Let's create a science based juice recipe for Crohn's disease

I know there are a lot of people here who are delving deeper and deeper into the nutritional science of Crohn's disease. Let's apply that knowledge. Let's create a juice recipe specific for Crohn's disease based upon reputable information.

Types of Recipes
There will likely need to be different types of recipes based upon a variety of variables. Macro variables include location of the disease such as ileitis, ileocolitis, colitis, etc. Additional variables might include disease state such remission/active flare, strictures (inflammatory/fibrotic), fistula, perianal disease, diarrhea, constipation, etc. Further variables may include medication(s) they're on. Obviously there are many more variables but let's start simple (lol).

We'll start with Crohn's Ileocolitis, no abscess, no fistula, no strictures, diarrhea 1-5x per day, and no prednisone. We will begin by listing ingredients desire for inclusion or exclusion, the reason, and reference supporting that reasoning. We'll determine what foods will allow us to obtain the desired ingredients at a later time.

Submissions and References
We need to keep this efficient and utilize reputable sources for references. To submit an ingredient for debate for submission or exclusion, please copy and paste the following:

Template said:

[b]Ingredient:[/b]
[b]Inclusion/Exclusion:[/b]
[b]Reasoning:[/b]
[b]Supporting Reference(s):[/b]
[b]Quantity per day:[/b]
[b]Reasoning for quantity:[/b]
[b]Reference(s) supporting quantity:[/b]

Click to expand...

An example might look like this:

Ingredient: Magnesium
Inclusion/Exclusion: Inclusion
Reasoning: An essential element. Utilized in over 300 metabolic reactions in the body.[1]
Supporting Reference(s): [1]http://lpi.oregonstate.edu/infocenter/minerals/magnesium/
Quantity per day: At least 600mg
Reasoning for quantity: The RDA for magnesium varies by sex and age with the average for all adults being 362mg per day.[1] Magnesium is absorbed primarily in the terminal ileum and our recipe is for someone with active inflammation in the small intestine.[2] No adverse affects have been reported from food based magnesium, only supplements.[1] Magnesium deficiency is common due to western diets and inflammation of the small intestine and diarrhea can lead to deficiency.[1] This source recommends an intake in deficient patients of 600mg daily.[3]
Reference(s) supporting quantity:
[1]http://lpi.oregonstate.edu/infocenter/minerals/magnesium/
[2]http://www.cmellc.com/geriatrictimes/g020208.html
[3]http://www.jacn.org/content/23/6/730S.full

Anyone interested? Kiny - Gianni - mf15 - anyone at all wanna help out?

I will edit agreed upon ingredients into this first post. The magnesium entry is up for peer review as well.

I would like to add where best to get it (cost + availbility v effectiveness) ie. pure form or as a different additive.. ie oranage juice

That's way down the line. Let's not even discuss the foods yet. Just the base nutrients and quantities of those nutrients. Once we have a list of what we want to include, then we'll discuss the foods and quantities of that food to obtain the desired nutrients.

Something tells me this ain't gonna taste very good.

LOVE it! let's do it!

Ingredient: Selenium
Inclusion/Exclusion: Inclusion
Reasoning: An essential trace mineral.

Selenium deficiency has been associated with impaired function of the immune system (16). Moreover, selenium supplementation in individuals who are not overtly selenium deficient appears to stimulate the immune response. In two small studies, healthy (17, 18) and immunosuppressed individuals (19) supplemented with 200 mcg/day of selenium as sodium selenite for eight weeks showed an enhanced immune cell response to foreign antigens compared with those taking a placebo. A considerable amount of basic research also indicates that selenium plays a role in regulating the expression of cell-signaling molecules called cytokines, which orchestrate the immune response (20).

Click to expand...

People who have had a large portion of the small intestine surgically removed or those with severe gastrointestinal problems, such as Crohn's disease, are also at risk for selenium deficiency due to impaired absorption.

Click to expand...

Supporting Reference(s): http://lpi.oregonstate.edu/infocenter/minerals/selenium/
Quantity per day: At least 70mcg a day, optimally 200 mcg a day.
Reasoning for quantity: RDA yields that 55mcg of selenium should be supplemented each day yet studies have proven an increase in Immune response and overall health with a 200mcg a day supplementation. Supplementation should not exceed 400mcg because selenium is a TRACE mineral and we need trace amounts for optimal health.

Although selenium is required for health, like other nutrients, high doses of selenium can be toxic. Acute and fatal toxicities have occurred with accidental or suicidal ingestion of gram quantities of selenium. Clinically significant selenium toxicity was reported in 13 individuals after taking supplements that contained 27.3 milligrams (27,300 mcg) per tablet due to a manufacturing error. Chronic selenium toxicity (selenosis) may occur with smaller doses of selenium over long periods of time. The most frequently reported symptoms of selenosis are hair and nail brittleness and loss. Other symptoms may include gastrointestinal disturbances, skin rashes, a garlic breath odor, fatigue, irritability, and nervous system abnormalities.

Click to expand...

Reference(s) supporting quantity:http://www.ncbi.nlm.nih.gov/pubmed/7946899?dopt=Abstract

Fruits and vegetables with selenium: Asparagus, Broccoli, onion, Grapefruit (not much in grapefruit).

Hope this works

Gianni

Love it!

Beautiful work Gianni! I've been slammed with work after a couple days off but hope to contribute to this soon. I was thinking we can make it easier on ourselves as it's obvious we'll need the essential vitamins/minerals. I'll ponder how to best do that.

This is a great idea. Just bought a vitamix for my daughter (UC) and am really looking forward to juicing for her.
Zinc? It's mostly meats and dried fruit but for our juicing needs it looks like raspberries and blackberries have some (not a tonne but still).

Question for you pro juicers - do you dilute in the beginning and work up or have you always tolerated glasses full from day one? In the past, it's always made my daughter go to the bathroom and I don't know how to get around this. Tips?

killcolitis said:

This is a great idea. Just bought a vitamix for my daughter (UC) and am really looking forward to juicing for her.
Zinc? It's mostly meats and dried fruit but for our juicing needs it looks like raspberries and blackberries have some (not a tonne but still).

Question for you pro juicers - do you dilute in the beginning and work up or have you always tolerated glasses full from day one? In the past, it's always made my daughter go to the bathroom and I don't know how to get around this. Tips?

Click to expand...

You know my brother has the same issue, but I never did. We couldn't really find a way around it but I think your daughters body will just get used to it. I never diluted the juices as it will just dilute digestion and I never did so for my brother either.

What may be happening is your daughter isn't digesting the sugars all correctly if she has inflammation in her ileum. I would suggest cutting down on the sugars (fruit) and stick to more vegetable juices for a little while and see if that helps.

Gianni

Thanks for the advice Gianni. We've always done mostly veg and she has UC so (knock on wood) no inflammation in the ileum. I think we'll start very slow and see how it goes this time..

I had a thought today. The science has already been done for us. I'd want to tweak this but this would provide us a starting point and enable us to focus on what ingredients to juice. Allow me to present the ingredients for:

Peptamen Jr for kids:


Peptamen for adults:



These are scientifically formulated and often used for treatment of IBD.

PEPTAMEN® is a nutritionally complete peptide-based elemental formula specifically designed for people who cannot digest or absorb nutrients from conventional foods. Six 250-mL servings provide 100% of the RDI for 22 key vitamins and minerals. And with 16% of calories from high-quality whey-based peptides, this formula can help promote absorption to help provide the body with the nutrients it needs. May be used for tube feeding or oral supplementation.

Note: PEPTAMEN® contains milk protein. Not appropriate for individuals with cow’s milk protein allergy.

Click to expand...

So multiply the left column by 6 and we have our initial numbers (prior to tweaking) for daily intake.

Thoughts?

So if the goal was to provide nutrients for growth could you essentially swap supplemental shakes for juicing or would you then be missing out on calorie intake?

Hubby got us a juicer for Christmas, an inexpensive one to see if C might like juicing. I was pretty excited but C said he equates it to getting coal in your stocking, not too thrilled.

We haven't tried it yet, going to start tomorrow.

That's a good question Clash, I'm not sure if we'll be able to provide equivalent calories or not. The amount of protein we're able to come up with should be interesting as well.

I could see how a 16 year old might not be excited about a juicer. But when they're 35 and in better health because of that juicer, they'll look back with fonder memories

I'm not quite as optimistic that this could be an ongoing regimen, taste is going to be a huge factoruke_r:. We probably should have purchased something similar to what CIC did as I think a smoothie would probably be more palatable in some instances.

I'm just trying to get my head around his needs compared to what each of these supplements provides. For instance, he now takes Vitamin D(last lab still low), calcium, folic acid(due to MTX). I get his detailed report this upcoming week on B12, D, zinc, folic acid and I believe one more.

He is consuming(cover your ears, I know how you dislike these:eek2 Ensure in an effort to ensure nutrients and calories for growth.

Undx, at 15(Jan 2012) he was 5' 1/4" and weighed 98lbs. He was started on pred in Feb at 40mg and tapered off the first of june. No height gained but he topped out at 129lbs.

Since coming off pred he steadily lost weight and has settled to 112lbs for the last 2 mos, also he is now 5' 6 and 3/4 inches. I mentioned his growth(weight) to the GI, he wasn't too alarmed but wanted him to supplement with nutritional shakes until his next appointment.

I'm not too concerned about his weight but I am concerned about his height and I am looking to find the best way to give him a nutritional punch to help bolster and promote good growth. But I also don't want to over do it(ie, shakes, supplements, juices, medival stretch torture:whistleinnocently

Can we over do it? I really just want to give him the best opportunity to seize the growth window he has left, especially for his vertical growth. Any suggestions, tips or advice?

Hello and Happy New Year! My Mother is the one w/ Crohn's. Every year for the past 3 years she ends up in the hospital on the bags to let her colon rest. One year they opened up her esophagial sphincter which helped for a while. I want to try juicing for her , but if Peptamen might help, I would try that first. Any thoughts? BTW, she has had 6 surgeries for blockage. They worked for a little while... She is 91, but still golfs, garden's and drives.

I am in the same boat with Clash. My son is having a hard time gaining weight. The G.I. wants him to drink 2 ensure a day but I am concerned about the carrageenan. The endocrinologist said he won't grow unless he gains weight. The Ensure clear doesn't have carrageenan but also lacks a lot of calories or protein.

I don't want to disregard the G.I.'s instructions but I don't think he will take me seriously if I say I don't want him drinking Ensure because of Carrageenan. Any good alternatives?

Johnnysmom

Only the over the counter stuff has carregean-( ie cheaper stuff )
Has he tried the peptide version or peptamen version?
Neither have carregean?both are nutritionally complete
Even if your child despises them - they helped my 9 go from 50 lbs to 70 lbs and stay there.
He was 50 lbs from age 6 to 8.

Peptide is suppose to taste better out of the two

What about resource breeze? 9 G protein but a supplement not nutrional complete.

http://www.naturesone.com/pediasmart-dairy/ingredient-quality/
All organic so maybe???

Even slim fast would help- it only makes you lose weight if your not eating meals ..
Check out abbott nutrition
Or Nestlé nutrition
Both have a wide variety to try without carregean .
It is never easy

http://www.tactiosoft.com/en/products/childbmi

App I use to tract bmi so I call tell where he is trending
There is one for weight as well

As far as juicing I think it great -
To get a lot of the needed nutrients .
Of course my kid will drink the foul formula ( aka peptamen)
But really dislikes juice - so we don't push it since he doesn't fight us on the formula .

Well I don't know what to tell ya but O had her usual oatmeal with flax, bee pollen, wheat germ and hemp seeds and after that asked me to zip her up a smoothie...1/2 spinach, the rest banana, strawberry and blueberries (and more hemp seeds). She has been off them since Saturday because we were away visiting family and she said she misses them! I am curious to see if the weight gain continues or if it was just holiday gain.

MLP,

Is there a place to buy just one or two of some of these to try the flavors before I buy the whole case?

I like the peptamen version but I don't know if he would drink vanilla and that was the only flavor I found it in. He liked the look of the resource breeze so I might try that too.

His Dr. wanted the ensure. Are most G.I.'s aware of carregean? I can't understand why he would ask DS to drink this if it might make the inflammation worse.

Thank you for the information!!

Your GI office will have plenty of samples of peptamen and resource breeze etc-- just call and ask. They never offer but they have it :lol
The junior version has choc vanilla and strawberry - but our DME only carries vanilla and since the insurance covers it through the DME- DS learned to drink the "free" version.
if he is under 13 then he can easily have the junior version and if he is using it as a supplement then as long as he is drinking it well ( ask your doc but mommy opinion just go with it)

Walgreens carries resource breeze in orange- it taste really good but has some stringy thing that ends up in your mouth later - maybe ours was a bad case???

IF your GI does not have samples- which would be hard to believe

You can call nestle nutrition and ask for a sample or two.


Your GI knows that Boost/ENSURE/pediasure are the ones that kids are most likely to drink since they taste really good AND that most parent wont fight to get their kids to drink the less than good tasting ones. They also know that a heavier kid fairs better when in a flare so the lesser of two evils KWIM.

FWIW our GI has not had much luck at all with kids drinking the pedisure peptide or peptamen junior- they were very surprised DS did not need a NG tube when he went elemental only.

It only has a bit of an after taste

IF he actually drinks the samples then have your GI write a letter of medical necessity to the local DME (durable medical supply company)- most inssurances have a DME clause where they cover X% but dot not outright cover formula- This should get the formula at a cheaper than the retail price.
DME does charge a ridiculous fee to the insurance and over charge the price of the formula but its still cheaper than buying it OOP.

Let me know if you need more info

one last tip- always use a straw for the peptamen -it by passes the taste buds
plugging their nose also helps until they get used to it.
Trust me they will get use to it.
My Ds can chugg his in 5 minutes flat if necessary when it used to take hours for him to finish 8 oz. But he developed a taste for it after a few days.

He used to think the kids boost was bad too at first :lol

This may have some good information to help you David

http://dspace.mit.edu/bitstream/han...rams/SP-235Spring-2007/LectureNotes/index.htm