Dangers of Low Residue Diets in IBDs

During my last interview trip with Tara Marie Rosas, she told me how the very foods that were recommended by her gastroenterologist, such as white rice, pasta and mashed potatoes from the low-residue diet [1], [2] were in hindsight, the very foods that hurt her by continuing her symptoms.
The low-residue diet is the only diet that is recommended by gastroenterologists for symptoms of bowel pain, otherwise, they advise patients to eat whatever they want, because they believe diet plays no role in inflammatory bowel diseases (IBDs).

In IBDs, the intestines can be inflamed and high fiber foods can cause a scraping, painful sensation. The low-residue diet is used on a temporary basis to decrease pain because the low-residue foods do not have a lot of fiber and don’t bulk up in the intestines.

In the worst case, fiber and seeds can cause intestinal blockages that perforate the intestines, leaking feces into the naked abdominal cavity and may lead to death if not treated immediately.

Low-residue foods in this view make sense, a lot of sense and do reduce the pain caused by rough foods passing through narrowed sections of the intestines. I can personally attest to just how dangerous high residue foods can be and was fast headed towards surgery several years ago.

But on the other hand, eating on the low-residue diet includes complex carbohydrates in the form of refined grains and starchy foods, which do not make any sense at all, especially for those with IBDs.

This is because in people with IBDs, the microvilli that line the intestines are damaged. The microvilli are important because they produce disaccharide enzymes. These enzymes break down complex carbohydrate foods like grains, rice, corn, potatoes. Without the microvilli producing disaccharide enzymes, the complex carbohydrate food from a low-residue diet are not digested.

Undigested food can be fed on by pathogenic bacteria that live in our guts. They produce toxins that end up poisoning the body. This occurs because in addition to the microvilli being damaged, the intestinal wall is permeable [3]. From the intestines is an astounding network of blood vessels that carry the nutrients from our food to other parts of the body and its organs.

When the intestinal wall is permeable, bacteria, their toxins and food particles can leak from the intestines into the blood stream. All of these are then called antigens (toxins and foreign objects that trigger immune responses).

These antigens are not supposed to be in the blood stream and the immune system launches an attack. It is this immune response that causes the autoimmune inflammation in the intestines, which then is described medically as IBS, Celiac disease, gluten intolerance, Crohn’s disease or ulcerative colitis depending on location and type of damage seen.

Simply put, low residue diet foods cannot be digested and end up fueling the fire in the inflammatory response from the immune system.
As a quick aside, a study was conducted comparing the microbiota diversity [4] in 6 patients who used both a low-residue diet and then followed up with the Specific Carbohydrate Diet. The Specific Carbohydrate Diet produced vastly more diverse microbial communities in people’s guts than the low residue diet.

Research is emerging that people with inflammatory bowel diseases have compromised, less diverse microbiota than healthy people. When researchers throw in genetics, intestinal permeability and environmental factors, they aren’t sure just how important a compromised microbiota is in the pathogensis of IBDs, but I’m 100% convinced it is one of the most important factors.

My Experimentation with White Rice

I decided to test whether someone like me with IBD can digest complex carbs because I believe that low-residue diets may be causing more harm than good for people like Tara, with IBDs.

Since 2004 when I started on the Specific Carbohydrate Diet I have mostly avoided white rice. The only time I can remember eating it was November or December, 2010 when I experimented with my health by having a fully loaded burrito from Chipotle. At that time, I saw mucous during my bowel movements for the first time ever since starting SCD.

On July 11th, 2011, for dinner I cooked myself some organic “long grain” white rice. Prior to this meal I had had fifteen days in a row of solid bowel movements. Three hours after my dinner of having white rice, I had a bowel movement which was unusual for that time of night. It wasn’t diarrhea, but it was not well formed, very wet, a noticeable bit of mucous and floating in the water. I also saw a lot of undigested white rice in the stool.

Clearly the white rice was not good for me. On the 12th, I had no white rice, two solid bowel movements, but saw lots of undigested white rice in them. The 13th was the same as the day before with no white rice eaten and two solid bowel movements. The second BM I didn’t see any white rice in my stool.

On the 14th my only BM that day seemed to regress slightly and I saw more white rice in it. On the 15th, my morning BM was completely normal in form, size, consistency and I didn’t see any white rice in it. I decided to continue with my white rice experiment and ate it later in the day.

Almost 3 hours later, I pretty much had diarrhea. It was urgent, not formed at all with a lot of liquid and mucous. I also saw white rice in the bowl. Another 3 hours later and my stool form was improved, but still not normal.

Surprisingly, the very next day, I had a normal bowel movement and have had five days of solid BMs as of July 20, 2011, and haven’t eaten white rice since the 15th.

It is clear to me that I cannot tolerate white rice and I fear the same will be true of other low-residue diet foods such as mashed potatoes, pasta and white bread. I’m concerned that my reaction is more common than we know about. It will be very hard to know if this is the case because people who are put on low-residue diets are already experiencing symptoms of diarrhea.

As I mentioned earlier, the low-residue diet does have the benefit of removing foods that may be causing partial bowel obstructions, but in my opinion, at the expense of continuing the cycle of inflammation and diarrhea.

Are there any solutions out there?

Alternative Solutions to LRDs

I believe there are. Based on my knowledge of the Specific Carbohydrate Diet and the more recent spin-off, the Gut and Psychology Syndrome diet there are ways to get excellent nutrition without blocking the intestines with roughage. It comes down to how one prepares vegetables and fruits to be eaten safely.

  1. De-seed vegetables, such as cucumber.
  2. Skin vegetables, such as carrot.
  3. Cook thoroughly to the point of being mushy.
  4. Puree mushy vegetables and fruit.
  5. Juice vegetables and fruit and if you want to, filter the juice through cheesecloth to be extra sure fiber/seeds are removed.

Based on the above suggestions, you can combine them to eat your vegetables and fruits in a variety of safe and nutritious ways. One option is to make a soup with thoroughly boiled vegetables that have been skinned and deseeded. What’s great about this is that even though the vegetables are being cooked, the nutrients stay in the broth. I personally love freshly juiced vegetables and fruit in the morning.
Using the above techniques, you’ll get the best of both worlds, pain-free nutrition and no complex carbs that continue the vicious cycle of autoimmune response and disease.

[1] http://www.mayoclinic.com/health/low-residue-diet/my00745
[2] http://www.ccfa.org/info/diet
[3] http://www.sciencedaily.com/releases/2005/09/050917085509.htm
[4] http://www.secondgenome.com/2011/07/diet-impacts-crohns/
[5] http://meghantelpnerblog.com/2010/03/19/lower-the-load-and-heal-disease/