Patients after this surgery will only have part or none of their stomachs in their bodies, thus nutrient absorption is important to retain and regain their weight and strength.
Below are some very useful information that an overseas doctor and dietitian friend have provided and I would like to share this as it does help me and given me ideas on how I should plan and take my meals as well as what type of food I should take.
Good Nutrition after a Gastrectomy
Some of the problems that may occur after a gastrectomy (removal of part or all of the stomach), are early fullness, weight loss, anaemia and dumping syndrome.
Dietary recommendations to help overcome these are:-
Recommendations
Early Fullness
* Eat small frequent meals. Spread your food throughout the day. Have 6-8 small meals rather than 3 large ones. This will get less with time.
- Avoid fluids with meals. Drink ½ - 1 hour before or after your meal when your stomach is not so full.
- Chew food well and don’t rush over meals.
Anaemia
Vitamin B12
If you have had all of your stomach removed, Vitamin B12 can no longer be absorbed. You will require regular Vitamin B12 injections. In my case, doctors have advised me to take this every 3 months eventhough I have 1/4 of a stomach. This helps the nutrient absorption.The medicine can be bought at any pharmacy( in liquid ampuoles type ) and brought to any normal clinic for the doctor to administer the injection.
Weight Loss
- Focus on high protein foods. Include ‘protein foods’ with all your meals eg. milk, eggs, fish, poultry, nuts, beans, legumes (beans and lentils), yoghurt and cheese.
- Use high protein milk ( Enarcal Plus / Ensure ) whenever possible (see recipe) eg. in desserts, sauces, milk drinks.
- Have nourishing meals and snacks eg. cheese and biscuits, milk drinks, yoghurt, scones, raisin toast, dried fruit, nuts, peanut butter on bread, sandwiches, milk desserts, scrambled eggs, steamed eggs with minced meat and tofu.
- Replace fluids such as tea, coffee, clear soups, water, with milk, egg flip, milkshakes, thick soups like chicken soup, mushroom soup, fish porridge or congee.
- Weigh yourself weekly. If you are losing weight, contact your dietitian for further assistance.
Breakfast
Lunch
Dinner
Fresh or canned fruit
Egg / Cheese
Bread / oats
Margarine / Butter
Vegemite / Bovril / Marmite
* 1 glass high protein milk (see recipe below)
Sandwich / Butter / Margarine
- Meat, Cheese, Chicken
- Salad, eg tomato, lettuce, broccoli, spinach
Fresh or tinned fruit
* Tea/Coffee with milk
Meat / Fish / Chicken
Potato / Rice / Pasta
Vegetables or Salad
* High Protein milk
Morning Tea
Afternoon Tea
Supper
Crackers and Cheese
Scones and margarine
Yoghurt / Custard / Milk Pudding
Fresh or canned fruit
* Drink 30 - 45 minutes later, half an hour before meals or an hour after meals.
- Biscuits and cheese
- 1/2 a sandwich with protein
filling - Toast, raisin toast
- Scone, crumpet, muffin &
spread - Milkshake, flavoured milk/
smoothie - Supplement drink eg
Sustagen, Ensure, Enercal Plus - Yogurt
- Boiled egg
- Cake, biscuits
- Muesli bar
- Chocolate
- Fruit salad and yogurt
- Corn chips. Potato chips
- Instant noodle with protein meat, fish
- Fresh or Canned fruits
- Left overs
60g (¾ cup) skim milk powder
500mls (2 cups) milk
Beat together
Add flavouring or pureed fruit as desired.
Use as a base for milkshakes, eggflips and in soups, sauces and desserts.
Dumping Syndrome
Dumping syndrome occurs to a small number of people following a gastrectomy. It is caused by the rapid dumping of food in the intestine. Two types of dumping can occur. Early dumping (15-30 minutes after meals) this can cause nausea, vomiting, stomach bloating, cramping pains and diarrhoea. Late dumping (occurs 2-3hrs after meals) is associated with palpitation, sweating and drowsiness.
Dumping syndrome can be avoided by:-
- Avoiding drinking with meals. Fluids should be taken 30 minutes before or after meals.
- Have small frequent meals. Avoid very hot or very cold fluids and foods.
- Eat slowly and chew food well .
- Avoid foods containing large amounts of sugar. Sugar is emptied rapidly from the stomach resulting in the symptoms above. Some high sugar containing foods include:-
- soft drinks, cordial, fruit juice, flavoured mineral water, cakes, biscuits, chocolate, honey. - Avoid alcohol.
LESS TOLERATED FOOD AFTER GASTRIC SURGERY
- Sweetened cereals, donuts and sweet rolls
- Frozen or dried fruit, fruit cooked or canned with sugar,
sweetened fruit juice, prune juice. - Malted or chocolate milk, sweetened custard, pudding or
yogurt. - Cakes, cookies, pies, ice cream, jams, honey, lollies.
- Carbonated drinks.
SOME LOCAL MALAYSIAN FOOD
* Chicken rice
* Dumplings ( har gow, dim sum, siew mai)
* Chee cheong fun
* Fish ball / paste noodles
* Pork, chicken, beef meatballs with beancurd + a dollop of sesame oil
* Soya drink , tau foo fa ( any milky pudding)
* Steamed fish with bean curd
* Steamed minced meat and egg (with tofu)
* Porridge / Congee with fish, minced meat , egg, ikan bilis
* Bubur cha cha
* Red / green bean soup
* Stir-fry vegetables -- leafy vegetables should be chopped up and chewed well
* Midmeal snacks -- small serving of peanuts, almonds, cashews, pumpkin or other seeds ( must chew well and finely :- very important )
FRESH VEGETABLE & FRUIT JUICES
Daily I drink 2 types of raw vegetables and 2 kinds of fruits. I used an electric juicer to extract the liquid which I drink immediately in order to prevent oxidation. In this way I hope to keep myself healthy and avoid falling sick.
Eg : 1 Carrot + 2 stalks of Celery + a large red apple + a large orangeor
1 Carrot + + Cucumber + a green apple + a guava
Raw Vegetables ..................................Fruits
Carrot....................................................... Green / Red Apples
Leek ..........................................................Guava
Beet root ..................................................Pineapple
Broccoli .....................................................Star fruit (carambola)
Spinach .....................................................Orange
Cabbage ....................................................Pear
Cucumber .................................................Mango
You can mix and make any combination of fruits and raw vegetables according to individual taste and how palatable you can swallow.
In the beginning, I could drink only 100 ml of the juices. Slowly I increase it to 150 ml, 200 ml and now after a month I can drink a full cup (250 ml)
Liquid Diet
For the first few days after surgery, I drank enercal/ensure milk, water, plain milo, soya milk, watery porridge / broth, strained chicken or vege soup, cereal / oat porridge plus enercal/ensure milk, yogurt drink, etc. Fruit and vegetable juices are an important daily drink. Slowly I increased the amount of liquid from a quarter bowl to half a rice bowl.
Later I change my liquid diet to a soft and low residue ( no high fibre) diet. For example, I soaked half a slice of bread or a cracker biscuit into my milk. I ate more steamed white flesh fish like pomfret, tofu slices, blanched broccoli, sawi or kale and carrot slices.
