I created this post because the answer is too long to place as an answer in a thread.
I have noticed multiple posts with ostomates wondering if they can eat beans, mushrooms, popcorn, etc. There are numerous lists available listing foods to avoid in order to prevent blockages. For persons with recent ostomies, this can be bewildering since the lists often contain foods we like to eat. First, these lists are primarily for those with ileostomies since the small intestine is much smaller in diameter than the colon, and it becomes even narrower as it comes out into a stoma (life investment). Therefore, the information that follows is not intended to inform those that have plenty of experience over the years with their ostomies — it is for those new to ostomies. We are often told what not to eat but not why — the information I am providing attempts to provide some of the "whys." There is no single "ostomy diet" that works for everyone. Tolerance to specific foods, fluid and electrolyte needs, and the risk of nutritional deficiencies depend on individual factors such as the reason for the ostomy, the length and health of the remaining bowel, the presence of underlying conditions like IBD, and the degree of intestinal adaptation over time. The discussion on blockages is primarily about how to deal with insoluble fibers.
Insoluble fibers, although they have health benefits, pose the most danger to ileostomates due to the heightened risk of physical blockage in the altered digestive tract. Types of insoluble fibers include:
• Cellulose — found widely in vegetables, fruits, legumes, and whole grains. It is particularly resistant to breakdown.
• Hemicelluloses — found in many fruits, vegetables, grains, and other plant-based foods. Their solubility varies, but many are insoluble.
• Lignin — found in bran, nuts, seeds, and the tougher parts of vegetables. It is highly resistant to digestion and fermentation.
Certain substances, often referred to as "undigestible," pass through much of the digestive system intact. "Undigestible" refers to components of food that cannot be broken down into absorbable units by the enzymes secreted within the mouth, stomach, and small intestine. These substances travel through the upper gastrointestinal tract largely unchanged because humans lack the specific enzymes required to break down the chemical bonds holding them together. It is very important to identify which foods have undigestible components. Foods high in undigestible components include:
Whole Grains
• Examples: Wheat bran, whole wheat products, brown rice, quinoa, barley, oats, rye, corn bran
• Undigestible Components: Cellulose, Hemicellulose, Lignin
• Ileostomy Concern: High blockage risk (esp. bran, whole kernels). Choose refined grains initially. Chew well.
Vegetables
• Examples: Skins (potato, cucumber), corn kernels, celery, broccoli/cauliflower stalks, cabbage, leafy greens (kale, spinach), green beans, peas, mushrooms, bell peppers, onions
• Undigestible Components: Cellulose, Lignin, Hemicellulose
• Ileostomy Concern: High blockage risk (skins, kernels, stringy parts). Peel, de-seed, cook well until soft, chop finely. Avoid tough stalks/leaves initially.
Fruits
• Examples: Skins/Peels (apples, pears), seeds (berries), dried fruit (raisins, figs, prunes), pineapple, coconut, citrus pith/membranes
• Undigestible Components: Cellulose, Lignin
• Ileostomy Concern: High blockage risk (skins, seeds, dried fruit, pith). Peel, de-seed, avoid dried fruit initially. Cook or choose canned (without syrup) initially.
Legumes
• Examples: Beans (black, kidney, lima), lentils, peas
• Undigestible Components: Cellulose, Hemicellulose
• Ileostomy Concern: Can cause gas and potentially blockage. Cook well, consider removing skins if possible. Introduce cautiously in small amounts.
Nuts & Seeds
• Examples: Almonds, walnuts, sunflower seeds, flaxseeds, sesame seeds, chia seeds, popcorn
• Undigestible Components: Lignin, Cellulose, Hemicellulose
• Ileostomy Concern: Very high blockage risk. Avoid whole nuts/seeds and popcorn initially. Choose smooth nut butters.
Other
• Examples: Tough meats with gristle, meat casings (sausage)
• Undigestible Components: (Connective tissue, casings)
• Ileostomy Concern: Casings and gristle are indigestible and pose blockage risk. Remove casings, choose tender cuts.
Undigestible, bulky materials entering the narrower ileum of the small intestine, or passing through the stoma can easily form a bolus (soft mass of chewed food) and cause a painful and dangerous blockage.
Items like fruit and vegetable skins, seeds, nuts, corn, popcorn, and stringy or tough plant materials (like celery or pineapple) can swell with fluid or clump together, forming a solid mass or bolus that becomes lodged. The small intestine naturally narrows as it approaches the stoma, making it more susceptible to obstruction by bulky material. Dehydration can worsen the risk by making the intestinal contents thicker and less mobile — adequate fluid intake is essential when increasing fiber, as fiber works best when it absorbs water.
Finally, while individual tolerance varies, certain foods are consistently identified across dietary guidelines as having a higher potential to cause blockages in individuals with an ileostomy due to their indigestible nature, texture, or structure. Foods commonly associated with ileostomy blockage risk include:
Nuts & Seeds (all types)
• Reason for Risk: Indigestible, hard pieces
• Eating Approach: Avoid whole. Choose smooth nut butters.
Popcorn
• Reason for Risk: Indigestible hulls, bulky
• Eating Approach: Avoid.
Corn (kernels)
• Reason for Risk: Indigestible outer layer (skin)
• Eating Approach: Avoid whole kernels initially. Chew very thoroughly if reintroduced. Consider creamed or pureed corn.
Fruit/Vegetable Skins & Peels (e.g., apple, potato, cucumber, tomato)
• Reason for Risk: High insoluble fiber, indigestible
• Eating Approach: Peel all fruits and vegetables, especially initially. Reintroduce small amounts of thin skins cautiously later, if desired.
Fruit/Vegetable Seeds & Pips (e.g., berries, tomatoes, grapes)
• Indigestible, can clump
• Eating Approach: Choose seedless varieties. Remove seeds/pips. Strain juices/purees.
Stringy/Fibrous Vegetables (e.g., celery, pineapple, cabbage, tough greens, bean sprouts, asparagus stalks, mushroom stems)
• Reason for Risk: High insoluble fiber, tough texture
• Eating Approach: Avoid initially. Cook very well until soft, chop finely, remove tough stalks/strings. Chew thoroughly if reintroduced.
Dried Fruits (e.g. raisins, prunes, figs)
• Reason for Risk: Concentrated fiber, can swell.
• Eating Approach: Avoid initially. If reintroduced, use very small amounts, soak first, chew thoroughly.
Coconut (raw, desiccated)
• Reason for Risk: Fibrous texture
• Eating Approach: Avoid initially. Use coconut milk/cream instead.
Citrus Pith/Membranes (e.g., orange, grapefruit)
• Reason for Risk: Indigestible fiber
• Eating Approach: Peel fruit thoroughly, removing white pith and membranes between segments. Consider juice without pulp.
Mushrooms
• Reason for Risk: Can be fibrous, indigestible components (chitin)
• Eating Approach: Avoid initially. Cook well, chop finely, start with caps only. Chew thoroughly.
Legumes (whole beans, peas, lentils)
• Reason for Risk: Skins, fiber content
• Eating Approach: Cook well until very soft. Consider removing skins (e.g., chickpeas). Start with small portions. Chew thoroughly.
Meat Casings (e.g., sausages, hot dogs)
• Reason for Risk: Indigestible casing material
• Eating Approach: Remove casings before cooking/eating.
For ileostomies, in regards to blockages, how food is consumed/prepared is as important as what is eaten. Particular attention must be devoted to chewing, preparation, and portion sizes:
Thorough Chewing: This is considered, by many, to be the most important. Chewing food extremely well breaks it down mechanically into smaller particles, reducing the burden on the digestive system and significantly lowering the risk of larger pieces causing an obstruction. This applies to all foods but is especially vital for meats and any high-fiber items. Eating slowly and mindfully facilitates better chewing.
Careful Preparation: Modifying the preparation of high-risk foods can make them safer and more tolerable:
• Peeling: Remove skins from all fruits and vegetables initially.
• De-seeding/De-pithing: Remove seeds, pips, and tough membranes.
• Cooking Thoroughly: Cook vegetables until very soft and tender. Stewing or boiling is often better than roasting or stir-frying initially.
• Chopping/Mincing/Pureeing: Cut foods, especially fibrous vegetables or tough meats, into very small pieces. Blending fruits and vegetables into smoothies or soups can also make fiber easier to manage.
• Choosing Processed Forms: Opt for smooth nut butters instead of whole nuts, or seedless jams instead of those with seeds.
Portion Control: Continuing with smaller, more frequent meals can help manage output volume and prevent overloading the system, especially early on. When reintroducing potentially problematic foods, starting with very small test portions is crucial.
I will wrap up by re-emphasizing the importance of chewing — chew until there is only mush in your mouth, nothing solid or stringy. The digestive journey begins in the mouth, where food undergoes mechanical breakdown through chewing (mastication) and initial chemical breakdown by enzymes in saliva, such as amylase for starches and lipase for fats. Saliva also moistens the food, forming a bolus for easier swallowing. The bolus travels down the esophagus via peristalsis – wave-like muscular contractions – into the stomach. The goal is to have the food in your mouth completely covered with saliva, not just the outside partially covered with saliva. It is important that the breakdown of starches and fats starts being broken down with the saliva enzymes. There is much more to learning, but there are ways to safely eat to avoid blockages. If you understand the "whys," the "whats" become easier.
Page Location:
https://www.meetanostomate.org/discussion-forum/viewtopic.php?t=34664#275184
— Proud owner of lifesaving ostomy, vintage 2023, V6 colostomy engine.
