Elimination diet, how best to tackle it

[ALI_101]

I'm strongly considering starting an elimination diet. I am figuring that many people before me have done this and i am hoping i can get some advice on how best to tackle it.

I realise that i need to begin on a basic list of foods, that when eaten, do not cause me any discomfort or pain whatsoever. Does anyone have any recomendations as to what this list might contain? I realise everyone is different, but i am pretty clueless as to where i might start. I really have no idea at this stage what foods are/are not causing me problems. There is not a day passing now where my abdominal pains are not at least mild, or mild/moderate.

Once i get the first part on lock, i will then start introducing new foods one step at a time. How quickly should i be doing this. Lets say, for example, today i want to introduce yogurts. If i decicde to eat two per day everyday, after how many days with no discomfort/pain arising can i safely assume yogurts are ok for me and move on to introducing the next food item?

Also, roughly how long should an elimination diet last for, a few months, or a year or more?

Any feedback would be appreciated.

PS. i'd be interested in reading others expieriences of doing an elimination diet. Also, perhaps someone knows of a good online blog i could read?

 

[Rebecca85]

Look up the LOFFLEX diet. It stands for LOw Fibre, Fat Limited EXclusion diet. It was designed for Crohn's patients, and the starting foods are designed to be easily dogested by the majority of IBD patients (though I don't know what those foods are offhand!).

 

[slightlysilly]

I bought a juicer the other day and juiced some fruit and vegetables and noticed for the first time in a while, I didn't feel any pain as the stuff went through... there's something to that juicing stuff.

 

[happy]

Hello ALI_101,
Have you considered going on an elemental diet before starting the elimination diet? An elemental diet consists of a liquid formula that is consumed, usually for two to three weeks, to induce remission first, before starting either the LOFFLEX diet (as Rebecca85 suggested above) or a full elimination diet. I think that it is worth it to try the elemental diet first if you are going to go through the effort of the elimination diet. Information about the food diets and the elemental diets can be found at this website:http://www.crohns.org.uk/ and in the following books: Inflammatory Bowel Disease by Professor John Hunter and Beat Crohn's: Getting to Remission with Enteral Nutrition by Margaret Oppeneheimer.

I have just spent 10 weeks on a liquid elemental diet (3 weeks of Ensure followed by 3 weeks of Vivonex). I had done the LOFFLEX diet by itself for 6 weeks prior to the liquid diet. It did take care of the diarrhea, but not any of my other symptoms, and I continued to have rapid weight loss. Once I started the Vivonex (the Ensure caused increased nausea and bloating) my weight loss slowed and most of my symptoms stopped. I started eating again this week by following a full elimination diet. I started eating with small amounts of rice for two days, then chicken for two days then pears today following the plan in the book by John Hunter. So far things are going well.

Soupdragon69 on this forum also has experience with an elemental diet and the LOFFLEX diet. Supercellbaebe also has lots of experinece with an elemental diet.

May you have success in whatever program you decide to follow.

 

[ALI_101]

Thanks everybody, i knew starting this thread could prove to be very productive and i've not been dissapointed!

One major enlightenment that has come to me through this thread, it is this passage from the Crohn's.org website:

"Diet allows long remissions of Crohn's disease. Once the process of foods testing is complete it is unusual for patients to relapse. After a year of successful dietery treatment most patients remain completely well and find after 5-10 years their diet has returned to normal, the Crohn's disease having apparently burnt itself out."

I also read some parts of John Hunter's books on Amazon and he seems to concur, that with the right diet and after a long remission of several years, Crohn's can dissapear in the night never to be seen again!

I had no idea that was possible. I had only ever heard there was no cure which i pressumed to mean, once diagnosed, Crohn's is for life. But reading this gives me hope that there is a chance for me to rid my body of Crohn's if i can put in the work on the dietery side. I am very excited by this 'new' finding.

If anyone can go into more details on this i would very much appreciate it.

 

[happy]

What specific questions do you have?

 

[ALI_101]

I dont know anyone with Crohn's (that i can talk to) and have very little experience of the disease other than the few bits and peices i have read on the internet over the last few weeks.

Whats described above seems almost to simplistic and easy, i am sure there must be catches left right and center. Can i really beat Crohn's by just sticking to a very strict diet for a few years, or does it work that way just for a lucky few? It seems to simple to me!

If i can find a diet (that keeps me healthy) and puts me into remission, i'd be more than happy to stick to it religously for 2 or 3 years if i know at the end of it i will wave goodbye to Crohn's forever.

Just how plausible is that for your average Crohns sufferer?

 

[soupdragon69]

Hi Ali,

I did post on another thread of yours a couple of days ago about the LOFFLEX diet. You will find my contribution in the "elemental" thread as Happy and I have been chatting about it.

Dr Hunters team and research does show that up to approx 80% crohns patients can go into remission with an elemental diet. It's maintaining that remission is the tricky part. Many crohns patients find they can only tolerate certain foods when not flaring for instance. Others find they must stay away from certain foods for life or try them every so often to see how they react.

Unlike Coeliac disease for instance where staying away from gluten for life heals the gut Crohns is a different beast. I have found the main thing to focus on is not how to permanently heal/cure the crohns but to focus on maximising the absorption from my diet. The elemental diet and LOFFLEX both contribute to that in a big way and my own asthma/allergy consultant is adamant that I should be on elemental for life as it is the best he has ever seen me healthwise! Tough thing though to just be on elemental drinks for life - even if I did have them for 6.5mths initially!

Keep posting. We will help where we can. Thinking of you.

 

[happy]

Most of the research for the elemental diet (liquid formula) followed by an elimination diet (food) was done from the 1970s to the 1990s. In one study the researchers compared people who were treated with corticosteroids only (on a tapered course of 12 weeks) with people who started with an elemental diet to induce remission followed by an elimination diet to maintain remission. When the two groups were compared after two years more people had maintained remission in the diet group than those in the corticosteroid group. The LOFFLEX diet was developed to make it easier to return to eating after the elemental diet and in studies comparing the LOFFLEX versus the full elimination diet the results were very similar.

One theory of Crohn’s disease is that, for unknown reasons, the body begins to attack the normal flora of the intestine, which causes an inflammatory reaction. Researchers have found that a liquid elemental diet reduces the intestinal flora by at least 50%, reducing he ‘food’ that the attacking immune system can feed on. This seems to be part of the mechanism that induces the remission from the elemental diet. Keeping the flora reduced that the immune system seems to want to feed on during the reintroduction to food phase is what the elimination diet is supposed to do. Keeping on the tolerable food diet is what keeps a person in remission.

So why doesn’t everyone go on an elemental diet followed by the LOFFLEX or elimination diet? There are several reasons. First, the studies that were done had very few people in them as they are time intensive studies for the patients and the researchers, meaning it is very expensive to do this type of research. So, as a result this treatment is not as well known as much as medication treatments. Second, it is much easier to give pill ‘a’ versus pill ‘b’, have a placebo control group, and blind the researchers from which treatment is being offered (the gold standard in research) in a medication only study than it is to do this in a study of diet. So, the research on diet is not as well accepted as research done on medications. Third, many people dropped out of the diet studies because it is a very long process, the diet is not easy to follow and the foods allowed are more expensive and less convenient than an unlimited diet.

So, in answer to your question, ALI_101, some people find that they are successful using an elemental diet followed by an elimination diet (or the LOFLLEX diet) to induce and maintain remission. However, I believe that people have to think of this as a lifestyle choice because it does require a lot of persistence to figure out what diet works best for them, and then to stick with it for the long haul. And remember in all the successful studies an elemental diet was used first, before the elimination diet. I should also mention that because of the mechanism of how the diet process works, the researchers have found that the process does not work for Ulcerative Colitis (when they are certain that it is Ulcerative Colitis).

May you become well however you choose to treat your disease.

 

[ALI_101]

Thanks folks for your very helpful and informative replies, i appreciate your time very much.

Confusion is running through my brain on what i need to be doing, which direction to take etc. I am due to see my gastroenterologist on the 15th March and hope to be able to discuss several points. Trouble is, GI's, as with all doctors, cannot give you to much of their time and i'm sure i'll be left wanting, as i was after my first meeting, and that lasted almost an hour!

I am making inroads to joining a local IBD group in my city and hope soon to be able to meet with Crohn's patients. Being able to talk with people in person who know a lot about the disease will help me enourmously i think.

I am also going to order a book or two, i've posted about this in the books section of the forum. Gaining knowledge should help cure my current confused state.

Thanks again, take care and wishing you all good health!

Regards
Ali