Disability - fibre and constipation

Some people with disabilities suffer from constipation. Contributing factors can include the medications that they may take, low levels of physical activity, insufficient fluids and a diet that may be too low in fibre. Increasing the amount of fibre in the diet not only treats constipation but also lowers cholesterol, may reduce the risk of various cancers and bowel diseases, and improves general health and well-being

Two main types of fibre
The two broad categories of fibre include:

• Soluble fibre - softens the faeces by absorbing water and helps slow the rate of digestion and lower blood cholesterol and blood glucose. It is found in a range of foods including legumes, fruits, vegetables and oat bran

• Insoluble fibre - helps prevent constipation and other associated disorders, such as haemorrhoids, by adding bulk to the faeces and making the food products pass more quickly through the bowel. It is found in a range of foods including wheat bran and wholegrain cereals and breads.

Fibre keeps the digestive system healthy
Fibre:

• Encourages the passage of food and wastes through the digestive system (peristalsis).

• Reduces the risk of bowel diseases such as chronic constipation, diverticulitis and irritable bowel syndrome.

• May reduce the risk of various cancers, particularly those of the bowel.

Fluid is also important
Fibre can only help to relieve constipation if there is enough fluid in the diet for it to be able to do its work. Fibre absorbs water to produce a soft and bulky stool. Everyone should drink at least 2 litres of water each day, particularly in hot weather. Some people with a disability may need to be reminded to drink regularly. Water is the best drink.

Inactivity can cause constipation
Some people with a disability have conditions that affect their mobility, and this can also be a reason why a person is constipated. A person with a disability needs to be as active as possible each day, as every little bit of regular exercise helps.

Fibre can help with other health problems
A diet rich in fibre can help in many ways, including:

• Weight management - obesity increases the risk of a range of health problems, including diabetes and heart disease. Fibre is key to healthy weight management. Since it is indigestible, it provides a sensation of fullness without the kilojoules.

• Atherosclerosis - high blood cholesterol is a contributing factor in the development of atherosclerosis (narrowing of the arteries), which can cause a range of health problems including high blood pressure and heart disease. Soluble fibre (such as legumes, fruits and vegetables) helps to reduce blood cholesterol.

• Diabetes - a diet high in soluble fibre is digested and absorbed more slowly, which leads to lower blood glucose levels.

How much fibre?
Dietitians generally recommend about 30g of fibre every day. Packaged foods such as breads and cereals include nutrition information labels, which can help you to calculate your fibre intake, and nutrition books often include fibre charts. A dietitian can provide information to individuals on the type and quantities of foods that need to be eaten to achieve 30g of daily fibre in the diet each day. Examples of the fibre content in some foods include:

• Four slices of wholemeal bread - about 7g

• Half a cup of baked beans - about 7g

• Two medium pieces of fruit - about 6g.

General cautions
Changes to eating habits should be made with some care. For example:

• A sudden increase in dietary fibre can upset the digestive system and cause symptoms including flatulence (gas) and abdominal pain. It is better to slowly increase the amount of fibre in the diet over a period of several weeks.

• Diets that are too high in fibre can hinder the absorption of certain minerals including iron, zinc and calcium. Avoid consuming more than 35g of fibre per day.

• Do not use fibre supplements unless you have checked with your doctor or dietitian, since these products can aggravate or cause constipation, particularly if you don’t drink enough fluids. Some people with a disability have swallowing problems. Many fibre supplements thicken when added to fluid and this may cause a person with swallowing problems to choke.

• It is important to drink sufficient fluids. It may be helpful to always include a glass of water at each meal or snack.

Things to remember

• Some people with a disability suffer from constipation.

• Contributing factors can include medications, low levels of physical activity, insufficient fluids and a diet that is low in fibre.

• Dietitians generally recommend about 30g of fibre every day.

No special diet or ‘miracle food’ can cure arthritis, but some conditions may be helped by avoiding or including certain foods or supplements. Arthritis is a general term describing over 100 different conditions that cause pain, stiffness and (often) inflammation in one or more joints. Everyone with arthritis can benefit from eating a healthy, well-balanced diet to maintain general good health.

Some conditions may be helped by dietary changes. For example, people with inflammatory conditions such as rheumatoid arthritis seem to benefit from an increased intake of omega-3 fats, found in oily fish such as sardines and salmon, while gout sufferers may benefit from avoiding foods high in purines, including offal, shellfish and beer and drinking plenty of water.
Always seek the advice of your doctor or dietitian before changing your diet. You may be restricting your food intake unnecessarily or taking too much of products (such as mineral supplements) that may have no impact on your condition at all. Some supplements can also interact with other medications.

General recommendations
General dietary recommendations for a person with arthritis include:

• Eat a well-balanced diet. This will help to maintain general good health, and a healthy weight.

• Avoid crash dieting or fasting.

• Increase dietary calcium to reduce the risk of osteoporosis in later life.

• Drink plenty of non-alcoholic fluids.

• Keep your weight within the normal range. Excess bodyweight increases the stress on joints, especially weight-bearing joints such as the knee and hips.

Dietary modification for gout
Uric acid is a waste product that is normally excreted from the body in urine. Gout is a type of arthritis characterised by the build-up of uric acid in the joints (such as the big toe), which causes inflammation and pain.
It is believed that lowering uric acid levels through small changes in your diet may help reduce the chance of future gout attacks. These changes include:

• Restrict or avoid alcohol.

• Avoid binge drinking.

• Restrict or avoid offal meats, such as liver, kidneys and brains.

• Restrict or avoid shellfish, such as prawns and scallops.

• Restrict or avoid some sea foods including sardines, herrings, mackerel and anchovies.

• Restrict or avoid products containing yeast, such as beer and Vegemite.

• Drink plenty of non-alcoholic fluids.

• Avoid fasting or ‘crash’dieting

• Make sure you don’t overeat on a regular basis.

• Take your time when eating.

Omega-3 fats and Inflammation
Foods that contain omega-3 fats have been found to help reduce the inflammation associated with some forms of arthritis, such as rheumatoid arthritis. These effects are modest compared with medications, however they do not have side effects, and may also have other health benefits, such as reduced heart disease.

Foods rich in omega-3 fats include:

• Fish – oily fish such as salmon and sardines, have greater amounts of omega-3 fats

• Linseeds and linseed (flaxseed) oil

• Canola (rapeseed) oil

• Walnuts

• Foods fortified with omega-3, such as margarines and eggs

• Some fish oil supplements.

It is important not to confuse fish oils with fish liver oils (such as cod liver oil and halibut liver oil). Fish liver oils also contain vitamin A. Large amounts of vitamin A can cause serious side effects. Ask your doctor before taking any supplements, to ensure the correct dosage.

Other supplements
The supplements glucosamine and chondroitin are popular – yet evidence about their success in treating arthritis is limited.

Studies show that glucosamine and chondroitin, taken either separately or in combination, may relieve pain for people with osteoarthritis where there has been a breakdown of cartilage. There is no evidence that these supplements are effective for any other forms of arthritis.

Glucosamine and chondroitin may interact with other medications, including warfarin, and should only be taken after consultation with your doctor.

Obesity may worsen arthritis symptoms
If you are overweight or obese, the extra load on your joints may be exacerbating your arthritis symptoms, especially if your affected joints include those of the hip, knee or spine. There is also a clear link between being overweight and an increased risk of developing osteoarthritis.

To lose excess weight you must be active, but this can be difficult for people with arthritis due to pain or stiffness. See your doctor, dietitian or health professional for information and advice.

Current evidence for dietary cures is sparse
Gout can be helped by avoiding some foods. However, there is no substantial scientific evidence that other forms of arthritis can be helped by avoiding particular foods, unless that person has specifically shown intolerance to them.
There is no evidence that acidic foods such as lemons, tomatoes, potatoes and eggplants or dairy foods trigger arthritis symptoms. These foods all contain important nutrients and avoiding them may be a health risk.

Tips for managing arthritis and diet
If you think a particular food may aggravate your arthritis, it can help to keep a diary of your food intake and symptoms. After a month, you may have some idea about which food could be provoking symptoms. Discuss these results with your doctor or a dietitian.
Don’t cut whole food groups from your diet – for example, all dairy products – without talking to your doctor, as you may miss out on important vitamins and minerals.

Remember that remission may be coincidental
The symptoms of arthritis, particularly the inflammatory types, can change for no apparent reason. Don’t assume any improvement in your symptoms is due to what you eat or avoid. Be guided by your health professional.

Things to remember

• Arthritis is a general term describing over 100 different conditions that cause pain, stiffness and (often) inflammation in one or more joints.

• No special diet or ‘miracle food’ can cure arthritis, but some conditions may be helped by dietary changes.

• Fish oil can ease the symptoms of inflammatory types of arthritis, such as rheumatoid arthritis.

• The symptoms of gout can be eased by avoiding alcohol and offal meats, and by drinking plenty of water.