Nutrition Therapy and Crohn’s Disease

 

What Is Nutrition Therapy?

Nutrition therapy is way to treat health conditions or their symptoms with a special diet. Sometimes, nutrition therapy is used instead of standard treatments, such as medicine. A doctor or registered

can create these diets.

Nutrition therapy is also called medical nutrition therapy.

What Is Enteral Nutrition Therapy for Crohn’s Disease?

Crohn’s disease is a type of inflammatory bowel disease (IBD) that causes

of the intestines. Enteral (EN-tur-ul) nutrition therapy uses a drinkable
formula, such as Boost or Pediasure, to control inflammation and promote healing in Crohn’s disease.

Why Is Enteral Nutrition Therapy Done for Crohn’s Disease?

Enteral nutrition therapy is an alternative to steroids and other medicines that ease the symptoms of Crohn’s disease. Steroids can have serious side effects, including poor growth and increased chance of infections.

Enteral nutrition therapy can help improve nutrition and growth, ease inflammation, and heal the gastrointestinal tract (or “gut”).

How Does Enteral Nutrition Therapy Work?

The two types of nutrition therapy used to manage Crohn’s symptoms are:

  • exclusive enteral nutrition (EEN), also called total enteral nutrition (TEN): Formula is used for all meals. Plain water and some other liquids may be allowed.
  • partial enteral nutrition (PEN): Some food is allowed along with the formula. This makes the diet easier to follow.

Some kids drink the formula, while others get it through a nasogastric (NG) tube that runs from the nose into the stomach.

Enteral nutrition therapy helps improve nutrition for people with Crohn’s disease. But it’s not clear why and how it works. Providing balanced nutrition with these formulas might give the gut a chance to heal. It may also work by changing the mix of

that live in the gut. Good bacteria in the gut can help protect the intestinal lining and regulate the immune system.

How Long Do People Need Enteral Nutrition Therapy?

Kids with Crohn’s disease will need to follow this diet for at least 8–12 weeks. Enteral nutrition therapy can begin at the time of diagnosis or during flare-ups (when symptoms get worse). This is called induction therapy. Its goal is to relieve symptoms.

What Happens After Enteral Nutrition Therapy?

After induction therapy, food is slowly added to the child’s diet. The amount of formula decreases as more food is given.

When symptoms are under control, you’ll make a plan with your child’s doctor to help keep symptoms under control and prevent flare-ups. On maintenance therapy, your child may:

  • have a balance of regular food, special diets, and formula
  • take maintenance medicines

Your child’s doctor and dietitian will help you choose the diet that works best for your child.

Are There Any Risks From Enteral Nutrition Therapy?

Enteral nutrition therapy is very safe. But it can be hard for kids and teens to stick with the diet because:

  • They have to drink the same thing every day without much variety. Allowing some food may help to keep kids on the diet.
  • The formula might cause stomach upset, vomiting, and diarrhea.

Children with Crohn’s disease may become malnourished because:

  • belly pain, nausea, and other problems decrease their appetite
  • the body needs more calories, especially during flare-ups
  • digestion is poor and nutrients aren’t absorbed

Not eating enough food or getting enough nutrients from food can lead to poor growth. So doctors check all children with Crohn’s disease for malnutrition.

Children with severe malnourishment have shifts in fluids and electrolytes during nutrition therapy. Rarely, this can lead to a problem called refeeding syndrome, which causes:

  • irregular heartbeats
  • breathing problems
  • seizures

To help prevent this, these children get enteral nutrition therapy in a hospital, where the care team can watch them closely.

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Dr. Sletten Discussing Central Sensitization Syndrome (CSS)

Mayo Clinic’s Christopher Sletten, Ph.D., ABPP discussing Central Sensitization Syndrome, which is the prevailing theory of the cause of chronic pain & other chronic symptoms. A patient and/or provider understanding of this process can lead to seeking appropriate treatments including the Pain Rehab Center (PRC) at Mayo Clinic’s Florida campus.

Learn more about the PRC program in Florida: http://mayocl.in/prcfl

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NIMH » Therapy Reduces Risk in Suicidal Youth

 

Preventing suicide has proven to be a difficult public health challenge. The suicide rate has climbed in recent years across age groups. In adolescents, suicide is the second leading cause of death. For every young person who dies by suicide, many more have suicidal thoughts, attempt suicide, or deliberately injure themselves without intending suicide.

To date, there have not been any research-validated treatments for preventing suicide among youth. And research has found that it’s hard to get adolescents with suicidal thoughts to start and stay with existing treatments.

Researchers at the University of Washington, Seattle Children’s Research Institute, and collaborators at the Los Angeles Biomedical Research Institute at Harbor- University of California, Los Angeles (UCLA) Medical Center, and the David Geffen School of Medicine at UCLA are addressing the treatment void for adolescents. A recent clinical trial of a psychotherapy called dialectical behavior therapy (DBT)—which has been shown to be effective in reducing suicide-related behavior in adults—showed that DBT can also reduce suicide attempts and suicidal behavior in adolescents.

“We have a real need for more evidence-based interventions to help suicidal youth,” said Jane Pearson, Ph.D., chair of the Suicide Research Consortium in NIMH’s Division of Services and Intervention Research. “This study is significant because it reinforces previous DBT studies with adolescents. DBT shows clear promise for helping at-risk youth develop skills that will set them on a “life preserving” path.”

For this study, Elizabeth McCauley, Ph.D., and colleagues enrolled youth ages 12-18 who were at risk for suicide. The adolescents entering the study had attempted suicide at least once, had a history of repeated self-injury, and had trouble with emotional control—for example, unstable, intense, and often negative moods. Youth entering the trial were randomly assigned to either DBT or a comparison treatment, individual and group-supported therapy (IGST).

By the end of the first six months of the trial, suicide attempts and non-suicidal self-injury (NSSI) were significantly less likely in youth receiving DBT than those receiving IGST. Self-harm, which combines both suicide attempts and NSSI, was about a third as likely in DBT recipients compared with those in IGST. Of 65 youth randomly assigned to IGST who completed the end of treatment assessment, 9 had one suicide attempt and 5 had two or more; out of 72 assigned to DBT, 6 had one suicide attempt and 1 had two or more.

Twelve months after the trial began, rates of self-harm had declined in both groups; the rate was still lower in the DBT group, but the difference was not great enough—given the number of participants in the trial—to be statistically significant. Nonetheless, the benefit seen in the first months potentially saved lives; the authors point out that clinical trials of greater size or length may demonstrate a more sustained advantage to DBT and may assess whether altering components of the therapy could increase its effectiveness.

Another finding of the study was that youth receiving DBT attended more treatment sessions and were more likely to complete DBT treatment (attend at least 24 individual sessions) than youth receiving IGST. The greater success in this respect of DBT may have been an element in the difference in treatment effectiveness relative to IGST.

DBT was developed by Marsha Linehan, Ph.D., senior author on this report, for treatment of people who are suicidal and have symptoms of borderline personality disorder, which is marked by a pattern of unstable moods, self-image, and behavior. The risk of suicide among those with borderline personality disorder is high; recurrent suicidal behavior is among the diagnostic criteria for the disorder. Among the essential elements of DBT are skills training aimed at helping a person regulate emotions, for example, their reactions to stresses; and developing coping strategies to deal with life challenges, including social interactions and relationships with friends and family. The therapy includes individual psychotherapy, multi-family group skills training, youth and parent telephone coaching, and weekly therapist team coaching.

Comparing DBT with another therapy that has some of the general elements common to psychotherapy provides an opportunity to evaluate the effectiveness of the specific components that set DBT apart from other therapies. Comparing DBT with no treatment or treatment as usual would not offer the same insight into the elements that contribute to effectiveness.

The paper reporting this study is online June 20 in JAMA Psychiatry.

Grants

MH090159; MH093898

Clinical Trial

NCT01528020

Reference

McCauley E et al. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA Psychiatry. 2018 June 20. doi: 10.1001/jamapsychiatry.2018.1109. [Epub ahead of print]

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Proton Beam Therapy – Mayo Clinic

Standard radiation therapy is an effective way to treat many cancers. But it isn’t perfect. It kills cancer cells, but it also kills some healthy cells in its path through the body. That’s just one of the reasons Mayo Clinic is bringing a new type of radiation therapy to its patients. It’s called proton beam therapy, and it has the potential to cure more cancers with greater safely, and help people live longer. Learn more: http://mayocl.in/2gVKTKs

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