GASTROINTESTINAL AND

LIVER DISEASE
NUTRITION
DESK REFERENCE

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GASTROINTESTINAL AND
LIVER DISEASE
NUTRITION
DESK REFERENCE
Edited by

Gerard E. Mullin
Laura E. Matarese
Melissa Palmer

Boca Raton London New York

CRC Press is an imprint of the

Taylor & Francis Group, an informa business

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Cover designed by Melissa Palmer, M.D.

CRC Press
Taylor & Francis Group
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2012 by Taylor & Francis Group, LLC
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Contents
Preface...............................................................................................................................................ix
Editors................................................................................................................................................xi
Contributors.................................................................................................................................... xiii
Chapter 1 Major Components of the Gastrointestinal System and Their Role in Digestion......... 1
Monica van Dongen and Gerard E. Mullin
Chapter 2 Malabsorption............................................................................................................... 9
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Babatunde Adeyefa and Carla W. Brady

Chapter 3 The Role of the Gut Microbiota and Probiotics in Gastrointestinal Disease
Prevention and Management....................................................................................... 21
Gerard E. Mullin
Chapter 4 Short Bowel Syndrome................................................................................................ 35
Laura E. Matarese
Chapter 5 Celiac Disease............................................................................................................. 51
S. Devi Rampertab
Chapter 6 Food Allergy and Food Intolerance............................................................................ 65
John Leung and Sheila E. Crowe
Chapter 7 Anatomy and Physiology of the Liver......................................................................... 81
Melissa Palmer
Chapter 8 Nutrition and Alcoholic Liver Disease........................................................................ 91
Melissa Palmer
Chapter 9 Nutrition and Nonalcoholic and Viral Liver Diseases.............................................. 109
Melissa Palmer
Chapter 10 General Nutritional Guidelines for Liver Disease, Cirrhosis, and Its
Complications............................................................................................................ 139
Melissa Palmer

vi

Contents

Chapter 11 Nutrition and Liver Transplantation.......................................................................... 159

Melissa Palmer
Chapter 12 Nutritional Considerations in Acute and Chronic Pancreatitis................................. 171
Deepa Gosine, Mohammed R. Kaleel, and Vikesh K. Singh
Chapter 13 Nutrition in Irritable Bowel Syndrome..................................................................... 185
Ashley Koff and Gerard E. Mullin
Chapter 14 Inflammatory Bowel Disease.................................................................................... 197

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S. Devi Rampertab, Amy Brown, and Gerard E. Mullin

Chapter 15 Nutrition and Colorectal Disease..............................................................................209
Myles R. Joyce and Victor W. Fazio
Chapter 16 Nutrition and Colorectal Cancer............................................................................... 221
Mitra Rangarajan and Gerard E. Mullin
Chapter 17 The Influence of Bitter, Aromatic, and Pungent Medicinal Plants on Gut
Function.................................................................................................................. 237
James Snow and Kevin Spelman
Chapter 18 Obesity and Nutrition................................................................................................ 251
Katrina B. Seidman and Lawrence J. Cheskin
Chapter 19 Micronutrients........................................................................................................... 265
Omar S. Khokhar and Timothy O. Lipman
Chapter 20 Role of Fiber, Prebiotics, and Probiotics in Gastrointestinal Health and Disease.... 283
Martin H. Floch and Violeta B. Popov
Chapter 21 Overview of Genomics and Gastrointestinal Health and Disease............................ 303
Ruth DeBusk
Chapter 22 Enteral Access and Enteral Nutrition........................................................................ 317
Amy Berry and Mark H. DeLegge
Chapter 23 Parenteral Nutrition................................................................................................... 343
Mandy Corrigan, Bijo K. John, and Ezra Steiger

vii

Contents

Chapter 24 Pediatric Enteral and Parenteral Nutrition................................................................ 359

Jenifer Hampsey and Tiffani Hays
Chapter 25 DrugDrug and DrugNutrient Interactions in Gastrointestinal Disease................ 375
Mark G. Klang
Chapter 26 Nutrition Assessment................................................................................................ 387
Tina Colaizzo-Anas
Chapter 27 Critical Care Nutrition.............................................................................................. 415

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Tara Nealon and Jonathan Waitman

Chapter 28 Perioperative Nutrition Support................................................................................ 423
Jill Schuman and Kishore R. Iyer
Chapter 29 Bariatric Surgery....................................................................................................... 437
Scott A. Shikora, Kerri Anne Hawkins, and Meghan Ariagno
Chapter 30 Home Parenteral Nutrition (HPN)............................................................................ 447
Alice Illian, Carol Ireton-Jones, and Kevin M. McNamara
Chapter 31 An Integrative Nutrition Approach to Eating Disorders........................................... 457
Carolyn Coker Ross and Gerard E. Mullin
Chapter 32 Ethical and MedicalLegal Considerations.............................................................. 471
Julie OSullivan Maillet

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Preface
The gastrointestinal tract is concerned with ingesting, digesting, and absorbing nutrients and the
liver is a metabolic engine that transforms nutrients, synthesizes plasma proteins, and detoxifies
bacteria and toxins absorbed from the gut. It is therefore not surprising that gastrointestinal and
hepatic diseases have a major impact on the nutritional state of the individual. This text is easily
referred to, integrating the gastrointestinal tract and nutrition, and is a valuable addition to the
literature of the practicing gastroenterologist.
The desk reference is edited by Dr. Gerard Mullin, who directs the integration of nutrition and
gastrointestinal disease at Johns Hopkins Medical Center; Dr. Laura Matarese, who specializes
in the nutritional care of persons with gastrointestinal failure at East Carolina University; and Dr.
Melissa Palmer, the medical director of hepatology at New York University in Plainview. They have
track records and current interests suited to such a reference. The book has a total of 32 chapters
covering a range of topics relevant to being a reference integrating nutrition with gastrointestinal
disease.
Three chapters, entitled Major Components of the Gastrointestinal System and Their Role in
Digestion, The Role of the Gut Microbiota and Probiotics in Gastrointestinal Disease Prevention,
and Anatomy and Physiology of the Liver, give the reader an understanding of the normal state.
Other sections cover the role of nutrition in gastrointestinal and liver disease, including alcoholic
and nonalcoholic liver disease, malabsorption, colorectal disease, transplantation, pancreatitis, and
inflammatory bowel disease.
Of special interest to the practicing gastroenterologist are areas such as food allergy, food
intolerances, effects of medicinal plants, and the role of fiber in the gastrointestinal tract. These
areas are rarely covered in standard texts.
The remaining chapters cover the standard areas of nutrition, namely, nutritional assessment,
enteral and parenteral nutrition, home parenteral nutrition, obesity, critical care nutrition, and surgical nutrition.
Finally, there are two chapters that cover eating disorders and ethical issues.
This text is a valuable practical reference for practicing gastroenterologists as it covers the important aspects of nutrition in gastrointestinal and liver disease.
Khursheed N. Jeejeebhoy
University of Toronto
St. Michaels, Toronto

ix

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Editors

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GERARD E. MULLIN, MD
Dr. Gerard Mullin is an associate professor in the Department of
Medicine as well as director of Integrative Gastroenterology Nutrition
Services at the Johns Hopkins Hospital.
He is an internist, gastroenterologist, and nutritionist and the only
physician in the United States who is board certified by the American
Board of Internal Medicine for Gastroenterology, American Society of
Enteral and Parenteral Nutrition, American College of Nutrition, and
the American Board of Nutrition Physician Specialists. Nationally and
internationally renowned for his work in integrative gastroenterology
and nutrition, Mullin has accumulated over 15 years of clinical experience in the field of integrative gastroenterology and earned his masters
degree in nutrition while in practice.
He is an associate editor of several nutrition and integrative medicine journals. Dr. Mullin was
selected by Dr. Andrew Weil to serve as a senior editor for the first book for physicians on integrative gastroenterology by Oxford Press released in December of 2010 and has contracts for three
other books on nutrition and digestive health.
He is also the former president of the Maryland and Long Island Societies of Parenteral and Enteral
Nutrition and the cofounder of M&Mvites LLC, a firm for designing digestive health nutraceuticals.
In 2009, he was named the American Dietetic Associations honorary member of the year.
Dr. Mullins writing and communications skills are well known in both the medical and lay
communities. He has been interviewed on radio and television and has contributed to stories in The
New York Times, the Associated Press, ABC News, Good Morning America, Newsday, Martha Stewart
Living, Rodale Press, Consumers Digest, Readers Digest, Prevention, Natural Health magazine, Body
& Soul, Cooking Light, Womens World, Mens Health, Good Housekeeping, Glamour, and more.
Dr. Mullins biography has been included in Marquis Whos Who in the World and in Marquis
Whos Who in America numerous times. His contributions and discoveries have led to multiple
awards and his continued selection as one of Americas Top Physicians by the Consumers Research
Council of America since 2004.
He received his medical degree from the University of Medicine and Dentistry of New Jersey
and came to the Johns Hopkins Hospital in 1988 as a gastroenterology fellow.

LAURA E. MATARESE, PhD, RD, LDN, FADA, CNSC

Dr. Laura Matarese is an associate professor of medicine in the Division
of Gastroenterology, Hepatology, and Nutrition, Department of Internal
Medicine, Brody School of Medicine, East Carolina University. She is
responsible for the nutritional care of patients with intestinal failure.
She is the author of over 150 books, chapters, manuscripts, abstracts,
and videos and currently serves on the editorial boards of several
journals. She has lectured extensively, both nationally and internationally, and has held numerous positions within the American Dietetic
Association and the American Society for Parenteral and Enteral
Nutrition. Dr. Matarese currently serves on the board of trustees of the
xi

xii

Editors

Oley Foundation and is president of the National Board of Nutrition Support Certification. She is
the recipient of numerous awards including the American Dietetic Association Medallion Award,
the American Dietetic Association Foundation Award for Excellence in the Practice of Clinical
Nutrition, the American Society for Parenteral and Enteral Nutrition Award for Distinguished
Achievement in Nutrition Support Dietetics, Excellence in Nutrition Support Education, and the
first recipient of the Advanced Clinical Practice Award as well as the Dietitians in Nutrition Support
Distinguished Service Award.

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MELISSA PALMER, MD
Dr. Melissa Palmer is medical director of hepatology at New York
University Hepatology Associates, Plainview and is clinical professor
of medicine at New York University. She graduated from Columbia
University and was trained in hepatology at the Mount Sinai School of
Medicine in New York City. Dr. Palmer is the author of the best-selling
book Dr. Melissa Palmers Guide to Hepatitis and Liver Disease,
which has been translated into multiple languages for worldwide use.
She has authored numerous medical and lay-public book chapters and
contributed to three encyclopedias on various liver-related topics. Her
scientific publications in the field of hepatology have appeared in such
peer-reviewed journals as Hepatology, Gastroenterology, Seminars of
Liver Disease, Transplantation, and Archives of Internal Medicine, and she is a contributing editor
of numerous peer-reviewed journals. Dr. Palmer has been selected multiple times for inclusion in
Castle Connollys Best Doctor in the New York Metro Area, for Consumers Research Council Top
Physicians in America, and for the Patients Choice Award for Best Doctor in New York.
Dr. Palmer runs the popular liver website www.liverdisease.com, which has been the top-ranked
website for liver disease on Yahoo since 1996. She is frequently called upon by the media for her
opinion on various topics related to liver disease. Dr. Palmer has appeared many times on television
as a liver disease expert and has been cited for her expertise in such publications as the Wall Street
Journal, TIME magazine, Cosmopolitan magazine, Womens World, Money magazine, Prevention
magazine, the Los Angeles Times, and Newsday. She has also appeared in numerous videos and
CD-ROMs aimed at educating doctors and the public about hepatitis C and other liver diseases, such
as primary biliary cirrhosissome of which can be viewed on Youtube, www.youtube.com/users/
melissapalmermd. Dr. Palmer lectures to the medical and general public on liver diseaserelated
topics on a regular basis.
Since 1991, Dr. Palmer has sat on the medical advisory board of the New York chapter of the
American Liver Foundation and been a member of the American Association for the Study of Liver
Disease (AASLD), where she currently serves on both the Finance Committee and Development
Committee, and has previously served on the Practice Guidelines Committee, the Enduring
Educational Materials Committee, and the Program Evaluation Committee.
Dr. Palmer has performed trials of various experimental medication for the treatment of hepatitis
and other liver diseases since 1983 and is currently conducting research on new therapies for liver
disease, specifically in the area of hepatitis C and nonalcoholic fatty liver disease.

Contributors
Babatunde Adeyefa, MD
Resident, Department of Medicine
Duke University Medical Center
Durham, North Carolina

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Meghan Ariagno, RD, LDN

Weight and Wellness Center
Tufts Medical Center
Boston, Massachusetts
Amy Berry, MS, RD, CNSD
Surgical Nutrition Support Team
University of Virginia Health System
Charlottesville, Virginia
Carla W. Brady, MD, MHS
Assistant Professor
Division of Gastroenterology
Duke University Medical Center
Durham, North Carolina
Amy Brown, PhD, RD
Associate Professor of Medicine
Department of Complementary & Alternative
Medicine
John A. Burns School of Medicine
University of Hawaii
Honolulu, Hawaii
Lawrence J. Cheskin, MD, FACP
Associate Professor, Health Behavior & Society
and
Director, Johns Hopkins Weight Management
Center
Baltimore, Maryland
Tina Colaizzo-Anas, PhD, RD, CDN
Dietetics and Nutrition
Buffalo, New York
Mandy Corrigan, MPH, RD, CNSC
Cleveland Clinic
Cleveland, Ohio

Sheila E. Crowe, MD, FRCPC, FACP,

FACG, AGAF
Professor of Medicine
Division of Gastroenterology & Hepatology
Digestive Health Center of Excellence
Charlottesville, Virginia
Ruth DeBusk, PhD, RD
Private practice
and
Adjunct Associate Professor at the University
of Medicine and Dentistry of New Jersey
Tallahassee, Florida
Mark H. DeLegge, MD
Division of Gastroenterology and Hepatology
Medical University of South Carolina
Charleston, South Carolina
Victor W. Fazio, MB, MS, MD (Hon),
FRACS, FRACS (Hon), FACS, FRCS,
FRCS (Ed)
Cleveland Clinic
Cleveland, Ohio
Amy K. Fischer, BA
Masters Candidate in Clinical Nutrition
The Steinhardt School
New York University
New York, New York
Martin H. Floch, MD
Clinical Professor of Medicine
Yale University School of Medicine
Section of Digestive Diseases
Yale Medical Group
New Haven, Connecticut
Deepa Gosine, MSc
Pancreatitis Center
Division of Gastroenterology
The Johns Hopkins Hospital
Baltimore, Maryland

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xiv

Contributors

Jenifer Hampsey, MS, RD, CSP, LDN

Pediatric Nutrition Practitioner
Division of Pediatric GI and Nutrition
Johns Hopkins Childrens Center
Baltimore, Maryland

Omar S. Khokhar, MD
Clinical Assistant Professor of Medicine
University of Illinois College of
Medicine-Peoria
Peoria, Illinois

Kerri Anne Hawkins, MS, RD, LDN

Supervisor of Clinical Dietitians
Weight and Wellness Center
Tufts Medical Center
Boston, Massachusetts

Mark G. Klang, PhD

Core Head, Research Pharmacy
Sloan-Kettering Institute
New York, New York

Tiffani Hays, MS, RD, CDE, LDN

Assistant Director of Pediatric Nutrition
Division of Pediatric GI and Nutrition
Johns Hopkins Childrens Center
Baltimore, Maryland
Alice Illian, MSN, CRNI
Clinical Services, Coram Specialty Infusion
Humble, Texas
Carol Ireton-Jones, PhD, RD, LD, CNSD,
FACN
Nutrition Therapy Specialist/Consultant
Carrollton, Texas
Kishore R. Iyer, MBBS, FRCS, FACS
Associate Professor of Surgery and Pediatrics
Director, Intestinal Rehabilitation and
Transplantation Program
Mount Sinai Medical Center
New York, New York
Bijo K. John, MD
Cleveland Clinic
Cleveland, Ohio
Myles R. Joyce, MB, Bch, BAO, MD,
MmedSci, FRSCI
Digestive Disease Institute
The Cleveland Clinic Foundation
Cleveland, Ohio
Mohammed R. Kaleel, MSc
Pancreatitis Center
Division of Gastroenterology
The Johns Hopkins Hospital
Baltimore, Maryland

Ashley Koff, RD
Registered Dietitian
Venice, California
John Leung, MD
Clinical Instructor
Division of Gastroenterology
Tufts Medical Center
Boston, Massachusetts
Timothy O. Lipman, MD
GIHepatologyNutrition Section
Washington DC Veterans Affairs Medical
Center
Washington, DC
Julie OSullivan Maillet, PhD, RD, FADA
Interim Dean and Professor of Nutritional
Sciences
School of Health Related Professions
University of Medicine and Dentistry of New
Jersey
Newark, New Jersey
Laura E. Matarese, PhD, RD, LDN, FADA,
CNSC
Associate Professor of Medicine
Division of Gastroenterology, Hepatology, and
Nutrition
Department of Internal Medicine
Brody School of Medicine
East Carolina University
Greenville, North Carolina
Kevin M. McNamara, Pharm D
Clinical Pharmacist
Tampa, Florida

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Contributors

Gerard E. Mullin, MD, CNSP, FACN, AGAF

Director of Integrative Gastroenterology
Nutrition Services
and
Associate Professor of Medicine
Johns Hopkins School of Medicine
The Johns Hopkins Hospital
Baltimore, Maryland

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Tara Nealon, RD, CNSC

Nutrition Support Dietitian
Philadelphia, Pennsylvania
Melissa Palmer, MD
Clinical Professor of Medicine
New York University
and
Director Hepatology
NYU Hepatology Associates Plainview
Plainview, New York
Violeta B. Popov, MD
Senior Gastroenterology Fellow
Yale Digestive Diseases (Gastroenterology)
Sterling Hall of Medicine
Yale University School of Medicine
New Haven, Connecticut
S. Devi Rampertab, MD
Assistant Professor of Medicine
Milton S. Hershey Medical Center
Penn State University College of Medicine
Hershey, Pennsylvania
Mitra Rangarajan, MSN, ANP-BC, MPH,
CDE, MS, RD
Nurse PractitionerGI Motility/Advanced
Therapeutic Endoscopy/Pancreatic Disorders
Department of Gastroenterology and Hepatology
Johns Hopkins University School of Medicine
Baltimore, Maryland
Carolyn Coker Ross, MD, MPH
Consultant
Clinical Assistant Professor
Center for Integrative Medicine
University of Arizona School of Medicine
Denver, Colorado
Jill Schuman, RD, CNSD, CSP, CDN
Clinical Nutrition Coordinator
Intestinal Rehabilitation and Transplantation
Program
Mount Sinai Medical Center
New York, New York

Katrina B. Seidman, MS, RD, LDN

Johns Hopkins University School of Public
Health
Johns Hopkins Center for Weight Management
Baltimore, Maryland
Scott A. Shikora, MD, FACS
Director, Weight and Wellness Center
Chief, Bariatric Surgery
Tufts Medical Center
and
Professor of Surgery
Tufts University School of Medicine
Boston, Massachusetts
Vikesh K. Singh, MD, MSc
Assistant Professor of Medicine
and
Director, Pancreatitis Center
Medical Director, Pancreatic Islet Cell
Autotransplantation Program
Division of Gastroenterology
The Johns Hopkins Hospital
Baltimore, Maryland
James Snow, RH (AHG)
Director
Master of Science in Herbal Medicine Program
Tai Sophia Institute
Laurel, Maryland
Kevin Spelman, PhD, RH(AHG), MCPP
Tai Sophia Institute
Laurel, Maryland
Ezra Steiger, MD, FACS
Consultant in General Surgery and
Gastroenterology
Digestive Disease Institute
Cleveland Clinic
Cleveland, Ohio
Monica van Dongen, MSN, CRNP
Division of Gastroenterology
The Johns Hopkins Hospital
Baltimore, Maryland
Jonathan Waitman, MD
Medical Director of Nutrition Support Service
Weil Cornell Medical Center
New York Presbyterian Hospital
New York, New York

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