www.EvelynTribole.com
Etribole@gmail.com
In addition, IBD, particularly Crohn's disease, is often associated with poor digestion and
absorption of dietary protein, fat, carbohydrates, water, and a wide variety of vitamins
and minerals. Thus, much of what a person eats may never really get into the body.
Therefore, while dietary habits do not cause the disease, they do play a crucial role in
managing it.
While there is not one “IBD diet” for everyone, you can work with your registered
dietitian to develop an eating plan that will help manage symptoms during the acute
phases of a flare up, help determine what types of foods may exacerbate symptoms, and
help resume a healthy eating plan that will promote recovery during “remissions.”
• Calcium
• Cyanocobalamin (vitamin B12)
• Folic acid
• Magnesium
• Niacin (vitamin B3)
• Thiamine (vitamin B1)
• Vitamin D
• Vitamin K
• Zinc
• Omega-3/Omega-6 Fats
• Prebiotics such as psyllium (a complex carbohydrate)
• Probiotics – lactobacillus preparations and live-culture yogurt
• Psyllium
• Indian frankincense (Boswellia serrata) contains the anti-inflammatory agents
boswellic acid and alpha-boswellic acid. There's preliminary clinical research that
taking 350 mg Indian frankincense gum resin three times daily might induce
remission of ulcerative colitis. This is promising, but it's too soon to recommend
Indian frankincense for treating patients with active ulcerative colitis.
• Wheatgrass (Elytrigia repens) juice. There's preliminary clinical evidence that
wheatgrass juice might help reduce rectal bleeding and abdominal pain in patients
with active ulcerative colitis.
Supplement Contains
Alder buckthorn anthraglycosides which have a laxative effect
Aloe latex anthraquinones which have a laxative effect
Cascara anthraglycosides which have a laxative effect
Castor oil Has stimulant laxative effects
European buckthorn anthraquinones which have a laxative effect
Fo-ti anthraquinones which have a laxative effect
Rhubarb anthraquinones which have a laxative effect
Senna anthraquinones which have a laxative effect
Caution
There have been rare cases of pathogenic colonization involving Lactobacillus in
severely immunocompromised patients. To be safe, patients on conventional
immunosuppressants should avoid probiotics.
Tip
Take antibiotics and bacterial probiotics, separately, by at least 2 hours. Theoretically,
simultaneously taking antibiotics might kill a significant number of the live organisms.
References:
Crohn’s and Colitis Foundation of America. Diet and nutrition. Available at:
http://www.ccfa.org/info/diet?LMI=4.2
Diet and nutrition, Living with Crohn’s. Remicade: Infliximab. Available at:
http://www.remicade.com/crohns/crohns_lifestyle/crohns_diet.jsp
Tsang, G. Nutrition & health: Inflammatory bowel disease IBD diet (Crohn’s diet).
Available at: http://www.healthcastle.com/ibd-diet.shtml
BLOND PSYLLIUM
What other names is the product known by?
Blond Plantago, Blonde Psyllium, Che Qian Zi, Dietary Fiber, Englishman's Foot,
Indian Plantago, Isabgola, Isabgul, Ispagol, Pale Psyllium, Plantaginis Ovatae Semen,
Plantaginis Ovatae Testa, Plantago decumbens, Plantago fastigiata, Plantago insularis,
Plantago ispaghula, Plantago ovata, Ispaghula, Psyllium, Psyllium husk, Sand Plantain,
Spogel.
What is it?
Blond psyllium is an herb. The seed and the seed husk are used to make medicine.
Is it Effective?
Natural Medicines Comprehensive Database rates effectiveness based on scientific
evidence according to the following scale: Effective, Likely Effective, Possibly
Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence
to Rate.
Diarrhea.
Irritable bowel syndrome (IBS).
Lowering blood sugar after eating a meal in people with diabetes (type 2).
Preventing the relapse of ulcerative colitis.
High blood pressure.
Hemorrhoids.
Treating side effects of a drug called Orlistat (Xenical, Alli).
Preventing fat redistribution syndrome in people with HIV disease, some types
of cancer and skin conditions, and other conditions.
Some people can have an allergic response to blond psyllium with symptoms such as
inflamed nasal passages, sneezing, inflamed mucous membranes of the eyelids, hives,
and asthma. Some people can also become sensitized to psyllium through occupational
exposure or repeated ingestion of psyllium. Discontinue using blond psyllium and seek
medical attention immediately if you develop symptoms such as flushing, severe
itching, shortness of breath, wheezing, swelling of the face or body, chest and throat
tightness, or loss of consciousness.
Digoxin (Lanoxin)
Interaction Rating = Minor Be watchful with this combination.
Talk with your health provider.
Blond psyllium is high in fiber. Fiber can decrease the absorption and decrease the
effectiveness of digoxin (Lanoxin). As a general rule, any medications taken by mouth
should be taken one hour before or four hours after black psyllium to prevent this
interaction.
Ethinyl estradiol
Interaction Rating = Minor Be watchful with this combination.
Talk with your health provider.
Ethinyl estradiol is a form of estrogen that's in some estrogen products and birth
control pills. Some people worry that psyllium can decrease how much ethinyl
estradiol the body absorbs. But it is unlikely that psyllium will significantly affect
ethinyl estradiol absorption.
Lithium
Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.
Blond psyllium contains large amounts of fiber. Fiber can decrease how much lithium
the body absorbs. Taking lithium along with blond psyllium might decrease the
effectiveness of lithium. To avoid his interaction take blond psyllium at least one hour
after lithium.
Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta,
Evelyn Tribole, MS, RD
www.EvelynTribole.com
Etribole@gmail.com
Vitamin D
Chief Functions
▪ Regulates absorption and use of calcium and phosphorus for
development of bones and teeth
▪ Aids in maintenance of healthy nervous and muscular systems by
regulating blood calcium levels
▪ Aids in calcium absorption from intestines and deposition of
calcium in bones/teeth
▪ Prevents excessive urinary loss of calcium and phosphorus
▪ Stimulates maturation of cells and proper formation of skeleton
▪ Helps with maintenance of bones in ears for hearing
▪ Essential for mineral homeostasis
Possible benefits
▪ Insulin—may aid in function of insulin, therefore possibly aiding in regulation of blood glucose
▪ Cancer—might aid in prevention or treatment of cancer by altering growth of cells
▪ Immunity—might assist function, thereby helping defend against infection
▪ Dialysis patients—might improve zinc status
Deficiency symptoms
▪ Osteomalacia (adults)
▪ Rickets (children)
▪ Inadequate mineralization of the bone, leading to malformed bones
▪ Deafness
Stability
▪ Stable to heat and oxidation
▪ Destroyed by excess ultraviolet irradiation
Dietary sources
▪ Fortified milk Cod liver oil Liver
▪ Cheese Butter Eggs
▪ Cream Fatty fish Oysters
Other facts
▪ Vitamin D exists in two forms, D2 (ergocalciferol) and D3 (cholecalciferol)
▪ D2 is the supplemental form of vitamin D
▪ D3 is the naturally occurring form of vitamin D, found in foods and manufactured in the skin
with exposure to sunlight
▪ Light-skinned people require 10-15 minutes/day of sun exposure for complete vitamin
synthesis
▪ Dark-skinned people require 3 hours/day of sun exposure for complete vitamin synthesis
▪ Persons with limited exposure to sunlight may require a vitamin D supplement
▪ Toxicity can not occur from too much exposure to the sun
▪ If an infant is breastfed and not exposed to sunlight, a daily supplement of 5-7.5 mcg or 200-
300 IU is recommended
▪ Fortified foods are the major dietary source of vitamin D
Lab Test
25-hydroxy-vitamin D
References
Sizer F, Whitney E. Nutrition Concepts and Controversies. 11th ed. Belmont, CA: Thomson &
Wadsworth; 2008:219-259.
Somer E. The Essential Guide to Vitamins and Minerals. New York, NY: Harper Collins
Publishers; 1992:1-65, 224-246, 287-293.
Schlenker E, Long S. Essentials of Nutrition and Diet Therapy. 9th ed. St Louis, MO: Mosby
Elsevier; 2007:107-144.
US Dept of Agriculture, National Agricultural Library, Food and Nutrition Information Center.
Dietary Reference Intakes: vitamins. Available at:
http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=3&tax_subject=256&to
pic_id=1342&level3_id=5140. Accessed July 28, 2008.
Chief functions
▪ Required to make all new cells
▪ Involved in synthesis of DNA, red blood cells, and protein
▪ Acts with vitamin B12 in the production of hemoglobin
▪ Required for practically all biochemical reactions involving one-
carbon transfers
▪ Functions metabolically as a coenzyme
Possible benefits
Heart disease—when folate is in short supply, it is not possible to complete the conversion of
methionine to cysteine, and homocysteine accumulates in the blood; high blood levels of
homocysteine lead to atherosclerosis, adding to risk for cardiovascular disease and stroke
Deficiency symptoms
▪ Impaired cell division
▪ Alterations of protein synthesis
▪ Abnormal digestive function
▪ Immune and nervous system depression
▪ Mental confusion
▪ Fainting
▪ Poor growth
▪ Smooth red tongue
Stability
▪ Unstable to heat and oxidation
▪ Up to 50% lost in preparation, processing, and storage
Dietary sources
▪ Best—green leafy vegetables, brewer’s yeast, liver, and fortified cereals
▪ Other—citrus fruits (especially orange juice), beets, broccoli, wheat bran, other whole grains,
and tomatoes
Other facts
▪ DRI for infants and children are based on body weight and the folic acid content of breast milk
▪ 3 mcg/kg of body weight or 100 mcg/day prevents folate deficiency anemia
▪ Folate deficiency is the most common vitamin deficiency
▪ Macrocytic anemia (red blood cell volume >100 milliliters) is caused by folate or B12
deficiency
▪ Deficiency limits cell function, and affects growth and repair of cells and tissues
▪ Inadequate intake of folic acid is linked with the risk of neural tube defects in a fetus during
pregnancy; in 1989, the US Food and Drug Administration ordered all manufacturers of
enriched grain products (breads, cereals, rice, and pasta) to fortify these products with folic
acid
▪ Because supplementation with folic acid began, the incidence of neural tube defects has
dropped by 25%, even in women who have no prenatal care
▪ The amount of folacin in vitamin supplements is limited to 400 mcg to prevent masking of B12
deficiency
References
Sizer F, Whitney E. Nutrition Concepts and Controversies. 11th ed. Belmont, CA: Thomson &
Wadsworth; 2008:219-259.
Somer E. The Essential Guide to Vitamins and Minerals. New York, NY: Harper Collins
Publishers; 1992:1-65, 224-246, 287-293.
Schlenker E, Long S. Essentials of Nutrition and Diet Therapy. 9th ed. St Louis, MO: Mosby
Elsevier; 2007:107-144.
US Dept of Agriculture, National Agricultural Library, Food and Nutrition Information Center.
Dietary Reference Intakes: vitamins. Available at:
http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=3&tax_subject=256&to
pic_id=1342&level3_id=5140. Accessed July 28, 2008.
Benefits Of Probiotics
Probiotics allow the healthy bacteria to thrive. They also:
▪ Synthesize vitamins (particularly the B vitamins)
▪ Improve immunity (approximately 60% of your immune cells are found in the intestine)
▪ Decrease allergies (particularly in regard to skin reaction, such as dermatitis or eczema)
▪ May decrease the risk of developing dental caries
▪ May speed recovery from bacterial vaginosis
▪ May lessen the problems associated with inflammatory bowel disease (particularly related to
pouchitis or ulcerative colitis) and irritable bowel syndrome
▪ Seem to help people with lactose intolerance digest dairy products more easily
▪ May improve cholesterol levels
▪ May decrease the risk of colon cancer
▪ May help people suffering from diarrhea associated with antibiotic usage or acute illness
Benefits Of Prebiotics
Prebiotics are nondigestible substances that feed the probiotics, helping them to thrive in the
gastrointestinal tract. Not all probiotics consumed will survive; it is important to consume
prebiotics with probiotics.
Prebiotics release short-chain fatty acids, which decrease the pH of the colon and, thereby,
enhance mineral absorption, particularly calcium, iron, and magnesium, possibly decreasing the
risk of osteoporosis development. This decrease in pH also leads to the decreased survival of
some pathogenic bacteria. Prebiotics may decrease cholesterol levels and reduce the risk of colon
cancer, as well. Some forms of prebiotics aid in the relief of constipation. Different strains of
prebiotics provide different health benefits.
Resistant Starch
Resistant starch helps to feed probiotics, similarly to prebiotics. Resistant starch is found in
cooked starchy products, such as hot cereals, and unripe fruit, such as bananas that are still firm
to the touch. On food labels, resistant starch is referred to as starch, modified food starch, corn
starch, or maltodextrin.
Restrictions
Individuals who are immunocompromised or have compromised gut integrity should only use
these products under the advisement of a doctor.
Roberfroid MB. Am J Clin Nutr [serial online]. 2000;71:1682S-1687S. Probiotics and prebiotics:
are they functional foods? Available at: http://www.ajcn.org/cgi/content/full/71/6/1682S.
Accessed July 8, 2008.
Douglas LC, Sanders ME. Probiotics and prebiotics in dietetics practice. J Am Diet Assoc.
2008;108:510-521.
Heart Disease 1g/day Am. Heart Association Kris-Etherton.Circulation. Circulation. 2002 Nov 19;106(21):2747-57.
Patients w/ Mood, Impulse- 1 g/ day Am. Psychiatric Assoc. Freeman MP et al.Omega-3 fatty acids: evidence basis for treatment and future
Control or Psychotic Disorders. research in psychiatry.J Clin Psychiatry. 2006 Dec;67(12):1954-67.
Mood Disorders 1-9 g/day Am. Psychiatric Assoc Freeman MP et al. 2006 Dec;67(12):1954-67.