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Pamela A. Duncan, MS, RD, LDN

Dietitian III, IBD Clinic, Vanderbilt University Medical Center

Q: My friend's son is 14 yrs old and was recently diagnosed with Crohn's disease. He is constipated. What type of diet would best suit him?

A: Because it is a recent diagnosis, there is likely inflammation in the intestine, rather than remission. The amount of inflammation in the intestine can be determined by medical tests (labs, endoscopy, etc.) and will help us decide what diet is recommended for him. A diet that is lower in fiber including refined grains, cooked vegetables and soft fruits without seeds and skins is recommended when there is inflammation, because fiber is irritating. The doctor can recommend a (non-fiber containing) medication to help with the constipation until the inflammation is improved. Once a patient is in remission, we encourage a gradual increase in fiber to a Moderate Fiber diet which would include whole grains and more variety of fruits and vegetables. hide answer

Q: I am 20 and was diagnosed with mild Crohn’s this summer. I am on Mesalamine (highest dose) and also currently on Budesonide for 8 wks. to get over my flare. I’ve been researching diets and lifestyle changes so that I can try to feel my best. I started trying to go completely gluten free, but is that even necessary? I have read so many different opinions on diets etc. I have been buying organic and cleaner foods but not sure what to do!

A: The overall goal with IBD is to move to remission. This does best with a combination of medication and diet, but diet does not alone enable remission. There is no research with Crohn's & Colitis patients supporting the need to avoid gluten or dairy in the diet, but many feel better with lactose free dairy products or lactose free plant milks. There are many refined grains that can be helpful to improve symptoms and some contain gluten i.e. white toast and white pasta and some do not i.e. white rice and white potatoes, so I agree that going gluten free is not necessary. Budesonide is a medication prescribed to reduce inflammation and fiber is irritating to the intestine, so a diet lower in fiber including refined grains, cooked vegetables and soft fruits without seeds and skins is recommended until weaned off budesonide. Within a lower fiber diet, choose less high fat or spicy foods, and limit or avoid drinks with caffeine, sugars or sugar free additives. Cooking at home rather than eating meals out enables you to know what was added to the food and is a better choice most often. When tests have confirmed remission, then gradually increasing fiber in the diet with whole grains, and more variety of fruit and vegetables is recommended. hide answer

Q: I was diagnosed with ulcerative colitis in 1984 when I was 14 and in 2004 had a total colectomy. My small intestine was reattached and I now have a J pouch. Since 2007 I am constantly battling intestinal blockages and dehydration. What are some things I can try with my diet to keep this from occurring so often? Is there a specific diet plan I should be following or things I should be eating that I am not currently taking? What is a good diet plan for dealing with this issue?

A: A J pouch often can result in increased trips to the rest room which can result in dehydration. Consuming adequate fluids daily which are not high in sugar are beneficial. Oral rehydration solution contains added salt and may be helpful for maintaining hydration. It can be purchased ready-to-use and there are many recipes available on the internet listed with the Ostomy Association. Secondly, intestinal blockages require a diet very low in fiber which includes foods that are very easy to digest from all food groups: protein, refined grains, soft fruits and vegetables without skins or seeds and foods with Calcium. Once you are staying well-hydrated, you may be able to increase fiber, but I would check with your doctor first and then seek care from a Registered Dietitian to help you put this into practice. hide answer