Diet experience for kids with Crohns

[wdeepakmail]

My Daughter was diagnosed with crohns in June 2017.
Was put on initial steroids then on imuran till now. All well.
I changed her diet pattern , her was a mild early diagnosed crohns and chronic constipation was a main problem
Lactose free milk , organic fresh food. We are indians so lots of focus on indigenous pulses and vegetables. White meat occadionally .
Lot of focus on fruits , 2 portions of fruit and 1 portion of vegetable a day regime.
I would like suggestions / experiences to make diet more wholesome and at the same time , which does not cause ibs or gastric issues .

 

[momof8yrold]

I'm also Indian. My son has Crohn's disease. He was diagnosed in April, 2015. Diet didn't play any role for my son. I actually feel, diet totally depends on the disease location. If your daughter has Crohn's in the colon, fresh fruits and vegetables have to be completely avoided. Infact all high fiber diet is a big NO-NO. My son has Crohn's activity mostly in the colon. And hence, I avoid all fresh fruits/vegetables.

We met one of the dietitian to get a food plan. Pulses cause a lot of gas too.., you should be careful on that. Each kid is different and how they react to the food is totally different too.

I would let the child decide what he/she wants to eat and see how they react.

 

[Maya142]

Actually, I think new studies are now showing that fiber is good for IBD - it's just to be avoided if your child does not tolerate it or has a stricture (narrowing due to scar tissue) because then it could cause an obstruction. Now a diet similar to the Mediterranean diet is recommended, with whole foods.

It does depend on the kiddo - your child will figure out over time what works and what doesn't. For example, my daughter used to have a VERY hard time with high fiber or high fat foods - especially fried foods. Now her IBD is doing well and she has started eating salad again. Lots of fiber, no issues so far! She is adding more and more veggies back into her diet. It's really trial and error - she cannot tolerate lentils for example.

She still cannot really tolerate high fat fried foods though - they tend to cause pain and nausea and sometimes cramping.

There is no need to cut out gluten and dairy unless she can't tolerate them. Additionally, if she was found to be lactose intolerant (they can test stomach biopsies to measure the lactase enzyme) during a flare, it's possible that she might produce more lactase when her IBD is controlled and the lactose intolerance might actually go away. It doesn't happen with every lactose intolerant kid, but it does happen with some.

I'm going to tag @crohnsinct since she follows the research carefully.

 

[crohnsinct]

Maya is absolutely correct on this one.

There is a lot of research being done on diet and microbiome etc. The factors that contribute to getting Crohn's are GEM - genetics, environment and microbial. The standard western diet is not good for Crohn's for a few reasons: additives (emulsifiers and such), inflammatory foods, lack of fiber. A high fiber diet is very good for improving the microbiome and for years now researchers are finding it is very good for Crohn's disease. As Maya pointed out, the important caveat is that high fiber should probably be avoided if it bothers you when in a severe flare or when there is a narrowing or stricture.

Whole foods (foods without a label that lists ingredients) are a good focus. Organic if you have access and it isn't cost prohibitive is another good focus. I would venture to say that in all I am reading 2 servings of fruit and 1 of vegetable is probably still a little low but perhaps your serving sizes are a lot larger than the US serving sizes. Variety is another great way to improve the micro biome. Pulses are an excellent source of fiber and protein as well as a host of other beneficial things. If eating them gives you uncomfortable gas, there are things you can do to mitigate their affects. Eat a small amount at first and gradually increase. Rinse canned beans first. Soak dried beans for several hours. Rinse and stack a second time. Rinse and then cook. Cook beans before adding to dishes (i.e. salads). Eat beans with lots of green vegetables.

 

[momof8yrold]

Great to know that fiber is good for IBD patients. I thought it is the other way around. Thanks for sharing the info.

I can tell my son's experience. He had a moderate to severe activity at the time of diagnosis. His disease activity was limited to his colon. I used to monitor his poop everyday and I could see veggies pass through him as is..(even steamed vegetables like carrots.., a bit of TMI). He couldn't tolerate anything. Deep fried., he has never eaten in his life. May be, he couldn't tolerate it from the beginning! Even when he was on remission.., he avoided deep fried. He eats greasy food though.., mac n cheese, pizza, 5 cheese pasta are his favorites.

Lentils.., he can eat and tolerate(when he is not on severe flare!). Raw veggies.., he wouldn't attempt even now. 4.5 years after diagnosis, he still avoids it. I tried forcing him and tried bribing him.., nothing works.

His best bet for Indian food is always steamed white rice, home made yogurt, lentils curry powder (chutney powder, as we call in South India), ghee (clarified butter), dal (lentils). He doesn't let vegetables(Even when cooked) or fruits come near him. Fried foods are also a big "NO" for him. If i force my son to eat something, I know for sure.., he eats forcibly and later throws up everything (within mins of eating!)

I would say.., don't force your kid. Let her decide what she wants to eat. Give her suggestions.

Now that I know fiber is good for IBD.., I'm thinking ways of hiding fiber in his diet

 

[my little penguin]

@momof8yrold
Can your Gi talk to him about fruits and veggies ?

I understand the seeing veggies While on the way out
Ds was like that in the beginning
We were told low fiber 9 years ago (wow time flies)
But that advice has changed

if he won’t eat them will he drink veggie /fruit juice from a juicer ?
Has he talked woth psych - therapy is often advised for these kids
Especially if he is forcing himself to be sick after eating food he doesn’t want to eat

Ds couldn’t tolerate much in the beginning
And didn’t want to try
Begin slow
Muffins with fruit or veggies baked in
(Pumpkin muffins /blueberry muffins )
Shredded bbq chicken (we added carrots ) when cooked in the slow cooker less of an issue
Now Ds can handle more fiber (oatmeal ,beans , pulses etc...)
But must be done slowly
We also made a veggie pizza
Whole grain dough plus stove cooked veggies added to the pizza under cheese

 

[crohnsinct]

Momof8yrold. What you are describing is not uncommon around here. The kids don't realize they are doing it but before they are diagnosed food causes issues (pain, diarrhea etc) so they learn to avoid these foods. Because the road to diagnosis could be long they fall into deep rooted eating habits. Then when they are in remission it is very hard to reverse their eating patterns.

Start slow. Try one thing at a time. It usually takes 15 consecutive exposures to a good before a child will willingly eat something. Don't talk about it. Just put it on the plate. You eat it and be an example. When turning my oldest daughter's eTing around I would delay dinner so she was nice and hungry. Then the vegetable would be ready first (mommy trick). If she was hungry enough she would eAt it.

Smoothies are a great way to hide greens in a yummy drink.

There are lots of books about hiding veggies. I have used them. Some dietitians say it is a double edged sword in that it encourages avoidAnce but when a mama is desperate.....

One easy place for you to start would be swapping out the white rice for brown rice.

Wanted to add that high fiber diets are good for our kids also because low fiber diets are linked to colon cancer. If you have UC it Crohns in the colon your risk of getting cancer down the road are increased. A good way to try to reduce this risk is a healthy high fiber diet.

 

[Maya142]

momof8yrold, my daughter is very similar! Or at least, she was, as a kid. She ate fruits and veggies till she was 3 or 4 and then one day just stopped. We tried every trick in the book, but like your son, she'd throw up. Now looking back I wonder if that's when her IBD started. It is when she was first diagnosed with an autoimmune issue - nail psoriasis. She also always had mild gut issues when she was a kid but we were living in India at the time, and blamed it on food or water.

Like crohnsinct said, we started slow. Realized forcing her was just going to make her hate the food more, so we let her lead the way. One day, out of the blue, she wanted to try broccoli. She liked it! Then it was corn. Then green beans. In the beginning, when she was trying veggies, I made them as tasty as possible - for example, I'd bake broccoli in a white sauce with plenty of cheese and bread crumbs on the top. I did the same with creamed spinach. Over time, we stopped doing things like that and she continued to eat vegetables. I'd say she was 8-9 years old when she started trying veggies by herself.

When she was diagnosed with IBD and was inflamed, veggies caused horrible cramping and diarrhea and we were told no fiber until we had the inflammation under control. Before we were told to avoid vegetables, she had several bad experiences with them, and so she started associating them with pain and diarrhea and cramping.

It took awhile to convince her to start re-trying them but she eventually did. I didn't put pressure on her because during that time she was on supplemental formula which gave her vital nutrients she was missing and knowing how stubborn she is, I knew it would backfire.

Now we do make sure vegetables are well-cooked most of the time - no raw veggies for her except when she has salad. She does not digest everything - we see lettuce in her poop often! We even see baked, home-made french fries in her poop! I'm not sure why since her IBD is under control. But I figure it's better than not eating them at all, even if she isn't digesting everything. We do soups a lot, since she won't drink smoothies. And I do hide veggies in soups - for example, when she was younger and wouldn't eat carrots, I would hide them in tomato soup.

She has just recovered from 6 months of C.Diff. and during that time, she again stopped eating veggies - not altogether, but definitely ate less, due to stomach pain, nausea, diarrhea etc. Now that she is feeling better, we're re-introducing them and she is so THRILLED whenever she gains a food. Never thought she would ever like vegetables based on how picky she was as a kid, but she really does now.

I guess this is a really long way of saying don't give up! Kids surprise you as they grow up.

I do think having his GI talk to him about the importance of fruits and vegetables might help - kids tend to listen to adults who are not mom LOL.

 

[Carolina*]

I am in a group called SCD Families on FB. I was researching the SCD diet, but ended up with a diagnosis change so haven't personally done it. The admin works on NIMBAL adivsory board with Dr. Suskind and founded Gut Harmony. The amount of knowledge on all things diet both SCD and beyond is astounding. It's a tremendous resource.