Ross, I read through your response.
I think you took my response as not taking your dietary changes seriously, but that wasn't my intent.
My response was more directed to people like Grace about the structural issues that can cause "blockages," etc., since she'd mentioned that issue. Not so much what food to eat, but HOW to eat it. And while you have FAP and pouchitis, the percentage of UC patients who get it vs. FAP patients heavily hits the UC group. It's not that FAP patients can't get it, but it's way more rare.
As for vitamin absorption, some J pouch patients don't have issues absorbing them, some do. It's random... but I theorize that some of us have a longer small bowel than others, and perhaps that's why some of us absorb better, or maybe even have less issues with things like incontinence... stands to reason. I read one patient say their doc said they had a "long" small bowel, and they did about like I did post op (very little issues). It's a possibility, though I don't have any conclusive evidence for that.
It IS true that anal exit area where pouch is connected to cuff IS less pliable than prior to surgery after ileoanal anastomosis, and it's also prone to strictures. And it is true that the J pouch mucosa will change to more colonic tissue, which leads me to believe that more water absorption is happening over time. Again, the GI mentioned the changes are seen in OLD pouches (20, 30 years along). I've had my pouch, come January 10 of next year, for 24 years. I fit that category. And I sometimes have that issue, and need to "loosen things up" like Grace does.
That's why I mentioned being *careful* with foods that don't break down, like for me, I used to be able to eat apples no problem, but NOW, with my lower issues from time to time, a raw apple can get blocked up in there at the exit, because it comes out looking LIKE apple if I don't chew it well. A few weeks ago I made Brussels sprouts, and roasted them. I had a devil of a time getting out all of that fiber, and even had to flush it out with an enema: had I steamed the sprouts, or eaten 3-4 of them roasted rather than a huge plate of them, I might have been ok. Sometimes for me, it's moderation or a few bites are ok, but eating with abandon is not.
I absolutely agree with the sugars issues we have in the world, and I agree that fats are not the issue. That's why I've never restricted fats, but I HAVE instinctively over the years, restricted carbs/sugars. In the early 90's, my hubby and I were balancing our eating doing 40/30/30 which focuses on balancing your GOOD carbs (low sugar/glycemic carbs, no refined carbs) to good percentages of fats and proteins. That's how we ate forever. So yes, I'm not arguing your dietary changes. In fact, I AGREE with them. I've done full FODMAP, too, and found some of my triggers by doing that. In fact, apples can be one of them for me!
Yes, no two people are the same. But nature intended us to have our colons, and we don't. I meant "NORMAL" like that: with the plumbing you're meant to have biologically, the STRUCTURAL normal. Also, now they are finding so many reasons we really NEED a colon, with all the new stuff they're finding out about good bacteria, etc.; our large bowels are truly more important than they thought, in regards to our immune systems. They're not the "throw away" organ from the days of my surgery, anymore. My daughter's pediatric GI docs have said that is one reason they really try VERY hard to get kids in remission rather than rush to surgery: to keep that large intestine. Obviously if they can't get to remission and they need it, they still revert to surgery, but they recommend surgery at way lower rates these days, and when they DO recommend surgery, they counsel patients a lot.
Back when I had my surgery, they called it a "cure." NOW my GI says he tells everyone he counsels about to have this surgery that it's not a cure, and that half of the people who have the surgery will have SOME sort of issue down the line, be it a bout of mild pouchitis, or something worse. The resources out there now to help people after our surgery are HUGE compared to what I had when I had my surgery in 1991... and I think it will continue to get better over time. I truly talked to one person who had the surgery before I went in for mine, and after surgery, met a group of about 4 and connected with them for a year. But I didn't have to seek help, as I had truthfully a very easy course post op and for the 20+ years after. Maybe eventually dietary counseling will be taken more seriously, too. There is a place for it.