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ILEOANAL POUCH &
DIET
Karen Jackson
Dietitian RD, BSc Hons, Sports Nutrition
Specialist PG Cert
Oxford University Hospitals NHS Trust
May 2014
Function of the colon
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Re-absorbs electrolytes e.g. salt (sodium)
Re-absorb water
Forms stool
Fermentation
Synthesize & absorb vitamins
( Vit K, B12, thiamine)
Post op Guidelines
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Improve nutritional status
Light, soft & low fibre
Adequate fluid & salt intake
Regular eating pattern
Re-introduce fibrous foods after 4 wks
in small quantities & well chewed
• “Restore eating confidence”
What should you eat to maintain
a healthy body?
• In most cases - a healthy balanced
diet
• CHO (55%)
• Fat (30%)
• Protein (15%)
• 5 food groups
5 Food Groups
1. Fruit & Vegetables
2. Breads, cereals, rice, pasta &
potatoes
3. Meat, fish & alternatives
4. Milk & dairy products
5. Fats & sugars
1. Fruit and Vegetables
• Excellent source of many vitamins, minerals &
antioxidants
• Aim for as much variety as possible
• Aim for 5 or more serves every day – determine
individual tolerance
1 serve
=1 medium sized fruit (eg apple,
banana, peach, orange)
=2 small fruit eg satsuma, plums
=2 tablespoons vegetables
=1 small glass fruit juice
= 1 small bowl of salad
Low Fibre
Fresh tinned or stewed:
Apples, cherries, grapes,
melon, banana, plums,
pears, peaches, plums
(avoiding pips, skin & pith)
Carrot,beetroot,courgette
lettuce, spinach, squash,
pepper, swede, broccoli
or cauliflower florets,
skinned cucumber &
tomato, turnip
High fibre
 Berry fruits, dried fruit,
unripe bananas, kiwi
fruit, grapefruit, rhubarb,
mango, oranges
 Beans & pulses, chick
peas, split peas
 Brussel sprouts, peas,
mushrooms, cabbage,
garlic, green beans,
okra, onions, leeks &
sweetcorn
2. Bread & Cereals
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Starchy foods provide us with energy
Excellent source of fibre & B vits
Cheap & easy to prepare
Base each meal around
Opt for lower fibre choices if required
– eg sweet potatoes, pasta, noodles, scones,
baguettes, crackers, cous cous, rice
krispies, corn flakes
3. Meat, fish & alternatives
• Protein is essential for growth & repair
• Excellent sources of B vits, iron & zinc
• Try to have lean & low fat versions
where possible:
eg lean meat, poultry, fresh fish, oily
fish, eggs, soya products, pulses, nuts
• 1 – 2 serves day (approx. 45g/11/2 oz)
4. Milk & Dairy foods
• Most abundant supply of calcium – major “at
risk” nutrient
• Good sources protein & energy
• Low fat versions have the same amount of
calcium
• 3 serves day =
1 glass (250ml) milk
1 pot yoghurt
1 matchbox (30g/1 oz) cheese
5. Fats & Sugars
• Limit animal fats
• Restrict fats/sugar if excess weight is a
problem
• Practice good oral hygiene
• Beware of hidden fats & sugars
• Become a label reader
Fluid Intake
• Very important (rehydrate well)
• Thirst is not a good indicator of
your hydration status (too late)
• Aim 8 - 10 of cups of fluid per day
• High pouch output looses water,
salt & potassium
Types of fluid
• Rehydration drinks
(sports drinks with added
salt, dioralyte, WHO)
• Keep tea & coffee to
<4 cups/day
• Limit fruit juice &
sugary/fizzy drinks
• Encourage water
Special dietary
considerations
• Calcium intake
• Vitamins &
minerals
• Hydration
• High energy
The Dysfunctional Pouch
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erratic eating habits
high caffeine intake
high alcohol intake
high fibre diet
high fat intake
poor fluid intake
sorbital intake
irritable bowel syndrome
food intolerance
pouchitis
probiotics
Probiotics
• “Friendly bacteria” in the digestive tract
• Pouchitis associated with lack of “good
bugs” (Lactobacilli + Bifidobacteria)
• Patients with chronic pouchitis
remained in remission after taking high
dose probiotics (Gionchetti et al., (2000);
Mimura et al., (2004) )
• Yoghurt, Yakult, Actimel, capsules,
powders (VSL#3)
Probiotics
• Vary in their efficacy
• A small increase in bloating or
flatulence when first commenced is
normal
• Try to take both Bifidus & Lactobacillus
and with food preferably
• Trial for several weeks - 3 months
Foods that thicken output
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rice & rice cakes
pasta (fresh) & white bread
mashed potato
apple sauce
smooth peanut butter
marshmallows & jelly cubes
banana (ripe)
Increase wind & odour
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broccoli, sprouts, cabbage
onion, garlic, leeks, asparagus
beans
spicy foods
carbonated drinks
beer
eggs
differing individual tolerability
Increase pouch output
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pulses & leafy vegetables
high fibre fruit & veg
wholegrain cereals
nuts & sweetcorn
alcohol, fruit juice &
caffeinated beverages
• chocolate
• fatty foods
• food intolerance
When to use the Exclusion Diet?
• Final dietary step,
– when all initial modifications have
failed to improve symptoms
• Only reliable method of investigating food
intolerance
• Threshold effect/dose response
• Challenge beliefs
• Motivated / appropriate client
• Support / extra financial burden
• Recipes / meal planning / access for
support
Foods that are likely to cause
symptoms
• Wheat, rye, oats, barley, corn, potatoes, cows
milk, sheeps milk, goats milk, corn oil, veg oil,
onions, sweetcorn, garlic, leeks, citrus fruits, tea,
coffee inc decaff, squash, sparkling mineral water
& processed foods
• Foods allowed Rice,Tapioca,Sago, Millet,
Buckwheat,Quinoa,Arrowroot, gram flour, soya
milk, herbal tea
Exclusion Diet cont’d:
• State Registered Dietitian who is experienced /
interested in food intolerance
• 2-3 week period on baseline diet
• If symptoms improve proceed to reintroduction of
foods
• Careful food reintroduction is crucial & support
required ++
• Follow up
–At start of diet
–During exclusion phase
–Regularly during reintroduction phase
Optimizing Pouch Function 1
• Don’t skip meals,
eat small meals
regularly
• Include foods that
thicken output
• Avoid eating &
drinking at same
time
Optimizing Pouch Function 2
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Healthy eating, freshly cooked CHO
Fruit & veg to tolerance
Consistent fluid intake throughout the day
Probiotics
Limit foods that cause irritation e.g. spicy
Optimizing Pouch Function 3
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Limit food that increases output
Limit foods that cause gas
Chew food well
If active overnight aim to finish
eating early in evening
• Formal assessment from dietitian in exceptional cases - exclusion
diet
Good nutrition and
healthy eating
make a difference!
References
• Gionchetti P, Rizzello F, Venturi A, et al. Oral
bacteriotherapy as maintenance treatment in patients
with chronic pouchitis: a double-blind, placebocontrolled trial. Gastroenterology (2000) 119:305–9
• Mimural T,
Rizzello F, Helfwig U, Poggioli G,
Schreiber S, Talbot IC, Nicholls RJ, Gionchetti P,
Campieri M, Kamm MA. “Once daily high dose
probiotic therapy (VSL#3) for maintaining remission
in recurrent or refractory pouchitis”. Gut (2004)
53:108-114 doi:10.1136/gut.53.1.108