Diet

CC,

Your post is interesting in that I did not realize fiber turns into sugar. So many people are on high fiber diets with jpouches to bulk up their stools. I think it is unrealistic for Dr. Shen to think you can exist on greek yogurt and chicken breasts, but coming from someone who has chronic pouchitis and eats a lot of salads and veggies you have me thinking. I do have a low sugar diet and avoid whites/flours etc.

I also have noticed an increase in my weight since having the surgery. Do you mind if I ask your age? I happen to be simultaneously going through menopause since my takedown and have attributed my weight gain to this, but sometimes I wonder if it is not due to the surgery also. As I have always been very thin until the last year.

I hope you report back your findings after you see Dr. Shen. BTW are you on probiotics as I have read people who take them tend to weigh more than those who do not and I have been on them since my surgery.

How has Dr. Shen handled your pouchitis in the past?
Did you find if you altered your diet from what you are currently doing that this caused the pouchitis to flare?

Nothing wrong with eating Greek yogurt and chicken breasts, but you might want to vary how you prepare the chicken because it could get boring after a while. I also don't know why seafood would be a problem, substituted for the chicken. I eat a lot of shrimp, lobster and fish. My diet is low in carbs, high in protein, yogurt, and salad/veggies. I also eat a lot of nuts and fruit.

I don't think that fiber turns into sugar. I think you probably misunderstood Dr. Shen. Foods that contain soluble fiber tend to be high starch foods (grains, peas, corn, potatoes, etc.). It is the starch that is broken down into sugars in the gut, not the fiber. The insoluble fiber just adds bulk. Fruits and vegetables that are high in insoluble fiber also add bulk, but some people are sensitive to it. Plus, of course, fruit does have sugar in it, fructose, which has a laxative effect for many. But, not necessarily a cause of pouchitis.

But, if avoiding all fruits, vegetables, sugar and starch has improved your function, can't argue with that!

Jan

Hi cc rocks,
Glad you are doing well. I had my takedown two years ago this october as well. My j pouch as been very good to me.

I'm curious as to why he put you on a restricted diet. I was told I have no diet restrictions. I eat lots of veggies and salads. I try to eat a well balanced diet and eat right. So far so good. I guess after all the years of dealing with UC and not being able to eat, I don't want to deprive myself now. I have cut my sugar intake down though and that helps me a lot.

My diet is very high in fresh fruit, it's probably 50% or more of what I eat daily. I also eat a lot of dairy; cottage cheese and plain yogurt, and huge salad for dinner at night. I have no pouch problems with the way I eat; my frequency is probably higher than it could be but I feel healthy. I would be devastated to be on a high protein diet; but if it made me feel better it would be worth it.

Sue

this is now the 4th or 5th time i have read on this forum that Dr. Shen at CC tells his patient ---- NO FIBER! examples:

http://j-pouch.org/eve/forums/...557089116#5557089116

"Dr. Shen at the Cleveland Clinic said to stay away from fiber"

http://j-pouch.org/eve/forums/...257010326#9257010326

"Dr. Bo Shen in Cleveland Clinic tells his patients that fiber, sugar, dairy and rice are bad for pouch. They ferment and cause gas, ulcers.... He advices all of his patients to eliminate as much of this as possible"


there was another post that i can no longer find that said Dr. Shen says Metamucil is not good for the pouch, and makes you go to the bathroom more.

I am not sure what TYPE of fiber he is referring to, but metamucil is soluable.

I am confused to read some of this, because i actually was NOT eating fiber and was having problems - straining more, as an example. So I added a little and felt some improvement. I even thought RICE is supposed to be good, and is one of the most recommended foods by other j-pouchers?

my surgeon never said i could not eat anything. but then again, Dr. Shen is j-pouch specialist GI, and maybe does a lot more experiments?

maybe if you already have pouchitis or chronic pouchitis, or some other condition, then fiber can be aggravating? but then above person said he "advises ALL of this patients" ??

either ways, i feel diet is HIGHLY individual

Jan, what do you think of Dr. Shen's statements above on this?

It is highly individual, and that is frustrating when you are trying to figure things out. For me, Metamucil made things worse, because it increased gas. Some people are sensitive to psyllium, and it can have a slightly irritating effect. But that that is specific to psyllium, not all soluble fiber.

While we do not digest and absorb soluble fiber, it does ferment in the colon or pouch by bacterial action, resulting in gas and byproducts. Maybe this can result in pouchitis or ulcers. But, obviously, not everyone who eats a diet with fiber winds up with chronic pouchitis.

I also don't think Dr. Shen is implying that fiber and other nutrients are bad for ALL pouches. But, if you are suffering with chronic or recurring pouchitis, there can be a number of factors involved. Remember, Dr. Shen runs the CC pouchitis clinic, so many of his patients are suffering with chronic issues.

The trick is not to apply everyone else's ills to yourself. But, if you do have chronic issues, it is worth trying that approach.

Jan

quote:

It is highly individual, and that is frustrating when you are trying to figure things out. For me

Agreed, I've seen some people say they've ate lettuce here with no problems, but it's always been rough for me to consume it, along with other greens.

quote:

For me, Metamucil made things worse, because it increased gas. Some people are sensitive to psyllium, and it can have a slightly irritating effect.

Besides the taste, I never had any problems with Metamucil, and noticed some improvement. I only wish I could say the same for Metamucil Clear. Every time I've touched it, it's given me such bad gas, that I've regret taking it. I'm sorry that's the case, since its taste is far more agreeable than Metamucil psyllium is.

I spoke to my pouch specialist today and mentioned this thread to him. He trained under Dr. Shen at Cleveland Clinic and is a protege of Dr. Shen.

He told me the thinking about fiber supplements may be changing on J Pouch patients because it leads to too many bowel movements and the excessive bowel movements leads to dehydration.

However he thinks fiber supplements should be taken in my case because of my narrow bowel above the J Pouch. He does not want me getting constipated because I am having a problem with fecal stasis or pooling of the feces above the J Pouch which may be causing some of my inflammation seen in the ileum above the J Pouch.

Seems just like anything else, no set gospel "truth" out there. Conventional wisdom is always changing. I guess that is why i never really got the "never or always" advice regarding j-pouch care. It changes from person to person, and even evolves within the same person.

The main point is to be adaptable. If something isn't working for you, stop it. But don't think it will always be the same. I can't count how many times I have restricted and added back in one thing or another.

Jan

My take down was around 20 months ago. Every time I try a little lettuce and/or fresh veggies I don't digest them at all. I have to cook them until they are mushy.

I eat in my fruits and veggies in my protein shakes and vegetable juice. I miss good salads.

I quit taking metamucil caplets and take 1 Imodium daily. When I have cuffitis flares it's better to have my stool in a form that doesn't hang around in my pouch. Plus my j-pouch has learned how to do it's job. I'd say it's like a teenager and still needs to grow up a bit

It does sound like a boring diet. We have to do what is best for us.

Diet and the j pouch is such an induvidual thing. Just like when we all had colons certain foods would bother us and maybe not the next person. I can't tell you how many things my hubby can't eat and he has a healthy colon. I tease him all the time about it because I'm the one with the disadvantage!

My diet would still be boring if I avoided foods just because they seemed to not be digested by the time I pooped them out! But, the reality is that nobody actually fully digests plant cell walls (unless you are a cow). But, you DO get nutrients from them. I just do not worry about what it looks like in my toilet bowel. Sure, if something makes me feel sick when I eat, I would avoid it. But, it does not bother me to see pieces of lettuce or what-not floating around.

Certainly did not keep me from getting fat!!

Jan

I'm up about 14 pounds from my low point earlier this year. I'd like to put on about 25 more, but I've got plenty of time for that. My diet plan pretty much consists of throwing different foods at my system until it knuckles under and does what I want it to. It's not always fun, but I think it will get me to where I want to be.

quote:

While we do not digest and absorb soluble fiber, it does ferment in the colon or pouch by bacterial action, resulting in gas and byproducts. Maybe this can result in pouchitis or ulcers. But, obviously, not everyone who eats a diet with fiber winds up with chronic pouchitis.

Interesting.... so then is INSOLUBLE fiber better compared to SOLUBLE for us? Does the same thing happen in our bodies if we eat INSOLUBLE FIBER? Does it also ferment in the colon/pouch? thanks!

Yes and no. Strictly speaking, insoluble fiber does not ferment or cause gas, because it is inert. But, many insoluble fiber containing foods, like some vegetables do contain gas producing components (think broccoli or cauliflower). So, you just have to experiment and figure out what your tolerances are.

I have been avoiding a diet high in carbohydrates (which also avoids most foods high in soluble fiber) mostly because of my type 2 diabetes (same with my husband), and it seems to agree with my pouch. So, maybe Dr. Shen has something there. But, I don't exclude them completely. It also helps keep my weight down.

Jan