Food substitutions may be required if your digestive problems extend to more than just having a stoma. For some of us with IBD (Ulcerative Colitis or Crohn’s), there may be problems like strictures, internal scarring or active disease that might be preventing us from eating certain foods. This certainly poses a problem, as getting adequate nutrition often involves eating a variety of food. So what can we do about that?
First, let me say that if you have access to a Registered Dietitian, please make an appointment with them so they can help you optimize your diet for your specific need (I have a guide on how to find one HERE). The suggestions I’m making are solely from experience – I’m not a trained professional when it comes to nutrition.
There are a lot of variables that must be considered when you’re planning out a diet, but I’ll try to simplify it so that you can get a general sense of how to substitute and plan for your specific need.
Many of us with IBD are often underweight. Chronic diarrhea, vomiting, an inflamed gut – it all impacts our ability to eat and absorb nutrients. Getting enough calories is important as it not only helps us to maintain an ideal weight, but absorbing enough calories allows our bodies to get the fuel it needs to run.
You can get calories from just about any food (artificial sweeteners usually don’t have calories). Fruits, vegetables, legumes, grains, oil, nuts/seeds all contain calories, but they are in varying amounts. You’ll need to find out which foods you can tolerate and add more of it to your diet. In some cases, you might need to resort to a meal replacement or sugary drink in order to boost those calories. In general, the “calorie density” of various foods can be listed as such:
In general, start with easy to digest foods, like bananas, rice, potatoes (without skin) and oatmeal. These foods are relatively calorie dense and they offer nutrients that you’ll need to stay strong and healthy.As you can see, there’s a huge difference between certain foods. The foods we’ll want to eat more of to be healthy are usually lower in calories vs. processed/unhealthy foods – the exception are nuts and seeds, which can be very nutritious IF you can tolerate them.
If digestion isn’t an issue, move to other high-calorie foods like legumes and nut/seed butters (these are often far more tolerated than whole nuts/seeds, which can irritate an inflamed gut or could even cause blockages.
If eating a large volume of food is problematic for you, consider a meal replacement until you’re healed up enough to try solid food. They can provide an excellent source of calories and are often fortified with vitamins, minerals and protein.
An all-important nutrient for building muscles and an aid to healing, protein is essential in our diets. Contrary to popular belief, vegans get plenty of protein. If you’re getting enough calories eating most food, you’ll likely be getting enough protein. However, there is some planning involved if you’ve got an IBD. In my post “Protein – what why and how” , I gave some examples of protein shakes you can use to get extra protein in your diet. However, if digestion isn’t a problem for you, then I’d always suggest getting your protein from whole-foods instead.
In THIS wonderful article on protein on the VeganHealth website, we can see that our protein requirements vary, depending on who’s giving the advice. Current research shows us that plant-based proteins do not cause the same problems as animal-based protein, so getting a bit more as a vegan isn’t too much of a concern, and if you’re healing, you’ll want more protein anyways.
The challenge for those with an IBD or ostomy is that most of the high-protein foods are legumes, nuts/seeds, veggie meats or soy-based products – foods which some of us may find difficult to digest. What do we do then?
Focus on nut/seed butters if you can – for one, they are delicious (try sunflower seed or almond butter), they provide a good amount of calories and healthy fats, and they are full of protein. Nut/seed butters are also easy to digest vs. whole nuts/seeds and for those of us with ileostomies, they help to thicken our output.
If you’re ok with soy products, add tofu to your dishes or drink soy-milk, which has one of the highest protein levels compared with other non-dairy milks. Tofu is also ok during a post-op ileostomy diet.
Potatoes also include a fair amount of protein. You can boil, bake, roast or steam them… whatever you like, just remove the skin if you have issues with blockages or strictures. If you have trouble with potatoes causing your ostomy output to be too thick, try eating after they’ve been cooled in a fridge – this causes them to develop “resistant starch” and may digest better for you.
If you’re ok with beans and legumes, I’d highly recommend them – my favorite is red kidney beans and lentils, although the small skins on the lentils do require more chewing. I often eat legumes from the can, as they are usually softer and easier to digest compared with the dried and cooked variety. If you’re a hummus fan, enjoy! Hummus (made with chickpeas and tahini) is full of protein and calorie goodness… make it at home, it’s super-easy! Try this recipe from one of my favorite vegans, Heather Nicholds
Processed veggie meats are a tasty way of adding protein to your diet too. It’s still up for debate as to how healthy these foods are, and many vegan purists will avoid them. I personally use fake meats for their convenience and flavor – when you’re cooking for a family of four, you have to accommodate everyone. Plus, when you’re faced with an illness that affects your ability to eat ANYTHING, getting something in your stomach is better than nothing.
Fat in the diet is often a highly debated topic. Many vegan MD’s, like Dr. John McDougall or Dr. Caldwell Esselstyn are against all oils in the diet, but almost all will agree that whole-food fats (avocados, nuts/seeds, for example) are healthy in moderation. Because fats trigger bile excretion in our GI tract, some of us with ulcerated an inflamed guts are better off avoiding too much fat, but it’s important to include the healthy kind when you can.
Fats can be a great source of calories, so like I mentioned above, try nut/seed butters when you can. I love adding guacamole spread (avocados) to my sandwiches or on potatoes.
Oils can be used, but use it as a condiment – there’s no need to add a half-cup of oil to your morning smoothie!
Vitamins and Minerals (the micro nutrients)
This category can be daunting as it encompasses dozens of nutrients and thousands of undiscovered phytonutrients (found in plants), but it’s a highly important category when it comes to maintaining good health.
If it were only about getting the macro nutrients (carbs, protein and fat), then you could eat pure sugar, olive oil and isolated soy protein all day – but that’s not going to get you very far. You’ll still need the essential vitamins and minerals.
The vitamin and mineral contents of foods fluctuate a huge degree – some foods may have an abundance of one vitamin or mineral and be completely lacking in another. Eating a variety of food is a great way to avoid this imbalance. Unfortunately, the foods we should be eating the most of (green leafy vegetables, fruits and whole vegetables) often cause the most problems with our stoma and our IBD. There are several things we can do minimize these problems. See which ones work for you:
Smoothies. It’s hard to resist a good smoothie. Blending fruits and vegetables can make them much easier to digest. The hard skins and cell walls of these foods are broken down in the blender and the nutrients contained in those foods can be easily absorbed by our small intestine. Add a non-dairy milk for extra calories/protein and include a banana to naturally sweeten your smoothie and include cashews to add creaminess.
- Juicing. Unlike blending, juicing removed any fiber from food and leaves you with only the liquids from those foods. Juicing can add an abundance of nutrients to your diet, especially if eating raw greens is difficult. For some, juicing may produce diarrhea, so experiment with different combinations (all vegetable, veg/fruit mix, all fruit) and see which works for you. You may have to try slowly and add more juice to your diet as your body adjusts.
- Cooking. If raw fruits and vegetables are a problem, try cooking them. A raw carrot, for example, can be hard to digest unless you chew like a pro – cooked carrots, however, are far easier for your body to break down. Some tough greens, like kale or collard, are easy to get down once steamed or boiled.
- Canned food. Getting fruits, vegetables and legumes out of a can be another way of adding those foods to your diet. My post-ileostomy diet included canned carrots, canned beans, canned peaches and applesauce, since the raw varieties were off-limits at the time.
- Peeling. Sometimes, it’s all about the skins on our food that crease problems with blockages. If you have trouble with strictures or stoma blockages, try peeling your food. Potatoes, apples, peaches, cucumbers – all of them become far easier to process when peeled before consuming. There are nutrients in the skins of these foods, so peel when necessary, but try to include the skins if you don’t have problems with them.
- Liquid foods. Non-dairy milks can be an great source of calcium, protein, calories, vitamin D, vitamin B12 and magnesium. Try different brands, flavors and types. Check the labels too – some non-dairy milks have less protein than others. Soy milk is usually the highest in protein.
If you have a damaged ileum or have Crohn’s disease which affects your ileum and/or small bowel, you may need to find alternative ways of getting certain nutrients, like B12. Some of us who can’t adequately process B12 through our gut, rely on injections and oral supplements (B12 sublingual tablets or drops under the tongue are effective). You’ll need to consult a doctor and likely have blood tests to determine if you need additional supplementation.
Chronic bleeding may also cause you to become anemic and you may be required to take iron supplements (check the ingredients on those, as some are made with the hemoglobin of cows!).
A few notes specifically for plant-based diets when it comes to the RDA of certain nutrients. Iron and Zinc are two nutrients where vegans should try to get more than the RDA suggests. That’s because the plant-sources aren’t as bioavailable as the animal-sources and certain components found in plants (like phytates), can affect the absorption of certain nutrients. There are ways to offset this, like adding vitamin C-rich foods to increase iron absorption. Or adding garlic and onions to a dish to improve on both iron and zinc absorption: see THIS study. Sodium and potassium are two things that ileostomates should include more of in their diets, since our colon would normally absorb those electrolytes and now our small intestine needs to compensate for the loss.
I hope that I’ve been able to offer some tips which you can apply to your own diet. As I mentioned before, consult with a Dietitian so that you can plan out meals specific to your condition.
If you have any questions about this post, please feel free to comment.
Article updated: Feb 19, 2015