Conflicting Diet Advice: Ileostomy vs. Diabetes Diets

So I went to my appointment with the dietitian. Well, there were actually two of them that met with me. They gave me lots of handouts about ileostomy diets and diabetes diets, and guess what, the two contradict one another. What is good and healthy for one is a no for the other. They told me I should have no more than 13 grams of fiber a day. Well, guess what? I take 6 grams of fiber in tablet form every day, so that is half my fiber for the day right there. There is no way that I have only 13 grams of fiber a day. I probably have upwards of 25 grams of fiber. See, for the diabetic diet, they encourage fiber because you can subtract it from the carbs in things. So the more fiber, the fewer net carbs. Like, I drink Boost Glucose Control drinks, and they have 3 grams of fiber for one of them. (Incidentally, the regular Boost has none.) So I am sort of at a no-win. Plus, the diabetic diet is full of fruits and veggies, which I have a hard time digesting. It especially suggests raw veggies and salads, which I can't eat. So then you go to the information that they gave me on ileostomies, and it is all "don't eat this" and "that will cause a blockage." I found out that pineapple can cause a blockage. I love pineapple. I have a can of it in the pantry, and now I find out I shouldn't be eating it? And since I got a blockage, my mom keeps making me eat soft foods. I like mac & cheese and mashed potatoes and all, but I want to have more in my diet. I left the hospital on a soft foods diet, but I had thought once I got home I could eat whatever. Well, I guess that isn't so if I don't want to wind up with another blockage. So, I go back to the dietitian in a couple of weeks, and I plan to confront her with the conflicting information and see what she has to say. I am sure that she will be unable to bring the two diets together into one. Maybe she will be as confused as I am.

Lee

Hi IC,

Good fun, eh? So... you have to sort of understand where each dietician is coming from. For diabetes, it's all about weight control and insulin resistance. For an ileostomy, it's all about digestion and getting the proper nutrition since your plumbing has changed. Fiber is a carbohydrate, which is why when counting carbs and trying to lose weight, they want you to eat the 'good' carbs and reduce the 'bad' ones. It took me some time to figure out what exactly a 'carb' was since fiber and sugar/starches don't seem to be very related. It turns out that the term 'carbohydrate' has nothing to do with any 'types' of food, but rather how they're assembled chemically. So things can be 'carbs' that are vastly different in appearance and composition. It only matters how their molecules are constructed. So the term 'carbs' really has nothing to do with dieting or foods... it's all about the chemistry. When trying to eliminate diabetes, dieticians want you to eat more of the 'good' carbs... meaning the ones that don't spike insulin levels in your blood. Fiber is one such carb. So the more that you replace sugars and starches with fiber... the fewer changes in insulin you'll have in your bloodstream (as well as reduce calories, which happens because your body can't break down and digest fiber... so no calories!). So for those dieticians... it makes sense.

For an ileostomy, it's all about eating foods you can digest and avoiding those you cannot... while trying to balance all your nutritional needs. As for having a blockage... if your remaining bowels are in good shape, and you have minimal adhesions and scar tissue... fiber isn't really a problem. It's just that you're not going to get any nutritional value from leaves, sticks, and twigs. Although it might help firm up your output. If you're having blockage issues... you've got something else going on that needs to be addressed. The whole point of any ostomy is to return bowel function to normal... so if it's not... that needs to be fixed. Your favorite, pineapple... is really high in sugar (insulin spike) and full of fiber (hello blockage)... so you might want to resist that temptation if you can. I know it's hard. Believe me... I know. The best thing you can do is get it out of your house... so you can't succumb to it... which you eventually will.

So in your case, where you're treating diabetes and living with an ostomy... you'll need a hybrid diet. I would think both your dieticians could put their heads together (after they take them out of their asses, of course) and put together a diet for you that works for both of your conditions. I'm not saying you'll like everything they recommend, but it's going to be a bit of sacrifice and self-control on your part to get through this. And if your dieticians can't or won't work together to get you a suitable diet... and not dump all that 'figuring out what to eat' on you... you know the deal... find some who will. I'd call your dieticians well in advance of your next visit and explain the trouble you're having figuring it all out and tell them you expect them to come up with a diet plan for you to follow that works for both conditions... or have them at least be prepared to discuss it at your next meeting in a couple of weeks. If you don't, you'll just be wasting a couple of weeks, and probably longer. Hope that helps!

;O)

It's all so confusing. I have lots of questions for the dietitians when I see them next. I do have to find some kind of in-between the two very different diets. I wonder if they knew what they were giving me for information contradicted. I am thinking I am not the average client of theirs.

Thank you for explaining some things to me. It raises more questions, though.

Lee