Nutrition Challenges After Ostomy Surgery: Weight Loss and Dietary Solutions

Nutritional absorption issues due to the presence of a stoma?

Hello, Doctor.
My father underwent surgery for acute intestinal obstruction in mid-December last year, during which a portion of his small and large intestine was removed.
It has been nearly four months since the surgery.
The stoma site occasionally experiences minor skin breakdown and some eczema, for which he has been applying anti-itch ointment.
Other than that, there are no significant issues.
The surgical team mentioned that they would schedule a reversal of the stoma, but due to damage to one side of his vocal cords from intubation, they have decided to wait until the vocal cords fully heal before proceeding with the second surgery.

Additionally, the stoma's placement at the proximal end has made nutrient absorption difficult.
Despite consulting with a nutritionist and following their recommendations for nutritional supplements, he has been unable to gain weight.
His weight was 63 kg before surgery, dropped to 52 kg after, and is currently down to 47 kg (173 cm tall).
There were initial concerns about potential post-operative diabetes or other internal medicine issues.
After blood tests at the endocrinology department, he was diagnosed with type 2 diabetes and chronic kidney disease (he did not have these conditions prior to surgery).
The internal medicine physician suggested starting dietary adjustments for a month, and we are currently awaiting the next blood test to check for improvements.

I had mentioned to the internal medicine doctor the possibility of receiving nutritional injections, but this was not arranged.
The surgical doctor does not seem to think that his low weight would prevent him from undergoing further surgery.
I would like to ask if you have any recommendations for easily absorbable nutritional products suitable for short bowel syndrome, and how his weight might impact future surgeries.
Additionally, how should I best approach the topic of nutritional injections? (Also, my father is vegetarian and does not consume any meat.) Thank you, Doctor.

Jessie, 20~29 year old female. Ask Date: 2021/03/21

Dr. Chen Jiaming reply Surgery

First, it is unclear whether the stoma is an ileostomy or a colostomy.
If it is an ileostomy, there may be issues related to fluid and electrolyte balance, which can be more complex.
If it is a colostomy, it depends on whether there are any bowel function issues, such as diarrhea, which can affect nutrient absorption.
If such issues are present, it would be advisable to discuss medication adjustments with the primary physician or a gastroenterologist.

Additionally, diabetes has specific dietary recommendations that can be obtained from a metabolic specialist or a nutritionist.
You can also discuss your concerns about maintaining your father's weight with them to explore ways to "gradually" increase his overall daily caloric intake.
Although your father is vegetarian, there are many diabetic-friendly enteral nutrition formulas available that can be discussed with a nutritionist.
First, you need to keep a detailed record of your father's daily dietary intake, including types and quantities of food, as well as his bowel movements.
This information can then be shared with a nutritionist or a metabolic specialist for further discussion.
For the surgeon, weight gain is a secondary concern; the primary focus should be on ensuring adequate nutrition.
As for nutritional supplementation, it may be provided during the next hospitalization for stoma closure.

Reply Date: 2021/03/21

More Info

After ostomy surgery, patients often face significant nutritional challenges, particularly when it comes to weight loss and dietary adjustments. In your father's case, the surgery has led to a substantial decrease in weight, from 63 kg to 47 kg, which is concerning, especially given his height of 173 cm. This weight loss can be attributed to several factors, including the surgical removal of portions of the small and large intestines, which can severely impact nutrient absorption.

Nutritional Challenges Post-Surgery
1. Nutrient Absorption: The small intestine is primarily responsible for nutrient absorption. When parts of it are removed, as in your father's case, the body may struggle to absorb essential nutrients, leading to malnutrition and weight loss. This is particularly critical for macronutrients like proteins and fats, as well as micronutrients such as vitamins and minerals.

2. Dietary Restrictions: Given that your father is vegetarian and does not consume animal products, it is crucial to ensure he receives adequate protein and other essential nutrients from plant-based sources. This can be challenging, especially if he is also dealing with diabetes and chronic kidney disease, which require careful dietary management.

3. Increased Caloric Needs: Post-surgery, the body requires more calories to heal. If your father is not consuming enough calories, this could contribute to his weight loss.

Dietary Recommendations
1. High-Calorie, Nutrient-Dense Foods: Focus on incorporating high-calorie, nutrient-dense foods into his diet. This includes:
- Nut butters (like almond or peanut butter) spread on whole-grain bread or added to smoothies.

- Avocados, which are high in healthy fats and calories.

- Smoothies made with high-protein plant-based milk, fruits, and added protein powder or nut butters.

- Legumes (beans, lentils, chickpeas) which are excellent sources of protein and fiber.

2. Protein Supplements: Since he is vegetarian, consider plant-based protein powders that can be added to smoothies or oatmeal. Look for options that are low in sugar and high in protein.

3. Frequent, Small Meals: Encourage him to eat smaller, more frequent meals throughout the day rather than three large meals. This can help increase caloric intake without overwhelming his digestive system.

4. Hydration: Ensure he stays well-hydrated, but be cautious with fluid intake if he has kidney issues. Sometimes, electrolyte drinks can help if he is losing fluids through the ostomy.

5. Monitor Blood Sugar Levels: Since he has been diagnosed with type 2 diabetes, it’s essential to monitor his carbohydrate intake and choose low-glycemic index foods to help manage blood sugar levels.

Nutritional Support and Injections
Regarding the idea of nutritional injections, it’s important to discuss this with his healthcare team. Nutritional injections, such as those containing amino acids or other nutrients, can be beneficial in certain cases, especially if oral intake is insufficient. Here’s how to approach this:
- Discuss Concerns: When speaking with his doctor or nutritionist, express your concerns about his weight loss and the challenges he faces with oral intake. Ask if nutritional injections could be a viable option for him.

- Request a Referral: If the current healthcare providers are not addressing your concerns, consider asking for a referral to a specialist in nutrition or a dietitian who has experience with post-surgical patients.

Conclusion
In summary, your father's situation requires careful dietary management to address the challenges posed by his ostomy surgery and subsequent weight loss. Focus on high-calorie, nutrient-dense foods, consider protein supplements, and ensure he is eating frequently. Additionally, keep an open line of communication with his healthcare team regarding nutritional support options, including injections if necessary. This comprehensive approach can help improve his nutritional status and overall health as he prepares for further surgical interventions.

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