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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is The FODMAP Diet Safe For A Teenager Recovering From Proctocolectomy?

Are there special considerations when beginning the low FODMAP diet for my 13-year old who is recovering from proctocolectomy with a J-pouch and is experiencing pouchitis that is antibiotic-sensitive. Since the proctocolectomy she has been growing very rapidly.
Thu, 28 Sep 2017
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Dietitian & Nutritionist 's  Response
Hello & Welcome to HCM

Your question is very good and really needs to be directed to the clinician who prescribed the FodMap since this diet should be supervised to assure that reactive foods are identified and menus can be developed to meet your daughter's nutritional needs as she is growing.

Since her ileum may be compromised due to the surgery I would be concerned with B12 status/absorptive capabilities for one thing.

Stool management may be problematic and if too frequent may indicate inflammation/pouchitis & may indicate diet too high in lactose or fructose.

The challenges you will be facing are to provide enough protein , calories and nutrients for growth while following a challenging diet.
Specifically, the problems with any FODMAP diet are the following:
•     Fiber – Natural sources of fiber may be limited in this diet because the dietary sources such as fruits, vegetables, grains, beans, nuts and seeds, are also sources of FODMAPs .Because of the pouch you may need to supplement with a special formula put out by Nestle to meet all needs. It is compatible with the FODMAP diet.
o     Careful food re-challenge with the guidance of a FODMAP dietitian expert can help identify the most common triggers in your diet.     
•     Calcium and Vitamin D – As milk and milk-based dairy foods are commonly restricted on the Low FODMAP Diet, sources of calcium and vitamin D are limited.
o     Low FODMAP sources of dairy and calcium-fortified non-dairy include lactose free milk, calcium-fortified almond milk as well as leafy green vegetables and should be included in the meal plan, as tolerated.
o     Fatty fish such as salmon, tuna and sardines are great sources of vitamin D, but high in fat.
o     Calcium and vitamin D supplements may also be warranted. I like to use a liquid multi, but need to read labels carefully for sugar alcohols (high FODMAP).
•     Protein -- Adequate protein may be especially important for vegetarians and vegans to obtain as their FODMAP restrictions may likely include dairy, beans, nuts and seeds, which largely make up their dietary protein options.
o     Low FODMAP sources of protein include eggs, nut butters, tempeh and tofu, nuts and seeds, rice protein powders, as tolerated.
o     For non-vegetarians, additional protein sources include fish, chicken, beef, pork and lamb.
o     A Low FODMAP nutrition expert can provide recommendations for additional dietary supplementation or alternative options, as needed.


I recommend working with a Dietitian to help you get your questions answered as you get used to following the diet, determining the most offensive foods and in developing menus appropriate for your daughter. Best Wishes Kathy Shattler, MS, RDN
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Is The FODMAP Diet Safe For A Teenager Recovering From Proctocolectomy?

Hello & Welcome to HCM Your question is very good and really needs to be directed to the clinician who prescribed the FodMap since this diet should be supervised to assure that reactive foods are identified and menus can be developed to meet your daughter s nutritional needs as she is growing. Since her ileum may be compromised due to the surgery I would be concerned with B12 status/absorptive capabilities for one thing. Stool management may be problematic and if too frequent may indicate inflammation/pouchitis & may indicate diet too high in lactose or fructose. The challenges you will be facing are to provide enough protein , calories and nutrients for growth while following a challenging diet. Specifically, the problems with any FODMAP diet are the following: • Fiber – Natural sources of fiber may be limited in this diet because the dietary sources such as fruits, vegetables, grains, beans, nuts and seeds, are also sources of FODMAPs .Because of the pouch you may need to supplement with a special formula put out by Nestle to meet all needs. It is compatible with the FODMAP diet. o Careful food re-challenge with the guidance of a FODMAP dietitian expert can help identify the most common triggers in your diet. • Calcium and Vitamin D – As milk and milk-based dairy foods are commonly restricted on the Low FODMAP Diet, sources of calcium and vitamin D are limited. o Low FODMAP sources of dairy and calcium-fortified non-dairy include lactose free milk, calcium-fortified almond milk as well as leafy green vegetables and should be included in the meal plan, as tolerated. o Fatty fish such as salmon, tuna and sardines are great sources of vitamin D, but high in fat. o Calcium and vitamin D supplements may also be warranted. I like to use a liquid multi, but need to read labels carefully for sugar alcohols (high FODMAP). • Protein -- Adequate protein may be especially important for vegetarians and vegans to obtain as their FODMAP restrictions may likely include dairy, beans, nuts and seeds, which largely make up their dietary protein options. o Low FODMAP sources of protein include eggs, nut butters, tempeh and tofu, nuts and seeds, rice protein powders, as tolerated. o For non-vegetarians, additional protein sources include fish, chicken, beef, pork and lamb. o A Low FODMAP nutrition expert can provide recommendations for additional dietary supplementation or alternative options, as needed. I recommend working with a Dietitian to help you get your questions answered as you get used to following the diet, determining the most offensive foods and in developing menus appropriate for your daughter. Best Wishes Kathy Shattler, MS, RDN