Read the label: it may be the brand, not the food

Nobody with an ileostomy needs to take a laxative. But products sweetened with sorbitol instead of sugar can act as one, and artificial sweeteners are in a growing number of products. It is therefore well worth reading the contents label to see what a particular food actually contains.

The muesli argument

The case is easiest to see with an example. Some people find coconut rather indigestible, and some brands of muesli contain coconut. The problem is the coconut, not the muesli — and there are plenty of coconut-free mueslis available.

The same logic runs the other way. Why give up a food for life because one or two brands of it have a laxative effect from sorbitol? It may be the brand causing the problem rather than the type of food.

A method, rather than a list

The approach that works is closer to running an experiment than following a diet. Start with small, appetising meals at regular intervals. Introduce new items gradually. If something upsets you, try it again after a week or so — and on further occasions — before you finally decide you cannot tolerate it.

The published advice also pushes in a direction people rarely expect. Your stoma care nurse can give you dietary advice, but you will soon learn what is best for you — and the suggestion is explicit: experiment with foods you previously avoided because of your colitis. The list of things ruled out during active disease is often longer than the list that is genuinely a problem afterwards, and nobody removes items from it for you.

One practical note on timing before you judge a result: appetite itself takes a while to come back. It may take several weeks before yours returns, especially if you have been unwell for some time. A food eaten in the first fortnight home is not a fair test of that food.

Where this lands

Be careful and moderate in the early post-operative stages, then gradually return to a full, normal and balanced menu — avoiding only excesses of items known to cause unwanted reactions. The reasoning behind that is worth keeping: one of the main advantages of having an ileostomy is being able to return to normal health and a full, active lifestyle, in contrast to the restrictions so often experienced during prolonged inflammatory bowel disease.

The wider point about eliminating things

The sorbitol example is a specific case of a general problem: a bad experience produces one data point, and one data point identifies a meal, not an ingredient. Whatever you ate it with, on an empty stomach or a full one, in what quantity, and how well you chewed it are all in that data point too.

Every one of those variables turns up elsewhere in the same guidance. High-fibre foods are most noticeable eaten on an empty stomach, when they are not thoroughly mixed with less fibrous food. Chewing thoroughly aids digestion and helps prevent flatulence. And the answer is framed, repeatedly, as quantity — avoiding only excesses — rather than presence or absence.