Nutrition Help Please

Wow , you cant eat any fruit or veggies ? Not even cooked ones ? Its true post op I can't eat them but cooked to soft and without skin I can do all day. I'd stay away from juices specially packaged ones , too much sugar kills my pouch. I can do bananas, oranges, mangoes and pineapples without any issues. Also to add in all the vitamins you can take a multivitamin tablet daily. I take them and zinc tablets on random days. But one iron tablet I take daily, though not that I am low on it but following my surgeon's advice to always eat an iron tab a day.

Hi John. I have looked into Juice Plus and it is very much just a scam. There are lots of docs on the internet showing that the "studies" they have to back up their claims were sponsored by their parent company and aren't double-blind studies. In fact, those pills have less nutrition than a multi-vitamin. Do not waste your money! As for fruits and veggies, I have difficulty as well but juice isn't sufficient because it doesn't spend enough time in our gut to absorb fully. The transit time is quick and the surface area of our small intestine to small to realize benefits. Are you most certain it's every fruit and veggie? With some "effort" to digest I have found some that are annoying but tolerable:

well cooked broccoli
butter lettuce / live lettuce
cucumber no skin
bananas
apples no skin
blueberries a couple at a time
baked fruit no berries
cauliflower well cooked

There are more, but each person needs to try a little here and there to find it.

Jennifer

You can also try mixing fruit and vegetables in a smoothie with almond milk or yogurt.  I have found that I tolerate greens better when mix them this way.  

If you find you can't digest pill vitamins, try the liquid kind.  Alive makes one that tastes horrible, but does the job to add nutrients to the body. 

I'd also eliminate juicing due to sugar that could lead to pouchitis.  Blending cooked veggies or fruit to start with gives you the fiber needed to keep the sugar levels in check.

Thank you for all the recommendations everyone. I will try out those options. 

I did juice plus for about 2 years... Id agree it's basically a very expensive vitamin tablet (and vitamin tablets may or may not work according to research).  If say there are definitely better ways to spend your money. 

I know everyone is different, but I can't see how vegetables would suddenly be bad for you, if you have been able to eat them when you had a colon.  Digestion occurs in the upper end of the digestive tract (the bits you still have!) Cutting a bit of water absorbing colon out wouldn't affect that.

What having a colon might do is mask symptoms, so if a certain food increased your transit time, you would still have a colon to slow and soak more fluid.  For example I now get ill of I eat apples or avocados, but I never noticed this when I had a colon.  I noticed that both the foods contain polyolys, I then ate other polyolys and also felt Ill.  

I'm summary have a look at the scd diet.  As for sugar,  I'm the same, the RDA for sugar is 35g, of I stay below that I seem ok.   Also I find it's best not to eat sugar immediately after a meal (encourages fermentation)

Hth

My doctor told me never drink bottled juices because of the sugar.  Depending on the bottle size it can take 3 or more oranges to produce a small container of orange juice. You wouldn't eat three or more oranges at one sitting, same applies to a bottle of juice. When I make smoothies, I'll use 1 serving of whatever fruit, blueberries, or a small peeled orange, or 1 serving of strawberries. Mix with cup of almond or soy milk (low sugar, low carb) with a spoonful of Greek yogurt. Or try blending raw spinach and (peeled) cucumber smoothie. Can you eat peeled and roasted zucchini?  It will provide soluble fiber. Maybe steam a pot of veggies, add some broth and use a hand blender to make the whole thing into a smooth soup?  

I started the FODMAP diet by my GI dr.  You can check list on line on the do's and dont's.   It has worked for me, not 100% but without it I would be in a bad way.  I also wrote down my menu each day and checked off the foods that gave me gas, bloating, pain and diarrhea.  I make all my own food, mostly from scratch.  I am Gluten free, lactose free.  I buy Non GMO and organic foods.  I don't eat meat much.  A Lot of fish and chicken.  You do have to get creative.  I don't eat out much because I don't know how it's made. 

I know it's tough trying to get the nutrition when u can't eat veggies or fruit, salad, meat.  You have to work in with smoothies, vitamins.   The FODMAP diet list all these foods in categories and which can be tolerated with less symptoms.  It really helps.   Best of Luck

Apologies for the long post - its my first...  Almost embarrassed to say that I had my reconnect surgery was in early 2013 and although my quality of life was greatly improved by having my colon/rectum removed, I still have not adopted a regimen of sorts that makes me feel my healthiest.  (I do not take any supplements - after surgery, I loved not having to take any pills!)

I am intrigued that someone spoke about a Pouch clinic or specialists dealing with pouches.. I asked my surgeon after the surgery if I should seek out a dietician or nutritionist and he shrugged the idea off and simply responded, "you probably won't ever eat Kale".  That was my parting advice.  I have not seen my GI in several years because no dire need but some bits of advice she gave at the time were to eat marshmallows or P. butter to slow my output and eat greek yogurt for the probiotic.  Other than that, I should be able to eat whatever But will find, some things won't agree with me.  I gather I have not found the right resources and will consider revisiting this doctor as in 3 years, perhaps she has changed her thinking of how diet affects our gut.  I should be in the right place as my doctors are with a top ranked medical school here in St. Louis.

For now, I seek advice on a few things : ) and perhaps what I learn from this forum will lead to questions for my GI...

I am currently under weight as I know I am more anxious lately and know the brain/gut connection is a huge factor for me.  I have also been experiencing leakage or having to use the bathroom in the middle of night for the last month.  I also need to eat more.  Sometimes food does not always sound good or I get full fast or I get busy!

• What regimens have helped put weight on?  I read someone used (unsweetened) AbSorb Plus a Protein shake but would rather go natural...
• For those anemic - can you handle iron pills and what dosage?
• Are probiotics useful for us and which ones?  I was once under the impression only expensive VSL for us Jpouchers but I have no clue what strands I should seek.
• When your gut is seemingly not healthy, what is useful in improving its Flora (Kimchi, kraut..)
• Does anyone use metamucil or something like this or anti-diarrheal to firm things up?

I best stop here!  Thank you for your time and any information you have to offer - Kate

Hi, Kate! I use VSL in high doses, to help with pouchitis. I suspect its effectiveness may be mostly because of the very high number of bacteria in a typical dose. Visbiome may be easier to find, and might even work better than VSL. They are expensive, though.

I’ve used psyllium (Metamucil/Konsyl) every day since my surgery 17 years ago. When I’ve stopped it a couple of times it immediately became obvious that my gut works better with it. Some people use it with less water than directed on the package, but I find that it works just fine with the package directions.

I use Lomotil at bedtime, but usually not during the day. It helps me sleep through the night without any interruptions. Some people prefer Imodium. 

Your nighttime leakage might be a symptom of pouchitis. This is generally easy to handle with 10-14 days of an antibiotic (usually Cipro or Flagyl).

The major reason your doctor isn’t likely to give you much dietary advice is that there isn’t any dietary advice that’s generally helpful for most J-pouchers. I’m not saying that your diet doesn’t matter, but rather that each of us must mostly find our own way. Other people (or professionals) can suggest things that may be worth trying, but that’s as far as it goes.

Good luck!

I am not anaemic but still take one iron tablet a day. As my surgeon says pouchers can have low iron levels and its something that will help balance it. There's no harm in precaution.

For weight, I was down to 42 kg post op and now weighing around 57-58 in 9 months, mostly muscle mass. I've tried different diets to bulk up fast. A homemade weight gain shake helps, made from 2 bananas, 1mango, 1cup milk, 2 tsp peanut butter, 1 cup oats and 1 scoop whey. You can add or deduct anything that may not suit you. I eat upto 5-6 tsp peanut butter and 3-4 bananas a day. Also I use more than required olive oil just to get in extra calories. Rest hard boiled eggs and chicken daily for protein. This works when you're following some sort of training , I do weight training 6x a week. 

I've been taking pysillium husk now with reduced amounts as my stool is thick enough with all bulking foods in my diet. But it sure does help in ease of motion. Though initial gas pains and urge to go often can come with it but the gut adjusts to it after sometime.