“All disease begins in the gut.” – Hippocrates

Tuesday, August 31, 2010

Diet and Vitamin Supplementation for IBD, Part 1

Note: Everything in this post and the rest of my series on supplements is synthesized from books and advice gleaned from my reading list.

Health guru’s, nutritionists, doctors, and, yes even my mother, suggest taking vitamin supplements. This is the beginning of a short series on vitamin supplementation. I’ll elaborate on why supplements are needed (even for healthy people) today, and why people with IBD should be especially vigilant in taking supplements.

Healthy Diet
Your body needs around 19 vitamins and minerals for optimum functioning. This is in addition to the appropriate amounts of fiber, fat, protein, and carbohydrate material. Some you need in relatively large quantities (like calcium), and others you only need in trace amounts (like Folic Acid, or Selenium).
The most common argument against supplementing your diet with vitamins is the healthy diet argument. If I just consume a balanced, healthy diet, then I won’t need supplements. Indeed, the argument is simple and generally true. If we consumed, daily, a wide enough variety of foods, and if we consumed those foods in the proper quantity, then we indeed wouldn’t need supplements. Unfortunately, nutritionists agree that the majority of people today (especially in the US and Europe) eat a calorie rich, nutrient poor diet. This means that people can get fat, but they can’t generally get fit (nutritionally) on the average, for example, American diet.

This is because we consume too many processed foods (the processing of food strips natural nutrients); because conventional farming practices (where most Americans get their food) strip the soil of many essential micro and macro nutrients, essential soil organisms, and natural compost material which in turn lessens the nutritional content of food (nutritional density of food 150 years ago ≠ nutritional density of food today), making it difficult to eat enough variety to get what we need from food alone; and because we just don’t, on average, eat a balanced diet. Americans especially, eat too many processed grains, and not enough whole vegetables, fruits, and legumes. We consume too much red meat, fat, and alcohol. We don’t eat enough fish. We don’t exercise enough. Get the picture?

What’s Unique about People with IBD? Why is it so important for them (us) to Supplement?
People (like me) with IBD are in a unique position where all of the above may be true for us, but at the same time our processing plant is only working at partial capacity. This makes it doubly important for those with IBD to eat as healthy a diet as possible and to supplement, because invariably some portion of what we eat will not be processed and absorbed. Let me elaborate.

For those with Crohn’s, inflammation in the small intestine, where the majority of fat, carbohydrate, and nutrient uptake takes place, can lead to deficiencies in B-vitamins, and the fat-soluble vitamins such as A, D, and E (and much more). Decreased appetite only worsens these deficiencies.

For those with Colitis, inflammation of the large intestine (whose function is to absorb electrolytes and water, produce vitamin K, and retain/store stool) can cause diarrhea and increase transit time in the gut. This diarrhea can lead to folic acid deficiencies (which increases your risk for cancer), vitamin K, calcium, potassium, and other electrolyte deficiencies. Vitamin K is essential for healing and rebuilding tissue. Calcium is essential for bone mineralization and nerve and muscle conduction, and electrolytes are in just about every body process you can think of (and many you can’t). Vitamins are essential for bone health, blood clotting, proper immune functioning, proper neural function, general energy levels, mental well-being (B-vitamins are an accepted treatment for mild depression), etc. Folks with IBD just can’t process or absorb these as well as a gut-normal person.

Medication can complicate your dietary needs. For example, corticosteroids, such as prednisone can increase your need for folate, vitamin B6, and ascorbic acid. They decrease calcium and phosphorus, and increase levels of zinc, potassium, phosphorous, calcium and vitamin C in your urine. Even simple aspirin increases the need for folic acid and vitamin C. Jini Patel Thompson has a short discussion of medications and nutritional needs in Listen to Your Gut. For a more through discussion see the Encyclopedia of Natural Medicine, by Murray and Pizzorno.

Okay, what do I do?
With rapid transit times and decreased absorption, it’s important to increase the quality of food you eat. In the beginning of my last flare-up, I avoided fruits and vegetables at all costs—they sprinted through me like a wild horse. Then I began to read and learn. I started the SCD and followed the diet’s instructions with fanatical flare. But the SCD allows fruits and vegetables, which I couldn’t eat right away, so I read some more (see my growing reading list). After much reading, observing other’s comments, and after experimenting on myself, here’s what I recommend. Ideally, you would do all of this within the parameters of the SCD.
·         Gradually increase your calorie consumption. If you’re having trouble processing food, then you’ll need to take in more than you need, because some portion of that is leaving undigested. I know, eating can make you feel worse, so be gentle on yourself, but not eating…well we all know where that goes.
·         Steam your vegetables. It’s not the veggies themselves your gut can’t take; it’s the complex fiber matrix. Steaming softens the fiber matrix and makes it easier for your damaged gut to process them. This is the method I used for months to get my veggies. Yes you do lose some of the phytonutrients, but you retain most of the vitamins. If you’re really concerned about the nutrient loss from steaming, you can drink the leftover water. Yum!
·         Cook your fruits. Bake or steam fruits high in soluable fiber, like pears or apples. Add a little cinnamon and honey and you have a winner.
·         Peel your fruits, and avoid fruit with lots of insoluable fiber. Again, your system can’t handle the rather rough insoluable fiber skin, so remove it or don’t eat it. Examples of fruit to peel are apples, pears, peaches, plums, etc. Examples of fruits to avoid (or to try cautiously until you can handle them) are, oranges, grapefruit, cherries, grapes, berries, and anything else with a tough outer skin.
·         Avoid seeds. Just do it. You’ll thank me—strawberries, blackberries, raspberries, kiwi, figs, goji berries, etc.
·         Supplement with vitamins. I’ll go over this in more detail in future posts, but for now, a good multi-vitamin (2x/day), a good B-complex (1-2x/d), and a calcium supplement (as calcium citrate) will do for a start.

Onward to Health.

No comments:

Post a Comment