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Hi All,

I see in many posts, particularly on pouchitis, that people recommend a low carb/sugar diet. (I’m currently being treated empirically for pouchitis with abx before an upcoming scope). Could you elaborate on this? Are you talking simple or complex carbohydrates? Do you avoid fresh fruit and high-starch veggies? What about grainy bread? Avoiding things with added sugar seems easy/obvious (including for general health) but we all need carbs in our diet so wondering about specifics.


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The most reliable advice I've seen is for a very low carb diet. It doesn't grant special status to "healthy," "complex," or otherwise charismatic carbs. Some people report good results if they are patient with it, but I didn't experience any benefit. I'm not sure we all "need" carbs in our diet, but complex carbs probably do most of us some good, and carbs from fiber clearly have benefits.

We absolutely all need carbs in our diets. Glucose is the first and most efficiently utilized source of energy in our body. You can cut out carbs and force your body into fat metabolism (the basis for Atkins diets, etc) but utilizing ketone bodies as an energy source comes with its own costs. Protein will be the last energy source for obvious reasons (you need muscle to do things like sustain your heart beat! With those ketogenic diets you need to eat a lot more fat which increases LDL levels as well as the fact that your liver is in overdrive producing ketone bodies. Also you’re not getting any nutrients from fruits/veg/grains. Not eating carbs is effectively forcing yourself into the state of a diabetic with total insulin resistance and the inability to use glucose as an energy source. Diabetic ketoacidosis is ugly.

So, there must be some approach to a “lower carb diet” that people are following with preferential sources of carbs.  

I’m not particularly recommending a very low carb diet, but that’s the dietary intervention that seems to sometimes keep pouchitis at bay. It’s not really the same as diabetic ketoacidosis (it’s just ketosis), but you shouldn’t do it if it seems like a bad idea to you. Making special exceptions for favored carbs is unlikely to achieve the intended result.

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