Dieting & Crohn's: Small Changes Pave the Way to Your Weight Loss Goal

Now there are good four-letter words - try food for one - and bad ones.

Ever since I was an overweight child who suffered the symptoms of Crohn's disease but was undiagnosed, diet fell into the bad pile. Years of Prednisone and other steroids didn't do a thing but pack on the pounds.

Approaching a monumental birthday last year, I assessed who I was: an overweight Crohn's patient with torn cartilage in both knees and high blood pressure. It was time for a change. I can't say I got revved up and excited about losing weight. After all, in the prior 34 years, I had joined the same weight-loss organization 20 times.

As a result of three small-bowel resections, I have a shortened small bowel that makes it necessary me to be extra-vigilant about what I put into my mouth. Medications can control to some degree the extra diarrhea resulting from short-bowel syndrome. But avoiding the big four categories - caffeine, alcohol, tobacco and sugar - can also help reduce the number of treks to the bathroom each day.

Another problem for many patients suffering from inflammatory bowel disease (IBD) in the small intestine is absorption. While many weight-loss programs . . . um, diets . . . are based on specific caloric values or grams of intake, how much of what we eat is actually absorbed remains a mystery.

In order to finally succeed and lose 55 pounds, I had to do things a bit differently from the norm. Here's a rundown:

Let your doctor know. Step number one should be telling your doctor you want to lose weight and asking for any input. If you don't have a goal weight in mind, ask him or her to suggest one. Make sure that by the time you leave the office, you know exactly which things you should't put into your mouth due to Crohn's restrictions or any that should be limited based on your judgment on any given day. Your primary objective is finding a safe way to lose weight.

Consult with a nutritionist. If you have health insurance, check the fine print. Many now pay for visits to nutritionists who have a contract with the insurer. An initial visit in which you explain your restrictions should yield some positive and creative suggestions for meals.

Make water #1. Not only does it fill you up, it also does a great job of dispersing many of the medications Crohn's patients take. Make sure to drink at least six eight-ounce glasses a day. You can substitute caffeine-free drinks for two of them, but make sure you're not sensitive to the artificial sweeteners in these products.

Avoid diet pills. Think of them as questionable quick fixes. They might or might not be safe when considering other medications you take and the state of your gut.

Give up envy. It's hard to sit in a room with 60 other people losing weight and listen to them complain about only being able to have a large versus a gigantic salad when you can't have any fresh fruits and vegetables. It's time to give up the F word: F-A-I-R. Everyone has problems. What you need instead of envy is realistic expectations.

Think beyond weekly numbers. Some weeks, the scale will show a lower number. Even if you do everything right, the next week, you might weigh more but have fewer inches on your hips. For a Crohn's patient, the journey will probably have more fluctuation than for other dieters, especially if you end up for a short time on steroids to quell the inflammation. After about six weeks, I finally learned that it was far more important to make a series of small changes and stick to them than it was to run up some impressive numbers at the scale. Numbers come and go, but habits stay.

Move more. You will not find me in the gym due to the state of my knees. If Crohn's puts regular exercise out of the picture, you can still move more. Park a few rows farther from your office. Lift some cans of vegetables while watching TV. Even housework counts.

Respect the drugs. When you make medication shifts, it can affect your weight. I was thrilled to dump one of the two blood pressure medications I had taken for years after I had lost 35 pounds. However, the week I stopped taking the diuretic, my weight shot up three pounds. You need to respect what the drugs can do to fight the disease and go with the flow as far as temporary weight setbacks.

Write down what you eat. That's everything. Keep it in a looseleaf or spiral notebook. If you had a bad day, write it down, then end the day. Keeping a record of what you ate when and how much can also be helpful to your gastroenterologist.

Forgive yourself. You didn't do anything to cause this wretched disease. And like every other human being on earth, you're not perfect. When the scale doesn't move or you eat one bagel too many, learn from the experience and just close the book on one imperfect day.