Do You Know What You Are Missing?
March 14, 2018

Do You Know What You Are Missing?

Part 3

In 2012, once I was home and well on my way to recovering from bowel surgery, I was struck by one overwhelming question—what absorbs where? You see, after several years competing in endurance sports, I knew that the primary role of my colon was the absorption of water and with that came key minerals, particularly electrolytes. So, I obsessed. If I am missing my colon, will I always be deficient in electrolytes? And, if that was true, then what else should I be concerned about? 


I also knew that the gallbladder played a role in fat absorption, but I wasn’t really clear on what that meant. I asked everyone on my health care team. I was ultimately and unsuccessfully provided the council of six different nutrition experts. No one could answer my question. This was the single greatest motivator behind my education in holistic nutrition. I wanted to learn how to properly fuel my altered, injured and unwell body.ostomy diet tips

Without regurgitating a compendium of anatomy, physiology and bio chemistry texts, I’m going to give you the (not so) short answer. 

The alimentary canal (or digestive tract from mouth to anus) has several stops along the way which extract nutrients to be used by the body for myriad biochemical processes. The first stop is in the mouth where simple carbohydrates are absorbed. Didn’t know that did you? Well, OK. It was news to me. So, when your grandmother told you to chew your food 25 times before swallowing, she was actually onto something important. 

Next, the stomach breaks down your food using a combination of mechanical and chemical digestion processes. It is not uncommon for some of those chemicals—gastric juices—to decrease with age or illness (typically as a side effect of medication). This decrease can affect the breakdown of foods, which will impact absorption further down the GI (another reason to chew your food thoroughly!). Your body will try to compensate by ratcheting up the mechanical churning, which can lead to reflux, that burning at the back of your throat often perceived as heartburn. 

When this churned up mess of food, known as chyme, exits the stomach it is dumped into the first section of the small intestine, known as the Duodenum. Here, it is washed in bile, expressed from the gallbladder. Made by the liver, bile has a few different roles. For our discussion however, its primary purpose is to emulsify fat particles. That is to break them down into smaller, easy to absorb molecules. If you, like me, no longer have a gallbladder, you may wish to consider supplementing with an external form of bile (I use ox bile, taken 15 minutes before meals). ostomy vitamins

The good news is that the next section of small intestine, the Jejunum is the longest and does the lion’s share of nutrient absorption. Nearly all of your macro nutrients and vitamins, plus some minerals are absorbed here. 

The final section is the Ileum. Some nutrient absorption takes place here such as certain amino acids and carbohydrates. It is here where the spent bile and cholesterol are absorbed back into the blood stream and sent off to the liver. The ileum, specifically the ileo-cecal valve, also plays an important role in preventing waste and bacteria from traveling back up into the small intestine. If you are planning a reconnection surgery, be sure to read my final post at the end of March to help you prepare, as this will become important to maintaining a healthy gut micro biome. 

We are now at the large intestine. For those with an ileostomy, your digestive journey is complete and this is where you need to pay attention. The first chamber of the large intestine is called the cecum. It is here where the vitamin B12 is absorbed. B12 plays an important role in the creation of DNA, blood and nerve cells. It is often called the energy vitamin. It is critical for your mental, nerve and immune health. If you are missing this section of colon you must have your B12 measured regularly. You may be required to supplement via injection or sublingual tablets. Symptoms of a deficiency include lack of energy, depression, brain fog and/or rapid heartbeat. 

Next, the colon turns upward (called the ascending colon). Here is where many minerals (electrolytes) such as sodium, potassium, calcium, magnesium and bicarbonate are absorbed along with any remaining fluids. A shortage of these can lead to all sorts of trouble ranging from nausea, dizziness, headache, muscle cramps right through to seizures and heart failure. So, when you ask your primary health provider to test your blood for B12, also ask them to check your electrolytes. Sodium is the most common deficiency, so don’t be afraid to salt your veggies (I prefer mineral salts such as sea or Himalayan). ostomy nutrition

After a right hand turn, your colon traverses across the body and then turns downwards to descend towards the sigmoid colon, rectum and the anus. However, it is here in the transverse colon that the body manufactures vitamin K. Vitamin K is a bit of a misnomer as it is not just one vitamin, but rather a compilation of three that work synergistically to regulate the viscosity of the blood, in particular it contributes to normal blood clotting. It is also thought to play a critical role in the mineralization of bones. No transverse colon virtually guarantees a vitamin K deficiency. However, this is one that must be closely monitored by your physician, so do not supplement without a blood test and a thorough vetting by your primary physician. 
gut bacteria


Finally, a word on probiotics. By now, most of us have seen the litany of articles and advertisements discussing the value of a gut full of good bacteria. But what about those of us without a colon or as is my case, a semi-colon? My opinion, in the absence of any real science, is to proceed carefully. Personally I opt for food sources, such as Greek yogurt, kefir, kombucha and kimchi. Further, I make sure I have ample prebiotics in my diet—asparagus, artichoke, dandelion greens, garlic, onion and bananas, etc. These are the foods that feed the gut bacteria you already possess. Sure, there are times when I’ll supplement, like after a round of antibiotics. However, I specifically look for fewer bacteria numbers and a greater variety of cultures. In fact, a children’s supplement usually does the trick. When I buy supplements, I always buy top quality. The typical drug store brand in all likelihood is not going to do you much good. You should be getting these from the fridge at your local health food shop. And lastly, take your supplement before bed. Your colon “rests” during REM sleep which will allow the bacteria to settle in and colonize your gut.

So, you see, where your ostomy truncates your GI tract can have a great impact on your ability to absorb nutrients. As always, if you need assistance, seek the advice of a registered dietitian or licensed holistic nutritionist, specifically one who has experience working with Ostomates. Better still, look for a nutritionist who has or has had an ostomy. There is nothing better than firsthand experience. 

I hope you are finding these posts helpful. Post your comments or questions in the space provided below. Or come visit me on where I post several times a month on all things nutrition, exercise and lifestyle for Ostomates. I look forward to hearing from you. 

Next week I will discuss safe exercise for Ostomates of all ages. I will show you how to work your core safely, to rebuild balance, strength and endurance.

See you next week,



Trish is a graduate of the Canadian School of Natural Nutrition and a Personal Trainer. In 2012, she was diagnosed with stage-4 colon cancer and after six months of chemotherapy, underwent several lifesaving surgeries. Today, Trish draws from her experience and education to empower others to survive and thrive. She writes for Your Health and Fitness Matters Magazine and she is the principle consultant for In The Bag Nutrition, which is dedicated to helping patients with ostomies, or resected GI tracts, to eat healthfully, exercise safely and to embrace life fully. Check out her story at