Dr. Shen's diet advice to me...

Oops!! I guess I popped my staple about a thousand times over in the 18 years since my srgery. No, I was never told not to lift more than 25 pounds for the rest of my life. Maybe I don't have that staple....

And the diet, a lot of members here have found the best function with a lowcarb/high protein diet. Coincides with the Paleo diet, Atkins, South Beach, etc.

For me, I found this as a happy coincidence. I am diabetic.

Jan

Good lord, I'm a nurse in an ICU and have lifted a LOT of weight in my nearly 20 years there. Never was given that advice by my surgeon, who I still see, and never had issues.

I have also never heard that lifting proscription, and I've done plenty of lifting over the years. Maybe the doctor can provide a reference in the medical literature?

I met with Dr Shen just last week and was told the exact same thing on the diet, low sugar is a extreme challange for me. Concerning the 25 lbs, It was not him that mentioned this but his new assistant and at the time I thought that it sounded odd. My thought was she is new and that her advise was over kill !

I had my j-pouch for 15+ years and was never told that about lifting. I wonder if the nurse was confusing you with someone who recently had the surgery and was still healing?

I find that I feel much better on a Paleo diet and, though I never believed it would happen, I eventually stopped craving the sugars, pasta, etc. Having said that, though, I also need to mention that I firmly believe that there is not one "right" diet. Each person needs to experiment. If you pay attention to how you feel after eating and look for patterns, you will eventually start noticing what foods fuel you well. It has been a very long process for me and I'm not totally there, but I've been in the ballpark ever since committing to Paleo.

Good luck!

Yeah, some more detail about this "global lifting restriction" would be nice. I imagine that my hand sewn pouch done in 1995 is not exactly the same as the pouches they construct today in Cleveland Clinic!

The diet thing seems to have gone full circle, since they used to recommend a very carb heavy diet (although ALWAYS recommended to go easy on sugar, since that has ALWAYS been associated with promoting diarrhea and fluid loss).

I think the conventional wisdom at the time was that carbs were easy to digest, so easy on the gut. Yeah, well, that is true until you have carb overload and the bacteria have full blown carb party, making gas and diarrhea, not to mention colonizing your gut with bad boys. Live and learn... Now they are finding that just like with folks sporting a colon, we really don't need all those carbs, even if we WANT them.

Sure, rice and applesauce are great when you have acute gastroenteritis or are a fresh post op. But, not as a daily forever diet.

Jan

I'm kinda doing the diet recommendation, in that I have had success with a low sugar, low insoluble fiber diet. But I still take a good bit of soluble fiber (can't imagine life without it) and middling protein consumption (still enjoy the carbs). The biggest factor for my getting off cipro (for pouchitis) has been sugar/processed food reduction.

Good luck!

Hm. Maybe that's why I have my worst issues around Christmas?

We eat very little processed/sugary foods in my house, as a whole. I've never been one to buy crappy food, or frequent fast food, or be a big carb eater. I like savory foods, and proteins and veggies best. I generally order salads, not to stay slim, just 'cause I like them.

I usually have my worst times around the holidays, when I bake a ton. Of course, I also EAT a ton of cookies, etc then, which is way off my norm. I've rarely had documented pouchitis, but again, most of my issues cluster around Christmas. I'm going to scale back things this year, and see if it helps.

agreed that the diet you mention really does seem to help keep the pouch happy, but also, i have no lifing restrictions. i have two kids...40# and 25# lbs that i carry up and down the stairs and in and out of the car and throw up in the air all day long. never have had a problem.

Haven't heard of the low sugar thing.

SInce I eat only 1 meal a day, I tend to try for high carbs and high protein, with a sugary desert.

Sometimes I will eat popsicles in the evening to help with hunger pains.

I'm not a fan of fake sugars, but if switching to sugar substitute helps, I'll do it. It's worth a try, anyway!

When they did my k pouch back in 79 I was put on high protein, low fiber, low carbs and it worked great...other than when I go all bulimic I am a happy camper that way, my pouch loves me and life is fine...had a bagel last night (first carbs in 2 weeks) and am waiting for the fall out...notably the carb cravings coming back...funny how 1 little bagel gets it all going again...will have to go back to my usual chicken/fish/salad diet...I have yet to get rid of the sugar cravings but once off of the carbs for more than 3 days I no longer crave them...been trying 'diet' ice cream while here and that helps (no sugar added) so maybe I will be able to live on that.
The no lifting restriction was on for 12 months post op according to my doc but then it was 'use your intelligence and prudence' advice...obviously he does not know women very well...I was moving furniture and lifting the grandkiddies after 3 months...much to my dismay and his...and 5 hernia surgeries.
Be careful and do not over do it...best post op advice I ever recieved was, "learn to ask for help".
Sharon

I eat a gluten-free, sugar-free diet. It is also low carb and medium protein. I use Sweet Leaf Stevia Clear Liquid for baking and very small amounts of maple syrup on some cereals and vegetables.

My family made the switch with me and everyone loves it. So far the pouchitis has stayed quiet.

Subzeromambo reminded me that I am not a zero sugar guy, but when I do need to add sweetness it is via stevia, maple syrup or honey.

Since my wife is a beekeeper, and since she just processed something on the order of 5 gallons of honey from one of her hives, I am definitely eating more honey than your average bear. Honey mixed with plain whole milk yogurt has become a regular staple. I haven't gone all Winnie the Pooh yet, but am sorely tempted.

We also just had our usual saturday morning pancakes (real men make them from scratch) which I will never allow to be assaulted by non maple tree based products.

In any event, I'm beginning to think that the type of sugar/sweetener may be an important factor along with the amount consumed.

Yea Shen will explain why low carb and low sugar, it grows bacteria.

I follow paleo but even paleo I knock some things out that produce to much sugar. I avoid fruits as well since it is also sugar. Strawberries I do on occasion since they are the best option for Candida issues and for SIBO.

Can anyone explain how to pull off the low fiber side of this diet? I ate paleo for years before getting sick so I understand that diet, but I wouldn't call it low fiber... every meal consisted of meat/eggs and a few large servings of veggies. Do you have to limit produce and live on mostly meat? Or is "low fiber" relative here?

The OP did not mention whether this was all fiber or insoluble vs. soluble. Although, if it is going to be a low carb diet, it would be hard not to also reduce the soluble fiber.

Personally, I eat lots of fruits and vegetables and do not limit them at all. I have fresh fruit and a big salad almost every day. Lots of cooked veggies too.

Jan

Interesting about the sugar thing. I have a horrible sweet tooth. I try to stay away from too much sugar, but it always wins out. I eat lots of fruits and veggies too. Knock wood, going on three years and no pouchitis. As with everything else, it boils down to everyone is different with what they can and cannot eat. I had this surgery to regain my quality of life so I do not limit myself to things I love to eat. If I have problems down the road, I will have to change that. In the meantime, if it's not broke, don't fix it!

I have to limit my fruit since it is sugar and I have a life time battle of SIBO since I had most of my gut removed as well with the colon.

Paleo is a high fat and high protein diet. I follow Primal mainly since I do have some dairy and cashews, etc. As for veggies I eat cucumbers mainly. Some iceburg on occasion and the stalks of romaine but the not leaves.

I stay away from bread, gluten and sugar. Shen mainly is talking about that when it comes to sugar in general. For me the fiber is oranges, romaine, etc. I can't digest any of that stuff.

Shen also says to eat high fat. I keep healthy with less fat on my body and my metabolism is good on Paleo/Primal. Bacteria can't grow in a high fat diet (healthy fats such as olive oil, bacon, etc) He also suggests this for people that need nutrition and when you have SIBO especially the body holds on to the wrong things to digest.

I can digest pistachios the best, coconut flour and almond flour for gluten free options stops me up, so I made a paleo pistachio nut flour cake with coconut oil and did just fine and was to DIE FOR. Might be a new staple for a weekly treat. I am actually writing a long overdue blog article about some food I have made recently.

I never heard of bacon as a healthy fat, especially with all additives for curing. I love it, but don't consider it a healthy addition to my diet, but more of a flavoring.

Jan

I don't buy store bought bacon so I have no additives. It is not bad for you if you go that route.

Oh and just to comment on this. I am not on antibiotics for the first time since I had surgery so diet does help. I hardly have gas or bloating and my pouch is funtioning good.

I did a 14 day course of Tindamax 3 times, 14 days on and 14 days off and cleaned up my diet. My SIBO as of now is under control.

Post your yummy pistachio cake recipe!

My sibo has gotten almost totally under control with the FODMAP diet recommended by Dr. Shen. I am almost out of the underweight category. I eat tons of produce (though selective based on FODMAP) and meat. Good fats - olive oil, cocunut oil (huge spoon in my smoothie each morning), and natural bacon like vanessa. Also lactose free,gluten free, almost sugar free (only maple syrup and small amounts ofwhite sugar allowed) and prebiotic free. Found out that inulin (chicory root) which is a prebiotic and in almost all bars and cereals is hugely problematic for me. Same with fructans - big no no.

Almost ready to brave it and stop the antibiotics for a week.Though FODMAP seemed challenging at first, it does allow a variety and well balanced diet and I am feeling a million percent better.

Ah, uncured bacon! Thanks for the clarification. Makes sense now...

Jan

The term "healthy fat" is most commonly used in terms of heart/cardiovascular health. A good example is olive oil. I love bacon, cured and uncured, but I am unlikely to ever imagine it to be "healthy." It has enormous amounts of saturated fat. While I won't celebrate the stuff used to cure bacon, I don't think the biggest negatives of bacon are much reduced by switching to uncured. Just my two cents.

quote:

The term "healthy fat" is most commonly used in terms of heart/cardiovascular health

The term I heard used by a registered cardiovascular dietician is "monounsaturated fat". These are considered healthy fats.

Vanessa, thanks for the input. I just have to ask though... when you say "as for veggies, cucumber" do you mean that is the only vegetable you eat??? I understand with the k-pouch there are some extra concerns about consistency, undigested foods, etc. Just curious...

Yeah, well, everything is relative. You DO need fat in your diet and sure, monosaturated is best. But, a little bit of anything, even arsenic, won't kill you. I think the point was that when you diet is extremely limited, you need to include what you can.

Jan

Bacon being bad for you is really a myth. A good book that goes into more detail about it with amazing recipes is called Beyond Bacon.

Anyway, the nut flour cake I will once I get the recipe down. I just tossed stuff together since that is how I am and I can't give you measurements or time yet.

My diet isn't limited so I eat a lot. I am a serious weightlifter and crossfiter so Paleo was in me way before this pouch. Once Shen mentioned how to eat, I just said it the same thing basically. I was stuck in the habbit of eating ice cream, pasta and bread since that moves through me easily but was making my life absolute hell. Now that I don't eat gluten I don't even get gas.

About the cucumbers. It is my go to green item. I use it instead of bread a lot. You can put hotdogs in a gutted one or pile on chicken and salad dressing. I eat them with the skin on in some areas even. If I eat a salad it usually is diced up tomatoes, cucumbers and avocado and once in awhile chick peas if I am in the mood for them.

Other day I made snacks that were mini sandwiches with cucumbers. I used 2 slices and in between I put a slice of tomato, goat cheese and pesto.

I can eat any veggie out there. But if I can't poop for 2 days it is pure hell and that happened when I ate quinoa and zucchini burgers. Absolute nightmare it was stuck in my pouch and I eventually drank some MOM to get it moving.

Just a FYI on digestion. I wrote on my blog recently. I tend to not be able to digest red meat, I guess for me it is the lack of stomach I have left. Steak is a total pain and ground meat just sits in my gut. But Buffalo (also way better for you) digests beautifully! You can also pig out on it and not feel as guilty

Sounds like yummy stuff Vanessa. When I said "limited" in reference to diet, I didn't mean volume, but food types. Many of us are not free to eat whatever is on the menu, but have to tailor our diets to what we tolerate and, of course, what we find palatable.

I still have not mastered giving up bread and other carbs, but have reduced my intake. Plus, I have definitely done a 180 from my prior "knowledge" that a carb heavy diet was better for you than a protein and fresh plant based diet. Funny how conventional wisdom can trend in such opposite ways...

Jan

quote:

About the cucumbers. It is my go to green item.

For some reason, I have never been wild about raw unmarinated cucumbers. To me, it is a pretty tasteless vegetable, which is why it needs to be pickled in so many different ways. I am not even crazy about cucumbers in my salad, and it is the only thing served in a salad that I consistently pick out and do not eat. Even though I get that it is low FODMAP.

The veggies I have been emphasizing are edamame, brussell sprouts, butternut squash, and bok choy, as well as many salads.

Is the nut flour that you use almond flour, or do you prefer another kind of nut flour? My secretary made some zucchini bread and brought it to work the other day, but since she used normal white flour I did not try any. Although I encouraged her to try making it next time (or at least a small test batch) with almond flour. Would that be the correct flour for this type of a bread?

You can use cashews, hazelnut, coconut, tapioca, almond, etc. Most use almond and coconut in recipes. Coconut flour to me feels like it causes a blockage in my rib cage area and has too much fiber. This is just me though and I have digestion issues in general. Almond flour I try but I just don't love it. I even have a cook book that is ALL almond flour. It moves out of my pouch super slow motion and I just want to be in and out of a bathroom and feel empty when I go.

I am using pistachio flour, it is more moist than almond and has better flavor. I also digest it way better and it causes less gas in my system.

I love cucumbers so I guess that is why I like them! A snack I can dig into is raw sweet potato slices and cucumbers with a dash of grapeseed oil and salt. I can eat some raw veggies easier than cooked.

Dr. Shen saying low fiber and low carb high protein. Does that also mean high fat. What foods qualify other than tuna fish, peanut butter, shrimp, almond butter. Who is doing this and IS IT HELPING???

Look into the Paleo or Primal diet. Many recipes and literature out there. I wold follow that for the proper fat and protein intake. Peanut butter isn't that good but almond butter is. I use Ghee (only use grass fed butter), olive oil, lard, avocado, etc.

I love the bacon from US Wellness meats, but it is very expensive: 1.5 lbs for $16.45 + shipping. Its only ingredients are pork and salt. Here's their website: http://www.grasslandbeef.com/StoreFront.bok

There are so many great Paleo cookbooks out there now. My current favorites:

Against All Grain by Danielle Walker (author manages UC thru diet): http://www.amazon.com/Against-...ds=against+all+grain

Practical Paleo by Diane Sanfilippo: http://www.amazon.com/Practica...+by+diane+sanfilippo

Even though it can be discouraging that there isn't one exact diet formula to help everyone with IBD, it is worth taking the time to experiment, journal, etc. to figure out what your body needs. Hang in there!

And what great news that more doctors are understanding that food plays a role in our health management!

On this topic a member of my CCFA support group shared these 2 books with me, which are perhaps more oriented to those who have UC and Crohn's, but still contain helpful information:

1. Crohn's and Colitis Diet Guide http://www.amazon.com/s/?ie=UT...f=pd_sl_61ieaf8lf5_b

2. What To Eat With IBD http://www.amazon.com/dp/09814...f=pd_sl_47gvx6zmvd_e

Of the two books she liked the first one better as it has a more user friendly format. Both books have recipes but the first one sort of has a cheat sheet that tells you which categories each recipe falls under in terms of carbs, fiber, etc.

Lynne/L.Mac thanks for posting those Paleo Diet books as well - I will be looking at them.

The books I showed above aren't specifically for IBD and, especially the one by D. Walker, are primarily cookbooks. I do a SCD/Paleo/GAPS approach to eating and believe it has helped me significantly.

If you want more info about the reasoning behind Paleo, I'd start with Robb Wolf's book: http://www.amazon.com/Paleo-So...+wolf+paleo+solution

If you want an accessible book that includes recipes and fitness, I'd also look at: http://www.amazon.com/Paleo-So...+wolf+paleo+solution

If you want a cookbook for IBD using SCD, I don't have a favorite, but here are a couple I use when cooking SCD instead of adapting Paleo recipes:

Day to day type of SCD cooking: http://www.amazon.com/Cooking-...ic+carbohydrate+diet

Fancier SCD cooking: http://www.amazon.com/Eat-Well...90607/ref=pd_sim_b_2

There is sooo much info online now that you could always start by doing prelimary research there to see if the dietary approaches click with you before investing in the books.

I am publishing a book in a couple of months. Mine is more about eating with pouches than just primal. What I can do and how I modify a primal diet/lifestyle. Things I have learned and did my own personal research on with how to eliminate gas and the SIBO gurgles, etc.

I think for now I will have it as a kindle download or ibook off itunes. IT talks a lot about my BCIR and FAP. I had a half book written about my life with IC and FAP but I am a total foodie and have recipes to share that might help someone else. I want to educate people that we still eat REAL food

Good for you! Congrats!