This short paper is to give you information and general advice on how to follow a low-fibre diet. For recipe ideas, also look at my new, work-in-progress page, Easy and Delicious Low-Fibre Diet Recipes. But please read this page first. Visit your nearest Maggies Cancer Caring Centre, or click on their website/on-line community, for personal support. This article is based on clinical and patient-derived information, but be aware that a low-fibre diet can be quite variable from person to person and situation to situation. Take into account your own intolerances, likes and clinical advice.
It is well-known that a diet high in dietary fibre is a healthy one, helping to prevent colorectal and breast cancers, Type 2 diabetes, diverticulitis, cardiovascular disease, varicose veins – among other illnesses. However, for some people it is necessary to at least temporarily curtail their intake of fibre in order to rest the bowel and/or intestines.
What is a low-fibre diet? Simply put a low-fibre diet decreases painful gut irritation by reducing the amount of insoluble fibre/undigested food that passes through your system. This restrictive and short-term diet is designed to ease discomfort and allow tissue healing. A low-residue diet is similar but slightly more restrictive; differences are noted below.
Who needs a low-fibre diet? You may have been put on a low-fibre diet because of a risk of bowel blockage or to recover from digestive tract surgery. Or you may be having treatment-related diarrhoea, or difficulties in digesting your normal diet. Flare-ups in inflammatory bowel disease (IBD), diverticulitis, Crohn’s disease or ulcerative colitis may also require a temporary low-fibre diet, too. Eating less fibre can help with the bloating, wind, cramping, pain and fullness associated with these situations. Below are general guidelines only: follow the advice of your doctor if it differs from what you read here. If you have been told to follow a low-fibre diet but haven’t been told how to do this, discuss these guidance notes with your doctor.
The following information also applies if you are to follow a low-residue diet, except that you will be avoiding all caffeine (tea, coffee, chocolate, energy drinks) and most likely all dairy products too – these are all gut-stimulants. Those needing to follow a low-residue or a liquid diet should seek professional advice.
•Eat little and often; this helps with discomfort. Aim for three small but calorific meals and 2-3 snacks or nourishing drinks (milkshakes, fortified milk) meals a day. OR any permutation of this ideal. Some people find it easiest to eat a little something every two hours rather than think in terms of meals as such. Whatever suits you and keeps you comfortable and nourished is good.
* Digestion starts in the mouth so make sure and chew your food well before swallowing. This can really help with symptoms of bloating and discomfort, as can eating more slowly. After you finish eating resist the temptation to rush to the kitchen and wash up – relax for a bit to allow the body to concentrate on the initial stages of digestion.
•Have no more than 10 grams of fibre per day (and not all at once!), or as advised by your treatment team. Some people may be able to have more, but 10 grams is often a benchmark number that doctors use. Here is an excellent website with a chart of some commonly eaten foods and the number of grams per serving they contain. Please do look at this.
•Try to drink as much as you can without filling yourself up, choosing ‘food’ drinks such as clear fruit and vegetable juices rather than just water. Drinking is very important to prevent constipation. Making your own clear and strained juice from combinations of peeled fruits and vegetables will maximise your nutrient intake during this restricted diet, but commercially produced clear juices are a good second option. If you are losing weight, drink your calories – milkshakes and prescription fibre-free supplement drinks.
•Choose a variety of foods from the low-fibre list. Grazing from this list will keep things from getting boring and will give a fair spread of nutrients. I am planning an ebook of suitable recipes. But in the meantime please have a look at Easy and Delicious Low-Fibre Recipes. I am gradually adding more (started the page on 26 April 2012) so please keep checking back for more tasty and family-friendly low-fibre recipes. If you have any that you would like to share, a suggestion for a recipe that you would like me to ‘doctor’, or if you have anything to say about the recipes, please leave a comment: I appreciate comments and always reply.
•If you are advised to follow a restricted diet for more than five days ask your treatment team about multivitamin/mineral supplements. You are at risk of not getting enough of the water-soluble vitamins like Vitamin C (cooking destroys them) if this diet is followed long term.
•Steer clear of foods that worsen your symptoms. Everyone’s situation is different and some of the foods on the list may be difficult for you – you know best.
•With your team’s approval, and as your symptoms improve, gradually increase the amount of ‘approved’ fruits and vegetables from 2 servings. As these are tolerated, add small quantities of other foods into your diet, but stay away from high fibre foods for now. Keep a note of what you introduce and how you react to them. If a food doesn’t ‘work’ try it again some other time. Many people find that keeping a food diary helps them keep track of food and symptoms. This can also be very useful to show your treatment team or GP.
* Your appetite will probably fluctuate but do try and keep eating regularly. Regular eating helps with appetite and bowel function.
* Capitalise on eating when you are hungry, not when you think you should eat. With that in mind, don’t worry about eating at the ‘wrong times’ or eating meals out of sequence: if you fancy having a bowl of Rice Krispies at 2 a.m., just do it. Have quick snack and easily heated meals available for any time that hunger strikes.
* Make efforts to enjoy your food: nice presentation, pleasant eating environment, a stress-free atmosphere – all of these things will help with appetite and digestion.
•If your symptoms rapidly worsen, despite the restrictions, SEE YOUR DOCTOR IMMEDIATELY.
FOOD TO INCLUDE/AVOID ON A LOW-FIBRE DIET
o All fruits and vegetables should be peeled, deseeded and membrane-free
o Vegetables should be well-cooked (except as listed below)
o Limit fruits and vegetables as indicated below, or as advised by your treatment team;
o A serving is roughly 80 grams
Vegetables – 1-2 servings per day + peeled, mashed potato (if liked); all skin and seeds removed. Those with recent bowel obstructions may not be allowed vegetables.
Okay raw or cooked: lettuces; de-seeded and peeled cucumber, courgettes/zucchini and tomatoes
To be well-cooked or tinned/canned: asparagus, aubergine, beetroot, carrot, celery, tinned green beans, leek, lettuce, mushrooms, (bell) peppers/capsicums, white potato, pumpkin, radish, spinach, squashes, swede, tinned wax beans
Caution OR have very small amounts (these are very individual foods, tolerated well by some people and not others): other fine, green, French and runner beans; cabbage; cauliflower; onions (check with your doctor on this one); mangetout/snowpeas; parsnips; sweet potatoes (not yams)
Fruits – 1-2 servings per day; all seedless, skinless and membranes removed. Those with recent bowel obstructions may not be allowed fruit.
Okay raw or cooked: very soft ripe apricots and peaches; ripe melon; ripe banana (1/2 small); very soft avocado (1/4 piece)
Well-cooked, poached or tinned/canned: applesauce/stewed apples/pears; tinned cherries; tinned lychees, mango (Pakistani and Alphonse are least fibrous), pineapple (the latter not a low-residue diet); poached/tinned rhubarb; tinned skinless fruit cocktail
Fruit and vegetable juices (clear/pulp-free/strained): apple, orange, grape, grapefruit, cranberry; tomato, carrot & vegetable based juices
Bread: all white (refined) and seed-/nut-free breads – white loaf, plain bagel, soft pretzels, matzoh, melba toast, zwieback toast, waffles, French toast (‘eggy bread’), white English muffins and crumpets; white flour tortillas, naan, chapattis, roti, lavash and pitta. Some other breads may be suitable but read the label – flours made from/with legumes are unsuitable.
Cereals: any cereal less than 1 g of fibre per serving, e.g. cornflakes, puffed wheat, Rice Krispies, Special K, Cheerios.
Pasta and Rice: white rice, plain white pasta, noodles, macaroni, orzo.
Meat, Fish and Other Proteins: well-cooked, ground/minced beef, turkey, pork, chicken; cooked eggs; fish and seafood; tofu and tempeh; smooth peanut butter (up to 2 tablespoons per day). Tip – use moist heat to cook proteins; avoid grilling or roasting as it can make food crispy or tough. Avoid: Nuts, crunchy peanut butter, seeds, legumes and pulses (e.g. chickpeas, baked beans, lentils)
Dairy and Dairy Substitutes: up to 480 ml/2 cups of any milk, plain yogurt (add unseeded jam for fruity taste) and yogurt/kefir drinks; mild cheese. Most dairy is fine unless it has ‘bits’ in it. Usual precautions for live/probiotic dairy products if on chemotherapy. Low-residue: avoid dairy but non-dairy is fine, e.g. soy or rice milk (check fibre per serving on non-dairy milks and products).
Fats, Oils, Sauces, Gravies and Dressings: all allowed except spicy dressing and sauces. Low-residue: avoid dairy but non-dairy is fine.
Snacks and Desserts: ‘white’ crackers, ginger snaps/biscuits, plain biscuits and cookies such as vanilla wafers, arrowroot biscuits and ‘rich tea’ biscuits; pancakes and waffles made with refined flour; smooth puddings such as Jello® brand or Alpro® soya; jellies/Jello ®; approved supplement drinks; rice puddings; ice cream and sherbet (not low-residue), sorbets and ices (with no fruit pieces)
Soups: broth and strained soups from allowed foods (add milk, cream or silken tofu to give ‘body’ and protein); cream soups (aim for no more than 1 g of fibre per serving); noodle and rice soups (ditto). Avoid any beans, whole grains, corn or peas.
Drinks: clear fruit and vegetable juices (freshly pressed and sieved will add nutrients to the body – see “Juicilious recipes’); squashes and cordials; milk and non-dairy milk (check fibre on label); approved supplement drinks (not Fortisip Multi-fibre or any fibre-containing drinks). Tea and coffee are usually fine, but not on a low-residue diet.
Cooking Tips: Make sure all cooked foods are soft and easy to chew. Best cooking methods are those that keep moisture in the food – poaching, braising, stewing, microwaving, boiling and steaming. Roasted, broiled and grilled foods take moisture away from food, making it tough. Fried foods can cause stomach upset and cramping in many people so it is often best to use a moist method and add oil at the end of the cooking time. This may be necessary to ensure enough calories in the day.
Menu Planning: Eating little and often is recommended, perhaps three main meals (but small ones to aid digestions) and two to three snacks. Juicing (not smoothies) of fruit and vegetables is encouraged to help add nutrients that are missing from eating so little whole fruit and vegetables.
FOODS TO AVOID ON A LOW-FIBRE DIET
Whole grain breads, pasta, grains, rice, noodles and anything made with these; herbs (even chopped ones); strong cheeses; yogurt with fruit skin or seeds; most raw vegetables and fruits; tough meat/chunky meat; dried fruit and prune juice (check fibre of any juices you buy), olives, all beans, pulses, nuts, seeds and whole grains; food with whole coconut/desiccated coconut; popcorn; horseradish; cocoa powder (high in insoluble fibre), highly spiced food and dressings/sauces. You may or may not be allowed chocolate/chocolate syrup: check. Other foods may be allowed/disallowed by your doctor, so do ask.
Here are some extra resources that you may find helpful:
Addenbrooke’s Hospital NHS (London) Patient Information Sheet on Low-Fibre Diet
Continuum Health Partners (New York Hospitals) – Some Useful Foods with No Fiber
Continuum Health Partners – Fiber in Food Chart (an excellent list)
American Cancer Society – Low Fiber Foods
Kellie Anderson 2012 (updated 31 May 2012)