Whipple’s disease (WD) is an extremely rare disease produced by the bacterium Tropheryma whippelii. The risk factors are unknown although it seems to affect more middle-aged men. It is characterized by a syndrome of malabsorption, associated with other clinical manifestations such as arthralgias (joints pain) and even in advanced stages, cerebral involvement.
What is a Good Diet for Whipple’s Disease?
Many of the diseases such as Whipple’s disease that cause malabsorption syndrome have a specific treatment, for example, the suppression of foods containing lactose and gluten in lactose intolerance and celiac disease respectively, the low-residue diet in idiopathic ulcerative colitis and in Crohn’s disease.
The dietetic guidelines common to all diseases including Whipple’s disease that occur with a malabsorption syndrome have as objectives: Increase digestion and absorption, moderate intestinal transit and improve the state of nutrition.
The Whipple’s disease diet must be strictly balanced, that is, satisfy the needs of energy and all nutrients, ensure that the proportions between the latter are adequate and that must be achieved in each food intake. The ingestion of a reduced amount of food each time, along with the increase in food frequency, allows these requirements to be met simultaneously.
The ingestion of dietary fiber, especially the fibrillar type, should be practically eliminated, since it damages the mucosa of the small intestine, already injured. Therefore, it is recommended not to eat the “viands” (banana, tubers and starchy roots) whole but in puree, the beans should be passed through a homogenizer and strained, the fruits should be consumed in juices, boiled vegetables, soft rice and that is not precooked. Pasta and whole wheat bread are contraindicated.
The Whipple’s disease diet must provide proteins of high digestibility contributed by red or white meats well chopped. The meat hash spread with soy is not advisable because soy provides more dietary fiber.
Sweets in syrup and sugary foods are prohibited because they increase osmolality and can cause diarrhea due to an osmotic effect.
The Whipple’s disease diet should have a low-fat content to avoid steatorrhea (presence of fat in feces). The administration of medium chain fatty acids, if possible, is useful.
It is advisable not to eat fried foods, mayonnaise, butter or animal fat. Peanut nougat is prohibited for its fat and sugar content.
It is recommended to eliminate milk and milk derivatives due to the eventuality of a relative lactase deficiency. These foods can be substituted for soy yogurt.
About Malabsorption Syndrome
The malabsorption syndrome occurs as a result of a deficit in the intestinal absorption of different nutrients, that means it is produced by the abnormal transfer of absorbed substances from the intestinal lumen to the internal environment, which may be due to different physiopathological mechanisms and obey various causes.
Absorption is the main function of the intestine. The small intestine of a supposedly healthy adult individual has a total area of approximately 2 million cm2. This is achieved through 3 types of morphological differentiation: the connivent valves, the intestinal villi and the microvilli of the enterocyte. At the level of the membrane of the luminal pole of the enterocyte (microvillus membrane), there are proteins with a double function, structural-enzymatic, which are involved in the completion of the digestion of carbohydrates and proteins in the diet.
In the small intestine, there are 2 types of digestion: luminal and membrane. The first occurs essentially in the lumen of the organ and preferentially affects the fats in the diet. The surface or membrane digestion is of interest to the carbohydrates and proteins of the diet and is carried out when these are absorbed to the glycoproteic fibers of the glycocalyx, where the enzymes that hydrolyze the partially digested foods are located, for the completion of the digestion.
The literature on the nutritional treatment of Whipple’s disease is scarce. However, it is known that due to the difficulties in absorbing nutrients associated with Whipple’s disease, the doctor may recommend that you take vitamin and mineral supplements to ensure adequate nutrition. Your body may need the additional amounts of vitamin D, folic acid, calcium, iron, and magnesium.
- Mayo Clinic: Whipple’s Disease. https://www.mayoclinic.org/diseases-conditions/whipples-disease/symptoms-causes/syc-20356228
- Gastroenterology & Hepatology: Whipple’s Disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987261/
- World Journal of Gastroenterology: Whipple’s Disease: Clinical Presentation of 21 Patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917355/