Diet does matter in inflammatory bowel disease (IBD). Not only in how it affects the digestive system, but also in overall health. Adults with IBD have greater incidences of heart disease, lung disease, cancer, diabetes, arthritis, kidney disease, liver disease, and ulcers than do people without IBD. (Xu, 2018.)
For those reasons and more: thinking about diet and how it affects all these other body systems, as well as the IBD, is important.
To discuss how diet relates to IBD, Amber talks to Clemmie Oliver, IBD Specialist Registered Associate Nutritionist and Nutritional Therapist (MSc, ANutr, Dip ION, mBANT, CNHC). Clemmie shares her personal journey of living with ulcerative colitis from the age of 9, undergoing surgery, and ultimately receiving a j-pouch.
She covers the impact of her condition on her family, particularly her parents and siblings. Clemmie also emphasizes the importance of nutrition in maintaining health and how dietary choices can influence j-pouch function. She provides practical advice for navigating social situations, such as parties and work dinners, where dietary restrictions may apply. She encourages open communication with healthcare professionals and offers thoughts on adapting food textures to better suit those with stomas or internal pouches.
Find Clemmie Oliver and the Lifestyle Medicine Clinic Ltd at:
Find Amber J Tresca at:
- AboutIBD.com: About IBD
- Verywell: Verywell Health
- Facebook: @aboutIBD
- Twitter: @aboutIBD
- Pinterest: @aboutibd
- Instagram: @about_IBD
Find Mac Cooney (mix, sound design, and theme music) at:
- Facebook: @maccooneycomposer
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- Web: Cooney Studio
- LinkedIn: @macooney
- Theme music, IBD Dance Party, is from ©Cooney Studio.
Episode transcript and more information at: https://bit.ly/AIBD138
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Amber Tresca 0:00
Hi I’m Amber Tresca and this is About IBD.
Amber Tresca 0:09
I’m Amber Tresca and this is About IBD. I’m a medical writer and patient educator who lives with a j-pouch due to ulcerative colitis. It’s my mission to educate people living with Crohn’s disease or ulcerative colitis about their disease and to bring awareness to the patient journey.
Amber Tresca 0:22
Welcome to Episode 137.
Amber Tresca 0:25
Nutrition is difficult enough to manage while living with a digestive condition, but it gets even more confusing after having ileostomy or internal pouch surgery.
Most of us could use a little guidance to help us sort through all the information. That’s where my guest for this episode comes in. Clemmie Oliver is a Registered Associate Nutritionist (ANutr) and a Nutritional Therapist who founded The Nutrition and Lifestyle Medicine Clinic.
Amber Tresca 0:52
Clemmie was diagnosed with IBD as a child and what is unique about her journey is that she lived with an ileostomy through her tween and teen years. She had j-pouch surgery at 18, before she went to college.
After a few years of struggle, she connected with a nutritionist and was able to improve her pouch function based on the advice she was given. It was then that she realized she was meant to study nutrition herself, and today she uses her personal and professional experience to help patients craft the eating plan that’s right for them.
Amber Tresca 1:25
Clemmie, thank you so much for coming on About IBD I’m really excited to talk to you today.
Clemmie Oliver 1:30
Thanks so much Amber, for having me on. I’m really excited to be here.
Amber Tresca 1:33
Oh, absolutely. You have some really unique experiences that I can’t wait to dig into. But first, I would love if you would introduce yourself. So the listeners get an opportunity to understand who you are and what your work is. Yeah, of course.
Clemmie Oliver 1:48
So I’m clammy, I am actually based in London in the UK, I am an IBD patient. So I was diagnosed with colitis, ulcerative colitis when I was nine years old. And I’ve been through quite a journey on that. And I think we’re probably going to talk about that. I now I have a j-pouch. And my work is supporting patients with inflammatory bowel disease. So whether that is pre surgery, so perhaps from just when someone’s been diagnosed with Crohn’s or colitis, right away until perhaps someone’s had surgery. So I founded a clinic about five years ago called the Nutrition and Lifestyle Medicine Clinic. And we specialize in supporting patients, when it comes to diet and lifestyle, to help support their disease.
Amber Tresca 2:36
That’s incredible. A lot of patients are looking for someone that has personal experience to also help them through their journey. I think that creates a really great bond and an understanding in a way that maybe other people can’t quite understand. So I’d love to start with understanding about your IBD journey so far. You were diagnosed so young, I imagine it probably feels like you’ve had IBD your whole life because you were nine. So can you tell me a little bit about that diagnosis process? And what those years were like for you and what you remember about them?
Clemmie Oliver 3:17
Yeah, of course, I was very young. And I’m not sure I remember loads about life, pre colitis. And I think also, my memory of those years is clear in some parts, but hazy and others. And I think it’s our brains way of kind of coping with the trauma, I suppose that I went through, right. So I do have memories of it. But some of it’s a bit hazy, but I know that I was away at school at the time. And I started developing symptoms. So I had diarrhea, and that I started experiencing blood, but I didn’t actually tell anyone about it. And I think that I was probably wasn’t really sure what it was, I think I was probably a little bit afraid.
Clemmie Oliver 4:03
And it was actually when I was at home that I forgot to flush the loo. And someone went into the loo and came on I remember this bit so clearly. I remember sitting in the kitchen on the floor with my sister playing with our dogs. My mum came in and said, someone’s been to the loo and not faster and there’s blood in the loo Who is it? And I remember done denying it and saying it wasn’t me to start with. And then eventually just bursting into tears and explaining to my mom and she was like, well, where’s the blood coming from trying to get an idea?
Clemmie Oliver 4:39
And then very quickly, she took me straight to the doctor. So I went to our GP so what’s your kind of family doctor? And then quite quickly, I was taken straight to A&E. So the emergency room, and then I was diagnosed reasonably quickly after that.
Amber Tresca 4:58
All right. I have a couple questions about this story. You were quite ill with ulcerative colitis. And so that probably had an effect on your parents and your siblings and a lot of other things. So how did that change your life over the next few years while you were still at home?
Clemmie Oliver 5:15
Yeah, of course, I think I’m, I feel very lucky and very fortunate that my parents, my siblings, were incredibly supportive. My dad continued to work, but my mom wasn’t working at the time. So she was able to be with me the whole time in hospital and dad came and visited me when he could. And my brother and sister they were at school, but when they could, they’d come and see me as well.
Clemmie Oliver 5:43
And I also remember when I have my j-pouch surgery, my brother working in London in the in the city at the time, but my hospital being on the outskirts and him having to get like two tubes, like two buses, to get to come and see me and he came like every other day after work when I was in hospital for the two weeks. And one time, he’s a bit of a comedian. And he always can’t here’s like, he says his role is to, like, bring humor to every situation. Because yeah, he feels like that’s the kind of thing that helps cheer everyone up.
Clemmie Oliver 6:16
Anyway, he made me laugh so much. And I was in so much pain that I was like, half, half laughing, half crying. And my mom and the nurse was like, I think you need to leave and the poor guy, he’d spent all that time traveling, and he’d only been there for like, 10 minutes. And my mom like to come out for dinner and things like that. But But no, I think I’ve been I’ve been super lucky that I’m, I am sure that it really had quite an impact on my siblings, my parents as well.
Clemmie Oliver 6:45
And I think it’s only now that I’m older that I can kind of reflect and look back at how hard it must have been for them all. I think everyone always says, Oh, it’s so hard for the patient, oh, it must have been so hard for you. You’ve been through such an ordeal. But when you’re the patient, I didn’t know about you, but you just kind of do it. You just put one foot in front of the other. And I actually think that maybe it’s harder watching. And being a family member and not being able to do anything about it. Basically.
Amber Tresca 7:17
I agree completely. And I don’t think I’ve ever met anyone that’s said the reverse. Like, I know how to be in the hospital bed. I don’t know how to be in the chair next to the hospital bed. It’s a lot more difficult. And when it is your child, that is a whole other level of helplessness.
Clemmie Oliver 7:36
[MUSIC: About IBD Transition]
Amber Tresca 7:51
Alright, so you were diagnosed at nine. I know just from your blog and about your story that you did have collected me surgery and you lived with an ileostomy for a time. What ages was was that situation?
Clemmie Oliver 8:06
Yeah, of course. So I spent they spent two years trying to I had pain colitis. So the whole of my colon was affected, and it was pretty aggressive disease. And I was on steroids for more time. I think that I was often in those two years. And they tried lots of different medications. Although saying that you may not lead to different medications, because this was all before the era of amazing biologic medications, and some of the other immunosuppressants.
Clemmie Oliver 8:38
So really, I tried azufadine and steroids. And then I think, basically, the doctors said to my mom that the next step is cyclosporine. There’s some pretty crazy side effects for someone so young, and what we’re doing is just putting off the inevitable, which is her disease isn’t getting under control. And we are going to be faced with surgery. Like sooner rather than later, probably my parents made the decision not to go down that route in terms of that those medications, and to go down the route of surgery. And actually, so it was pretty much two years from diagnosis that I ended up having the surgery and by that stage, I was pretty unwell.
Clemmie Oliver 9:23
So I was about two and a half stone and I was 11 years old. And it got to the stage and again, this is a bit that I remember really clearly is that I like got up one day went downstairs have my normal like bowl of cereal, and then felt really sick and threw it back up and was like okay, that’s weird. And then tried to eat again and then throw it back up. And then every time I tried to eat was throwing up and I was like, something’s not working here. And my mom was like, I think it’s time.
Clemmie Oliver 9:54
So we went straight to the hospital and they said like, I think we’re gonna have to operate but we don’t think that you’re actually stable enough or strong enough to withstand the surgery at the moment. So I think I was about a week to 10 days being stabilized in hospital with IV nutrition before they felt that they that I was stable enough to operate. Wow, that’s just
Amber Tresca 10:18
Oh my gosh, that’s a lot. Remind me though. What is? What is two and a half stone in kilograms? Oh, really?
Clemmie Oliver 10:28
Good question. Hang on. I can write out it’s okay. 15, nearly 16 kilograms.
Amber Tresca 10:38
Oh, my gosh. Okay. All right. Yeah. So that was not great. And you were 11 years old?
And so Alright, so what was the conversation around ileostomy versus j-pouch? How did that all happen? Because now you live with the with the j-pouch. So how did that go?
Clemmie Oliver 10:55
Yeah, I think this is a really interesting one. And something that I’ve reflected on kind of more recently. So I had the surgery at 11. And then I was just always told, when you are 18, we will reverse it. And but we want you to grow, we want you to develop, we want you to catch up with the stunted growth that you’ve had and just finished school and whatever. So I am not sure that I ever realized that having a j-pouch was a choice.
Amber Tresca 11:23
Okay, it was always presented to you as this is what we’re going to do for you. Yeah,
Clemmie Oliver 11:28
of course. And I don’t think it would have changed my decision. So I would have still gone ahead and had the j-pouch. But I think it was yeah, it was just an interesting one that I think it was always presented to me like that. That’s just the next step that happens in your journey.
Amber Tresca 11:45
So you’re in a unique position, I think to compare between having an ileostomy and having a j-pouch, because you had the ileostomy for so long before moving to the j-pouch. That must have been a real trip to have that first bowel movement after you got your j-pouch. Do you have anything that you can share about contrasting the two?
Clemmie Oliver 12:08
Yeah, of course, yeah, I mean, seven years without going to the loo and then go to the loo again, was a pretty wild experience. But in terms of the contrast, I suppose I found that my ileostomy really gave me my life back, I was so unwell. By the end, I couldn’t do anything I was taken out of school. In the end, I’d homeschool for a bit, I couldn’t do anything.
Clemmie Oliver 12:32
So actually having my ileostomy really gave me my life back, which was great. But there was always that. And actually I had a I had a really good journey with my ileostomy, I had very few leaks, although, as always they did happen now. And again, generally, I had a really good experience with it. And I was able to eat most things.
Clemmie Oliver 12:56
I didn’t go and stay at friend’s houses that often. So just because I didn’t quite feel comfortable doing that at that age. And I didn’t really talk about my experience either no one really knew I had an any ostomy which I now looking back on it. If I did it, if I if I had my time again, I talked about it loads. But in terms of the contrast, like I really such an advocate for both. I think that there’s so many positives to in ileostomy. I’m a really real advocate of a j-pouch.
Clemmie Oliver 13:29
But I have had a really good experience. And I think that that’s something that I feel very lucky that I’ve had a really good experience, and that I haven’t had lots of complications and through the research, but also through my work with lots, lots and lots of j-pouch patients. I do know that lots of people do have complications. So I think I think yeah, it’s there’s pros and cons to both for sure. But I think I’m very much an advocate of personal decision.
Clemmie Oliver 14:01
So if someone is like, you know what, I just don’t want to take the risk of maybe having complications with the pouch, and I’ve got super comfortable with my ileostomy. And actually, I’m pretty happy with it. If someone wants to stay with it, then I think that that’s a great choice. As long as it’s what they want to do. I think that’s a great decision. But if someone’s like, you know what, I’ll always be thinking what if or I want to give it a go, I’d always say Yeah, absolutely. I would 100% recommend giving it a go if that’s what you want to do.
Amber Tresca 14:30
You came to a point in your life where you thought I need to maybe pay more attention to what I’m eating and what I’m doing and how this affects me. And then it it kind of changed your life and changed I think also what you do for a career if that’s right.
Clemmie Oliver 14:46
Yeah, absolutely. So I post Jeep out surgery six months later, went to university, had a great time. Just did everything a normal Uni student does really I would say looking back on it, I probably didn’t look after my body.
Amber Tresca 15:08
If you’re a normal student at College, then yeah, probably,
Clemmie Oliver 15:12
I look back now. And I think, oh my gosh, I was six months out of j-pouch surgery. And my pouch then got such a battery. And I think for me, it was a bit of a like, I’ve 307 years of leading up to this. And then yeah, I can do this anyway. So I just ate and drank everything.
Clemmie Oliver 15:33
And actually, I was told all the way through my journey with my colitis with everything and with the j-pouch as well, but that diet didn’t make a difference. And so it really didn’t matter why he basically said and I very much lived by that I basically just ate what I wanted quite a lot of rubbish food. Not many fruits and vegetables, and things like that.
Clemmie Oliver 15:58
And there was a point in my, I think towards the end of my first year of university, when I I got them something called the Norovirus like a really nasty gastroenteritis. And I was pretty unwell for like a week or so. And then basically just never felt the same again. And I lost loads of weight, and I my pouch function changed. And I started losing my hair. And I was like, This is so weird. And I went to the gastroenterologist and they ran a load of tests and they said, Yeah, there’s no pouchitis no information in your pouch. Pouch is working fine all your other bloods, alright, like, we’re giving you a clean bill of health.
Clemmie Oliver 16:44
And I was like, hang on a minute, though, I feel awful. Like I’m bloated all the time, my pouch functions really bad. And I’m just exhausted, and I feel nauseous every time I eat and all of those kinds of things. And it was actually my mum who said, who’s always been like looking at other options outside of medical treatment alongside medical treatment to support me. And she said, Look, I know that you’re that, we’ve always been told that it doesn’t make any difference. But let’s go and see someone that’s like, I’m gonna book you went to see a nutritionist. And let’s see whether it makes any difference. And I was like, I’ve got nothing to lose, it’s not going to help. But I’ll go.
Clemmie Oliver 17:28
And thank you mom for that. Because quite literally, that appointment changed my life, it opened to my eyes, it opened my eyes to the fact that it really does make a difference to not only your pouch function, but actually your overall health, what you put in your mouth, and what you put in your body. And within a couple of weeks of making some really quite simple dietary changes, I felt like a different person. And that really started my journey into exploring how I could support myself and my pouch better through nutrition.
Clemmie Oliver 18:06
And then I thought, well hang on a minute. I’ve been told throughout this whole journey, that diet doesn’t make a difference. And I’ve lived by that how many other people are there out there, you have that experience as well. And I did some research and realized lots of people. I thought to myself, Okay, my life’s been changed. And I want to change others in the same way. And I was working in a job at the time that I didn’t really enjoy. And I couldn’t see a future in it. And I thought you know what I want to help, I want to help other patients like me, I want to help others the way that I’ve been helped.
Clemmie Oliver 18:40
And so I did a complete career change. I went back to studying, I went back to Uni, I’ve now done five years extra in terms of studying, I finished a master’s last year. And I set up my clinic five years, five years ago, I absolutely love the work that I do. And I’m so lucky that something caught, I guess something really bad in terms of having colitis, having loads of surgeries and stuff that that then turned into something that I find the most rewarding thing and I absolutely love working with other patients.
Amber Tresca 19:16
You know, I don’t want anyone to go through any of this. But at the same time, you’ve come through it and you’ve learned so much and now you can help other people and that’s just like the best. That’s just like the best outcome, you know, honestly.
Clemmie Oliver 19:30
Yeah. And I think it’s one of those things as well. But you said right at the beginning of our conversation about patients like like, it’s nice to meet someone else who has the disease or has had zero experience because this that when you meet someone who have has IBD this that like immediate just connection and that immediate like unsaid understanding of what that person might be going through.
Clemmie Oliver 19:53
And that’s why patients come to us so there’s me and I also have a lovely dietician who works with me called Jess, she also has a quite a reasonably similar journey to me in terms of IBD. And now is a dietitian specializing in gastroenterology and helping IBD patients. So people come to us because they know that we get it in inverted commas. That’s what people say, they come to us because we get it.
Amber Tresca 20:18
Right, right. In a in a way, there’s a shorthand. And there’s an understanding that I think you eliminate a whole lot of questions and conversation, because it’s just not necessary. Exactly. You could sort of immediately get down to work, I think,
Clemmie Oliver 20:36
I completely agree with you and say, a patient might be explaining to me something about a symptom. And I’m like, I get it. I understand what you’re talking about. Yeah, that’s fine. And they’re like, I know that you get it, because I know that you have been through it. And I’m, and I’ve obviously seen it lots in clinic too. So. But it’s I think we provide a unique service to our patients that we have the qualifications and the clinical experience, but also that personal experience, which doesn’t impact on the advice that we’re giving, but just gives us that empathy with patients.
Amber Tresca 21:09
Right, right. I’m going to ask you something that I’ve never asked another nutritionist, but I’m just wondering about. So all right, do you manage your own care? Or do you talk to somebody from time to time to try to figure things out with your j-pouch?
Clemmie Oliver 21:27
Yeah, I think that’s such a good question. I haven’t had someone support me for a while. But I did see. So I saw that nutritionist a few years ago. And then I saw a dietician of, gosh, probably about six years ago now, who helped me a little bit. But I am not afraid if I have challenges or issues to go and seek out help from someone else.
Clemmie Oliver 21:54
And I think, with the knowledge that I have in my area, there’s a lot I can navigate myself. But I also know that sometimes actually, it’s just really useful to get someone else’s perspective. So I normally manage it myself. But if it’s something else, or if it’s something else nutrition related, then I will seek help from someone else.
Amber Tresca 22:12
So alright, you are going to have a unique perspective, I think also on helping people manage their sort of their day to day lives. So what do you do for yourself? Or what do you tell your clients, when they’re out at a party? They may not have a good food choice there. Or there’s not a bathroom available? There’s not a toilet available? Do you have any tips to share?
Clemmie Oliver 22:40
Yeah, of course, I think it’s a specific situation like being at a party. Sometimes it takes a bit of kind of pre planning or kind of pre thinking about going to the party. So sometimes, if I’m aware that at that party, there isn’t going to be any food that I can eat, or that I don’t feel comfortable eating, I can eat most things. There’s some things that I don’t tolerate. And that’s really different in terms of the different foods that people can and can’t tolerate, that tend to be really different with different people with j-pouches.
Clemmie Oliver 23:16
There’s one like common phenomenon, where which is shown in the research, but also I see it in clinic quite a lot, which is coffee, and caffeine. Some a lots of people find that they tend it tends to kind of speed up pouch function and loosen things up a bit. I find personally that it does, but some people actually are totally okay with that. But I’ve segued a bit off there.
Clemmie Oliver 23:40
But in terms of kind of coming back to the question, I would always if there was some if I felt like there wasn’t anything I could eat at the party, what I would do is make sure I had something to eat before I went. If it was a dinner, I would generally look to speak to the host perhaps before I went I think it really depends on the situation. So if I’m going to a friend’s house, or if it’s like a work dinner, then I would always talk about my dietary requirements so that hopefully there’ll be something there that I can eat.
Clemmie Oliver 24:15
But if it’s like going out to a restaurant, then again, I might have a look at the menu in advance and just see if there’s anything on the menu that’s okay. So that I when I go to the that event that I feel more confident. So sometimes perhaps it takes a bit more pre planning, but then when I go there, then I feel relaxed, and I don’t feel stressed about being put in that situation. In terms of going out to eat the advice that I often say to people is like if you can be in charge of where you go and you know, they’re somewhere that does food that you can eat them perhaps why not suggest that to whoever you’re going with and the other thing is have a look at the menu online before you go.
Clemmie Oliver 24:52
If there’s something you’re not sure about phone, the restaurant, ask them most of the time they’re really happy to help and then you can go again that you can go into that situation, reduce that anxiety, reduce that stress around that. And also, if you get to the restaurant, and you haven’t managed to do any of that, you can always speak to the waiters about perhaps change swapping some ingredients out or changing things.
Clemmie Oliver 25:14
And that doesn’t have to be really obvious, that can be something that you can just pull them to one side quietly and do because I know some people don’t want to draw attention to it. So there’s loads of ways that we can manage that. And sometimes it just takes a bit of pre planning, but it really depends on the situation that you’re in as to what might be appropriate to do.
Amber Tresca 25:34
Yep. From my own experience, I think work dinners are the most challenging. When people don’t know your situation, I still don’t have a good response. So I don’t know. It’s just really it’s kind of strange trying to manage other people’s thoughts or around it when it just seems like it would be great if people would just worry about themselves and about what other people are eating?
Clemmie Oliver 25:59
Yeah, of course. And like I, in my view, it’s never appropriate to comment on what someone’s eating or drinking, but lots of people do. They can’t help themselves. Or, actually, that’s just really awkward for the person who is receiving that comment, because then it draws attention to it. And it makes you perhaps you felt uncomfortable about that before, and then it draws attention to it.
Clemmie Oliver 26:21
And I guess it really depends on your personality as to how you might respond to that. So some people might use humor to respond to it. Some people might actually call that person out on that, and say, it’s really not appropriate for you to be asking me why. And some people perhaps, like their boss, maybe it’s worth having a conversation. Yeah. Before you go out to saying I’m not going to be drinking tonight, because I do have bowel issues. And maybe that’s something you’ve talked to them about before.
Clemmie Oliver 26:52
So yeah, I guess there’s kind of different ways of handling it. Whether some people feel like they can be open and honest about their medical conditions and things with their boss, some people feel like they can’t. So uh, yeah, I think it really depends on your personality.
Amber Tresca 27:16
It well, when it happened. It’s happened many times in my life and at different stages in my life when it happened. I was in my mid 20s. And I literally did not know how to respond. Today, I would absolutely say my business. What I’m eating and drinking is not a concern of yours. Although there’s probably nobody across the world that doesn’t know that I live with a j-pouch. Thanks to the work that I do in this show and everything else.
Amber Tresca 27:48
If somebody knows about your situation, they can help you out and sort of make excuses or, you know, because I know for myself, I will like…I won’t cross the street for myself. But if another person tells me that they’re dealing with a situation, I will move boulders for them. So I think that’s worth considering as well.
Clemmie Oliver 28:06
Yeah, I think that is such a good point is like hopefully in the situation that you’re in, you’ll have a buddy, you’ll have someone who knows your situation or someone who who’s got your back and who can deflect the conversation away because you may not feel like you can call that person out and that’s totally okay.
Clemmie Oliver 28:24
But actually maybe someone else can do that for you or someone else can change the subject or something like that. But absolutely my sister is such a great advocate in terms of bathrooms for me, so we talk about our loo-dar So like rather than a radar as we call toilets, so our leader and our lewd ours are on point and wherever we go and still now wherever we go, she’s like there’s a loo over there and I’m like cool clock tick got it.
Clemmie Oliver 28:55
So it’s just it’s really good having an advocate like that, and I’m absolutely the same as you if I know some someone’s like whether it’s IoT related or not, if something’s happening for someone, I will like help protect them I will help them make sure they’ve got everything they need. support that because I know what it’s like to be in that position.
[MUSIC: About IBD Transition]
Amber Tresca 29:34
Not to give away everything that you do in your professional life, we want to leave something on the table. But what advice do you have for j-pouches as they’re considering their diet and you can include ileostomy in this too because I feel like they might be pretty similar but maybe, maybe not with j-pouch you have that? I don’t know I call it taco but where you have that acid Yeah, especially in the beginning, there’s a lot of like acidic stool, and you’re dealing with your with skin issues at that point. But what kind of diet tips do you, in general sort of give to people as they’re as they’re starting out in adjusting to their new bodies?
Clemmie Oliver 30:17
Yeah, of course, I think it’s a really good question. And what I would say is like, above everything else, no matter what you’re told, diet makes a difference. And although the research is really in its infancy, and there’s still some kind of slight missing connections in terms of understanding the role of diet and how that affects pouch health, it seems to be that that diet can make a difference to someone’s risk of pouchitis, for example, we need as I said, we need more data on that.
Clemmie Oliver 30:50
But no matter whether we’ll if we take the parts out of it, diet matters for our overall health and our other disease risk going forward. So our risk of things like type two diabetes, cardiovascular disease, all of those kinds of things, diet, right, and our lifestyle really matters to those. So don’t let anyone ever tell you that diet doesn’t matter. What we know at the moment is that it’s really common for people to avoid foods, whether that’s food groups or specific foods when they have an ileostomy, but also with a j-pouch as well.
Clemmie Oliver 31:25
And I always explore with my patients, why they’re avoiding certain foods, is that because they found through process of trial and error that that food really doesn’t work for them? In which case, maybe that’s okay. Or, actually, is it that they were told right at the beginning of that journey, just off surgery that they couldn’t eat that thing, or they couldn’t eat that food group.
Clemmie Oliver 31:46
But they were never given other advice to change that as their bow healed? And as things got better, or is it something that they read somewhere? And that’s why they’re avoiding that food. So I always go through that with my patients.
Clemmie Oliver 32:00
If anyone’s avoiding anything, we go through each of the foods and we talk through them. So why is it that you’re avoiding that? Let’s talk about that a bit more. And also, something’s causing symptoms. Usually, there’s a, there’s an explanation behind that. So there’s a reason why that that food is perhaps triggering symptoms for you, whether that’s that burn that we’re talking about, I call about burn, or whether that is kind of looser power output or anything like that.
Clemmie Oliver 32:26
So it’s really important, I often see that patients are given advice, post surgery to follow a low fiber, low residue diet to let the bowel heal. But often people are, maybe they’re told at that kind of follow up session, you’ll find start eating anything you want now, or maybe then diet isn’t even approach. So people are stuck on this low fiber, low residue diet, or they’re told that they can eat anything, but they’re terrified. And they’re afraid to start eating new foods and trying new textures for fear of causing some kind of problem.
Clemmie Oliver 33:01
So I think there’s a real lack of guidance and support and in transitioning away from that post operative diets on to one that’s more much more supportive for not only our overall health but our pouch health going forwards, it is really important to to know that changes do need to be made and that it’s not necessary to avoid lots of foods. When you have a j-pouch. There’s lots of people I know who eat everything, and nothing has an impact on their pouch. There’s some people who I work with who lots of things might do. I guess, going back to kind of what the advice is.
Clemmie Oliver 33:40
So generally, where the research is pointing towards a Mediterranean style dietary pattern being useful, so including things like fruits, vegetables, whole grains, nuts, seeds, well, lots of people that I know with a j-pouch would go, but I can’t wear the stoma actually. But I thought I couldn’t eat those things, or whatever. And actually, there are absolutely ways that we can enjoy a Mediterranean style of eating, but in a way that is more friendly to a pouch and to a stoma by, for example, adapting textures and things.
Clemmie Oliver 34:19
So for example, someone might say nuts really don’t agree with me. Or maybe someone’s got some kind of complication like a stretcher and they can’t enjoy them. But that doesn’t mean that they can’t ever have nuts ever. It just means that we need to adapt those textures. So something for example, like a nut butter, a smooth nut butter. So smooth peanut butter, smooth almond butter is absolutely fine for those patients to have, or using crowned nuts or nut flours and baking, it means you can still get the lovely nutrients from those foods and still include them, but in a way that’s not going to cause any issues internally.
Clemmie Oliver 34:55
So that’s I guess just one example is there are loads of ways that we You can adapt the textures of foods to help them be better tolerated for people with stoners, but also people with pouches. And that, in itself then helps pouch house but also helps long term health as well.
Amber Tresca 35:13
You know that you’re the first person I think I’ve ever heard talk about the nut flours, for instance, because I do see those referenced a lot by dieticians, and in recipes and such, I don’t have a problem with regular wheat flour. So I never really thought too much about using a an alternative type of flower. But I also never considered that they might contain nutrients. And that’s why you might try try them out and try them in your baking. So that’s a really important point, I think.
Clemmie Oliver 35:48
Yeah, definitely. And look, I’m a great advocate of things like smoothies, and soups and stuff like that to get all these things in as well. If we’re blending those textures up, it means that we still get to enjoy all those nutrients and digs icon nuts are full of really good healthy fats and minerals as well. And that is really helpful for our overall health as part of a healthy balanced diet. So including those and things like baking, and it doesn’t mean that you can’t have the wheat flours, but maybe just add them in and experiment with that a bit and have a bit of fun with them.
Amber Tresca 36:23
Yeah, that’s okay. You’ve convinced me so because before I was like, I’m not gonna get almond flour Come on. But there’s definitely a place for it. So I want to touch for a minute more on this idea that people are often told before, while they’re living with IBD fulminant colitis, you know that they should avoid certain things and they should go on that low fiber diet. I think people are often given a list of no no foods, rather than being given a list of foods that they can eat. That just seems to be the approach. But what does a person do when they are a little fearful of expanding their diet?
Clemmie Oliver 37:03
Yeah, I think just coming back to a point that you made about people often being given lists of things they can’t have. It’s a real bugbear of mine, about this slight obsession online, but also this thing in hospitals as well of like, this is what you can’t have, and always focusing on exclusion.
Clemmie Oliver 37:24
Actually, I really think we should always be flipping the tables and saying like, actually, let’s focus on what you can have. Because actually, psychologically, that’s so much easier and more supportive and more helpful. So with our patients, we always provide first and foremost lesson ideas of foods, and recipes that people can enjoy. But we also to help support them as well give them lists of foods that actually for the time being, maybe it’s not quite right for you to have that however, you can still enjoy it, but adapt it in this way, and you might still be able to tolerate it.
Amber Tresca 37:55
Clemmie Oliver 37:56
So I think that’s it, it’s changing the narrative to a more positive view of food, rather than always a negative restrictive view, because that negative restrictive review view leads to fear around foods. And we work with so many people who are ready to transition or want to transition or wants to change their diet, but are so scared that they don’t know where to start, and they don’t know what to do. And I have been there myself as well. So anyone out there listening I, I hear you, I it’s not a nice situation to be in. And that’s where it can be really useful to get support.
Clemmie Oliver 38:39
But what I often suggest kind of some, like general stuff for people to do, is I guess it’s making sure that you’re in the right place in terms of your disease and things like that, and making sure there’s not anything that you definitely should be avoiding for medical reasons. So for example, if you have a narrowing in the bowel or a stricture, then actually keeping to that adaptive fiber diet is a good idea. But actually, if there’s no complications, you think given the all clear, and they’ve said like, you’re absolutely fine to start increasing fibers a bit more, then just start with cooked foods, and small amounts first of all, as well.
Clemmie Oliver 39:19
So often, we think, Oh, we just have to go in with a whole portion but actually go in with like, a quarter or a third of a portion to start with. So if it was, for example, broccoli, let’s use broccoli as an example. Okay, so yeah, great. So maybe that’s something that someone may have been avoiding, but broccoli is actually like the floor. It’s the broccoli Well, coats are fine to have on a kind of adapted fiber diet, but maybe it’s something that someone’s avoided.
Clemmie Oliver 39:46
So what I would always suggest to someone is just you go for one floor it start with chop off the store can just have the head so the floor at bit and just steam it really well into it’s really nice and soft. And just to that really well and have that alongside a meal that you know that you’re absolutely fine to have. And nine times out of 10, it will be absolutely fine.
Clemmie Oliver 40:07
And then next time you have that maybe you have to florets, but still nice and soft and really well cooked. And then just work your way up to a more full portion, then you can work your way up to having a little bit more of the stock. And maybe then have not having it so like mushy, and soft, but maybe then a bit more fun.
Clemmie Oliver 40:26
But that’s how we can build confidence, but also help to understand maybe what foods don’t agree with us or not. So I’d always suggest, yeah, going slowly, doing things one at a time to start with, and then you might get your confidence up. And you might then feel actually that you can start introducing things a bit more quickly. And that’s absolutely fine.
Clemmie Oliver 40:46
But just to start with, and it can be really helpful as well to to understand that foods can sometimes causes symptoms, but it’s not anything to do with inflammation, or it’s not anything bad that’s happening. It’s just how that reacting with our intestines and the things inside our intestines that maybe is for example producing gas and things like that. It’s not doing any harm, it can sometimes be a bit unpleasant in terms of symptoms.
Clemmie Oliver 41:12
And that’s where working with someone like us can really help you to understand, Okay, why is that food doing that for you? And what can we do to make that better for you. But it is really important as well, that we don’t neglect the fact that if we have fears around introducing foods, that that in itself can cause the symptoms. So our brains are so powerful. And that connection between our brain and our guts, there’s so much research going into that area now. And it’s so fascinating.
Clemmie Oliver 41:42
But we can actually cause pain and discomfort and things like that in our intestines just thinking about it and being in that kind of fight or flight and stress state. So if we’re really, really, really worried about trying new food, and we’re really anxious about that, and we think it’s definitely gonna cause me symptoms. And so we’re in that fight or flight. And we’re stressed about it, when we’re eating it, when we have it, it might cause symptoms, but it’s not the food, it’s the fact that we’re really fearful about it. And that’s what’s causing the symptoms, because stress has a huge impact on the way that our bowels move and the way that our bowels function.
Clemmie Oliver 42:18
So again, that’s where it can be really helpful to get support with how you do that if fear of food is something that’s really impacting you. And as I said, we work with lots of patients like that. And often when they leave us, they’re like eating lots of different foods and feeling much more confident and everything about it. So yeah, it is it’s a really important thing. And just I guess, going back to another thing is the low fiber diets are something that are really useful post surgery. But it’s often something that is given out too, liberally when people have active disease, for example, and the understanding around kind of low residue, low fiber diets, if people aren’t given given information about it, it can be quite confusing.
Clemmie Oliver 43:05
And actually, the data that we have at the moment doesn’t ban the use of low fiber diets. That’s really quite an old school, kind of thinking around what we should be doing to support us. Now, as I said that our patients way is appropriate to follow low fiber diet. But actually just sometimes adapting fibers. And changing certain types of fibers can be enough because we’re understanding more and more the really important role that fiber plays in actually helping to support our gut health, and to maybe also help to reduce inflammation in the bowel as well. And also to keep the bowel functioning properly. So again, I just wanted to put that in there because it’s something that’s often still advised for people to do, even though the research is suggesting that that’s not the best way forward.
Amber Tresca 44:02
Yeah, a lot of things we did back in my day are definitely you know, the Bible rest in I mean, there were times when I ate nothing but jello for weeks. So that’s like not great. And you don’t want people to do that anymore. You know, let’s not do that anymore. So let me ask you really briefly, just some broad strokes, if someone does come to work with you, it’s not a forever situation, right? But how many times might you work with somebody I know there’s probably a whole spectrum, but what might that look like?
Clemmie Oliver 44:29
Yeah, of course. So we it really depends on where that patient is on their journey, and how much support they need. The minimum that I would see someone would be twice. I always talk to someone on the phone, or on Zoom, who is interested in working with us, so I can hear more about them. They can get to know me, we can work out if we’re a good fit, but I can also understand a bit about their journey so far, and how much support I think that they might need so they I can manage their expectations about how much Some time we might need to spend together.
Clemmie Oliver 45:02
But the minimum I would work with someone would be two sessions, which would be about four to six weeks. And the longest I’ve worked with someone is over two years, maybe three years. So it really depends on first and foremost, I guess how much support I feel that person might need, but also how much support that patient feels like they need as well.
Clemmie Oliver 45:25
But also, where they’re at in their journey, all of those kinds of things. And sometimes people just like to keep checking in and keep checking that they’re doing the right things. And sometimes we’re waiting on people changing medications, or they’re having flare ups or whatever. So it might mean that we’d work with someone for a little bit longer. So it really depends, but I’d see someone on a minimum of a two session basis.
Amber Tresca 46:11
So Clemmie, everyone who’s listening can tell that you are in the UK. Tell me about some of the things that you like to do I read that you enjoy hiking around the Scottish Highlands, that might be something that people who are facing ileostomy or j-pouch surgery might not think would be available to them. Tell me how you manage that and what you like about it?
Clemmie Oliver 46:41
Yeah, of course. So yeah, if I’m not living in London, in the city, my favorite thing is to escape to the country. And I’m really lucky that my family on my dad’s side is Scottish. And we actually have a place up on the West Coast, which is the most beautiful place in the, I think in the entire world. And I absolutely love climbing the mountains up there and getting out on the hills.
Clemmie Oliver 47:05
And what I would like to say to people is that those things are absolutely accessible for everyone. Our lovely dietician Jess, who works with me, she cycles, semi professionally, she skis, she does loads and loads of sporting activities. And she has a stoma, so I think we’re both advocates for like outdoor pursuits. But in terms of how I manage that, I actually always take toilet roll with me. Yeah, normally also, I might adapt my diet a little bit. If I know that I’m going out for quite a long day, and I’m not going to be near loo, I might eat the foods that I know, kind of bung me off a bit more or slow things down for me a little bit more. So I adapt things in that way.
Amber Tresca 47:54
Yeah, I will, I will modify my diet as well. Something I might do, which maybe I don’t know, I might think about how much I’m drinking that day to just just to be aware of it. And but I mean, I think I think like, you know, regular people might have to consider that as well. So too much different.
Clemmie Oliver 48:15
I think something just to clarify that that’s really important is when I say I modify my diet, it’s not that I don’t eat, it’s that I eat because I need to have the energy when I’m walking all day. So I need to make sure that I’m eating but I’m eating foods that I know, move through my bowels more slowly, that generally slow down wipeouts output. And then you’re absolutely right in terms of liquids and stuff, actually having the right liquids, if you’re walking in the heat. We know that dehydration is much more common for people without a colon. Anyone with an ileostomy or a j-pouch. So taking rehydration solutions with me, as well as water. Those are all the things that I definitely consider when I’m doing those walks.
Amber Tresca 49:00
Right? Yeah, maybe having a cup of coffee before you go. Might not work. Although I know. I’ve done it, I refuse to give up the coffee. Clemmie: this has been a fantastic conversation, you are a wealth of information. I want to make sure that everyone can benefit from all of the things that you’re putting out online. Where can people find you? Where can they follow you on the interwebs?
Clemmie Oliver 49:27
Yeah, of course. So my Instagram is @clemmieolivernutrition and our websites. So the clinic is http://www.nalmclinic.com.
Amber Tresca 49:42
Perfect. Thank you so much for agreeing to talk with me and for sharing so much about your experiences and your life living with IBD and ileostomy and a j-pouch. And again, I’m so sorry that you have had to go through all of these things in your life. But I’m really grateful that the community has you to rely on and to Share your experience and knowledge with so thank you so much for that.
Clemmie Oliver 50:03
Well, thank you so much for having me, Amber. It’s been such a pleasure chatting to you.
Amber Tresca 50:11
Hey super listeners.
Amber Tresca 50:12
Thanks to Clemmie Oliver for all her work in helping patients navigate their journey with nutrition and IBD as well as taking the time to talk with me about it.
You can find Clemmie and her team at The Nutrition and Lifestyle Medicine Clinic at nalmclinic.com, which is N A L M C L I N I C dot com and on instagram @clemmieolivernutrition and Facebook as @nalmclinic.
Amber Tresca 50:34
Links to a written transcript. Everyone’s social media handles and more information on the topics we discussed is in the show notes. And on my Episode 137 page on AboutIBD.com You can follow me Amber Tresca across all social media as @aboutIBD thanks for listening. And remember, until next time, I want you to know more about IBD.
Amber Tresca 51:08
Xu F, Dahlhamer JM, Zammitti EP, et al. Health-risk Behaviors and Chronic Conditions Among Adults with Inflammatory Bowel Disease — United States, 2015 and 2016. MMWR Morb Mortal Wkly Rep. 2018;67(6):190‒195. DOI:http://dx.doi.org/10.15585/mmwr.mm6706a4