Eating & Ostomates

An Anthology of Ideas

 

Articles Included:

         Foods and Your Ostomy

         Diet Guidelines for Ostomy Patients

         Diet Cautions for Ostomates

         Gas in the Digestive Tract

         Potassium

         Abdominal Noises

         Electrolyte Replenishing Drink Comparisons

         Some Food Facts for Ileostomates

         Toffee Gums Up the Ostomy

         Quick Food Reference

         The Affect of Fiber

         Fat Substitutes

         Hydrox Fecalis

         Eat Sensibly with an Ileostomy

 

Foods and Your Ostomy

Some Helpful Hints

By The New Outlook, Chicago's North Suburban Chapter UOA

 

There is No "Ostomy" Diet

 

There used to be, and to some extent still are, some outdated theories about what foods ostomates should and should not eat. Mushrooms, onions and fresh vegetables were considered troublemakers, along with some meats. Today, we find that the old food taboos don't necessarily apply. In moderation, most foods need not be avoided. If you have any questions about food, and the way your body reacts to it, consult your doctor or ET nurse.  Here are some common foods, and hints on how to enjoy them without causing excessive gas, irritation or stoma blockage.

 

Fibrous vegetables


Vegetables like celery, asparagus and broccoli have long, fibrous strands running through them. Such strands are hard to digest and can form a "ball" behind the stoma. When eating:

 

        Celery. Choose the hearts. These are tender, and the fibers are not as thick as those in the outside stalks. If you must eat the outer stalks, peel down and toss out the outside strands.

 

        Asparagus. Medium stalks are usually the most tender. Start at the tip and work down. As soon as the spear gets tough to cut, go on to the next one and you should have no blockage problems.

 

        Broccoli. The same principle applies as asparagus. Asparagus causes odor in the urine, which can be particularly bothersome to a urostomate.

 

        Onions can produce odor in the stool.

 

        Broccoli, cauliflower and turnips, among others, are considered gas producers, and may require an extra trip to the restore to relieve that pressure.

Cheese

Natural cheese tends to be more binding than processed cheese, so avoid too much natural cheese at one time. Processed cheeses, such as american, cream and cottage cheese, are easier to digest.

Fresh Fruit

In moderation, fruit can and should be included in a well balanced diet. If you have trouble digesting oranges and/or grapefruit, try squeezing the juice and discarding the skin.

 

        Apples, pears and peaches are great without their skins, if you find them hard to digest.

 

        Oranges: Fresh Oranges are usually listed as a problem. Many ostomates choose orange juice instead. One member had persistent pouch system leakage problems until he discovered that switching away from eating fresh oranges with the inherent pulp, to filtered orange juice, permanently solved the problem.

Fruit naturally produces activity in our elimination systems. Keep this in mind when you're at a picnic or the beach...or anywhere facilities are not readily available.

Oysters, clams & mussels

Though delicious treats, mollusks can be more difficult to digest than other types of seafood, and may cause a minor blockage behind the stoma. Be sure to chew mollusks well. Avoid tough morsels. These are the major offenders giving ileostomates the most trouble. Seafood of all kinds may cause odor in the stool. Appliance deodorants are most helpful in controlling this problem.

Nuts

The most difficult nuts to digest are the hard ones, such  as peanuts, almonds and hazelnuts. Chew them well, and be careful not to overindulge--no more than a handful at a sitting. Even non-ostomate nut lovers may experience discomfort after enjoying more than a reasonable share of nuts.

 

One of our members with an ileostomy tells this story. "If I can have one handful of nuts one night last week, then five handfuls one night this week might be okay." This error landed our member in the hospital overnight with a complete blockage. Trying to give birth to a plug of peanut pieces behind a stoma is definitely not to be put on your wish list.   Moderation is the key. Also, if he drank water and had other food with the nuts, the blockage may not have been so bad, or even happened.

Meats

Most meats and poultry do not present problems for the average ostomate, but those with fat content or heavy casings can be somewhat more difficult for the bowel to handle. Some of the bratwurst types can have very heavy casings that should be removed to reduce the chance of blockage.

 

Try sausage patties instead of links, or try hot dogs with the skin removed. Most sausage casings nowadays are purported to be very thin plastic, which are not something you would want in large pieces behind your stoma. When eating fatty cuts of pork, lamb or beef, cut small pieces, avoid eating gristle, chew well and limit your intake.

 

Other

Corn on the cob, popcorn, dried foods & coconut. Creamed corn seems to be fairly well tolerated, some people report eating corn on the cob as a sure trip to the hospital. Coconut seems to be mentioned very often as something to eat only in small quantities. Some people tolerate popcorn fairly well, others do not. Try cautiously.   When it comes to obstruction behind the stoma, these are major offenders. In fact, even people without ostomies can suffer major tummy aches after indulging.

 

A doctor told us of a fellow who would eat huge amounts of popcorn at one sitting. He was not an ostomate, but ended up in the hospital three times in one year with gastritis. Chew, chew, chew... and remember limit your intake. Never overeat. This warning is especially true for people with an ileostomy. Corn and peas are better tolerated when the hard outside husks are slit. We have ileostomates who will occasionally eat a small sweet corn. They slit each line of the cob with a very sharp knife. This breaks the kernel and makes the corn easier to digest.

 

Spices & Carbonation

Heavily spiced foods and sauces can act as agents that speed up our bodily functions. For some people they may produce gas. Carbonated beverages are gas producers, too. One great way to get the bubbles out of carbonated drinks is with a dash of sugar. It will cause a frenzy of fizz and leave the beverage safely flat. Don't fill the glass too full first, or the pop will foam over the top of the glass.  

 

 

Diet Guidelines for

Ostomy Patients

--Registered Dietitians Nutrition Services

 

General Guidelines:

 

        You will be able to eat a general diet eventually, based on your own tolerance, but initially you may be asked to follow a bland, low residue or soft diet for a month or two.

 

        As you advance your diet, add new foods in small amounts.

 

        Eat meals at regular times, three or more meals daily. Ileostomates especially should eat many small meals all through the day. Give up that one big meal once a day.

 

        Do not fast for long periods of time because of the potential to upset your electrolyte balance.

 

        Experiment with foods, one at a time to pinpoint any intolerances. Only use small quantities. As you get accustom to the food, you may then try eating more.

 

        If a specific food does not agree with you, and you would like to eat it, you might want to try it again next month in a very small quantity.

 

        Avoid any food which did not agree with you prior to surgery. This will probably not change after surgery.

 

        Chew foods thoroughly to avoid blockage at the stoma site. For many foods, the size of the piece you swallow will be the exact size it will come out. If you chew your food well, all the time, you will reduce the probability of problems occurring.

 

        Drink plenty of fluids - at least 64 ounces (two liters) per day. This is even more important for ileostomates and urostomates.

 

        Avoid chewing gum. You swallow air with gum chewing which may create a noisy stoma.

 

        Avoid gaining excessive weight which may affect stoma function, and make you more susceptible to hernia and other avoidable health issues.


 

These foods may cause gas:

 

cabbage, green beans, radishes, brussel sprouts, onions, beer, peas, melons, carbonated beverages

 

These foods may cause odor (of course the pouch is closed and you may not care about this):

onions, cabbage, egg yolks, garlic, fish, turnips, cauliflower, alcohol

 

These foods may help control odor (inside the pouch, if you are sensitive):

yogurt, parsley, cranberry juice, buttermilk

 

These high fiber foods, especially with seeds or kernels, may cause blockage:

celery (raw), coleslaw, corn (whole kernels), nuts, popcorn, coconut, seeds, Chinese

vegetables, olive pits, tomato skins, orange pulp, apple skins, shrimp, lobster

 

Editors Note: Some people tolerate creamed corn well. These foods as well as most others may still be eaten, but should only be eaten sparingly when drinking plenty of water. In addition, some foods clump. When eaten alone these may create a problem but when mixed with other foods are fine. I eat nuts all the time, but chew each one to a powder. Never swallow large nuts or seeds whole. You'll need a surgeon to remove them. Never sit down and eat three ears of sweet corn. You are asking for trouble. These items are mostly concerns for ileostomates.

These foods may cause diarrhea in some people:

fried foods, highly seasoned foods, beer, raw vegetables, onions, licorice, raw fruits, baked beans, large meals, milk, chocolate

 

These foods may help alleviate diarrhea:

 

banana, applesauce, boiled rice, cheese

 

Editors Note: Seems like there are many foods to be concerned about. But not really. There many foods that you can enjoy and most of the offenders in moderation. Most of us eat virtually everything we did before surgery. In fact, many with diseases like Crohn's may actually have a much bigger selection than before. We always chew well, drink plenty of water, never overeat; let me repeat: chew well, drink liquids, never overeat. This keeps us out of serious trouble.

 

Diet Cautions for Ostomates

By The New Outlook, Chicago's North Suburban Chapter UOA

 

If you have just had abdominal surgery, it will take a little time for your bodily functions to return to normal, so you should be eating food that is nourishing and easily digested.

 

Later, the doctor will give you the go-ahead to return to a normal diet. You may want to add one new food at a time. But in general, any food that has agreed with you in the past should continue to do so.

 

If you are already on a special diet (e.g.., diabetes or high blood pressure), stay with it to maintain good health, eat a balanced diet--one that supplies the amounts of carbohydrates, protein, fat, minerals and vitamins your body needs.

 

Even if you no longer have a colon, the small intestine will efficiently extract the nutrients you need if you provide it with the proper food. Chewing your food well, eating regularly, and drinking plenty of water are a few other common sense rules to follow. Other than that, eat what is comfortable for you and what satisfies you.

Editors Note: If you have had some of your small intestine removed, you may not absorb all of the vitamins properly. New research indicates that various sections of the small intestine have specific job functions to absorb a specific vitamin. Particularly, the last part of the small intestine is devoted to absorbing vitamin B12. If you are checked by your doctor and found to be anemic, you may need injections of B12, as your body may not be able to absorb enough naturally.

 

Gas in the Digestive Tract

--National Digestive Diseases Information Clearinghouse

 

Everyone has gas and eliminates it by burping or passing it through the intestines. However, many people think they have too much has when they really have normal amounts. Most people produce about one to three pints a day and pass gas 15 to 30 times a day.

 

Gas is made primarily of odorless vapors—carbon dioxide, oxygen, nitrogen, hydrogen and sometimes methane. The unpleasant odor of flatulence comes from bacteria in the large intestine that release small amounts of gases that contain sulfur.

 

Although having has is common, it can be uncomfortable and embarrassing. Understanding causes, ways to reduce symptoms and treatment will help most people find relief.

 

What Causes Gas?

 

Gas in the digestive tract; that is, the esophagus, stomach, small and large intestine, comes from two sources:

 

        Swallowed air

        Normal breakdown of certain undigested foods by harmless bacteria naturally present in the large intestine.

 

Swallowed air

 

Air swallowing—aerophagia—is a common cause of gas in the stomach. Everyone swallows small amounts of air when eating and drinking. However, eating or drinking rapidly, chewing gum, smoking or wearing loose dentures can cause some people to take in more air.

 

Burping or belching is the way most swallowed air—which contains nitrogen, oxygen and carbon dioxide—leaves the stomach. The remaining gas moves into the small intestine where it is partially absorbed. A small amount travels into the large intestine for release through the end. The stomach also releases carbon dioxide when stomach acid and bicarbonate mix, but most of this gas is absorbed into the blood stream and does not enter the large intestine.

 

Breakdown of undigested foods

 

The body does not digest and absorb some carbohydrates—the sugar starches and fiber found in many foods—in the small intestine because of a shortage or absence of certain enzymes.

 

This undigested food then passes from the small intestine into the large intestine, where harmless and normal bacteria break down the food producing: hydrogen, carbon dioxide, and in about one-third of all people, methane. Eventually, these gases exit through the end of the intestine.

 

People who make methane do not necessarily pass more has or have unique symptoms. A person who produces methane will have stools that consistently float in water. Research has not shown why some people produce methane and others do not.

 

Foods that produce gas in one person may not cause gas in another. Some common bacteria in the large intestine can destroy the hydrogen that other bacteria produce. The balance of the two types of bacteria may explain why some people have more gas than others.

 

Which Foods Cause Gas?

 

Most foods that contain carbohydrates can cause gas. By contrast, fats and proteins cause little gas.

 

Sugars

The sugars that cause gas are: raffinose, lactose, fructose and sorbitol.

 

Raffinose

Beans contain large amounts of this complex sugar. Smaller amounts are found in cabbage, brussel sprouts, broccoli, asparagus, as well as other vegetables and whole grains.

 

Lactose

Lactose is the natural sugar in milk. It is also found in products; such as, cheese and ice cream. It is also found in processed foods; such as, bread, cereal and salad dressing. Many people—particularly those of African, Native American or Asian background—have low levels of the enzyme lactase needed to digest lactose. Also as people age, their enzyme levels decrease. As a result, over time people may experience increasing amounts of gas after eating food containing lactose.

 

Fructose

Fructose is naturally present in onions, artichokes, pears and wheat. It is also used as a sweetener in some soft drinks and fruit drinks.

 

Sorbitol

Sorbitol is a sugar found naturally in fruits, including apples, pears, peaches and prunes. It is also used as an artificial sweetener in many dietetic foods and sugar-free candies and gums.

 

Starches

Most starches, including potatoes, corn noodles and wheat, produce gas as they are broken down in the large intestine. Rice is the only starch that does not cause gas.

 

Fiber

Many foods contain soluble and insoluble fiber. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Found in oat bran, beans, peas and most fruits, soluble fiber is not broken down until it reaches the large intestine where digestion causes gas.

 

Insoluble fiber, on the other hand, passes essentially unchanged through the intestines and produces little gas. Wheat bran and some vegetables contain this kind of fiber.

 

What Are Some Symptoms and Problems of Gas?

 

The most common symptoms of gas are belching, flatulence, abdominal bloating and abdominal pain. However, not everyone experience these symptoms. The determining factors probably are how much has the body produces; how many fatty acids the body absorbs; and a person's sensitivity to gas in the large intestine. Chronic symptoms caused by too much has or by a serious disease are rare.

 

Belching

An occasional belch during or after meals is normal and releases gas when the stomach is full of food. However, people who belch frequently may by swallowing too much air and releasing it before the air inters the stomach.

 

Sometimes a person with chronic belching may have an upper GI disorder; such as, peptic ulcer disease, gastroesophageal reflux disease (GERD) or gastritis.

 

Believing that swallowing air and releasing it will relieve the discomfort of these disorders, this person may unintentionally develop a habitual cycle of belching and discomfort. Frequently, the pain continues or worsens, leading the person to believe he or she has a serious disorder.

 

Two rare chronic has syndromes are associated with belching: Meganblase syndrome and gas-bloat syndrome. The Meganblase syndrome, which causes chronic belching, is characterized by severe air swallowing and an enlarges bubble of gas in the stomach following heavy meals. The resulting fullness and shortness of breath may mimic a heart attack.

 

Gas-bloat syndrome may occur after surgery to correct GERD. The surgery creates a one-way valve between the esophagus and stomach that allows food and gas to enter the stomach but often prevents normal belching and the ability to vomit.

 

Flatulence

Another common complaint is passage of too much has through the intestine. However, most people do not realize that passing has 15 to 30 times a day is normal. Although rare, too much has may be the result of severe carbohydrate malabsorption or overactive bacteria in the colon.

Abdominal bloating

Many people believe that too much has causes abdominal bloating. However, people who complain of bloating from gas often have normal amounts and distribution of gas. They actually may be unusually aware of gas in the digestive tract.

 

Doctors believe that bloating is usually the result of an intestinal motility disorder; such as, irritable bowel syndrome (IBS). Motility disorders are characterized by abnormal movements and contractions of intestinal muscles. These disorders may give a false sensation of bloating because of increased sensitivity to gas.

 

Splenic-flexure syndrome is a chronic disorder that seems to be caused by trapped gas at bends—flexures—in the colon. Symptoms include bloating, muscle spasms and upper abdominal discomfort. Splenic-flexure syndrome often accompanies IBS.

 

Any disease that causes intestinal obstruction; such as, Crohn's disease or colon cancer, may also cause abdominal bloating. In addition, people who have had many operations, adhesions—scar tissue—or internal hernias may experience bloating or pain. Finally, eating a lot of fatty food can delay stomach emptying and cause bloating and discomfort, but not necessarily too much gas.

 

Abdominal pain and discomfort

Some people have pain when has is present in the intestine. When gas collects on the left side of the colon, the pain can be confused with heart disease. When it collects on the right side of the colon, the pain may feel like the pain associated with gallstones or appendicitis.

 

What Diagnostic Tests Are Used?

 

Because gas symptoms may be caused by a serious disorder, those causes should be ruled out. The doctor usually begins with a review of dietary habits and symptoms. The doctor may ask the patient to keep a diary of foods and beverages consumed for a specific time period.

 

If lactase deficiency is the suspected cause of gas, the doctor may suggest avoiding milk products for a period of time. A blood or breath test may be used to diagnose lactose intolerance.

 

In addition, to determine if someone produces too much gas in the colon or is unusually sensitive to the passage of normal gas volumes, the doctor may ask patients to count the number to times they pass gas during the day and include this information in a diary.

 

Careful review of diet and the amount of gas passed any help relate specific foods to symptoms and determine the severity of the problem.

 

If a patient complains of bloating, the doctor may examine the abdomen for the sound of fluid movement to rule out ascities—build up of fluid in the abdomen—and for signs of inflammation to rule out diseases of the colon.

 

The possibility of colon cancer is usually considered in people 50 years of age and older, and in those with a family history of colorectal cancer, particularly if they have never had a colon examination—sigmoidoscopy or colonoscopy. These tests may also be appropriate for someone with unexplained weight loss, diarrhea or blood not visible in the stool.

 

For those with chronic belching, the doctor will look for signs or causes of excessive air swallowing. If needed, an upper GI series—x-ray to view the esophagus, stomach and upper small intestine—may be performed to rule out disease.

 

How is Gas Treated?

 

The most common ways to reduce the discomfort of has are changing diet, taking medicines and reducing the amount of air swallowed.

 

Diet

Doctors may tell people to eat fewer foods that cause gas. However, for some people this may mean cutting out healthy foods; such as, fruits and vegetables, whole grains and milk products.

 

Doctors may also suggest limiting high-fat foods to reduce bloating and discomfort. This helps the stomach empty faster, allowing gases to move into the small intestine.

 

Unfortunately, the amount of gas caused by certain foods varies from person to person. Effective dietary changes depend on learning through trial and error how much of the offending foods one can handle.

 

Nonprescription medicines

Many nonprescription, over-the-counter medicines are available to help reduce symptoms, including antacids with simethicone and activated charcoal. Digestive enzymes; such as, lactase supplements, actually help digest carbohydrates and may allow people to eat foods that normally cause gas.

 

Antacids; such as Mylanta II, Maalox II and Di-Gel, contain simethicone, a foaming agent that joins gas bubbles in the stomach so that gas is more easily belched away. However, these medicines have no effect on intestinal has. The recommended dose is two to four tablespoons of the simethicone preparation taken one-half to two hours after meals.

 

Activated charcoal tablets may provide relief from has in the colon. Studies have shown that when taken before and after a meal, intestinal gas is greatly reduced. The usual dose is two to four tablets taken just before eating and one hour after meals.

 

The enzyme lactase, which aids with lactose digestion, is available in liquid and tablet form without a prescription—Lactaid, Lactrase and Dairy Ease. Adding a few drops of liquid lactase to milk before drinking it or chewing lactase tablets just before eating helps digest foods that contain lactose. Also, lactose-reduced milk and other products are available at many grocery stores.

 

Beano, a newer over-the counter digestive aid, contains the sugar-digesting enzyme that the body lacks to digest the sugar in beans and many vegetables. The enzyme comes in liquid form. Three to 10 drops are added per serving just before eating to break down the gas-producing sugars. Beano has no effect on gas caused by lactose or fiber.

 

Prescription medicines

Doctors may prescribe medicines to help reduce symptoms, especially for people with a motility disorder; such as, IBS. Promotility or prokinetic drugs; such as, metocopramide (Reglain) and cisapride (Propulsid), may move gas through the digestive tract quickly.

 

Reducing swallowed air

For those who have chronic belching, doctors may suggest ways to reduce the amount of air swallowed. Recommendations are to avoid chewing gum and to avoid eating hard candy. Eating at a slow pace and checking with a dentist to make sure dentures fit properly should also help.

 

Conclusion

 

Although has may be uncomfortable and embarrassing, it is not life-threatening. Understanding causes, ways to reduce symptoms and treatment will help most people find some relief.

 

Points to remember

              Everyone has gas in the digestive tract.

              People often believe normal passage of gas to be excessive.

              Gas comes from two main sources: swallowed air and normal breakdown of certain foods by harmless bacteria naturally present in the large intestine.

              Many foods with carbohydrates can cause. gas. Fats and proteins cause little gas.

              The most common symptoms of gas are belching, flatulence, bloating and abdominal pain. However, some of these symptoms are often caused by an intestinal motility disorder; such as, IBS, rather than too much has.

              The most common ways to reduce the discomfort of gas are changing diet, taking non-prescription or prescription medicines and reducing the amount of air swallowed.

              Digestive enzymes; such as, lactase supplements, actually help digest carbohydrates and may allow people to eat foods that normally cause gas.

 

Foods that may cause gas include:

              Beans

              Vegetables; such as, broccoli, cabbage, brussel sprouts, onions, artichokes and asparagus

              Fruits; such as, pears, apples and peaches

              Whole grains; such as, whole wheat and bran

              Soft drinks and fruits drinks

  Milk and milk products; such as, cheese and ice cream, and packaged foods prepared with lactose; such as, bread, cereal and salad dressing

              Foods containing sorbitol; such as, dietetic foods and sugar-free candies and gums.

 

Potassium

--Internet Sources

 

Potassium, sodium, and chloride are intricately related electrolytes—mineral salts that conduct electricity when dissolved in water. Electrolytes are always found in pairs. A positively charged molecule like potassium or sodium is always accompanied by a negatively charged molecule like chloride.

 

This is why they are intricately related. Every cell has a sodium-potassium pump which actually pumps sodium out and potassium into the cell. If sodium is not pumped out, water accumulates in the cell and causes it to burst. The pump also helps maintain the electrical charge within the cell. This is very important to muscle and nerve cells, and explains why a potassium deficiency affects muscles and nerves first.

Potassium is the most important of the three because it is also essential for converting blood sugar into glycogen, the storage form of blood sugar in the muscles and liver. A shortage of potassium results in lower levels of stored glycogen, which can hinder exercise due to the rapid depletion of energy. A potassium deficiency produces great fatigue and muscle weakness, the first signs of potassium deficiency.

 

Excessive fluid loss through sweating, diarrhea or urination is a common cause of potassium deficiency. Athletes, people who regularly exercise, or those working in warm environments can lose up to three grams of potassium a day through perspiration. Diuretic medicines, which are designed to rid the kidneys of excess fluid and help sodium, can also cause potassium deficiencies. Where sodium goes, potassium does too, and so potassium needs to be replenished.

 

The proper potassium and sodium balance in food is important, as is the proper balance of potassium and sodium consumption. One of the most common problems is too much sodium in the diet, thus disrupting the balance. A great many studies demonstrate that a low-potassium, high-sodium diet plays a major role in the development of cancer and cardiovascular disease. A diet low in sodium and high in potassium, not surprisingly, protects against these diseases.

 

Though low potassium levels are associated with high blood pressure, it is not clear if higher potassium levels regulate it. Sodium restriction alone will not improve blood pressure control in most people. It should be accompanied by a high potassium intake. Most Americans ingest twice as much sodium as potassium mostly through prepared foods. Researchers recommend a dietary potassium-to-sodium intake of greater than 5 to 1 to maintain health, a level that is ten times higher than the average intake.

To insure that enough potassium is being received, a natural diet rich in fruits and vegetables high in potassium is strongly recommended including: avocados; bananas; chard; citrus fruits and juices; lentils; milk; almonds, brazil, cashews, peanuts, pecans and walnuts; potatoes; raisins; sardines; spinach; whole-grain cereals.

 

Some of the proven benefits:

 

              Promotes regular heartbeat.

              Promotes normal muscle contraction.

              Regulates transfer of nutrients to cells.

              Maintains water balance in body tissues.

              Preserves or restores normal function of nerve cells, heart cells, skeletal-muscle cells, kidneys, stomach juice secretion.

              Treats potassium deficiency from illness or taking diuretics (water pills), cortisone drugs or digitalis preparations.

 

Some unproved speculated benefits:

 

               Cures alcoholism.

               Cures acne.

               Cures allergies.

               Cures heart disease.

               Helps heal burns.

               Prevents high blood pressure.

 

Special benefits are given to:

               People who take diuretics, cortisone drugs or digitalis preparations.

               Anyone with inadequate caloric or nutritional dietary intake or increased nutritional requirements.

               Older people (over 55 years).

               Pregnant or breast-feeding women.

               Women taking oral contraceptives.

               People who abuse alcohol or other drugs.

               Tobacco smokers.

               People with a chronic wasting illness, excess stress for long periods or who have recently undergone surgery.

               Athletes and workers who participate in vigorous physical activities, especially when endurance is an important aspect of the activity.

               Those with part of the gastrointestinal tract surgically removed.

               People with malabsorption illnesses .

               Those with recent severe burns or injuries.

               Vegetarians.

 

Complications include:

 

               Hypokalemia—abnormally small amounts of potassium ions causing weakness or paralysis due to loss from gastrointestinal tract or kidneys.

               Low blood pressure

               Life-threatening, irregular or rapid heartbeat that can lead to cardiac arrest and death

 

Note well: It is virtually impossible to develop a potassium deficiency with a balanced diet. People with diabetes, ulcerative colitis, Crohn’s or kidney disease are an exception. Potassium supplements should only be taken under your doctor's supervision.

 

Abdominal Noises

--Internet Sources

 

Everyone seems to receive those certain messages from inside our tummy at some time or another. Rumbles, grumbles, growls and howls…these noises come from the abdomen and are sometimes noticed by anyone within hearing distance.

 

Since this happens to everyone, you would think that we could just laugh them off or ignore them. Instead, we are embarrassed. As ostomates, we wonder if something is wrong since it seems to happen more often with us. Or, at least we seem to be more sensitive to it than we were before we had surgery.

 

These abdominal noises are formally named barborygmi (bore-bore-rig-my). If pain accompanies these noises, it could be a sign of an obstruction, an ulcer or a gall bladder problem. It is necessary to see a doctor if these conditions persist. However, it is usual that all these sounds with all there fury really signify nothing important. The cause may be any of the following:

 

                    You are hungry. Peristalsis goes on whether there's anything to move or not.

                    You are nervous. Peristalsis increases with stress.

                    You have been drinking coffee, tea, cola or beer. These also stimulate peristalsis. Since these are often drank on an empty stomach, they produce gurgles as peristalsis redoubles its movement.

 

There is literature about lowering ones cholesterol by eating a high fiber diet. You may have taken this advise and adder these high fiber foods to your diet. Digesting fiber produces gas therefore, abdominal noises will increase. If you wear an appliance, you will notice that it quickly fills with gas, and you are wearing a balloon.

 

Eating too many carbohydrates will also increase gas. Our digestive systems do not digest starches and sugars as easily as protein and fats. The concerns are often lactose, a sugar found in milk and mild products, sorbitol, a sugar free sweetener, and raffinose and stachyose, sugar in dried beans. The result is more gas gurgling.

 

You may be eating too fast, have your mouth open when eating or talking while eating. Your mother always told you it was impolite, but she didn't mention that you would swallow air. Air which makes grumbly noises as it is moved along the digestive tract.

 

To prevent gas eat a snack of healthy fruit or vegetables between meals if your are hungry. You may also eat smaller more frequent meals. And finally, eat slowly, chew your food well and don’t gulp.

 

Electrolyte Replenishing Drink Comparisons

By http://ourworld.compuserve.com/homepage/branded/gatorade.

 

Sports Drinks

 

The problem with some sports drinks is that they have too much carbohydrate(CHO) and that can slow down gastric emptying (and cause you stomach distress). The recommendation has been to keep to drinks that are 8% or less CHO load (or dilute down to that point) to avoid this problem. You can also make your own, as most of these drinks provide fructose and sucrose along with sodium to help you maintain electrolyte balance.   For instance, Gatorade provides 14g of CHO per 8 oz serving, half of what you'd get from the same amount of apple juice.   A diluted mix (1:2 or 1:4 of fruit juice with water) with a few tablespoons of table sugar and a pinch of salt would do it. I have used a mix of 50% apple juice, 50% water, and a squeeze of lime to improve the taste, to limit things to mostly fructose.   I tend to mix Gatorade 50/50 with water, or carry one bottle of each. The key is that you want to like the taste of whatever you're drinking to be sure that you keep drinking - and stay hydrated! Here are some typical products I have found some data on (some specialize in adding potassium, calcium, chloride, magnesium, or vitamins):

 

Values for 8 oz serving (~225 ml)

Drink                 %CHO         sodium mg         potassium mg

Quickick 5 115 25

Gatorade 6 110 25

Gatorlode 20 low n/a

10-k 6 55 25

Endura 6 90 180

ThirstAde 6 110 25
Everlast  6 100 20             Hydra Fuel 7 25 50               
Exceed 7.5 50 45

Exceed Hi Carb  26 115 n/a
PowerAde 8 70 30             Pro Motion 8 8 100             
Allsport 9 55 55                   
Cytomax  11 100 200              Gookinaid 12 70 70

 

The higher percentage products are often intended for after exercise recovery of your lost glycogen stores (studies have shown that glycogen levels in the muscles reach normal quicker if you do carbo loading after a workout).

 

Editors note: The home-made drink does not appear to have much potassium, an important thing for ostomates.   The 6% to 8% CHO (carbohydrates) has been proven by studies to be the most effective in getting rapidly from your bloodstream, across the capillary walls, to the muscles, etc. Up around 12% CHO, it actually impedes rapid crossing from the bloodstream into your body and happens at a much slower rate with less efficiency.           

 

Some Food Facts for Ileostomates

By Dr. Phillip Kramer

 

For ileostomates, it's important to know the effects of various foods on ileal output.

 

Dr. Phillip Kramer of Boston University's School of Medicine has conducted 224 studies of ileostomates, exploring exactly that. Here's a summary of what he found:

 

        The average output per day from an ileostomy is about a pint, comprised 90% of water and IO% of solids. Normal fecal matter is 70% water and 30% solids. Fat and nitrogen content of ileal discharge is normal, indicating food absorption in an ileostomate is normal. Salt output is very high, around one tsp. per day, versus almost none in the feces of a person with an intact colon. Proper intake of salt by an ileostomate is therefore very important.

 

        Intake of too much salt is to be avoided because it increases ileal output. The body itself seems to compensate for salt and water loss by discharging less salt and water than normal through urination and perspiration.

 

        Above-normal water intake is needed to minimize potential for kidney stone development, because urine output is usually subnormal in an ileostomate.

 

        One of Dr. Kramer's studies involved high intake of water, up to 3.5 quarts per day. At this high level, ileal output was unchanged, but urine output increased.

 

        Some foods tested in Dr. Kramer's studies produced no increase in ileal output. They are: dark rye bread, milk, cottage cheese, pork, apple juice, grape juice, watermelons and cantaloupe. Some foods which increased output were: prunes, raw figs, dates, stewed apricots, strawberries, grapes, bananas, beans and cabbage.

 

Toffee Gums Up the Ostomy

By The New Outlook, Chicago's North Suburban Chapter UOA

   

I wanted a sugar fix and went out and bought lots and lots of nice soft toffees.

 

Alas, after having to change my flange 5 times in 48 hours, I realized the toffees had gummed up the works. That is to be taken literally and figuratively.

 

Yes, my system was stressed. The stoma was stretched and bleeding. It also exhausted me, and I spent most of the of that day lying down.   I hope this warning prevents some of you ostomates from going through the pain and frustration that I went through before I clued into the fact that the problem was the toffee.

 

Oh well, I did enjoy them but never again.

 

Editors note: Many of us continue to eat toffee. The problem comes in when you eat too much for your system to handle. Also, you should always drink water whenever you eat anything. This is more true for ileostomates than colostomates or urostomates. In our new life we must never overeat. Some test this and get away with overeating because the foods they eat are safe for their system and pass right through. Eventually, they will overeat something like toffee. That is when they have problems. They blame the food and not their own eating habits. I don't mean to be insensitive. I do want you to live a full live without any pain or problems with your ostomy. Maybe if I make a warning stern enough, it will save just one person from this.

 

Quick Food Reference

By Jason Dale, United Kingdom

 

After you have had a stoma operation you may find certain foods affect you in ways they didn't before. This can be embarrassing at times and it helps if you know which food can do what to your system. This table is designed to help you find problems foods, and either avoid them or moderate your intake.

 

Remember that we are all different though, if it affects me for example, it may not affect you. Don't be afraid to try new foods, we are all different. Read the key so that you can see how foods affect you. This table is designed for colostomy, ileostomy and urostomy patients.

 

F = May cause flatus
O = May cause odor
L = May cause loose stool
C = Requires chewing well
D = May discolor urine

Col = Colostomy patients
Ileo = Ileostomy patients
Uro = Urostomy patients

 

Food & Drink                    Col                Ileo                    Ur
------------------------------------------------------------------------------
Apples                                                       L
Apricots                                                    L
Artichokes                            F
Asparagus                                                F                           O
Bananas                                F                 F
Beans (all types)                  FLO            FLO
Beef                                                          C
Beer                                     F                   F
Beetroot                                                                                D
Broccoli                               O                  FO
Brussel Sprouts                                       F
Bean Sprouts                       L
Bamboo Shoots                   L

Food & Drink                    Col                Ileo                    Ur
------------------------------------------------------------------------------
Cabbage                               F                  LF
Cauliflower                           FO               FO
Cereals                                                     L
Cheese                                                     O
Celery                                                       L
Chocolate                             L                  L
Coconut                                                    CL
Coleslaw                                                   C
Cucumber                            F                   OF
Curry                                   LF                 LF
Eggs                                                          OF
Figs                                     L                    L
Fish                                                           O                        O
Fizzy drinks                        F                    F
Gooseberries                                            L

Food & Drink                    Col                Ileo                    Ur
------------------------------------------------------------------------------
Grapes                                                     LC
Kiwi Fruit                                                 L
Lamb                                                        C
Lettuce                                                     L
Mango                                                      L
Mushrooms                         F                   F
Nuts (all types)                    C                  C
Oil based salad dressing     L                  L
Oranges                                                    L
Onions                                 OF                OLF
Parsnips                              O                  O
Peas                                                          L
Pears                                   L                   L
Pineapple                                                  LC
Plums                                                        L

Food & Drink                    Col                Ileo                    Ur
------------------------------------------------------------------------------
Popcorn                                                    L
Porridge                                                   L
Potatoes                                                   C
Prunes                                 L                   L
Radishes                             F                   F
Raspberries                                             LC
Rhubarb                              L                   L
Seafood                                                    O                         O
Spinach                                LF                L
Spring Greens                                         O
Strawberries                                            L
Sweet corn                          L                  LF
Tomatoes                                                L
Turnip                                O                   O

 

The Affect of Fiber

By Kay L. Peck, MPH

 

Whether or not to include fiber and to what extent should be based on the ostomates tolerance of foods. The intestine has a remarkable capacity to adapt. Digested food in the small intestine is quite watery. After it moves into the large intestine, a good portion of the water is re-absorbed into the body.

 

Most fiber is indigestible material from plants that acts like a sponge, soaking up water and increasing the bulk of the intestinal contents. This makes matter move through the system more quickly.

 

In a person with a colon, fiber is essential to preventing constipation and keeping a person regular. This is the main function of fiber. Another theory about fiber is that it promotes mucosa growth thus keeping the intestines healthier and promoting gut function.

 

Usually a person without a colon doesn't have a problem with constipation and may have mostly watery stools. Over time a person may adapt, especially if the last section of the small bowel, the ileum, is still intact.

Consuming too much fiber, that is insoluble fiber, may aggravate a person's watery stool. If this is the case, limiting insoluble fiber such as bran, popcorn hulls, seeds, nuts, skins and stringy parts of fruits and vegetables may be helpful.

 

However, another type of fiber, that is soluble, may be beneficial. The function of soluble fiber is to make intestinal contents thicker. This can actually prevent diarrhea.

This fiber is found in oatmeal, barley, certain beans, apple sauce, and the pulp of certain fruits and vegetables. Most foods have a combination of both types of fiber.

 

Editor's note: Ileostomates and some colostomates must be careful not to over eat certain types of fiber. These will cause a blockage at the stoma. Always moderate your eating, and drink plenty of liquids to keeps these foods soft while being digested. This article is suppose to encourage ostomates to eat fruits and vegetables.

 

Fat Substitutes

Contributed by Jane Michnik

 

Individuals using products with fat substitutes rarely lose weight, researchers say. Their report in Circulation: Journal of the American Heart Association notes than more than 90 percent of U.S. adults report eating low or reduced-fat foods and drinks, many of them made with fat substitutes.

 

“Yet the number of overweight individuals continues to increase," said Judith Wylie-Rosett, a member of AHA’s Nutrition Committee. Fat substitutes are compounds used in place of fat to provide food with the moisture retention and texture that usually come from fat. "The bottom line is that foods made with fat substitutes, used in moderation, may provide some flexibility in food selection, but are not an effective strategy on their own for weight control.

 

Often, reduced-fat versions of products have the same or even more calories than their full-fat versions," said Wylie-Rosett, a professor of epidemiology and social medicine at the Albert Einstein College of Medicine in New York. Fat substitutes have contributed to the overall trend of less fat in the U.S. diet, she notes. Americans have nearly met the government's population-wide goal of reducing fat consumption to no more than 30 percent of total calories.

 

A 1988-1991 government survey showed that Americans consumed about 34 percent of total calories from fat, compared to 40 to 42 percent of total calories in the 1950s. "We've done well in getting out the message about reducing fat intake," Wylie-Rosett said. "Now we must put the emphasis on obesity, which has doubled in the last 20 years.”

 

Hydrox Fecalis

--Tufts University, Diet and Nutrition Letter

 

Dark Bowel movements are met with alarm by physicians and patients alike, particularly when they coincide with stomach aches. The blackish color can be a sign of serious illness.

 

The greatest concern is that it is a sign of blood loss from some internal organ. But, an editorial report in the New England Journal of Medicine suggests that black stool may simply be the result of overindulgence in Hydrox-type cookies.

 

Stephen Sulkes, MD of Monroe Developmental Disabilities Service Office in Rochester, NY, reports on a presence of black stool movements and abdominal pain be questioned about their dietary habits.

 

Dr. Sulkes states that tests with other cookies, including oatmeal, peanut butter and chocolate chip, have not caused bowel color change, "although abdominal pain or nausea or both appear to be equally frequent associations" and suggests that people complaining of dark stool movements and abdominal pain be questioned about their dietary habits.

 

So, if you go on a binge of eating chocolate sandwich cookies or other dietary components, including licorice, certain fruits, and iron supplements. (these can also give you black stools) be prepared.

 

Eat Sensibly with an Ileostomy

--The Good News, Macomb County Michigan

 

Say it has been several months since you had your ileostomy surgery, and now you are beginning to adapt to your new plumbing. You have a beautiful stoma, and changing your ostomy system is almost routine. Your skin has now become accustom to the skin barrier, and you wear you appliance about five days before changing it.

Boy, this is living! No more pain, and you can go out without worrying about finding the location of every toilet. You accept an invitation to a party for the first time in two years and really enjoy being out with you friends again.

You drink with freedom and down handfuls of peanuts. You wander to the table set with raw vegetables and dip and join in. The dinner is delicious, including the corn. This has been a truly good night—just like old times.

Now, it’s two o’clock in the morning and you haven’t been able to sleep. There has been a persistent pain around your stoma that won’t let you sleep. And now it is increasing.

You recall that you have not had much effluent in your pouch and what you did have looked like dirty water. By three o’clock, it is much worse and be four o’clock you are considering calling your doctor. But, you decide to wait just a little longer.

You remember remedies that were mentioned at a Chapter meeting. You drink some hot tea; pull your knees to your chest and rock back and forth. You drink some more and get on your hands and knees and rock. You eat some crackers, drink more tea and knead your stomach.

You drink some more hot tea while getting into the shower to let the warm water roll down your back. You’re about to remove your barrier to let your stoma expand when things seem to ease up a bit, and then you notice that your pouch is not longer empty.

When you finally empty your pouch, it’s like pouring a bag mixed with peanuts, vegetables and corn into the toilet. You have learned a valuable lesson. You may be able to eat nuts, popcorn, raw vegetables, or even corn-on-the-cob, but common sense will tell you that in the future not to eat large quantities of them all at the same time. The moral of this story is:

        Never overeat

        Eat high fiber foods only in moderation

        Chew...chew...chew!

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