Dietary advice for J-Pouch – Eating your way to…

Dietary advice for J-Pouch-Eating your way to rude, good health

Rest and relaxation are vital aids to recovery after major surgery – but then there’s diet, says Christopher Browne

Glance through any tabloid newspaper or popular weekly magazine and one of the hottest topics you’ll find is dieting. Most of these diets aim to make you feel good about yourself, slimmer and more svelte-looking (both men and women).

And why not indeed! But dieting is not just a way to lose weight. Your diet and what you choose to eat and drink is a major priority when you are recovering from an operation. Your body needs sustenance, essential minerals, salts and vitamins to help you grow stronger and recover your former health.

Some of us were lucky enough to see a recent webcast about healthy eating by Gabriela Poufou, lead IBD dietitian at St Mark’s Hospital – See below for recording.

[Note: You can download the slides to this webcast at the end of this post]

It was the best guide to diet and recovery I have ever seen  – far more thorough than any newspaper guide. And I’ve got to admit that until recently – apart from taking care to avoid certain foods – I haven’t taken diet as seriously as I should. Neither, I might add, has it seemed to be a top priority in hospitals – apart from St Mark’s and Central Middlesex Hospitals perhaps – GPs’ surgeries and health clinics.

Until now. Pleasingly, this trend is changing. Surgeons, GPs, clinicians, nursing staff, patients and support groups are recognising the importance of diet and healthy eating and as an enthusiastic layman I make no apologies for drawing on the outstanding knowledge and advice Gabriela Poufou gave us in her webcast.

Let’s start with dehydration. If you have a pouch, do you remember how tired and thirsty you felt as the effects of the final closure of your pouch began to wear off. This is because you were dehydrated. The removal of your large bowel meant it could no longer act as a reservoir to reabsorb water and salts. 

This major change in your bodily functions needs time to settle. So one of the best go-to remedies is St Mark’s Hospital’s electrolyte solution – six teaspoonfuls of glucose powder, a teaspoonful of salt and a dessertspoonful of bicarbonate of soda dissolved in a litre of water. Pouchees are advised to drink this solution at regular intervals during the day (There are other variations too which you can find on Google). 

Gabriela Poufou encourages pouchees to continue this rehydration regime for at least two months as your body starts to heal after your final pouch closure.

Here are some of the other keys to post-surgical diet and recovery. [Please watch Gabriela’s video for a much fuller and more detailed version].

For the first few weeks dietitians recommend a soft, low-fibre diet, and, as you start to recover, move on to high protein and energy foods to encourage the wounds from the surgery to heal more quickly, reduce the risk of blockages and help prevent weight loss.

The diet Gabriela Pouchou and specialist dietitians recommend for pouchees after four to six weeks has many of the features of the NHS’s excellent Eatwell guide – Click HERE for NHS Eatwell Guide.

The foods recommended for pouchees after four to six weeks are: proteins – meat, fish, cheese, eggs, milk yogurt and pulses; carbohydrates including cereals, bread, rice, pasta and potato; healthy fats and calcium-rich dairy products – or lactose-free alternatives – including olive oil, milk puddings, yogurts and petit filou (small yogurts), custard and blancmanges.

After two months you’ll also be able to drink fluids such as water, tea and coffee (in moderation), unsweetened fruit juices and sugar-free squashes. If your loo output is up you may need to continue with an electrolyte mix 30-60 minutes before meals.

During the first few weeks post-surgery (and, in some cases, permanently) pouchees should avoid nuts, seeds, peas, raw vegetables, mushrooms, sweetcorn, celery, dried fruit and coconut. In time you may be able to reintroduce some of these foods in small amounts.

Dietitians advise pouchees to adopt a “little and often” approach to food and to eat slowly and chew your food well. They also recommend you experiment with the size and timing of your meals and you may find some foods suit you better than others. So a bit of trial and error won’t do you any harm!

In the NHS’s Eatwell Guide is a dietary caveat which applies to all of us whether pouchees or otherwise: “Most people in the UK eat and drink too many calories, too much saturated fat, sugar and salt, and not enough fruit, vegetables, oily fish or fibres.” 

Whatever approach you take to your post-surgery diet, if you are in any doubt whatsoever about anything please seek advice from your hospital dietitian. He or she will be only too happy to pass on dietary advice and eating tips.

The Michelle Martin formula

Pouchee and RLG committee member Michelle Martin who had her pouch fitted in 2019 says: “I religiously followed what I refer to as the ‘beige diet’ – avoiding anything with too much fibre including too many vegetables and fruit. After that, I gradually reintroduced fruit and veg and very quickly I was able to enjoy a very healthy and varied diet.

“I have made some adaptations to my diet as I find certain foods do not agree with the pouch. I have therefore limited the amount of red meat I eat, I avoid ice cream and despite my love of sugar and chocolate I have to limit these to a treat. However, I frequently give in to my sugar cravings and regularly regret that decision! I also find I have to limit my alcohol intake to one drink per sitting! 

Adds Michelle: “I start my day with porridge and fruit. I have a varied lunch menu including sandwiches, salad, homemade soup, and whenever possible I make my own bread or sourdough. I really enjoy cooking. I make the majority of my dinners from scratch and most of them are based around vegetables, salad and fish. I am still able to enjoy spicy foods and I love curry or chilli dishes. 

“I find the policy of eating a little and often works very well, so I have a reputation for always eating! But I normally only eat small amounts at any one time, and I can’t eat a three-course meal as I get full up very quickly. Eating out can be more challenging as I need to ensure the food is of good quality and that minimal oils and fats are used during the cooking process. I also find that to save wastage I generally order starters for my main course.

Probiotics are another of Michelle’s dietary favourites. “A while ago I had my first bout of pouchitis. It was caught early and is now under control, however I have now introduced probiotics to my diet and take them every morning with homemade natural yoghurt,” she said.

“To keep my pouch healthy, I find I must look after my general health. I know my pouch is at its best when I take care of myself ie eat the right foods, exercise, and get enough sleep. When I start to rush around, get stressed, and do not take the time to think about what I am eating, my pouch and my overall health deteriorates.” 

The vegan approach

The recent rise in the number of people seeking meat-free alternatives has led to the growth of vegetarianism and in some cases veganism in the UK.

The vegan diet is based on plants such as vegetables, grains and fruit and foods made from plants. It also excludes meat, fish, dairy products and eggs.

Veganism is not for everyone but Andrew Millis, our very own marathon man who was RLG vice-chair and is a very active member of the committee, is a passionate advocate. Andrew, who has run many marathons for various causes, says: “Two years into a vegan lifestyle I can report my pouch and I are doing very well indeed.

“I can still run half marathons, the odd marathon and park runs and my pouch is working brilliantly. No pouchitis, no medication whatsoever, and a good plate of veg with rice or potatoes leaves me wondering if I have had any surgery at all.

“I have so much energy for activities and to help focus on my work as well as stamina for the cycling and running I enjoy. I do take a vitamin supplement called Veg 1 which is a chewable tablet and tastes like the Haliborange we used to take as kids. It is available from the Vegan Society.

“I don’t have any colds or such similar elements and if I was missing out on any nutrition, I think I would have known about it after two years. I had a blood test at my local practice, and my vitamin B12 was well up (> 300ug, compared to minimum 200ug).”

Trendy diets that entreat you to slim, impress your colleagues or attract a new partner are one thing. Carefully planned ones that aid recovery and help you regain strength after an operation are another – and a timely aid for anyone with bowel problems or conditions. 

Christopher Browne
RLG Commitee member and ROAR! editor.

A version of this article first appeared in ROAR! If you would like to read other articles like this, why not become a member of the Red Lion Pouch Support group? You will receive printed copy of ROAR! twice a year and have online access to archive ROAR! editions going all the way back to issue number 1, published in 1994.

See pouchsupport.org/join for further information.

You can download a copy of the slides for the Gabriella Poufou webcast below.

Healthy eating for patients with an internal pouch

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