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Dr Mariano posts - gastrointestinal, IBD

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by , 09-10-2012 at 03:23 PM (290 Views)

As far as I know, there is no specific diet for patients with Inflammatory Bowel Disease (IBD, e.g. Ulcerative Colitis, Crohn's Disease) that is going to be a therapeutic and effective in treating the disease. In general, I don't tell my patients to avoid Legumes.

Some considerations:

The answer for any particular individual is: It depends on many factors. These foods may need to be considered on a case by case basis if a patient is having problems with certain foods or has active symptoms.

With the IBDs, food sensitivities frequently occur and exposure may worsen the patient's symptoms. Various tests, dietary changes may need to be done to get a person healtier.

With the inflammatory bowel diseases, a big problem is getting enough nutrition for the body and mind to function well. The inflammatory bowel changes impair nutrient absorption.

Legumes (such a peanuts and various beans) which are high in fiber, in various amino acids, B-vitamins and antioxidants are useful to help obtain high nutrient density in the diet. Poor patient's can't afford high nutrient density foods like meats. Legumes are affordable.

When you look a list of commonly used legumes, you can realize that legumes can be very important parts of a good healthy nutrient-dense diet: Asparagus bean or snake bean, asparagus pea, baby lima bean, black bean, black turtle bean, Boston bean, Boston navy bean, broad bean, cannellini bean, chickpeas, chili bean, coco bean, cranberry bean, Egyptian bean, Egyptian white broad bean, English bean, fava bean, fava-coceira, field pea, French green beans, frijo bola roja, frijole negro, great Northern bean, green beans, green and yellow peas, kidney beans, lima bean, Madagascar bean, Mexican black bean, Mexican red bean, molasses face bean, mung bean, mung pea, mungo bean, navy bean, pea bean, Peruvian bean, pinto bean, red bean, red eye bean, red kidney bean, rice bean, runner bean, scarlet runner bean, small red bean, small white bean, soy bean or soybean, wax bean, white kidney bean, white pea bean.

Peanuts, themselves, are used ubiquitously in many protein bars as a primary protein ingredient.

If a patient is vegetarian, they will need to eat legumes to balance the grain products in their diet so they can have an adequate amount of each essential amino acid. Otherwise, amino acid deficiencies may occur in the diet.

When IBD is active and symptomatic, however, the high fiber content of legumes may not be tolerable, causing gas, worsening abdominal pain and diarrhea. During those times, patients may want to avoid them to reduce their discomfort. The active symptoms, in any case, such as diarrhea, would reduce absorption of nutrients.

A concern with Legumes with some people is the presence of Lectins in legumes. Lectins are substances wotj a sugar fused to a protein (i.e. glycoproteins). Lectins occur in all foods (meats, vegetables, grains, etc.) and to varying degrees. They are higher in certain foods such as grain products and legumes.

A concern is that Lectins can bind to the disrupted and changed intestinal lining in patients with IBD and - like gluten - can stimulate an inflammatory response - or even promote abnormal cell growth which increases the risk of gastrointestinal cancer. A person's susceptibility to this varies between ethnic groups, nutritional status, etc.

Moreover, legumes can be cooked in ways which can neutralize almost all of the lectins in them - e.g by employing soaking, heating past 100 degrees celcius, etc. - thus cooking method can greatly reducing or eliminate the risk.

Additionally, if part of a nutrient dense diet, the anti-inflammatory effects of such a diet can outweigh the inflammatory contribution of lectins in the food, just like the inflammatory effects of gluten can be outweighed by the nutrient density of traditional heavy breads, like the Portuguese breads that traveled at see with explorers.

The answer, again, is it depends.


In regard to digestive enzymes and dietary acids, the answer is it depends.

Some people clearly benefit from the addition of digestive enzymes and acid. Some don't. The response will vary with person's genetics, GI health, etc. Some people improve digestion with Apple Cider Vinegar, some don't.

It has be considered on a case by case basis. A clinical trial may be considered. There generally is low risk to giving it a limited trial. But this risk needs to be assessed for the health care provider.

Dr M, Do you recommend supplementing with HCL and digestive enzymes to increase absorbtion?

The standard psychiatric answer is: It depends. It's not that simple.

If some patients clearly have problems digesting their food, first a gastroenterology consult may be necessary.

Absent problems that the gastroenterologist can identify and address, if problems with digestion of food persist, then some people may benefit from digestive enzymes and or increased acidity in their food.

The vast majority of patients will not needed these additives. The gastrointestinal system generally can make sufficient digestive enzymes and acids unless a clear structural or functional defect exists such as a missing gallbladder due to cholecystectomy or pancreatitis.

Some people clearly benefit from the addition of digestive enzymes. Some don't.

Some people improve digestion with an increase in food acidity, such as by the addition of apple cider vinegar.

The response will vary with person's genetics, GI health, etc. Things have be considered on a case by case basis and the risks of treatment assessed. For example, increasing food acidity may help digestion, but it may also increase systemic acidity, which may or may not be helpful.