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Enjoying your food again: diet after stoma reversal
Barbara Engel DietitianBarbara.engel@centralsurreyhealth.nhs.
uk
liver
Sites for absorption of nutrients
• 9 litres of fluid pass through the duodenum each day of which only 1.5L reaches the colon
stomach duodenum jejunum ileum Ascending colon
minerals Water sol vits
sugars
Vits A & D Bile salts Water, sodium, potassium, vits
Fats Vit B12
Water & sodium
Amino acids
Why is the Intestine important?
• ‘The intestinal tract contains the body's largest interface between a person and his or her external environment’. [Farhedi 2003]
• It acts as:– a filter which allows selected nutrients to pass through – a barrier to prevent the penetration of harmful
microorganisms & chemicals
Small Intestine: nutrients from food are digested and absorbed here as food is moved through by peristalsis.
Large Intestine: absorbs water and electrolytes, (sodium, calcium, and potassium). Home for bacteria…
liver
Low residue diet
• Doctors often have their patients follow a low-residue diet the first weeks after any abdominal surgery.
• This includes only foods that are easily digested and don't leave much waste behind,
• When going back to foods you have not eaten since surgery, try one new food a day. Keep a food and symptom log. – if they seem to cause symptoms, try them again
in 2-3 weeks. Record results. Eventually you should be able to have a full and varied diet.
Reintroducing foods…• ‘It took about 6 mos for me to eat fresh fruits and
vegetables without them speeding through my system. It takes time for the body to slow down. Some foods work better than others, peanut butter made me worse as did applesauce, however others have had great results with them. Keep a food log. Try new foods, if they don't work, try them again in 2-3 weeks. Log results. Eventually you should be able to have a full and varied diet. I live on fresh fruits and vegetables now but it took a while to achieve this. As for weight loss you can try bulking up by using powders or drinking high calorie shake drinks. They make them dairy-free so you should be able to tolerate them’.
• ‘I had the reversal ileostomy 10 weeks ago just like Cathy and I eat everything’.
• ‘Certain foods like salad and chinese do go through a bit quicker, and curry and chilli do cause some bottom burning for a day or so, but I still eat them. I take 10ml of immodium syrup before bed but thats all’.
Foods and drinks that may cause loose stools:
May be caused by;• Very large meals• Spicy meals• Soup• chocolate, liqourice, Drinks:• apple juice, prune juice • Red wine• beer • milk • Tea & coffee
Vegetables & Fruit• baked beans, Dried
beans • green beans • spinach • cabbage • broccoli • raw fruit
Relieving diarrhoea
May be helped by:• Apple sauce• Peanut butter (smooth)• Bananas• Rice / pasta / potatoes• Tapioca• marshmallows, pretzels• jelly• Boiled milk, eggs• Drink plenty; bouillon, ginger ale, Weak tea
Wind
Eat regularly; missing meals can use gas build upAvoid swallowing air; relax, take your time and don’t talk with your mouth fullAvoid chewing gum or drinking through a straw
Foods that may cause gas and odour:
• Alcohol; beer • carbonated or caffiene
beverages • Sorbitol
• Eggs; meringues
• fish • strong flavored cheeses • spiced foods • fatty foods (pastries/deep
fried foods)
• Melons, apricots, banana • asparagus • cabbage family , brussels,
broccoli• cauliflower• dried beans and peas ,
baked beans• Radishes, onions,
Cucumbers• pickles • mustard
• Milk, nuts
buttermilk, parsley and yogurt may reduce the odour
Relieving constipation
• Increase liquids• Eat high fibre foods; fruit (chew well),
veg – raw & cooked, • Wholemeal breads and cereals
(oatmeal, wheat flakes, branflakes)• Coffee, chocolate, lemon juice,
liqourice, prune juice• Exercise
FOODS WHICH MAY CONTRIBUTE TO ANAL
IRRITATION
• certain raw fruits and vegetables (e.g., oranges, apples, coleslaw, celery and corn)
• popcorn • Chinese/oriental vegetables • nuts • coconut • dried fruits (e.g. raisins, figs) • food with seeds • spicy foods
Probiotics: protective bacteriaDefinitions; 1. Live micro-organisms which when administered
in adequate amounts confer health benefits on the host (WHO / FAO 2002)
• They must remain viable during their passage through the gut
• Usually representative of species present in infants; Lactobacillus, Bifidobacterium, yeast Saccharomyces boulardii
• Safe; by virtue of their long use in fermented diary products
Protective bacteriaFerment dietary fibres & complex starches in food
in the colon resulting in:• short chain fatty acids; increase sodium,
potassium uptake in the large intestine • energy provider for colon cells • Can produce gases (the down side!),• also some vitamins B12, K• may alleviate symptoms of lactose (milk sugar)
intolerance• Reduce inflammation• Improve Bile salt metabolism; these may have
an irritant effect on the bowel• Probiotics associated with decreased reduction
in rate of progression of colon cancer in some small studies
How to achieve a Balanced Diet
• aim to have less than 6g of salt per day
• Aim to consume around 2 litres of fluid a day
FRUIT AND VEGETABLESSTARCHY FOODS
e.g. bread, rice, potatoes, pasta, cereals
MEAT, FISH, EGGS, BEANSi.e. protein containing foods
MILK AND DAIRY FOODSe.g. cheese, yoghurt,
fromage fraisFOOD/DRINK HIGH IN FAT AND/OR SUGAR
Eatwell plate
• This plate, demonstrates how to achieve a healthy balanced diet. As you can see the two biggest sections are Fruit and Vegetables, and bread, rice, potatoes and pasta, each contributing a third to the plate. The meat, fish, eggs and beans section and milk and dairy foods contribute smaller amounts to the plate.
• Some of you may be disappointed to see that foods high in fat and sugar take up the smallest section on the plate!!
• In addition to the plate you should ensure you do not consume more than 6g per day. Salt is found mainly in processed and pre-prepared foods so try to avoid too many of these and minimise the amount of salt you add at the table.
• Fluid intake is also crucial to a healthy diet and you should aim for about 1.5 to 2 litres a day
Summary– Eat a balanced varied diet. i.e. food choices
from all food groups
– Eat slowly and chew your food well. – Drink plenty of fluids each day. (i.e. ~ 8
cups of fluid per day) – Add foods to your diet gradually to see how
your body responds. – Any queries you can email me
barbara.engel@centralsurreyhealth.nhs.uk
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