By Eric C. Sharer, MPH, RD, CDN

VRG recently received this question:
I’m an oncology dietitian and have a patient who is trying to follow a vegan diet, but also has short bowel syndrome due to several intestinal resections. Do you have any information about how someone could follow a vegan short bowel syndrome diet?

Here are some suggestions.

Where I used to work, we had a fair number of significant bowel resections and short bowel syndrome. We often recommended that they follow as close to a plant-based diet as possible. However, a whole-foods plant based diet can be tricky with bowel resections. Everyone was different, but often they were able to build up pretty good tolerance to whole plant foods. 

Fiber

• This can be one of the trickiest components of a vegan diet for patients with bowel resections. I have found that generally soluble fiber is more tolerated than insoluble fiber due to the function of the insoluble putting a lot of pressure on the digestive tract. I would recommend small amounts of fiber spread out through the day in small and frequent meals instead of just a few large meals per day. Soups can be a great place to start. Getting the vegetables well cooked and even blending the soups can help. For extreme cases of  bowel resections, the blended soup can also be strained through a cheesecloth to remove most of the fiber.
• The patient may need to focus on more of the processed grains/grain products (white rice, white bread, white rice pasta, etc.) for now until they can determine how they handle whole grains. I have found that many patients tolerate starchy vegetables, especially  potatoes and sweet potatoes/yams better than grains.
• In terms of legumes/pulses, often people tolerate the smaller legumes/pulses better than larger legumes. They can try split red lentils cooked and puréed into a soup or tomato sauce or well cooked black beans. They can try techniques to reduce the gas from the beans such as cooking the beans in kombu, rinsing the beans before and after soaking, and buying canned beans that contain kombu such as the Eden brand. Beans can be tricky for some, so usually recommend that people start with a very small amount at a time such as 1 Tbsp. Depending on symptoms they can gradually increase the volume over time.

Protein

• See above for discussion on beans. Often patients have to rely on low fiber plant-based protein options such as protein powder used in smoothies, cooking with protein powders such as pea protein (which often has 0g of fiber per serving).
• Tofu is often well tolerated
• A low fiber moderate to low fat veggie burger or meat alternative can also be a great option.

Fat

• Too much fat at one time can also exacerbate their symptoms, so they want to have small amounts of fat throughout the day instead of concentrated high fat meals..
• Some patients do not tolerate plant fats very well so I would recommend they try 100% coconut based MCT oil. It can be added to smoothies, sauces, soups, starch side, etc. The MCT generally require very little digestion/lipase so it often is a great option to help get nourishment in.

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