milk products).

Food should consist of proteins, fats and carbohydrates in the following proportion: 30%, 10%, 60%. Of these, proteins are white meat, fish, cottage cheese (fat content from 5% to 9%). They need to be consumed at 250 g per day. Fats – exclusively vegetable oils (except for sunflower): olive, grape seed, linseed, mustard, rosehip, milk thistle. And the diet should be up to 25-30 g per day. Carbohydrates – vegetables (including potatoes) and fruits – from 500 g per day. Remember to also drink at least 1.5 liters of clean water a day.Such a diet will eliminate all functional disorders and cleanse the body within a few days. And if you follow such a diet constantly, the body will thank you.

In general, after overeating, you should form the diet of the next days in accordance with the amount of harmful substances that entered it the day before. For example, if you overeat fatty foods, especially of animal origin (jellied meat, meat gravy, mayonnaise, a lot of butter, cracklings, etc.), then in addition to adding vegetable oil to the diet on the following days (which will stimulate bile secretion), go to a vegetarian diet using beans, lentils, bulgur and cottage cheese as proteins (5-9%).Also add fruit to the diet (but not more than 300 g per day).

If you overeat protein foods (meat, beans, cheese, eggs), on the following days sit on cereals (except semolina and millet), vegetables, vegetable soups with the addition of butter (up to 20 g per day).

If the body is overloaded with simple carbohydrates (donuts, bread, sweets), then rest should be given to the pancreas and duodenum, introducing cereals, not animal proteins (legumes), fish (fatty or red), cottage cheese and ground vegetables (not potatoes, beets, carrots).We exclude fruits altogether, along with sugary drinks and alcohol. But we definitely introduce fermented milk products (from 300 g per day).

Milk and fermented milk products

Dairy products are subdivided into, in fact, dairy and fermented milk. Both the first and the second are beneficial for the body. However, after overeating, especially animal fats and simple carbohydrates, fermented milk products should be introduced into the diet: kefir, yogurt, fermented baked milk, various sourdough cultures, and cottage cheese.It is they, due to the content of beneficial bacteria, that will restore the necessary balance of the microflora of the large intestine.

Kefir is extremely useful among fermented milk products. It contains a huge database of lactobacilli and other microorganisms such as: Lactobacillus acidophilus, Bifidobacterium bifidum, Streptococcus thermophilus, Lactobacillus delbrueckii subsp. bulgaricus, Lactobacillus helveticus, Lactobacillus kefiranofaciens, Lactococcus lactis. All these microorganisms live in our intestines.They are responsible for the breakdown of carbohydrates and vegetables, accelerate the motility of the gastrointestinal tract and, as a result, remove toxic substances. Most of them are found in probiotics. But in kefir they have a multicomponent composition. Studies have shown that with the use of Lactobacillus acidophilus in probiotic preparations, the level of cholesterol in the blood decreases. And regular use of kefir reduces the amount of fat in the liver, that is, it leads to regression of the so-called fatty liver infiltration, which is a very complex pathology.So, kefir, unequivocally, ranks first among the drinks that cleanse the body and help restore the intestinal microflora.

In the production of fermented baked milk, Streptococcus thermophilus is used, which absorbs and processes lactose and therefore is used for lactase deficiency. Its acidifying effect is able to stop fermentation in the intestine, providing a bactericidal effect against pathogenic microorganisms. It is also able to synthesize and release polysaccharides, which makes this product not only a probiotic, but also prebiotics (nutrition for microflora, a source of further recovery and growth).

Curd is useful not only for its probiotic activity, but also for its diuretic effect. Under stress, the body accumulates water. This leads to edema not only external (face, legs), but also more dangerous – internal, which put pressure on the organs and prevent them from recovering well and starting to work fully. In addition, cottage cheese contains an easily digestible protein, which, after excessive consumption of animal products, will provide valuable trace elements to the body and will not cause a protective reaction after overeating in the form of protein indigestion.Cottage cheese also contains vitamins B1, B2, PP, C, and calcium, which are very valuable for the body.

Regarding yoghurt. They are different. There are yoghurts with lactobacilli, there are with bifidobacteria, and there are with bacterial spores, which have a tonic effect on the body and help it recuperate on its own. It is important not to be mistaken in choosing the right type of yogurt, as not all bacteria are equally beneficial. And the uncontrolled use of a certain type of bacteria can lead to intestinal hyperfunction.

For example, Bifidobacterium animalis is useful for constipation, improves the motility of the alimentary canal and allows not only to quickly cleanse the large intestine of bad bacteria, but also to teach it to further independently fight opportunistic flora. Lactobacillus casei imunitass helps to increase intestinal immunity, and with regular use, protects its walls in case of holiday overeating.

Give preference to home-made yoghurts or yoghurts without dyes or preservatives.And consume no more than 500 g of yogurt per day, taking breaks from time to time: after a month of daily consumption of yogurt with one type of bacteria, you need to take a break.

Irritable bowel syndrome: causes, symptoms and treatment

How this disease manifests itself. What is the key to its successful cure.

Incomprehensible, but common in our time diagnosis: irritable bowel syndrome. How to calm him down? Irina Pichugina, Ph.MD, gastroenterologist, psychotherapist, specialist in the field of psychosomatics.

The rhythm of modern life imposes its own conditions. We experience a lot of stress, exercise little, eat irregularly and improperly, sleep poorly and get very tired. All these factors can lead to autonomic dysfunction, which, in turn, can lead to psychosomatic diseases. One of which is irritable bowel syndrome (IBS).

It manifests itself in different ways:

• abdominal pains, migrating, without clear localization;
• bloating;
• Stool violation.

The classic IBS patient is a young man or woman who works hard, is stressed, and has no time for sleep, food and rest.

Irritable bowel syndrome is a diagnosis of exclusion, that is, a disease that is detected only when serious organic diseases are excluded based on anamnesis, physical examination, blood tests, feces, colonoscopy and other research methods. Although recently more and more cases of combination of IBS with organic diseases have been mentioned.

The diagnosis of IBS is given to those patients in whom structural changes in the intestinal wall were excluded, but the function suffers. If the intestines contract too quickly, then food and water cannot be absorbed. In this case, the patient has intense pain of the type of spasm, increased frequency and change of stool (becomes liquid).

If the intestine contracts very slowly, the food stagnates, fermentation processes begin and, in fact, the body is poisoned with decay products. The patient experiences a dull, non-intense pulling pain, bloating, constipation.Often in one, the damage is mosaic, that is, some departments contract quickly, while others – slowly.

In both cases, immune processes are triggered, the composition of the microbiota – the bacteria that inhabit our intestines – is disrupted. IBS – despite the absence of structural changes, is not a “fictitious” disease. Patients experience pain and discomfort and also need medical treatment and attention.

IBS treatment consists of:

• in the normalization of lifestyle;
• in the normalization of nutrition;
• in the correction of the regime of the day, work and rest.

The selection of a diet depends on which disorders are more present. But there is a main rule for everyone – the importance of good nutrition, the presence of proteins, dietary fiber, vitamins.

This disease should be treated by a gastroenterologist, because the emerging problems, including a violation of the microbiota, can only be corrected by a specialist in this field. Without solving psychological problems, the treatment of this disease is also impossible, therefore, correction of treatment by a psychiatrist and / or psychotherapist is necessary.

IBS is not a disease that can only be cured by taking medications without changing your lifestyle. But in some cases it happens that the normalization of the lifestyle leads to recovery.

90,000 How does stress affect digestion? / Blog / Clinic EXPERT

Zinovieva Evgeniya Nikolaevna

Chief physician, therapist, gastroenterologist, hepatologist of the highest category, Ph.D., associate professor

September 20, 2020

14.7 thousand views

We live in times world stress.Of course, it cannot but affect the work of our body and can have a negative effect, including on the functioning of the gastrointestinal tract. More often it is discomfort or pain in the abdomen, disturbed stool, bloating.

If the body is in a nervous tension for a long time, and, at times, in nervous exhaustion, or severely overworked, this can lead to a whole complex in the form of disturbances in the work of the digestive, nervous and cardiovascular systems. In case of indigestion due to stress, the following symptoms are characteristic:

• persistent or recurrent pains in the stomach and along the intestines, “in the abdomen”, as patients often explain;
• feeling of fast or early satiety; 90 120
• heartburn;
• bitterness in the mouth;
• nausea;
• unpleasant taste in the mouth;
• abdominal cramps;
• diarrhea (diarrhea or mushy stools) or constipation.

All these symptoms can lead to the appearance of inflammatory changes in the gastric mucosa (ulcers and wounds – erosion) or a whole complex of functional disorders.

In violation of the intestinal microflora – dysbiosis, the production of hormone serotonin may decrease, and this, in turn, affects the regulation of motility and secretion of the gastrointestinal tract. In addition, serotonin is called the “hormone of happiness”, so it can also affect your mood worsening, which leads to an imbalance in the functioning of the gastrointestinal tract and a tangle of problems.

The connection between the central nervous system and the intestines forms a vicious circle. The brain sends signals to the digestive tract that you are under stress. In the intestine, the absorption of nutrients decreases, the rate of enzymatic reactions decreases, which in turn leads to contraction of the gastrointestinal tract muscles and inflammation, increased sensitivity of the receptive nerve endings – receptors to the slightest, even normal, changes. And vice versa.A signal is sent from the intestine to the brain that there are certain disorders. Sometimes this signal is overly intense, distorting the true picture of events. Therefore, the connection between these two systems is very close. It is not for nothing that they say that “the brain and intestines have a lot in common, because they both have something to digest.” The process of blood flow and the activity of blood supply to the digestive system are reduced, all processes occurring in the digestive tract slow down.Chronic stress affecting the human body can lead to such diseases (or serve as a triggering or provoking factor) as:

• functional gastric dyspepsia;
• gastritis (erosive form) or acute gastric or duodenal ulcer;
• irritable bowel syndrome;
• functional disorder of the gallbladder and sphincter of Oddi;
• Crohn’s disease or ulcerative colitis.

How to identify gastrointestinal diseases?

First you need to make an appointment with a gastroenterologist.The doctor will direct you to the necessary examination and prescribe tests, according to the results of which the necessary treatment will be recommended. The foundation for maintaining healthy digestion is diet and exercise. It must be remembered that the body needs physical activity, but do not forget that it is not recommended to deplete it with excessive physical efforts, as this can also adversely affect your digestion. Doctors, psychologists and psychotherapists will help you to get out of a stressful state.

You will most likely be prescribed an informed course of sedatives or psychotherapeutic practices to help you and your nervous system relax so that your treatment is more productive. Yoga classes, walks in nature, meditation, art therapy and, most importantly, adherence to a sleep and rest routine have a relaxing effect. You will be surprised how much easier life will become for you if you start observing your sleep and wakefulness routine! The main thing in your treatment is your participation in the restoration of the body.As a prevention of gastrointestinal disorders, it is worth remembering simple rules: – do not have a snack on the go; – to observe the regime of sleep, rest and nutrition; – exclude fast food, soda and other unhealthy foods from the diet.

Let’s find the good in life and strive for it!

Irritable Bowel Syndrome – Health Institute

07/08/2020

Irritable bowel syndrome is classified as a functional disorder, it is one of the most common diseases that can manifest itself at any age.This is a syndrome that manifests itself in painful sensations and a violation of deformation.

The causes of the onset of the disease are not well understood; estimated risk factors:

1. Psychoemotional is considered one of the significant factors of occurrence. The disease often appears in patients prone to depression, anxiety, hysteria, and panic attacks. There is a relationship between the stress experienced (divorce, violence, death of a loved one) and the appearance of the syndrome.
2. Postponed intestinal infection.
3. Injury to the intestine.
4. Hormonal imbalance.

Classification

Irritable bowel syndrome manifests itself in disorders of the colon. This may be an option accompanied by diarrhea: frequent urge to defecate, loose stools. There is also a clinical form with a predominance of constipation: bowel emptying is difficult, gas formation is increased, the urge to defecate is rare. Another form is mixed manifestations.

Irritable bowel syndrome: symptoms

The clinical manifestations of the disease are varied and can be disguised as other disorders.

• dull, cramping pains in the lower abdomen. They intensify after eating, disappear after emptying the intestines;
• feeling of fullness, bloating;
• tension during bowel movements;
• the appearance of mucus in the stool;
• constipation – emptying three times a week or less;
• diarrhea – emptying occurs three times a day or more often;
• Increased urge to defecate.

Symptoms not related to bowel function

The disease is often accompanied by irritable bladder syndrome.Patients suffer from headaches, nausea, vomiting, belching, lower back pain. Sleep disorder becomes a frequent accompanying symptom: patients suffer from insomnia or drowsiness.

Diagnostics

A comprehensive laboratory and instrumental examination is required to exclude other causes of existing manifestations (for example, diverticular diseases, inflammatory bowel diseases, celiac disease, etc.).

Leading research is performed by colonoscopy to exclude organic pathology.Blood tests usually show no change. Irrigoscopy is used to exclude neoplasms.

Irritable bowel syndrome treatment

The therapy takes place in two directions: psychotherapy and gastroenterology. Psychotherapists prescribe psychotropic drugs, antidepressants to relieve stress and tension. From the side of gastroenterology – symptomatic treatment. Depending on the clinical form, laxatives or anti-diarrhea drugs are prescribed.Antispasmodics are used to relieve pain. The restoration of intestinal microflora is carried out with the help of probiotics.

For the duration of treatment, patients are shown food that does not irritate the intestines. Dairy products, fatty, fried, smoked, salted products are excluded.

An important factor in successful treatment will be the restoration of a calm emotional background of the patient. A daily routine, regular, light exercise, good rest, and the basics of proper nutrition will help maintain a state of remission.

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90,000 Doesn’t spare the stomach: the Delta coronavirus strain has caused an increase in gastrointestinal problems | Articles

Sales of drugs that reduce gastric secretion, in monetary terms, increased by 13% in May-July, and drugs for diarrhea – by 20% compared to the same period last year.This is evidenced by the data of the analytical company DSM Group. According to doctors, the fact that people suffer from the gastrointestinal tract (GIT) is to blame for COVID-19, namely its new strain “Delta” , which was active just at the end of spring. When infected with this variant of the virus, in most cases, a person has diarrhea. That is why the “new version” of covid was initially confused with a common intestinal infection. The increase in sales of drugs that reduce the acidity of the stomach is due to the fact that they are now taken together with antipyretic and anti-inflammatory drugs.

One disorder

The sale of digestive enzyme preparations and means for restoring intestinal microflora in May-July (for 10 weeks – from May 3 to July 11) grew on average by 8%. Sales of drugs that reduce gastric secretion increased by 13%, and drugs for diarrhea – by 20%, according to a study by DSM Group, prepared for Izvestia.

The most significant growth was observed in the period from 7 to 14 June. During this period, sales of enzymes jumped 19%, diarrhea drugs by 34%, prebiotics by 32%, and gastric secretion suppressants by 24% .

This dynamics can be partly explained by the rise in prices. In general, in the first half of the year, the price of medicines increased by 7.6% , Nikolay Bespalov, development director of the analytical company RNC Pharma, told Izvestia. But at the same time, there was an increase in the physical volume of sales of certain groups of drugs, the expert confirmed, linking this with seasonal demand.

Photo: TASS / DPA / Jochen Eckel

– The increase in sales of diarrhea and poisoning products is a typical seasonal phenomenon for the time before 2020 (the beginning of the coronavirus epidemic.- “Izvestia”), – agreed the general director of DSM Group Sergey Shulyak. – People traditionally go south in summer, where they get intestinal infections when they eat unwashed vegetables and fruits . This trend was broken last year when everyone was isolated. But this year people again rushed to rest, and we see the result. By August, the demand for gastric drugs will subside. Gradually, by September, sales of anti-cold remedies will begin to grow, since people will return from vacation and catch seasonal ARVI, – said Sergei Shulyak.

But specialized specialists do not share the opinion about the exclusively summer nature of sales of such drugs .

– There are more complaints about gastrointestinal problems than in the same period before the pandemic. Such symptoms appear against the background of the disease COVID-19 , – the head physician of the Leader-Medicine medical center, virologist Yevgeny Timakov told Izvestia.

The number of patients who applied in May-June with complaints of problems with the gastrointestinal tract increased by 62% in 2021 compared to the same period in 2020 , Izvestia was told in the SM-Clinic.However, it should be borne in mind that it was not easy to see a doctor last year due to restrictions imposed in connection with the risk of the spread of a new coronavirus infection, the company noted.

“Delta” -sila

The emerging trend is associated with the influence of the strain “Delta” , I am sure the infectious disease doctor, chief physician of “Invitro Siberia” Andrey Pozdnyakov. The variant of the coronavirus, which received this official name, was first discovered in India, which is why it is often called Indian.On June 18, Moscow Mayor Sergei Sobyanin said that this strain was detected in almost 90% of the residents of the capital with coronavirus.

– When infected with the Delta strain, in most cases, a person has diarrhea. At first, this symptom was not even considered as a manifestation of COVID-19 , the disease was mistaken for a common intestinal infection, ” said Andrei Pozdnyakov.

Photo: TASS / Zuma

According to him, with a new strain of COVID-19, dyspeptic phenomena are observed, when, due to a lack of special enzymes that are involved in the digestion of food, this process slows down .Therefore, various diseases develop, in particular diarrheal syndrome. In addition, antibiotics, which many have to take, also have an effect.

– People are trying to restore digestion, for which they buy enzymes, prebiotics and probiotics. This is not the worst option, since these drugs are quite harmless, – added Andrey Pozdnyakov.

The growth in sales of drugs that reduce gastric acidity is also associated with the peculiarities of therapy for coronavirus. Doctors prescribe them when the patient is taking antipyretics, anticoagulants, antibiotics, and anti-inflammatory drugs, including dexamethasone.Together with the latter, doctors must prescribe a drug that reduces the amount of hydrochloric acid in the stomach, noted Andrei Pozdnyakov.

Myths of dysbiosis

The growth in sales of products for the gastrointestinal tract may also be associated with the general anxiety of people, which has recently increased due to coronavirus infection , noted Alina Gubanova, gastroenterologist-nutritionist of the SberZdorovye online medical service.

– In gastroenterology there are a number of functional diseases that are closely related to the human psyche.And in such a nervous period, their exacerbations are characteristic, – said Alina Gubanova.

Photo: Depositphotos / Milkos

Purchases of drugs for the treatment of the gastrointestinal tract often occur without the consultation of doctors – patients prescribe drugs for themselves or purchase them on the recommendation of a pharmacist in a pharmacy, added, in turn, the head of the department for the development of medicine at BestDoctor Yulia Tkachenko.

In Russia, they are traditionally carried away with the diagnosis of “dysbiosis” – doctors often make it unreasonably, the expert believes.According to her, now the concept of dysbiosis has been revised – formally, such a diagnosis no longer exists. Therefore, probiotic treatment is not always justified from the point of view of evidence-based medicine. But while many doctors continue to prescribe therapy in the old fashioned way, the expert concluded.

Nutrilon Pepti Gastro dry mix 450g from 0 months

Nutrilon Pepti Gastro dry mix based on fully hydrolyzed whey proteins with medium chain triglycerides and nucleotides

For dietary (therapeutic) nutrition of children from birth.

• For children with intestinal malabsorption syndrome and food intolerances
• Relieves symptoms of food intolerance

Nutrilon Pepti Gastro

Intestinal malabsorption syndrome and food allergies / post-surgery , with impaired absorption of fats and inflammatory bowel diseases.

Nutrilon Pepti Gastro is a lactose-free blend, developed on the basis of international recommendations, and is suitable for long-term use.

Nutrilon Pepti Gastro relieves symptoms of food intolerance and impaired intestinal absorption

Due to the special composition of NutrilonPepti Gastro:

• has a low residual allergenicity due to the presence of specially processed (highly hydrolyzed) whey protein, the amino acid spectrum of which is similar to breast milk;
• satisfies the high energy needs of a child with malabsorption with high-calorie medium-chain triglycerides
• normalizes intestinal barrier function and improves digestion due to its nucleotide content;
• is well tolerated in lactase deficiency, i.e.because it does not contain lactose.

The high effectiveness of Nutrilon Pepti Gastro is proven by international clinical trials.

The effectiveness of this mixture is due to the use, along with other components, of a highly hydrolyzed whey protein. Therefore, the taste of the mixture is characterized by the presence of a bitter or tart note.

The stool of a child receiving this mixture may turn greenish, which is also due to the presence of hydrolyzed protein in the mixture.These changes are typical for all whey protein hydrolyzate mixtures.

IMPORTANT:

• Breastfeeding is preferable for feeding young children.
• Nutrilon® is used as a breastmilk substitute when breastfeeding is not possible.
• Consult a specialist before using the mixture.
• Failure to follow the instructions for preparing and storing the formula may harm the health of the child.
• Never leave your baby alone while feeding.
• For baby food.
• Do not administer to children who are allergic to any component of the product

WARNING:

• Prepare food immediately before use!
• Do not use leftover food for subsequent feeding!

• Do not heat the mixture in a microwave oven to avoid the formation of hot lumps of the mixture.
• Strictly follow the recommendations for the amount of mixture during preparation and do not add anything to the prepared mixture.
• The new formula should be introduced into the child’s diet gradually. For additional questions, contact the Nutriclub® Mom Expert Line.

STORAGE:

• Store an unopened can at temperatures from 0 ° to 25 ° C and a relative humidity of no more than 75%.
• Once opened, keep tightly closed in a cool, dry place, not in the refrigerator.
• Use the contents of an open can within three weeks.

COMPOSITION:

Glucose syrup (polysaccharides, maltose, glucose), hydrolyzed whey protein concentrate, medium-chain triglycerides, a mixture of oils (rapeseed, sunflower, palm, Mortierella alpina – ester and emulsifier), emulsifier diglycerides of fatty acids, minerals, fish oil, choline, vitamin complex, taurine, inositol, trace elements, L – carnitine, nucleotides.