Running with Crohn’s: Diet

Doctor’s, public service announcements, dieticians, popular TV shows, and even Michelle Obama extoll the virtues of a high fiber diet that includes lots of fruits and vegetables.  As someone suffering from Inflammatory Bowel Disease, every time I look at a salad like this and wonder whether it will put me in the hospital:

Over the last 23 years of my disease, I researched and spoke to GI doctors about diet.  Many websites recommend restricting your diet for Crohn’s Disease.  They often advise reducing or eliminating dairy, nuts, seeds, spicy foods, and many other food items.  However, most of these items do not seem to bother me.  The best advice I received was to notice how foods affect me and eliminate foods that cause me problems.  I included a table of how my body responds to various foods.

Updated on 3/18/2015 - after bowel resection surgery
This table provides information for how these foods affected me prior to surgery.  I will write a follow-up post describing how this changed after the surgery removed my strictures.

Food Type	Bleeding	Obstruction	Cramping	Gas	No issues
Nuts	Rarely	Rarely	Rarely	Rarely
Popcorn & coconut	Rarely	Rarely	Often	Rarely
High fiber vegetables		Often	Rarely	Rarely
Carbonated			Often	Often
Alcohol			Often	Often
Spicy foods			Rarely	Rarely
Ensure / soy			Every time	Every time
Caffeine
Dairy
Gluten
Low residue
Multivitamin
Pureed vegetables

Typical warnings apply; you should speak to your healthcare professional about the proper diet for your Crohn’s Disease.  Also, although I do not suffer from problems with Dairy products does not mean the same is true for you.

You can find more information on diets for IBD at the link.

Fiber

I suffered a partial bowel obstruction in 1987 from a deep-dish pizza, caused by the vegetable toppings.  Ever since then I have periodically suffered from them after eating vegetables.  Over the last couple of years, the frequency of my obstructions increased and I spent more effort avoiding them.  However, my recent problems with fistulas encouraged me to try getting more fiber in my diet.  I’ve started looking for foods with high in fiber but in a form that’s unlikely to cause an obstruction.  I’ve included a list of foods that satisfies these criteria:

Product	Fiber content
V8 Juice	2 g
Applesauce	2.7 g
Prune Juice	3 g
Diet shake	5 g

I later jotted down some more foods that don't cause me bowel obstruction issues and have fiber in them.

When I eat at restaurants and worry about eating vegetables, I often ask the server to replace my salad or vegetables with applesauce.  I sometimes get odd looks when I order applesauce but not suffering from bowel obstructions is well worth the slight social ostracization.

I recently read that baby food contains all the fiber and other nutrients of that food (e.g., baby food peas contain all of the fiber and nutrients of regular peas).  This made me realize that people with strictures probably can consume pureed vegetables and other foods too.  I have not started doing this but plan to try it some time.

Vitamins

IBD damages portions of your bowels and your damaged bowels absorb nutrients less efficiently.  Furthermore, if you have had a bowel resection, your bowel may not be able to absorb certain nutrients at all.  Since I must restrict my consumption of fruits and vegetables to prevent bowel obstructions, it worsens the problem.

My bowels do not absorb vitamin B-12 (and some of the other B vitamins) very efficiently and this causes vitamin B-12 deficiency (and related issues like anemia) in me.  I partially address this through taking a multivitamin and a B-12 or B complex supplements, however, I also require a monthly vitamin B-12 injection to absorb enough B vitamins.

If you suffer from IBD, have had bowel surgery, or suspect you have anemia; get a blood test for blood serum levels of vitamins and minerals.  If you are deficient, then supplement your diet with the proper vitamins and nutrients.

Other stuff

IBD and IBS patients both frequently suffer from abdominal cramping.  As I mentioned in previous entries, the prescription drugs Bentyl (Dicyclomine) and Levsin (Hyoscyamine) help relax the cramping intestinal muscles.  If you experience intestinal cramping, speak to your doctor about prescriptions for these medications.

However, non-prescription food items also provide me relief from these cramps and some other bowel symptoms.  Those foods are mints and ginger.  Foods with mint oils soothe the intestinal muscles and can reduce or eliminate abdominal cramping.  I specifically look for mint candies with peppermint oil Candy canes and “peppermint stars” often contain peppermint oil (this can be found in most stores that sell candy), but check the candy’s ingredients before buying it.  Often consuming one or two of these sometimes eliminate my cramps.

I personally experience less relief from ginger; however, ginger sometimes reduces the severity of my abdominal cramps.  If you plan to try ginger as a remedy, I recommend purchasing “candied” or “crystalized” ginger (you can get this at Penzy’s stores).  Then I eat them like candy.  Crystalized ginger tastes a bit “spicy”, so some may dislike consuming it.  Also, remember that ginger is a fibrous root so do not consume too much of this at a time.

For running

Before run: medicine, energy, electrolytes, and water

To have the energy to complete a run, especially longer runs, you must fuel and prepare your body properly.  For most runners a meal consisting of complex carbohydrates (like oatmeal) provides food in a form that your body can convert to energy over a long period.  That makes it ideal for pre-run fuel for other runners.  Because oatmeal also possesses a lot of fiber, it can induce severe problems in IBD patients.

For me, rolled oats have not cause bowel obstructions in me.  I assume it is because my strictures are large enough to pass them.  Therefore, oatmeal remains a great pre-race meal for me.

However, eating any food still overstimulates my digestive system causing cramping and diarrhea.  Therefore, I do not eat any meal within two hours before I plan to run.  When I fail to follow this plan, I typically experience diarrhea and cramping during my run.

I also ensure that I take both Imodium (loperamide) and Levsin (hyoscyamine) before or with my meal to reduce the reaction of my intestines to the food.

Speak to your doctor before using these with running.  They cause dry mouth and reduce sweating.  They may not be appropriate for everyone

Levsin side effects

Imodium side effects

During run: energy, electrolytes, and water

During long runs, you will burn a lot of energy and sweat a lot of water and electrolytes.  Even a 2% loss of body mass from sweating will significantly harm your run.  Therefore, you should try to replenish them during your workout.  Since you cannot consume enough of them to replace the protein, sugars, and water as fast as you are burning them, you should begin replenishing them as soon as you start running.

My loose standards for whether to attempt to replenish during the run is as follows:

under 30 minutes        I sometimes bring fluids but never bring food/fuel

over 30 minutes          I always bring fluids, sometimes bring food

over 60 minutes          I always bring fluids and fuel

When it’s hot or when I’m breathing heavily, drinking water makes me feel a lot better.  So just because I do not feel it is necessary, does not mean you should not bring water or Gatorade when you want it!

When running, I slowly chew & suck on an energy chew gel over 10 minutes.  After swallowing the last of each chew, I drink a couple of quick gulps of water.  The water helps dilute the concentrated sugars and electrolytes of the chew.  I attempt to eat the chews over the entire run.  However, the concentrated flavor of the chews sometimes becomes repulsive after a couple of hours.  This provides me with another incentive to try using different foods to eat during the run.  When I eat these gels, I no longer use Gatorade and instead rely upon water for rehydration.  The water also helps dilute the concentrated nutrients of the gel.

When I’ve performed very long runs (90 minutes or more), I nearly always suffer from worse than usual diarrhea when I’m recovering.  I suspect that the concentrated electrolytes and sugars in the gels impose osmotic pressure that pulls water out of my gut (increasing cramping, increasing diarrhea, and dehydrating you).  I am considering alternating between the gels and other less concentrated foods (e.g. trail mix, pretzels, or other sources of carbohydrates and sugars).

Many people (myself included) find that Gatorade and other sports drinks have too much sugar and electrolytes in them.  Some people cope with this by diluting their Gatorade with water.  I just bring two bottles, one with water and the other with Gatorade.

Post run/recovery: protein, energy, water

After running, your body craves protein, to repair the muscle damage caused by your run, and carbohydrates, to replace the energy you burned during your run.  In order to reduce your recovery time and the improve your ability to recover from difficult runs, you should consume a healthy meal of 10-20 grams of protein, 30-60 grams of carbohydrates (try to keep the ratio between 3:1 to 4:1 of carbohydrates to protein), and it should contain other vitamins and nutrients.  If you can eat this within 30-45 minutes after completing hard workouts, it will shorten your recovery time, reduce muscle soreness, and aid in muscle repair and growth.

Since the real world is often less than ideal, many runners utilize “recovery drinks.”  Recover drinks (such as Gatorade G3) contain protein, carbohydrates, and often vitamins to aid your recovery.  Most recovery drinks are also shelf stable, so you can leave them in your car on a hot day and not have them spoil during a two hour or longer run.  However, I don’t think they taste very good.  The site below also states that Gatorade G3 does not possess the proper ratio of protein to carbohydrates.

I've included a link that contains a lot more information on optimal nutrition and timing.

Since I discovered that diet shakes like SlimFast include all the nutrients of a recovery drink, include fiber, and are shelf stable; I switched to using them when I need a convenient recovery food.  Since my diet rarely includes enough fiber, the fiber content is very desirable.

Other runners prefer quick and easy foods like Chocolate Milk, however, it usually is not shelf stable and it doesn’t contain any fiber.

Product	Size	Protein	Carbs	Fiber	Vitamins	Taste
Chocolate Milk	8 oz	1 g / oz	2.5 g / oz	None	No	Good
Diet Shake	12 oz	0.8 g / oz	2 g / oz	0.4 g / oz	Yes	OK
Gatorade G3	12 oz	1.7 g / oz	4 g / oz	None	Yes	OK

Conclusion

Well this entry rambled a bit and I apologize for that.  I hope that it provides you with some basic information on nutrition for both running and IBD.  Please write comments on any suggestions or ideas that you might.  I’m still trying to figure this topic out and am only sharing some of the things that work for me.  I’d like to do even better but just haven’t figured it out yet.