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How To Manage Dehydration When You Have IBD

Do you find that you have trouble staying hydrated because of the signs and symptoms of inflammatory bowel disease (IBD)? Diarrhea can lead to dehydration even in healthy adults and can be a special problem when IBD causes chronic diarrhea. People with Crohn’s disease and ulcerative colitis sometimes also have surgery to treat their disease, which can include the removal of some or all of the large intestine. The large intestine is where most water is absorbed, and when part or all of it is missing, less water might be absorbed by the body. This is why hydration is a special area of concern for people who have an ileostomy or have had j-pouch surgery (ileal pouch-anal anastomosis or IPAA). Dehydration is a major cause of readmission to the hospital after ileostomy surgery.

The Origin Of Sports And Energy Drinks

Many people turn to sports drinks as a source of hydration. There are a few different groups that developed drinks that were meant to provide hydration and energy before, during, and after exercise. The most famous of them was originally developed for use by athletes who may lose a lot of water by sweating, especially during hot weather. Dr. Robert Cade of the University of Florida, at the request of the university’s assistant football coach, led a team that originally developed a drink containing electrolytes and carbohydrates. The football team went on to have a successful season while using the drink, and other colleges started asking for it. This, of course, was the start of the sports drink Gatorade.

In time, manufacturers began adding other ingredients to their drinks, including stimulants like caffeine, to create energy drinks. Most energy and sports drinks also contain artificial colors and sweeteners.

Sports Drinks May Not Be the Answer to Dehydration

There are a few things about sports and energy drinks that make them a less than perfect choice for people with IBD who need to replenish fluids and electrolytes. The first is that they don’t actually offer the right mix of nutrients: most don’t contain enough electrolytes. The second is that some brands contain things that aren’t needed that make them taste better (sugar or artificial sweeteners), look colorful (artificial colors), and provide a burst of energy (caffeine).

The World Health Organization has developed an oral rehydration salts (ORS) solution that is used across the world, especially in areas where severe dehydration is a cause of illness and death.2 Using a special combination of salts and water to rehydrate is called oral rehydration therapy (ORT), and it saves lives in areas of the world where diarrheal disease is a leading cause of death in children. ORS is available in Western countries at pharmacies, hospital supply stores, and sometimes in sporting goods stores with the first aid kits. There are also recipes for ORS that can be made at home. ORS is usually fairly inexpensive but checks with a doctor before resorting to buying it or making it at home for rehydration.

How Can People With IBD Get Hydrated?

Short of keeping a supply of ORS on hand (although it’s not a bad idea to keep some with your emergency supplies), how can people with a j-pouch, an ileostomy, or IBD, rehydrate at home? According to the University of Michigan IBD Team, rehydration is probably best done with a mix of a few things most people with IBD probably already have at home. The experts at U of M recommend that the sports drink is just a start.4

To bring hydration up, they suggest eating and drinking the items in this “recipe” designed to mimic ORT:

  • 1 liter of sports drink
  • 1/2 cup of chicken soup
  • One of the following:
    • 1.6 bananas
    • 1.6 sweet potatoes
    • 1.6 medium avocados
    • 1.5 cups of yogurt
    • 1 cup of spinach
  • 3 1/2 tablets of 650 mg of sodium bicarbonate (or 7 325 mg tablets)

The United Ostomy Association of America also has recipes available for replacing electrolytes and fluids. This is the suggested homemade electrolyte drink:5

  • 1 teaspoon salt
  • 1 teaspoon baking soda
  • 1 teaspoon white Karo syrup
  • 1 6-ounce can freeze orange juice
  • Add water to make one quart, mix well

What To Do If You’re Dehydrated

Mild cases of dehydration can usually be dealt with at home. Severe cases of dehydration may need to be treated by a physician or in a hospital. For severe dehydration, with symptoms of confusion, dizziness, or fainting, call 911. If you have more questions about how to avoid becoming dehydrated, or what you should eat or drink if you are dehydrated, ask your physician.

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COVID-19 vaccinations in patients with inflammatory bowel disease

Advances in the treatment of patients with inflammatory bowel disease (IBD) have substantially improved disease activity and quality of life, and reduced hospitalization rates and the need for surgery. However, prolonged immunosuppression in these patients can result in increased susceptibility to opportunistic infections. Many of these infections are preventable through vaccination and immunization strategies that should be undertaken as early as possible after diagnosis because the risk of opportunistic infections increases following the first year of immunosuppressive therapy.

The COVID-19 pandemic has led to substantial concerns for patients with IBD who are on immunosuppressive medications, many of whom are using additional protective measures. Although early COVID-19 studies have suggested that immunosuppressive medications are safe, robust and reproducible data are not available to adequately risk stratify patients with IBD, and current measures are mostly based on observational studies and theoretical risk.

 Large scale, prospective, population-based registry studies, and meta-analyses have identified key risk factors associated with a higher probability of mortality from COVID-19, including age, socioeconomic deprivation, diabetes, respiratory disease, obesity, and being from a Black, Asian, or other minority ethnic group.

One of the best ways to mitigate the risk of COVID-19 is the rapid development of safe and effective vaccines. Although initial phase 1/2 studies are promising,

 patients on immunosuppressant medications have largely been excluded from these studies, creating potential future concerns regarding the safety and generalisability of outcomes for individuals with IBD.

To achieve a sufficient degree of herd immunity, vaccination programs are primarily successful only when there are high rates of coverage and acceptance. The importance of patients with IBD being included in vaccine trials is compounded by the concern that these patients have a lower response to vaccinations and that vaccinations are generally underused in this population. Melmed and colleagues

 showed that in patients with IBD there was an uptake of only 22–46% for the influenza vaccination, and a mere 9% were vaccinated for pneumococcal pneumonia, despite both vaccines being recommended in the British and European IBD guidelines for vaccinating patients.

 A patient survey showed a perceived lack of benefit from a vaccination as the most frequent reason for low vaccine uptake, as well as concerns regarding side-effects, risk of disease flares, needle aversion, and inconvenience.

 However, in the present pandemic, both perception of risk and health awareness might be very different, with implications for vaccine acceptance.

In patients with IBD who were vaccinated against influenza, an immune response was induced, but the use of concomitant infliximab and immunomodulatory therapy were associated with inadequate rates of seroconversion.

 In adult populations vaccinated with the pneumococcal vaccine PSV-23, an impaired immune response was shown in patients with Crohn’s disease taking combination immunosuppressive therapy.

 Other vaccines such as those against hepatitis A and B virus, tetanus, and herpes zoster have also been shown to be potentially less effective in patients with IBD than in control groups.

The extent to which medications might affect vaccine response, independent of underlying disease activity, is unclear. Of note, concurrent anemia, which is a common finding in patients with active IBD, might impair response to vaccinations.

 There is therefore an urgent need for a better understanding of both the effectiveness of potential vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with underlying health conditions, as well as the potential impact of effective disease control on rates of vaccine response.

Currently, the candidate vaccines in phase 3 trials include inactivated, mRNA, or vector-based approaches. The classic inactivated or live-attenuated vaccines raise safety concerns due to possible induction of the disease. However, the ChAdOx1 nCoV-19 trial vaccine uses a replication-deficient chimpanzee adenovirus to deliver a SARS-CoV-2 protein to induce a protective immune response. This vaccine seems to be promising for patients with IBD because adenovirus vectors do not integrate the viral genomic DNA into the host’s genome, are highly immunogenic, and can induce robust innate and adaptive immune responses. The same adenovirus vaccine platform is also being assessed for use against malaria, HIV, influenza, and the Ebola virus.

 Nevertheless, the phase 1/2 trials of the ChAdOx1 nCoV-19 vaccine were done on young, healthy volunteers and as such do not address the potential immunity concerns in patients with chronic diseases or those on immunosuppressants.

 Moreover, we cannot assume that data on one vaccine type in a specific group of people can be extrapolated to other vaccine types.

There needs to be a stronger emphasis on vaccinating patients with IBD within the broader health-care preventative scheme. These factors must be considered when policymakers and national health services start to design and develop future COVID-19 vaccination programs. Equitable access to COVID-19 vaccination programs should be endorsed. If this is not feasible, then we propose that future community vaccination programs support and promote vaccines that can be used by the high-risk cohort of patients with IBD.

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stay safe

Having been under virtual house arrest for some time, it’s easy to get carried away with the excitement of a short break, post Covid-19. You’re taking in new sights, sounds, smells and tastes. It’s an adventure for the soul. But rich foods and drinks, lack of exercise and the stress of travel, particularly with young children, can take a toll on your health. To avoid paying for it later on, take a few steps to remain healthy.

REMEMBER TO GET ENOUGH SLEEP

A holiday after such a stressful period for everyone might be much welcomed, but don’t neglect your sleep patterns. Aim for six to nine hours a night and take a short nap in the afternoon if you need it.

WASH YOUR HANDS OFTEN

Stop germs in their tracks. Remember: wet, lather, scrub, rinse, and dry. This isn’t just good advice in a pandemic, it’s important every single day of your life. Practice it frequently throughout the day to prevent spread of diarrhea and respiratory disease, too. PACK SMART While it’s great to finally be free to enjoy a break, beware of the holiday cheer. Many hotels offer complimentary drinks, snacks or cakes. The result can be hard on your system. Pack Udo’s Choice Ultimate Digestive Enzyme Blend, to aid your digestion. A unique blend of seven plant-based digestive enzymes assist in the breakdown of proteins, fats, carbohydrates and fibre. Udo’s Choice Super 8 Microbiotic is a hi-count microbiotic blend that contains eight strains of lacto and bifido bacteria. Each daily capsule contains 42 billion ‘friendly’ bacteria. Both products can be found in your local health food store or pharmacy.

ALWAYS KEEP HYDRATED

Drink lots of water. Spending hours travelling can dehydrate you. Carry a large bottle of water to have throughout your journey, and pack Manuka Lozenges with vitamin C for an added immune boost and try to choose caffeine free drinks throughout the day.

EAT FISH

If you’re staying by the sea, eat lots of fresh grilled fish. Oily fish –including sardines, fresh tuna, salmon and mackerel – is particularly good as it’s rich in Omega 3, which keeps your skin hydrated and encourages healthy digestion as well as weight loss. Try to eat a variety of different coloured fruits and vegetables – oranges, red peppers, green courgettes, yellow sweet corn – to get a wide range of antioxidants.

PROTECT FROM THE SUN

Lying in the sunshine feels great but you only need 10 minutes of unprotected sun to get your daily dose of vitamin D. After that you should use sunblock. As we get older, the collagen in our skin breaks down more rapidly, leading to lines, wrinkles and discolouring. To prevent the breaking down of collagen, eat lots of purple fruits, such as fresh blackberries, blueberries and black grapes.

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