My doctor recommended I talk to a registered dietitian about following a fat-controlled eating plan to control my chronic diarrhea. I don’t understand how changes in my diet can help me. Please explain.

Fats–- such as butter, margarine, oil, mayonnaise or salad dressing –require certain enzymes to be digested. If fat is not digested, it may cause nausea, bloating, diarrhea or other unpleasant side effects. The purpose of a fat-controlled eating plan is to limit the total amount of fat that you eat to prevent side effects.
A registered dietitian can provide in-depth personalized nutrition education to help you develop a personal action plan. A dietitian will tell you how many grams of fat you should consume each day.

I am in search of a chart that shows the grams of fiber in certain foods and juices. I have kept track of this because I have a 5-year-old on a high fiber diet and I have to make sure that he eats 10 grams of fiber a day. I really need some sort of measurement chart so that I can log this. He has an intestinal blockage and is taking medication as well as receiving enemas and drinking 8 glasses of water and juices throughout the day. When he returns to his normal physician I have to have his intake of fiber documented. Could please help me and tell me if I can get a copy online?

The following chart gives the fiber content of common high-fiber food selections. The information has been adapted from the Home Medical Guide published by the Columbia University College of Physicians & Surgeons Complete. The U.S. Department of Agriculture (www.usda.gov) and the American Dietetic Association (www.eatright.com) also give guidelines for fiber intake on their web sites. You should discuss these fiber guidelines with your son’s physician to see which guidelines are appropriate. Your son’s physician also may refer you to a registered dietitian for further help in meal planning, label reading and grocery shopping. However, this listing should give you a place to start.

Fiber Content of Foods

Source	Serving Size	Total Fiber (in grams)
Breads, grains and cereals White bread  Rye bread  Whole grain bread French bread  Dinner roll  White rice  Brown rice  Egg noodles  Spaghetti  Bran 100% cereal  Oats, whole  Corn grits  Graham crackers  Rye wafers  Popcorn	1 slice 1 slice  1 slice  1 slice  1 roll  1/2 cup cooked  1/2 cup cooked  1/2 cup cooked  1/2 cup of noodles  1/2 cup  1/2 cup cooked  1/2 cup cooked  2  3  3 cups	0.53 2.7 2.9 1.0 0.8 0.5 1.5 0.8 0.8 10.0 1.4 1.9 1.4 3.3 3.8
Fruits  Apple Apricots Banana Blackberries Cherries Grapefruit Peach Pear Pineapple Plums Strawberries Tangerine Legumes, kidney beans Lima beans Pinto beans White beans	1 small 2 medium 1 medium 1/2 cup 10 1/2 portion 1 medium 1 small 1/2 cup 2 medium 1/2 cup 1 medium 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked	3.9 1.2 1.3 3.7 0.8 1.0 1.0 2.5 0.5 2.3 2.8 1.3 4.5 1.4 3.3 4.2
Vegetables  Broccoli Lettuce Parsnips Peas Potato Squash, summer Zucchini	1/2 cup cooked 1 cup raw 1/2 cup cooked 1/2 cup cooked 1 small 1/2 cup cooked 1/2 cup cooked	2.5 0.5 4.4 5.7 3.8 2.3 2.5

know it’s good to eat a lot of fiber to stay regular, but sometimes I eat too much fiber and have painful gas or even diarrhea. What’s the best way to strike a healthy balance?

Dietary fiber is a combination of plant materials that cannot be digested. There are two kinds of dietary fiber: insoluble (cellulose, hemicellulose and lignin) and soluble (gums, mucilages and pectins).

Insoluble fiber promotes normal elimination by providing bulk for stool formation and quickens the passage of stool though the colon. Insoluble fiber also helps you eat less because it gives you a full feeling more quickly than other foods. Preliminary studies are now showing that soluble fiber may reduce the risk of heart disease, lower the risk of colon cancer and reduce LDL (bad) cholesterol in the blood, so it is important to make sure that you are getting enough fiber in your diet.

The Food and Nutrition Board of the National Academy of Sciences has not set a Recommended Dietary Allowance (RDA) for dietary fiber. However, several other health organizations, including the Federal Government and the National Cancer Institute, recommend 20 to 30 grams of fiber per day, with an upper limit of 35 grams per day.

Eating a variety of foods that contain dietary fiber is the best way to get an adequate amount. Foods that are good sources of dietary fiber include whole-grain breads and cereals, fruits, and vegetables and beans, peas, lentils, nuts and seeds. To get enough fiber in the foods you eat, serve vegetables and fruits with edible skins and seeds and use whole-grain flours when baking.

If you would like to increase the amount of fiber in your diet, do so slowly. A drastic increase in the amount of fiber in your diet could cause symptoms such as gas, cramping and diarrhea. If you’ve added fiber to your diet at a moderate rate and are still experiencing an abundance of gas and diarrhea, you may need to decrease the amount of fiber in your diet. Try to consume fiber within the range of 20 to 25 grams per day. Keep in mind that some gas is normal–in fact, the average person produces approximately one to three liters of gas a day. If you feel you have too much gas, many nonprescription, over-the-counter medicines are available to help reduce symptoms, including antacids with simethicone and activated charcoal. Digestive enzymes, such as those found in Beano, will help digest the sugar in fiber-rich beans, fruit and many vegetables. Severe diarrhea may be a sign of a more serious illness. Contact your health care provider if you have diarrhea or a fever that lasts more than 24 hours.

To aid in the digestion of fiber-containing foods, you should drink at least 8 cups of fluid every day.

If fiber doesn’t protect against colon cancer, why should I continue to eat foods high in fiber? Is there any value to altering my diet to protect against colon cancer?

A recent study published in the New England Journal of Medicine questioned the role of dietary fiber in colon cancer prevention. The study showed that women with the highest fiber intake did not have any additional protection from colon cancer than women with the lowest fiber intake. This news alarmed many people, but an editorial accompanying the article stated that the link between fiber and colon cancer is complex and the researchers have yet to sort it out.

Therefore, people should continue to add fiber to their diets, as fiber-rich foods are an important source of nutrients and help prevent many other serious conditions. Fiber can help fend off heart disease, America’s top killer. A study in the January issue of the American Journal of Clinical Nutrition, which received much less attention, provided the findings of 67 trials compiled by Harvard researchers. This study reported that two to 10 grams a day of soluble fiber lowered total cholesterol and LDL’s (the “bad” low-density lipoproteins) by small but significant amounts.

The study results indicated that a high-fiber diet may also help lower blood pressure, improve blood sugar, combat overeating and help prevent gastrointestinal conditions like diverticular disease, constipation and maybe even stomach and esophageal cancers.

Bottom line? More research is needed before we’ll know for sure what fiber’s exact role is in colon cancer. But it still makes sense to get 20 to 35 grams of fiber a day. To help prevent colon cancer: keep active, eat a balanced diet, maintain your ideal body weight and schedule polyp screenings every five years after age 50 or earlier if you have a family history of colon cancer.

What foods should a person avoid if he or she has heartburn, GERD, or Barrett’s esophagus?

Eating certain foods, including onions, chocolate, peppermint and high-fat foods, as well as alcohol consumption, contribute to relaxing the lower esophageal sphincter muscle which controls the opening between the esophagus and the stomach. Usually, this muscle remains tightly closed except when food is swallowed. However, when this muscle fails to close, the acid-containing contents of the stomach can travel back up into the esophagus, producing a burning sensation commonly referred to as heartburn.

Caffeinated beverages and foods (such as coffee, tea, colas and chocolate) also cause heartburn and gastroesophageal reflux disease (GERD). Tomatoes, citrus fruits or juices also contribute additional acid that can irritate the esophagus.
In addition, smoking relaxes the lower esophageal sphincter, contributing to heartburn and GERD.

Improving your eating habits can also reduce reflux. After eating, keep an upright posture. Eat moderate portions of food and smaller meals. Lastly, eat meals at least three to four hours before laying down and avoid bedtime snacks.

As far as foods to emphasize in your diet, theoretically a high protein diet contributes to improving the pressure of the lower esophageal sphincter muscle.

What are some common foods that may contain gluten?

People with celiac disease or gluten sensitivity may need to follow a gluten-free diet.
A gluten-free diet means avoiding all foods that contain wheat (including durum, semolina and spelt), rye, barley, oats and other related grains (such as kamat and triticale). Therefore, most grains, pastas, cereals and many processed foods should be avoided. Enriched products should also be avoided.
Here’s an overview of the types of foods commonly containing gluten:

n Dairy

•	Ice cream
•	Cheese spreads
•	Nondairy creamer
•	Yogurt with fruit
•	Beverages
•	Cocoa
•	Hawaiian Punch
•	Hot chocolate mixes
•	Instant coffee
•	Instant tea

n Condiments/Miscellaneous

n(Squer Bullet) Meats
 

•	Honey-baked hams
•	Hot dogs and sausages
•	Luncheon meats
•	Self-basting fowl
•	Snacks
•	Chip and dip mixes
•	Corn tortillas
•	French fries
•	Dry roasted nuts
•	Marshmallows

In addition, there are many personal and over-the-counter items that commonly contain gluten, such as:
 

•	Lip balm
•	Communion wafers
•	Lipsticks
•	Aspirin
•	Tylenol
•	Rolaids
•	Face powder
•	Toothpaste
•	Envelope glue
•	Body powder
•	Hand lotions
•	Stamps (postal or those used in sticker books)

A registered dietitian, a health care professional who specializes in food and nutrition, can help you learn more about following a gluten-free diet.

My son has just been diagnosed with celiac disease and needs to follow a gluten-free diet. Can you offer some suggestions to help us get started?

A gluten-free diet means avoiding all foods that contain wheat (including durum, semolina and spelt), rye, barley, oats and other related grains (such as kamat and triticale). Therefore, most grains, pastas, cereals and many processed foods should be avoided. In addition, there are many hidden sources of gluten. These include ingredients added to foods to improve texture or enhance flavor and products used in food packaging. Gluten may even be present on surfaces used for food preparation or cooking.

A registered dietitian, a health care professional who specializes in food and nutrition, can help you learn more about following a gluten-free diet.
The gluten-free diet requires a completely new approach to eating and preparing foods that will affect your child’s entire life. Your son needs to be extremely careful about what he buys for lunch at school or work, eats at parties or grabs from the refrigerator for a snack.

When grocery shopping for your child, you’ll need to scrutinize ingredient labels carefully. With practice, screening for gluten will become second nature and you’ll learn to recognize which foods are safe and which are off limits. Remember, wheat-free does not mean gluten-free, as many additives contain gluten. If you are in doubt about a product’s ingredients, contact the manufacturer.

Children with celiac disease may feel that they stand out from others because they have to avoid certain foods. Work together with your child to find gluten-free treats and snack that he likes and can share with his friends. The following tips might also help:
 

•	Meet with your child’s teacher each year and explain about celiac disease. Give the teacher information on your son’s gluten-free diet. Ask to be notified of special events, so that you can prepare something for your child in advance. In addition, since celiac symptoms (such as diarrhea or gas) can arise suddenly, arrange a special signal between your child and the teacher if your child needs to visit the restroom.
•	Communicate with your child. Help your child develop habits of checking first with a responsible adult when he/she is not sure of the food being offered.
•	Take along gluten-free foods when traveling or on vacation. Gluten-free snacks and meals keep well with proper storage.
•	In your home, have special places set aside for gluten-free foods. Have a labeling system that you and your child understand and is easily identified by any visitor or caregiver.

How important is nutrition for people with inflammatory bowel disease (IBD)?

Good nutrition plays a key role in helping reduce symptoms and promote healing for people with IBD.

Nutritional deficiency is one of the main complications in patients with IBD. Most patients lose weight, usually due to inadequate intake of nutrients. This occurs for several reasons:
 

•	Your body might not absorb all the dietary carbohydrates, protein, fat, vitamins and minerals that you eat, depending on what section and how much of your small and large intestine is affected.
•	Your appetite may be reduced due to medications or during times when your IBD is “flaring up.”

There is no special diet for people with IBD. Because people tolerate various food differently, the general guideline is to eat a balanced diet and try to avoid foods that seem to make your symptoms worse.

If the inflammation has caused a stricture (narrowing) in the intestine, a doctor might ask you to follow a low-fiber (low-residue) diet or a special liquid diet. In these special cases, a registered dietitian can assist you in developing a temporary diet until the inflammation subsides.

What should I do to maintain proper nutrition?
 

•	Make sure you are not skipping meals. Eat regular meals and snacks.
•	Eat a variety of foods from all food groups to get all the nutrients you need.
•	Choose foods high in calories and nutrients.
•	Drink eight, 8-ounce glasses of fluid. This is especially important with diarrhea and in warmer weather to prevent dehydration.
•	Drink high-calorie liquid supplements in place of low-calorie drinks or in addition to your meals and snacks.
•	Tube feedings can be used to deliver high-calorie formulas if you are unable to consume enough calories by mouth.

I am concerned that my child, who has been diagnosed with inflammatory bowel disease (IBD), is not getting the nutrition he needs. What’s the relationship between IBD and nutrition in children?

Children with inflammatory bowel disease may suffer from malnutrition and growth failure. This is thought to be the result of several different factors including poor appetite, abdominal pain, impaired absorption and loss of dietary nutrients, increased calorie requirements. Malnutrition can also be secondary to medication side effects.

Nutritional therapy is necessary to correct vitamin and mineral deficiencies, provide adequate energy for healing of the inflamed intestine and to provide enough calories for growth.

Children with IBD benefit from a balanced, high-energy, high-protein diet. Some children may need supplemental nutritional support to provide 150 percent of the recommended daily dietary allowance. Low residue (low-fiber) diets may be recommended in patients with symptoms of abdominal pain or diarrhea. Children with IBD are often prescribed supplemental vitamins, trace minerals and iron.

Nutritional therapy, in the form of liquid formulas, has also been prescribed for children as a single form of therapy. This form of therapy has been shown to be effective in the treatment of children with active IBD and growth failure, helping these children avoid medication side effects and improve their growth.

I recently had the pelvic pouch surgery, and diarrhea (up to 15 loose bowel movements daily) has become a real problem for me. Can you suggest any dietary changes to help improve this?

Let’s begin with a definition of the pelvic pouch, for those who aren’t familiar with the procedure. The pelvic pouch is an internal pouch or reservoir constructed from the small intestine in order to drain stool.

A small valve constructed inside the reservoir can be accessed through a stoma, or opening, in the groin area, just below the belly button.
The pouch is drained about 4-6 times daily by inserting a catheter into the valve.

The function of the pelvic pouch will change over the first year and improve as it stretches and becomes larger. But at first, frequent bowel movements are common as your body adjusts to the pouch.

Dietary changes may help improve your diarrhea. Certain foods which have been found to help decrease the water content of the stool may also decrease the number of loose bowel movements. These foods include: applesauce, bananas, rice, creamy peanut butter, potatoes (without skin), cheese, marshmallows, pretzels, toast, yogurt and tapioca pudding. Limiting fried and fatty foods as well as milk and dairy products may also help decrease diarrhea. Try keeping a food journal to record what foods seem to decrease or increase diarrhea for you, and adjust your diet accordingly.

Bulking agents such as Metamucil, Citrucel, Fibercon or Konsyl also help thicken the stool. These products are ingested with little fluid to allow the extra fluid in the gastrointestinal tract to be absorbed. They can be taken up to 3 times daily.

Medications such as Lomotil or Imodium are sometimes prescribed by a doctor to slow down stools. These medications should not be used without your doctor’s approval. If these drugs do not work, there are stronger medications that can be prescribed by your doctor..

Should I be taking a vitamin or mineral supplement if I have a gastrointestinal disease?

Certain gastrointestinal diseases can affect the levels of vitamins and minerals in your system. Malabsorption, or the impaired absorption of nutrients from the gastrointestinal tract, can occur as the result of liver disease, celiac disease, sprue, dysentery and severe diarrhea. Significant malabsorption can result in low levels of all the essential nutrients. However, fat-soluble vitamins, calcium, magnesium and zinc can be more adversely affected than other nutrients.

A well-balanced diet is sufficient to maintain adequate levels of vitamins and minerals for most people with gastrointestinal diseases. However, oral nutrient supplements may be prescribed if you have any of the following conditions:
 

•	Cirrhosis of the liver or severe liver disease: can result in a diminished capacity to store vitamins A and B12.
•	Atrophic gastritis: leads to the malabsorption of vitamin B12. This vitamin can be measured in your blood if atrophic gastritis is suspected. To correct this deficiency, your doctor will likely need to provide you with periodic injections of vitamin B12 to maintain normal body stores.
•	Diseases which result in pancreatic insufficiency and diminished bile acid secretion by the liver can also lead to malabsorption of fat-soluble vitamins.

I am confused about the diet for diverticulitis . They say more fiber, even fruit with skin, but other information I’ve read states that people with diverticulitis cannot tolerate seeds, skins, raw vegetables, etc. Can you give me direction on exactly what is digestible for people with this condition? Sure hope to get some help, I’m in a panic.

The condition you mentioned, diverticulitis, occurs when a single pouch, or diverticulum, becomes infected and inflamed. Diverticula (plural form of diverticulum) are outpouchings that form in the muscular wall that lines the intestines. These pouches each about the size of a pea form in the weakened areas of the intestinal walls due to increased pressure. The inflammation can cause the diverticulum to trap stool or bacteria, leading to infection.

Increasing the amount of fiber in your diet can help reduce the effects and complications associated with diverticulitis. Fiber is the indigestible part of plant foods. The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume this much fiber every day.

You were right that high fiber foods include uncooked fruits and vegetables with the skin on, or with seeds (such as berries), but there are other high fiber options that can help you fulfill your daily requirement. Other foods include whole grain breads, crackers and cereals, brown rice, bran products, and cooked dried peas and beans, among other foods. If skins on fruits and vegetables or seeds cause flare-ups, you can remove skins and seeds, or steam your fruits and vegetables. Although this will cause you to lose some of the fiber content, you can retain enough to contribute to your daily fiber requirement. You may find that avoiding certain foods with skin, seeds or other irritating agents can prevent certain symptoms of diverticulosis, including bowel obstruction. In addition make sure you are getting enough rest, monitoring changes in bowel movements (constipation and diarrhea) and drinking eight 8-ounce glasses of water a day to further improve your condition.


Reprinted with permission.
The Cleveland Clinic
www..ClevelandClinic.org