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Vitamins and Minerals with an Ostomy

Vitamins and minerals contribute to the proper functioning of the body. A balanced diet assures ostomy patients the ingestion of the right types and quantities. The large intestine absorbs these nutrients, which makes ileostomates susceptible to nutritional deficiencies. Colostomy and urostomy patients also have particular dietary requirements. For this reason, ostomy patients require adequate vitamin and mineral intake.

Digestion and nutrient absorption

“The word ostomy, derived from the Latin word ostium, refers to mouth or opening. An intestinal ostomy is a surgically created opening between the intestinal tract and the skin and is specifically named according to the site of origin along the intestinal tract. Approximately 100,000 people in the United States undergo operations that result in a colostomy or ileostomy each year.”1

Vitamins

Vitamins fit into two categories: fat-soluble and water-soluble.

Fat-soluble vitamins

“Vitamins are essential nutrients your body needs in small amounts for various roles in the human body. Vitamins are divided into two groups: water-soluble (B-complex and C) and fat-soluble (A, D, E and K). Unlike water-soluble vitamins that need regular replacement in the body, fat-soluble vitamins are stored in the liver and fatty tissues and are eliminated much more slowly than water-soluble vitamins. Because fat-soluble vitamins are stored for long periods, they generally pose a greater risk for toxicity than water-soluble vitamins when consumed in excess. Eating a normal, well-balanced diet will not lead to toxicity in otherwise healthy individuals. However, taking vitamin supplements that contain megadoses of vitamins A, D, E and K may lead to toxicity. Remember, the body only needs small amounts of vitamins. While diseases caused by a lack of fat-soluble vitamins are rare in the United States, symptoms of mild deficiency can develop without adequate amounts of vitamins in the diet. Additionally, some health problems may decrease the absorption of fat, and in turn, decrease the absorption of vitamins A, D, E and K. Consult your doctor about this.”2

Fat-soluble vitamins come from animals (butter, dairy foods, liver, fish oils) and vegetables (various oil types). These vitamins are key to everyday activities. However, the liver and fatty tissues store them, so daily consumption is unnecessary. Consider a moderate consumption, since the excess of fat-soluble vitamins may have adverse consequences. 

“Fat-soluble vitamins are stable at cooking temperatures while water-soluble vitamins are destroyed. Usually, deficiencies do not occur when the daily requirements of vitamins are balanced by their dietary intake. Deficiency of vitamins K and biotin in the body is very rare because they are synthesized by the intestinal flora, the microorganisms of the body. Fat-soluble vitamins of Vitamin A, D, E and K structurally resembles partially cyclized isoprenoid polymers and are soluble mainly in lipids or oils and thus called fat-soluble vitamins. Absorption and transportation of these vitamins in the body is mainly associated with lipids in the intestine and stored in the liver and adipose tissue and eliminated slowly from the body owing to their lipophilic character. High intake of fat-soluble vitamins may result in their accumulation in the body known as Hypervitaminosis due to the cause of delayed elimination rate. Fat-soluble vitamins regulation is one sort of particular significance in cystic fibrosis.”3

Water-Soluble Vitamins

The body stores no water-soluble vitamins; therefore, they require frequent consumption. Excess consumption is harmless since it is eliminated through urine.

“Vitamins play a vital role in many biochemical functions in the human body and are essential components for maintaining optimal health. There are two main groups of vitamins– those that are fat-soluble (easily stored in fat upon absorption) and those that are water-soluble (washed out and not easily stored). Although adequate intake of all vitamins is important, due to the transient nature of water-soluble vitamins, regular intake is required to avoid deficiency. The water-soluble vitamins include Vitamin C and Vitamin B complex (thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folate, and cobalamin).

Vitamin B complex and vitamin C are found in many foods, especially vegetables and fruits, as well as dairy, meat, legumes, peas, liver, eggs, and fortified grains and cereals. In addition to serving as cofactors in biochemical reactions, vitamin B complex is vital for normal body growth and development, healthy skin, properly functioning of nerves and the heart, and red blood cell formation. The overall lack of water-soluble vitamins is rare in North America, though it can present in alcoholism, malabsorption syndromes, strict veganism, and malnourished states.”4

All fruits, vegetables, legumes and grains are sources of water-soluble vitamins. They are fragile when exposed to the environment or high temperatures. Therefore, we should consume these foods right after chopping, and steam them to preserve their full nutritious content. Water-soluble vitamins include Vitamin C and the B vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6, B7 (biotin), B12, and folic acid.

Vitamin C

“The body needs vitamin C, also known as ascorbic acid or ascorbate, to remain in proper working condition. Vitamin C benefits the body by holding cells together through collagen synthesis; collagen is a connective tissue that holds muscles, bones, and other tissues together. Vitamin C also aids in wound healing, bone and tooth formation, strengthening blood vessel walls, improving immune system function, increasing absorption and utilization of iron, and acting as an antioxidant. Since our bodies cannot produce or store vitamin C, an adequate daily intake of this nutrient is essential for optimum health. Vitamin C works with vitamin E as an antioxidant and plays a crucial role in neutralizing free radicals throughout the body. An antioxidant can be a vitamin, mineral, or a carotenoid, present in foods, that slows the oxidation process and acts to repair damage to cells of the body.”5

Vitamin B

“Surprisingly, given their pivotal physiological significance, our understanding of the role of the B group of vitamins (thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), vitamin B6, folate (B9) and vitamin B12) in health and brain function is limited in several respects. As an example, the major human epidemiological and controlled trial research effort in this area has concentrated almost exclusively on that small subset of B vitamins (folate, vitamin B12 and, to a lesser extent vitamin B6) that play the most obvious roles in homocysteine metabolism.6

B1

Thiamine is essential for ostomates. “Thiamine (also spelled thiamin) was the first B vitamin to be discovered and is also known as vitamin B1 and aneurin. Thiamine pyrophosphate is a coenzyme in the metabolism of carbohydrates and branched-chain amino acids. Thiamine is water-soluble, stable at acidic pH, and unstable in alkaline solutions and with exposure to ultraviolet (UV) light. The major food sources of thiamine are various whole, enriched, or fortified grain products and pork. Other sources include legumes, poultry, processed meats, and soy-based meat substitutes.”7

B2

Vitamin B2 is present in multiple foods. “Riboflavin is unique among the water-soluble vitamins in that milk and dairy products make the greatest contribution to its intake in Western diets. Meat and fish are also good sources of riboflavin, and certain fruit and vegetables, especially dark-green vegetables, contain reasonably high concentrations. Biochemical signs of depletion arise within only a few days of dietary deprivation. Poor riboflavin status in Western countries seems to be of most concern for the elderly and adolescents, despite the diversity of riboflavin-rich foods available. However, discrepancies between dietary intake data and biochemical data suggest either that requirements are higher than hitherto thought or that biochemical thresholds for deficiency are inappropriate”8

B3

“Niacin is crucial for the proper function of our body and is especially important for sportsmen. It is a compound of two important enzymes – NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate). These coenzymes are engaged in more than 500 enzymatic reactions in the human body. The whole energy production in our bodies, including oxidative phosphorylation in mitochondria, Krebs cycle, and cytosol glycolysis, depends on these enzymes. NADP and NADH, biomolecules also dependent on niacin, are important for the synthesis of nucleic acid, fatty acids, and cholesterol, which is vital for the repair of DNA and production of steroid hormones. Moreover, it has a huge influence on the reduction of the risk of cardiovascular diseases and cancers.”9

B5

“Pantothenic acid (Vitamin B5) is the precursor of the phosphopantetheine moiety of coenzyme A (CoA) and the acyl carrier protein (ACP), cofactors required in many essential reactions, particularly of lipid metabolism. Pantothenic acid is synthesized in microorganisms, plants, and fungi, but not in animals, and so the enzymes of the pathway are potential targets for agents against these organisms. The pathway is best understood in E. coli, where it comprises four enzymatic reactions.”10

B6

“Vitamin B6 is a unique vitamin that is involved in the metabolism of proteins, lipids and carbohydrates. The metabolism of amino acids requires enzymes that use pyridoxal phosphate as the co-factor or prosthetic group. In the amino acid decarboxylase reaction that leads to the formation of monoamine neurotransmitters, vitamin B6 is closely associated with the function of the nervous system. It also has an important role in the immune and endocrine systems. Thus, the biological role of pyridoxine in health and ailment is considered vital.”11

B7

“Biotin (also known as vitamin B7 or vitamin H) is a water-soluble vitamin that serves as an essential cofactor for carboxylase enzymes in multiple metabolic pathways. Due to its relatively low cost and abundance of availability in cosmetic products, biotin has become the new trend for consumers wishing to have longer, healthier hair and nails. “12

B9

“Folic acid is a water-soluble vitamin, which is synthetically-produced and found in fortified foods and supplements. Folate is found naturally in plants, such as the dark green leafy vegetables. Folate is not synthesized de novo by humans; therefore, the daily requirements are met from the dietary intake of folic acid supplements or food rich in this vitamin. Folate deficiency could lead to numerous common health problems.”13

Minerals

Minerals perform three key functions: forging strong bones and teeth, maintaining cell fluids, and converting food into energy. Minerals are inorganic, come from soil and water and penetrate into plants and animals. Food sources include meats, fish, dairy foods, vegetables, fruits, dried fruits (more than in regular fruits), and nuts. The main minerals are calcium and iron. The human body requires other minerals but in lower quantities. These are known as Trace Elements: Chromium, copper, fluoride, iodine, selenium, and zinc.

General Healthy Eating Guidelines in Stoma Patients

  1. “Consuming a balanced diet to obtain necessary vitamins, minerals and calories needed for good health. Usually after the surgery, the patients start out with a low fiber/residue diet. The reason is that the surgery causes the bowel to swell. The swelling will reduce in 6 to 8 weeks. Thereafter the patients can resume a regular diet.
  2. Adding one new food at a time to observe their effects. Keeping food consumption may be helpful.
  3. The patients may need to take a multivitamin supplement during the first year of recovery from the surgery.
  4. Consuming a wide variety of food.
  5. Eating at regular intervals. Skipping meals increase the incidence of stool and gas. Small frequent meals may be helpful.
  6. Chewing the food thoroughly. Cutting up food into bite-size pieces may also improve tolerance.
  7. Lactose intolerance is common. The patients may want to avoid dairy products for the first month if noticing gas, bloating and diarrhea after the ingestion of dairy products. It may be tried soymilk or low-lactose cow’s milk.”14

Each ostomy patient has different nutritional requirements, depending on age, gender, and general activity. Seek your physician and nutritionist before engaging with particular diets or vitamin and mineral supplements.

 

References:

(1) Mahan, L. K., Raymond, J. L., & Escott-Stump, S. (2013). Krause’s Food & the Nutrition Care Process-E-Book. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?id=DXIwDAAAQBAJ&pg=PA554&dq=ostomy+patient+nutrition&hl=es-419&sa=X&ved=0ahUKEwjgie_QgLXiAhXwuFkKHV7UA8MQ6AEILjAB#v=onepage&q=ostomy%20patient%20nutrition&f=false

(2) Anderson, J., & Young, L. (2003). Fat-soluble vitamins. Food and nutrition series. Health; no. 9.315. Available online at http://www.westernnationalroundup.org/skillathon/FNJC/Fat%20Soluable%20Vitamins.pdf

(3) Ravisankar, P., Reddy, A. A., Nagalakshmi, B., Koushik, O. S., Kumar, B. V., & Anvith, P. S. (2015). The comprehensive review on fat-soluble vitamins. IOSR Journal of Pharmacy, 5(11), 12-28. Available online at  http://iosrphr.org/papers/v5i11/D0511012028.pdf

(4) Sharma, S., Lykstad, J. (2019). Biochemistry, Water Soluble Vitamins. Available online at https://www.researchgate.net/publication/331425417_Biochemistry_Water_Soluble_Vitamins

(5) Bellows, L., Moore, R., Anderson, J., & Young, L. (2012). Water-soluble vitamins: B-complex and vitamin C. Food and nutrition series. Health; no. 9.312. Available online at https://extension.colostate.edu/docs/pubs/foodnut/09312.pdf

(6) Kennedy, D. (2016). B vitamins and the brain: Mechanisms, dose and efficacy—A review. Nutrients, 8(2), 68. Available online at https://www.mdpi.com/2072-6643/8/2/68

(7) Sriram, K., & Lonchyna, V. A. (2009). Micronutrient supplementation in adult nutrition therapy: practical considerations. Journal of Parenteral and Enteral Nutrition, 33(5), 548-562. Available online at http://www.nutritioncare.org/uploadedFiles/Documents/CNW/Electrolytes%20and%20Trace%20Minerals%202.pdf

(8) Powers, H. J. (2003). Riboflavin (vitamin B-2) and health. The American journal of clinical nutrition, 77(6), 1352-1360. Available online at http://vorga.org/77-6-1352.full.pdf

(9) Szczuko, M., Migrała, R., Drozd, A., Banaszczak, M., Maciejewska, D., Chlubek, D., & Stachowska, E. (2018). Role of water soluble vitamins in the reduction diet of an amateur sportsman. Open life sciences, 13(1), 163-173. Available online at https://www.researchgate.net/publication/325254089_Role_of_water_soluble_vitamins_in_the_reduction_diet_of_an_amateur_sportsman

(10) von Delft, F., Lewendon, A., Dhanaraj, V., Blundell, T. L., Abell, C., & Smith, A. G. (2001). The crystal structure of E. coli pantothenate synthetase confirms it as a member of the cytidylyltransferase superfamily. Structure, 9(5), 439-450. Available online at https://www.cell.com/structure/pdf/S0969-2126(01)00604-9.pdf

(11) Ahmad, I., Mirza, T., Qadeer, K., Nazim, U., & Vaid, F. H. (2013). Vitamin B 6: Deficiency diseases and methods of analysis. Pakistan journal of pharmaceutical sciences, 26(5). Available online at https://www.researchgate.net/publication/256610587_Review_Vitamin_B6_Deficiency_diseases_and_methods_of_analysis

(12) Patel, D. P., Swink, S. M., & Castelo-Soccio, L. (2017). A review of the use of biotin for hair loss. Skin appendage disorders, 3(3), 166-169. Available online at https://www.karger.com/Article/FullText/462981

(13) Liew, S. C. (2016). Folic acid and diseases-supplement it or not?. Available online at http://www.scielo.br/pdf/ramb/v62n1/0104-4230-ramb-62-01-0090.pdf

(14) Akbulut, G. (2011). Nutrition in stoma patients: a practical view of dietary therapy. International Journal of Hematology and Oncology, 28(4), 061-066. Available online at http://www.uhod.org/pdf/PDF_452.pdf

 

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more:

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