NEW LOFFLEX Diet & Diary Booklet 2013-FINAL VERSION
LOFFLEX DIETLow.Fat.Fibre.Limited.Exclusion.Dietfor Crohn’s disease
Patient detailsLOFFLEX Diet for Crohn’s DiseaseWhat is Crohn’s Disease?Name:.Date:.Crohn’s disease is a type of inflammatory bowel disease (IBD). It can affect any part of the gutbut most commonly affects the small and large bowel. Crohn’s disease tends to go throughperiods of remission with minimal symptoms, and active phases when symptoms flare. Whenthe bowels become inflamed, common symptoms experienced are pain, wind, bloating andloose stools.Dietitian:.How can Crohn’s Disease be treated with diet?Contact:.Dietary treatment of active Crohn’s disease usually starts with a prescribed course of a liquiddiet (enteral nutrition) to induce remission. Once remission has been achieved, foods can bereintroduced following the LOFFLEX diet.What is the LOFFLEX diet?There are two stages to the LOFFLEX diet:1. Basic LOFFLEX diet2. Reintroduction stageContentsWhat is Crohn’s Disease?.3Stage 1: Basic LOFFLEX Diet. 4What might a typical daily menu look like?.101. Basic LOFFLEX dietLOFFLEX stands for Low Fat, Fibre Limited Exclusion. It consists of foods that are least likelyto cause symptoms of Crohn’s disease, as identified through research.1 It is low in fat and fibreand excludes specific foods that some people with Crohn’s disease have identified to triggersymptoms. It is recommended that you follow the basic LOFFLEX diet for at least two weeks.You may need to continue this for longer, depending on your symptoms. Your Dietitian willmonitor your progress on the diet and advise you when to proceed to the reintroduction stage2. Reintroduction stageDuring this stage, foods that may be more likely to trigger symptoms are reintroduced one at atime. It will take a few months to complete the reintroduction stage. The aim is to establish a ‘safediet’ which consists only of those foods that have not caused symptoms on reintroduction.What are the benefits of following a LOFFLEX diet?Food & Symptom Diary. 12Stage 2: Reintroduction Stage. 15The LOFFLEX diet helps in the transition from a liquid diet (enteral nutrition) to a ‘safe diet’.Reintroducing foods gradually, makes it possible to identify any foods that might triggersymptoms. There is some evidence to suggest that a LOFFLEX diet may help to maintainremission of Crohn’s disease.1Reintroduction Diary. 19References1. Woolner, J.T., Parker, T.J, Kirby, G.A. & Hunter, J.O., 1998. The development and evaluation of a diet formaintaining remission in Crohn’s disease. JHND., 11: 1-11.3
Stage 1: Basic LOFFLEX DietFood groupUnsuitable foodsSuitable foodsWhen should I start the basic LOFFLEX diet?Cooking methodsHigh fat cooking methods e.g.deep-fat frying, roasting, fryingwith large quantities of fatLow fat cooking methodse.g. baking, steaming, grilling,poaching, stir-frying, dry-roasting,frying with low calorie spray oilsCooking oilsCorn oilNut oilsSunflower, soya, olive,rapeseed oilsMeat and poultryPork and pork products e.g. ham,bacon, pigs liverChicken, turkey, game, duck,ostrichBeef, lambYou should start the basic LOFFLEX diet in consultation with your Dietitian when your symptomshave settled following a period of time on a liquid diet (enteral nutrition).Which foods can I eat on the basic LOFFLEX diet?The following tables detail which foods and cooking methods are suitable and unsuitable on thebasic LOFFLEX diet.For the first few days, it is advisable to eat only a few plain foods with minimal fat and fibrecontent e.g.: Rice, rice cakes, puffed rice cerealProcessed meat products e.g.sausages, beefburgers, meat pies,pâté, meat paste, ready meals Rice milk or soya milk (with added calcium)‘Ready’ meals Small amount of milk free margarine and/or suitable oil Plain chicken or turkey (baked, steamed, poached) White fish (baked, steamed, poached) Potato (baked, boiled without skins) Herbal or fruit teasLiver, kidneyRemove visible fat and skin.Choose lean cutsPre-packaged, cooked meats andpoultry as above(check ingredients)Meat alternativesSoya products e.g. tofu, burger,sausage, minceNoneQuorn and quorn productsIf you follow a vegetarian diet, youmay need to include these (discusswith your Dietitian)To begin with, it may be helpful to introduce food as four to five small meals or snacks spreadover the day.FishTinned fish in oil or tomatoTinned fish in water or brineFish in batter or breadcrumbsWhite fishIf, after a few days your symptoms remain settled you can start to introduce other foods listed assuitable on the basic diet. Gradually increase the size of your portions, aiming to eat three mealsper day with snacks in between.Fish paste, taramasalataSeafood & shellfishScampiSmoked fishProcessed fish productsIt is best not to rush your meals; take time to chew food well. This will help your gut to digestthe food.‘Ready’ mealsOily fish e.g. mackerel, salmon,sardines, trout(1 portion of oily fish per week isrecommended for healthy eating– you may wish to discuss thisfurther with your Dietitian)It is important to check the ingredients lists on the food labels of packaged food and drinks asthey may contain other ingredients that are not suitable on the diet. As a general guide, choosefresh products where possible as packaged or processed products are more likely to containunsuitable ingredients. For example pre-packaged cooked chicken often contains wheat or cow’smilk derivatives, soya milk may contain apple juice.Milk & Dairyalternatives,EggsCow’s, sheep’s & goat’s milkincluding fresh, dried, tinned,evaporated, condensedReady made milkshakes &yoghurt drinksProbiotic and prebiotic drinks& yoghurtsMilk alternatives(choose calcium enriched types)Soya milk (not with apple juice)Rice milkHemp milkCoconut milk(fresh milk substitute)Low fat tinned coconut milk(small quantities – discusswith your Dietitian)45
Food groupUnsuitable foodsSuitable foodsFood groupUnsuitable foodsSuitable foodsMilk & Dairyalternatives,EggsOat milkMilk or dairy free spreadNut milks e.g. almond, hazelnutSoya milk productsVegetables& PulsesPeas – garden peas, chickpeas,marrowfat peasAll other vegetables includingsaladTinned coconut milk (full fat)(check ingredients e.g. notcontaining corn, cocoa)Pulse beans e.g. kidney beans,baked beansLentilsOnionParsnipsSweetcornTomatoRemove skins, seeds and stalksAppleBananaCitrus fruit e.g. orange, satsuma,tangerine, clementines, mandarins,grapefruit, lemon, limeAll other fresh, tinned or cookedfruits and their juices.Cow’s, sheep’s & goat’s milkproducts e.g. butter, margarine,spreads, cheese, cream, yoghurt,ice cream, custard, mousses, foolsSoya cheese containing yeast,corn/maizeBreads, flours,cereals & grainsSoya spreads, yoghurts,desserts, custardSmall quantities of the following –discuss with your Dietitian:Eggs, egg custardSoya cream, ice cream & cheese(check ingredients for corn/maize& yeast)Wheat, rye, barley, corn/maize,oatsRice and rice products(choose white products preferably)All products made from thesegrains including flours, breads,biscuits, cakes, crackers, savourysnacks, breakfast cereals, porridge,cereal bars, pasta, noodles, pizzabases, semolina, custard powderWhite riceRice pasta (corn-free)Rice noodles (plain)Rice cakes (plain or salted)Ground riceRice flourPuffed rice cereal(barley malt extract is suitableas an ingredient – discuss withyour Dietitian)‘Free from’ & gluten free/ wheatfree products e.g. bread, flour,cakes, biscuits, pasta, pizza bases,crackers, breakfast cerealsBuckwheat flakes, flour, pastaGram flourMillet flour, flakesQuinoaSoya flourSpelt flourCarob flourFruitDried fruitBerries & currants (juices suitable)DrinksBlack tea and coffee (caffeinated)Green teaCitrus (lemon, lime, orange,grapefruit), apple, banana andtomato juices, squashes, cordials,fruit teas & fizzy drinksColaArrowrootTapioca / cassavaSagoXanthan gumBarley fruit squashesWine, cider, beer, lager, ale,Alcoholic spirits/ drinks(discuss with your Dietitian)Savoury rice packetsRice cakes or snacks withflavouring or corn/maizePotato skinsChips (‘full fat’)Potato crisps (‘full fat’)Vegetable or sweet potato crispsMashed potato with suitable milk(see above) and small amount ofmilk or dairy free spread and/orsoya creamSweet potato (without skins)6Smoothies of suitable fruits(check ingredients)Aim to eat a combined total of fiveportions of fruits and vegetablesper day (see portion guide)Decaffeinated tea & coffeeHerbal teas e.g. rooibos,peppermint, rosehip, camomileFruit teas of suitable fruits(check ingredients for apple, citrus)Still water – tap, bottledFizzy/carbonated water, tonicwater, soda water(discuss with your Dietitian)Fruits cordials, squashes, coconutwaters and, flavoured waters ofsuitable fruits (check ingredients &discuss with your Dietitian)Fruit juices of suitable fruits(one glass of fruit juice can becounted as one portion of your fivefruits & vegetables per day)Potato – baked, boiled, dry roastedwithout skinsLow fat oven chips and potatocrisps (check ingredients)Remove skins, seeds and pipsStewed, cooked or tinned fruit maybe better toleratedProcessed noodles e.g. potnoodles, super noodlesPotato andPotato productsAim to eat a combined total of fiveportions of fruits and vegetablesper day (see portion guide)MiscellaneousMarmalade, citrus jamsLemon curdJams of suitable fruits, honey,syrup, treacleYeast & yeast extractMeat extractsTrace ingredients of citrus& citric acidSugarJelly(without apple or citrus pieces)Sorbets (check ingredients)Nuts (all types)Peanut butterSeeds7
Food groupUnsuitable foodsSuitable foodsMiscellaneousMustardSalad cream and dressingsSoy sauceTomato products e.g. ketchup,puree, sauce, passata,pasta saucesReady mixed jar & packet saucese.g. pasta sauces, curry sauces,sauces for meat/ fish/ poultryGravy mixesWorcester sauceChilli sauceSalt, black pepperHerbsSpices in moderationVinegar (all types)Chocolate, cocoa powderMost confectionary(check ingredients)Carob confectionarySugar free sweets, mints(discuss with your Dietitian)Chewing/bubblegum(discuss with your Dietitian)Home made gravy(see recipe booklet)The following sauces are likely tobe suitable (check ingredients):Miso (fermented rice or soya bean,avoid fermented barley)Mirin (Japanese flavouring)Fish sauceTabasco sauceMango chutneyTamari (wheat free soy sauce)Carob flour in small quantities(discuss with your Dietitian)Kendal mint cakeClear boiled sweets & mints(check ingredients)How much is one portion of fruit or vegetables?Suitable portion sizes of fruits and vegetables are shown below.Please refer to the fruit and vegetable sections in the table above to check which types aresuitable on the basic diet. Note that unsuitable fruits and vegetables are included here also forthe purpose of the reintroduction stage.FruitsVegetables1 medium sized fruit e.g. apple, banana,orange, pear, peach3 heaped tablespoons raw, cooked,frozen or tinned vegetables1/2grapefruit1 dessert bowl mixed salad(lettuce, tomato, cucumber)1 slice large fruit e.g. melon, pineapple3 heaped tablespoons of pulse beans(can be counted ONCE a day as one portion)2 plums, kiwis, clementines or similarsized fruit1 medium tomato or handful of cherrytomatoesHandful of grapes, cherries, berries3 heaped tablespoons fruit salad, stewedfruit, tinned fruit1 heaped tablespoon (25g) dried fruit e.g.raisins, figs, apricotOne small glass (150mls) of fruit juice(can be counted ONCE a day as oneportion of fruit)89
What might a typical daily menu look like?FoodBreakfastChoose from a selection of:- Puffed rice cereal with milk alternative and sugar/honey- Rice cakes, milk-free margarine and jam/honey- Lean meat/ poultry/ fish cooked using low fat cooking methods- Potato cakes (see recipe booklet)- Soya yogurt/dessert with fruit- Fruit juice- Herbal/ fruit teaMid morning snackChoose from the list of snacks belowDo I need to keep a food and symptom diary?Yes. For the duration of the LOFFLEX diet it is helpful to record the types and quantities ofeverything you eat and drink and the symptoms you experience, including times of the day. Anexample food and symptom diary is shown below. It is helpful to include brand names of foodproducts and approximate portion sizes.Please bring your diary with you to appointments with your Dietitian. Your Dietitian will be ableto use this to help determine which foods might be triggering your symptoms and to assess yournutrient intake.FoodBreakfastSymptoms8.00 amMedium bowl puffed rice cereal 2 tsp sugar 1/4 pint rice milkLunchLean meat/ poultry/ fish cooked using low fat cooking methodsBoiled white rice/ rice pasta/ potato/ rice cakes with milkfree spreadVegetables / salad (see recipe booklet for meal ideas)Soya yoghurt/dessert or sorbet2 rice cakes thin spread milk-free marg 1 tsp jam on eachSmall glass cranberry juiceMid morningMid afternoon snack125mls soya yoghurt (added calcium)Choose from the list of snacks belowSmall mug herbal teaEvening mealLunchLean meat/ poultry/ fish cooked using low fat cooking methodsBoiled white rice/ rice pasta/ potato/ rice cakes with milkfree spreadVegetables / salad (see recipe booklet for meal ideas)Soya yoghurt/dessert or sorbet with fruitGrilled chicken breast, 3 tbsps boiled rice,handful green beansEvening snackHomemade peach soya milkshake(200mls soya milk 1/2 tin peaches in syrup)Choose from the list of snacks below11.00 amLoose bowel motion10.30 am1 medium pear (no skin)1.00 pmLarge glass blackcurrant cordialMid afternoon3.00 pm4.00 pmStomach pain & bloatingSmall bag low fat crispsSnacksRice cakes with milk-free spread margarine and jam/syrup/ honeyHomemade cakes or biscuits (see recipe booklet)Soya yoghurt or dessertLow fat crisps (check ingredients)FruitHomemade soya milk shake (see recipe booklet)Please refer to the LOFFLEX recipe booklet for recipe ideas.10Evening meal6.00 pm1 average piece grilled haddock 4 boiled potatoes carrots (3 tablespoons)1 vanilla soya dessert pot (125g)Bedtime snack8.30 pm2 homemade crispy rice cakes (made using recipe booklet)200ml glass of rice milk11
Date:.What if my symptoms return on the basic LOFFLEX diet?FoodSymptomsBreakfast:Time:Mid morning:Time:Lunch:Time:Mid afternoon:Time:Evening meal:Time:Bedtime snack:Time:If your symptoms return on the basic diet, it is possible that one or more foods you are eatingmay be triggering your symptoms. Using your food and symptom diary, your Dietitian will helpyou to identify these foods, which should then be excluded.When should I stop taking the liquid diet?If you followed a liquid diet (enteral nutrition) before starting the LOFFLEX diet, your Dietitanmay recommend that you continue taking some of these drinks during the early stages of theLOFFLEX diet. These will help to ensure you get all the nutrients you need for health and help tomaintain your weight. It is likely that you will only need to continue these for a temporary periodof time until you have reintroduced enough foods in to your diet. Your Dietitian will advise youwhen to stop taking these.How much fluid should I drink?It is advisable to drink plenty of fluids while following the LOFFLEX diet to maintain goodhydration. Aim to drink 8-10 glasses (approx. 2 litres) of suitable drinks daily.What should I do if I find I am losing weight?It can be difficult to maintain your weight while following the LOFFLEX diet as the food choicesare more limited and because it is low in fat. If you find that you are losing weight, it is importantthat you contact your Dietitian. Your Dietitian will advise you on suitable changes to your diet ornutritional supplements to help maintain your weight.What should I do if I eat an unsuitable food?Do not panic. Return to eating only suitable foods as soon as possible. It may take a few days foryour symptoms to settle if they have flared up.Food & Symptom DiaryIt is recommended that you keep a record of foods consumed and symptoms experienced tohelp you know which foods may be an issue and which will need retesting. An example is set outfor you here. These diary pages can be found online for printing.If you are a healthcare professional please visit www.elemental028.com to access the pages.If you are a patient/carer, please visit www.crohns.org.uk1213
Local health food shops / additional informationStage 2: Reintroduction Stage.When can I start the reintroduction stage?.You can start the reintroduction stage in discussion with your D
tangerine, clementines, mandarins, grapefruit, lemon, lime Dried fruit Berries & currants (juices suitable) All other fresh, tinned or cooked fruits and their juices. Remove skins, seeds and pips Smoothies of suitable fruits (check ingredients) Aim to eat a combined total of five port
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