Nutrition for High Ostomy Output

UCSF Medical Center 加州大學舊金山分校醫療中心 Nutrition for High Ostomy Output 造口術後高排出量對營養方面之影響和處理 What is high ostomy output? High ostomy output is more than 2 liters (8 cups) of fluid from your ostomy in a 24 hour period. This puts you at risk for: Poor absorption of food, vitamins and medications Dehydration and loss of electrolytes Unplanned weight loss Tips to decrease ostomy output The following tips can help control ostomy output and improve your body's ability to absorb nutrients: Eat small, eat often Eat every 2 to 3 hours. Aim for 6 or more small meals per day. Eat slowly and chew food well to help improve digestion. Avoid overeating at meals. Go low residue A low residue diet includes starchy foods that can help thicken your output. The diet also limits foods that are difficult to digest. Choose: Applesauce, bananas, boiled white rice, cheese, creamy peanut butter, cream of wheat, potatoes, tapioca and white toast. Try to include one of these foods at each meal. Limit or avoid: Whole grains, raw vegetables, fruits with edible skins, nuts and milk. 什麼是高排出量 ( 造口術後 )? 造口術後高排出量是指在 24 小時內有超過兩升 ( 或八杯 ) 液體從造口處排出 使你遭受以下危險 : 減少吸收食物 維生素與藥物的能力 脫水與流失電解質 體重意外的減輕減低造口處排出量的提示下面的指導可以幫助你控制造口處的排出量, 並增強你吸收營養的能力 : 少食多餐每隔兩至三小時進食, 力求每天少量膳食六頓或以上 慢慢的吃和細細的嚼以協助改善消化 進餐要避免時吃得太飽 采取低渣滓飲食吃低渣滓飲食, 包括澱粉類食物, 可以協助將排出物變得更稠的 飲食也要限制難消化的食物 選擇 : 蘋果醬 香蕉 白米飯 芝士 ( 乳酪 ) 幼滑花生醬 小麥霜 馬鈴薯 木薯粉與烤白麵包片 嘗試每餐都試用以上食物中的一種 限制或避免 : 全穀物 生的蔬菜 有皮的水果 堅果與牛奶 Reviewed 2/2015 / p.1

Start a soluble fiber supplement Your doctor may prescribe a soluble fiber supplement to help thicken your output. Examples of these are Benefiber, NutriSource Fiber and Citrucel. Instructions: Mix 1 tablespoon of powder into 4 ounces of any beverage or soft food (hot or cold). Stir well until fiber powder is dissolved. Take 3 times daily with meals. Add salt to foods Eat salty foods and snacks such as pretzels, deli meats, cheese and condiments to help replace salt that is lost from your ostomy. Tame your sweet tooth Limit foods that are high in sugar such as candy, ice cream, juice, soda, smoothies and fruit drinks. Avoid food made with sugar alcohols such as sorbitol, mannitol and xylitol. Sugar alcohols are usually found in diet candies, cookies, pancake syrups and ice cream. Be careful with fluids Drink beverages 30-60 minutes before or after your meals. Drinking more than 1/2 cup of fluid during meals can cause food to move too fast through your digestive tract. Sip on drinks slowly. Avoid sugary drinks, alcohol and caffeinated beverages. Hydrate with oral rehydration solutions Limit plain water, tea and milk products to a total of 2 cups per day. Drinking too much plain water and other drinks can increase the output from your ostomy and cause dehydration. Oral rehydration 開始服用水溶的纖維補充劑 醫生可能會開處方給你一種水溶的纖維補 充劑, 以協助你將排出物變得稠些, 例如 :Benefiber, NutriSource Fiber 與 Citrucel 用法 : 將一湯匙纖維粉末混入任何四安士 熱或冷的飲料或軟質食物內, 充份地攪拌, 直至纖維粉末完全溶解 與每日三餐共 進食 在食物中加入鹽類 吃咸味的食物與點心, 例如椒鹽捲餅 熟 食肉類 芝士 ( 乳酪 ) 與調味料, 以協助補 充你從造口處所流失的鹽份 控制你嗜甜的喜好 限制吃高糖份食物, 例如 : 食糖 冰淇淋 ( 雪糕 ) 果汁 蘇打水 冰沙與水果飲料 之類 避免進食含糖醇 ( 例如 : 山梨糖醇 (sorbitol), 甘露醇 (mannitol) 與木糖醇 (xylitol) 的食品 糖醇通常在減肥糖果 甜 餅乾 吃煎薄餅糖漿和冰淇淋中可找到 謹慎進飲 飲料需要在餐前或餐後之 30 至 60 分鐘喝 進食中飲用超過半杯液體 one 導致食物過 快通過消化道 要慢慢一小口地啜飲飲料 避免含糖 酒精與含咖啡因的飲料 口服補充體液的溶液恢復體內水分 限飲白開水 茶與牛奶產品, 以每日總用 量不超過兩杯為限 飲用太多白開水與其 他飲料會增加造口處之排出量而導致脫水 Reviewed 2/2015 / p.2

solutions are better absorbed because they are made of a special blend of water, electrolytes and sugars which help your body stay hydrated. Watch for weight loss If you are having trouble maintaining your weight, try to add extra calories and protein to your diet. Here are some suggestions: Mix unflavored soy protein powder to soft foods or beverages. Try a low-sugar nutrition supplement with less than 10 grams of sugar per serving. Good options include: Boost Glucose Control, Glucema, Premier Protein and Pure Protein. Weigh yourself at home 1 to 2 times per week. Contact your doctor if you are concerned about your weight loss. Take a daily multivitamin and zinc supplement It is important to include a multivitamin with minerals and zinc supplement every day. Chewable, liquid, crushed and sublingual (under the tongue) forms may be easier for you to absorb than whole tablets. Your doctor or dietitian may also recommend other vitamins and mineral supplements. 用口服補充體液的溶液會得到較好的吸收, 因為它們是由水 電解質與糖特製而成, 可助你的體液得以保持 關注體重減少若你在保持體重上發生問題, 可設法在食物中額外增加卡路里與蛋白質 下面有些建議如下 : 在軟的食物或飲料中加入原味大豆 ( 黃豆 ) 蛋白粉 試用一種低糖營養補充物, 每一分中含糖低於十克 適當的選擇有控制血 糖飲料 :Boost Glucose Control, Glucema, Premier Protein 與 Pure Protein 每星期在家量自己體重一至兩次 若對自己的體重減少有疑慮, 就請與醫生聯繫 每天服用多種維生素 ( 維他命丸 ) 與鋅的補充劑每天服用含多種維生素 礦物質 和鋅補充劑是重要的 可咀嚼的 液狀的, 粉狀的與置於舌下的可能比口服劑容易吸收 你的醫生或營養師可能會給你建議用其他的維生素與礦物質補充物 Reviewed 2/2015 / p.3

Low Residue Diet 低渣滓飲食 A low residue diet can help decrease the number and frequency of stools. Residue refers to undigested foods, including fiber, that make up stool. What are the different types of fiber? There are two types of fiber, insoluble and soluble. Each has different properties. Soluble fiber absorbs water, slows the movement of food in the digestive tract and helps to thicken stool output. Food sources include: bananas, peeled fruits, barley and oats. Insoluble fiber does not absorb water during digestion. This type of fiber helps move food through the digestive tract more quickly. Food sources include: fruits and vegetables with edible skins or seeds, whole grains, whole wheat breads and pastas, bran cereals, bulgur, wheat germ, buckwheat and brown rice. 低渣滓飲食可以幫助減少排便量及次數 渣滓是指糞便未消化的食物 ( 包括組成糞便的纖維 ) 纖維有哪幾類? 纖維有兩類, 即可溶的與不溶的, 它們各有其特點 可溶性的纖維吸收水份, 使食物在消化道內減慢移動, 並協助將排出物變得稠密些 食物來源包括有香蕉 去皮水果 大麥與燕麥 非溶性的纖維在消化的時候並不吸收水份 這類纖維使食物通過消化道時移動較快 食物包括有帶可食用表皮和種子的水果及蔬菜 全穀物 全麥麵包及意大利麵制品 麥麩麥片 幹小麥 小麥胚芽 蕎麥與糙米飯 Food Group 食物分類 Starches and Grains 澱粉和穀物 Choose 選擇 White breads, bagels, tortillas, English muffin, rolls and biscuits White rice, white pastas, polenta, couscous, low fiber cereals and grains Crackers such as saltines, graham crackers, animal crackers and pretzels Peeled and well-cooked potatoes and sweet potatoes, Avoid 避免 Whole grain breads, bagels, tortillas, rolls and biscuits Whole grain pasta and cereals, brown rice, barley, bulgur and any whole grain item with more than 1 gram of fiber Whole grain crackers, popcorn, cracker jacks, snack mixes with nuts or seeds, Potato skins Reviewed 2/2015 / p.4

mashed potatoes 白麵包 硬麵包圈 玉米餅 英式鬆餅 卷餅與餅乾 白米飯 白麵條 玉米粥 蒸粗麥粉, 低纖維的穀類食物與穀物 餅乾, 例如 : 鹽脆薄餅乾 全麥餅乾 動物餅乾與椒鹽捲餅 全熟去皮馬鈴薯與番薯 馬鈴薯泥 全麥麵包 硬麵包圈 玉米餅 卷餅與餅乾 全麥麵條和穀類 糙米飯 大麥 幹小麥與任何含超過一克纖維的全穀物類 全麥餅乾 爆米花 加上焦糖和花生碎的爆米花 混有堅果或種子的零食 馬鈴薯皮 Vegetables 蔬菜 Soft, tender-cooked, nonfibrous vegetables like wellcooked carrots, zucchini, green beans, creamed spinach, eggplant and squash Canned or pureed vegetables Butter leaf lettuce Pulp-free vegetable juice 軟 嫩而非纖維的蔬菜, 例如 : 煮熟的胡蘿蔔, 夏 南瓜, 綠豆, 奶油菠菜, 茄子與南瓜類植物 罐頭蔬菜或蔬菜濃湯 奶油生菜 無渣之菜汁 Any raw or undercooked vegetables Fibrous vegetables like broccoli, Brussels sprouts, bamboo shoots and asparagus stems Green salads and fresh spinach Peas and corn 任何生的或未熟透的蔬菜 高纖維的蔬菜, 例如 : 西 蘭花 抱子甘藍 竹筍與 露筍 綠色生菜沙律與新鮮菠菜 豌豆與玉米 Reviewed 2/2015 / p.5

Fruit 水果 Soft, peeled, non-fibrous fruits like bananas, melon, peaches Canned fruits, drained Peeled and baked apples 軟 去皮 無纖維水果, 例如 : 香蕉 瓜類 桃 罐頭水果 ( 將水隔走 ) 去皮蘋果與焗蘋果 Fresh fruit with skin Berries and cherries All fruit juices, especially prune juice and juice with pulp Dried fruit 帶皮新鮮水果 漿果與櫻桃 所有果汁, 特別是西梅汁與帶果肉的果汁 乾的水果 Dairy and Milk Substitutes 奶製品和牛奶 替代品 Protein 蛋白質 Up to 2 cups per day of dairy products, including milk and yogurt Try taking lactase enzymes with dairy to improve tolerance. Unsweetened soy milk, almond milk, rice milk, Lactaid or lactose-free milk, non-dairy creamer, soy-based cheeses and yogurts, and cream cheese 每日不超過兩杯奶類飲品, 包括牛奶與酸奶 試用乳品時要加上乳糖酶 ( Lactaid), 以提高耐受性 不含糖份的豆奶 杏仁奶 米奶 乳糖酶或無乳糖 牛奶 非奶類奶精 大豆 為主的乳酪和酸奶與奶油 乳酪 Tender, well-cooked or ground meats like poultry, beef, lamb, ham, pork, organ meats and fish Cheese and cottage cheese Eggs Creamy nut butters, as Over 2 cups per day of dairy products If you have a hard time tolerating full-fat dairy products, choose low or fatfree dairy instead. 每日飲用超過兩杯奶類飲 品 如果你不能接受全脂乳製 品, 可選擇低脂或脫脂的 替代品 Any tough, fibrous meats and all legumes including dried or canned beans, split peas and lentils Meat with casing, like hot dogs and sausages Nuts, crunchy nut butters, Reviewed 2/2015 / p.6

tolerated seeds Fats and Oils 脂肪與食油 Other 其他 嫩的 全熟或絞碎的肉類, 如家禽, 牛肉, 羊肉, 火腿, 豬肉, 內臟和魚 乳酪或乾酪 雞蛋類 幼滑堅果醬 ( 若能忍受 ) Margarine and butter Olive, canola, and other vegetable oils, as tolerated 人造牛油與牛油 橄欖油 菜籽油與其他植 物油 ( 若可容忍接受 ) Seedless jam, jelly, cookies without nuts, plain donuts and cake Baked products without nuts or seeds 無核果醬 果子凍 無堅 果的甜餅乾 油炸圈餅與 蛋糕 無堅果或籽成份的烤製食 品 任何韌 多纖維的肉類與 各種豆類, 包括豆乾或罐 頭豆 裂莢豌豆與扁豆 帶腸衣的肉, 例如 : 香腸 與肉腸 堅果 含粗果粒堅果醬 種子 Deep fried, greasy foods Any food with visible grease, such as bacon, fried chicken and French fries 油炸 油膩食物 任何可用肉眼看得到油脂 的食物, 例如 : 煙肉 炸 雞與炸薯條 Seeded jams, bakery items with nuts or seeds, coconut Highly seasoned or spicy foods Caffeine and alcohol 有籽果醬 帶堅果或籽的 烤製食品 椰子 濃調味或辛辣的食物 咖啡因與酒精 Reviewed 2/2015 / p.7

Foods that May Affect Ostomy Output 可能會影響造口處排出物的食品 Listed below are general guidelines which describe how different foods may affect your ostomy output. These effects may vary from person to person. You may try any food that you like in small amounts to determine which foods you tolerate best. 下列為一般指引, 描述不同的食品如何會影響造口處排出物 對於不同的人, 這些影響可能會有異 你可以先嘗試一點點任何你喜歡的食物, 以決定那一款食品與你最合拍 Helps to Thicken Output 協助排出物變得更稠 Applesauce 蘋果醬 Banana 香蕉 Boiled white rice or pasta 白飯或麵條 Cheese 乳酪 Creamy peanut butter 幼滑花生醬 Marshmallows 棉花糖 Potatoes 馬鈴薯 Pretzels 捲餅 Tapioca 木薯粉 White toast 白吐司 Choose 選擇 Buttermilk 酪奶 Yogurt 酸奶 Parsley 香菜 Odor Control 控制 ( 排出物 ) 異味 Tomato juice 番茄汁 May Worsen Diarrhea 可能使腹瀉惡化 Alcoholic beverages Whole grains Bran cereals Beans May Cause Obstruction 可能造成阻塞 Raw cabbage Chinese vegetables Corn Raw celery Limit or Avoid 限制或避免 Gas Producing* 產氣食物 * Alcoholic beverages Beans Soy Cabbage Carbonated drinks Odor Producing* 產異味食物 * Asparagus Baked beans Broccoli Cabbage Cod liver oil Reviewed 2/2015 / p.8

Cooked cabbage Fruits with skins Leafy greens Milk Prunes Raisins Raw vegetables Spicy food Sugary drinks 酒精飲料 全穀麥 麩麥片 豆類 煮熟的捲心菜 帶皮的水果 綠葉蔬菜 牛奶 梅乾 葡萄乾 生的蔬菜 辛辣食物 含糖飲料 Mushrooms Coconut Apple peel Tomato Popcorn Dried fruits Nuts Grapes Oranges Pineapple 生的捲心菜 中國蔬菜 玉米 生的芹菜 蘑菇 椰子 蘋果皮 番茄 爆米花 水果乾 堅果 葡萄 橙 菠蘿 *Only avoid these foods if they worsen your symptoms of gas, bloating or odor. Cauliflower Dairy products Chewing gum Nuts Onions Radishes 酒精飲料 豆類 大豆 捲心菜碳酸飲料 花椰菜 乳製品 口香糖 堅果 洋蔥 小蘿蔔類 Eggs Fish Garlic Onions Peanut butter Strong cheese 蘆筍 烤豆 西蘭花 捲心菜魚肝油 蛋類 魚 蒜 洋蔥 花生醬 強烈的奶酪 * 如果這些食物使你排氣 腹脹或產生氣味 的徵狀惡化, 你只好避免食用 Reviewed 2/2015 / p.9

Oral Rehydration Solutions 補充體液的口服溶液 High ostomy output can lead to dehydration and loss of important minerals called electrolytes. Losing electrolytes, notably sodium and potassium, can cause serious physical problems. Symptoms may include muscle weakness and cramps, irregular heartbeat, confusion, and fatigue. Severe dehydration and electrolyte loss can lead to convulsions and coma. Oral Rehydration Solutions (ORS) can help replace fluids and electrolytes. Rehydration solutions are made from special combinations of water, electrolytes, and sugars. The sugars that are in rehydration solutions improve the absorption of sodium and fluid. The salty taste is due to the sodium content. Sports drinks such as Gatorade are not good options to replenish fluid and electrolytes. They do not contain the correct ratio of ingredients for proper rehydration. Below is a list of recommended premade ORS products that you can purchase at the store. The recipes further below can be made at home. Because of the ratio of ingredients used in the WHO pre-made product and recipe, these solutions will best replenish losses. 造口術後高排出量可以引起脫水和流失重要的礦物質叫電解質 失去電解質, 尤其是鈉和鉀, 可以造成嚴重的身體問題 徵狀可能包肌肉無力和痙攣 心律不齊 精神錯亂與疲勞 嚴重脫水和電解質流失可導致抽搐和昏迷 補充體液的口服溶液 (ORS) 可以幫助恢復體液與電解質 補充體液的口服溶液是用水 電解質與糖依特製組合而成 溶液中的糖是增加納和體液的吸收 那種咸味是由於其含納的原故 運動飲料, 例如 : 佳得樂 Gatorade, 並不是補充體液和電解質的適合選擇 它們並不含補液成分的正確比例 以下例表推薦預製恢復體液的口服溶液, 都可在商店里買到 再下的食譜, 讓你能在家中製作 這些溶液對所流失的體液補充效果最佳, 因為預製產品與食譜的成份比例都是世界衛生組織所納用的 Premade Products Oral Rehydration Salts packet (Jianas Brothers) Ceralyte 90 (Cera) Equalyte (Abbott) Drip Drop (Elite Hydration Science) 預製產品 口服補充液鹽小包裝 (Jianas Brothers) Ceralyte 90 (Cera) Equalyte (Abbott) Drip Drop (Elite Hydration Science) Reviewed 2/2015 / p.10

Homemade Recipes WHO: ½ teaspoon salt ½ teaspoon salt substitute (potassium chloride) 8 teaspoons sugar ½ teaspoon baking soda 4½ cups water Combine and stir until well mixed and dissolved. Crystal Light may be added to improve flavor. Gatorade Based: 2 cups Gatorade G2 ¼ teaspoon salt Combine and stir until well mixed and dissolved. Apple Juice Based: 1 cup apple juice 3 cups water ½ teaspoon salt Combine and stir until well mixed and dissolved. Homemade Recipe: 4½ cups water 1 cup orange juice 8 teaspoons sugar ½ teaspoon baking soda ½ teaspoon salt Combine and stir until well mixed and dissolved. 家常食譜世界衛生組織 : 半茶匙食鹽 半茶匙食鹽替代品 ( 氯化鉀 ) 八茶匙糖 半茶匙蘇打粉 四杯半水合併攪拌, 直至完全混合和溶解 要增加美味, 可加入 Crystal Light 以佳得樂 Gatorade 為主劑 : 兩杯佳得樂 Gatorade G2 四分之一茶匙食鹽合併攪拌, 直至完全混合和溶解 以蘋果汁為主劑 : 一杯蘋果汁 三杯水 半茶匙食鹽合併攪拌, 直至完全混合和溶解 家常食譜 : 四杯半水 一杯橙汁 八茶匙糖 半茶匙發粉 ( 小蘇打 ) 半茶匙食鹽合併攪拌, 直至完全混合和溶解 Reviewed 2/2015 / p.11