Enjoying your food again: diet after stoma reversal

1. Enjoying your food again: diet after stoma reversal Barbara Engel Dietitian Barbara.engel@centralsurreyhealth.nhs.uk

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3. 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

4. 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…

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6. 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. 

7. 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’.

8. 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 Foods and drinks that may cause loose stools:

9. 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

10. Wind Eat regularly; missing meals can use gas build up Avoid swallowing air; relax, take your time and don’t talk with your mouth full Avoid chewing gum or drinking through a straw

11. 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 Foods that may cause gas and odour: buttermilk, parsley and yogurt may reduce the odour

12. 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

13. 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

14. Probiotics: protective bacteria Definitions; • 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

15. Protective bacteria Ferment 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

16. aim to have less than 6g of salt per day • Aim to consume around 2 litres of fluid a day How to achieve a Balanced Diet STARCHY FOODS e.g. bread, rice, potatoes, pasta, cereals FRUIT AND VEGETABLES MEAT, FISH, EGGS, BEANS i.e. protein containing foods MILK AND DAIRY FOODS e.g. cheese, yoghurt, fromage frais FOOD/DRINK HIGH IN FAT AND/OR SUGAR

17. 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

18. 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