I don't know enough about what you're eating to say much about your diet, and your combination of conditions is unfortunately a dietician's nightmare. One concern I do have: law carb/low fat usually means high protein (if you're actually consuming calories), and that can be very bad for chronic kidney disease. I think you need good guidance about what dietary limitations are most important for you, and not get distracted by the less important ones. And then you need good advice about how to achieve that diet in a way that's compatible with your GI tract.

If regular Metamucil gives you trouble you might try Benefiber or Citrucel. Good luck!

Scott, For protein I eat only chicken and fish, not really high calorie either.

The calories and protein are separate problems. Too much protein can burden kidneys that are struggling, regardless of the kind of protein. Independently of that you mentioned not eating enough calories, which made me cautious about the ordinary assumption that your low carb/low fat diet was also a high protein diet.

I've seen two nutritionists in the 14 years I've had a pouch. One told me my diet was fine, keep it up. The other couldn't believe how unhealthy my low veg/fruit diet was and insisted I needed to up my intake to what would leave me in the bathroom pooping a ton of undigested fruit and veggies!

that said, I think our condition is complex. Additionally, you have several conditions with competing needs and your goal should be the best quality of life with minimizing your health complications.

my PCP has been helpful for me with this. Each specialist will give one set of instructions putting the condition you are seeing them first, and the information and sometimes treatments ocan be contradictory.

I've  also had to do a lot of my own research regarding diet for conditions and medications for conditions and their side effects so I can go into my provider as an educated patient. Or just a patient with a lot of questions!

I wish you the best of luck.

Also, I have luck with immodium more than fiber.

Hello, Alaine.

I meet with a dietician regularly regarding my rising blood sugar levels (type 2 diabetes) who knew what a j pouch is and the problems associated with it, especially when diabetics are encouraged to eat fewer carbs, but a j poucher is encouraged to eat more starchy foods to thicken output. Contradictory.

If you are pre-diabetic you will, or already have, learned about the "plate" method to simplify the intake of vegetables, starch, and protein. Divide your plate into half. Fill one half with vegetables. Divide the other half into a further 2 sections, one section for a starch, the last section for a protein. That sounds easy if you are dealing with only diabetes and not an active pouch that doesn't like vegetables, or if you must be careful about the protein you take in because of your kidneys. I have to cook my vegetables very, very well so my pouch doesn't have to do a lot of work, and hopefully I can absorb some nutrients before they exit.

Try a smoothie from spinach, peeled apples, banana, almond milk?  Google what proteins will cause the least overload on your kidneys and try to have that in a section of your plate. Eat complex carbs to keep your blood sugar from shooting up too quickly. Simple carbs will cause sugar spikes. I'm sorry that I don't know about kidney problems, but I wanted to give you some small suggestions to get your fruit and vegetables, and some encouragement, at least.  If you can eat beans or chickpeas as your protein, try hummus on crackers or dipped with peeled cucumber -- this way the chickpea is already pulverized into tasty mush and your pouch might tolerate it well. Mine does, thankfully, and this is the protein section of my plate. I hope you find relief, and more suggestions.

Hi Sarahxyz, and Winterberry,

Thank you for your help. I have so many issues, and yes each doctor has blinders on. I saw my Gasrto doc today, of course he wants to scope me, I don't think this is the problem. I think this diet is the problem. I also don't have much of an appetite. My last blood work showed my sugar was just normal so that was good news. Unfortunately I cannot eat bananas due to my kidney problems. I only eat chicken and fish due to cholesterol problems, so not a lot of calories there either. I think I need to be very methodical, and go through my foods for calories, nutrition and pouch tolerance.

Alaine, if you haven't been scoped in a long time then it's very appropriate for your GI to have a look. If you're in pain you'll be best served by finding whatever's going on rather than assuming it's your diet.

Hi Scott,

I'm going to let my doc take a look, it has been several years.