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Most experts agree that fiber is a vital part of any healthy diet. But how much fiber is appropriate? And could eating too much cause your Crohn's disease symptoms to flare? In this HealthTalk show, two opposing views are presented about the role of fiber in Crohn’s disease.
Announcer:
Before we begin, we remind you that the opinions expressed on this show are solely the views of our guests. They are not necessarily the views of HealthTalk or any outside organization. And, as always, please consult your own physician for the medical advice most appropriate for you.
[Medical editor’s note: Please note that some of the subject matter of this program is controversial and the speakers disagree on many points. You should read both opinions before following any of the advice that is given.]
Now here’s your host, Mary White.
Mary White:
Hello and welcome to our show, Crohn’s and Fiber: Helpful or Harmful? I’m your host, Mary White.
We hear a lot about fiber being a vital part of any healthy diet. Yet fiber itself remains somewhat of a mystery. What is fiber, and how much is appropriate? Could eating too much fiber cause your symptoms to flare or help your symptoms? With all the controversy surrounding the role of fiber in Crohn’s disease, it’s no wonder we’re all confused. Tonight, we’ll discuss both sides of the debate and attempt to uncover the mystery with our expert panel.
Joining us is Konstantin Monastyrsky. Konstantin graduated with a degree in pharmacology. He’s a member of the American Association of Nutritional Consultants and a certified nutritional consultant. He has written two best-selling Russian language books entitled “Functional Nutrition, the Foundation of Absolute Health and Longevity” and “Disorders of Carbohydrate Metabolism.” In 2006, Konstantin released his first English language title, “Fiber Menace, the Truth About the Leading Role of Fiber in Diet Failure, Constipation, Hemorrhoids, Irritable Bowel Syndrome, Ulcerative Colitis, Crohn’s Disease and Colon Cancer.” Welcome, Konstantin.
Konstantin Monastyrsky:
Hello everyone, and thank you, Mary, for inviting me to participate in your show. I look forward to helping our listeners with what some may say are very unusual insights.
We’re glad you’re here. Thank you for being here.
Also with us is Dr. Marcia Nahikian Nelms. Dr. Nelms is a professor, registered dietitian and director of the Dietetics Program at Southeast Missouri State University. She has over 25 years of experience practicing as a clinical dietitian and public health nutritionist, and she specializes in gastrointestinal diseases, hematology-oncology, nutrition support, bone marrow transplant, HIV and AIDS. She has published numerous articles and books including “Nutrition Therapy and Pathophysiology” and “Medical Nutrition Therapy – A Case Study Approach.” Welcome, Dr. Nelms.
Dr. Marcia Nahikian Nelms:
Thank you so much for having me.
Dr. Nelms, let’s start with you. We talk a lot about fiber, but most people don’t know what fiber actually is. Can you tell us what fiber is and how it is different from a carbohydrate?
Dr. Nelms:
I would like to be able to give you a very simple definition because many scientists define fiber simply as the portion of plants that cannot be digested. But others may give you a slightly different definition, and therein lies some of the confusion about fiber. In order to understand fiber, you have to give a quick mini-lesson on carbohydrate.
In quick detail, remember that carbohydrates are like their name. They are composed of carbon, hydrogen and water. In their simplest form, we call them a monosaccharide, or one carbohydrate unit. Glucose [sugar] is a monosaccharide that is the simplest form of carbohydrate. All carbohydrates and fiber, for that matter, are combinations of glucose and other carbohydrate molecules. We call starch and fiber a polysaccharide, or simply another word for many glucose molecules.
The difference between fiber and other types of carbohydrates is the chemistry. It’s the bonding between the molecules and the other types of molecules that may be located on that structure. The other thing that’s important to remember is that carbohydrates come from plants, and fibers play different roles in the plants from which they come. Some of them may serve as the woody part or the outer covering of the plant, or some of them may be part of the plant cell wall. The differences among different types of fiber have to do with the plants that they come from, their chemical bonding and the chemical substances that are found within their structure. That is what makes up the difference between fiber and other types of carbohydrates.
In other words, a slice of bread is different from a carrot peel?
Absolutely. It’s difficult to define fiber as one word because in actuality we’re talking about lots of different substances. Our listeners may have heard some of those words like lignan, cellulose and hemicellulose. Those are all different types of fiber that make up different parts of plants. When you and I eat, we don’t eat one thing. We eat a mixture of foods, and, therefore, we eat a mixture of fibers.
Konstantin, what are the different types of fiber?
Konstantin:
There are two of them known, but the specifications may sound strange because fiber is an undigestible substance. On the other hand, it’s divided into soluble and insoluble parts. The closest thing to insoluble fiber is paper, which is made from cellulose, an alternative name for fiber. Just like paper, insoluble dietary fiber is undigestible in the small intestine because the human body, unlike sheep, pigs or cows, lacks the enzyme to digest cellulose. Hence, it absorbs water, gobs of water, about five times its own weight, and it expands in the process. This particular quality of insoluble fiber is employed in what is known as bulking laxatives, the substances which are intended to bulk up stools, stimulate intestinal peristalsis (movement of muscles that pushes food through the gastrointestinal tract), and plunges stools from your colon by means of mechanical pressure and gravitation. These particular physical properties of insoluble fiber are the primary, from my perspective, culprit behind hemorrhoids, diverticular disease, constipation and the subject of our conversation, Crohn’s disease. The human body wasn’t designed to process undigestible substances, and little children and, especially, senior citizens are the most vulnerable.
Examples of insoluble fiber are the skins of fruits and some vegetables, bran, husks, and the shells of nuts and grains. It’s actually quite hard to consume a lot of undigestible fiber unless you are ready to eat a lot of potato skins, raw carrots, celery sticks or bran. So most of the insoluble fiber in the contemporary diet comes not from regular food but either from processed fiber, intentionally added to food, such as fiber in high- fiber cereals, or fiber in bran-enriched bread, or from laxatives that may contain psyllium or psyllium seeds. These are your laxatives Metamucil DM and Benefiber and a number of generics that specifically say they contain fiber. Soluble fiber is a much more complicated beast.
All soluble fibers that are found inside of plants and fruits and vegetables are the main sources of soluble fiber in our diet. A lot also comes from food additives, and that is where real harm comes. It’s in yogurt, ice cream, desserts, sauces, salad dressings, canned soups and even breakfast foods for kids.
You mean like carageenan?
It comes from carageenan, cellulose, guar gum, [agar], inulin (an extract of chicory root that’s used as a fiber supplement in some foods), modified corn starch and many others. Chemically, they go by names such as oligopolysaccharides, starches or complex carbohydrates. The most common type of soluble fiber is also used in laxatives. Psyllium, which I mentioned, contains 30 percent soluble fiber. Soluble fiber from my perspective is even more dangerous than insoluble because it isn’t evident. And because it is not evident, it’s harmful. The main harm comes from its inability to get fermented in the intestine and its ability to block intestinal absorption of water and gases, which are by-products of normal digestion.
Does fiber contain calories?
Fiber itself doesn’t contain calories, but here’s a very distinct point about it. If you are healthy and your gut is populated by healthy bacteria, when fiber finally gets into the large intestine it gets fermented. In the process of fermentation, bacteria generate short-chain fatty acids, and these fatty acids contain the same nine calories [per gram] that are attributed to regular fat. If they get absorbed into the bloodstream, they carry a fairly substantial caloric load. And, according to experts, up to 70 to 80 percent of insoluble fiber and almost a 100 percent of soluble fiber gets digested in the guts in people who have these bacteria.
Dr. Nelms, does fiber contain nutrients or vitamins?
There are a couple things that are important to remember. One is that when you asked the question, “Does fiber provide calories?” our other speaker is correct that some fibers are fermentable in the large intestine, and they do produce short-chain fatty acids and lactate. But all of us do that in a very different way, so the ability to measure that is very difficult. One of the reasons why calories from fiber are not listed on a soup label is that’s it’s very difficult to measure that.
Your next question is, “Does fiber contain other things beside energy?” You have to put fiber in the context that plant foods are our best sources of not only carbohydrates but also vitamins. They are important for vitamins such as folate, vitamin C, vitamin E, and minerals such as iron and calcium. And plant foods contain our best sources of other substances such antioxidants and phytoestrogens. So in order to talk about fiber, we have to talk about the source. Our plants and whole grains that have the largest amount of fiber contain the largest concentration of these other nutrients.
Fiber – does it aid in vitamin absorption, or does it detract from that? Konstantin, would you have an answer to that?
Natural food and natural plants do contain a great deal of minerals, vitamins, micronutrients and antioxidants. However, most Americans do not consume these kinds of foods. They mostly consume processed food that contains added fiber. The major source of fiber in the American diet is morning cereals. This is a very processed food, and all the fiber is artificially added, and not necessarily from the food. Also, minerals or vitamins in those foods are added artificially, so they (cereals) are all fortified.
When we think about the fiber benefits from plants that also contain vitamins, it’s a great idea, but, unfortunately, we don’t consume these foods. Also, it is a well-known fact that insoluble fiber inhibits assimilation in the small intestine, and the primary reason for assimilation is to absorb the vitamins, minerals and micronutrients you’re getting from food. This would be quite inhibited by insoluble fiber. And insoluble fiber has a tendency to scoop up the supplements from pills we take and inhibit their digestion. [Medical editor’s note: This is controversial, see below.]
Dr. Nelms, do you agree with that?
No I don’t. There are a couple of things that were said that I think are misleading. One is that, when we think about the sources of fiber in the American diet, breakfast cereal is an excellent source, and a lot of breakfast cereals are made from whole grains. So I don’t think you can lump all of those together. I don’t think it’s an all or none principle. The other thing is that fiber does not necessarily inhibit digestion in the small intestine. It is the small intestine where most digestion does occur, but fiber does not interfere with digestion in the small intestine. There doesn’t appear to be evidence that consuming fiber within the recommended amounts of 25 to 30 grams for adults should have any impact on the absorption of vitamins and minerals.
Is that all kinds of fiber, doctor?
It sounds to me like we have a couple of very strong opinions. Before we talk about how the body processes fiber, can you tell us, in general, Konstantin, how a healthy stomach and a healthy colon work to process foods verses how someone with Crohn’s disease processes foods?
Very briefly, a healthy stomach and healthy intestine process food well, but for people with Crohn’s disease it’s a very serious problem. They pretty much don’t process food. The whole point of digestion is to digest. The digestion begins in the mouth with chewing and maceration literally soaking food with saliva. The stomach is the next step. It performs three primary functions: digestion of proteins; sterilization of food, not a well-known fact; and storage of excess food. To digest proteins, the stomach excretes hydrochloric acids and proteolytic enzymes. To sterilize food, the stomach excretes the same hydrochloric acid. That is why acidity is important in the stomach.
To store excess food and liquid, the stomach stretches out from its usual capacity of about 1, 1-1/2 to 2 quarts to a gallon or more, if you’re a big eater. A very important point is that the stomach does nothing to digest carbohydrates, including fiber, and the stomach has nothing to do with the digestion of fats. In fact, a great deal of fiber in the stomach stimulates appetite and causes the stomach to expand more. It’s why restaurants will give you free bread – so you order more food. The real digestion, as the doctor correctly mentioned, happens in the small intestine. This action takes place with the help of bile, very important for fat, and enzymes for the rest, including proteins and carbohydrates. Obviously, while a person is healthy, the whole process works likes clockwork. Once you get Crohn’s, it doesn’t, and here’s what’s going on. [Medical editor’s note: The following information is controversial and represents the personal opinion of the speaker.] Because inflammatory bowel disease blocks the digestion of essential nutrients, neither the stomach nor the intestines are capable of producing sufficient quantities of digestive enzymes to digest proteins in the stomach, and undigested proteins enter into the small intestine and begin to rot. It’s a natural consequence of not digesting food properly.
Rotting and undigested proteins may cause an allergic reaction and contribute to further inflammation of the immune response, and those undigested products slip into the blood and wreak even more havoc there. The same is true for pancreatic enzymes intended to assimilate carbohydrates and fats. The result is that whatever you eat doesn’t digest except, perhaps, simple carbohydrates like glucose, galactose and fructose in a simple form like table sugar, orange juice or grape juice because they digest very quickly.
If you don’t digest food too well, you can’t assimilate what you eat. And if you assimilate undigested food, it causes diarrhea and inflammation, and everything else suffers including your immunity, your brain and your mood. The body begins to waste.
A reason for weight loss during Crohn’s is because proteins stored in our muscles and fat stored in the skin become a source of nutrients. It’s not a pretty picture but one that explains weight loss, muscle wasting, depression, fatigue, sexual diseases and other prominent manifestations of Crohn’s disease.
Dr. Nelms, did you have anything you wanted to add to that?
I just want to make sure that our listeners understand that in normal digestion that is exactly correct. The stomach is a holding place where food is liquefied, and a small amount of protein digestion begins there. No carbohydrate digestion occurs in the stomach. In a normal, healthy small intestine, as carbohydrate passes into the small intestine, we separate the simple sugars and the starch, and they’re broken down by enzymes into glucose, which then can be absorbed. Then the fiber particles that cannot be digested in the small intestine reach the colon, chemically unaltered. This is where the micro-organisms will begin to act and chemically change different types of fiber. We then have electrolytes and water that are re-absorbed. What’s left is what makes up our feces.
How does the body process fiber specifically, Konstantin?
Actually, it doesn’t. That’s why the French and Italians skin their tomatoes. And if you go to an Italian restaurant in Italy and ask for a sandwich, they cut the crust from bread so they can enjoy lots of food without bloating, constipation and the risk of intestinal obstructions. That said, when fiber reaches a healthy large intestine, the local bacteria begin to ferment most of it. Up to 70 to 80 percent, according to some sources, gets digested. If there is too much fiber, that results in a lot of by-products of fermentation. The process is very similar to making alcohol at home. While gases cause bloating and flatulence, short-chain fatty acids get absorbed back into the bloodstream, and they may contribute to obesity. By the way, excessive acidity isn’t too welcoming by the large intestine because it’s an acid, I think up to 2.5 pH. It may cause severe diarrhea for the body to get rid of the offending acids. This point is irrelevant for people who suffer from Crohn’s because they took antibiotics for some time and may no longer have any bacteria left, so the fiber leaves their bodies unprocessed.
Dr. Nelms, is that why this process will be different for people with Crohn’s – because they don’t have the right bacteria?
Not completely. One of the things that is important to remember is that Crohn’s disease is an inflammatory disease that can affect any portion of the gastrointestinal tract, unlike ulcerative colitis, which mainly affects the colon. Crohn’s disease can affect everything from the mouth all the way through the colon. Another distinction about this disorder is that individuals go through periods of exacerbations or flare-ups that are followed by periods of remissions. When someone is experiencing an exacerbation or flare-up of the disease, they may experience bleeding, diarrhea and inflammation of the GI tract, and that can interfere with normal digestion and absorption in any part of the GI tract. So processing of any nutrients is going to be affected. But during periods of remission, the ability to digest and absorb nutrients should return back to their normal state.
A lot of people experience gas and bloating after eating fiber – why is that?
That is exactly what we were talking about with the fermentation process. The symptoms are due to the action of the micro-organisms in the colon, their processing and release of those by-products, including methane, carbon dioxide and hydrogen. Those gases have to be released. That is what you’re referring to.
Let’s talk about the pros and cons of fiber from both your perspectives. Dr. Nelms, I want to start with you. If fiber isn’t absorbed by the body and it expands in the stomach, how can it be good for you, and, specifically, how can it be good for someone with Crohn’s?
I have to go back to what I just said in that our nutrition therapy recommendations for someone with Crohn’s need to be highly specific for that individual. That’s one of my concerns in making a statement that all fiber may be harmful is that we have to be very individualized with our recommendations. During periods of acute flare-ups and exacerbation, fiber may make symptoms worse. But during periods of remission, fiber helps normalize gastrointestinal function. It produces normal soft bowel movements. It’s like aerobics for your intestine. We have to have fiber there in order to provide substrate for the micro- organisms in the large intestine to grow. It’s even been proposed that a disturbance in the bacteria population may, in fact, play a role in the development of Crohn’s. That’s where we have come into the discussion of pro- and prebiotics and their relationship in the inflammatory process that we see in Crohn’s disease. We might find in the future that fiber intake may help treat Crohn’s. So, in summary, a variety of plant sources can help provide the concentrated sources of our phyto-chemicals – the antioxidants, vitamins and minerals – and fiber. But how much fiber we recommend truly depends on the status of disease with that individual.
If fiber does expand in the stomach, how can that be good for someone with Crohn’s?
If it expands in the stomach, it is simply there for a short period of time. It may cause someone to feel full, but it doesn’t necessarily cause any damage by just being in the stomach. It will be liquefied and then slowly released into the small intestine. One of the things that was said a few minutes ago about the acidity reaching the small intestine if we have a normal pancreas, it’s going to release bicarbonate, and that will neutralize the acidity that’s going from the stomach to the small intestine. So that should not be an issue.
You mentioned earlier that for someone with Crohn’s in an active situation, fiber can be a negative. Do you think there are any cons to fiber?
If someone is experiencing acute exacerbation of their disease and if they have active bleeding or large amounts of diarrhea, high-fiber foods may be contraindicated at that time. It doesn’t mean that once they reach their remission stage they can’t add fiber back because if you eliminate all high-fiber foods, then you are eliminating large sources of nutrients that are important for you to consume.
In general, for healthy people, are there any cons to fiber?
Primarily the only situation that we would be concerned about large amounts of fiber is one, when we don’t consume adequate amounts of fluid with it because that might cause constipation if you’re increasing fiber intake but not increasing fluid intake.
That would be one. The second is that in young children when fiber makes them feel full, if they eat large amounts of fiber, it may decrease their appetite. So it would be important to monitor that so that they have large amounts of nutrients from all kinds of foods.
Konstantin, let’s get your take on this. Many professionals and ads on TV say fiber’s great. Why do you think it’s bad?
That fiber feels great is a conventional point. It was made for over a 100 years, and there is a great body of circumstantial and observational evidence that points towards fiber’s greatness. I undertook very substantial research. I’m a recovering diabetic, and I was consuming a huge amount fiber. I was consuming an enormous amount of carbohydrates, and it brought my body to the point of destruction. I’ve been on a fiber-free diet for almost 11 years.
What is a fiber-free diet?
It’s a very natural diet. It’s described in detail in my book. I’m 52 years old. I work for about 12 to 15 hours per day. I have a beautiful young wife. Obviously, so there is a huge lot of energy required for me just to exist. I get up in the morning and have a glass of water. My lunch is usually 50 grams of boiled rice. The rice contains only 0.5 percent of fiber, so the fiber load is minimal. To that I add about 100 grams of regular butter, and that keeps me happy until 6 in the evening. At 6 in the evening, I’ll just have a very simple dinner – lamb chops, filet mignon or meatballs, usually with a small salad. That’s about all I eat. I love drinks, but drinks make me gain weight, and they interfere with my work, so I try to drink as little as possible. I’ll maybe have half a glass of wine. I look with dread at holidays or birthdays because that’s where I get loaded with everything.
What about vitamins, minerals and coenzymes?
I take a lot of vitamins. Let me recite the points which I’m making in my book about how fiber harms.
My book begins with an opening statement, “If you consume a moderate amount of fiber, there is nothing wrong with it as long as it’s soluble.” The harm comes from processed foods, which are rich in carbohydrates, preservatives, colorings, trans-fats and neurotoxins, such as monosodium glutamate. It’s terrible for people who suffer from Crohn’s because the foods that contain a lot of fiber also contain a great deal of gluten, which is exceptionally allergenic, especially for someone with inflammatory bowel disease. If you have Crohn’s and are in remission and afraid of relapse, you have to stay away from all foods containing gluten. [Medical editor’s note: controversial, see below.] Most likely, if you once had an inflammatory disease, your body has already built up a great deal of antibodies, so it’s unable to respond the second time around.
Second, dietary fiber has zero nutritional value on its own. It contains no vitamins, minerals or micro elements. Worse, it removes most minerals and vitamins from the body or blocks their absorption, if it’s in an insoluble form. We mention the point that fiber absorbs water and expands, while the purpose of chewing and digestion is to reduce food particles to the barest minimum and liquefy them for easy passage through the digestive tract. Fiber does the complete opposite. It balloons from its normal size, four to five times. It grows in weight and has a tendency to congregate into large lumps. This particular property of fiber is a primary cause of intestinal obstruction and many hernias, especially in older people because their intestines are no longer as flexible as younger people.
Next point, dietary fiber makes the stool large and heavy. The average American has about 500 grams of stool daily. A normal person should have no more than about 100 grams. When you carry four to five times more stool than necessary, that may cause constipation, hemorrhoids and diverticular disease. By age 70, about 80 to 90 percent of all adults already have all those combined.
Next point, dietary insoluble fiber makes stools rough. It’s called roughage, and it’s rough enough to cause anal tears. That’s why, incidentally, many toddlers on high-fiber diets refuse to move their bowels because they experience pain. But they’re too young to actually verbalize this point. Parents have to go to the hospital, and doctors have to perform manual disimpaction, which is a terrible procedure by itself and will leave a child traumatized for the rest of his life.
Next point, dietary fiber causes bacterial fermentation. Gases and acids, which are the by-products of fiber fermentation, cause bloating, flatulence, abdominal pain and are the driving force behind IBS (irritable bowel syndrome), diverticular disease, ulcerative colitis and Crohn’s disease. That’s why, for people who have Crohn’s, doctors prescribe antibiotics specifically to wipe out those bacteria. Unfortunately, once the bacterial are gone, constipation becomes forced because in the healthy human being about 50 percent of the stool is made from those bacteria. At this point, doctors recommend even more fiber.
Next point, dietary fiber, especially insoluble, causes diarrhea. It is specifically sold as a laxative, and its laxative effect is described as mucilage. Once inside the intestine, soluble fiber blocks water absorption. It acts like a hyperosmotic laxative. Along with blocking absorption, it blocks all essential nutrients, vitamins and minerals. [Medical editor’s note: controversial opinion, see below.] This causes diarrhea. Of course, consuming foods that have laxative effects can’t be good for our health, particularly for people who already have diarrhea coming from Crohn’s.
Konstantin, do you think there is anything good about fiber?
If you’re young and healthy, and you have no chronic disease, do not consume processed food with added fiber, and don’t take fiber laxatives. There is nothing wrong with eating plenty of fruits and vegetables. Enjoy them. But once you develop problems or you go over 40, fiber, especially fiber from processed food, added fiber, and fiber consumed with laxatives, causes a great deal of harm to the body, and I would stay away from it.
Dr. Nelms, a lot of Crohn’s sufferers are confused about what they can and cannot eat, especially when it comes to fiber. How much fiber would you recommend for someone with Crohn’s?
If the recommendations are during the period of remission, my recommendations would be the same as for any adult – about 14 grams per 1,000 calories. That comes to be about 25 to 35 grams for most adult men and slightly less for women. During periods of an acute flare-up, all nutritional intake may need to be adjusted in order to minimize the symptoms and promote healing. It’s important for us to clarify a couple of positions that were stated a few minutes ago. In one of them, Konstantin was mentioning that all Crohn’s patients needed to restrict gluten in their diet. Gluten intolerance is in celiac disease, not inflammatory bowel disease, so that is wrong. Another point is that fiber doesn’t remove or block the absorption of nutrients. There is no evidence for that whatsoever. Another is that when physicians prescribe antibiotics for someone with Crohn’s, I’m not sure how Konstantin suggests that we repopulate the colon with bacteria, unless we consume fiber. That would be the only way that we could repopulate the bacterial population in the colon – provide it with food – and that would be from fiber.
Konstantin, what is your fiber recommendation to someone with Crohn’s and why?
Crohn’s disease is a very complicated affair, and it doesn’t take place on its own. This is a very important point. It manifests itself in what is known among physicians as gastroenterocolitis. Hence, you can’t treat Crohn’s on its own. You must undertake a whole gamut of actions intended to pacify your gastritis; which means stomach inflammatory disease; enteritis, which means inflammation of the small intestine; and colitis, which means inflammation of the large intestine. In the amount of time we have, I can’t provide a full-blown recommendation, so I’ll just go briefly over the points, which I make in my book.
Point one, you have to have prevention first. Remove all sources of soluble and insoluble fiber from your diet. That means excluding all processed foods.
Which would eliminate all vitamins and minerals.
You’re absolutely correct, but what I am talking about is the person with Crohn’s. We’re talking about somebody who is trying to prevent a relapse, so we have to undertake some drastic actions. I know everything is alarming you in my suggestions for the right reasons. We won’t be getting enough vitamins and minerals. So let’s take quality supplements. That is what our government does for our food supply. They require food processors to fortify foods with iron, folic acid, vitamin D, vitamin A, vitamin C, calcium and so on. Food processors don’t buy high quality supplements that you can get in a health food store, and they don’t add that much. My point for people who want to protect themselves is to consume all natural food in its least processed form. That means, from my perspective, fresh meats, poultry and fish.
I don’t suggest eggs to people with Crohn’s because they may be highly allergenic. [Medical editor’s note: controversial] And, obviously, you must exclude all dairy. [Medical editor’s note: controversial] That will deprive you of dietary calcium. So cook yourself some bones for the bone marrow. It will have a very high amount of calcium, magnesium, phosphorus and other minerals. Take quality supplements and calcium ascorbate. It delivers a double punch.
You must also exclude all wheat products because of the gluten. [Medical editor’s note: controversial] Dr. Nelms mentioned celiac disease.This is an inflammatory disease of the bowel. It may become a precursor of Crohn’s. The reason this disease is unknown in the United States is because you can’t stick an endoscope in the particular region where it takes place, so physicians don’t know. It’s always a speculation. If you look at the Merck [Manual], it’s says only 0.5 percent of Americans suffer from celiac disease. But if you look at some European sources, they say 30 to 40 percent of the population who consume a great deal of whole wheat may suffer from this condition. It’s simply very hard to diagnose.
Also, if you are to the point of excluding all wheat from your diet, you have to be very careful because there is a great deal of hidden wheat and gluten in foods, like chicken nuggets. They use breading which contains a great deal of this stuff. Also, exclude all vegetable oils because they’re not synergistic in the human body, especially during inflammation. Yes, it will deprive our bodies of omega-3 fatty acids. So my suggestion is to take liquid cod liver oil instead.
But our bodies react differently to supplements than they do to food.
That’s true, but, again, we’re talking about people who are taking autoimmune modulators and who take antibiotics and steroids. We are talking about people who are facing 40 to 50 percent risk of having their colon or intestines removed. We are talking about people that have a 1,600 percent risk of colon cancer. With all that, I wouldn’t be so concerned about them taking supplements. I would be concerned about them surviving and staying away from this terrible disease.
Your recommendations are based solely from your own personal experience, not from long-term research.
It’s not my personal experience. I’ve seen over 1,000 patients. I’m on the radio every week. I have sold many of my books, and a lot of people follow the particulars I’m offering. I don’t see patients. I work on a volunteer basis with a lot of people with ulcerative colitis and Crohn’s disease, as I can. Everybody who took my suggestions is in the remission stage. I cannot say they’re fully recovered. You are never fully recovered from an autoimmune condition. But if you stay in remission, that is good.
How old is this research – 10, 20 or 30 years? It means very little. A great amount of research is being done in academia, and most of the funding for this research comes from the industry.The Kellogg Foundation is the largest source of money for researchers who would write up articles on fiber benefits.
And if you do what I do, the Kellogg Foundation would not let you in because they are a major purveyor for fiber. That is how it goes.
We have an e-mail from Bonnie. Her question is, “Are flaxseed and wheat germ okay for someone with Crohn’s?” Konstantin, what would you say to that?
Flax is recommended because it contains flax oil, and it’s a well-known source of omega-3 fatty acids. Years ago, flax oil and flax seeds were used essentially as a food for cows, and flax oil was used primarily to grease sewing machines. So when I hear people taking flaxseed oil, it’s laughable. If you need high quality omega-3, take liquid cod liver oil. Wheat germ, it’s the same thing. It’s even more difficult to digest. And if you have Crohn’s disease, I would stay away from all wheat products.
Dr. Nelms, how about you?
Flaxseed and flax oil are concentrated sources of omega-3 fatty acids. They can assist with the anti-inflammatory reactions. So I would not be opposed for someone who is in a remission period to take flaxseed and flaxseed oil.
In remission, you think those would be okay?
Sue from Cedar Hill, Texas, has a question. Her e-mail says, “I have had Crohn’s for almost 30 years. All fiber causes major pain for me. I can eat a salad, but I have major pain for several hours, sometimes for several days. But I experience the same with fruit, bread, milk as well as roughage. I must tell you also that I only have approximately 12 feet of small intestine left. Now, do you recommend the water soluble fiber that can be taken in water?” Dr. Nelms, what do you think?
What is important is that last sentence in her e-mail, that she has only a very small portion of her small intestine left. When you remove large amounts of the small intestine, you have difficulty digesting and absorbing. So I would avoid large sources of fiber because of the difficulty in processing those nutrients. She has to also work very hard to meet her calorie and protein needs.
That’s one of the biggest issues that’s important about her situation and other patients with Crohn’s is that we have to take into consideration if someone has previously had surgery. How much of their bowel has been removed? What portions of their bowel have been removed? What medications are they on? We have to consider every single person’s case individually.
Here’s an e-mail from Himstead, New York. The question is, “Whenever I add cereal to my diet, any type, I have increased stools, 15 times a day. Is this normal for a Crohn’s patient? I am on 100 milligrams, 6-MP daily. Thank you.” Dr. Nelms, what would you say to that?
Probably, they are not tolerating that amount of fiber. I would reduce the amount of cereal fiber that they consume because it wouldn’t be normal to have that number of stools a day. But, again, it depends on if they’ve previously had surgery and how much damage they have to their intestine.
Konstantin, what would you say to that?
I would like to make a point about fats. Fat is the best source of calories for people with shortened intestines. It’s very important if you have Crohn’s to consume fat, and here are the reasons. First, you must neutralize bile because if there are no fats in your intestine, the bile slips through, and it is very astringent and will reach affected intestinal sections in its original form. And it will literally burn them and cause more inflammation and diarrhea. It’s very important to consume fats to neutralize bile. [Medical editor’s note: Information on bile is controversial – see below.]
Number two, fat is essential for assimilating vitamins A, D, E and K that are essential for health. Vitamin K is very essential for recovery for people with ulcerative colitis or Crohn’s disease because they lack bacteria, and the body no longer produces vitamin K. The production of vitamin K takes place in the colon thanks to these bacteria. Fat is also very essential for intestinal cells, particularly restoration of mucosal membranes. The turnover of mucosal cells takes place daily, and without innate fats – I mean animal fats, saturated fats – this turnover stops and our membranes suffer. I believe that lower fat diets are behind a great deal of cases of IBD (inflammatory bowel disease). The question comes up, what is the best source of fat? The best source of animal fat is regular butter. I prefer European brands because many of them are produced from milk harvested from cows whose nutrition comes from natural pastures, and it contains more vitamins. If cholesterol alarms you, don’t be alarmed. The membrane of each and every cell in your body, including your intestines, is made from cholesterol.
So you feel that fat is much more important than fiber?
Absolutely. Fat is a critical for a recovery, and fat contains a great deal of calories and digests quite well, up to 98 percent. It helps people, maybe 80 percent of people, who are not healthy and provides a source of energy. In fact, if you consume an adequate amount of fat, you can be on a completely carbohydrate-free diet, as I used to be for six years. I still feel great and have a great deal of energy.
Dr. Nelms?
One of the things I think is important to also remember is that when people have Crohn’s and they previously had surgery, fat is probably one of the things that is most difficult to digest and absorb. I have to agree with what Konstantin has said that fat is an essential part of our diet. We have to have those essential fatty acids and calories in order to maintain our nutritional status. But fat is oftentimes one of the things that causes diarrhea because it is not easy to digest and absorb. There are a couple of things Konstantin said that I disagree with. First of all, talking about fat neutralizing bile, bile is what allows us to digest fat. I’m not sure what we mean by the neutralizing of bile. The other point is that when we reduce the amount of time that food has in the small bowel, fat is the first nutrient that is not digested or absorbed well. It causes a condition called steatorrhea, which simply means fat in the stool, fat malabsorption. A lot of people with Crohn’s have fat malabsorption.
My research indicates that soluble fiber blocks digestion of fats a great deal.
I think that’s totally not true.
It’s a very simple point. If something breaks absorption, it doesn’t matter what’s inside the small intestine – it can be water, fat, supplements, proteins or any other nutrients – as long as you have a substance which prevents assimilation of food, it impacts everything.
I have to agree with that. One of the biggest issues we have with someone with Crohn’s is simply that they aren’t able to digest and absorb during those acute exacerbations of the disease. The other thing that’s important to remember is that some of the medications that we use for Crohn’s cause an increase in nutrient requirements. For example, steroids increase your need for both calcium and vitamin D.
Some individuals with Crohn’s will be on methotrexate or sulfasalazine, and that increases the need for the vitamin folate. There are certain times that vitamin and mineral requirements change during treatment for Crohn’s.
Here’s a question from Joe from Spartanburg, South Carolina. “I rarely find fiber to be helpful, even when in remission. I’ve had Crohn’s since before 1972, short gut since that year’s surgery, and now an ostomy means that unrelenting diarrhea makes life awful. How do I eat any fiber without blockages?” Doctor, what would say to that?
The deciding factor for him is that he has an ostomy and short gut syndrome. Fiber is not going to be tolerated well.
What is short gut syndrome?
Short gut syndrome is when more than 75 percent of the small intestine is not usable. That’s usually because of damage that has occurred because of an infection, because of the Crohn’s, and we’ve had to do a surgical resection.
I have a question from Portland, Oregon. “If you’re eating bread at all, what kinds of breads are the best?” What do you think about that, doctor?
I would recommend bread that the first ingredient says whole grain, so we know that the majority of the carbohydrate source is from a whole grain, whether it’s from wheat or whatever the grain source is, if we’re talking about encouraging a high-fiber diet during a remission period.
Konstantin, even if the person was in remission, you would disagree?
I would stay away from bread because any wheat bread is a source of gluten. Even if you’re not allergic to gluten, I would eat only white bread and would cut the crust. And if you go to whole wheat or high glutinous wheat bread, you consume a much greater deal of gluten and fiber, especially when it’s added with bran.
You guys have a very differing opinion.
That’s because there’s really no relationship between gluten intake and Crohn’s disease that we understand at this time. There is a definite relationship between gluten and celiac disease. We’re talking about two completely different disorders.
Here’s a question from Morris from Tucson, Arizona. “I have Crohn’s disease, and eating high-fiber cereal just made me feel worse. Is this normal?” Doctor, what would you say to that?
During a period of flare-up, a high-fiber cereal will cause an increase in pain. So we have to slowly increase fiber from fruits and vegetables in small amounts.
We have an e-mail from Carbondale, Illinois. “I’ve two friends recently diagnosed with Crohn’s disease. Both went to the same physician, but they were advised differently. One was advised to reduce his fiber intake and the possibility of surgery was discussed. The other, however, was advised to increase his fiber intake except during any flare-ups, of course. And he was prescribed several medications, but no surgery was discussed. Why would my friends, both suffering from the same disease, get different treatments?
That goes to the point that we have to have highly individualized recommendations. That’s what my biggest concern is with Konstantin’s recommendations. We have to look at everyone’s situation very differently. We cannot wholesale say that all fiber is bad.
I respectfully disagree because, essentially, the genetic difference between us is about 0.1 percent. So whatever harms me will also harm you, and whatever heals me will also heal you. The reason the doctor gave different advice to those patients is because by experience he or she knows that the closer the person is to surgery, the more vigorous reaction he or she will experience to taking fiber. When you get admitted to the hospital, the first thing they do is put you on what is called a low-density diet, a diet which is completely free of fiber.
It’s to help reduce the symptoms that they are experiencing.
Nobody said, “I have Crohn’s, I eat fiber, and I feel great.”
We have an e-mail from Bolivar, Ohio. The question is, “I would like to know about fiber consumption for children. Our son is 10 years old, and he was diagnosed at age 8.” Konstantin, what would you say to that?
Children should stay away from fiber completely because their organs are much smaller and much more vulnerable. [Medical editor’s note: controversial, see below] They have a much more vigorous immune system, so it will respond with more vigor and inflammation. Also, if a child consumes a great deal of fiber, especially gluten, there is a high risk of developing celiac disease. [Medical editor’s note: controversial assertion] That immune condition stays with you for the rest of your adult life. Also, because children are growing up and developing, they need to consume a great deal of food and need to absorb it. They need to get all those vitamins and minerals for intellectual development. I would just keep them on a very basic, simple diet. Just provide them with what they want in abundance.
Remember the big scandal about broccoli in the Bush family, and the kids never wanted it, but the mother was pushing broccoli onto them? It’s exactly the same point. Children cannot verbalize what’s wrong with fiber, but they sense it. They’re much more instinctive. If you have a cat or dog, try to give the cat or dog a food that contains a great deal of fiber and observe them. The dog may eat it, but the cat will not. That’s why it’s difficult to convince kids to consume fiber because they feel the sensation of pain much faster, and they’re more assertive about it. Dogs, because of conditioning, can do a lot of things to harm themselves unconsciously.
Dr. Nelms, do you have anything to add about what children should be eating?
My biggest concern in the recommendations that children should avoid fiber is that when we limit fiber, we’re eliminating fruits and vegetables that are our highest sources of vitamins and minerals. That’s a very drastic approach to young children who need to meet their growth needs. We need to make sure that we are not substituting a pill for foods. There are other things in foods that we don’t even know about as far as phytochemicals and phytoestrogens that can be helpful.
Konstantin, are there any last words you’d like to leave us with?
I wish to remind everyone that we started on this earth with breast milk or formula, and neither had any fiber. That didn’t stop most of us from having healthy and abundant stools and health, so let’s consume as little fiber as possible.
I want to make sure that all of our listeners know that individual tolerance and needs are paramount for any nutrition recommendation. That’s especially true for you with Crohn’s. Your individual case is unique. You need to consider what portion of the gastrointestinal tract has been affected, whether you’ve had surgery and your medications. Make sure that you talk about your concerns with a registered dietitian and with your physician. Be careful in taking wholesale advice.
You both have been very interesting. I want to thank you all for listening tonight. I’m Mary White, thank you for listening.
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