You are what you eat!
When I was fifteen years old and I
was diagnosed with Crohn’s disease they explained to me that it was an inflammation
of the bowel which is part of the digestive system, and that as a result of
this I would have to adapt myself to various eating habits. “No problem”, I
said, “just tell me what’s permitted and what’s not, and I’ll keep to a correct
diet and everything will be alright.”
After a conversation with the
doctor who diagnosed me with the disease, a medical insurance dietician and a
range of clerks and other officials at the health institutions, I managed to
make the following summarized list of problematic foods:
·
Spicy is forbidden –
“because it burns you bowel”.
·
Everything that includes
fiber is forbidden – “because it scratches the bowel wall”. That meant
vegetables and fruit were not allowed (especially citrus fruits) as well as
whole-wheat bread and other foods that contain fibers. Tomatoes, eggplants and
peppers were forbidden also, as foods that contain fiber, and more than that,
because “they are too acidic”. Naturally
ketchup was out of the question, and if you thought about it – the same went
for all other herb products as well.
·
Meat is not recommended
because “it is hard to digest”.
·
White sugar – “not
recommended because it encourages inflammation, and is anyway generally not
healthy”. It’s true of all foods of course, that they contain sugar, especially
all the sweetened drinks. White bread was also not recommended because of the
white flour it contains.
·
Everything that contains
preservatives is forbidden – because “with them the food remains in the
intestine and can encourage inflammation”.
·
Everything that contains
food coloring is forbidden – “because it is simply not healthy”.
·
Every fizzy drink is
forbidden – “because as it stands we already have enough gas in the bowel”.
Cola, from which it was very hard for me to part, of course contains both sugar
and food coloring. The prohibitions on fiber and sugar left me with a glassful
of water.
·
It’s not recommended to eat
out – “because it’s not clean”.
·
Fried foods – “not
healthy”.
·
Dairy products – “not
recommended because they are not digested well and can encourage diarrhea”.
·
Pulses such as chick-peas
and broad beans – they cause gas and are therefore not worth it.
After all the conversations,
consultations and the lists, I was left, as you can see, with rice and water.
The doctors of course added that it was important to eat a lot because I was
very thin and needed lots of vitamins so that my body could cope with the
disease.
After a week of a strict and
depressing diet, I celebrated its sooner than expected end at McDonalds.
Setting aside the cynicism, I admit
that the advice that I got was not wrong. It is all correct in principle, but
of course one needs to follow it in moderation. First and foremost, you need to
understand that Crohn’s is not a disease for lazy people (in the end it will turn
out that excess diligence will be the real reason for the disease…). Also and
mainly, from a nutritional point of view, there is no alternative to hard work.
Every patient has to make an investment and learn by himself which types of
food are good for him, and which are not. After long years of treatment, and
ups and downs, it seems that the best advice I got from any doctor ever was
“eat everything you want, and if something gives you a sore stomach, don’t eat
it again.” In the end, you are for yourself and your health, and as the wise
man used to say: “Listen to everyone’s advice, but take your own decisions.”
The great problem with the subject
of nutrition stems from the gap between what is forbidden and the many
constraints, and the body’s need for essential nutritional elements (vitamins,
minerals and so on). What is even more serious for patients is that their
disease is active in the small intestine, something that causes absorption
problems. Thus, even if your nutrition is appropriate, balanced and contains
all the required nutritional components, you will still encounter deficiencies.
Many Crohn’s patients therefore suffer from a deficiency of iron, vitamin B12,
folic acid, zinc and calcium. Similarly, not a few suffer from malnutrition and
weight-loss. This gap obliges every patient whose health is important to him to
thoroughly know the state of his health so that he can consume most of the
nutrients his body needs while making the least possible mistakes.
Despite the fact that every patient
responds differently to various types of foods, it’s possible to define a
number of common guidelines for correct nutrition:
No eating out
Long before the question “What
should I eat?” comes the question “Where should I eat?” I’ll try to be as clear
as possible on this matter because people sometimes have a tendency to distort
things. Repeat aloud after me, and practice with me the most important rule of
nutrition: “I will never be tempted to eat out!” Repeat this mantra three times
a day – there’s a chance that you’ll start to feel better. I know at first-hand that this is a harsh
sentence, and not just from the point of view of entertainment and indulgence.
It’s also from a practical point of view that it seems impossible. Most people
are not at home for most of the hours in a day, and they can’t return home
every time they want to snack on something. I’m definitely aware of the
problematic nature of this. I live it. However, as I indicated earlier – this
is not a disease for lazy people, and the solutions require investment.
Eating out endangers your health
for the simple reason that you can never control the quality of every
ingredient that appears before you on the plate. An unsuccessful dish that
would cause an ordinary member of the community no more than a little gas,
could send us to the emergency room within half an hour. I must emphasize that
it makes no difference how clean the place is, and how nice the people there
are. It could be any restaurant, any cafeteria, any fast food stand or any
kiosk that sells popcorn for the movies. It can happen even if the owner cleans
the kitchen three times a day (something he doesn’t do), and even if he
verifies that the person making the snack remembered to wash his hands after
going to the bathroom (and who knows if he did so). It’s enough that one single
tiny pickled cucumber has had enough of its miserable life in the jar. Such a
cucumber, already not fresh, becomes a large dwelling for germs. All on its
own, as part of the wonderful and sterile “health helping” that you ordered, it
can get you into deep trouble. Our angry
bowels are just looking for a reason to get irritated, and the quality of the
food is an excellent reason. Even if you don’t feel the results immediately, an
angry bowel has the memory of an elephant. It will not forget, and will
definitely not forgive, the unnecessary bite you gave to a dying cucumber.
You will say, and rightly so, that
home food is also not sterile. Having said that, because we know exactly what
the level of sterility is and what the best ingredients are (and we can ensure
a high level that suits our needs) we can minimize the danger significantly.
Likewise, when the person preparing the food does it in the knowledge that the
customer is the owner of a sensitive digestive system, it’s clear that the
ingredients and the herbs will be suitable.
And when you do go out? It’s very
simple: we take food and drink with us – sandwiches that will keep you going at
your studies until the afternoon, or a container of food to heat up in the
microwave at work. True – it’s not always the tastiest, and it’s definitely
less simple and pleasant. “Not for lazy people,” did I say? I promise that
you’ll thank yourselves in the evenings, when your stomach remains calm.
The ban, my friends, is in place
when you’re enjoying yourself at a restaurant. Do your best to make do with a
light dish and a drink. Remember that even if someone else is paying the bill,
you will pay the price for every mistake – with your health. For those of you
who can’t help yourselves, or when there is simply no alternative, do
yourselves a favor: reduce the amount, and avoid experimenting with new dishes
and with adventures at the expense of your intestines. Even in cases where you
have to eat out, keep fast foods out of the picture, and choose from among the
better quality restaurants.
Learn to cook
Just as a diabetes patient learns
to use syringes and needles to inject himself with insulin; just as a celiac
patient learns to look for the gluten in every food he consumes – in the same
way Crohn’s and Colitis patients need to become proficient in everything
connected with food, and yes – learn to cook. We have to know exactly what’s in
every single thing that we put into our mouths, and to adapt ourselves to
habits of checking the ingredients and expiration date of every product. It is only in this way that we’ll be able to
discover which ingredients are problematic for us, and it’s only in this way
that we’ll know to guard against them in the future.
Despite the negative viewpoint, you
must never forget that food is one of the greatest joys of life. You have to
discover what you can eat, and to vary your menu as much as possible. If the
menu is not varied and tasty enough, you will lose your appetite and you won’t
eat enough, and worse than that, you will be tempted to find easy and harmful
solutions.
As I mentioned in the chapter in
which I discussed lifestyle, cooking can also benefit you psychologically –
both as occupational therapy and out of a sense that you are taking
responsibility for your health – being proactive for the sake of your health as
opposed to the passivity of taking medication and following the instructions of
the doctors blindly.
Small meals with high frequency
The digestive system of bowel
patients is very sensitive, and therefore should not be overburdened, even if
it’s with healthy, quality food. Give the system small amounts that it can deal
with. Eat a little, but with high frequency. Eating large meals is an unhealthy
custom for any person, and most certainly for bowel patients. In addition, it’s
desirable to stop eating a moment before the stomach is completely full – when
the feeling of satiety is just beginning to appear.
Nutritional Agenda
It’s important to ensure daily
nutritional planning. When you go out of the house for an extended period, it’s
important to take sandwiches or food in a container to avoid as far as possible
arriving at a state of hunger. That kind of situation is dangerous for a number
of reasons. (1) When you are hungry, your judgment concerning what you should
eat becomes blurred. A situation like this increases the chances of giving in
to the temptation of food not prepared at home, or food of lesser quality. (2)
Most bowel patients are not overweight, which means that their reserves are
relatively diluted. Hunger is just one step before bodily collapse. (3) Hunger
tends to lead to a large meal the next time you do eat. And large meals are not
recommended for owners of a sensitive bowel.
The daily struggle over the amount
of food that we consume is extremely important. There is a tendency to eat less
when there is pain and diarrhea, something that can cause fatigue in our
bodies. In accordance with what I said in the last paragraph, I recommend that
you spread the amount of food you eat over the whole day, and not concentrate
it, especially not towards the end of the day. I recommend that you reduce your
eating before sleep, and in this way allow your system to rest and the body to
enjoy a calm sleep without pain and stress. Eat only food prepared at home, but
if you have to eat out it’s important to know exactly where it will be so that
you can avoid disastrous spontaneity. Yes, it’s boring, but the disease loves
routine, and we love life.
We pay for every mistake
You cannot play with nutrition. You
will pay with your health for every wrong decision, even if it’s in ways that
are not immediately apparent. The accumulated damage that is caused to the
system as a result of poor nutrition will also cause you to regret every time
that you gave up when it came to food. Be honest with yourself – know which
food is not good for you and don’t eat it again. There is no dish in the world
that is worth the deterioration of your health.
Let the system rest
The digestive system (yours in
particular) needs rest, especially in light of the fact that it is active for
most of the day. Do your best to calm the system a good few hours before you go
to sleep. About three hours before going to bed it’s desirable to consume
mainly liquids and food that is easy to digest and to prepare the system for
complete rest during sleep. Just as you need rest in front of the television or
with a good book at the end of a hard day, so should you also give your
digestive system a chance to recover from the hardships of the day.
Try on your own
The directive regarding spicy food,
preserved food, or low-quality food is simple – it’s out of the question. The
decision concerning most other types of food is not so clear-cut. All might go
smoothly with a particular food for a particular patient, yet wreak havoc in
the stomach of another. The reason is the complexity of the intestine and the
location of the inflammation which differs from patient to patient, with time,
and even within the bowel of each patient himself. Every patient therefore must
learn which foods are good for him and which are likely to make the state of
the disease worse.
The only way to do this is via
trial and error, but try to ensure that the ‘error” part will be as small as
possible. Introduce an item of any given food gradually and in an isolated
manner into your menu, and check the response of your system in the hours
following the meal. It’s important to take note of every sound and feeling in
your stomach, not to mention of course any diarrhea and pain. In my experience
the real problem of this check is actually psychological. It’s very difficult
for people to admit that a particular food that they love is not good for them.
However, we need to remember that the obligation to discover and research lies
with you, and in order to succeed you have to be honest. It is only through
honesty and awareness of the fact that you have to take that wonderful dish
that you love off your menu, that you will succeed in avoiding a colossal
catastrophe in the toilet after each meal. It is important not to give up on
adding new items to your menu, otherwise it will be difficult to maintain
nutritional discipline.
It’s not just the disease, but the
studies too that are dynamic. It’s very possible that your correct diet will
change over the years. With time and experience you will become your own best
dieticians, and you will know by yourself which foods are good for you and
which you should not eat, and you will even be able to quickly adapt to
changes.
The senses as sensors
Our bodies contain many senses and
we need to learn how to use them. When it comes to food, this is extremely
important, especially for those of us who are the owners of sensitive digestive
systems.
Smell
– You need to use your sense of smell without any sense of shame or guilt.
Smell the dishes that are presented to you, from milk to fish. Using it is
important for example in identifying the early stages of decay in meat, chicken
and fish. Even if it only smells a little bad, don’t eat it, and it doesn’t
matter how prestigious it is. There is only one reason why the food smells bad,
and it’s not such a good one. Your stomach will also be quite resolute on this
issue, believe me.
Taste
– You can immediately feel on the tongue whether a dish is too spicy, too sour
or too hot. The burning sensation in the oral cavity is a warning sign to us
that the food that we are about to swallow in another few seconds is not good
for our bodies.
Sight
– A dish that doesn’t look good testifies to its quality. It’s especially true
when you eat out. Pay attention to the general state of hygiene in the place
(which is usually a reflection of the state of the kitchen), as well as to the
look of the dish that you are getting, of course. Just about every food product can reveal its
condition by its look – freshness, rottenness, level of sterility and so on.
Open your eyes and in time your senses will get sharper.
Start your day gently
After you get up in the morning
it’s desirable to also allow your digestive system to wake up calmly. Begin the
day with a hot drink, preferably tea or an infusion, and move to something
light like a slice of bread or toast. After a few minutes you can continue with
heavier things (but still with care!).
Hot is preferable to cold
On the recommendation of a number
of alternative therapists, I adopted the rule according to which hot food and
drink is preferable to cold. The digestive system responds better to these
kinds of dishes, especially in cases of inflammation and narrowing of the
bowel. It’s possible that this is connected with the fact that heat expands the
blood vessels, and cold shrinks them. I must emphasize that I’m not saying that
you should take cold foods off your menu, only that you should reduce the amount
you consume, especially in cases of active inflammation.
Know the ingredients of every product
Create a habit for yourself: read
the label on every product that you buy, and check what it’s made up of. You
should avoid substances that are not natural like food coloring and
preservatives. Remember that when there is doubt there is no doubt: if you come
across strange names of ingredients that you don’t know, you can safely assume
that they are not natural ingredients, and therefore also not particularly healthy.
The order in which the ingredients appear on the label is also very important.
The ingredient that appears first is the one of which the product contains the
greatest amount; the second is found in a lesser quantity and so on.
Preservatives
There are substances that are known
not to be particularly healthy, and even less so for patients suffering
digestive system problems. Preservatives are among the most prominent of these
substances, and as their name implies, they preserve the food so that it won’t
decay and rot. The problem is that the preserving does not end at the moment of
swallowing, but continues also inside the body causing the food not to be
digested properly. The result is an increase in food residues in the digestive
system. It is therefore recommended to avoid, as far as possible, products that
contain preservatives (pastrami, sausage and yellow cheese, among others).
Beef
This is a sensitive subject for
every lover of beef who suffers from a disease of the digestive system. In meat
there are many essential substances such as iron, protein, B12, and fats that
are lacking in the bodies of many Crohn’s patients. But before these substances
there is an even more difficult problem – meat is simply tasty, and someone who
is used to consuming it on a daily basis will find it hard to part from it. The
problem for Crohn’s patients is that meat is hard to digest, and its passage
through the digestive system requires a lot of time and resources. Moreover,
meat, as it is sold today in all its different forms is very likely to contain
organisms that cause a deterioration in the inflammation. Therefore, and with a
heavy heart, I have to admit that meat is indeed a problematic item on the
menu, and it is desirable to reduce its consumption to a minimum. If you can’t
resist it, at least insist on quality and on small amounts, in particular to
make it easy on the system.
Chicken
People need to eat, and for someone
who has to give up meat on the menu, chicken is not a bad substitute. Chicken
can provide the energy that is lacking for us as patients, while at the same
time being easier to digest than beef. More than that, chicken can be very
tasty – even more so than meat – if you put some effort into it. However,
before you pounce on the nearest chicken run, it’s advisable even with chicken,
not to overdo it. It’s preferable to eat fish, but for those who insist it’s
better to make do with three portions a week, in small amounts (free-range
chicken is preferable, not fried and without side dishes).
Fish
After we have finished with the
negative side of the ten commandments of diet, we can happily move to the
positive side – what is allowed, and even worth eating: fish should be the main
item on your menu. We’re talking about every kind of fish (sea-fish are
preferable), as long as they are fresh and perfectly cooked. Fish is easy to
digest and rich in proteins essential for the body. For the sake of comparison,
the digestion time for fish is on average twice as fast as for chicken, and
five times as fast as for meat. While these figures are true for a healthy
person, the relative ratios remain more or less the same also for ourselves,
the patients. More than that, fish dishes are rich in fish oil that contains
omega 3 (yes, exactly the same supplement from the advertisements, only better
because it comes in its natural form). The omega 3 acids have a hugely positive
effect on the immune system in preventing inflammation in the body and even
cancerous growths. Similarly these acids are responsible for the production of
many balancing substances and processes in our bodies – blood pressure,
temperature, inflammations, welling, pain and so on. Thus, for Crohn’s
patients, there are great benefits in consuming fish, both dietary and medical.
Eggs
I have yet to meet a patient who
claimed that eating eggs caused him digestive problems. As opposed to other
protein-rich foods such as chicken or meat, eggs are usually digested properly
and supplement the missing energy that results from the eating of less chicken
and meat. Even when I have had an acute attack with pain, when every other food
only encouraged the inflammation, the eating of soft-boiled eggs never caused
problems for me. The opposite is true – eggs helped return energy to the body,
and even produced a feeling of fullness. Eggs cooked in different forms are
recommended for your weekly menu.
Milk
For various reasons many people are
sensitive to products produced from cow’s milk. Officially, Crohn’s and Colitis
patients are not described as among these, but in my experience milk is
difficult to digest, and even promotes diarrhea. In Dr Arieh Avni’s book Fools
of Milk [i]
he describes how an organism that is found in cow’s milk causes many diseases,
among them Crohn’s. “I have determined that Crohn’s disease is caused by the
infection in people by the organism MAP, that is found in cow’s milk and its
products.” Also: “Today with sophisticated
methods the organism can be identified in between fifty to eighty percent of
all patients… milk is contaminated by what generates the disease. If you do not
touch milk products – you will not see Crohn’s disease…”
It must be pointed out that no
proven connection has been found in research between Crohn’s disease and the
consumption of dairy products. It is important to know that there is a high
frequency of a lack of lactose [1]
among Crohn’s patients, and therefore, in cases where milk is avoided, it is
necessary to supplement the diet with vitamin D and calcium.
I recommend approaching cow’s milk
and its products with suspicion and trying them with caution. Milk is also
forbidden in the Specific Carbohydrate Diet (see below). For those who are
sensitive there are substitutes in the form of goat’s milk and soya milk (see
also camel milk in the sub-section that deals with alternative medicine). Today
there is a wide range of products that make a good substitute for cow’s milk in
cheeses, delicatessen products, and milk in cartons. It’s easy to find them on
the shelves, and after you try them, you’ll find that most are even more tasty.
Rice
Rice is healthy and nutritious and
helps in stopping diarrhea. It’s recommended not to eat large amounts in one go
and not to eat Brown rice that contains fiber. There are many kinds of rice and
dishes that can be made with it (please note – not to spicy!). Even cooking
doesn’t need to deter you – there is a special Chinese pot that makes it
particularly easy. You can put the rice together with chicken or fish and
thereby enrich the taste. This dish is forbidden for those who choose the Specific
Carbohydrate Diet (see below).
Millet and quinoa
Millet and quinoa are grains that
have a high nutritional value. Millet is particularly rich in iron, while
quinoa is rich in carbohydrates and proteins. Both are very rich in vitamins.
They are very easy to digest and can form a good basis for a menu for anyone
who suffers from a sensitive digestive system. Millet and quinoa are also easy
to cook (simple cooking with water, similar to rice, only without the need to
be exact with amounts and time). They are now available not only in health
shops. This dish is forbidden for those who choose the Specific Carbohydrate
Diet (see below).
Organic or not organic – that is the question
The organic food faithful can skip
this paragraph. For those who don’t know about it, and before taking any
decision as to whether to consume it or not, it’s recommended that you at least
learn about the advantages of organic food. The price of organic food is higher
than for regular food, but the advantages are proportionately greater. Here are a number of points that as patients
you should know:
Vegetables
and fruit – No sprays harmful to health are used in the growing of
organic vegetables and fruit, as opposed to that of regular crop growing. While
it’s frustrating, it’s still important to know that when we consume regular
vegetables and fruit, and pat ourselves on the back, aside from vitamins we are
also putting harmful substances into our bodies. In our case, these substances
are likely to promote inflammation. Apart from the risk, it’s important to know
that the nutritional value of organic fruit and vegetables is higher, and
mostly, their taste is richer too.
Meat and
chicken – The conventional raising of cattle and chickens also suffers
from methods that serve up to our tables products filled with harmful
substances such as various drugs, antibiotics and other matters. These are
intended to fatten the animals and grow them to dimensions beyond their natural
size. If the danger of these substances reaching your table doesn’t convince
you, perhaps the moral argument will (even if you aren’t vegetarian) – during
the process of raising the animals, the conventional chicken and meat industry
causes dreadful suffering to the them, from force-feeding to slaughter. The
organic industry, in its more natural approach, causes a lot less suffering in
terms of this.
Fish
– There are two kinds of fish: marine fish, and farmed fish. As I have
mentioned, marine fish are preferable, in both taste and quality, for one
simple reason – the non-interference in the raising process. (In the farm ponds
they use various substances to feed the fish.)
Milk
– There are those who claim that cow’s milk is less healthy because of the
antibiotics and drugs with which the cows are injected. Goat’s milk, which
contains fewer harmful substances, is therefore recommended.
I am not a fanatic about organic
food, but I definitely do my best to consume it as much as I can. For those who
don’t consume organic food, either for economic reasons or because they don’t
know about its advantages, I recommend at least broadening your information on
the issue, and to try out and include organic products out on your weekly menu.
Vegetables in forms you did not know
Vegetables can cause problems
because of the fibers which make them up. Foods which contain fibers may
scratch the interior of the bowel and cause pain and feelings of discomfort.
Having said that, integrating vegetables into your daily menu is very
important, mainly because of the vitamins they contain. Here are some ways to
consume vegetables in a manner that makes it easier for patients who suffer
from inflammation of the digestive system.
Eat little
– Few people who have a sensitive bowel are able to eat a large salad and not
feel that they are going to explode immediately afterwards. Therefore, if you
are not prepared to give up fresh vegetables add a different vegetable each
time to your meal. When it comes to dressings, incidentally, it’s worth giving
them up completely. It’s possible to make do with a little olive oil.
Preferably
cooked or steamed – Cooked or steamed vegetables are very easy to
digest, and they still maintain a nutritional value similar to that of fresh
vegetables. The taste may not suit everyone, but whoever can adapt and persist with
it will reap great benefits for their health. It’s desirable to try different
forms of cooking and steaming – the investment will pay off. If you can’t eat
cooked vegetables, it’s desirable that from time to time you have a soup that
is rich in vegetables (without soup powder and with some chicken to improve the
taste).
Spraying
– Most vegetables are sprayed with substances that kill not only harmful
organisms, but us as well. It’s very important to wash vegetables thoroughly.
Getting rid of the peel can help to a degree, as well as ease the digestive
process. For those who are willing to make the effort, it’s recommended to move
to organic vegetables.
Vegetable
juices – This is a fantastic way of supplying the body with the vitamins
that go to make up vegetables. There are quality appliances that are made
especially to separate the juice from the fiber and enable you to gulp down
juice that is pure health. It’s important to drink the juice soon after
preparing it to take advantage of its full nutritional value. Chef’s
recommendation: carrot juice with a little beetroot that provides lots of iron.
Not
recommended – certain vegetables that are considered acidic such as
tomatoes, eggplants and peppers.
Fruit
As with vegetables, eating fruit is
important mainly because of the vitamins, but is dangerous because of the
fiber. Citrus fruit, for example, is completely out of the question in this
regard. Here too an appropriate solution is to drink home-made juices that do
not contain fiber and maintain the nutritional value of the fruit (for example
those that have been squeezed in machines that filter out the fiber). If you’re
having fruit, do your best to eat those that are less acidic and that contain
less fiber.
Dietary fiber [2]
Dietary fiber is that part of the
plant that the body does not digest. It arrives at the large intestine where it
is fermented by bacteria. Dietary fiber has no nutritional value and lacks
calories, and therefore provides no energy at all. It’s possible to distinguish
between two main groups of fiber: the insoluble and the soluble.
Insoluble
fiber has an outstanding capacity to absorb water, and thus increase the
volume of the feces and facilitate their exit. It also limits the mobility of
the intestine, shortens the time taken for the passage of food through it and
exerts pressure on its walls. It’s therefore clear that patients who suffer
from Crohn’s disease or patients who suffer from narrowing with a background of
intestinal scarring must exclude this fiber from their menu.
Foods rich in insoluble fiber:
·
Vegetables: cabbage,
cauliflower, broccoli , celery, kohlrabi, peels of fruit and vegetables
·
Whole grains: brown rice,
whole wheat, bran, corn
·
Seeds: walnuts, almonds and
peanuts
Soluble
fiber, as opposed to these, inhibit decomposition and the passage of
food through the digestive system, and extend the feeling of fullness. They are
able to absorb toxins, excess bile, cholesterol, carcinogenic substances, and
even remove them from the body. They also slow down the absorption of sugar in
the blood.
Foods rich in soluble fiber:
·
Fruit: apples, bananas,
pears
·
Vegetables: zucchini, carrots,
pumpkin
·
Pulses: chick peas,
lentils, dried beans, dried peas, broad beans and soya beans.
·
Oats
Dishes rich in fiber such as fruit
and vegetables, contain soluble and insoluble fiber in varying proportions. It
is therefore advisable to avoid all fiber-rich foods when there is active
inflammation, and to try to include them in your daily menu later on if the
inflammation allows it.
Pre- and Probiotics [3]
In the digestive system there are
friendly bacteria that inhibit the action of undesirable microorganisms, and
that improve the breakdown of food and its digestion. These are called
probiotic bacteria. There are several types of probiotic bacteria, and each
part of the digestive system has its own different types that are capable of
existing in it. During antibiotic treatment, and even after it, these positive
bacteria can be harmed. They are also likely to be harmed in cases of preparation
for a colonoscopy, operations on the digestive system, and frequent diarrhea
and vomiting among other things. Today there are two main approaches in
maintaining a balance in positive bacteria:
The first is
the probiotic approach – the consumption of a food supplement or food
that contains live microorganisms (usually bacteria) that have a positive
action and ability to break down food. Yoghurt is an example of a food that is
rich in positive bacteria. It is important to match the food or the supplement
to the area of the digestive system that we want to strengthen – that they
contain the same type of probiotic bacteria. The problem with this approach is
that most of these bacteria do not survive the acidity of the stomach.
Therefore, in order that a certain amount will reach the areas (such as the
bowel) that need them, you need a large amount of bacteria.
The second
approach is the prebiotic approach – the consumption of food or
supplements that contain ingredients that are not digested, such as dietary fiber,
that encourage the growth and thriving of friendly bacteria in the bowel.
There is research that points to
probiotic bacteria aiding in maintaining remission in Colitis. There is no
evidence that these bacteria directly help in suppressing Crohn’s disease, but
it is important to maintain them at proper levels. This is because their
positive action is essential to the proper functioning of the digestive system.
Because dietary fiber is not desirable for those with a sensitive bowel, you
should adopt the first approach and consume food that is rich in bacteria such
as yoghurt (preferably made from goat’s milk) on a daily basis to maintain
normal numbers of the bacteria.
Snacks and munches
This is a subject that hurts. One
of the most difficult things is giving up snacks and munches when you’re
watching a game on TV, or giving up popcorn at a movie. Experience shows that
there is no option. None of these snacks contributes to your general condition
and can even mean the beginning of the next attack. The reason apparently lies
in the fact that most of them are saturated with oil or that they are not made
with nutritious ingredients (particularly in the case of snacks). If you cannot
manage, and sometimes slide into sin, it’s preferable to deal with baked snacks
like pretzels, with as little oil and spices as possible.
Dried fruit
I have often been urged to eat
dates and figs with the claim that they have a high nutritional value and that
they have energy-giving natural sugars. Even one of the Chinese therapists that
I had recommended dates, that according to him could suppress the inflammation.
After I chose to begin the Specific Carbohydrate Diet I discovered dates as a
source of energy and as a good substitute for sweet foods that contain sugar.
Sweets
The sweeter and more complex a food
is, the more problems it causes. This is particularly true with heavy cakes
that contain cow’s milk, white sugar and other ingredients that can stimulate
the inflammation. As one who doesn’t like sweet tastes it was not especially
difficult for me to give these things up. I’m sure it’s not at all that easy
for many others. Despite the difficulties, however, it’s desirable to reduce
your consumption of sweet foods as much as you can and to check out a graduated
system of smaller and smaller helpings of those that are digested properly as
well as those that are not. Remember that your health comes first.
Bread and pasta
Most bowel patients who take all
forbidden items off the menu are usually left with bread as the main component.
There are many kinds of bread. The simplest is white bread. Every alternative
therapist will tell you just how bad it is, and just how much it promotes
inflammation. I’m not at all sure that many patients will agree with this
statement, but in any event it worth checking it yourself. The main alternative
to white bread is whole meal bread. This bread is problematic for us, of
course, because of the large amount of fiber that it contains. You should
therefore try any other type of bread that doesn’t contain a large amount of
fiber on the one hand, but is not white on the other, such as spelt bread (you
can find spelt in health food stores – baking bread is an experience that even
people who are not ill appreciate). With every bread purchase it’s advisable to
pay attention to the ingredients: Sometimes what seems like whole meal bread or
spelt bread can in fact contain white flour mixed with buckwheat. I’d like to
add that for sensitive people it’s advisable to eat the bread as toast to make
it easier on the digestive system. By the same token, pasta that is not made
from white flour is also recommended. Pasta can indeed be a good source of
energy, but the quality of the pasta is also important to ensure easy
digestion. For those who choose the Specific Carbohydrate Diet (see below),
this food is not permitted.
Sugar
The claim is that white sugar is
not healthy because it is processed. Various nutritionists even claim that it
promotes inflammation, although this has not been proven in research. In any
event it won’t hurt to move to brown sugar (real, and not the “colored” kind
that is offered in most coffee shops). In addition, there are natural candies
that make use of sugar substitutes such as stevia (which doesn’t sweeten enough
to my taste), or molasses, an extract of sugar cane, and with the value of pure
gold. The substitute that I prefer is honey.
Tea or coffee
Generally it’s preferable to drink
hot drinks rather than cold. Herbal tea is preferable to coffee, which contains
caffeine, and for most, also milk – especially if it’s a caffeine-free infusion
which helps to calm the stomach. Anyone who is prepared to go beyond the
sachets, can buy the loose herbs for infusing, or can grow them themselves in
pots. A recommended infusion is from the chamomile plant, which in high
concentrations is a great help in calming the digestive system.
Cola
In the past I used to drink nothing
less than a liter and a half of cola a day. It was difficult for me to admit
the distressing fact that I was addicted. I wouldn’t be telling you anything
new if I detailed here the harm that is likely to be caused to any person by
the acidity, the caffeine, the sugar and the rest of ingredients that are to be
found in this wonderful and cursed drink. Even from my addicted perspective
cola has the most problematic characteristics. Patients with a sensitive
digestive system who constantly drink cola find it particularly difficult to be
rehabilitated because cola is an available source of energy, tasty, and
comfortable mainly during periods of diarrhea. Heavy diarrhea causes
exhaustion, and patients will seek easy sources to supplement the energy they
lose. In cases like this, cola is a very bad solution. Only after you’ve
stopped for some while do you understand just how much your stomach has not
been calm, and how easy it is to develop a dependency on the amount of sugar
that there is in cola. The perfect solution would of course be to move to
water, although for people who are addicted (there is no easier word) as I was,
the change can likely to be too sudden. Begin perhaps with raspberry juice – it
also contains sugar but it is not acidic and does not contain caffeine. In any
event, during times of diarrhea it’s important to increase the amount you drink
so that you do not become dehydrated.
Alcohol
Alcohol is not recommended for
patients with inflammatory bowel disease. For those who nevertheless choose to
drink, it’s preferable not to drink cheap drinks, or those that are too harsh.
High percentages of alcohol are likely to stimulate anyone’s digestive system.
It’s desirable, therefore, to be careful.
Powders and ready meals
As I’ve mentioned, our disease is
not for lazy people. In order to get quality products that don’t come already
prepared in packages needs time and effort. You should just stay away from the
different powders of soups and meals, and from every food that comes ready from
the supermarket (all the various frozen schnitzels). Apart from the fact that
fresh food is both healthier and tastier, you can’t exactly know what a ready
meal contains. Don’t be lazy – it will pay off in the future. Every minute you
save with the help of ready meals will cost you an hour in the bathroom.
Pomegranate juice
Pomegranates are rich in iron, and
without the seeds they are also relatively easy to digest (if a little acidic).
I warmly recommend organic pomegranate juice that is a hundred percent
pomegranate. It’s an excellent daily nutritional supplement, especially for
patients who suffer from a lack of iron. You can find the juice at organic
stores throughout the year. Those who are sensitive to the acidity can dilute
the juice with a little water. In the last few years pomegranate juice has been
found to have anti-inflammatory properties, and hence has the capacity to help
those who suffer from chronic inflammation to cope with their disease.
Supplements and additives
In cases where the food is not
absorbed as it should be the attending doctor might recommend food supplements.
Food supplements are important in restoring to the body what it lacks in
vitamins and minerals, even those that don’t appear in blood tests. Only if we
balance the body nutritionally can we help it to better fight the inflammation.
It’s important to consume only those products that the doctor has recommended,
and not to be tempted by the various supplements that are not suited to the
intestines of Crohn’s patients. It’s important to note that the supplements
that we don’t consume don’t cause stomach pains or deterioration of the
inflammation. And be sure to check that they are indeed absorbed properly. It
is important to match the supplement you’re getting with the current state of
the inflammation. A supplement suited to a state of calm, can cause problems
with a state of active inflammation. In severe cases in which the patient does
not manage to achieve nutritional balance, it’s possible to give nutritional
support with an enteral feeding regimen. An enteral feeding regimen means
balancing by means of broken-down food constituents.
Enteral feeding formulas are
divided into protein and fat constituents. Research has shown that enteral
feeding is efficient in inducing remission in Crohn’s in fifty to seventy
percent of active flare-up cases [4].
In cases where the patient’s bowel does not function, the digestive system is
bypassed by means of an intravenous infusion that supplies the nutritional
constituents that the patient needs. As you might expect, this method brings
with it serious side-effects, and is recommended only in extreme cases.
Guidelines for the chef
Forbidden ingredients:
·
Hot foods or foods that
have too many spices
·
Reduce fiber-rich food such
as vegetables and fruit. You can use them in combination in low doses
·
Brown rice and bread that
contains fiber
·
Beef that is difficult to
digest
·
Any low-quality food such
as preservatives, food colorants, powders
and ready foods
·
Fried foods rich in oils
·
Reduce cow’s milk products
·
Reduce foods rich in pulses
such as chick-peas and beans. You can use them in combination in low doses
·
Reduce eggplants and peppers
·
Reduce the use of hard cheeses in order to ease
digestion
·
Reduce sweet foods and
sugar
Permitted ingredients:
·
Baked or cooked foods
·
Cooked vegetables
·
Eggs – organic is
preferable
·
Chicken – not in large
amounts
·
Fish – not in large amounts
·
Goat’s milk, goat’s milk
yoghurt and soft cheeses
·
Honey
The following ingredients are
allowed but are not part of the Specific Carbohydrate Diet:
·
Fruit and vegetables that
are low in fiber such as sweet potato, garlic, pumpkin, zucchini, artichokes,
carrots, potato and more
·
Bread and pasta –
recommended, but only if made with flour that is not white such as spelt
·
White rice
·
Root vegetables
·
Soya
In addition to your current diet
it’s important keep up a constant monitoring according to various parameters to
ensure that there is no suspicion of malnutrition. With children it is
especially important to monitor height and weight. You need to do blood tests
in order to identify nutritional deficiencies, especially of iron and vitamin
B12, and to bring their levels up with food supplements, injections or
transfusions when necessary. Balancing the diet for a Crohn’s or Colitis
patient is not a simple matter. Even with mentoring (which doesn’t exist for
most people) it is difficult to balance the digestive system, especially in the
case of active inflammation. However, it is important to remember that the hard
work pays off. A patient in the right nutritional state will deal better with
the inflammation, experience fewer difficulties in daily activities, and will
maintain a normal bodily condition. You should take your diet as seriously as a
prescription medication – a correct diet is your real medication.
The Specific Carbohydrate Diet – SCD
The Specific Carbohydrate Diet or
SCD is aimed at patients with inflammatory bowel diseases, those diseases
affects the intestinal wall, and as a result of which the bowel has
difficulties in breaking down disaccharides and multi-saccharides that remain
in the bowel and comprise a substrate in which bacteria grow and cause
additional harm to the intestine.
The diet was developed by Elaine
Gottschall, a clinical dietician and bio-chemist whose daughter was diagnosed
as a Colitis patient. Despite intensive drug treatment her condition
deteriorated until Elaine moved her to the Specific Carbohydrate Diet. Within
two years the symptoms from which the girl had suffered disappeared. After a
few years she returned to a normal diet and her health continued to be
excellent. Following that, Elaine researched the diet and published her results
in a book Breaking the Vicious Cycle.
Many patients have said that the
diet has helped them, although the research results are not definitive for all
patients. The diet is not an easy one, but patients who have achieved a state
of calmness have returned to a normal diet after a few years.
With this method you need to avoid
foods that contain disaccharides and multi-saccharides, which means that you
can’t eat foods that contain the flour of any grain whatsoever – corn, potato,
sugar, rice, chick-peas, pulses, soya and more. You are allowed to eat the
following: honey, eggs, fruit and vegetables, meat, chicken and fish and types
of nuts (you can for example prepare cakes with almond or walnut flour).
You can find the full list of what
products are allowed and what are not on the internet. The name of the book is Breaking the Vicious Cycle. The Specific
Carbohydrate Diet, by Elaine Gottschall. The site is www.breakingtheviciouscycle.info
.
[1] Lactose – the sugar that is found in milk
– www.answers.com/lactose
[2]
Nutritional fiber: www.webmd.com/diet/fiber-health-benefits-11/insoluble-soluble-fiber
[3] Probiotics:
www.webmd.com/digestive-disorders/tc/probiotics-topic-overview
[4] “Ten
years” experience with an elemental diet in the management of Crohn's disease. K
Teahon, I Bjarnason, M Pearson, and A J Levi –
www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1378738
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