Brief Answer:
Good Day, M'am

Detailed Answer:
Welcome to HCM!
I have reviewed your concern and understand the frustration completely.

Essentially, dear one, we are dealing with a disease of inflammation. So, the diet to focus on would be an anti-inflammatory diet with the appropriate anti-inflammatory supplementations.

Limit sweets, alcohol, red meats and increase your intake of vitamin C containing foods. Your overall diet should be balanced, but with my patients I do not push the fiber without knowing how it affects the patient. Please let me know if fiber aggravates or helps your condition. Large fecal volumes are undesirable and fiber may promote that. And, during a flare remove ALL fiber from your diet and follow what we call a "low residue diet" to allow for bowel rest until the flare subsides.

You need to eat your fruits, vegetables, grains unless you are gluten sensitive, lactose free milk products fortified with vitamin D, and lean proteins. However, there are definitely foods to avoid. Avoid beans (legumes due to the gas), cabbage, broccoli, caffeine.

Because most patients experience bacterial overgrowth in this condition, adding pre and probiotics to the diet should help. Make sure that these remain refrigerated.

The supplement ALA often relieves inflammation more effectively than do the omega-3 fatty acids, 600-1200 mg of ALA may help. What I am looking for is to promote anti-inflammatory foods and supplements as much as I can.

Now, I have given you several suggestions. Mesalamine is an anti-inflammatory as well. Suppository is the best way to take it. Please provide me further information and I will see if I can provide more specific guidelines as our official Nutrition Care Manual encourages a balanced diet, yet I have been able to give you more ideas than just that. If you can provide me with a sample one day typical food diary, all your meds/supplements and diagnosis, likes/dislikes, main problems (constipation, diarrhea or both), I can get to know you a bit better and can target some effective, workable guidelines specific to your lifestyle.

Have I helped answer some of your questions on diet? You asked about homeopathy, but it is better in my opinion to stick with diet control, supplements, probiotics, and herbs/teas. Please write back with the information I requested and a list of any other specific question you can think of.

It is 11:24 am my time. I am available until 6 pm today. I will be unavailable on Monday until between 3-6 pm and then all day Tuesday. I look forward to hearing from you. again. XXXXXXX XXXXXXX

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Brief Answer:
Lucky you - both diarrhea and constipation

Detailed Answer:
Here are some more tips I gathered while waiting for your response as far as diet goes:
Inflammatory Bowel Diet
*Eat small frequent meals
*Keep hydrated. If you have a hard time remembering to drink fluids, purchase a water bottle and carry it with you. You should drink 8-10 8ounce glasses of fluids per day. Keeping hydrated also helps with constipation.
*Type of probiotics often used with IBD: Saccharomyces boulardii or Bifidobacterium
Probiotic recommended to take with your specific medication:
Lactobacillus rhamnosus GG
*Prebiotics are indigestible carbohydrates and they stimulate the growth of certain beneficial flora in the gut. They can help increase the growth of good bacteria that the gut needs to function. Inulin for example is in asparagus, artichokes and bananas or can be made by soaking chicory roots in hot water.

I would lay off the candy corn - it isn't good for inflammation, constipation or diarrhea.

You aren't getting enough calcium or vitamin D if the reported food intake is typical. You also do not absorb your nutrients optimally. I do suggest 800 mg of calcium and vitamin D (up to 1,000IU) as you aren't getting these nutrients in your diet and the use of a supplement might help boost your levels.

You also might feel better if you included a source of protein at breakfast rather than having just carbohydrate and sticking to lean proteins rather than hot dogs (high in fat and fat isn't good for colitis), chemicals and nitrites.

When you are having bouts of diarrhea, try to keep your electrolytes up with popular sports drinks on the market if low in sugar. I noticed that fruit bothers you. You need extra vitamin C, are you able to tolerate juice?

And, because you don't look like you are getting a balanced diet as I don't see 5 servings of fruit and vegetables in your food recall, I suggest an easily absorbable multivitamin, preferably one you can chew.

Finally, I make this suggestion. Try a gluten free diet and see if your symptoms ease up. No lactose either. No sugar substitutes. And, you have already identified melon, fresh fruit, lettuce, grapes, cantalopes. No fried foods. Limit all high fat and chemical laden food.

For itching I suggest buying wipes and using those along with soft, chemical free toilet paper and a cortisone based cream such as is used for hemorrhoids, but you can ask your doctor about the cream. He might give you a prescription cream.

I hope I have answered your question in detail. If you have no further queries, please rate and close this question. Please come back and see me anytime. Respectfully, XXXXXXX XXXXXXX

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Brief Answer:
I am feeling like I did not give you what you wanted

Detailed Answer:
I must say when you mentioned you would try to incorporate some of my suggestions, were you looking for something else? Just clarify and I can do some research if I did not address all of your issues.

I want you to be satisfied. What suggestions do you think you might have trouble with and are there any different avenues I can pursue to help you?

I am here to help. Please be specific as to what you need if I did not answer your question to your satisfaction.

Truthfully, I feel you still have food sensitivities that need to be identified and eliminated to help improve the total picture, but I have tried to provide as much guidance as I thought you asked for.

Take care. XXXXXXX XXXXXXX

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Brief Answer:
Oh, I see

Detailed Answer:
Now, IBD and colitis can cause the proctitis which is inflammation located in the rectal area.The colitis causes sores in the large intestine which can cause gross inflammation of the tissues that lie further down in the rectal area.

I realize it is a difficult thing to control. The medications frequently given for one may aggravate the other, same with food I see. Well, is it possible to work out a plan - you know yourself best- where you can limit your foods that don't cause a flare in either condition? That could only be accomplished by detective work and a detailed food/symptom diary.
Clarifications: I see you drink cofee and avoiding caffeine is suggested. Despite avoiding lactose you might tolerate lactaid and certainly yogurt with live bacterial cultures.

When diarrhea symptoms improve, soft, bland foods can be added to the diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. If the diarrhea stops, a normal diet may be resumed if tolerated still limiting fiber, offending foods, lactose, msg,sweeteners (except stevia).

I don't think you will ever tolerate much fiber unless possibly soluble fiber in oats, quinoa.

I hope I have cleared a little confusion up. Good luck and I wish you the best. XXXXXXX Shattler, MS,RDN

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Brief Answer:
I don't want to contradict what the doctor told you

Detailed Answer:
You were told to eat white bread and white rice to follow a LOW FIBER diet which is different from gluten free.

Going gluten free is a huge step. If I were you, I would make small changes at first. I suggest reading up on gluten free diets before making a decision to go that route. There are plenty of books on going gluten free. Consider it carefully as it is restrictive and requires a lot of label reading.

Again, the issue with the vegetables is the fiber and gas. Are you able to eat
, whipped carrots and such vegetables if you cook them and change the texture to lower the fiber?

By not tolerating fruit, you have eliminated an entire food group. This will compromise nutritional intake further. Certainly your vitamin C, A, and many other phytonutrients will be missing. Multivitamins will help this. If pills bother you, get chewable multis ( they have gummy vitamins out now) as they are less irritating and absorbed better in your situation.

I would try soft asparagus, whipped potatoes, whipped carrots for vegetables. Avoid cabbage, broccoli, cream soups for the vegie group. Continue with your low residue diet when diarrhea present.

You mentioned a few fruits that bothered you but not bananas. Fruit juice with pulp or seeds and prune juice are restricted, but I don't see all juices. Are you certain you were told all juices were restricted?

Getting adequate lean protein is important. Choose meats such as fish, chicken breast without skin cooked very tender, lean cuts of beef, as long as the meat is lean, tender and soft. No hot dogs, lunch meat, salami, or other high fat meats.

Again, no seeds, nuts or coconut, beans (legumes), lentils, tofu,dried fruit, corn onion, nectar, pickles, relish, saurkraut,

Have you found you can be a little more liberal when the constipation flares or do you still have to follow the low residue/low fiber diet?
Here is a sample menu:

Breakfast

Decaffeinated coffee with lactaid
Cup of juice, such as no-pulp apple juice, or cranberry juice
Cream of wheat
Scrambled eggs
Waffles, French toast, or pancakes
White-bread toast with margarine and grape jelly (no seeds)
Lunch

Baked chicken, white rice, canned carrots, or green beans
Salad with baked chicken, XXXXXXX cheese, smooth salad dressing, white dinner roll
Baked potato (no skin) with sour cream and butter or margarine
Hamburger with white seedless bun, ketchup, and mayonnaise -- lettuce if it doesn't worsen your symptoms

Dinner

Tender roast beef, white rice, cooked carrots or spinach, white dinner roll with margarine or butter
Pasta with butter or olive oil, French bread, fruit cocktail
Baked chicken, white rice or baked potato without skin, and cooked green beans
Broiled fish, white rice, and canned green beans

This is a sample low residue diet matching almost all your restrictions.

I hope this helps. XXXXXXX XXXXXXXXX

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Brief Answer:
You are very welcome

Detailed Answer:
I am glad I could help. If I have answered all of your questions, please rate and close this question. Once again, best luck and thank you. XXXXXXX XXXXXX

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