WORLD GASTROENTEROLOGY NEWS  MAY 2017                                                                                          13
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                  World Digestive Health Day in Montenegro: 
                  Your Diet in IBD and Liver Diseases
                                        Brigita Smolovic, MD, PhD
                                        Gastroenterohepatologist
                                        Assoc. Prof.
                                        Faculty of Medicine, Podgorica
                                        Clinical Center of Montenegro
                                                                                                            Lecture by Dr. Velimir Milosevic
                                                               Inflammatory bowel diseases (IBD) seem to result from 
                                                               the complex interaction of our genetic makeup, the 
                                                               increasingly clean environment in which we live, the food 
                                                               we eat and the bacterial flora in our gut.
                                                               (Faculty of Medicine in Podgorica) on        interval.  During the remission phase, 
                                                               “Healthy food for a healthy liver.”          however, patients with IBD do not 
                  Attendees at the WDHD event                  Diet and IBD                                 experience lactose intolerance at a rate 
                                                               Inflammatory bowel diseases (IBD)            that is higher than that observed in 
                                                               seem to result from the complex              the general population.  If a breath 
                  The Gastroenterohepatology Associa-          interaction of our genetic makeup,           test confirms the diagnosis of lactose 
                  tion of Montenegro celebrated World          the increasingly clean environment in        intolerance, patients should avoid 
                  Digestive Health Day 2016, on 25             which we live, the food we eat and the       lactose-containing foods for at least 
                  November. The theme was “Your diet           bacterial flora in our gut.  The causes      the next three to four weeks.  Because 
                  in IBD and liver diseases”.                  of IBD in foods could include some           most patients tolerate small amounts 
                     The symposium was held in                 of the following: different culprits         of lactose, individual testing of 
                  Podgorica. The event was attended            such as too many carbohydrates (es-          tolerance is recommended.  During 
                  by doctors and pharmacists. They             pecially refined); saturated fatty acids;    mild inflammatory flares or during 
                  actively participated in the discus-         excessive intake of iron and also the 
                  sion.  The conference was attended by        lack of glutamine and arginine; lack of 
                  representatives of the medical journal       fiber in the diet (“low fiber diet”); the 
                  MEDICAL.  A report from the meet-            absence of production of SCFA; and 
                  ing with pictures was published in the       vitamin D and calcium.
                  December issue of the journal.                 Thus dietary therapy may be one 
                     There were two lectures: Dr. Velimir      of the fundamental components of 
                  Milosević, PhD (Faculty of Medicine          successful therapy.  Nutrition during 
                  in Podgorica) on “Nutrition in IBD           an acute disease flare differs from 
                  - from the cause to the treatment”           that allowed during a symptom-free 
                  and Assoc. Prof. Brigita Smolović                                                         Lecture by Dr. Brigita Smolovic
                    WORLD GASTROENTEROLOGY NEWS  MAY 2017                                                                                                   14
                    Editorial  |  Expert Point of View  |  WCOG at ACG 2017  |  WDHD News  |  WGO & WGOF News  |  WGO Global Guidelines  |  Calendar of Events
                                                                    Diet and Liver Disease                          A “liver-adapted” diet 
                                                                    The liver is the main metabolic organ           is just as important as 
                                                                    in the body. The liver has many 
                                                                    different functions: production of              medications. 
                                                                    proteins, cholesterol and bile acids; 
                                                                    regulation of the blood sugar level;            •   the amount of fat should be 
                                                                    the neutralization and elimination of               limited to 40-60 g per day, and 
                                                                    products of the body’s own metabo-                  are the best vegetable fats, such as 
                                                                    lism and substances such as drugs,                  olive oil and nuts.
                   Healthy food and refreshments at break time      intestinal and environmental toxins as          •   coffee consumption should be 
                                                                    well as gut-derived bacterial products              encouraged, as coffee has been re-
                                                                    and storage of nutrients, minerals or               lated to a healthier liver in several 
                   remission, it may be sufficient to eat           vitamins.  So it is very important to               studies.
                   according to the guidelines of a light           protect the health of the liver.                Up to now there is no proof that cir-
                   full diet.  But the primary goal is to             There are some foods that can be              rhosis of the liver can be improved or 
                   prevent malnutrition before it starts.           included in the diet that some believe          cured.  The positive effect of dietetic 
                   Patients with severe diarrhea must               can promote a healthy liver.  Some              treatment, on the other hand, is well-
                   assure adequate fluid intake.  In very           consider those are “liver cleansing”            established.  A “liver-adapted” diet is 
                   severe inflammatory flares, patients             foods. These are two categories of              just as important as medications.  In 
                   may need to be maintained on par-                food: one encourages the process of             compensated type of cirrhosis of the 
                   enteral nutrition for several weeks.  If         detoxification, while others are rich           liver, no dietetic treatment is required.  
                   possible, nutritional intake through             in antioxidants (to protect the liver           In decompensated liver cirrhosis, it is 
                   the bowel, either as oral liquid diet            during detoxification).  These include          important to assure that the patient 
                   or tube feeding, should be preferred             artichokes, carrots, garlic, legumes            is getting the required amounts of 
                   to nutrition provided by intravenous             (peas, soybeans and beans), leafy green         nutrition.  These patients, who are 
                   infusion.                                        vegetables (like spinach), lemons,              often affected by a significant protein 
                      A frequent complication in patients           limes, apples and avocados.                     and energy deficit, should actually be 
                   with Crohn’s disease is the develop-               While there may be no absolute                taking 1.5 g of protein per kg each 
                   ment of narrowing of the bowel (ste-             restrictions in diet for patients with          day, or about 100-120 g of protein 
                   nosis).  Patients with stenosis should           liver disease, in general they should           per day in most cases regardless of the 
                   avoid high-fiber foods.  Patients with           follow the principles of a balanced,            presence of hepatic encephalopathy 
                   very significant narrowing may require           healthy diet.  Moreover, those patients         in order to prevent malnutrition and 
                   strained foods or formula diets that             absolutely avoid alcohol in any form.           sarcopenia. Salt restriction is just 
                   do not contain dietary fiber.  Patients            For all liver diseases the recommen-          recommended in cases of ascites.
                   with fatty stools should replace some            dations are:
                   of their dietary fat intake with eas-            •   most calories should be provided 
                   ily digested mid-chain triglycerides                 from carbohydrates, such as grains, 
                   (MCT fats).  So, it is important to                  fruits, vegetables and honey.
                   emphasize that there is no one single            •   a good source of protein are lean 
                   diet for all patients with IBD and                   meat, low-fat cheese, skimmed 
                   there is no specific “Crohn’s or colitis             milk, eggs and fish.
                   diet!”  It is because each patient reacts 
                   differently.