Ok gang. I need your take on this. Since 2001, post jpouch surgery, I've experienced pouch infection occurring about every three months and becoming more frequent lately. Flagyl and Cypro have been the go to drugs to get back on track. As with a lot of you we have tried about everything to avoid an infection and the destructive nature of antibiotics.

In January 2014 my wife suggested I try drinking lemon juice during the day to create a more alkaline system. Talk in media that an alkaline system is healthier. I was not much on board with this because juices have often not flown well.

Well, since starting this I have not had an infection going on seven months. For me this is something.

My take on this is the combination of a more alkaline system with the use of probiotics helps the probiotics to do their job down there keeping things more healthy. I just spoke with my gastro Dr about this. He just stated, "We just don't know." He was of course skeptical about my perspective.

So I'm coming here, to you, for assitance. Is this a real solution or is it just me?

So this is what I have done. I reduced sugar (acid) intake. I have not stopped sugar entirely. Each day I take my viatamins and probiotics. My probiotic preference is Jarrow. The more 'types'of bugs the betters and cheaper than VSL#3'. Yes, I tried VSL#3 in the past. Was not effective. Might be more so now. Then I juice a lemon (becomes alkaline in the system) and with a full glass of water add about 3 tablespoons. I don't like it to strong. This glass I swallow through the day. Not all at once. Simple as that.

I'm shocked and skeptical. Everything attempted before has eventually failed. But so far so good.

Would appreciate any feedback as to your results. We have medically proven things in the past. Perhaps we can do it again.

Thanks for all your input here over the years. We are reading and researching to find a better and healthier life. Jan, you are the best.
Original Post
I would suspect it was the reduction of sugar in your diet, not the change in pH, that was the main useful change for you. I am unclear how this alkaline diet thing works, since it seems like pseudoscience to me. But, since I really don't know much about it, I won't say anymore.

Pouchitis is most often NOT an infection, even though antibiotics are the treatment. Bacterial overgrowth is common and the treatment is the same. The fact that our ileocecal valve was removed with the colon means that bacteria can migrate beyond the pouch. Plus, the ileum that the pouch is made from is not designed to be in constant contact with bacteria. A good reason not to try to reduce your bowel movements too much.

Sugar has long been known to promote diarrhea and gas because of the osmotic effect and the fact that undigested carbs are acted upon by bacteria (which form gas as a byproduct). Lemon juice is fine and a good source of vitamin C. Other than that, I am skeptical.

But, whatever works for you is right and I am happy things are improved.

Jan Smiler
This somewhat explain the benefits of alkalinity vs. acidity, which really has nothing to do with treatment of bacterial overgrowth which is underlying the pouchitis situation of many:


On the issue of bacterial overgrowth, I have observed that many of the probiotic drinks on the market contain apple cider vinegar as an ingredient, which is presumably on the theory that a more acidic bowel, while possibly impacting on cell structure long term (see above article) also reduces bacterial levels.

I do not see any correlation between alkalinity or boosting alkalinity and fighting bacterial overgrowth.
Thank you Jan and CTBarrister for your response.

I'm aware and attempt to constantly learn more of the currently understood science of bacteria in the digestive tract and it's impact on a jpouch. I have always thought a more acid system was healthier than alkaline. Science is saying this is not the case. My sense is that it is more than just sugar reduction that is keeping me 'straight'.

I'm a big a skeptic when it comes to changing treatment or altering daily steps to prevention of inflammation (what we call infection) because everything I've attempted though the years has been ineffective and often expensive.

I'm aware when my system starts to shift towards needing antibiotics. I have felt that a number of times during this 7 month period. Usually once it starts it's not long before antibiotics are required. But each time it has corrected just by continuing the lemon juice and my probiotics.

I will keep posting as to my condition as months progress.

As always I am grateful for your input.
Your body will maintain a specific pH no matter what you eat, so the science really isn't there. That said, the recommended diet in the alkaline ash diet is a healthy one recommended by dietitians, just not because of any impact on pH.

When you make multiple changes there is no way to tell what is the useful change. Still, I suppose it really does not matter why this change worked for you. What matters is that your health is improved.

Jan Smiler
although I do not do this for the PH balance nor do I follow any specific diet (although I used to be rather strict on fit for life for over 20 yrs) I do make a huge jug of homemade lemonaide, with fake sugar, every night and drink throughout the day...hubby loves it and it keeps him hydrated and that makes me happy...it also keeps me drinking fluids so maybe it contributes to pouch health as well...added bonus!
I know that for good bone health it is reccomended along with various other things like kidney etc but I do it because we love it and it is habit forming...you do not have to do it as a punishment...I mix 1/4 jug of freshly squeezed lemon juice (fine, you can buy good commercial ones too) with water, chopped up fresh mint (no substitue possible) and add fake sugar or stevia and mix with ice...keep the jug in the fridge all day long...drink it with most meals and as a coctail at night (no vodka please!).
Does the trick for what I need and tastes yummy
wow this thread really interesting..cudos to the jpoucher that believes he found something that works for him...i think the proof will be in seeing if it holds..please keep us posted...i`m skeptical as well but always listening to people on site ..i hope you will post again in a few months with continued profess with ph..

best wishes it holds..
Anyone curious about acid vs alkaline should google jeri reid. I'm also skeptical but have two close friends who had colitis and claim to have been healed through a more alkaline diet.
Ok gang. Posting again and still ok. I'm at eight months without an antibiotic!

There have been several significant shifts in my pouch this last month where I felt like I was on my way to another course of antibiotics. Many of you know what this is like. These incidents I have thus far corrected by increasing my dosage of saccharomyces boulardii (probiotic) and continuing the lemon juice along with the other Jarrow product noted above.

(As a side note I have all ready been down the road of having nearly died 2012 due to CDIF. My gastro told me on exiting the hospital, "You take saccharomyces boulardii as a precaution. There are studies stating this fights against CDIF. We must be very careful with any usage of Cypro.")

Now brace yourself for a rant!

I would like to respond to comments about alkalinity. I have read the articles noted above and many others related to system alkalinity that the body naturally manages. I get that there is a PH balance that occurs varying from stomach, to small intestine to large intestine, and if we are healthy this maintains its self and life is good. For us it ends with the small intestine. But what happens when you put an aspirin or any other NSAID down there. Speaking for myself, this changes the dynamic considerably. Acid increases dramatically and can leave me sore in my gut and burned on exit. You try to manage this by eating with taking these drugs. Because of this I question the body is able to constantly maintain its PH through the digestion process. I have found that meat/proteins also increase acidity in my digestive system. So if this is happening why would it not be logical to swallow something alkaline to attempt to assist with some balance? Have we not done this for years with bicarbonate of soda?

I have done extensive study on probiotics. This I believe to be the answer to a lot of our issues with pouchitis and very likely the onset of colitis. I just don't think we know enough yet about probiotics to be effective in maintaining a healthy flora down there. And what has changed so much about our environment that we need them in the first place? I've often wondered why we have to continue to take a probiotic. Would it not make sense that once the bug is down there that it would reproduce itself? So what is making the environment destructive? This is where PH or some other mysterious event must come into play.

If there are any of you that would consider attempting a diet change to push for a less acid more alkaline environment while taking probiotics (I don't believe it has to be lemon juice) and find a change to your pouchitis frequency I would be most grateful for your comments.

I will post again in a month hopefully with continued health. Thanks for reading this draft on 'War and Peace' and your continuing open debate. Everyone take best of care.

Ok.  It is a year later and I'm posting current status on my theory related to keeping a more alkaline system.  If this had not worked I would post accordingly.  This is working.  I moved from lemon juice to using the probiotics noted and 4 tablespoons of vinegar in a glass of water which I swallow through the day, not all at once.  Antibiotic treatment has diminished from every three months to maybe once a year.  For me, there is something to this.  I know we are not all the same.  I'm hoping that I can manage pouch inflammation with increasing probiotics as needed and stay away from antibiotics.  Will post again in the months ahead.  If anyone else is experiencing a positive effect from managing acidity and use of probiotics would love to here about it.

I'm really happy to hear you're doing well on your regimen.  I  sincerley hope it continues!


I've been drinking water with a couple slices of lemon (and now lime) for ... ever.   Seriously - like, for 30 years now.  Just a habit.  I do get pouchitis from time to time, and I think that has to do with my sugar intake.  Not sure, of course, just a hunch. I also take probiotics regularly and have for probably 20 years or more.


I'm going to try vinegar, as it has other health benefits as well, from what I understand.


Thanks for posting your update.  I appreciate new ideas and thoughts.  Best of luck to you.




Thank you for your post.  I was starting to think it was just me.  I mentioned it to my gastro and he looked at me like I had lost any good sense that I had collected over the years.  (There have been a few of those years)  Good luck to you as well and wishing you the best of health.

I find this fascinating. I have vinegar practically every day for years and years (balsalmic on my salad), yet here I am with chronic pouchitis. I am hoping it resolves. Keep posting your updates though. I am definitely interested.



Hey Jan,  


Through these years you have been there responding to posts, often mine.  Thank you again for this support.  


So you also deal with chronic pouchitis.  I'm so sorry to hear this.  I was not aware you also suffer this way because I know how physically destructive this is.  Of course I will continue to post, but more importantly does this vinegar regimen assist you at all.  I should also tell you that through my pouch years I would crave vinegar and often added it to various food items.  I mentioned it to my gastro and he said it was probably my system wanting salt.  But it was not until I started the lemon juice water and moved to vinegar water (along with significant probiotic use) that I have seen a shift in pouchitis occurance.  


My thoughts are with you.


I want to note this forum is hugely important for all of us in this situation.  If resolves are found, I have no doubt it will surface here, through us, not necessarily through medical channels.  (I could tell you stories about the blank stares from numerous doctors, I counted ten, during my last hospital stay.  It was puzzling having to tell them how to treat/assist mean .  What an expensive waste that was.)  


I wish all of you all my best.


Hi guys,

I had my Jpouch since Feb/14, and since then I been dealing with a lot of issues, pouchitis constantly, big obstruction a year ago, C.Diff, etc.  My big concern now is I'm on Cipro which seem to be helping me in every episode of pouchitis, but not this time, I'm desperate because I tried to change my diet (more alkaline and less acidic food), more water intake, VSL #3 on daily basis, but nothing seem to work.  I'm emotionally, mentally and obviously physically worn out.  Even my GI doctor looks at me like "I don't know what else we can do for you". 

Please, if anybody have any suggestions, ideas, opinions, can you post them, I'm pretty desperated. Please help me! Some days I just want to give up!  I'm tired o being sick most of the time and don't be able to function anymore,

Thanks in advance!




Hi, Lauralee. There are still plenty of treatment options available to you. Despair would be premature. 

1) Print out the two articles linked to at the top of this "Pouchitis " forum, under "Need a good article about Pouchitis?" Read them if you can, and print them for your GI doctor. If he/she isn't interested, find a better GI doctor. 

2) Get tested for C. Diff. Ask if they can do the more accurate PCE test. C. Diff forms spores, so it can lurk when you think you've wiped it out. Cipro is risky when C. Diff is a possibility.

3) Try other antibiotics. Flagyl and rifaxamin are often good choices, but Tindamax, Augmentin, and others are also used.

4) Add another antibiotic to the Cipro. When Cipro stopped working for me, adding Flagyl was very effective, even though Flagyl alone had never helped. 

5) Check your VSL dose. It takes a very high dose to work for me: 4 DS packets daily. 

6) Try a very low carbohydrate diet. Eliminating nearly all sugars and starches is hard, but some people have great results.

7) Add an S. boulardi probiotic, like Florastor. This can help prevent C. Diff.

8) If all of the above fails, one of the biologics meds may fix you up.

Good luck!

Thank you so much Scott!! I appreciate your suggestions, and yes, maybe I need to combine 2 antibiotics instead of one.  

About my GI, he's a very nice guy, but he's not a colorectal issues expert, but Cleveland Clinic (FL) where I had my surgeries done, is almost 4 hours away from where I live.  My GI tries to help me, and last time he prescribed me Prevalite, did you ever hear of it? I started it last night (it comes in packets).  The other question is if you think is ok to take VSL and Florastor at the same time.  About the diet, I have to be honest to you.  I love carbs and sugar but the last couple of days I reduced substantially both on my diet, specially sugar because I know those are the worst enemies of a healthy pouch.

I will call my doctor and tell him about this other options and I'll keep you posted. Again, thank you so much for your quick response! I know in some way, we all here are on the same boat. ��

Prevalite is one of the artificially sweetened versions of cholestyramine, a bile acid sequestration resin. I tried it once without benefit. Some folks with terrible butt burn swear by it. I don't think it will do much for pouchitis, but it's worth a try. Make sure not to take any medication within several hours before or after Prevalite.

VSL and Florastor should be just fine together.

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