Nutrition Guide for People with Ostomies
by Kathy B. Glazer, MS, RD, LD
As a cancer survivor, registered dietitian, and cancer caregiver, I happen to know a lot about nutrition for people with ostomies, personally and professionally. It has been five years since my husband had colorectal cancer and a subsequent ostomy. Here are some things I’ve learned.
Basic Diet Principles
- Tolerance of food can be determined on an individual basis by trial and error.
- It is important to consume adequate calories, protein, fluid, and electrolytes (sodium, potassium).
- Try eating small frequent meals at first.
- Drink liquids with meals to prevent obstructions.
- Monitor lactose intolerance. Try yogurt, hard cheeses, and soy milk instead of cow’s milk.
- Restrict food high in oxalates to avoid kidney stones. These include beans, beer, beets, carob, cocoa, dark leafy greens, instant tea, coffee, nuts, sweet potatoes, tofu, wheat bran, whole wheat flour, and wheat germ.
- Drink hydration drinks if diarrhea occurs.
- It’s important to get enough fluid since the large intestine is normally where a lot of fluid is reabsorbed.
Aim for 8 to 10 glasses of liquid a day, or 64 to 80 ounces.
Watch What You Eat
- Foods that may cause diarrhea include spicy foods; high fat foods; foods with added sugar; and prune, grape, and apple juice.
- Foods that may cause odors include alcohol, asparagus, brussel sprouts, dried beans and peas, eggs, fish, garlic, onions, and cabbage.
- Foods that may decrease odors include buttermilk, yogurt, kefir, parsley, and cranberry juice.
- Foods that may thicken the stool include applesauce, cheese, pasta, potatoes, rice pectin, smooth peanut butter, and marshmallows.
- Foods that may cause an obstruction include unpeeled apples, corn, raw cabbage, coleslaw, celery, mushrooms, peas, bean sprouts, bamboo shoots, coconut, dried fruit, whole grapes, nuts, and popcorn seeds.
- Aim for 8 to 10 glasses of liquid a day, or 64 to 80 ounces.
- Drink more when you sweat, have diarrhea, or lose extra fluid.
- Drink decaffeinated coffee and tea and non-carbonated beverages.
Signs & Symptoms of Dehydration
It’s important for people with ostomies and their families to know the signs and symptoms of dehydration. Here is what to look for.
- When the body has lost 2 percent of its total fluid, you may experience thirst, loss of appetite, dry skin, skin flushing, dark colored urine, dry mouth, fatigue or weakness, chills, and head rushes.
- When the body has lost 5 percent of its total fluid, you may experience increased heart rate, increased respiration, decreased sweating, decreased urination, increased body temperature, extreme fatigue, muscle cramps, headaches, nausea, and tingling of the limbs.
- When the body has lost 10 percent of its total fluid, you may experience muscle spasms, vomiting, racing pulse, shriveled skin, dim vision, painful urination, confusion, difficulty breathing, seizures, chest and abdominal pain, and unconsciousness. If this occurs, call for emergency help.
Treatment for Dehydration
- Drink small sips of water, sports drinks, or hydration drinks very slowly.
- Eating salty foods may make a person more dehydrated. You need fluid to digest the food.
- With severe symptoms, get medical attention immediately.
- Severe dehydration may require IV fluids to rehydrate.
General Dos & Don’ts
- Swallowing air can cause gas. Avoid chewing gum, drinking with a straw, carbonated beverages, smoking, chewing tobacco, and eating quickly. Take small bites of food and chew them thoroughly.
- Maintain a regular schedule of small, frequent meals and snacks instead of large meals.
- Eat your largest meal at midday. This may help decrease stool output at night.
- Eat well-cooked vegetables without seeds and small amounts of lettuce, and drink strained fruit and vegetable juices.
- Eat ripe bananas and avocado, citrus fruit without membrane, soft melons, watermelon, honeydew, peeled or cooked apple, and canned fruit. Avoid pineapple.
- Take a daily multivitamin.
- Try a probiotic for gastrointestinal health, for example, DanActive™ yogurt.
- Keep a food log to track what foods you can tolerate.
- A willingness to experiment and a sense of humor can go a long way.
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Kathy Glazer is a registered dietitian in private practice in Virginia and Washington, D.C. She also is the director of Nutrition for the George Washington University Weight Management Program.
This article was published in Coping® with Cancer magazine, March/April 2009.