Yen

My husband is prone to small-bowel obstructions due to undigested (mostly, fiberous) food blocked by an adhesion (scar tissue) in his small intestine following hernia-repair surgery a few years ago. After 3 hospitalizations (including 1 surgery to repair a complete blockage), we're desperately looking for ways to prevent this from happening again. Doctors say low fiber and plenty of liquids, but how does one get a healthy does of fruits and vegetables in a low-fiber diet?!? and white flour/pasta/rice is not our way of eating as it can plug up the pipes in other ways. It seems that eating a pre-ride meal too close to a ride, without letting the meal digest, is probably one of the worst things he can do, so he has curtailed his morning group rides and long rides that include a mid-ride meal. This is very discouraging to us as riding with the group has become a major part of our life.

Does anyone have any suggestions (no horror stories, please!) to prevent this from happening again, and ideas to enable him to return to riding if at all possible?

CbadRider

There are yoga poses that aid digestion. My body tends to get thrown off when I travel and if I do yoga it has helped to get things back on track.

https://www.care2.com/greenliving/1-y...digestion.html

Carbonfiberboy 

Yup. Before and during rides, I use only liquid food. Ensure works, for example. I choose to go cheap and mix my own: 7 parts maltodextrin to 1 part flavored whey protein. I buy the malto in 50# bags from a homebrew supplier, the whey is Optimum Gold, which comes in 10# bags. 1 pt. of mixed powder in a water bottle will last a rider 3 hours.

After the ride, add more whey and some brown sugar to make a decent recovery beverage, or use chocolate milk or 1 pt. of regular milk with 5 T of sugar in it.

Otherwise smoothies, both fruit and vegetable work well. I had a dear friend who had adhesions after surgery. Though she didn't ride, this is about what she did. Kale smoothies, even. There are whole smoothie cookbooks. During the day, she'd use a sports drink for a few extra calories and hydration.

Edit: To use the Ensure, drink 1 - 1.5 for breakfast. Then put 1-2 bottles in a water bottle, depending on ride length, and fill the rest with water. Plain water in the other bottle.

There are surgeons who specialize in the laproscopic repair of adhesions. You might get an opinion from a specialist in this kind of thing.

WonderMonkey

I second the liquid food. The challenge is to find something that does well for this. I use AdvoCare's Meal Replacement Shakes. They are tremendous. I can get you information on them if you want. I use them on all of my long rides as mid-ride food (not on-bike snacks) as well as "start the day" food.

JimF22003

I sympathize. I've had 2 SB obstructions, in 2005 and 2012, that required emergency surgery and weeks in the hospital. In 2012 I was off the bike for 2 months because of complications following surgery.

None of the doctors ever gave me any specific dietary advice, which is kind of weird now that I think of it. They just said I would be prone to it now because of all the adhesions from these and other prior surgeries.

I'd probably be terrible at following their advice anyway. I haven't really changed how I eat when I'm riding. It's how I eat when I'm NOT riding that is most likely the problem.

Yen

Thank you all so much.

It seems that smoothies and liquid drinks are the way to go, but I believe we need to be careful with ingredients. After the first hospitalization he suggested I pick up some Ensure, but was turned off by many of the ingredients and decided it would be healthier to make them at home. We bought a NutriBullet and have used it every day since, blending yogurt with fruit and fresh greens for a tasty drink. But he doesn't want to eat smoothies all day long, and it's not practical when we are guests at someone's house, so we need to learn what whole foods he can and can't eat.

A smoothie or liquid cereal such as Cream of Wheat seems like a good option before a ride, followed by a smoothie after the ride.

Carbonfiberboy: Was your friend successful with preventing further obstructions with her diet? Haven't heard of laproscopic repair of adhesions, but we understand that anything that touches or irritates the intestinal wall can create a new adhesion, so even a repair of an adhesion can cause a new one. Imagine the horror if removing an embedded splinter in an infected finger created more splinters in its place!

JimF22003: Have you found anything that helps better than others? Doctors are trained to fix us through surgery and drugs, not by preventing something that would send us to their office to earn them more money.

We do know that every time this happened, he ate large servings of foods high in insoluble fiber in successive meals.

Myosmith

Your husband has a medical condition and you need to seek the counsel of a sports oriented physician working with a dietitian/nutritionist, not the opinions of an internet forum on bicycling. There are many intelligent, very knowledgable people here but I don't think any of them are qualified to prescribe treatment for a serious medical condition, patient unseen, based on a one-paragraph synopsis of his medical problems. Any advice given here, no matter how well meaning, should be run past your physician.

Not all doctors treat only with surgery and drugs. My physician, a general practice MD, was a huge help in getting me off several medications through fitness and nutrition goals.

GeorgeBMac

True -- but the doctor is not in charge of your health. He is a consultant that knows a lot but not everything.

Ulitmately, it is up to each and every patient to learn all that they can and make the wisest and best decisions possible. Seeking second opinions and outside help does not replace what the doctor says -- but it can be a valuable supplement to it.

And, a GOOD doctor welcomes patients being open and honest and bringing their own ideas and opinions to the table to discuss them.
... As soon as I see a doctor saying "My way or the highway", I find another doctor. But that does not mean that I do not value his opinion and follow his advice. It is not only possible to do both -- it is the smart thing to do...

But, at the same time, most doctors do not like being told their business -- there is a fine line. But ultimately it is what is in the patient's best interests that matters -- not the doctor's feelings. GOOD doctors know that.

Myosmith

No argument here. We are all responsible for our own health and must take an active role in it. That's why I didn't say not to listen to any outside advice, just to run it past a qualified physician before making the decision to act on it. I don't always agree with my physician, but he is a great resource, but then I've got a good one, not all of them are. I still don't think that opinions from strangers on an internet forum are the best outside medical information when there are potentially very serious consequences to your health. A second opinion from a sport oriented physician and a qualified nutritionist would probably provide more reliable information.

Some great online resources:

Mayo Clinic
Johns Hopkins
The American Dietetic Association
The American College of Sports Medicine
The American Medical Society for Sports Medicine
The International Organization of Sports Medicine
Food and Nutrition Board - Institute of Medicine
Journal of the International Society of Sports Nutrition
USDA Food and Nutrition Information Center

Not knocking anyone here who offers suggestions, just pointing out that even if we were medical experts, we don't have adequate knowledge of the OP's spouses condition. This is more serious than asking what energy bar is best or what sports drink causes the least stomach upset. The patient has already been hospitalized three times and had surgery once, he needs to seek the counsel of qualified professionals and recognized medical organizations.

To the OP: I hope your husband finds a solution and is able to once again enjoy the sport of cycling. Best wishes

Rowan

Isn't this the key to it all.

Maybe a little often is the right way to go. It's the "proper" way to refuel on rides, anyway.

Ensure has been a reliable go-to food source for randonneurs and their ilk for ages. There is nothing wrong with it, but a lot right if you need an easily digested, high-nutrient, reasonable-tasting fuel.

GeorgeBMac

Thanks for the clarification -- and sorry I misunderstood what your point was.

And, by the way, I agree with the above... I strongly agree.

phoebeisis

Smaller meals- very well chewed.
Plenty of fluid-
Don't avoid fiber-just make the servings small-
I would bias it toward water soluble fibers-fruits etc- av
Might be smart to avoid hours long rides-perhaps 1-1.5 hrs might be smart.
Low fiber-all fiber-sounds "off" since fiber tends to speed up intestinal transit.Perhaps they meant insoluble -All Bran corn etc
More smaller meals-bias toward soluble fiber-lots of fluids- keep ride duration in the 1-1.5 hr range.
It is true that digestion in general is a bit slower when exercising-so duration of exercise might be important.
MDs don't have good studies on this sort of thing-adhesions-obstructions-diets to prevent-role of exercise in etc.
His history-happened after BIG meals high in fiber(what sort of fiber) is what you need to run with.
He could certainly drink OJ pre ride- coffee milk sugar cream- get in 300 calories or so.
Do be careful with ride duration-dehydration etc
Luck
Charlie
PS- Sometimes a dietician will have a better feel than MDs but doubt they have hard numbers either-but worth asking around consulting-perhaps one who deals with athletic oldsters - post surgical adhesions and the obstructions they produce-common problem

JimF22003

Looking back, I think it was the same thing that triggered my episodes. Too much food, gulped down too quickly, and not very digestible. Some times you get away with it, and sometimes you don't. I'd like to say I've improved my eating habits, but it's a struggle. I have a history of eating disorders anyway (that's how I got up to 475 pounds )

But as for eating on bike rides, I don't really have any problem with that. I try to stick with bananas, apples, sometimes energy bars. Towards the end of a ride when I need something, but I just can't stand the thought of solid food, I'll usually finish up with GU's or something like that.

chandltp

There are people that believe fiber is damaging to the body and should be avoided. Typically, they eat a nearly zero carb diet consisting entirely of animal products.

Here's a web site (there is also a related facebook page):

https://zeroinginonhealth.com/

I guess another alternative is to juice all your fruits and vegetables.

Yen

Thank you all so much.

Of course he is under the care of a physician (his surgeon) who has referred him to a GI specialist and we will also see a Registered Dietitian for further guidance. I asked here only because doctors don't have ALL the answers, and I've found good information from other folks who did their own extensive research as I am doing now and found answers that worked for them. And, of course, what works for one may not work for us, but sensible measures (many of which are shared above) are a good place to start, in addition to following the advice of his doctor.