Frequently Asked Questions

Food & Nutrition I

Margaret Allan is a qualified Nutritionist with a history of Crohn’s Disease. She had ileostomy surgery over twenty years ago, and combines her personal experience and professional knowledge in clinical practice to advise both ostomates and the general public on diet and health-related matters.

This is an extract of a recent nutritional talk Margaret gave to ostomates at the Ileostomy Association of Victoria Annual General Meeting.

From the moment that food is taken into the mouth, the actions of the digestive system are aimed at progressively breaking down the food pieces into ever smaller particles, so they can be absorbed through the wall of the intestine into the blood stream. This is the process that provides nutrients, energy, water and electrolytes to our body for repair and function as well as general good health.

In a so-called ‘normal’ digestive system that hasn’t been affected by stomal surgery, the digestive tract can be up to 4.5 metres long, and this tissue is very convoluted and complex. It is said that if the human digestive tract were laid out flat, it would cover a tennis court! This extensive amount of tissue is necessary to provide a large surface area through which the complex process of absorption of nutrients can occur.

For a person who has undergone stomal surgery of the intestine, this surface area is reduced, and there may only be a squash court left! This can significantly compromise digestive function. Therefore, ostomates need to assist the digestive process as much as possible to ensure nutrients from food are still able to be absorbed across the intestinal wall and general health is maintained.

One of the easiest ways to facilitate this process is to chew food really well. This may seem like a really simple concept (and it is!) but the fact is that digestion doesn’t start in our stomachs. It starts in our brain and our mouth. When we smell food cooking or see something appetizing, the stimulation of our senses (sight and smell) triggers production of acid in our stomach that assists us to digest the food when we eat it. Chewing food also assists the digestive process by physically presenting the food to the stomach in smaller particles, which means the stomach and intestines have to do less chemical work to get the food into small enough particles for absorption.

Another strategy we can implement (and this is not always a popular one!) is to refrain from drinking large quantities of fluid while eating. My gastroenterologist advised me of this many years ago, and I have found it to be a useful strategy. Usually, we are encouraged to eat and drink at the same time, but consuming a lot of fluid with a meal can dilute the acid that builds up in the stomach in preparation for food consumption. It is therefore harder for the acid to perform the vital function of breaking the food into smaller particles for absorption. Too much fluid can also ‘flush’ the food through our digestive system, which can similarly compromise the digestive process.

Therefore, it can be more appropriate to stop consuming fluids about 20-30 minutes before a meal, and then to wait for 30-45 minutes after the meal has finished before consuming more fluid. Obviously, if a person needs to take medication with their meals, then fluid needs to be consumed at the same time, but half a glass of water should be enough to achieve this.

Socially, this can be achieved by having a drink when first arriving at the venue while getting settled and ordering food etc, then consuming only a little fluid while eating the meal. Once the meal is over and a suitable time has elapsed, it is then possible to have another drink after dinner.

Another practice that can aid digestion is to relax when consuming food. This strategy is easier in theory than in practice in today’s stressful climate but, again, it is a small thing we can do that takes very little time and effort. When I was growing up it was customary to say Grace before a meal, but that tradition seems to have lapsed in more recent times.

However, irrespective of anyone’s cultural or religious background, that little practice of stopping for a minute to breathe and reflect before eating can be enough to allow the digestive system to function to its full capacity in breaking down food. When we are stressed, our gastrointestinal system tightens up and this can impede the secretion of the digestive ‘juices’ in our stomach and intestine that facilitate the breakdown of food into smaller particles. Therefore, sitting down and relaxing while we are consuming food, taking a breath before we start eating our meal, and taking a little time over our food consumption can all help to make sure we are digesting our food properly.

I feel the above are three simple strategies we can all use to facilitate the digestive process to ensure we are absorbing the nutrients in our food to the best of our ability. It is possible for ostomates to experience good health and lead active and full lives, and these steps can help to ensure this is the case for everyone.

Wishing you good health and happy days, - Margaret.

Margaret is based in Melbourne and is available for clinical consultations in Northcote or phone consultations for those outside Melbourne. She can be contacted here.

Reprinted from the "Ostomy Australia" (Volume 17 No. 3 - December 2008)

Click here for Food & Nutrition II (on food choices, food combinations and food preparation practices).