Dietician Guidelines for IBD: Potential Problem Foods

This came from my dietician who was a referral from Aetna health insurance. These are GUIDELINES, she said, and not "Written in Stone"

Foods to Avoid
(Not all IBD patients have problems with every item - it's "trial and error")
BASIC GUIDLINE AVOID HIGH-FAT and HIGH FIBER

DAIRY
-Yogurt with berries (other yogurts are fine and recommended)
-Whole milk, heavy cream, half & half, sour cream, ice cream (low-fat or no-fat OK)
-High-fat or creamed cheeses (such as Brie)

MEAT
-Fried meat like sausage and bacon
-Bologna, salami, hot dogs (low-fat versions OK)
-Tougher cuts of meat

VEGETABLES
-Beans, peas, nuts
-Whole wheat and whole grains
-Avoid skins, seeds, or nuts including poppyseed
-Beets
-Cruciferous vegetables
-Corn
-Greens
-Lima beans
-Mushrooms
-Okra
-Onions
-Parsnips
-Peppers
-Spinach
-Winter squash

FRUIT
-ALL raw or fresh fruits except: peeled apples, ripe bananas, melons (canned fruit may or may not agree with you - you need to experiment)
-Canned berries
-Dried fruit
-Prune Juice

DRINKS
-Caffeine
-Alcohol
-Sweetened fruit drinks
-Carbonated drinks

MISC
-Sorbitol - Sugar alcohols

You will also find that food recommendations change for those with significant strictures vs those with fistula or colon oriented afflictions.

That is kind of why the whole diet thing cant be written in stone. Reactions to food can be quite variable but also the area afflicted really plays a role in what type of reaction we can have.

If a food stimulates more bile production, and you have terminal ilium irritation, bile will not be completely reabsorbed. Once bile makes its way into the colon it can no longer be dealt with and makes for issues.

If you have a severe restriction and consume insoluble fiber your gut can not handle the extra bulk material needing to be passed and you get in trouble.

If you are having malabsorption issues you need to run a very high calorie/nutrient diet to minimize health decline.

It is a very tricky thing sometimes and I totally see why the physicians take the position they do. They want to fix the diseased portions of our gut and find a way to treat what made us get that way. Radical diets can help cope for a time and allow the body to heal its self if to whatever degree it can. But I think the doctors see depriving ones self of a well balanced diet as a kind of unnecessary suffering they want to alleviate us from.

Thanks Joe and Kenny. Both helpful comments

Hey Joe, thanks. EJ cannot eat store bought sausage links but we have a local butcher that makes the best smoked sausage and he and I eat it all the time w/ no problems.

He used to eat apples and raw broccoli but now both pass through him undigested. They don't hurt him but it's just a waste.

WHY IS FIBER CONSTANTLY RECOMMENDED TO BE AVOIDED FOR PEOPLE WITH IBD!!!!!!!!

I DON'T GET IT.

***The main purpose of fiber in the intestines is to regulate the bowels and makes things flow easier***. This would seem like a big deal for anyone with Crohns, but hey that's just me. It also stimulates the production of good bacteria in the colon. I'm so sick of seeing this *do not eat your vegetables, you may get a blockage or whatever. Cooked vegetables are the number 1 thing people with IBD need to be eating. If you've never eaten vegetables before, and you all of a sudden eat a ton of them, you're going to have problems, especially if you have strictures, blockages, etc. This is why people that have problems eating vegetables need to GRADUALLY introduce them back into there diet. The theory that people with Crohns need to stay away and completely avoid vegetables (the most abundant source of fiber) is just flat out ignorance, and I'm frankly sick of seeing people recommend it to other people on this site.

Jeff D. said:

iminflamed: I would agree with you depending on certain circumstances. Those circumstances are if you have a stricture then fiber should be limited. If you have just had surgery, then fiber needs to be restricted for a time. Fiber can actually be quite harsh on your intestines so I would recommend adding fiber back very slowly. Start with a banana and move up in fiber over a period of months to years. Slow introduction is a necessity. For those with D it could very well help create bulk in the long term. I'm not a doctor so please don't take my advice without consulting your doctor but it could definitely help. Make sure you don't have strictures as they will catch and hold fiber which will make your strictures worse.

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Exactly. It's all about a GRADUAL introduction of fiber back into the diet. In fact, I provided a direct quote from my medical nutrition therapy book a little while ago that specified fiber needs to be added back gradually, NOT COMPLETELY AVOIDED, for people with IBD. If you have just had intestinal surgery, then yes fiber is obviously going to be a problem, I think the same could be said though for tons of other solid foods following surgery. But this anti-fiber, Pro low residue diet nonsense is just wrong.

Fiber's main purpose is to regulate your bowels. They soak up water in the intestines, stimulate the production of good bacteria, are soluble and mix with other foods, pushes food through the intestines, cleans up your intestines, provides bulk to stools, the benefits of fiber for digestive health cannot be overemphasized.

We also have to take into account that it depends on the person and really it all goes back the doctor. Seriously, talk to your doctor first about diet changes. My GI told me that some people with lots of D, low inflammation, and no strictures he will gradually introduce fiber and they make a great recovery. It depends on the situation. Several years back I wrote about a fiber idea I had which was to increase fiber.

But really advising people on a forum to go low residue is the correct call. I say this because if someone tries to add fiber then they could seriously hurt themselves if they are not under doctor supervision.

Jeff D. said:

We also have to take into account that it depends on the person and really it all goes back the doctor. Seriously, talk to your doctor first about diet changes. My GI told me that some people with lots of D, low inflammation, and no strictures he will gradually introduce fiber and they make a great recovery. It depends on the situation. Several years back I wrote about a fiber idea I had which was to increase fiber.

But really advising people on a forum to go low residue is the correct call. I say this because if someone tries to add fiber then they could seriously hurt themselves if they are not under doctor supervision.

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*If easily offended, do not continue reading* <------------

Doctor supervision? Doctor's are not trained in nutrition. In fact, they barely take any nutrition classes throughout college, or med school at all, if any. They are not trained in that area, so it is an anomaly to me why you would suggest listening to your doctor on diet advice. If I continued to listen to my previous doctor on diet advice I'd either be dead right now, or in extremely terrible shape, with no future. And that's the truth.

Why do you need to change your diet under a doctor's care, because if you have a lot of inflammation fiber will cause pain. If you have a stricture fiber will cause pain and blockages which will lead to surgery. If you have any other unforeseen problems, it would be good to be checked out before you try a diet that can easily do damage if not done properly. Also, any doctor worth his weight would send you to a nutritionist to help you in your decision. If you have mild disease without any other problems then yes fiber may help but other than that you can seriously hurt yourself if you are not 100% sure what you are doing.

If I ate a high fiber meal a few weeks ago I would have died had my doctor told me to go on low residue because of my stricture. You seem to not have trust in doctors and that's a real shame. It's also a shame that you come on here acting like you know everything without proving anything. If you give advice please back it up with something. i decided to take my post down previously because I realized after I posted it that I needed to have some support so I took it down to get some research on it. Please do the same.

Sorryr Regular Joe for derailing your thread for a bit.

Jeff D. said:

Why do you need to change your diet under a doctor's care, because if you have a lot of inflammation fiber will cause pain. If you have a stricture fiber will cause pain and blockages which will lead to surgery. If you have any other unforeseen problems, it would be good to be checked out before you try a diet that can easily do damage if not done properly. Also, any doctor worth his weight would send you to a nutritionist to help you in your decision. If you have mild disease without any other problems then yes fiber may help but other than that you can seriously hurt yourself if you are not 100% sure what you are doing.

If I ate a high fiber meal a few weeks ago I would have died had my doctor told me to go on low residue because of my stricture. You seem to not have trust in doctors and that's a real shame. It's also a shame that you come on here acting like you know everything without proving anything. If you give advice please back it up with something. i decided to take my post down previously because I realized after I posted it that I needed to have some support so I took it down to get some research on it. Please do the same.

Sorryr Regular Joe for derailing your thread for a bit.

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I never said I knew everything, I DON'T KNOW EVERYTHING. but I know a bit. I'm graduating in the Spring with dual degrees in Food and Nutrition Science, and Dietetics. I'm doing an undergraduate thesis that'll be done in the Spring on the effects denaturing has on the protein extracts from almonds. I've had Crohns for the last 15 years, since I was eight years old. Ate like shit for most of it, tried numerous different diets the last few years, read tons of books on gut health. Again, since you asked, I'm just saying I know *A BIT. Here's a post I made a while back that comes DIRECTLY from the medical nutrition therapy book I had to read for one of my classes. My post was ignored.

ust to further reiterate my point on the gradual introduction of fiber in the diet, here is a direct quote from my Medical Nutrition Therapy book. I have a test next week on the upper and lower GI tract.

"Appropriate cautions are also warranted for persons with GI strictures or dysmotility syndromes. In these situations the fiber content of the diet should be increased slowly, taking almost a month to reach desired intakes of 25 to 38 g of fiber per day. Gradual initiation of a high-fiber diet may help reduce unpleasant side effects such as increased flatulence, borborygmus (intestinal rumbling), cramps, or diarrhea. A gradual increase in fiber intake helps alleviate these symptoms."

further down...

"GI disturbances associated with initial fiber ingestion usually decrease within 4 to 5 days, but some increase in flatulence is normal with a high-fiber intake. The high-fiber diet is most effective when consumed continuously for several months."

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-Medical Nutrition Therapy, Krause, 5th edition

Can I just remind people that the OP did say they were only guidelines, and to experiment with what works for you!

The guidelines have certainly been helpful for me - I have been keeping a food diary and was struggling with determining what foods were giving me symptoms. By checking for these foods in my diary, it was fairly easy to realise that e.g. parsnips are a problem for me. Since I can eat carrots OK, it had thought that most root vegetables are OK. It wasn't until I saw parsnips mentioned that I thought to look for them.

I have not particularly changed my diet since diagnosis, I probably don't have the healthiest diet but it is much better than most people I know. So I have just made a few substitutions e.g. Well cooked carrots instead of parsnips.

But that's just me, remember I am not a doctor or nutritionalist or an expert in anything!

Heck when I was in my initial flair and diagnosis period I had to stick with almost a total liquid diet. Three months of clear broth soups and crap! Not even veggie soups. But it is all about the case presented. We are all different. I had to keep my GI material in a very liquid state so it would not put pressure on the intestinal wall. Dealing with blockages and the risk of a rupture is not fun. I ate mashed carrots one night and the damn things got stuck in my Perc Drain Line. It took me an entire bottle of Saline over two days of trying to flush out the carrot. It was picking up right at the Ilium and Cecum so that carrot was pretty much exactly like it went in as it was about to pass into my Ascending colon.

Not eating fibrous veggies just because you have IBD is one thing. Not eating Fibrous veggies because your trying to pass food through a straw sized segment of your gut that is leaking into your abdomen is all together another matter. I support caution with respect to fiber due to the possible nature of a lot of people that come here. I learned early on that there is a huge variance in the condition and needs of people on here.

Low residual Fiber is the diet recommended by the vast majority of Professional health teams dealing with Crohns during initial assessment. And for people like me that was something to work toward AFTER surgery.