The Low Residue Diet

The low residue diet is used for people with intestinal disturbances. This diet restricts the intake of dietary fiber and of milk which has medium residue. If the purpose of the diet is only to reduce the amount of residue in the lower bowel and to decrease fecal output, milk and milk products are not restricted. Highly seasoned and fried foods are generally omitted but individual tolerances should be considered. Foods should be well chewed and meals should be eaten slowly. Dietary fiber is reduced by using refined cereal grains, certain whole, well-cooked tender vegetables, cooked or canned fruits (without any seeds or skins), and tender meats.

Adequacy: The low residue diet is planned to meet the Recom­mended Daily Dietary Allowances.

to avoid the problem of absorption. Folic acid can be taken in pill form and iron can be replaced either by tablets or, if need be, in exceptional cases, by injection. In my experience many patients with IBD have abdominal distress if they take iron by mouth, especially cramps and constipation. Their stool may turn black and be confused with rectal blood. It may be neces­sary to try a few preparations of iron before finding one that agrees with you.

What Is the Role of Trace Elements?

Several vital substances circulate in the blood in very small amounts. Called “trace elements,” these substances are essen­tial for the healthy functioning of the body’s tissues.

The trace element we know most about is zinc. Researchers have found that some patients with skin and mouth problems, as well as intestinal problems, may have low stores of zinc. These patients have been nutritionally deprived through failure to absorb this substance or by starvation, given inadequate food, or intravenous fluids that lack the proper amount of zinc. For these patients, zinc should be given in a pill form.

Another trace element, selenium, can cause heart trouble if it is absent from the diet, but it is a rare deficiency. It is usually seen in individuals who receive all their nutrition intrave­nously, a procedure called total parenteral hyperalimentation. This deficiency has now been corrected by including selenium in all solutions given to sick people.

Food Supplements:

Because patients with IBD may have a capricious appetite or because of poor eating, some individuals may be given food supplements to increase both calories and nutrients. Some of those fluid preparations are high in calories and pleasantly fla­vored, but they are meant as supplements, not as replacements for real food not unless there is a mechanical blockage that prevents food from passing through the gut. Ensure, Susti­cal, or Flexi-Cal, are among the popular brand-name sup­plements you may be prescribed. The limitations in other “elemental diets,” as they are called, are their expense and un­palatable flavors. Patients are not happy to take them.

Another way of increasing calories even in patients who have had some of the intestine removed or in those with an inflamed bowel is to give them fat in a form that does not require the formation of micelles by bile salts and pancreatic juice which occur normally in digestion. What we give these patients is fat in the form of medium-chain triglycerides, which are shorter chains of fatty acid than we find in our normal diets. Corn oil, for example, is a long-chain fatty acid, but is not easily absorbed. The medium-chain triglycerides are digestible and are described at length in the article titled on mal­absorption.

Enteral Nutrition:

This term means supplying the patient’s nutrition by mouth in a liquid form that can be easily absorbed by the small intestine. With this approach, the diet is reduced to its essential chemical elements, a procedure recommended especially by our British colleagues in the treatment of Crohn’s disease. In some studies, elemental diets taken by mouth have reduced the complications of Crohn’s disease of the intestine.

These elemental diet preparations contain the smallest el­ements of the diets amino acids, sugar, triglycerides or fatty acids, vitamins, and trace elements. It is difficult to persuade patients with Crohn’s disease to take adequate amounts of these preparations because they are often so unpalatable. Even the astronauts rebelled against taking the elemental diet. But ele­mental enteral diets do appear to have a place in acute ulcera­tive colitis before surgery or as a way of treating inflammation in Crohn’s disease.

Prevention of Oxalate Kidney Stones:

At first glance, the title of this section may seem far afield from the dietary approaches we have been considering in this article. But patients with inflammatory bowel disease, both Crohn’s and ulcerative colitis, can and do often suffer from kid­ney stones, some of which are oxalate kidney stones. So it is important for us to understand how intestinal disease can con­tribute to the formation of oxalate stones.

Oxalate, which is the same as oxalic acid, is an organic com­pound that occurs naturally in food, especially in foods of plant origin. It is not essential for life and is excreted in the urine.

What are the foods that contain the high amounts of oxalate? The highest concentrations are found in green leafy vegetables, beans, cereals, beets, rhubarb, chocolate, tea, coffee, and pea­nuts.

What happens when oxalate is eaten by normal people? The ordinary diet contains between 80 and 100 milligrams of oxalate a day, and in most people, it is not absorbed, but forms insoluble calcium salts in the small intestine, which are excreted in the stool. In hyperoxaluria, on the other hand, excessive amounts of oxalate are excreted in the urine, and this leads to stones. For most individuals, an increased amount of oxalate in the urine stems from an increased absorption of the oxalate eaten.

How does the increased absorption take place in individu­als with intestinal disease whose small intestine has been af­fected by disease or surgery, or by bypass surgery? Two mechanisms seem to be very important. First, patients with small bowel disease absorb fatty acids poorly. Calcium in the intestine forms soaps with the fatty acids rather than with the oxalate. The oxalate thus remains in solution, allowing for increased absorption. Moreover, patients with intestinal disease, especially if the ileum is affected, have trouble absorbing their bile salts. That results in the passage of bile salts into the colon, which normally functions to absorb water and solidify the feces. The presence of increased bile salts in the colon enhances the absorption of oxalate in the colon.

What is the best way to prevent the formation of oxalate stones? You must restrict your oxalate intake in the diet, limit your fat intake, increase fluid each day to dilute the urine of its oxalate contents, and avoid vitamin C supplements. This last point is important since vitamin C is converted into oxalate in the body of some individuals.

If your kidneys function normally, then you can supple­ment your diet with calcium in the form of calcium gluconate or calcium carbonate, which can block the absorption of oxa­late. For some individuals, aluminum hydroxide will also block the absorption of oxalate, but not as effectively as calcium.

Rich fatty foods should be avoided, particularly butter, mar­garine, fried foods, and rich creams and sauces. On the other hand, cereals, meat, and some dietary products are low in ox­alate. Your goal should be to eat no more than 40 to 50 milligrams of oxalate a day.

Oxalate Content by Food Groups:

Cereal and Cereal Products

Bread, white 4.9
Cake, fruit 11.8
Cake, sponge 7.4
Cornflakes 2.0
Crackers, soybean 207.0
Egg noodle (Chow Mein) 1.0
Grits (white corn) 41.0
Macaroni, boiled 1.0
Oatmeal, porridge 1.0
Spaghetti in tomato sauce 4.0
Wheat germ 269.0
Milk and Milk Products
Butter 0.0
Cheese, cheddar 0.0
Margarine 0.0
Milk 0.15

Meats and Eggs:

Bacon, streaky fried 3.3
Beef, canned corned 0.0
Beef, topside roast 0.0
Chicken, roast 0.0
Eggs, boiled 0.0
Fish
haddock 0.2
plaice 0.3
sardines 4.8
Ham 1.6
Hamburger, grilled 0.0
Lamb, roast trace
Liver 7.1
Pork, roast 1.7
Vegetables
Asparagus 5.2
Beans, green boiled 15.0
Beans in tomato sauce 19.0
Beetroot, boiled 675.0
Beetroot, pickled 500.0
Broccoli, boiled trace
Oxalate mg/100 gm
Vegetables
Brussels sprouts, boiled 0.0
Cabbage, boiled 0.0
Carrots, canned 4.0
Cauliflower, boiled 1.0
Celery 20.0
Chard, Swiss 645.0
Chive 1.1
Collards 74.0
Corn, yellow 5.2
Cucumber, raw 1.0
Dandelion greens 24.6
Eggplant 18.0
Escarole 31.0
Kale 13.0
Leek 89.0
Lettuce 3.0
Lima beans 4.3
Mushrooms 2.0
Mustard greens 7.7
Okra 146.0
Onion, boiled 3.0
Parsley, raw 100.0
Parsnips 10.0
Peas, canned’ 1.0
Pepper, green 16.0
Pokeweed 475.0
Potatoes, white boiled 0.0
Potatoes, sweet 56.0
Radishes 0.3
Rice, boiled 0.0
Rutabagas 19.0
Spinach, boiled 750.0
Spinach, frozen 600.0
Squash, summer 22.0
Tomatoes, raw 2.0
Turnips, boiled 1.0
Watercress, early fine curled 10.0
Fruits
Apples, raw 3.0
Apricots 2,8
Avocado 0.0
Banana, raw trace
Berries
black 18.0
blue 15.0
dew 14.0
green goose 88.0
raspberries, black 53.0
raspberries, red 15.0
strawberries, canned 15.0
strawberries, raw 10.0
Cherries
bing 0.0
sour 1.1
Currants
black 4.3
red 19.0
Fruit salad, canned 12.0
Grapes
concord 25.0
Thompson seedless 0.0
Lemon peel 83.0
Lime peel 110.0
Mangoes 0.0
Melons
cantaloupe 0.0
casaba 0.0
honeydew 0.0
watermelon 0.0
Nectarines 0.0
Oranges, raw 4.0
Peaches,
Alberta 5.0
canned 1.2
Hiley 0.0
Stokes 1.2

Fruits:

Bartlett, canned                                                        1.7

Pineapple, canned                                                        1.0
Plums

Damson                                                                  10.0

Golden Gage                                                             1.1

Green Gage                                                              0.0
Preserves

Red plum jam                                                            0.5

Strawberry jam                                                          9.4

Prunes, Italian                                                            5.8
Rhubarb

Canned                                                                  600.0

Stewed, no sugar                                                   860.0

Nuts

Peanuts, roasted                                                      187.0

Pecans                                                                     202.0

Confectionary

Chocolate, plain                                                      117.0

Jelly, with allowed fruit                                               0.0

Marmalade                                                                10.8

Plain candies                                                               0.0

Beverages, nonalcoholic

Barley water, bottled                                                   0.0

Coca-Cola                                                                trace

Coffee (0.5 g Nescafe/100 ml)                                       3.2

Lemon squash drink (lemonade)                                   1.0

Lucozade, bottled (soda)                                               0.0

Orange squash drink (orangeade)                                 2.5

Ovaltine drink, 2 grain 100 nil                                   10.0

Pepsi-Cola                                                                trace

Ribena, concentrate (black currant drink)                     2.0
Tea, Indian

2 rain. infusion                                                       55.0

4 Mill infusion                                                        72.0

6 rain. infusion                                                       78.0

Tea, rosehip                                                              4.0

Juices:

Apple juice                                                                trace

Cranberry juice                                                            6.6

Grape juice                                                                  5.8

Grapefruit juice                                                            0.0

Orange juice                                                                0.5

Pineapple juice                                                             0.0

Tomato juice                                                                5.0

Beverages, alcoholic Beer

Bottled                                                                      0.0

Draft                                                                          1.0

Lager draft, Tuborg Pilsner                                          4.0

Stout, Guinness draft                                                   2.0

Cider                                                                           0.0

Sherry, dry                                                                trace
Wine

Port                                                                        trace

Rose                                                                           1.5

White                                                                         0.0

Miscellaneous

Cocoa, dry powder                                                      623.0

Coffee powder (Nescafe)                                                33.0

Chicken noodle soup                                                     1.0

Lemon juice                                                                  1.0

Lime juice                                                                     0.0

Ovaltine, powder canned                                              35.0

Oxtail soup                                                                   1.0

Pepper                                                                       419.0

Tomato soup                                                                 3.0

Vegetable soup                                                              5.0

100 grams = 1/z cup, usually

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Comments

  1. Barb says:

    Finally someone who understands my problem with these “prescription” diets! My malinios has diarreah that is generally stress related but has been exasterbated by his current condition catagorized as idiopathic effusion. All the vets I have seen do not want to hear that the diarreah gets worse as fluid accumulates in his chest and insist he simply has sheperd type GI problems which can be cured by the Iams Prescription low residue diet. After calling Iams for their product analysis, I switched to Innova's large breed formula which I think has similar properties but without me having to feed grains and chemicals. I have been reading up on pro-biotic formulas but there seems to be wide variation on dosages and if pet products actually deliver like human grade products. Do you recommend an all in one pet product or maybe a human grade Saccharomyces boulardii / slippery elm combo? I am aware this is just a bandaid right now considering his effusions but the top vets can't seem to offer any help.

  2. Amber says:

    When you do an allergy test for food, you start with only one kind of food and you eliminate it for a few weeks then slowly introduce it back. Milk coagulates in the stomach. If you want alternatives, you can drink soy milk, rice milk, almond milk or even raw goats milk or buttermilk which is really good for you. Also you can take digestive enzymes that are plant based that you can find at your local health food store. Also I would start taking acidophiles which creates new healthy bacteria in your intestines to fight the bad bacteria.