Liquid diet for colitis

Is a Liquid Diet Right for Your IBD?

When a flare hits, corticosteroids are often the first line of treatment for adults with Crohn’s and ulcerative colitis. However, while corticosteroids can induce remission, they also have the potential for unpleasant side effects – causing some people to search for alternative remedies. One alternative remedy constantly in question is diet. But is it possible to get similar results and relief of inflammatory bowel disease (IBD) by changing your diet? Research suggests that it’s worth a look.

While corticosteroids are effective for many adults with Crohn’s, the first line of treatment for children with Crohn’s is often exclusive enteral nutrition therapy (EEN) — nutrition provided in liquid form. EEN therapy isn’t the first line of treatment for adults other than in Japanese populations, according to a study in the November 2013 “World Journal of Gastroenterology.” Though early studies showed that adults don’t adhere well to the therapy, the study’s findings conclude that newer nutritional formulations may make elemental liquid diets more successful for some people and may be even more beneficial than corticosteroids.

Understanding Liquid Diets

When most people hear the term “liquid diet,” they typically envision common foods found in the grocery store that are either in liquid form or a consistency that becomes liquid — juices, soups, Jell-O, meal replacement drinks, and the like.

A standard liquid diet is beneficial if you need to temporarily give the digestive system a rest, says Karen Langston, CN, a certified holistic nutritionist and therapeutic lifestyle educator and director of nutrition and program development at Sanoviv Medical Institute in Baja California, Mexico, who has Crohn’s herself. “It can be used for those who are suffering with vomiting or diarrhea or as an introduction to eating solid food. This type of diet is also recommended in a hospital setting for those who have had surgery, are coming off an elemental diet, or as preparation for a test that requires no solid foods,” she adds.

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An elemental liquid diet is sustenance that consists of protein (broken down into amino acids), easily digestible vitamins, minerals, carbohydrates, and small amounts of fats, Langston says. The type of elemental diet used and the method of administration depend on the specific nutritional needs of the individual and his or her ability to absorb nutrients. Some people can drink the fluid. Others require a feeding tube placed directly into the stomach or intestine — this is called enteral nutrition. If the gastrointestinal tract cannot be used as the entry point because of an intense flare or other reason, an elemental diet is administered via a thin catheter inserted into a large vein in the chest, arm, or neck — this is called parenteral nutrition.

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The Benefits of Liquid Diets

A liquid diet allows for an inflamed bowel to rest and heal. “It will reduce bowel movements, reduce the bulk to allow the colon to rest, which can be a relief to some who may go to the toilet 20 to 30 times daily,” Langston says.

When poor digestion and malabsorption are concerns, you may need elemental nutrition because the nutrients are more easily absorbed, Langston says. This diet is beneficial for those with short bowel syndrome or individuals who have had intestinal surgery, she adds.

The “World Journal of Gastroenterology” study found that in addition to avoiding the adverse effects of corticosteroids, EEN therapy in children with Crohn’s led to:

  • Higher rates of mucosal healing
  • Greater weight gain
  • Decreased disease activity
  • Reduced inflammation
  • Improved bone health
  • Better quality of life after treatment

The Risks to Consider

If you’re wondering whether a liquid diet is a viable solution, start by speaking with your doctor and your nutritionist. Not only are liquid diets difficult to maintain for an extended period of time, there are also potential risks associated with them. Here are important considerations:

Will you be getting the nutrition you need? It’s important to maintain a healthy weight and to eat nutritious food to stay healthy. Many foods commonly found on the list for the standard liquid diet are filled with preservatives, additives, fillers, and coloring agents. Processed foods often have a lot of sugar, which can drain your body of energy and lead to blood sugar issues, Langston cautions.

One concern with an elemental liquid diet is that, while the solution provides essential nutrients, it may not contain all necessary vitamins and minerals, Langston says. Further complicating matters, some people lack the enzymes necessary to convert synthetic nutrients and so may not reap the benefits of the nutrients in the formula.

How will your body respond to the ingredients in an elemental diet? Elemental products may contain sugar, artificial flavors and colors, and soy- or casein-based proteins, Langston says. People with diabetes or food sensitivities or allergies need to be aware of what’s in the products they use. Clear communication with your doctor and nutritionist is necessary to prevent an adverse reaction.

Can you take proper care of a catheter? If your doctor prescribes an elemental diet administered intravenously, it is essential that you properly care for the insertion site to prevent infection. Inspect it daily to check for any redness, swelling, or leakage. Also, catheters must be carefully maintained to prevent clogging.

13 Ridiculous Facts About Poop That’ll Make You Sh*t Your Pants

You know coffee makes you poop. You know poop shapes are important, tracking your bowel movements is a thing now, and sometimes poop can be green.

But even if you’ve been dropping logs your whole life, there’s a lot of weird and wonderful facts you might not know about feces. Here are some of the craziest things we’ve found.

There’s a phenomenon that makes people have to poop upon entering a bookstore

There’s something so calming, so relaxing about bookstores: the smell of fresh ink and paper, the quiet atmosphere, the raging urge to run to the bathroom and drop a deuce. Maybe it’s the coffee you downed from the requisite cafe, but people getting the urge to poop in bookstores is a rather common phenomenon.

So common, in fact, it has a name: the Mariko Aoki phenomenon. The name comes from a Japanese woman who first described the feeling in 1985. While there’s no real clinical definition of the condition, or any established causes, there are a few theories about why people suddenly have to poop after browsing the latest YA fantasy novels: The smell of ink or paper could have a laxative effect, people associate reading in bookstores with reading at home on the toilet, and the posture you have while you’re looking at books is prime for taking a dump.

Sounds super-legit, right?! The Mariko Aoki phenomenon isn’t in any medical literature, obviously, but there are plenty of different people who experience this urge, enough to make it a veritable phenomenon.

Lots of poop can spontaneously combust

If you’ve ever been the victim of the ole light-a-bag-of-shit-and-leave-it-on-the-doorstep prank, then you know a pile of poop somehow smells even worse when it’s aflame. It turns out that you might not even need a lighter to pull this off; on a record-hot July day in 2016, a huge pile of horse manure spontaneously caught fire in upstate New York. How lovely for residents in all the neighboring towns!

The conditions were just hot and dry enough to have the massive pile of shit catch fire, sans spark. All that a fire needs is the proper mixture of heat, oxygen, and fuel, which the horse manure unfortunately had. Although there aren’t any recorded incidents of this happening with human feces — why would there be huge piles of human poop just baking out in the summer heat anyway? — hypothetically, if the conditions were just right (or wrong?) enough, it could.

Speaking of fire… you can start one in your colon

Your GI system thrives thanks to a collection of healthy bacteria. These bacteria ultimately produce gas, which is why you fart all the time. If one of those gases happens to be hydrogen sulfide, this can spell disaster during a colonoscopy procedure.

Gastroenterologist Urvish Shah explains that when someone is getting a polyp removed from the colon, it’s usually burned off with a cautery. With an abundance of gas, however, the cautery can spark, resulting in a brief flame.

“If the person has too much hydrogen sulfide in and if you are using cautery to cut the polyp… it can happen,” he says. Yikes! Luckily, this fire-in-your-ass situation is incredibly rare. He’s only ever heard about it, and never seen it in practice.

It’s possible to poop out of your mouth

It’s called fecal vomiting, and aside from being utterly disgusting and terrifying, it’s an indicator of a major health problem. Though if you’re vomiting your own poop, you probably know you have a major health problem. When people have a blockage in their small or large intestine, known as an intestinal obstruction, waste can’t travel to the rectum.

“If you have an obstruction generally in the lower small intestine or within the colon, you can eat food but it has nowhere to go,” says Dr. Ben Dalton, gastroenterologist at the University of Tennessee Medical Center. “Eventually, you hit a critical mass and if it cannot get out from the south, it’ll come out the north.” That means you will vomit fecal matter; it probably won’t look like regular poop, but it’s as disgusting as it sounds.

Fecal vomiting is usually accompanied by abdominal pain, dehydration, and constipation, and untreated blockages could lead to death. Fortunately, Dr. Dalton says this is pretty rare.

Your poop is full of fat, bacteria, dead cells, and more!

Turds (usually) slide nicely out of your digestive tract because they’re made mostly out of water, about 75% percent. Of the 25% that’s solid, the biggest component is bacteria, with the rest being a mix of indigestible food matter, fat, inorganic substances, and protein. Your poop is (usually) brown because of the way bacteria work on bilirubin, a pigment in bile that’s the end result of dead red blood cells. So there’s a lot of dead stuff and bacteria in your crap.

There’s millions of dollars in silver and gold hiding in poop

One of the fortunate results of modern sewage systems is that you don’t have to use outhouses. One of the unfortunate results is that a bunch of precious metal winds up in the sewage, incapable of being put to good use.

Scientists presenting to the American Chemical Society last year said that there are tiny fragments of metal everywhere — beauty products, deodorant, even socks — that wind up literally flushed down the drain. Metals like gold, silver, platinum, and everyone’s favorite, vanadium, are present in commercially viable amounts in poop. One estimate calculated that the shit of 1 million Americans may contain $13 million in metal. All someone has to do is go get it.

Even if you don’t eat, you’ll still poop

Sure, some foods make you poop more than others, and it can take on the color and texture of your latest meal. But even if you don’t eat anything, you’ll still need to take a dump. That’s because poo is made up of more than just the food you ingest.

“If you don’t eat, you can still have feces because the body produces secretions. Juices from the pancreas, intestinal lining, bile, gastric juices, all those juices are mixed together, that produces the liquid stool that empties from the small bowel into the colon, which is the large bowel,” Dr. Shah says. “And the large bowel’s function is to absorb all the water from the feces. That’s why the feces that comes out of the rectum is really solid.”

There’s poop on the moon

One giant leap for bowel movement-kind? When the Apollo astronauts wanted to take back some moon rocks as souvenirs, they had to make some room on the spaceship to accommodate the weight. That meant letting go of some waste — 96 bags, to be exact, of poop, pee, and puke. Although it makes total sense, it’s an unfortunate discovery for the next group of astronauts or Martians who make a moon landing. Although the smell on the moon probably isn’t nearly as bad as it is on a hot July day on Earth…

Poop transplants are a thing

Thanks to poop transplants, people suffering from Clostridium difficile infections — when healthy bacteria in the gut die off, often as the result of antibiotics, and C. diff takes over, causing bad GI symptoms like raging diarrhea or life-threatening inflammation of the colon — can finally find relief.

The process, although potentially life-saving, sounds pretty gross. Doctors take fresh poop, blend it into a slurry, and inject it into patients, usually via colonoscopy. Or, you can straight-up just eat the poop… sort of.

“A patient ingests somebody else’s poop,” Dr. Shah says. “Now, they’re making it into pills. And it’s very effective.”

About 90% of people who get them are cured of their C. diff infections, compared to only 26% from medication. Thanks to its wild success, doctors are looking into using poop transplants for other GI issues, such as IBS or ulcerative colitis. Poop — saving lives, one transplant at a time.

You can grow full plants from undigested seeds in your poop

Not everything you eat gets completely digested; this is why you can sometimes see little kernels of corn in your turds (fun fact: it’s not the whole kernel, just the outside layer that isn’t absorbed). The same thing goes for tomato seeds, as evidenced by this whole tomato plant grown out of human poop.

Another tomato plant was discovered in a pile of feces on Surtsey, a volcanic island in Iceland, which begs the question: What else can be grown out of human poop? Watermelons? Lemons? The possibilities of a poop produce farm seem endless.

You can drink poop

Well, technically you can drink water taken from poop, but it’s basically the same thing. Not to worry; Bill Gates gives his stamp of approval for the Omniprocessor, a machine that takes human waste, extracts water, and sanitizes it to be used for drinking and to power electricity. Gates hopes this will solve the sanitation and contaminated drinking water problems poor countries face. And if the billionaire tech mogul says the water is just as good as bottled water, it must be legit. He did drink it himself, after all.

There’s a name for people who willingly eat poop

They’re called coprophagics, which comes from the word coprophagy: the eating of feces. Although loads of animals do this too, it’s most alarming in humans. The act of coprophagy is (you’re not going to believe this) usually an indicator of a mental or developmental disorder. Doesn’t exactly take a psychiatry degree to sort that one out.

A 19-year-old man in South India was brought in for a psychiatric evaluation after he was observed eating not only his own poop after defecating, but also the poop of goats, cows, and dogs. Looking to possibly treat coprophagia, scientists studied a 6-year-old girl who enjoyed eating, smearing, and playing with poop so much, the researchers recreated a less toxic copycat version of poop made from flour, water, and food coloring. The little girl still loved playing with and eating it.

Human poop could be the power source of the future

Imagine if “gassing up” meant literally using poop to fuel your vehicle. That eco-friendly dream is now a reality in Bristol, England, thanks to a bus that’s run entirely on household and human waste. It’s powered by biomethane gas, which is created from sewage and food waste, collected from local households.

Although there’s only one bus running at the moment, it’s a pretty genius idea — and riders swear it doesn’t smell!

Turns out, poop is more than just the smelly stuff in your toilet bowl and the inspiration behind your favorite emoji; it can save lives, power buses, create safe drinking water, and has even been to the moon. So maybe show your feces a little respect: Next time, instead of just flushing it down the toilet like some ungrateful human, donate it to someone in need, or use your turds to grow tomato plants in the backyard. (OK, maybe that’s taking it a little too far.)

Diarrhea and Diet

What is diarrhea?

Diarrhea is defined as the frequent passage of watery, loose stools, accompanied by an excessive loss of fluid and electrolytes. Another standard definition of diarrhea is passing more than three liquid bowel movements daily, or more than one litre of stool from an ileostomy or colostomy per day. Diarrhea occurs because the contents of the gastrointestinal tract are moving too rapidly, causing less fluid and nutrients to be absorbed.

What causes diarrhea?

Diarrhea is classified into four categories: osmotic, secretory, exudative, or rapid intestinal transit diarrhea.

Osmotic diarrhea is caused by the presence of solutes in the gastrointestinal tract that are poorly absorbed and produce an osmotic effect. The osmotic effect is the movement of water from low solute concentration to high solute concentration. The causes of osmotic diarrhea may be lactose intolerance, fat malabsorption, dumping syndrome after gastric surgery, or certain medications (i.e. hypertonic or sorbitol-containing liquid medications).

Secretory diarrhea occurs when there is an over secretion of water and salts in the intestine, which is caused by bacterial toxins (Clostridium difficile, E. coli, etc.), caffeine, viruses, or increased bile acids following an ileal resection.

Exudative diarrhea is associated with damage to the intestinal mucosa, leading to the release or oozing of mucus, blood, and plasma proteins from cells as result of inflammation or injury. This increases the fluid content of feces and is present in ulcerative colitis, Crohn’s disease, or radiation enteritis.

Finally, rapid intestinal transit diarrhea is defined as an increase in propulsive activity in the colon. When the colon contracts more intensely than normal, food is passed more quickly through the digestive system and less water is absorbed back into the body, making the stool too watery. Causes of this type of diarrhea are irritable bowel syndrome, surgical bypass, gastric and intestinal resections, antibiotics, or stress.

How can diarrhea be prevented?

Prevention of diarrhea depends on the underlying cause. If medications are causing a person to experience diarrhea, an alternative form (i.e. tablet instead of sorbitol-containing liquid) or type of medication should be explored, especially when diarrhea is chronic. Some people who are malnourished or on bowel rest, may experience diarrhea for the first few days when starting to eat again because the bowel wall’s ability to function decreases when it is not used and resumes normal function slowly. Consult your physician to determine the underlying cause and treatment for your diarrhea, especially if there is any associated pain, blood, or distension.

Dietary Recommendations for Diarrhea:

  • Drink 8-10 cups of fluid per day, like water, broth, half-strength juice, weak tea, or electrolyte replacement drinks.
  • Eat small frequent meals slowly during the day.
  • Try sources of soluble fibre to help firm up stool.
  • Limit fried or fatty foods since these can worsen diarrhea.
  • Some high fibre foods may contribute to diarrhea.
  • Foods with lots of sugar may worsen diarrhea, such as regular pop, candy, large quantities of juice, and chocolate milk.
  • Some people may become temporarily lactose intolerant when experiencing diarrhea (so can benefit from lower lactose choices, such as cheese, yoghurt, Lactaid® milk or Lactaid® pills).
  • Consult your physician to determine if an anti-diarrheal medication is suitable for you.

The following foods may be better tolerated:

Fruits and Vegetables Applesauce, apples, bananas, peaches, apricots, canned pears, grapefruit, potatoes, melons, squash
Breads and Cereals Oatmeal, oat bran, white rice, plain noodles, white bread/bagels, crackers, cream of wheat, arrowroot cookies
Protein foods Cheese (especially low fat), yoghurt, eggs, lean fish, beef, pork, skinless poultry

Foods to limit:

Fruits and Vegetables Prunes, prune juice, berries, dates, any dried fruit, figs, rhubarb, green beans, wax beans, peas, Brussels sprouts, corn, broccoli
Breads and Cereals Whole wheat, bran products, Shreddies, Mini Wheat, Raisin Wheat, Shredded Wheat, Bran Flakes, bulgur, Wheetabix, All Bran, Bran Buds, barley, Red River, wheat germ, Muslix
Protein foods Dried beans, dried peas, lentils, nuts and seeds, and fried meats, fish, and poultry
Mary Flesher, Clinical Dietitian
First published in the Inside Tract® newsletter issue 139 – September/October 2003

on diet image by anna karwowska from Fotolia.com

With the obesity epidemic on the rise, many people turn to extreme diets to lose weight. Liquid diets are a popular rapid weight loss method and also the recommended diet after bariatric or lapband surgery. In addition, liquid diets are sometimes used to treat conditions such as diverticulitis and irritable bowel syndrome (IBS) to help reduce bowel obstruction and increase elimination. Although liquid diets may lead to some weight loss, and alleviation of symptoms of IBS, they are often associated with intestinal problems.

Types of Liquid Diets

Liquid diets come in many forms including high fiber, clear and lactose intolerant types and each may have some side effects associated with their use. Clear liquid diets are usually given to patients following gastric bypass surgery, and are also used for cleansing purposes when detoxifying the liver, colon or bowel. They most often consist of water, pure juice and broth. High fiber liquid diets follow the clear diet after bariatric surgery, and are also used for those suffering from symptoms of diverticulitis or IBS to increase bowel function. Liquid diets for those who are lactose intolerant may use soy as a base product and are a substitute for high fiber diet drinks. Some liquid diets are available over the counter, and others only by prescription.

Stomach Discomfort

Ingesting any sort of liquid diet may lead to initial stomach discomfort. High fiber liquid diets lead to an increased need to eliminate, causing the stomach muscles to contract more frequently and produce cramps. This is also likely with clear and soy liquid diets because of the increased overall fiber content and absorption rate. In addition, liquid diets may lead to feelings of extreme hunger as the stomach empties and readjusts to a lack of solid food, causing stomach grumbling and upset. Try eliminating foods slowly before beginning a liquid diet to avoid the shock to your stomach caused by extreme dieting.

Bloating

Because liquid diets are composed of soluble fiber, or fiber that dissolves in water, their usage is more likely to result in abdominal bloat. According to the National Digestive Diseases Information Clearinghouse, soluble fiber in fruit juices used for liquid diets is not digested until it reaches the large intestine, leading to excess gas accumulation and bloating. Try drinking more vegetable juices to avoid the bloat associated with liquid diets.

Belching

Liquid diets may increase the amount of air you ingest due to the swallowing action involved in drinking. This can lead to a buildup of air and gas in the intestine that can cause discomfort and lead to belching. To avoid excess air accumulation that leads to belching, sip liquids slowly or through a straw when on a liquid diet.

Reintroducing Solid Foods

Adding solid foods after having been on a liquid diet can lead to digestive problems such as constipation, cramps and weight gain. The Mayo Clinic recommends introducing foods very slowly in order to digest properly. In addition, drink liquids separate from your meal, and eat several small meals per day. Avoid symptoms such as nausea and vomiting by avoiding foods high in sugar and fat that are more difficult for the digestive system to process following a liquid diet.

Liquid diets and inflammatory bowel disease (IBD)

Following a liquid diet

The amount of time you need to be on a liquid diet depends on the type. It can be anywhere from between 2-8 weeks and no other food or drink (apart from water) is allowed during this time. After this time food is slowly reintroduced.

Many people are advised to reintroduce a different food each day. If the food causes any symptoms then it is avoided. Doing this produces a ‘safe’ diet for the person. As the number of foods introduced to your diet increases the amount of liquid feeds will be reduced. Your doctor/dietician will help you to reintroduce the foods as some foods have a longer reaction time than others. Food testing is then carried out on the foods that could not be tolerated when they were introduced to check for allergies/sensitivities. This method can be time consuming, taking 2-3 months for all foods to be reintroduced.

Unfortunately the foods that affect people with inflammatory bowel disease are not all the same – and there isn’t a simple test that can be taken – so it is recommended that you keep a food diary documenting everything you eat and drink and how you are feeling. This will help to identify if there are any foods that trigger your symptoms.

What is the purpose of a liquid diet when dealing with Inflammatory Bowel Disease? I have gotten this question quite frequently in dealing with the nutritional aspects of this disease. In the traditional usage a liquid diet is prescribed to provide time for the bowels to rest. The bowels may need this type of rest after surgery or a particularly bad flare up.

One of the common liquid diets used in medical nutrition therapy is the Clear Liquid Diet. This diet consists of all non-caffeinated clear liquids. It also can include Jello, popsicles, and broth. It is meant to be used for very short periods of time because it does not meet the nutritional needs of adults or children.

The next step up from the Clear Liquid Diet is called the Full Liquid. This diet includes everything listed above and adds juices, ice cream, milk, pudding, cooked refined cereal and strained soups. Some people also add protein shakes to this diet but this is not part of the traditional definition of Full Liquid diet.

Some of the research does indicate that patients can benefit from the use of liquid diets during recovery periods. However, the long term use of such diets is not recommended. These diets do not provide enough of the essential nutrients the body needs to function properly. In the end it could end up weakening the body’s defenses to use this type of diet in a way other than what it was intended for. This is especially true for people with IBD who may have absorption issues adding to the problem.

If you are on a liquid diet that was prescribed by your physician you probably received instructions on how long to remain on the diet and when to transition to more normal foods. If you have problems with the diet or transition discuss them with your doctor or dietitian.

Frequently placing yourself on a liquid diet may also indicate to your physician that your IBD is not under control. They may want to take a closer look at your overall treatment plan. Try using our journals to keep close track of your symptoms and nutritional habits and bring them to your doctor appointments.

Dietary changes can seem so benign but can make a huge difference in your overall health. A healthy diet can dramatically improve the quality of life for many patients I have spoken with. Should you choose to place yourself on any form of liquid diet be sure your physician has been informed. They may need to watch you more closely for nutritional deficiencies.

Related Links:

Diet and Nutrition in IBD

My Elimination Diet

The Low Down on The Low Residue Diet

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