And Feeding . . . (of Colitis). A Colitis Diet Plan
I had just finished outlining the particular dietary needs of one of my patients. He took the colitis diet list in hand and gave it a sour look, commenting as he did: “I know three people who died on one of these diets,” which brought my rejoinder: “And I know one hundred and three people who have died from not being on one of these diets.”
I was curious to know how he thought the diet was responsible. “Their stomachs shrunk,” he explained. “Well,” said I, “the stomachs of the people I am talking about nearly burst, so I guess it’s a case of paying your money and taking your choice.” It’s a crazy world.
Astonishment never ceases at the weird ideas of diet one finds among people who have colitis. Whether these are picked up from well-intentioned friends or from the advertisements, it is hard to say. We would not be unduly concerned with them except that ill-advised diets interfere with the proper healing of the colon; therefore the fallacy of their use must be exposed.
Foremost among these fallacies is the belief that baby foods must be used in cases of colitis. These are, as you perhaps know, foods that have been passed through a sieve, so that no large solid particles remain in the food. I shall not venture an authoritative opinion in the field of pediatrics, though, in passing, I must register my doubt as to whether baby is getting a fair deal in the matter. However, for adults who have enough teeth to chew food with, to eat baby foods is to invite trouble.
Without going into the technical reasons for this, I assure you that when food is not chewed, as it cannot be when put through a sieve, one stage of the digestive process is bypassed and this aggravates an already disturbed internal nervous system. Furthermore, the liquidity of the food favors the swallowing of air and the additional gas in the intestines interferes with normal function.
All that has been said with regard to canned baby foods can be said with equal truth with regard to the so-called mixing or blending of foods in a mixer. However, here we have the sin against normality compounded by the danger that the foods are, in many instances, raw. These add the risks of bacterial and protozoal disturbance.
Curious indeed is the idea of what constitutes a bland diet. What it should mean is a diet free from irritating substances such as spices, seeds with sharp edge, rough substances like bran, etc. However, many people think that what is meant is a varied assortment of slops—soups, gruels, custards, etc. My own experience has been that soup and gruel tend to increase the motility of the bowel and the presence of gas in the intestines, two things which we are most anxious to avoid in a case of colitis.
Many people feel that a bland diet should contain no coarse food; but my own experience has been that certain coarse food such as stewed celery, string beans and pressure-cooked carrots are very valuable. They give the intestinal muscles something to contract upon and thus tend to promote normal colonic rhythm.
While the foregoing deals mainly with what not to give, the following will give an idea of what I feel should be the basic diet in a case of colitis. Bear in mind that everybody has his own peculiarities. When an unfavorable reaction to a certain food occurs, have no hesitancy in striking it off the suggested list of foods. On the other hand, under no circumstances add anything to the diet without consulting your physician.
DIET
Diet should vary with the needs of each case. If the case is severe, and diarrhea is present, one should avail himself of a physician’s guidance. At such a stage a very restricted diet is employed, and roughage is highly inadvisable. Later, when acute symptoms have subsided, a far more liberal diet may be allowed.
In my own experience the following diets have been used with much success. They are presented as types of diet used, rather than as suggested diets for particular cases. Anyone who reads these diets, and then attempts to apply them to the treatment of his own case, may possibly be doing himself an injury. No physician—and certainly no well-trained specialist—ever suggests a diet in a particular case until, by urinalysis and physical examination, he knows as much as possible about your especial requirements.
By so doing, he spares you the danger of indulging in foods that your individual system is unable to handle.
I recall a patient who recently came to me in a deplorable state. Somewhere she had heard of a high-protein diet and proceeded to use all types of meat, eggs, and proteins. She almost immediately became dropsical, and within three days came under my care at the hospital. In attempting to treating her colitis with a high-protein diet, she had aggravated a kidney condition. The ill effects of this made her case more complicated than the colitis in itself would have been. With this admonition, I mention the following typical colitis diet:
Colitis Diet: 120 Grams Protein – 2600 Calories
Consume certified organic foods and beverage as much as possible.
It will be noted that certain things, by their absence, are forbidden in this suggested diet. They are creamed soups, the more indigestible meats such as mutton, veal, and pork, raw fruits and vegetables, fruit juices by themselves, raw salads, and coffee. Also, highly spiced foods are prohibited. So, too, are foods containing small seeds, such as tomatoes, raisins, and figs. Naturally, fried foods are absolutely to be avoided. Tea, when used, should be weak. Bread, when used, should not be too fresh. Fruits, when taken, should contain both pulp and juice. That is, they should be in their natural proportions.
In my experience, most cases of colitis do not require food pureed, and while I do not favor the use of coarse substances like pure bran, I do favor the presence of the natural pulp in foods, providing they have been cooked. If one subsists too largely on fluids, he will find flatulence is greatly increased. One thing of utmost importance in this diet is that extremes of temperature in foods should be avoided. Neither very hot food nor very cold food should be taken. One important thing in any diet is for the patient to note carefully what agrees with him and what does not. By doing so, he can assist his physician very much in the construction of the final diet. All diets in the beginning are more or less experimental and must be adjusted to individual requirements. For convenience, the following list of permissible foods is given:
QUANTITY
While on the subject of feeding, I would like to add a word of caution with regard to quantitative as contrasted to qualitative selection.
I am quite sure that if you had a sprained arm you would avoid lifting heavy weights. You would realize that it was a sick member of your body and hence would favor it. Certainly you would not ask it to perform a heavier task than normal.
The logic of the foregoing is very apparent to most people, yet when it comes to intestinal ailments, they very often eat huge quantities in order to “keep up their strength.” What they lose sight of is the fact that this already disordered organ is being asked to work overtime when it rightfully should get a vacation. Far better to eat little and often than to eat big meals at any time.
FOOD ALLERGY
“I am allergic to it” has become a popular expression. No doubt you have heard it many times. Perhaps you don’t know what is meant by allergy, but neither does the person who is using the term. Perhaps what is implied is a recognition of the fact that some people are more sensitive to certain foods or drugs than other people. Allergy is a reaction, a reaction of living tissue to irritant substances. Just as one man’s food is another man’s poison so too what is food and nourishment to one person can be distress and misery to another.
There is perhaps no substance in the long line of foodstuffs which cannot claim somewhere a person who is sensitive to it. It is indeed possible to find some few who are sensitive to so universally popular a food as wheat. In fact, everybody is abnormally sensitive to something at some time or another.
Thus, instead of being alarmed and unduly concerned about the matter, let’s accept it good-naturedly as a sign of life—dead people not being allergic to anything. By assuming this matter-of-fact attitude toward your sensitiveness, you will rob it of much of its disturbing effect since anxiety over an “allergy” can greatly disturb the entire system.
Naturally there are degrees of sensitivity, just as there are different temperatures in people. It is my opinion that the important thing to remember is that any food, drink or drug that we put into the food digestion canal at the mouth is capable of disturbing the intestinal tract either locally at the point of entrance or elsewhere throughout the intestinal tract.
Not infrequently people complain of canker sores in the mouth or notice a swelling of the lining of the mouth. If this develops quickly, it is well to reflect on what food has been taken at the previous meal. This will often give the clue as to which is the disturbing food factor. For instance, some people are sensitive to melons. I have among my patients a man who develops a “sore throat” the moment he takes a small morsel of honey dew melon. The lining membrane of the mouth and throat becomes rough and angry and the throat feels “raw.” These symptoms can be produced in this man by merely rubbing a silver spoon over the melon and then passing it over his tongue. Certainly a high degree of sensitivity and a very compelling reason for the decision of crossing honeydew melon off his diet list!
The sensitivity, here, has been the mere contact with the irritating substance. However, it is possible to eat certain other foods without getting any local irritation, yet have full fledged evidences of sensitivity after absorption. For instance, many people after eating shellfish or strawberries will break out in a rash. This too is evidence of sensitivity to certain substances in the food.
The canker sores and the rash are external evidences of the disturbance caused by food sensitiveness. Closely similar disturbances occur along the lining membrane of the food digestion canal. At various localities along the canal, the irritation gives rise to characteristic symptoms.
When the irritation is in the stomach or upper small intestine, vomiting is a usual result. When the irritation occurs in the lower small intestine, it gives rise to spasm which makes itself evident through colicky pains. In the large intestines the spasm gives rise to distention and an increase in mucus. Even as low in the food digestion canal as the rectum, symptoms of irritation can occur and give rise to an intense itching in and about the anus.
Needless to say, all that has been noted with regard to food applies equally to drugs.
There are, of course, many skin tests which can be employed. However, my own experience has been that there are so many false negatives and false positives that the method turns out to be an endless maze of no value.
The best thing to do is to keep a food diary, that is, to make a faithful recording of the contents of your meals. When you have an allergic reaction go to your friend, the family doctor, with your food diary. He will be enabled thereby to discern what is likely to be the disturbing factor. By judicious trial and error, the food under suspicion can be identified as the disturber or else exonerated. Once a diet has been found that does not produce any symptoms of allergy then it is a simple matter to add one new item of diet every other day, carefully observing whether it produces symptoms.
Nobody need starve since there are rarely so many foods to which a person is sensitive that his general nutrition is interfered with.
Fortunately there are now available certain drugs—the anti-histaminic drugs—which effectively quiet the disturbance known as an allergic reaction. Still more fortunate is the fact that these drugs can be continued for a long time with no harmful effects. In discussing these medicines under the chapter on Wonder Drugs certain precautions in their use were recommended. It would be prudent to read these again (page 116) before starting their use.
Nowadays any doctor who gives a patient a diet runs the risk of being called to account on the score of vitamins. The patient will scan the diet with a knowing eye and piercingly query: “Where do I get my vitamin C?” or one of the other vitamins. Here indeed a little knowledge is a dangerous thing.
So much is “known” that is not true knowledge. Many people believe that the only source of vitamin C is orange juice, thanks to a heavy advertising campaign. Needless to say, it is present in many other foods and cooking does not destroy it completely. Still further, bear in mind that the doctor knows about vitamins too. Should he feel your condition requires them, he will prescribe them as a supplement to your diet.
It might be news to you that you can get too much of the vitamins. People have been poisoned by an excess. In my own experience, I have encountered many cases of colitis that have been made immeasurably worse by an over dosage of vitamin B Complex. This may sound like heresy, as I know that it is supposed to be good for intestinal conditions, but Vitamin B Complex gets no preferred place in my list of remedies for colitis.
“I don’t know what to eat,” was the opening complaint of one of my patients not long ago. Looking at his chubby face and tubby abdomen, I ventured to express my disbelief by saying: “I hope you never find out.”
Strange it is that grossly overweight people “never eat a thing.”
“But doctor,” said another one of my patients when I called her to account for being overweight, “I eat like a pigeon.”
“That may be,” I answered, “but not the same amount.” Written By: J. F. Montague, M.D., Continue Reading: Is Surgery Always Necessary In Colitis?
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