To date, dietary recommendations for people with ostomies are derived primarily from direct interviews with ostomates regarding problematic food choices, as well as the clinician’s experiences with people and their dietary problems. Each individual responds differently to surgery and the recovery process. Hence, each person should experiment with food choices and gradually add new foods in their diet to determine the effect on their ostomy function.

Results from a survey done on a target population of ostomates showed that 88% (n=526) reported that they they were not strictly following a special diet catered to their ostomy. Nevertheless, 61% of the participants said that they avoided certain foods because of their ostomy. These foods were avoided because they affected the ostomy by increasing output, blockage and gas. Of this population of ostomates, 71%; n=424 had colon cancer and the most common type of ostomy was a colostomy.

After surgery, the intestinal tract is edematous and sensitive to food. High-fibre foods can cause blockage because of the narrowed edematous intestinal lumen. Consumption of milk, milk products, and high-fat foods should be limited because they may cause increased intestinal gas, bloating and diarrhea.

When the intestinal edema reduces in about 6 to 8 weeks; a regular diet can be resumed. Specific foods can be added one at a time to monitor their effect on the ostomy. Keeping a food journal may help in identifying suitable foods and foods that are problematic to an ostomate. For the first year of recovery from surgery (especially if one has a long history with his disease), adding a multivitamin supplement may help in replenishing nutrients that were lost, in order to maintain healthy bodily function. Eating a variety of foods from the major food groups is also recommended.

An ostomate should eat at regular intervals. Increased meal frequency with smaller meals may help in reducing flatus and watery stools. Skipping meals increases the incidence of watery stools and does not stop output. Eating slows down output via the ostomy. Limiting foods and fluids in the evening improves uninterrupted sleep.

Lactose intolerance is common. Incidences of gas, abdominal bloating, increased liquid output or diarrhea 10 minutes to several hours after intake of dairy products can be managed by discontinuing them for a few days. Once the diarrhea stops, milk, one ounce at a time, can be added to determine the tolerated amount. Lactose-free milk, soy milk (may cause gas), rice milk or taking lactase tablets for lactose digestion may help to overcome lactose intolerance.

Intake of a variety of fats, monounsaturated (olive oil, canola oil), polyunsaturated (omega-3) and saturated fats in small amounts is recommended.

Dietary tips for individuals with a colostomy:

-	Eat regularly. Empty bowels produce gas.
-	When adding new foods to the diet, try in small amounts with other foods.
-	Take small frequent meals. Chew thoroughly.
-	Rice, potatoes or pasta once daily may reduce frequency and irritation.
-	High potassium foods will help offset effects of diarrhea.
-	Limit foods containing simple sugars, they aggravate diarrhea.
-	Drink 6 to 8 glasses of fluid each day- but not with meals.

Chang Yok Ying
Senior pharmacist
30/10/06

References
JWOCN vol 28 no.1Dietary choices of people with ostomies
United Ostomy Assoc Diet & Nutrition Guide 2002