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John Eyl
#1 / 10
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 diet for Crohn's (IBD) A friend has what is apparently a fairly minor case of Crohn's
disease.
But she can't seem to eat certain foods, such as fresh vegetables,
without discomfort, and of course she wants to avoid a recurrence.
Her question is: are there any nutritionists who specialize in the
problems of people with Crohn's disease ?
(I saw the suggestion of lipoxygnase inhibitors like tea and turmeric).
Thanks in advance,
John Eyles
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| Tue, 10 Oct 1995 00:14:07 GMT |
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Stephen Holla
#2 / 10
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diet for Crohn's (IBD)
Quote: > A friend has what is apparently a fairly minor case of Crohn's
> disease.
> But she can't seem to eat certain foods, such as fresh vegetables,
> without discomfort, and of course she wants to avoid a recurrence.
> Her question is: are there any nutritionists who specialize in the
> problems of people with Crohn's disease ?
> (I saw the suggestion of lipoxygnase inhibitors like tea and turmeric).
> Thanks in advance,
> John Eyles
If she is having problems with fresh vegetables, the guess is that there is some obstruction of the intestine. Without knowing more it is not possible to say whether the obstruction is permanent due to scarring, or temporary due to swelling of inflammed intestine. In general, there are no dietary limitations in patients with Crohn's except as they relate to obstruction. There is no evidence that any foods will bring on recurrence of Crohn's. It is important to distinguish recurrence from recurrent symptoms. A physician would think of new inflammation as recurrence, while pains from raw veggies just imply a narrowing of the intestine. Your friend should look into membership in the Crohn's and Colitis
Foundation of America. 1-800-932-2423
Good luck to your friend.
Steve Holland
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| Tue, 10 Oct 1995 03:57:48 GMT |
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S. Spenser Ad
#3 / 10
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diet for Crohn's (IBD) Quote:
>> A friend has what is apparently a fairly minor case of Crohn's
>> disease.
>> But she can't seem to eat certain foods, such as fresh vegetables,
>> without discomfort, and of course she wants to avoid a recurrence.
>> Her question is: are there any nutritionists who specialize in the
>> problems of people with Crohn's disease ?
>If she is having problems with fresh vegetables, the guess is that there
>is some obstruction of the intestine. Without knowing more it is not
>possible to say whether the obstruction is permanent due to scarring,
>or temporary due to swelling of inflammed intestine. In general, there are
>no dietary limitations in patients with Crohn's except as they relate
>to obstruction. There is no evidence that any foods will bring on
>recurrence of Crohn's.
Interesting statements, simply because I have been told otherwise. I'm certainly not questioning Steve's claims, as for one I am not a doctor, and I agree that foods don't bring on the recurrence of Crohn's. But inflammation can be either mildly or DRASTICALLY enhanced due to food. Having had one major obstruction resulting in resection (is that a good enough
caveat :-), I was told that a *LOW RESIDUE* diet is called for. Basically,
the idea is that if there is inflammation of the gut (which may not be
realized by the patient), any residue in the system can be caught in the folds
of inflammation and constantly irritate, thus exacerbating the problem.
Therefore, anything that doesn't digest completely by the point of common
inflammation should be avoided. With what I've been told is typical Crohn's,
of the terminal ileum, my diet should be low residue, consisting of:
Completely out - never again - items:
o corn (kernel husk doesn't digest ... most of us know this :-)
o popcorn (same)
o dried (dehydrated) fruit and fruit skins
o nuts (Very tough when it comes to giving up some fudge :-)
Discouraged greatly:
o raw vegetables (too fibrous)
o wheat and raw grain breads
o {*filter*} lettuce (iceberg is ok since it's apparently mostly water)
o greens (turnip, mustard, kale, etc...)
o little seeds, like sesame (try getting an Arby's without it!)
o long grain and wild rice (husky)
o beans (you'll generate enough gas alone without them!)
o BASICALLY anything that requires heavy digestive processing
I was told that the more processed the cooking.net">food the better! (rather ironic in this
day and age). The whole point is PREVENTATIVE ... you want to give your
system as little chance to inflame as possible. I was told that among the
NUMEROUS things that were heavily discouraged (I only listed a few), to try
the ones I wanted and see how I felt. If it's bad, don't do it again!
Remember though that this was while I was in remission. For Veggies: cook the
daylights out of them. I prefer steaming ... I think it's cooks more
thoroughly - you're mileage may vary.
As with anything else, CHECK WITH YOUR DOCTOR. Don't just take my word. But
this is the info I've been given, and it may be a starting point for
discussion. Good luck!
-Spenser
--
S. Spenser Aden --- Lockheed Engineering and Sciences Co. --- (713) 483-2028
NASA --- Flight Data and Evaluation Office --- Johnson Space Center, Houston
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| Tue, 10 Oct 1995 05:06:31 GMT |
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banschb..
#4 / 10
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diet for Crohn's (IBD) Quote:
> A friend has what is apparently a fairly minor case of Crohn's
> disease.
> But she can't seem to eat certain foods, such as fresh vegetables,
> without discomfort, and of course she wants to avoid a recurrence.
> Her question is: are there any nutritionists who specialize in the
> problems of people with Crohn's disease ?
> (I saw the suggestion of lipoxygnase inhibitors like tea and turmeric).
> Thanks in advance,
> John Eyles
All your friend really has to do is find a Registered Dietician(RD). While most work in hospitals and clinics, many major cities will have RD's who are in "private practice" so to speak. Many physicans will refer their patients with Crohn's disease to RD's for dietary help. If you can get your friend's physician to make a referral, medical insurance should pay for the RD's services just like the services of a physical therapist. The better medical insurance plans will cover this but even if your friend's plan doesn't, it would be well worth the cost to get on a good diet to control the intestinal discomfort and help the intestinal lining heal. Crohn's disease is an inflammatory disease of the intestinal lining and lipoxygenase inhibitors may help by decreasing leukotriene formation but I'm not aware of tea or turmeric containing lipoxygenase inhibitors. For bad inflammation, steroids are used but for a mild case, the side effects are not worth the small benefit gained by steroid use. Upjohn is developing a new lipoxygenase inhibitor that should greatly help deal with inflammatory diseases but it's not available yet. Marty B.
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| Tue, 10 Oct 1995 10:20:51 GMT |
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bac..
#5 / 10
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diet for Crohn's (IBD) Quote:
>> A friend has what is apparently a fairly minor case of Crohn's
>> disease.
>> But she can't seem to eat certain foods, such as fresh vegetables,
>> without discomfort, and of course she wants to avoid a recurrence.
>> Her question is: are there any nutritionists who specialize in the
>> problems of people with Crohn's disease ?
>> (I saw the suggestion of lipoxygnase inhibitors like tea and turmeric).
>> Thanks in advance,
>> John Eyles
> All your friend really has to do is find a Registered Dietician(RD). While
> most work in hospitals and clinics, many major cities will have RD's who
> are in "private practice" so to speak. Many physicans will refer their
> patients with Crohn's disease to RD's for dietary help. If you can get
> your friend's physician to make a referral, medical insurance should pay for
> the RD's services just like the services of a physical therapist. The
> better medical insurance plans will cover this but even if your friend's
> plan doesn't, it would be well worth the cost to get on a good diet to
> control the intestinal discomfort and help the intestinal lining heal.
> Crohn's disease is an inflammatory disease of the intestinal lining and
> lipoxygenase inhibitors may help by decreasing leukotriene formation but
> I'm not aware of tea or turmeric containing lipoxygenase inhibitors. For
If you do a MEDLINE search on "turmeric" you'll see that it is a potent lipoxygenase inhibitor which is being investigated in a number of areas. I'm in cardiology and about 4 years ago the cardiothoracic surgery lab at my hospital compared the effect of a teaspoon of dissolved turmeric vs. a $2000 bolus of tPA in preventing myocardial reperfusion injury in a perfused Langendorff sheep heart. The turmeric was more effective :-) A colleague of mine in the School of Pharmacy (Dr. Ron Kohen) has a paper "in
press" on the free radical scavenging activity and antioxidant activity of tea.
Josh
Quote: > bad inflammation, steroids are used but for a mild case, the side effects > are not worth the small benefit gained by steroid use. Upjohn is developing > a new lipoxygenase inhibitor that should greatly help deal with > inflammatory diseases but it's not available yet. > Marty B.
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| Wed, 11 Oct 1995 00:48:05 GMT |
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Stephen Holla
#6 / 10
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diet for Crohn's (IBD) Summary of thread: A person has Crohns, raw vegetables cause problems (unspecified) Steve Holland replies: patient may have mild obstruction. Avoid things that would plug her up. Crohn's has no dietary restriction in general.
Quote: > Interesting statements, simply because I have been told otherwise. I'm
> certainly not questioning Steve's claims, as for one I am not a doctor, and I
> agree that foods don't bring on the recurrence of Crohn's. But inflammation
> can be either mildly or DRASTICALLY enhanced due to food.
The feeling obout this has changed in the GI community. The current feeling is that inflammation is not induced by food. There is even evidence that patients deprived of cooking.net">food have mucosal atrophy due to lack of stimulation of intestinal growth factors. There is now interest in providing small amounts of nasogastric feeding to patients on IV nutrition. But I digress. Symptoms can be drastically enhanced by food, but not inflammation. Quote: > Having had one major obstruction resulting in resection (is that a good enough > caveat :-), I was told that a *LOW RESIDUE* diet is called for. Basically, > the idea is that if there is inflammation of the gut (which may not be > realized by the patient), any residue in the system can be caught in the folds > of inflammation and constantly irritate, thus exacerbating the problem. > Therefore, anything that doesn't digest completely by the point of common > inflammation should be avoided. With what I've been told is typical Crohn's, > of the terminal ileum, my diet should be low residue, consisting of: > Completely out - never again - items:
> o corn (kernel husk doesn't digest ... most of us know this :-)
> o popcorn (same)
> o dried (dehydrated) fruit and fruit skins
> o nuts (Very tough when it comes to giving up some fudge :-)
The low residue diet is appropriate for you if you still have obstructions. Again, it is not felt that cooking.net">food causes inflammation. These foods are avoided because they may get stuck. I'd go ahead and have the fudge, though ;-) . Quote: > Discouraged greatly: > o raw vegetables (too fibrous) > o wheat and raw grain breads > o {*filter*} lettuce (iceberg is ok since it's apparently mostly water) > o greens (turnip, mustard, kale, etc...) > o little seeds, like sesame (try getting an Arby's without it!) > o long grain and wild rice (husky) > o beans (you'll generate enough gas alone without them!) > o BASICALLY anything that requires heavy digestive processing > I was told that the more processed the cooking.net">food the better! (rather ironic in this
> day and age). The whole point is PREVENTATIVE ... you want to give your
> system as little chance to inflame as possible. I was told that among the
> NUMEROUS things that were heavily discouraged (I only listed a few), to try
> the ones I wanted and see how I felt. If it's bad, don't do it again!
> Remember though that this was while I was in remission. For Veggies: cook the
> daylights out of them. I prefer steaming ... I think it's cooks more
> thoroughly - you're mileage may vary.
> As with anything else, CHECK WITH YOUR DOCTOR. Don't just take my word. But
> this is the info I've been given, and it may be a starting point for
> discussion. Good luck!
Spencer makes an especially good point in having an observant and informed patient. Would that many patients be able to tell what causes them problems. The digestive processing idea is changing, but if a cooking.net">food causes problems, avoid them. Be sure that the foods are tested a second time to be sure the cooking.net">food is a real cause. Crohn's commonly causes intermittent symptoms and some patients end up with severly restricted diets that take months to renormalize. There was a good article in the CCFA newsletter recently that discussed
the issue of dietary restriction of fiber. It would be worth reading
to anyone with an interest in Crohn's.
And, as I always say when dealing with Crohn's, as does Spencer, Good Luck!
Steve Holland
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| Tue, 10 Oct 1995 23:23:20 GMT |
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Stephen Holla
#7 / 10
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diet for Crohn's (IBD)
Quote:
> > A friend has what is apparently a fairly minor case of Crohn's
> > disease.
> > But she can't seem to eat certain foods, such as fresh vegetables,
> > without discomfort, and of course she wants to avoid a recurrence.
> > Her question is: are there any nutritionists who specialize in the
> > problems of people with Crohn's disease ?
> > (I saw the suggestion of lipoxygnase inhibitors like tea and turmeric).
> > Thanks in advance,
> > John Eyles
> All your friend really has to do is find a Registered Dietician(RD). While
> most work in hospitals and clinics, many major cities will have RD's who
> are in "private practice" so to speak. Many physicans will refer their
> patients with Crohn's disease to RD's for dietary help. If you can get
> your friend's physician to make a referral, medical insurance should pay for
> the RD's services just like the services of a physical therapist. The
> better medical insurance plans will cover this but even if your friend's
> plan doesn't, it would be well worth the cost to get on a good diet to
> control the intestinal discomfort and help the intestinal lining heal.
> Crohn's disease is an inflammatory disease of the intestinal lining and
> lipoxygenase inhibitors may help by decreasing leukotriene formation but
> I'm not aware of tea or turmeric containing lipoxygenase inhibitors. For
> bad inflammation, steroids are used but for a mild case, the side effects
> are not worth the small benefit gained by steroid use. Upjohn is developing
> a new lipoxygenase inhibitor that should greatly help deal with
> inflammatory diseases but it's not available yet.
> Marty B.
Be sure a dietician is up to date on Crohn's and Ulcerative Colitis. Previously, low residue diets were recommended, but this advice has now changed. Also, there will be differences in advice in patients with and without obstructuon remaining, so input by the physician will be important. I find the dietician very important in my practice, and I send most of my patients to a dietician in the course of seeing them, since dieticians know so much better how to get diet histories and evaluate the contents of a diet than I do. Steve Holland
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| Tue, 10 Oct 1995 23:27:28 GMT |
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brian manning delan
#8 / 10
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diet for Crohn's (IBD) One thing that I haven't seen in this thread is a discussion of the relation between IBD inflammation and the profile of ingested fatty acids (FAs). I was diagnosed last May w/Crohn's of the terminal ileum. When I got
out of the hospital I read up on it a bit, and came across several
studies investigating the role of EPA (an essentially FA) in reducing
inflammation. The evidence was mixed. [Many of these studies are
discussed in "Inflammatory Bowel Disease," MacDermott, Stenson. 1992.]
But if I recall correctly, there were some methodological bones to be
picked with the studies (both the ones w/pos. and w/neg. results). In
the studies patients were given EPA (a few grams/day for most of the
studies), but, if I recall correctly, there was no restriction of the
_other_ FAs that the patients could consume. From the informed
layperson's perspective, this seems mistaken. If lots of n-6 FAs are
consumed along with the EPA, then the ratio of "bad" prostanoid
products to "good" prostanoid products could still be fairly "bad."
Isn't this ratio the issue?
What's the view of the gastro. community on EPA these days? EPA
supplements, along with a fairly severe restriction of other FAs
appear to have helped me significantly (though it could just be the
low absolute amount of fat I eat -- 8-10% calories).
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| Wed, 11 Oct 1995 05:11:08 GMT |
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Stephen Holla
#9 / 10
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diet for Crohn's (IBD)
Quote: > One thing that I haven't seen in this thread is a discussion of the
> relation between IBD inflammation and the profile of ingested fatty
> acids (FAs).
> I was diagnosed last May w/Crohn's of the terminal ileum. When I got
> out of the hospital I read up on it a bit, and came across several
> studies investigating the role of EPA (an essentially FA) in reducing
> inflammation. The evidence was mixed. [Many of these studies are
> discussed in "Inflammatory Bowel Disease," MacDermott, Stenson. 1992.]
> But if I recall correctly, there were some methodological bones to be
> picked with the studies (both the ones w/pos. and w/neg. results). In
> the studies patients were given EPA (a few grams/day for most of the
> studies), but, if I recall correctly, there was no restriction of the
> _other_ FAs that the patients could consume. From the informed
> layperson's perspective, this seems mistaken. If lots of n-6 FAs are
> consumed along with the EPA, then the ratio of "bad" prostanoid
> products to "good" prostanoid products could still be fairly "bad."
> Isn't this ratio the issue?
> What's the view of the gastro. community on EPA these days? EPA
> supplements, along with a fairly severe restriction of other FAs
> appear to have helped me significantly (though it could just be the
> low absolute amount of fat I eat -- 8-10% calories).
As you note, the research is mixed, so there is no consensus on the role of fatty acids in Ulcerative colitis. There is a role for short chain fatty acids in patients with colostomies and rectal pouches that are inflammed (Short is butyrate and shorter). There may be a role for treatment of UC with Short chain fatty acids, and I am looking forward to the upcoming AGA meeting in Boston to see what people are doing. You raise a hypothesis about the studies and restriction of other
fatty acids. You should contact the authors directly about that or
even write a letter to the editor - it is a good point. By the way,
the abbreviation EPA is not in general use, so I do not know what
fatty acid you are speaking about.
And to Brian an U of C --- There is a physician named Stephen Hanauer
there who is a recognized expert in the treatment of IBD. You might
give him a call. He is interested in new combinations of {*filter*} for
the treatment of IBD. If you call please say hello to him from me,
I was looking at U of C for a position, and perhaps still am. And
be sure to look into joining the CCFA.
Best of Luck.
Steve Holland
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| Wed, 11 Oct 1995 06:44:12 GMT |
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brian manning delan
#10 / 10
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diet for Crohn's (IBD) Quote:
>> One thing that I haven't seen in this thread is a discussion of the
>> relation between IBD inflammation and the profile of ingested fatty
>> acids (FAs).
>> [....]
> [....]
>even write a letter to the editor - it is a good point. By the way,
>the abbreviation EPA is not in general use, so I do not know what
>fatty acid you are speaking about.
Sorry -- I mean eicosapentaenoic acid. Quote: >And to Brian an U of C --- There is a physician named Stephen Hanauer
>there who is a recognized expert in the treatment of IBD. You might
>give him a call.
Coincidentaly, just yesterday I was (finally) referred from the clinic to Hanauer. I'm seeing him on May 24. I'll report what he says about this question. Quote: >the treatment of IBD. If you call please say hello to him from me,
>I was looking at U of C for a position, and perhaps still am.
Will do. -Brian Delaney
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| Wed, 11 Oct 1995 09:22:59 GMT |
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