I obviously get to speak to a lot of IBD sufferers, and have heard some true horror stories of things that have been advised by doctors and dieticians. But something I heard the other day has to be the WORST piece of advice yet…
Apparently, one lady had been told, in order to help keep her weight up, she should eat..
…wait for it…
Bowls of ice cream, and pour rum on the ice cream as the alcohol will increase her hunger!!
Yep. Really. Wow. Just wow.
(I’ve also heard of McDonalds and Monster Munch being suggested, but I think rum and ice cream probably beats that).
Now fortunately this type of advice isn’t given to EVERY IBD sufferer but something that almost always is suggested is that they go on the “low residue diet”. However, this too, unfortunately, is often not good for someone’s long-term health.
A “low-residue” diet is essentially a diet that is low in fibre. It is often recommended because, in certain cases, certain types of fibre can be an irritant in certain people when they are inflamed. However, in my opinion, this recommendation can be very short sighted. Here’s a quote from Wikipedia which I couldn’t have put better myself…
“New evidence tends to run counter to the well-established myth that a low residue diet is beneficial. A Mayo Clinic review from 2011 finds no evidence for the superiority of low residue diets in treating diverticular disease and in fact tends to show that a high-fiber diet can prevent diverticular disease. A systematic review published in 2012 found no high quality studies, but found that some studies and guidelines favor a high-fiber diet for the treatment of symptomatic disease.”
Yet despite these studies, 1000’s of IBD patients every year are told it is beneficial. The problem with a low residue diet is that normally 2 things will happen:
- Someone cuts ALL fruit and vegetables out of their diet, because of this overwhelming fear of all fibre. Fruit and vegetables are essential for your wellbeing and getting as much on board as possible (of the right type!) is so important.
- Someone eats lots and lots of white bread, because it’s one of the few things allowed, despite the fact that so many people are sensitive or intolerant to gluten and wheat.
Before going any further, it’s probably worth us getting clear on exactly what fibre is, and the effects of different types of fibre.
What is Fibre?
Dietary fibre is the indigestible portion of food derived from plants and waste of animals that eat dietary fibre. It remains intact through the gastrointestinal tract, meaning it has a cleansing function within the body.
Fibre is essential for ensuring gastrointestinal health and plays a huge role in the prevention of disease. It helps to change the nature of the contents of the GI tract and how other nutrients and chemicals are absorbed.
Fibre is very important for the healthy functioning of the gut. It can help to regulate the consistency of the stools and make the passing of them much easier. It also has a large influence on the growth of friendly bacteria in the gut and helps to control blood sugar levels.
Types of Fibre
There are two different types of fibre – soluble and insoluble. This basically refers to whether or not they dissolve in water (soluble being the one that does). The two types play different roles but both are important.
Soluble fibre is found in things such as oats, legumes, and some nuts (especially almonds), fruit (such as berries) and vegetables (including broccoli).
They form a gel like consistency within the gut and tend to slow the movement of food in the system.
It, therefore, can help to improve blood sugar regulation, satiety and would ideally be consumed at times when rapid digestion of foods is not required. The downside is that overconsumption can lead to constipation.
The digestion of soluble fibre produces short chain fatty acids, one of which is butyrate. Butyrate is the primary fuel source for the cells of the intestine, and so is extremely important and can be very effective for sufferers of IBD. It has been shown to be beneficial in reducing inflammation and reducing the chances of cancer in the GI tract.
With a very low fibre diet, it is highly likely that your SCFA and butyrate levels would be very low, which is obviously not good for long term health. Therefore, I do not recommend a low residue diet, certainly not for the long term.
Insoluble fibre is different. Found in foods such as leafy greens, sweet potato, whole grains, certain fruits (such as avocado), and many nuts and seeds, it tends to accelerate the digestive process and, therefore, helps to keep you regular.
It adds bulk to stool and allows them to pass through the gut more easily, although certain studies have demonstrated excess insoluble fibre may be harmful to the gut by being a potential irritant to an already inflamed gut, inflamed gut lining, fuelling the growth of opportunistic bacteria, and preventing nutrients from being absorbed.
Fibre, and different types of fibre, will have differing effects on different people. In particular, people who suffer with Crohn’s can sometimes develop strictures and in these cases insoluble fibre may need to be reduced. It can also sometimes be sensible to reduce the amount of insoluble fibre you eat when you are in a flare.
However, removing or reducing fibre completely should rarely be done for the long term because it is so important for your overall health for the reasons mentioned above.
So what should I do if I’m flaring?
Firstly it’s worth noting that it’s normally insoluble fibre that can sometimes be worth removing rather than ALL fibre (meaning soluble fibre can often stay in).
Again, this will come down to individual tolerances, but things such as carrots, parsnips, and butternut squash are normally ok, even when someone is in a flare. Whatever veg you do eat, it should be very well cooked and pureed if possible to be as kind on the digestive system as you can.
One fantastic product that you may want to consider using is a greens powder supplement. This is essentially a powdered version of a large amount of healthy vegetables that you can drink each day and give yourself a wide variety of nutrients without needing to do any food prep.
Easily my favourite version of these on the market is called Lean Greens. It’s something I personally use myself, and I often recommend it to my clients too. I personally use it for convenience (as quickly mixing this with water is easier than preparing a lot of vegetables) but someone who is struggling with fibre intake would also likely benefit because the amount of fibre in each scoop is likely very low (it varies but it is almost certainly less than 0.5g).
The list of ingredients in Lean Greens is pretty impressive and extremely beneficial for someone’s overall health. These include Alfalfa, Amylase, Barley Grass, Blackcurrent Extract, Blueberry Extract, Broccoli, Bromelain, Carrot Powder, Cellulase, Chlorella, Green Tea Extract, Lactase, Lipase, Protease, Siberian Ginseng Extract, Spinach, Spirulina, Stevia and Wheatgrass.
Pretty decent list huh? It’s very unlikely that you would be getting all of these each day from whole foods, so this type of product can be beneficial for everyone, regardless of whether they need to be on a low fibre diet for a while or not.
Interestingly, one of the brand ambassadors for Lean Greens is Alex Enlund (MMA fighter champion) who uses it again for the nutrients and it doesn’t cause him any problems related to the Crohns.
To order some of this product, head of to www.IamGregWilliams.com/leangreens now (and use code GREG10 at checkout for 10% off).
Juicing has a lot of popularity with some IBD sufferers. As per the rest of this article, I personally believe that relying on juicing long term is a mistake because it means your diet will be lacking in fibre and that in itself will lead to long term issues.
However, as a short term measure while you are flaring or really struggling to take on much in the way of fibre, then it can be a good way to take on some nutrients with aggravating symptoms.
Pretty much anything goes ingredient wise with a juicer. I would just experiment and see what you like and make sure you keep it varied (to keep the range of nutrients varied).
Get to the root of your problems
Finally, it’s worth adding, that it’s always important to get to the cause of your problems. While I personally do use Lean Greens on an ongoing basis, I do this because it increases my nutrient intake in a very effective and convenient way.
I don’t suggest that you rely on things such as Lean Greens or Juicing as long terms options just because you have trouble with fibre. In those instances understanding what has put you into a flare in the first place will help you to address those things.
The consumption of good quality fibre is not a driver of a flare, it is more of an irritant. Working with someone such as myself to resolve your problems so that you don’t frequently flare is hugely beneficial for long term health. Almost all of my clients end up at a stage where they not only feel amazing, but they can have a hugely varied diet, eating most things (in moderation) without an adverse reaction. It’s a great place to get to.