NUTRITION FOR THE OSTOMY

PATIENT
WOCN Fall Conference

September 16, 2016

Greta Lange, RD, CSO, LD

OBJECTIVES
Review the digestive system and identify where
nutrients are absorbed in the GI tract
Discuss how colostomy and ileostomy placement
affects digestion and absorption
Understand dietary recommendations for the
colostomy and ileostomy patient
Understand fluid needs of the ostomy patient

DIGESTION OVERVIEW

MACRONUTRIENT ABSORPTION

MICRONUTRIENT ABSORPTION

COLOSTOMY: WHATS MISSING?

ILEOSTOMY: WHATS MISSING?

DIET: ITS ALL ABOUT TEXTURE!

Vs

DIET: ITS ALL ABOUT TEXTURE!

Vs

DIET: ITS ALL ABOUT TEXTURE!

Vs

FIBER-RESTRICTED DIET
Meat

and meat substitutes

Lean, tender chicken, beef, pork, turkey, eggs

or fish
Baked, broiled, poached, roasted,
crockpot/pressure cooker
Marinate meats before cooking
Cut into small pieces, chew thoroughly
Avoid fried meats
Grilled meats can be tough and dry

FIBER-RESTRICTED DIET

Dairy Products
Milk, cheese and yogurt
If a patient is lactose-intolerant, consuming dairy
products can cause gas, bloating, cramping and
diarrhea
Degree of symptoms can vary amongst patientsQuantity!
Lactose-free products
Lactaid
Fair Life milk
Non-dairy alternatives
Soy products
Almond/Cashew milk-not an equivalent protein
source

FIBER-RESTRICTED DIET
Grains

Choose grains with <2gm fiber per serving

Choose grains with white or refined flour
Breads, bagels, pasta, crackers cereal
White Rice
Cream of wheat or cream of rice
Refined grits
Cereals made with refined grains without
added fiber
Chex, Cornflakes, Rice Krispies
Toasted bread easier to digest

FIBER-RESTRICTED DIET
Vegetables

Well-cooked vegetables without skin or

seeds
Green beans, carrots, squash
Potatoes without skin
Strained vegetable juice
Very tender greens well chopped

FIBER-RESTRICTED DIET

Fruit

Pulp-free fruit juice

Limit acidic juices like grapefruit or orange juice
No prune juice and limited apple juice

Ripe banana
Soft melon
Cut in small pieces
Chew thoroughly

Peeled and cooked apple

Canned fruits

No pineapple
Avoid heavy syrup

Avocado

FOODS THAT MAY CAUSE GAS AND ODOR

Lactose-containing
foods if the patient is
lactose intolerant
Beer
Apples
Asparagus
Broccoli
Brussels sprouts
Cabbage
Carbonated beverages
Cauliflower
Corn

Cucumber
Dried beans and peas
Eggs
Fish
Grapes
Green Pepper
Onions
Prunes
Radishes
Turnips

FOOD THAT MAY RELIEVE GAS AND ODOR

Buttermilk
Cranberry

juice
Yogurt with active Cultures
Parsley

GAS

Stress and anxiety

Swallowing too much air when you:
Eat or drink too fast
Smoke
Chew gum or suck on hard candies
Wear loose dentures
Sip through straws or bottles with narrow mouths
Simethicone

Gas-X, Phazyme, Mylanta Gas, Mylicon

Beano, on over-the-counter medication which contains

enzymes to breakdown the sugar found in vegetables
and beans
Exercise, which helps to push gas out of the intestine
Antacids

PROBIOTICS

Live microorganisms
Aid in digestion
Destroy disease-causing microorganisms
Produce vitamins (vitamin K)

FOODS THAT MAY CAUSE DIARRHEA

Alcohol
Fresh fruits with the
exception of banana
Beans
Bran
Fresh vegetables
Fried, greasy meats

Sausage!

Spicy foods
Sugar-free gum
Sugar-free substitutes

High fat foods

Dairy products
Caffeine
Sugar-free foods
containing mannitol or
sorbitol
Wine
Whole grains
Licorice
Apple or prune juice

FOODS THAT MAY THICKEN STOOLS

Applesauce
Bananas
White rice
Cheese
Marshmallows
Saltines
Tapioca

Oatmeal, instant
Pasta
White bread
Peanut butter, creamy
Potatoes, no skin
Pretzels

PSYLLIUM-FIBER SUPPLEMENTS

Psyllium fiber
Adds bulk to stools by soaking up water in the bowel
Quantity needed will vary
1 tsp Metamucil with 8 oz of water at each meal if
patient is having loose stools after every meal

ANTI-DIARRHEAL AGENTS

Loperamide-antidiarrheal

Diphenoxylate HCl with atropine sulfateantidiarrheal, anti-peristaltic agent

Lomotil, Lonox

Cholestyramine-antidiarrheal, bile acid

sequestrant

Imodium

Questran

Codeine-opioid

FOODS THAT MAY CAUSE BLOCKAGES

Unpeeled Apples
Bean sprouts
Cabbage, raw
Casing on sausage
Celery
Corn
Coconut
Coleslaw
Cucumbers
Dried fruit
Grapes
Green peppers

Nuts
Peas
Pineapple
Popcorn
Olives
Salad greens
Seeds
Spinach
Vegetable and fruits
skins
Whole grains
Tough, fibrous meat

OTHER TIPS
Eat small, frequent meals every 2-3 hours
Take small bites, cut food in small pieces and
chew thoroughly
Avoid enteric-coated, time-released medications

Notify physician if whole meds are seen in the ostomy

bag

Eat foods that can thicken stools several times

daily
Avoid eating large meals later in the day
Avoid products containing magnesium unless
prescribed

FLUID

General fluid requirements:

20-40 mL/kg/day
1.0-1.5 mL/kcal/day

Additional fluid required based on ostomy output

Focus on fluids between meals
No more than 8 oz of fluid at meals to support
absorption
Watch for signs of electrolyte imbalance during
times of high ostomy output

FLUID AND ELECTROLYTE PROBLEMS

Dehydration:
Increased thirst, decreased urine output, dizziness, dry
mouth, fatigue, dry eyes, headache, dry skin and shortness
of breath
Increase fluids of any kind

Sodium Depletion
Decreased appetite, drowsiness, headache, leg cramps,
dizziness/lightheadedness, particularly when standing,
cold sensation in extremities
Increase sodium-containing foods and fluids including
broth, bouillon, Gatorade/PowerAde, saltines, pretzels

Potassium Depletion
Fatigue, muscle weakness, gas, bloating, shortness of
breath, numbness in extremities
Increase potassium-containing foods and fluids including
coconut water, Gatorade/PowerAde, bananas, potatoes,
orange juice without pulp

FLUID: WHAT COUNTS?

Clear, non-caffeinated fluids:

Water
Club soda or seltzer
Sparkling water
Sports drinks
Clear broth
Gelatin
Popsicles
Caffeine-free soft drinks
Weak, caffeine-free tea
Clear fruit juices

Carbonated beverages can increase gas

VITAMIN/MINERAL SUPPLEMENTS

Chewable multivitamin

Consider bariatric multivitamin if loose stools are chronic and

with extensive bowel resection

Vitamin D
Check a 25-hydroxy vitamin D level
Minimum of 2000 IU vitamin D daily

B12

Calcium

Monthly IM injection
125-2000 mcg oral daily for deficiency
B-Complex
500 mg calcium citrate 2x/day

Potassium
Prescribed by a physician if lab values low
Diuretics

Zinc

Questions?

REFERENCES

American Dietetic Association. Nutrition Care

Manual. http://www.nutritioncaremanual.org
Mueller, Charles; Miller, Sarah; Schwartz, Denise;
Kovacevich, Deb; McClave, Steve. The A.S.P.E.N. Adult
Nutrition Support Core Curriculum, 2nd Edition. Silver
Spring: A.S.P.E.N, 2012
Digestive System Diagram
https://in.pinterest.com/pin/484770347366503293/
Short bowel syndrome: a nutritional and medical approach |
Fig. 1: The relative locations of digestion and absorption of
nutrients in the healthy gastrointestinal tract. CHO =
carbohydrate. Photo: Lianne Friesen and Nicholas
Woolridge. Published in CMAJ May 14, 2002 vol. 166
no. 10 1297-1302
Gropper, Sareen Annora Stepnick; Smith, Jack; Groth, James.
Advance Nutrition and Human Metabolism. Belmont:
Wadsworth, 2009
http://www.upstate.edu/surgery/healthcare/colorectal/colostom
y.php. SUNY Upstate Medical University, Syracuse, NY,
1988-2016.

REFERENCES
https://www.ibdrelief.com/learn/treatment/surger
y/proctocolectomy-surgery, 2016.
http://www.ostomy.org/uploaded/files/ostomy_info
/OstomyNutritionGuide.pdf?direct=1. United
Ostomy Associations of America, Inc., 2005-2016.
Pronsky, Zaneta. Food Medication Interations,
14th Edition. Birchrunville, 2006.