Living with an ileostomy for a long time can bring about some unique challenges, especially when it comes to nutrient absorption. One person who has had an ileostomy for 28 years is experiencing issues with malabsorption, leading to anemia, fatigue, and deficiencies in protein and B-12. Despite receiving iron infusions and being advised to eat more meat, these problems persist. They are reaching out to see if others have faced similar issues and what solutions have worked for them.

Here are some insights and advice shared by others:

1. Vitamin and Mineral Supplementation
- Many people with long-term ileostomies find that regular vitamin B-12 injections or tablets, along with daily multivitamins, can boost energy levels.
- It's important to advocate for yourself and ensure regular blood tests to monitor nutrient levels, as malnutrition can sometimes be overlooked by doctors.

2. Diet Adjustments for Managing Output
- Trying out calorie-dense and easily absorbable foods can help manage nutrient intake. Some people find success by experimenting with different food types to maintain their nutrient and calorie levels.
- Adding ground flaxseed to meals or juices can help thicken the output and slow down transit time.

3. Juicing for Nutrient Intake
- For those who can't tolerate raw fruits and vegetables, juicing can be a great way to get nutrients without the fiber.
- A recommended juicer is the Jack LaLanne Power Juicer Ultimate, which is available at Costco. It has stainless-steel parts, is dishwasher-safe, and comes with a recipe book and instructional DVD. Tips for easy cleaning include lining the pulp catcher with a plastic bag and using the small brush provided for the blade.

4. Emotional Support
- It's comforting to know that you're not alone. Sharing experiences with others who understand can be incredibly helpful, especially when medical professionals don't have all the answers.

5. A Lighthearted Note
- There's a playful mention of Guinness beer being "good for the blood," though this is not serious medical advice.