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September 21, 2016

Common Vitamin and Nutritional Deficiencies of Ostomy Patients

The large intestine is the final portion of the gastrointestinal tract. It performs the vital task of absorbing water in addition to vitamins and nutrients that have been produced by gut bacteria. Since some of your body’s nutrition is absorbed in the large intestine, those who have received an ileostomy are more susceptible to nutritional deficiencies. Colostomy or urostomy patients also have distinctive dietary variables to consider.

Your doctor and nutritionist will guide you in managing your dietary needs. By all means you should look to them for final say on all nutritional decisions. That being said, we know that anyone who is about to undergo, or has recently received, a colostomy, urostomy, or ileostomy has questions about nutrition right from the get-go. InnerGood is happy to provide you with some pertinent information about the deficiencies you may need to manage to live your life to the fullest, and then some.

Vitamins, Minerals, and Other Nutrient Deficiencies that those Living with an Otsomy Need to be Aware Of

Vitamin B-12

For all intents and purposes, B is the beginning of your nutritional alphabet. Vitamin B-12 is the most common of nutritional deficiencies. Studies show that an estimated 25 percent of all people who have received an ileostomy have developed a B-12 deficiency. You don’t want that. A lack of B-12 in your body can result in anemia, with further repercussions that include irreversible nerve and/or brain damage. Sounds scary, but with a nutritionist-advised schedule you can consume a B-12 supplement to abate these concerns. One item worth noting, is that B-complex may cause an odor, so many people opt for a B-12 injection or nasal spray. B-12 is not absorbed as well via an oral route so the injection or spray simply makes good sense.

Folic Acid

Some of you may be taking Sulfasalazine. Sulfasalazine can affect folate absorption, so you may have to take a folic acid supplement to balance the effects. A deficiency can result in mucosal impact in the intestinal lining. Folic acid is also absorbed near the ilium, so once again those who have received an ileostomy will need to be especially mindful.

Folic acid is a tricky one to monitor. For the most part, you can’t get too much B-12. But you can get too much folic acid. Here’s the catch, B-12 and folic acid work together to the point that a deficiency in one may be mistaken for a deficiency of the other (without proper testing). Since folic acid is absorbed in pill form (as opposed to a physician-supervised injection), you must be mindful and monitor your prescribed intake. If you’ve had an ileostomy you will also want to check to see if the folic acid pills are going through your digestive tract whole. If so, it is not being absorbed and you will need to look at an alternative form of delivery for this vitamin.


Common Vitamin and Nutritional Deficiencies of Ostomy Patients includes Potassium - image of potassium foods

A loss of potassium though the stomach and intestines is common to those living with an ileostomy. Ileostomies are susceptible to sodium and water depletion. Increased sodium output from the ileostomy is associated with a reduction in the sodium: potassium ratio. Your physician will measure sodium and potassium concentrations and determine a lack in the latter. However, if you notice a combination of fatigue, muscle weakness, shortness of breath, decreased sensation in arms and legs, and/or a gassy bloated feeling you may have a potassium deficiency. You will need to consult with your doctor immediately. Traditionally, potassium is most effectively delivered via food such as bananas and dark leafy greens. The issue, is that to get enough to account for a deficiency, you may have to eat a lot, to the point excessive weight gain. Thus, a supplement is recommended to complement your diet.


Vitamin B-12, folic acid, and potassium are the most common nutritional deficiencies. But there are others you may need to supplement with. These include Vitamin B1, Vitamin B9, Vitamin D, Vitamin K, calcium, iron, magnesium and zinc. As with everyone, a healthy balance of protein, complex carbohydrates, and essential fatty acids will help you not only maintain your health, but will allow you to maximize your potential for all sorts of activities, sports, and physical regimes.

Every person is different and nutritional requirements can vary by age, gender, conditioning and overall activity. Educate yourself further with this Ostomy nutrition guide and consult with your physician and nutritionist before ordering from our dietary supplements page. And of course, feel free to contact InnerGood anytime, with any questions you may have.


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4 Replies to “Common Vitamin and Nutritional Deficiencies of Ostomy Patients”

  1. Had full ileostomy. Except for folic(pill form)and b12 shots, take all other supplements in soft-gel form. Is this a good choice? Have no idea if anything is going where it should? Please advise

    1. Hi Michaele,

      First off, we cannot provide any direct medical advice on this topic. With that said, speaking as a fellow ileostomate, it’s hard to know exactly what we might be deficient in. When your surgeon cut the large intestine from the small, a centimeter either way can yield different vitamin uptake. You are on the right track with the soft gel pills as anything that can break down quickly (gels and liquids) will be absorbed more quickly.

      I would recommend that speak with your doctor and perhaps look into a routine blood test. Likely this will be the best guide to know your body is receiving all the nutrients needed.

      Thanks for the question!

  2. I ve had an ileostomy since 1988. First of all start with labs and determine your deficiencies and then take appropriate supplements. I am a VA patient and the VA did not offer much help in determining my vitamin deficiencies. Over the years and some terrible times, I was able to finally recognize and request the proper meds and supplements. I was the key to everything, you have to be able to read your labs and with some consulting eventually take the proper doses. It takes a very personal attention to your labs and to your condition to achieve the proper dos of vitamins subsequent to a ileostomy. Do not rely entirely on the doctor to identify your condition. Some doctors are good but most are not as involved as they should be. take care of yourself and be involved in your own care. You are the real key to your own health, no one cares more than you.

  3. Does any fellow ostomates… (nutritionist, ostomy nurses or doctors) out there know if they have experienced a really foul oder from their fecal matter… like an eggy smell… and it never stops.. like for months on end, no matter what you eat, smell is always the same. Could this be a fungus, bacteria, virus or parasite? The reason I ask… it NEVER changes… no matter what different foods I eat. It is ALWAYS a pungent eggy / broccoli / meat smell. So strange. I am also VERY tired since this started. I wonder could it be a vitamin deficiency… or maybe ‘Short Bowel Syndrome’… or ‘Malabsorption’. There is Something weird going on… just not sure what. Thanks for any advice! Thank you!

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