Eating marshmallows reduces ileostomy output: a randomized crossover trial

Aim Anecdotally, many ostomates believe that eating marshmallows can reduce ileostomy effluent. There is a plausible mechanism for this, as the gelatine contained in marshmallows may thicken small bowel fluid, but there is currently no evidence that this is effective. Method This was a randomized crossover trial. Adult patients with well-established ileostomies were included. Ileostomy output was measured for 1week during which three marshmallows were consumed three times daily, and for one control week where marshmallows were not eaten. There was a 2-day washout period. Patients were randomly allocated to whether the control or intervention week occurred first. In addition, a questionnaire was administered regarding patient's subjective experience of their ileostomy function. Results Thirty-one participants were recruited; 28 completed the study. There was a median reduction in ileostomy output volume of 75ml per day during the study period (P=0.0054, 95% confidence interval 23.4-678.3) compared with the control week. Twenty of 28 subjects (71%) experienced a reduction in their ileostomy output, two had no change and six reported an increase. During the study period, participants reported fewer ileostomy bag changes (median five per day vs six in the control period, P=0.0255). Twenty of 28 (71%) reported that the ileostomy effluent was thicker during the study week (P=0.023). Overall 19 (68%) participants stated they would use marshmallows in the future if they wanted to reduce or thicken their ileostomy output. Conclusion Eating marshmallows leads to a small but statistically significant reduction in ileostomy output.