Once you’ve passed your post-op healing phase (usually six weeks), and you’ve gotten tired of the restricted post-op diet, it’s time to start getting back into a more standard diet that will support you long-term.
Fortunately, most ostomates can return back their old diet, but there are some exceptions that ileostomates should know about.
Disclaimer: Your doctor or stoma nurse should be able to provide recommendations following your ostomy recovery period, however, it may be best to consult with a Registered Dietitian too.
This post focuses on an ileostomy diet based on my own experience, as well as the experience of many ostomates that i’ve been in contact with. Many of the foods and suggestions given should apply to colostomies too.
Dietary Goals Following Your Recovery
- Continue to maintain adequate hydration and electrolyte balance.
- Expand your diet to include more of the foods that had been restricted in your healing phase.
- Eat in a way that reduces the likelihood of blockages.
- Maintain a healthy weight.
- Eat in a way that supports long-term health.
My Golden Rule
I want to share a personal motto when it comes to eating with an ostomy. I live by this rule, and it’s given me the confidence to eat how I like, but that’s not to say that this rule works for every ostomate:
What does this mean? When I had a blockage that landed me in the hospital, I learned a few lessons, but since that time I’ve come to realize that there’s a right and wrong way to eat when you’ve got an ostomy.
For me, it doesn’t matter if I’m eating bananas or mushrooms because HOW I eat ends up being the main factor that determines whether I’m going to have problems or not.
- Chew. You can eat some pretty hard to digest foods if you chew well enough. I was worried about mushrooms until I learned that chewing as much as possible is key.
- Take your damn time! Your mother has probably told you that eating is not a race, and she was right. Practice mindful eating and pace yourself.
- Avoid really large meals. Digestion works best if you aren’t gorging on your meals, but eating small, frequent meals will also cause your stoma to be more predictable and easier to manage.
- Cook, blend, juice if you must. You may not be able to digest everything perfectly, but you can process your food enough to make it easier on your digestive system.
- Drink with meals if you are prone to having blockages. By keeping things moving, you’ll be less likely to run into trouble.
- Try new foods with caution. Until you know how your body will react to certain food, start new foods slowly – a bit at a time.
Food to Try or Experiment With
Nearly all beverages should be safe at this point, but there are some things to keep an eye out for if you have difficulty controlling your output or suffer from other health concerns.
A full guide to keeping hydrated can be found HERE.
Beverages to Include:
- Vegetable juice is a wonderful way to get a lot of nutrients in a small, low-calorie drink.
- Smoothies are a great way to include some harder-to-digest foods in more of a liquid form; nuts, greens, fruits and veg can all be added to a smoothie that is based on juice, non-dairy milk or water.
- Tea, including herbal teas, can be a nice way to increase your fluid intake while adding some flavor to plain water.
Beverages to Be Cautious About:
- Certain drinks may increase the output of gas, so you may find it helpful to avoid carbonated drinks.
- If you find that alcohol, coffee, soft drinks or fruit juice increase your output or causes you to have liquid output, either reduce or eliminate them from your diet.
- While alcohol can be consumed, many ostomates find that it increases output too much. In addition, it will dehydrate you faster and may interfere with any medication you might be taking (for IBD or otherwise).
- If you are anemic or struggle with low iron levels, cut back on things like tea and coffee, or at least drink them between meals.
- Some ostomates find that drinking fluids with meals can help to loose thick output; if you have the opposite challenge, then drink before or after meals instead.
Grains and Grain Products
Grains are a staple for many people, as they are inexpensive, easy to store and prepare, and also come with nutritional benefits. Provided that you don’t have celiac disease, grains like wheat shouldn’t be excluded from your diet.
You can start to include whole grains if you haven’t had any trouble with refined grains. This may take some experimentation.
Grain products to include:
- Whole grain breads, including pita bread, flat bread and wraps.
- Whole grain pasta, noodles, vermicelli, couscous.
- Brown rice, wild rice or parboiled white rice. (brown rice doesn’t digest well for me, but parboiled is a nice compromise between nutrition and digestibility).
- Whole grain cereal, including oatmeal, porridge and “ancient grain” blends.
- Whole wheat crackers.
- Refined grains (white bread, white rice, white pasta) will digest more easily than whole-grains,but they tend to be less nutritious.
- You may find that grain products that contain visible pieces of flax seed, sesame seed and similar ingredients are more difficult to digest – or at least it would appear that way when you empty your pouch! Feel free to avoid these, since they aren’t doing you any good if they are exiting from your body whole!
- Look for enriched or fortified grains, which tend to have added iron (among other things), if you find that you’re still having difficulties with getting enough nutrients through your food.
- Many ostomates find that grain products can slow down their output. This can be a good or bad thing depending on your goal.
Fruits and Vegetables
The bulk of our nutrition tends to come from fruits and veg, but these foods can also be some of the most difficult to pass through our stoma.
Some ostomates find that fruits and veg that upset their gut before surgery may still cause problems after their ostomy, so you may have to do some experimentation to find out which (if any) fruits and veg cause you difficulties.
I tend to follow this pattern with new fruits or vegetables:
Start with soft produce that doesn’t contain seeds, membranes or thick skins. Some examples include bananas, potatoes (skinned), ripe peaches (without the skin), cooked carrots, sweet potatoes, turnips, plantains, etc.
Chewing will always be an important part of eating fruits and veg, so if you notice undigested parts when you go to empty your ostomy bag, you might not be chewing well enough. The aim is to liquefy your food in your mouth before swallowing.
Fruits & Vegetables to Include:
You can continue having food from the post-op diet, without as many restrictions.
- Apple sauce, well-cooked apples (without the skin if you prefer that).
- Avocados. Great to add over potatoes or as a spread.
- Bananas, plantains. If you can stomach green bananas, they might help to slow down your output.
- Canned fruits and veg (I found canned peaches, canned carrots, canned green beans and canned beets worked really well).
- Fruit jelly.
- Most cooked veg are fine as long as they are soft (no skins or seeds if preferred).
- Potatoes with or without the skin (mashed, boiled, microwaved, steamed, baked).
- Soups made from blended veg or broths.
- Sweet potatoes (without skin) and squash.
- Tomato sauce, tomato paste, whole tomatoes (seeded and skinned if you prefer that).
- Vegetable juice (like V8) are excellent. Carrot juice and tomato juice on their own are great too.
Fruits & Vegetables to Try:
If the “safe foods” cause you no trouble, you can try these slowly.
- Asparagus, raw green beans, raw carrots, broccoli, cabbage (incl. sauerkraut, tomatoes, celery, etc.).
- Coconuts. You should still use caution with these as the pulp is very difficult to digest.
- Corn and corn products.
- Dried fruits.
- Fruits and vegetables with their skins.
- Greens. For better digestibility, start with something like iceberg, then move to romaine, then leaf lettuce, before moving onto harder-to-digest greens like kale or collard; remember that if you see a lot of undigested food in your pouch, you may not be getting the benefits of what you’re eating, so go with something that digests better for you!
- Micro-greens, like sprouts, are a great way to increase your nutritional intake and can be grown indoors.
- Mushrooms can be eaten (I eat them often), but they are high on the list of problem foods. Cook well and chew thoroughly!
- Salsa (I love chunky salsa!)
Most non-dairy foods are fortified and come packed with calcium, vitamin B12 and vitamin D.
Because there are so many options and brands to choose from in this category, I would suggest trying a variety of products to see which ones you like best.
- Non-dairy milks (soy, almond, hemp, coconut, rice, etc.).
- Non-dairy yogurt.
- Non-dairy pudding.
- Non-dairy cheese.
- Sorbet or non-dairy ice cream.
You may also decide to make your own non-dairy milk or cheese, and there are plenty of recipes available online. One fellow ostomate, Christy form Crohnie Balonie has a nice recipe for vegan cheese HERE.
This category was quite restricted during the healing phase, so try to expand if possible.
High-Protein Foods Considered Safe:
- Hummus, dips, sauces made from beans or legumes.
- Most mock meat products are safe, high in protein, fortified with vitamins and minerals, and taste great.
- Seitan (wheat gluten); ease into this one if you haven’t had it before.
- Smooth nut and seed butters (almond, peanut, sunflower seed, cashew, etc.).
- Soy milk contains more protein than other non-dairy milks.
- Tofu (yes, you should be seasoning/marinating it if you want it to have flavor.)
High-protein Foods to Consider:
- Chunky nut/seed butters.
- Edamame, which are young, whole soy beans make for a great snack, but can also be added to dishes.
- Legumes including: Adzuki beans, black beans, chickpeas (garbanzo beans), kidney beans, lentils, lima beans and mung beans. Go with canned for better digestibility.
- Tempeh, which is a fermented soy product, can be found seasoned with many flavors. I’ve even had Tempeh “bacon”, which is pretty nice with breakfast or in a sandwich.
- Whole nuts and seeds. You can pre-soak these to make them easier to digest (I love soaked almonds and pecans!)
Fats and Oils
Depending on your goals, you may or may not want to include added fats and oils to your meals. If you are still underweight, you might find that the extra calories from these foods will help to gain weight more easily.
- Avocados aren’t like the other fats I’ve listed, since it’s a whole food; you can create some wonderful dressings, dips and spreads with avocado (HINT: replace some of the other fats/oils with it if you can).
- Coconut oil can be used to cook with, or as a spread on bread.
- Oils are considered “safe” for new ileostomates, but olive and flax oil are the healthiest of the bunch.
- Vegan margarine.
- Vegan mayo.
Your doctor will be the one to decide if you need to take supplements, and I’d recommend getting regular blood work done to catch deficiencies early on.
Some Things to Consider:
- Provided that you’re eating enough calories, and are including protein-rich foods into your diet, protein powders are unnecessary, but shouldn’t cause your ostomy any trouble.
- If your doctor recommends a multivitamin, be sure that it’s not a slow-release version, or it may pass through your system without being fully absorbed. More details HERE.
- If you have IBD, you’ll likely need iron, vitamin D and B12 supplements (most common), but it’s always best to confirm this via blood work.
- All vegans should supplement with at least vitamin B12, but it doesn’t have to come from a pill since fortified foods work too.
- If you have absorption issues or have had your small bowel partially removed or resected, then you may have to take injections, patches, sublingual or even nasal supplements; these won’t interfere with your ostomy.
Things to Be Cautious Of:
- Some probiotics can increase gas; you may need some time to adjust or may have to change brand/strain of bacteria used.
- Some food, like tea or grapefruit may interfere with the absorption of certain medication or supplements. Speak with a pharmacist if you are taking any.
Condiments, Spices and Additives
Food should taste good, and there are many way to flavor food, but there are some things to be aware of as an ostomate.
Things to Consider:
- Most condiments will be fine to eat, but you might still want to keep an eye on chunky ones like relish, sauerkraut or mustard with seeds in it.
- Depending on why you have an ostomy, some spices may be off the menu for you. Experiment to see which ones agree with your gut.
- Certain spices may increase output, so adjust the type and/or quantity of the spices you use.
- Added sugars may also increase your output, so check labels if you notice this change.
- Artificial sweeteners may increase output, so keep an eye out when consuming “sugar-free” or “low-calorie” products.
Things You May Want to Avoid:
- When possible, it may be wise avoid foods that are artificially preserved, contain artificial colors or flavors, or contain additives that are known to cause issues ranging from gastrointestinal discomfort to headaches.
General Diet Tips
- I still recommend talking to a Registered Dietitian who understands the challenges of having an ostomy (or IBD), since they’ll be able to provide you with a personalized meal plan, as well as help you set goals for your diet. I wrote about how to find a dietitian HERE.
- Eat a variety of foods to make sure that you’re balancing nutrients; try different varieties of apples or beans or grains!
- Don’t let fear prevent you from trying new foods. Sometimes the fear of eating is disproportionate to the risks of eating as an ostomate; let your body, not your mind, decide which foods work for you.
- You might still want to keep a food diary in order to monitor your caloric and nutrient intake, but also to help narrow down “problem foods”. I’ve used, and still recommend CRON-o-meter for tracking foods eaten. You can find out more about nutrient tracking HERE.
- If pouch odor is a concern for you, I’ve put together a handy guide on controlling it HERE.
- Some of these foods and drinks may change the consistency of your stoma’s output, so keep an eye on them:
- Alcoholic beverages (especially wine).
- Artificial sweeteners.
- Certain fruits (for me it’s cherries).
- Coffee or tea.
- Fried foods.
- Fruit juices.
- Hot/spicy foods.
- Non-vegan foods like dairy (or other lactose-containing food, if lactose intolerant).
- Soda/Pop/Soft drinks (both diet and regular ).
- Sport drinks.
Additional Reading and Info
- To see what I’ve been eating since my surgery, have a look at THIS article and the included video.
- For more ideas on what foods to eat when eating is difficult, check out THIS article.
- For ways to enhance nutrient absorption, consider reading THIS article.
- if you like recipe ideas, I’ve got quite a few websites to check out on my vegan resources page HERE.
- If you are still taking oral medication or supplements, you should be cautious about THIS.