Familial GI Cancers Unit
Managing Nutrition
There are differences in nutrition management for individuals with an ilieostomy and those with a colostomy.
For Individuals with an Ileostomy
Some dietary changes are required for individuals with an ileostomy. Most of the changes are temporary, about 6 weeks after surgery (while the small bowel adapts after surgery), and some are more long term. If you had specific dietary restrictions before your surgery, you may want to discuss and review these with a dietitian.
Sometimes the restrictions are no longer required while at other times they should be maintained. If you need more long term changes (for example, ongoing difficulty with high outputs), a dietitian can review your dietary needs and restrictions more specifically.
Short-term restrictions include limiting fibrous fruits and vegetables (particularly raw), as well as whole wheat and whole grain products as these may not readily pass through the stoma during the initial stages (due to post-operative swelling). Cooked vegetables and fruits (chewed well) in limited quantities are acceptable. Nuts and seeds (whole) should also be limited during this time. Gradual re-introduction of these food items can occur after 6 weeks, adding one restricted item at a time and monitoring your response to it (cramping, loose stools).
Long term considerations can include adequately chewing foods before swallowing, separating solid foods from fluids during meals, and ensuring adequate fluid intake during the day. Fluid intake should be in the range of 8 to 10 glasses a day. Certain foods like popcorn can sometimes continue to be problematic, thus long term avoidance is based on individual food tolerances.
Some foods may cause increased gas or odour when emptying. These foods do not necessarily need to be eliminated from the diet, but you may want to choose when you consume these items so that it best fits in with your lifestyle and environment. Remember that sucking through a straw, chewing gum, sucking on candies/lozenges, chewing food with your mouth open, and smoking will cause you to swallow more air and will increase the gas through your pouch.
For Individuals with a Colostomy
For the most part, dietary changes are not required for individuals with a colostomy. There may be some initial temporary changes, due to the effects of surgery, but otherwise, there are no restrictions or concerns. If you had specific dietary concerns before your surgery, you may want to discuss and review these with a dietitian. Sometimes these restrictions are no longer required while at other times they should be maintained.
The most common concerns for individuals with a colostomy are gas and odour. Some foods may cause increased gas or odour when emptying. These foods do not necessarily need to be eliminated from your diet, but you may want to choose when you consume these items so that it best fits in with your lifestyle and environment. You may find that it takes about six to eight hours after the consumption of gas forming foods for gas to appear in the pouch. Some people find that over the counter enzyme preparations, such as Beano, are helpful for reducing the amount of gas produced.
Nutrition - Foods
The majority of foods impacting individuals with IBD have the same impacts on those with either an ileostomy or colostomy. There are some foods that impact only one or the other.
For Individuals with an Ileostomy or Colostomy
| Foods that may cause gas | |
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| Foods that may cause odour | |
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| Foods that may thicken stool | |
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| Foods that may loosen stool | |
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Only for Individuals with a Colostomy
| Foods and beverages that may help constipation | |
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Only for Individuals with an Ileostomy
For individuals with an ileostomy, the colon has either been removed or bypassed. The functions of the colon is to absorb water, salt and potassium. When the colon has been removed or bypassed, some of these functions have been lost. It is important to be aware of the signs, symptoms and treatment measures for dehydration and electrolyte imbalance.
| Signs and Symptoms | Treatment Measures | |
|---|---|---|
| Dehydration |
Increased thirst, dry mouth, dry skin, decreased urine output, fatigue, shortness of breath, stomach cramps. |
Increase fluids of any kind. |
| Sodium Loss |
Loss of appetite, stomach cramps, cold arms and/or legs, fatigue, feeling faint. |
The highest sources of sodium are found in: bullion, instant powder soups, canned soups, salted crackers, pretzels, pickles, tomato juices, smoked meats, ham, wieners. Cottage cheese, cheeses, milk and drinks such as Gastrolyte club soda, or Gatorade are lower sources of salt. |
| Potassium Loss | Fatigue, muscle weakness, shortness of breath, decreased sensation in arms and legs, and a gassy bloated feeling. | High sources in the vegetable family include: tomatoes, V-8 juice, potatoes, squash, carrots, vegetable and cream soups, salad greens. High sources of potassium in fruits, include: oranges, grapefruits, bananas, melon and avocado. Smooth peanut butter, nuts, butter, tea and coffee are also sources of potassium. |
Nutrition - Overview
Individuals living with Inflammatory Bowel Disease (IBD) are often interested in how their diet can affect disease management. Nutrition plays an important role in maintaining health during times of disease activity and remission. Diet can also help with symptom management during disease flare ups. It is important to remember that diet does not cause or cure IBD. There are two key ways that nutrition care impacts IBD:
- Maintaining good nutritional habits and preventing malnutrition helps with healing, immunity and increasing energy. This means eating a varied and healthy diet that is an excellent source for all nutrients. Nutritional deficiencies result from inadequate macronutrients (carbohydrate, protein, fat) and micronutrients (vitamins, minerals, trace elements).
- Preventing or minimizing gastrointestinal (GI) symptoms and normalizing bowel function.
Foods to Eat or Avoid: The "Million Dollar" Question
Photo: plate of nutritious foodFood intake is frequently associated with GI symptoms and by changing what or how food is consumed, individuals gain a sense of control over an unpredictable disease.
When making such decisions, it is difficult to sort out myths from facts. Messages from books, television or the Internet often claim that exclusionary diets (where a food or food group is eliminated) will cure or prevent relapse of IBD. There is no reliable evidence to support these claims and there is no standard diet for IBD.
If your IBD is under control and relatively symptom free, follow Canada's Food Guide as it emphasizes a wide variety of foods that provide all the nutrients your body needs. There is no need to restrict foods or to follow a special diet.
If you are experiencing acute disease activity, you may find it helpful to modify your regular diet (e.g. low fibre diet). This helps to minimize GI symptoms, but does not play a role in preventing the progression of the disease. It is of utmost importance that you try to maintain your nutritional status during this time.
Healthy Eating
Excluded certain foods is not necessary and restricts important nutrients the body relies on. Isolated nutrients in supplements may also be unnecessary. Eating "real food " is more tasty, filling, and provides more nutrient variety. A well-balanced diet including a variety of foods is best for good health.
It is important to remember that dietary changes should not compromise your well-being. This means maintaining weight and energy levels, continued enjoyment from eating, and participation in social situations involving food. Food is an important aspect of your quality of life, and your health care providers (including a Registered Dietitian) can help you to learn about your own food tolerances to find the diet that works for you.
Dietary Choices
Dietary choices and food tolerances vary from person to person. For individuals with IBD there are many factors which may affect food tolerance such as current disease state and the portion of the GI tract that is affected. Additional factors that contribute to increased risk for malnutrition include:
- malabsorption (altered digestion and absorption with inflamed gut mucosa)
- increased GI losses (bleeding, diarrhea)
- increased requirements
- decreased dietary intake (associating symptoms with eating) due to:
- bloating, cramping
- nausea, vomiting, diarrhea
- loss of appetite
- fear of eating due to pain
- elimination diets
- therapy: medical (drug-nutrient interactions)
- surgical (resections/shorter bowel with less absorptive surface)
Diet therapy is individualized as it considers all of the above factors. It usually focuses on hydration, electrolyte balance, ensuring adequate intake of nutrients, modifying foods to manage GI symptoms, and replacement of deficient nutrients if needed. This is all considered in the context of an individual's severity of symptoms, food preferences, tolerances, finances, and lifestyle.
Symptom Management
Symptom management often includes:
- reducing the frequency of bowel movements
- increasing consistency of loose stool
- minimizing obstruction risk (post-op or for individuals with bowel strictures)
Strategies to achieve this involve:
- decreasing insoluble fibre in the diet (e.g. skins and seeds of fruit and vegetables, whole wheat and whole grain breads and cereals)
- gradually increasing soluble fibre (oats, oat bran, pulp of fruits and vegetables, legumes, and barley)
Insoluble fibre increases the amount of stool and stimulates bowel movements. Soluble fibre contributes less to fecal bulk, and helps form loose bowel movements. Other strategies may include modifying dietary intake of lactose, fat, simple sugars, or caffeine. Changes to meal size, composition (e.g. nutrient density), and timing (e.g. small frequent meals) can also be evaluated.