A diet for antibiotic (clostridium difficile) induced psudomembraneous colitis
Let me get this out right off the bat. I am not a doctor, nor a dietician, or anyone else of any authority to advise anyone on health concerns. My knowledge on this matter is strictly from first-hand experience. I feel it necessary to tell my story because I found little information available about a recovery diet for people afflicted with colitis caused by antibiotic use.
This isn’t Irritable Bowel Syndrome (IBS) or Crohn’s Disease, nor is this form of Ulcerative Colitis treatable in the same way as traditional Ulcerative Colitis because it’s not an area that’s been damaged by radiation from cancer treatments, nor is it caused by a poor diet or parasites.
Psudomembraneous Colitis is the result of a resistant “bad” bacterium that survives a massive die-off caused by an antibiotic. This intestinal flora takes over when other intestinal flora is absent in your colon and remains dormant when there’s too much competition. Many foods that are acceptable for IBS, Crohn's, or Ulcerative Colitis are not OK in this situation because, not only is the colon damaged, but there are no probiotic bacteria left to aid proper digestion. Without knowing what foods you can tolerate it’s best to avoid all potential irritants until you improve.
Clostridium Difficile (C. Diff) is a bacterium that propagates through spore production. It also releases two toxins that irritate the colon, removing the outer layer of skin, causing puss pockets, and creating a foul smelling diarrhea. Not everyone has it, but finding out that you are one of the unlucky ones is a painful and unpleasant experience indeed.
For me, this nightmare started when I went to the dentist with a tooth abscess. Aside from a case of strep throat I have rarely taken antibiotics but in this case it was necessary. I was given a prescription of Clindamycin. It wasn’t until after I had taken the entire course of antibiotic that I started having warning symptoms of stomach cramps and frequent urgent bloody diarrhea. Some people show symptoms right away and need to stop medication. Others, like me, can experience symptoms as late as six weeks after finishing the course.
Since I didn’t have health insurance at the time I went to my local Doc-in-the-Box, along with my empty prescription bottle. I explained my dilemma and asked for Metronidazole, which is the treatment for C.Diff. The doctor seemed hesitant, saying I needed expensive tests and a colonoscopy — I can’t even imagine the torment of a colonoscopy under those circumstances. Look, I have never had any problems in my life; I took the pills and now have warning symptoms. Once I made it clear that I wasn’t going to have any expensive tests or a colonoscopy and that I wasn’t going to hold him accountable for coming to the same conclusion I had already come to, the doctor seemed OK with it. He gave me a prescription for Flagl (Metronidazole) and sent me home without any dietary guidance. I went home, ate banana pancakes, and before I could even pick up my prescription, I was sitting on the toilet very ill.
After getting my prescription, I went straight to bed. I had a fever, chills and extreme fatigue. When I wasn’t in the bathroom, I was asleep. My husband offered me some eggs cooked in butter the next morning and I nearly turned green. They say one of the symptoms is that you don’t want to eat. I wanted to eat. I wanted something that wasn’t going to make me sick. I just didn’t know what that was. The Metronidazole helped me quite a bit, however, because since I didn’t know how to take care of myself I kept relapsing, which is bad because the longer you are sick the more likely you will wind up with serious damage and very resistant bacteria.
I spoke to a friend of mine whose brother had Crohn’s. She bought him a book on IBD 18 years ago. She still had the book and offered it to me. Her husband, who is an RN was home when I picked it up and we went through it. He was open about the fact that he had little experience with this problem and only had one client with the bacteria so he had limited knowledge on what to do. He told me to go on the clear diet in the book, which included black tea and orange juice. Then, go on the liquid diet which recommended milk and coffee. I politely took the book but was hesitant about the advice. My body said that it had it all wrong. Wrong, wrong, wrong!
So if my doctor doesn’t tell me what to do, and a nurse doesn’t know what to tell me, then what was I to do? I started to research the topic and found very little good advice. I learned by research, trial and painful error. I hope to save others the pain and grief I went through by telling what worked for me and what was harmful. If anything listed below doesn’t help you, then please stop doing it. Maybe you will come up with more advice to share. If you are allergic to anything on this diet I am sorry, because that is one more thing in a long list of things that you can’t eat. It’s bland, but it’s not forever. The purpose of this diet is restorative, not a lifestyle change.
Also, if you can get someone to do some shopping for you it would be a big, big help. The fatigue is so extreme as to make you immobile. Some of the items I found at Save Mart or Safeway but a few, like the probiotics, crackers, and gluten free pasta I found only at Whole Foods, which caters to specialty diets, so look there first. Don’t forget to keep a food journal.
Avoid: animal fat, lactose, refined sugars/honey, citric acid, gluten, seeds/nuts/corn/popcorn/fiber/bran/ brown rice/quinoa, cauliflower/broccoli/brussel sprouts/ cabbage/beans/peas/legumes, salt/spices,
caffeine, coffee, carbonated beverages, alcohol, inulin.
There are always exceptions to the rule and some foods do more good than harm. So if you see something contradictory listed below. there’s probably a good reason for it
First things first. Give the colon a break! My friend had a good point – the colon needs a rest. Your colon isn’t working properly. Plus, the muscles have been over-active and spasmodic. Give your colon at least a day off to reset.
Remember, I never tried this part, but if I were to get sick again here’s what I would do.
Definitely: Drink plenty of smartwater to replace lost electolytes.
Do not drink flavored electrolyte water such as Gatorade. These contain citric acid.
Pacific natural foods low salt chicken broth, a multivitamin with vitamin k and a probiotic supplement.
I went to Whole Foods to buy a probiotic gut culture. I explained my condition and told them I didn’t need the most expensive, just the best.
Possibly: Drink diluted apple juice and tea. Tea is one of those more good than harm items. The anti-oxidant, tannin, in tea is less effective in decaffeinated tea. Black tea has more tannin than green tea but green tea is lighter and has less caffeine. Try lightly brewing hot green tea and making iced tea from a black tea to dilute it sufficiently.
If you decide to take a fiber supplement, take something like citrucel without citric acid only
Avoid fiber supplements with psyllium husks, which can damage the colon and supplements with inulin, which promotes bacteria growth.
So, you’ve given your colon a break. Now what? How do you get from chicken broth to eating solid food again without relapsing? For me it was baby food, but you can fix your own vegetables if you are feeling a little more energetic. Try to keep foods as natural and bland as possible.
Transitional food stage 1: Continue with vitamins, probiotics, and water. Switch to tap water if desired when you begin to loose that constant thirst. Drink tea and broth as desired.
Gerber Second Foods. Select baby food that contains no other ingredient but water, i.e. squash and water, or sweet potatoes and water, etc.
Make your own baby food. Peel skins from vegetables. Steam them in as little water as possible to keep from loosing nutrients then puree. Sauté tomatoes until the skins peel off. Eat plain avocadoes.
Lifeway kefir yogurt smoothies. Plain yogurt is best but I can’t handle that. Make sure there is no citric acid. When selecting a yogurt, do not choose the flavors orange, lemon, lime, grapefruit, or pineapple. I suggest a brand like Lifeway that has cane juice instead of high fructose corn syrup and many active cultures. Although I don’t advise inulin, in this case it promotes the growth of the cultures in the kefir.
The next best thing. Transitional foods stage 2:
Continue supplementation and yogurt. Eat and drink from above as desired.
Fix fresh or frozen vegetables by steaming. Use as little water as possible to retain nutrients. Continue to peel skins first. Peel potatoes and bake or microwave them.
Eat plain white rice. Do not eat brown rice because the husks can damage you.
Eat eggs. If you need to use something to keep it from sticking then use cooking spray or a little vegetable oil.
Eat poached chicken with the skin peeled or poached fish. Eat tuna packed in water
Eat low salt creamy peanut butter without additives like Adams 100% natural peanut butter.
Eat gluten free crackers like Edward & Sons unsalted plain brown rice snaps
Eat gluten free pasta like Ancient Harvest quinoa.
Look for changes in your stool. I never thought I would have to examine my stool for texture, color, or smell, but it’s necessary. As things begin to appear more normal, slowly introduce items into your diet. Try to add only one item at a time if possible. Then try a small salad with a bit of oil and vinegar. If you don’t have any problems then add it to your diet and try something else that’s not too extreme. Take baby steps and ease up a bit if you have pain or notice negative changes. It may take a while but you can get back to normal. Here's to your health!