From: uabdpo.dpo.uab.edu!gila005 (Stephen Holland)
Subject: Re: diet for Crohn's (IBD)
Organization: Gastroenterology - Univ. of Alabama
Distribution: usa
Lines: 81

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.

In article <1993Apr22.210631.13300@aio.jsc.nasa.gov>,
spenser@fudd.jsc.nasa.gov (S. Spenser Aden) wrote:
> 
> 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 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.

> 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 food causes inflammation.  These foods are
avoided because they may get stuck.  I'd go ahead and have the
fudge, though ;-)  .

> Discouraged greatly:
> 	o raw vegetables (too fibrous)
> 	o wheat and raw grain breads
> 	o exotic 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 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 food causes problems, avoid them.  Be sure that the foods are 
tested a second time to be sure the 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
