Reintroduction Diet Plans

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CarolinAlaska

Holding It Together
Joined
Jan 24, 2013
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I'm looking for information regarding what people have been told as far as how to start food again after EEN. My daugher's GI doc and our dietician aren't used to doing this with Crohn's kids. The more information I can get the better. I seem to be getting conflicting information from the two of them, and I would like my daughter to get the best starting chance she can get.
 
We did similar to an infant
so soft puree like foods easy to digest for a few days - week( applesauce etc...)
then onto dairy /grains
Lastly meats
be warned- meat is hard to chew and swallow
 
Hi CarolinAlaska,
Good luck--May her return to eating go smoothly.
Here are some resources:
http://www.crohnsforum.com/showthread.php?t=27154 Look doen the page for the heading "Nutrition in inflammatory bowel diseases" and click on the link. Then scroll down to page 25 in Section 8.

http://www.crohns.org.uk/Docs/3/crohns_disease/nutritional_therapy Has info about restarting on a LOFFLEX diet (LOw Fat, LOw Fibre, partiaL elimination-EX diet) and a full elimination diet.

I have copied an pasted some info from a thread from 2011 that soupdragon69 posted on. It is about the LOFFLEX diet and it really helped me when I was starting to eat again.

"Below is what is printed in the front of my book:

This diet excludes all those foods which are most likely to cause food intolerance.
The diet must be followed until further notice (approximately 2-4 weeks).
Do not rush your meals, take time to chew food well and eat regularly - 3 or 4 meals per day. Ensure you drink plenty of fluid (8-10 cups daily).
If you need to take medication for headache or other pain use SOLUBLE paracetamol.
Keep a diary during this period recording food eaten and symptoms suffered. Enteral feeds such as 028 remain useful supplements if weight gain is desired or if the full range of recommended foods is not being eaten.

Will give you a summary of the foods etc: All meat, poultry, game, beef and lamb can be eaten. Avoid Pork and pork products and anything processed.

Fish - can have white fish, tuna, in water or brine, oily, smoked and other tinned fish in water or brine. Prawns. Avoid anything tinned in oil or tomato, pastes, taramasalata, scampi or battered or breaded.

Veg - small portions of the following WITHOUT skins, seeds or stalks (maximum of 2 portions a day): courgette, marrow, lettuce, cucumber, celeriac, potato (not cold), carrot, swede, parsnip, cauliflower, broccoli, mushrooms, peppers, asparagus, beetroot, runner beans. Avoid pulses - peas, beans, lentils. Avoid onions, sweetcorn, tomatoes, anything tinned in sauce, tomato ketchup and puree.

Fruit - small portions of the following WITHOUT skins or seeds (maximum 2 pieces of fruit per day). Apricot (canned or stewed), grapes, melon, peach (fresh or canned), nectarine, pear (fresh or canned), plums (stewed), mango (fresh or canned) lychees (canned). Avoid citrus fruit e.g. oranges, satsuma, grapefruit, lemons. Avoid apples, banana, dried fruit, mincemeat.

Cereals - White rice, rice pasta (not cold), rice cakes, ground rice, rice flour, rice krispies, puffed rice cereal, arrowroot, tapioca, sago. Avoid Wheat e.g. bread, cakes, biscuits, pasta, noodles, semolina. Avoid breakfast cereals e.g. weetabix, shredded wheat. Avoid Rye e.g. ryvita. Avoid Oats, Barley, Corn e.g. cornflakes, cornflour, custard powder.

Cooking oils - Sunflower, soya, olive, rapeseed (1/2 teasp per person in cooking). Avoid Corn and vegetable oil.

Dairy products - Soya milk (calcium enriched), Soya yoghurt, Tofu, Milk free margarine 1oz per day. Avoid Cows milk all types, dried milk, tinned milk, sheep and goat milk, butter, cream, margarine, yoghurt, cheese and eggs.

Beverages - Herbal teas e.g. rooibosh, rosehip, camomile or fruit teas. Ribena, fresh fruit juices e.g pineapple, grape juice. Tap or mineral water. Avoid Tea, coffee, decaf of both, fruit squashes, orange, grapefruit, lemon, apple or tomato juice. Alcohol. Coca cola, lemonade.

Miscellaneous - Jams (no seeds), sugar, honey, syrup, salt, herbs, black pepper, spices in moderation, vinegar, tamari, brown rice miso, gravy browning with caramel and salt only, sorbet (not citrus). Avoid Chocolate, nuts, seeds, gravy mixes, yeast and extract, soy sauce, salad cream and dressings, mustard, marmalade.

REINTRODUCTION OF FOODS

If you have no symptoms from your Crohn's after following the exlusion diet for AT LEAST 2 weeks you may start to re-introduce foods slowly back into the diet.

Each food should be TESTED FOR 4 DAYS UNLESS OTHERWISE STATED. Foods should be taken in a large quantity twice a day. If your symptoms do not return you can assume that the food you ate was safe and go on to add another food. If they did return, the new food was probably responsible and should be left out of the diet from now on.

If a reaction occurs it will usually last for 2-3 days, but may go on longer. During this time it is impossible to assess other foods accurately, therefore stick to foods already known to be safe. If the symptoms are very severe, 2-3 days on 028 or similar that you have been having will usually settle them. DO NOT INTRODUCE NEW FOODS UNTIL YOU ARE WELL AGAIN.

Once you have finished reintroducing foods into your diet and identified the foods causing symptoms, it is essential that you have your diet checked for its nutritional adequacy."
 
I'm here :)

I've given Carole Stephen's reintro diet on her other thread but, it's always good to see how others have done it as well. :)

The only other info I can add to the reintro diet I gave was given to us by the Hospital for Sick Children in Toronto. They seem to use EEN quite often and EEN was really presented to us as THE treatment. Steroids were only vaguely mentioned and, even then, as an alternative with 'negatives'. They obviously do use steroids when necessary but, I suppose look at each case and decide if EEN is a viable option. So, I do believe they have quite a bit of experience with it (and, I would imagine their reintro diet as well) and the head of the GI department has been involved in a number of studies/publications, etc. re EEN. But, having said that, nothing's foolproof with crohns and our reintro diet may not work for everyone???

:)
 
We were given a reintroduction diet plan that was identical to the one Tess has posted on your other thread. My son was allowed clear fluids while on EEN so he had been having beef and chicken broth all along and when he was allowed to start introducing foods we added noodles to the broth. Did that for about 5 days and then added some lean chicken. Did that for about 5 days and then added cooked carrots. Did that for about 5 days and then let him have yogurt too. Sounds a bit bland but it all tasted WONDERFUL to him at the time.

Good luck with the reintroductions!
 
Im following along intently and hoping everything goes so well! Keep us posted........

J.
 
Right now we're switching around formulas to see what she can drink and tolerate. So far she is doing 2-3 Ensures a day in amongst her Peptides or Peptamen Juniors (orally doing 4 cans a day again). So far, so good. If she can drink six a day, I think she'll be good to forego the MICkey and start her reintro diet. Of course, I haven't bounced my change in plans off any of the docs yet, but I don't see the harm in waiting to see how she does... I'll have to make a decision of whether to put off the surgery by Thursday, I suppose.
 
If she does have problems on the Ensure keep in mind that they contain dairy and dairy is usually far down the list on food re-introduction. They may be lactose-free, but not dairy-free.
 
Yeah that ^^^^

I would talk to the Gi before adding ensure since she had symptoms on it before
It really isn't an EN as part or PEN - good for weight but....
If she didn't have trouble before with it -- then ...
But since she needed a more broken down formula well...
 
Thanks, yeah, the GI knows about the Ensure. Not my favorite solution to this problem, but so far she is tolerating it now. The ped wants us to continue 1/2 Ensure- 1/2 predigested formula (Peptide or Peptamen) because she is doing well with this and she can drink it. As of yesterday we are up to 6 cans drinking/day, 2 overnight with pump/NG. Tomorrow we'll go to all given orally during the day. If she tolerates this, we'll pull the NG (it has been in 5.5 weeks already - they are good for 4 weeks...). Wish us luck! Any tips on pulling an NG tube?
 
Sounds like things are going really well! Excellent to hear. Pulling the tube shouldn't be a problem, they just slide on out and it doesn't hurt at all. At least that is what my son tells me. Good luck!
 
Yes just pull it down and out.
:cool2: I've had to removed Grace's a few times.
A lot less traumatic coming out than going in.:smile:


:ghug:
 

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