Safe snacks for ileostomy patients?

Finding it hard to find snacks that won't cause loose output.

Is it safe for a recent stoma patient (ileostomy) to eat sausage rolls or pies similar to scotch pies?

I'm finding it hard to plan what to offer that won't upset the output.

Thanks!

Hi Jubilee,

I tend to think the word "sausage" is taboo to many ostomates. Not because it makes stools loose, but rather it is hard to digest and can cause blockages. I think it's pretty normal for a recent ostomate to have loose stools for days to weeks post-op, as the bowels come out of surgical shock and start to adapt to their new normal. But others will chime in for sure, so hang tight for just a bit and I'm sure you'll get lots of good advice.

Regards,

Bob

Hello Jubilee.

Having read many post on this subject over the years ( some of which you can find in the 'Collections' section) it seems that we are all different in what we can and cannot eat when it comes to output. The most consistent advice seems to be to masticate (chew) the food as much as you can before swallowing. As for what we eat, it's probably a matter of trial and error (mostly error)., and even when we have found what is and isn't suitable, this can change over time so, don't think that the game is over!  For my own part, I just tried different foods that I fancied, one at a time, so that I could tell what effect they were having. Nowadays I can eat more or less what I 'like'- NB. I am vegetarian, so cannot really comment on meat products. 

Best wishes

Bill 

Thank you both for replies.

I guess it will be a case of trial and error and tolerance of foods different for all.

I had read that the sausage casing was to be avoided but I thought perhaps sausage meat was used in most sausage rolls.

Just racking my brain for snacks.

Many thanks.

Regards.

Jubilee.

Another question but regarding drinks.

Does anyone with an ileostomy drink kefir? Is it beneficial?

Hi Jubilee, if you're worried about loose output, why not snack on foods that thicken it like peanut butter on crackers or applesauce, bananas, etc.? I occasionally eat a slice of summer sausage, but like Bill says, chew real well and with a couple of crackers, it ends up being quite thick output. But it also depends on how much fluids you drink during the day. I keep a glass of water handy and sip on that during the day, plus other fluids with meals. Good luck.

I would eat sausage rolls, pies, and have done so after any recent surgery, and never had any problems. My usual thing to eat after surgery is a ham salad baguette. I have been told once or twice by my doctors and nurses that I have a cast iron stomach, lol.

The first thing to do is throw those foods to avoid lists in the bin! They do more harm than good, giving people a fear of foods for no reason. It's normal for the first month or two to have loose output, so it's probably nothing to do with what you've eaten, but yes, very annoying. Try anything you want to eat or drink in small amounts and always try it at least three times. Come back to it in a few weeks/months' time to see how it goes through and out again before giving up on it.

Ron, as snacks, peanut butter on cream crackers is frequently eaten. As is banana and yogurt for dessert.

Cheese on cream crackers or Tuc biscuits as a snack, both cream and solid cheese.

Toast also!

I have been wondering if perhaps the Vitamin drink could cause the loose output; https://www.tesco.com/groceries/en-GB/products/278002866

To just supplement the loss of salts, I've been adding this drink as it has potassium.

I'm stumped, really, but surgery was just 5 weeks ago!

Thanks Panther.

I'm trying to follow the suggested foods via the booklet I got at the hospital.

It's all so new but I have to learn fast as it's not convenient to have lots of bag emptying.

Hi Jubes,

I've done the Kefir thing... didn't see any difference one way or the other. It's supposed to be a really good food... gets into the probiotics arena... so if it works then go for it. I can't tell from your post if you're the ostomate or if you're caring for one. Not that it really matters. If the goal is simply reduced output it goes to managing expectations. If the ileostomy was simply a disconnecting from the colon and routing it out to the new front-butt, meaning the small bowel is fully intact and full length, then post surgery the bowel will be in shock and there will be significant output for some time period (days to weeks). If any small bowel was removed then the output frequency will equate to the length left. As you lose more and more small bowel your output will get more liquidy. There just isn't enough absorbent material there. What you eat and when you eat it also play a role. If you can reduce what you drink... your output will solidify. If you can hold off drinking with your meal for 15 minutes or so... it will reduce the liquidity of the output. What you drink is also key. So there's lots to think about... which ultimately drives you to a "trial and error" approach, as many have indicated. Low residue foods are considered those that produce the least waste... but they're all high fiber, which may or may not be an issue, depending on the underlying conditions, if any. Sorry there's no real easy answer for you.

Regards,

Bob

Thanks Bob.

Worry about trying Kefir just in case it could add to the output, but wondered if others with an ileostomy had tried it and what the results were.

It's an end ileostomy but reversible, not sure how different that is to a loop one in dietary terms, just hoping it will settle and have less output.

I'll keep checking in to the forum for tips and advice from others as I learn.

Regards,

Jube

Good afternoon, Jubilee.

Certainly take your time experimenting with different foods, consistencies, fiber levels, etc. Introduce new items slowly and pay attention to how your body reacts.

On the savory side of things:

Consider adding a small can of regular V-8 juice (not the low-sodium version) to the cheese/cream cheese on crackers snacks.

Regular V-8 juice is high in potassium and sodium. Many of us ileostomates need more salt to help increase our thirst, help our body's cells retain fluids, and prevent dehydration & kidney issues. And the juice may provide enough liquid to help thin out sticky cheeses and dry crackers. Take intentional sips while munching on a favorite treat, as intestinal blockages are not fun...

If V-8 is not available, purchase some tomato juice, and add other savory items to increase flavor: Worcestershire sauce, hot sauce, garlic and/or onion powder, ground black pepper, celery salt. Have you ever had a Bloody Mary? It's the same concept, but no alcohol. And I have been known to supplement the tomato juice with seasonings, then add things like garlic-stuffed green olives, green onion, chopped cherry tomato, bell pepper slices, celery sticks, cauliflower florets...I mean, by the time I'm done, I basically have a "salad in a glass". (A HUGE glass!) Just be sure to chew all that fiber very well.

I also enjoy hummus with pita chips, and either a V-8 or another beverage to help with the sticky consistency. But it's a very healthy snacking option. :)

Hard-boiled eggs with a touch of salt are another great snack, as are tortilla chips with guacamole and/or salsa, or chicken or tuna salad on crackers.

Be well! :)

Lily17

Thank you, Lily, for more advice.

We have found that adding onions caused gas, so try and avoid those unless the recipe really requires them.

Salted plain crisps and pretzels are also on hand for nibbles while watching TV.

Eggs, both scrambled and boiled, are tolerated well.

As the problem is loose output, I thought I would thicken the output.

Main meals are now at lunchtime, with the later meal being more snackish like sandwiches or a boiled egg with toast or cheese on toast, despite all those variations being recommended as suitable output is fast and loose.

It's going to be a difficult learning curve, I think.

It's going to be a learning curve, but a difficult one, I think.

Thanks, all.

Jubilee

Change your diet to make it best fit the body's needs and reactions, certainly.

Also be aware of how fluids are taken in: As per my surgeon's sober advice, sip, sip, sip fluids - all day long. Gulping or chugging drinks does not allow the remaining GI tract to absorb what has been consumed - most of what is gulped goes right through to the pouch. Sipping often over the course of the day will allow the small intestine to more effectively take in liquids.

It's been 5 weeks, and it may take more time for the small intestine to "learn" its new role - absorbing more liquids now that the colon is gone. Try to be patient, gracious with the body as it adapts. :)

Lily17

Lily17-

I hadn't realized that one had to just sip. Good advice. I just thought that with output so runny, one had to replace fluids, so to drink lots.

Thank you for all the advice. It's much appreciated.

Jubilee

Another question.

Is an all cheese pizza advisable?

Good morning, Jubilee

Ileostomates can drink a lot, just a little at a time.   : )

Oh, I do hope that this information makes a positive difference!   And, you are so welcome.   : )

Make it an amazing day!

Lily17

Jubilee,

Now, not everyone may reply this way: My concern would be the sticky nature of the cheese and density/doughiness of the crust. If I did have a piece of all-cheese pizza, I'd be sure to sip a lot of fluid between small bites of the pizza, and chew the heck out of the pizza before swallowing. The combination of fluid and thoroughly chewing the food can help prevent intestinal blockages.

I actually prefer a combo pizza, so I have fewer issues with the cheese & crust because their ratio in a mouthful is reduced with the meat and veggies (fiber). Erring on the side of caution, I still sip & chew - A LOT. :)

Lily17

Hi Jubes,

Ok, you're swimming in slightly different waters when you talk about liquids. With an ileo, your colon is now out of the picture. And your colon is where most water and other liquids are absorbed, or re-absorbed, back into the body to keep you hydrated. Without your colon, you need to modify WHAT you drink and how much at one time, as Lily was alluding to. Your small intestine can't absorb water, as that's not what it was designed to do. Or maybe I should say it can't absorb all the water your colon could. Things change as you travel down the length of the small bowel, and the end can absorb better than the beginning. This hydration thing gets a little ugly, and I can explain in excruciating detail some other time, but the simple version is this: your small bowel only absorbs water if that water molecule is attached to the right amount of glucose (sugar) and sodium (salt). That's because the wall of the small bowel is a semi-permeable membrane that only allows stuff to pass through it if that stuff contains the glucose and sodium in the right ratio. The small bowel is there to absorb nutrients, and liquids containing nutrients........not plain water. So anything attached to that right amount of sodium and glucose will also be allowed to pass through the membrane on the back of the sodium and glucose molecules........and enter the bloodstream. If that's a water molecule......you get hydrated. But there's a downside as well. Because the small bowel is looking for stuff with that specific ratio of sodium and glucose......if you drink something with too much of those, it will actually pull water FROM your body to try to dilute that stuff down into the right ratio that it can absorb. Which means if you drink a very sugary water-based drink........like Coke or Gatorade.....you'll actually get more dehydrated than less! Because the body will start dumping water you have in you into the bowels to dilute the drink, but that stuff has so much sugar it won't get to the right ratio, and just keep traveling down your bowel........with all your precious water.........right into your bag. Again, this is also a function of bowel length, so if you have your full small bowel intact you may be ok......but tread lightly here. Many folks have gotten dangerously dehydrated by drinking lots and lots of water with an ostomy!

This is where Oral Rehydration Solutions or ORS come into play. These were developed to be absorbed by the small bowel directly..........but usually taste like sea water mixed with sugar. After all, they're only salt, water, and sugar. But there are ways to improve the taste, and I actually LOVE the stuff now. But I make it my way after years of experimenting and finding out what works for me. Your mileage may vary. If you Google Oral Rehydration Solution, you'll find more info than you care to read. You can also go to the WHO (World Health Organization) site as well.

So depending on the length of small bowel remaining, you may or may not have an issue with hydration and have to be careful what you drink. And when I say length......I mean intact, non-diseased length, just so we're clear. I like to think of the bowel wall in terms of surface area. The longer the bowel, the more area for absorption, and the more individual holes in the wall for things to absorb through. If all those holes are full of food, there's no way any liquid can get past. So folks with very short lengths of small bowel need to space out their drinking and eating and try not to do both at the same time.....because anything that doesn't find an open hole just keeps flowing downstream into your bag. So..........aren't you glad you asked????

Take care,

Bob

Hi, Bob

That's a lot of info! How'd you get so smart? And, why aren't you going to medical school? )

Lily17

Bob

That sure is a lot of info about drinking and keeping hydrated.

I need to try and absorb all of this. The only trouble with drinking anything with glucose is being diabetic, one has to be careful of their sugar intake. Tried the more vits drinks available in Tesco that seemed to have potassium but low in sugar, yet they seemed to make output more watery. But such a nice change from bottled water.

Lily17, thanks for info re pizza. I thought it might be a good snack option. Cheese on toast seems to be tolerated, so I guess that will have to be the pizza. Weight gain is needed, but it seems with the restricted diet this is going to be difficult.

Thanks all. I do have a lot to learn.

Jubilee

I don't know if you've tried any beverages/foods with artificial sweeteners, but I advise against it. The human GI tract was not meant to process those chemicals. My GI tract's response to it was diarrhea, unfortunately, which is the body's way of saying, "Get OUT!" (How many others of our membership have experienced that reaction to artificial sweeteners? Raise your hands...)

And please consider consulting a qualified dietician to receive guidance for the not-so-mutually-exclusive issues of diabetes, ostomy, and weight maintenance. They can help you make sense of your options.

Yep, there is a lot to learn, Jubilee. But you can do this! Start by taking a deep breath... :)

There are so many resources, especially these days with the Internet making information available. Take everything with the proverbial grain of salt, initially, and consult a doctor. And, when you encounter a trusted medical professional, add them to your Team! Keep asking questions of them, and of anyone you come across that has experience in the issues you need addressed.

Something else about medical professionals: if you are not finding the relationship beneficial for you - lack of communication/answers, respect, consideration, slow to respond, to test, or they KEEP testing without getting anywhere, etc. - fire them. It's as simple as that. Unlike in days of yore, you need to be your own health advocate. Pay attention to your body and how it responds to what you provide (and don't) and keep looking for answers until you get the right ones for you because we're all different and have differing needs.

That being said, continue to be gracious with yourself. There are blessings to be experienced everywhere, and sometimes we forget to notice. Take time to take care of your Self: smile, laugh when you can, do things that make you feel good, and help someone else when you're able. It'll come back to you, tenfold.

Looking forward to hearing back from you with a "progress report" - :) - when you have time, Jubilee!

Lily17

Lily17; I'm not aware of having used beverages with artificial sugar. The only drink bought had no sugar. I have not dared try orange juice, but would like to be able to have a beverage other than water or tea that won't cause loose output.

I got advice and a booklet from a dietician while still a patient in the hospital, but she did say that all ileostomy patients have different tolerances. Some can eat quite well and tolerate lots of different dishes, whereas others can't. She also mentioned that this could change and foods that didn't suit could at a later stage in the healing and settling. We are NHS, so we are allocated a GP, but many of those are pretty ignorant on living with an ileostomy. We can't fire our GPs as another practice might not accept us as patients.

I just want to be able to eat well and gain weight and also find beverages that suit.

Many thanks,

Jubilee

Hi Jubes,

Lily's advice about talking to a dietitian is wise. But it may be difficult finding one that understands the requirements of ostomates. It seems the vast majority of them focus on where the money is... which is diabetics. I've only run across 2 dietitians in the past 7 years that knew anything about ostomate needs. So it may take some time. As for orange juice... it can be used to make an ORS, but straight up it has way too much sugar. The latest reduced osmolarity ORS recipes call for around 25-29 grams of sugar per liter (32 oz). OJ has 21 grams of sugar in 8 oz. So if you mixed 1 1/2 cups of OJ with 2 1/2 cups of water in a 1 liter bottle, you'd be close. Just don't forget to add 1/2 teaspoon of salt to it. YUMMMMY!

Regards,

Bob

A trick for babies with loose stools is Jello. Maybe that would help you. Other options welcome.

Jello takes the shape of whatever container you put it in. Often cut in cubes for serving. We have individual premade single serving size in our stores. I think there are sugar-free options. I do not know the sugar content of the regular ones.

Is Jello a jelly like in cubes... would it be sugar-free?

No way would I make an ORS drink with that much sugar. I've been advised that a tonic called Metatone can help to replace potassium lost through loose output and also help recover from surgery. Has anyone else tried a tonic as a pick up while still feeling lethargic and low after surgery? I've also been advised that decaffeinated tea is best!

Hi Jubes,

I'm not very familiar with Metatone, but I pulled up their leaflet and it says:

"This product contains glucose and sucrose (sugars). It may be harmful to your teeth.

If you have been told by your doctor that you or your child has an intolerance to some sugars, consult your doctor before using Metatone.

Metatone contains 11 ethanol (alcohol), i.e. up to 442mg per 5ml dose, equivalent to 11ml beer or 5ml wine per dose. This may be harmful to those suffering from alcoholism. This should also be taken into account in pregnant or breastfeeding women, and high-risk groups such as patients with liver disease or epilepsy.

This product contains 16.4 mg sodium per 5 ml dose. This should be taken into consideration by patients on a controlled sodium diet."

I couldn't find the sugar content anywhere.......so not sure what's going on. But at least you'll get a good buzz on with this stuff!!! I don't know anything about what your glycemic limits are, but is 29g of sugar in a liter really a lot? I always compare things to a can of Coke......which is like 39 grams in 12 ozs....or roughly 120 grams in a liter!!!....which is a LOT! Funny thing for those who can't relate to numbers.........one day when you're baking......measure out 39 grams of sugar and put it in a cup........you'll be amazed at how much sugar they cram in a can of Coke!!! Remember, 4g of sugar is a teaspoon......so you'll be putting 10 teaspoons of sugar in a glass!!!!

The problem with going totally sugar-free in your drinks, besides not being in the right ratio to be absorbed by your small bowel, is that as that liquid simply flows down to your bag it carries with it some of the valuable nutrients in the food you ate with it. So there's another reason to eat, then wait, and then drink......if you can. I can't and always laughed at the idea of not drinking while eating. But I've heard some folks can do it.........I'm just not one of them.

Regards,

Bob

Like I've said many times, I'm one of the lucky ones. I can eat and drink whatever I like and do, haha.

Beer/curry, really everything.  

Bob

I think 29g of sugar is quite a lot for a drink considering that in a day one has carbohydrates during the day; that add greatly to the level, cereals bread pasta etc.

Trying to sip water through the day as was suggested + approx 4 cups of decaffeinated tea, I just wish there were drinks that could be consumed that wouldn't be full of sugar.

Metatone seems to get good write-ups following illness but would it add to output that I'm trying to resolve, surely 5ml tsp x3 daily shouldn't affect output, mostly B's I think and iron. I do need to get a buzz I'm only 5 weeks post-op so what with trying to find what one can and can't eat I'm getting really fed up.

Hey Bob, this is the first I've ever heard of ORS. Surgery salt water reminds me of the many colonoscopy preps I've done in a past life and I gag just thinking about it. Can you share with us how you mix your cocktail for an "improved" version?

(Great info as always)
Many thanks!
Doug