What is fibre?


Dietary fibre (also known as roughage) is the part of the plants
that cannot be easily digested. Some of it passes through the body without being absorbed.

Certain types of dietary fibre may be more difficult for your gut to breakdown. This fibre is mostly found in foods that contains skins, pips and seeds.


Who is this for?

Your dietitian may ask you to follow a low irritant lower fibre diet:

  • Before and/or after bowel surgery (temporary)
  • After the insertion of a colonic stent
  • If you have a bowel adhesion, strictures or narrowing of the colon
  • If you are at risk of a bowel obstruction/blockage
  • During an active flare up of ulcerative colitis, Crohn’s disease or diverticulitis
  • If you are suffering from diarrhoea
  • If you are experiencing excessive wind and bloating
  • If you have irritable bowel syndrome (IBS)
  • If you have a high output ileostomy/colostomy

This diet is usually tried for a 2-4 week period. If you have been
advised to do this diet for longer please request a referral to a
dietitian as your diet may not be complete in all the nutrients your body needs for health.

If this diet causes any weight loss, unwanted excessive weight gain or worsening of your symptoms, speak to your dietitian, specialist nurse or doctor.

Are you following this diet prior to having an operation/ treatment?

If yes, it is essential you have optimal nutrition to get through treatment. Ask for a dietitian referral if you feel your diet is too restrictive or you are losing weight.

When can I reintroduce foods back into my diet?

If advised by your dietitian/specialist nurse/doctor – see below for the reintroduction plan.

Should I take a laxative?

Only if advised by your nurses/doctor/dietitian. If your lower fibre diet is due to risk of a bowel obstruction (blocking), laxatives are often advised to prevent constipation.

What can I eat?

Fruit and vegetables

Aim to have 5 portions of fruit and/or vegetables every day. Always choose from the ‘foods allowed’ lists.

Fruit

Foods allowed; unlikely to cause symptoms

  • Fruit juice or smoothies (no bits)
  • Bananas
  • Melon, watermelon, papaya
  • Small amounts of fruit with the skins removed e.g. peeled apples, pears, peaches, plums, nectarines, apricots
  • Puréed, stewed or cooked fruit, (without skins, pips or stones)
  • Tinned fruit (not pineapple or cherries)
  • Fruit sauces and coulis with pips removed e.g. sieved raspberry coulis, apple sauce

Foods to avoid; may aggravate symptoms

  • Fruit juice or smoothies with bits
  • Fruits with skins on e.g. grapes, cherries, blueberries
  • Citrus fruit
  • Coconut
  • Pineapple
  • Rhubarb
  • Berries and fruits with seeds e.g. strawberries, raspberries, blackberries, kiwi, pomegranate, passion fruit
  • All dried fruit e.g. raisins, cranberries, apricots, prunes, dates (including stewed)

Vegetables

Foods allowed; unlikely to cause symptoms

  • Peeled white or sweet potatoes (boiled, mashed, fried or roasted),
  • Well cooked and peeled root vegetables e.g. carrots, parsnips, swede, turnips
  • Pumpkin, butternut squash, Peeled marrow, courgette, patty pan, aubergine
  • Well cooked broccoli and cauliflower (no tough stalks)
  • Peeled and de-seeded tomato, cucumber, cooked peppers
  • Ripe avocado
  • Liquidised and sieved vegetable soups
  • Small amounts of garlic and ginger paste
  • Soft tinned/pickled beetroot

Foods to avoid; may aggravate symptoms

  • All skins, pips and seeds
  • Skins of potatoes
  • Tough stalks of vegetables e.g. cauliflower, broccoli
  • Raw vegetables
  • Asparagus
  • Brussel sprouts, cabbage, spring greens, pak choi
  • Leeks, spring onions,
  • Onions, raw or undercooked garlic
  • Pickled onions, gherkins
  • Sweetcorn
  • Peas, sugar snaps, mangetout
  • Green, french and runner beans, broad beans
  • Mushrooms
  • Beetroot (raw or cooked)
  • Celery
  • Radish
  • Lettuce, rocket, watercress and spinach
  • Whole tomatoes
  • Bean sprouts
  • Soup with whole vegetables e.g. minestrone
  • Chicory, fennel

Breads and cereals

Foods allowed; unlikely to cause symptoms

  • Rice Krispies®, Cornflakes®, Cocopops®, Frosties®, Cheerios®
  • Special K® (without fruit)
  • Ready Brek®, finely milled oats/porridge
  • White flour, cornflour, rice flour, potato flour, chickpea flour, nut flour, lentil flour
  • White or 50/50 bread, rolls, baguettes
  • White pitta bread
  • Tortilla wraps
  • Crumpets, plain or cheese scones, scotch pancakes
  • Croissants, brioche
  • Melba toast, crackers, crispbreads (without seeds and grains)
  • Rice cakes
  • Oat cakes
  • Plain bagels
  • Plain muffins

Foods to avoid; may aggravate symptoms

  • Wholemeal, wholegrain and bran cereals e.g. All Bran®, Branflakes®, Weetabix®
  • Cereals containing dried fruit, seeds or nuts e.g. Sultana Bran®, Fruit n Fibre®, Muesli, Crunchy Nut Cornflakes®
  • Special K with berries
  • Jumbo oats/coarse porridge
  • Granola
  • Wholegrain flour, wholemeal flour, granary flour, cornmeal
  • Granary, malted, seeded brown, rye or multigrain bread
  • Bran
  • Wholegrain or seeded bagels
  • Muffins with berries or made with wholegrain flour
  • Wholegrain or seeded crackers or crispbreads

Rice, pasta, grains and potato products

Foods allowed; unlikely to cause symptoms

  • White rice
  • White pasta
  • Yorkshire pudding
  • White pastry
  • Waffles
  • Rice pudding, tapioca, sago
  • Couscous, bulgar wheat, quinoa
  • Gnocchi
  • Plain hash browns

Foods to avoid; may aggravate symptoms

  • Wild rice
  • Hash browns made with onion
  • Brown rice
  • Wholemeal pasta
  • Barley, pearl barley, spelt

Meat, fish, poultry, eggs and meat substitutes

Foods allowed; unlikely to cause symptoms

  • All types of fish, meat and meat products i.e. fresh, frozen, tinned, (soft, tender, not charred with visible fat and skins removed)
  • Smooth paté or liver sausage
  • Eggs
  • Tofu
  • Quorn
  • Soya mince

Foods to avoid; may aggravate symptoms

  • Skin and bones of fish
  • Convenience items which contain high fibre foods e.g. onions, peppers, wholegrains, pulses
  • Coarse paté made with onions

Pulses, nuts and seeds

Foods allowed; unlikely to cause symptoms

  • Smooth peanut butter
  • Smooth houmous
  • Ground nuts and nut purées
  • Marzipan
  • Small amounts of soft, well cooked marrowfat, peas or mushy peas and red lentils

Foods to avoid; may aggravate symptoms

  • Varieties of whole pulses, e.g. lentils, chickpeas
  • All varieties of beans e.g. borlotti, cannellini, kidney, soya, baked beans
  • All whole nuts
  • Crunchy peanut butter
  • Houmous with whole chickpeas
  • All seeds e.g. sunflower, pumpkin, sesame, poppy

Dairy foods

Foods allowed; unlikely to cause symptoms

  • All types of milk e.g. cow’s, goat’s, sheep’s, soya, rice, oat
  • Cream, crème fraîche
  • Buttermilk
  • All types of cheese (without dried fruit and nuts)
  • Butter, margarine, spread
  • Smooth yoghurt
  • Smooth ice cream and sorbet
  • Custard

Foods to avoid; may aggravate symptoms

  • Cheese containing dried fruit or nuts
  • Yoghurt containing whole fruit, nuts, seeds or pips
  • Ice cream and sorbet containing nuts, seeds and whole fruits

Sweet treats

Foods allowed; unlikely to cause symptoms

  • Cakes made with suitable flour (without dried fruit or nuts)
  • Plain biscuits e.g. Rich Tea, shortbread
  • Pancakes
  • Jelly
  • Boiled or jelly sweets
  • Chocolate (without nuts, seeds or dried fruit)
  • Toffee
  • Marshmallows

Foods to avoid; may aggravate symptoms

  • Cakes made with dried fruit and nuts
  • Hot cross buns, tea cakes, fruit scones
  • Wholegrain biscuits e.g. Hobnobs®, Digestives
  • Biscuits containing dried fruit e.g. fig rolls, Garibaldi®
  • Cereal bars containing dried fruit and nuts
  • Flapjacks
  • Jelly made with fresh fruit
  • Chocolate with nuts, seeds and dried fruit
  • Nougat

Savoury treats

Foods allowed; unlikely to cause symptoms

  • Crisps, tortilla chips
  • Plain bread sticks
  • Cheese straws
  • Mini cheddars® or
  • TUC® sandwich biscuits
  • Smooth dips e.g. taramasalata, guacamole

Foods to avoid; may aggravate symptoms

  • Nuts
  • Popcorn
  • Bombay Mix
  • Dips that contain whole tomatoes, cucumbers, onions e.g. salsa, tzatziki

Condiments

Foods allowed; unlikely to cause symptoms

  • Tomato ketchup and smooth chutneys
  • Smooth mustard
  • Brown sauce
  • Worcester sauce
  • Soya sauce
  • Mayonnaise, salad cream
  • Salt and pepper
  • Dried herbs
  • Powdered spices
  • Onion or garlic power
  • Gravy
  • Seedless jam or marmalade
  • Lemon curd
  • Honey
  • Golden syrup, maple syrup
  • Marmite®, Vegemite®, Bovril®

Foods to avoid; may aggravate symptoms

  • Chunky chutneys and relishes
  • Wholegrain mustard
  • Stalks and leaves of fresh herbs
  • Jam with seeds
  • Marmalade with peel

Reintroduction of higher residue/fibre foods

Follow the guide below on how to gradually re-introduce residue/fibre in your diet. Your dietitian can give you further advice, if required.

  • When introducing new foods, include one at a time, in small amounts (one third of your normal portion).
  • Keep a food and symptoms diary over the period of
    re-introduction. The aim is to identify a level of fibre that you can take comfortably.
  • Initially avoid foods that you know have upset you in the past.
  • With the reintroduction of fibre you may need to increase your fluid intake further e.g. up to ten cups a day.

Week 1:
Try eating the skins on fruit and vegetables such as apples, pears or potatoes.

Week 2:
Try fruit and vegetables from the ‘avoid’ list (not dried fruit yet).
Five portions of fruit and vegetables (not including potatoes) per day are recommended long-term for a healthy diet. Note: One glass of fruit juice counts as one portion of fruit.

Week 3:
Try replacing white bread with wholemeal bread

Week 4:
Try a higher fibre breakfast cereal, eg. Weetabix, Shredded Wheat or Bran Flakes

Week 5:
If you are still symptom-free, try including any of the other foods from the original ‘avoid’ list, including dried fruit. If a food causes any symptoms of discomfort, exclude it from your diet, but try reintroducing it at a later date.

Medications


If you have been taking medication to prevent constipation whilst on a low residue/fibre diet, you may find that as dietary sources of fibre are introduced, you can reduce or even stop the medicines. Discuss with your doctor or dietitian, if required.

Reference source(s):

  • Eswaran S, Muir J, William C (2013) Fibre and functional gastrointestinal disorders. The American Journal of Gastroenterology 108: 718-727
  • Gandy J (ed) Manual of Dietetic Practice 5th Edition. 2014 Blackwell Publishing
  • http://www.nutrition.org.uk/healthyliving/basics/fibre.html

Contact details


If you have any questions about the information in this leaflet
please contact the Dietetic Department:
Telephone: 01935 384250
Email: dietitians@ydh.nhs.uk


Acknowledgement: reproduced from The Royal Surrey County Hospital Dietitians Information Leaflet

Ref: 05-20-113
Review: 01/23