My husband’s family lineage has inflammatory bowel disease (IBD): Crohn’s, celiac, diverticulitis, pancreatitis. Recently a family member landed in the hospital with a severe bout. She was in for a week, clear liquids, IV fluids and antibiotics, and sent home. No one spoke to her about food, other than to go ahead and eat a lot of fiber from grains.
Within no time, she was in severe pain again, tolerating only clear liquids, and back to her GI specialist. After lots of poking and prodding, same advice: Go home, eat what you want. Fiber? Sure, that too.
Many infants, toddlers, and older children in my practice have been down this road too. Some have necrotizing enterocolitis, fundoplication, or feeding tubes inserted into their stomachs or upper small intestines. Others have newly diagnosed celiac, FPIES, or even Crohn’s at a young age. These conditions are deeply linked to what you eat and to what grows in your gut biome. But it’s common for the healing potential of food and “good gut bugs”to be overlooked by well meaning GI specialists. Research is rapidly expanding in these areas. But it’s not yet standard-of-care for people with painful IBD conditions to get much detailed guidance on foods and gut microbes. What you eat isn’t a GI doctor’s gig; some might choose to work closely with you on it, some might suggest or even prescribe a probiotic, some may refer you to a nutritionist or dietitian. But most are choosing whether or not you need surgery, steroids, or other drugs.
There is much that can be done beyond the prescriptions and surgeries. Check with your specialist on the recommendations I suggest here before using them. Your gut may be able to heal up (and you may avoid having a section of it removed) with some TLC, supportive eating, and some nourishing, soothing herbs. I’ve seen it happen many times in vulnerable children and infants I’ve worked with. You need and deserve to feel better – I know you’re a busy person!
1 – The common advice to eat high fiber grains after an IBD flare up is, well, bad. You might actually take some comfort in knowing that it is not surprising that those may worsen your tender condition. Grains are possibly the toughest stuff to feed an injured and inflamed gut. My usual approach in tender situations like this with vulnerable children and infants is the opposite: NO grains at all for a while. That would mean no bread, rice, pasta, pastries, bagels, toast and so on; no gluten free grains either, including rice, barley, spelt, millet, oats or oatmeal, cous cous, quinoa (not a grain technically but similar), corn (including corn starch, corn syrup or high fructose corn syrup, which is in many processed foods), and teff. No white bread, no bread, period. I usually advise avoiding all grains for a long time, at least three months, for scenarios like this. Your carbs in this scenario become certain cooked vegetables and some fruits. See below on how to introduce those, and which ones are okay. Meanwhile you can use broths (see number 2) and fats to hold you over.
2 – Broths are a good idea. But there’s not-so-great broth (store bought in a box, can, or a dehydrated cube, with MSG, gluten, corn starch, or wheat flour, additives, and little nutritional value) and then there is really good broth (homemade or special order homemade, full of minerals and helpful satiating fats)! If you happen to have vegetable scraps around and a chicken carcass leftover from a roast chicken, set those on the stove for a day or two, cover with water, add some vinegar (about a half teaspoon) or some white wine (1/4 cup) to pull the minerals out of the bones. Let everything cook until disintegrated and soft. Add water if needed as you go. Add herbs (fresh sprigs of sage and rosemary), throw in a whole chopped lemon, and 3-4 cloves of garlic. Strain this and enjoy as often as you like. It’s more nourishing and restorative that the stuff in the can, and is grain free (even tiny amounts of wheat starch might be irritating). Leave the fat in the broth, or skim off only some of it. You can use ham bones or any bones left over to make a broth, if it simmers long enough. If you like, you can even order this luscious, real bone and vegetable broth on line – you’ll find it is heartier and more satisfying than the store stuff.
3 – If you’re on a clear diet (clear fluids only), some foods may still be okay for you and I have seen this work in my practice too. Certain vegetables and fruits cooked soft that are easier to digest (because they have simpler, smaller, less fibrous carbohydrate in them) are where I would start. You can find a list of those that fit this criteria here: http://www.breakingtheviciouscycle.info/legal/listing/ Any food that is “legal” on this list worth a try. Clear foods that may be more harm, and do you no good: Store bought juices with corn syrup or sugar added, broths processed with additives as mentioned above, clear jello, or any processed, artificially colored and flavored “food”. Some veggies that you might not enjoy so much right now are the brassicas: Broccoli, cauliflower, Brussel sprouts; cabbages; or most any raw vegetable. Even well cooked, these may not feel good just yet. If you crave greens, enjoy them well cooked and not raw for now, if at all, until your IBD flare settles down.
4 – Meats, poultry, fish: These are very possibly okay even for a tender gut. Watch how you respond. They are very nourishing, so include whatever feels okay. Start with white soft cooked fish like tilapia or cod, without any bread coating; you can brush with coconut oil, ghee or olive oil or butter, garlic, lemon, and as much salt as you are currently allowed to use. For some, salt does not impact blood pressure, so use your usual amount – and use good culinary salt (sea salt or Himalayan salt, not plain old Morton’s type sodium chloride). The better salt has more minerals in it, which your gut needs to heal up. Next you might advance to some really good, organic, slow cooked, tender roast of beef, done in perhaps a crock pot or slow cooker so the juices stay in and keep it moist. Cook it to the point of just falling apart, soft enough for a fork to cut through. Roast chicken may also be okay, with skin. We often make a crock pot recipe that is easy (we skip the aluminum foil in the recipe, and add a whole lemon or two, some onions, and extra garlic chunks). Again the meat should be very tender and falling off the bone, juicy and moist. Roast pork, same thing, if it can be cooked long enough to be falling-apart tender. Avoid barbecue sauces until you feel better (usually they have gluten, grains, or other harder to digest additives). Avoid bread coatings, or gravies made with thickeners like corn starch, any flours (even gluten free), or arrowroot.
5 – Even if you are already using a probiotic, a prescription probiotic called VSL-3 is often beneficial and preferable for these situations. See if your specialist would agree. Don’t bother with the store bought stuff. Not worth it, may contain irritating additives, and the potency is so low as to be of no value in circumstances like progressed IBD. You might alternatively benefit from VSL-3 capsules, which are available without prescription. The prescribed version is a sachet of powder that mixes with soft food or liquid. It has a very high potency of 900 billion CFUs per dose of mixed strain beneficial microbes. The capsules are the same formulation except lower potency (180 billion CFU each), and without the maltodextrin. Caveat: If you have a condition called small intestine bacterial overgrowth (SIBO), probiotics may cause more pain and diarrhea. Check with your specialist about ruling out SIBO before using a high potency probiotic like VSL3. SIBO may need treatment first, before probiotics will be helpful. In my office, Dr. Jill Carnahan and I use a urine microbial organic acid test as well as stool tests to assess this.
6 – Use daily gut soothers: Peppermint tea, chamomile tea, or a blend of those. Other herbal helpers include slippery elm, ginger (fresh root), licorice (added benefit for some of lowering blood pressure), and you can use tinctures or teas. Skip capsules at first if you can, to give your gut one less thing to do (digest the capsule before getting to what’s inside). Glycerite tinctures are especially gentle and absorbable, versus alcohol blends. Meanwhile, another really good soother and healer for the gut is pure aloe juice. This is available at most better supermarkets or health food stores. Buy pure organic aloe juice – not the topical preparation, but the juice for oral consumption. Use 1-2 Tablespoons daily in water. Also eases any constipation if you have it. Avoiding all caffeine sources may help.
7 – Juices can help too – but not the store bought corn syrup stuff. We’re talking fresh juices you make at home. To make nourishing, easy to digest, healing juices, you need a powerful juicer machine that strains things (not a macerator juicer, but one with a strainer). Try what feels good, and your intuition may surprise you with its own skill! Some of my favorites are here. A good combination for a sore gut:
– 1-2 Delicious apples
– 1 inch peeled fresh raw ginger
– 5 stalks celery
– some sprigs of fresh mint or basil leaves
Your juicer should strain this while it juices. When you feel a little better, you can add ½ a small whole lemon to this blend. This is soothing for liver, kidney, and digestion. As for heartier greens like kale or chard, initially, searing those and eating them cooked, especially with healthy oils like coconut or sesame, will feel more soothing at first. Straining and drinking them raw can work better later on.
8 – You can temporarily use a supplement for ready-to-absorb protein, in case eating protein from whole food is painful. This is important because you need protein to build healthy gut tissue. If eating meats, poultry, eggs, or fish just does not work, I lean on specialized supplemental formulas in my practice. There are some available by prescription and some that are over the counter. These can help keep you replenished and give your gut something to rebuild with. I generally don’t reach for protein supplements based on dairy, soy, or rice, since so many of my patients have trouble tolerating them. Hemp protein may also be harder to use at first in a tender gut. When all else fails, I work with prescription essential amino acid mixtures from SHS North America. Some do well with whey protein that is from organic, grass fed cows and not denatured; I will order a specific brand that meets those criteria in some cases. Lastly, a supplement called Galactommune often helps my patients recover gut function more quickly, as it helps build immune boosting globulins in the gut. This can be ordered directly from its manufacturer with code 825.
9 – Fats and oils: These are healthful and important for you while you eat a limited diet. They keep hunger at bay, transport and absorb certain nutrients and vitamins into tissues and cells, and cut inflammation (when you eat the good fats). Eat what feels comfortable, from least processed sources if possible. That means butter, ghee, coconut oil (for cooking), eggs (if you find them comfortable), olive oil, bacon (if easy on you), meats, and fish. Fats to avoid are margarines, fake fats, canola oil, corn oil, soy bean oil, processed cheeses, dairy desserts with lots of corn syrup, highly processed puddings or calorie boost drinks, or anything GMO. Go organic if possible, since fats and oils are where many toxins situate in plants and animal foods. Nuts and seeds or their butters, a good source of minerals, proteins, and fats, may not be tolerable yet. Long short: Fake fat and low fat is not going to help your body. For a gentle soother, try cooking a soft scrambled egg in a tablespoon of coconut oil. Mix the egg and oil briskly with a whisk for about a minute. Coconut oil is easier to break down than most other fats and can work to calm an irritated gut wall.
10 – If you use a reflux medication on a regular basis, ask your specialist how to stop. Reflux medicine, when used too much, weakens digestion and makes it harder for beneficial gut bacteria to grow. Beneficial bacteria support your gut wall in avoiding autoimmune storms and infections. Meanwhile reflux medicine makes it easier for damaging, detrimental gut bacteria to grow. Minerals, including calcium, zinc, and iron, are harder to absorb in this context. Some studies have shown that long term use of reflux meds in elderly people means more broken bones. I have a number of young patients with delayed bone age and stunting who were given reflux medications from birth. These are over prescribed. If you use one daily and stopping is painful, there is a simple strategy to wean off slowly: Begin using raw apple cider vinegar (such as Bragg’s brand) daily in a glass of water. Use about a half teaspoon. You can do this at each meal, or only when you feel reflux or heartburn. This will gently promote normal digestion. A more aggressive strategy is to use betaine hydrochloride capsules, and swallow 1 to 3 of these with meals. As many as 6 or 7 capsules of betaine hydrochloride are safe to use at a time, but no more. You will know your limit if using these triggers a burning sensation at top of stomach. Find your comfortable dose. It may be just one capsule, it may be four; use only what you need. Note any changes (good or bad) in demeanor, behavior, anxiety, or affect too: Gut ecology has been linked to shifts in what we categorize as psychiatric disorders.
Have a conversation with your specialist and see what s/he says. Remember: Their tools are antibiotics, antiviral medications, steroids to stop inflammation, reflux medications, and surgery. All these have a place, but none of them are food. Food is what your body needs to rebuild, even as you use the specialist’s tools. If all the juicing and cooking is overwhelming while you are managing your symptoms, consider a home health aid or someone who might come in your home for two hours a day to help out. A week or two of help can pay itself back in quickening your return to health, if you are debilitated by symptoms or just had surgery. Meanwhile there are many, many supplements that are often used to help a gut heal too. But, food is still the baseline, and it’s what your body will work with to rebuild, recover, and heal.