 |
    |
Food and Diet
What I Tell Families About Diet I always talk to families a little bit about diet, because this is a bowel problem, and we consider diet to be something that has a lot to do with it. The truth of the matter is that we don’t know if one’s diet is a cause, but it probably does have something to do with it. However, no one has been able to pinpoint a specific group of foods that causes these diseases. For the most part, people with these illnesses can eat pretty normally, but there are a few exceptions to that. For some patients with Crohn’s whose intestines are very narrow, we recommend a low residue diet. A low residue diet is one in which anything that might block the bowel should be avoided. One example is popcorn, because it might get in there and obstruct, and you shouldn’t eat nuts and things like that that might obstruct. That is the one diet that doctors recommend. I also encourage everyone to take a multi-vitamin, and I encourage everyone to eat a heart-healthy diet. Athos Bousvaros, MD, Associate Director, IBD Program
Increasing these children’s nutritional intake can be a bit of a challenge. If you’re talking about increasing the intake of someone who is not feeling well, you’re not going to have very good luck persuading him or her to eat more. Sometimes, we try high calorie puddings or to recommend formulas like Boost, Boost Plus, Ensure or Ensure Plus as snacks, in addition to food. Sometimes we try supplementing high-calorie foods for things like applesauce, Jell-O and apple juice. We ask them to drink milk, milk products, ice cream and frozen yogurt. If lactose is a problem, we give them a lactase product like Lactaid to help them digest the milk. We also try to make sure that they’re getting enough meat, vegetables, and poultry dishes for basic protein. Richard Grand, MD, Director, IBD Program
Diet can be difficult. In general, we really try to have people with Crohn’s disease avoid seeds and nuts, because they can cause increased inflammation of their GI tract. Some of the kids don’t do well with milk and milk products, but most do fine with them. I think that there is a lot of information out there in the community about specific diets, such as a specific carbohydrate diet that some of our families have tried. There is not a lot of literature that indicates that it works, but some families have said that it works for them, so we try to support that. As long as the kids are getting the right amount of calories, it’s okay. I worry when parents restrict their child’s diets. Children need the calories and restricting things like milk, which really provides a lot of calories for kids can be an issue. If we do need to increase calories, we encourage the kids drink extra milkshakes or take Boost or other dietary supplements, in addition to their regular diet. Lori Hartigan, RN, Clinical Coordinator, IBD Program
The Role of a Clinical Nutritionist My role as a dietician is to assess patients, and then either to prevent depletion of their nutrition status or to replete them, depending on what state their nutrition status is in when they come to see me. Nutrition does play a really important role in the management of IBD and in their outcomes. What I try to do is to really think about what a patient is normally eating and identify a kind of personalized plan. Catherine DiSanto, RD, LD, Clinical Nutrition Specialist
If a child with IBD has a lot of diarrhea, I think sometimes they are afraid to eat. And changing nutrition status is slow and steady- it takes a lot of time to have someone come into your office and to work with them, and then have them work on these things at home. It’s a continuous process, unlike taking a medication, where you take the medication and it’s done. So I think that’s where it gets hard. Even once you educate people and they know what to do, in the adolescent population they may just not want to do it or just not see the significance of it, because it is slow. I think for clinicians it’s a matter of both presenting the knowledge and then taking the next step of thinking about how to really work it in. And I think that second step is what is difficult. Catherine DiSanto, RD, LD, Clinical Nutrition Specialist
Sometimes parents are looking for a quick fix, and they may tap into some of the “fad diets” for IBD, so to speak. But I always approach that with an open mind. If they’re really eager to try something, that’s fine, as long as it’s not omitting key nutrients or major food groups. The best nutrition plan is the one that works for that patient. Catherine DiSanto, RD, LD, Clinical Nutrition Specialist
Ideas for Taking Nutritional Supplements Parents can mix up canned supplements such as Boost to make puddings or different shakes with them. Oftentimes they do find, with the older population, that even Carnation Instant Breakfast works. It’s fortified with some vitamins and minerals and protein, and definitely allows someone to increase their caloric intake with a limited volume, but it doesn’t have that tinny taste. I have recipes that I give parents for different shakes, and uses for the shakes too. Sometimes with the kids they’ll make them into popsicles. I think the biggest thing is trying to find something that they can incorporate daily so that it almost becomes second nature to have a bedtime shake, for example. Catherine DiSanto, RD, LD, Clinical Nutrition Specialist
Oftentimes what I like to do is to increase the calories in a food that is already a healthy food, if children need more calories in their diet. So if someone is having mashed potatoes, they could add a little bit of heavy cream or butter to them. Or, to be even healthier, they could add olive oil or nuts. Other people in the family can then have what is still a healthy meal, but without the extra calories. I think that’s better than saying, “Well, at least we’ll give them more calories in general” and giving them Krispy Kreme donuts and Cheetos. That’s not the way to go, because it’s just giving empty calories and not really increasing their nutritional status. We really like to focus on the key nutrients such as iron, protein, calcium, and vitamin D, and make sure they’re getting enough, and not just eating carbohydrates and junk food. A patient can actually present without any weight loss- they can maintain a normal weight- but be undernourished. I think we can increase calories by adding healthy oils and nuts and that sort of thing to someone’s diet, rather than just saying, “Okay, you can just eat a gallon of ice cream a day.” Catherine DiSanto, RD, LD, Clinical Nutrition Specialist |
 |
Copyright © 2005, Children's
Hospital Boston Department of Psychiatry. All Rights Reserved. The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional. Updated November 12, 2004 |
 |