Gastrectomy Nutrition

Nutrition Post Gastrectomy
What is a Gastrectomy? “dumping syndrome”. See advice

A Gastrectomy is an operation that below. If diarrhoea persists, seek
removes all or part of the stomach (total medical advice.
or partial). As a result, the stomach is 3. Weight loss
smaller with less room for food to be held. • Eat nutritious snacks between meals
It may also mean that you will feel full e.g. cheese and crackers,
more quickly, and food will pass through sandwiches, nuts, dried fruit, yoghurt,
into your gut sooner after eating. You dairy desserts.
should still be able to enjoy all the foods • Include foods that contain fat and
you ate before your operation; however protein at each meal e.g. eggs, meat,
you may have to make some changes to chicken, fish, tofu, baked beans,
your eating habits. cheese, milk, olive oil, avocado or
nuts (including peanut butter).
Common problems and management
• Choose nourishing drinks – select
It can cause problems as described
milkshakes, Milo™, Sustagen™, or
below. However not everyone will get
Ensure™ rather than tea and coffee.
these symptoms.
• Monitor your weight weekly and let
1. Feeling full early
your Dietitian know if you keep losing
• Eat small meals every few hours;
weight, or ask for a referral from
aiming for a total of six or more meals
your GP.
each day.
4. “Dumping Syndrome”
• Eat nutritious snacks between meals. Normally there is a muscle at the bottom
• Have drinks at least 30 minutes before of the stomach that controls the amount
or after meals, not with meals as this of food the stomach lets into the small
may fill you up too quickly. intestine. This muscle is often taken out
2. Diarrhoea or doesn’t work as well following a
• Drink plenty of liquids between meals. gastrectomy, causing food to move too
• If diarrhoea occurs 15 to 30 minutes quickly from the stomach into the
after eating, you may be experiencing small intestine.
This is a consensus document from Dietitian/ Nutritionists from the Nutrition Education Materials Online, "NEMO", team.
Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp Reviewed: December 2016
Due for review: December 2018
The following symptoms may occur after • Taking a starchy snack (e.g. slice of
your stomach surgery including: bread, banana, oatmeal biscuit) may
• Nausea and vomiting help symptoms.
• Bloating, cramping or diarrhoea 5. Vitamins and Minerals
• Palpitations, sweating or shakiness When all or part of your stomach is

removed, your body may be unable to
• Fullness
absorb vitamin B12 and iron as easily
• Lack of concentration or tiredness
from your food. Both of these nutrients
are required for healthy blood. Your
These symptoms are referred to as
doctor may need to give you injections to
“dumping syndrome”. Most people
replace vitamin B12.
experience symptoms 10 to 30 minutes
after eating (early dumping syndrome),
To help your body get the iron it needs
others have symptoms one to four hours
you can:
after eating (late dumping syndrome).
• Eat foods high in iron: red meat,
chicken, fish, eggs, liver, kidney,
To help prevent these symptoms:
shellfish, and breakfast cereals or
• Avoid large meals; choose six to eight
meat alternatives with added iron (e.g.
small meals or snacks each day.
Special K™, cornflakes, tofu).
• Have drinks 30 minutes before or after
• Eat foods high in vitamin C within 30
meals, instead of with meals.
minutes of eating iron rich foods.
• Avoid food and drink that contains a These include: fruit (especially citrus
lot of sugar e.g. regular cordial, soft
fruits, fruit juices, and berries) and
drink, mixed alcoholic beverages.
vegetables (especially tomatoes,
• Include high fibre foods if you have capsicum).
late dumping symptoms or trial a fibre
supplement. High fibre foods include: You may also be at increased risk of low
lentils, baked beans, oat bran, calcium and vitamin D intake or
wholegrain breads and cereals, skins absorption.
on fruit and vegetables.
• Try to include 2 serves of dairy each
• Lying down after eating may help if day (e.g. cheese, yoghurt, milk,
you experience severe symptoms. custard, ice cream, fortified soy
products). You may need to take a to help in meeting your increased
supplement if your levels are low or nutrient needs after surgery.
you cannot meet this with diet alone.
• A multivitamin can help if you are 2. Pureed diet
unable to manage a wide variety of Your surgeon may move you to a pureed
foods from the different food groups. diet if free fluids have been tolerated well.
Alternatively, you may be placed directly
Eating again onto a soft diet. Pureed options include:
• Following your surgery your diet will • Soup: thick and smooth, continue to
be progressed back to normal over avoid large chunks.
time. The steps below will explain how • Pureed meat and vegetables: select
your diet might change over the next from the pureed hospital diet or puree
several days. in a blender with extra liquid.
• After your surgery, you may only be • Cereals: milky porridge, softened
allowed sips of water or clear fluids WeetbixTM with extra milk.
under the direction of the surgeon.
• Creamy desserts: semolina, mousse,
crème caramel.
1. Free fluids – liquids only
This diet is usually followed for 1-2 days if
3. Soft diet
clear fluids have been well tolerated.
If liquids have been well tolerated, you
Options should include liquids only:
may be able to move directly to a soft diet
• Soup: smooth and liquid based with under the direction of your surgeon.
no bits or lumps.
• Softened foods: minced, mashed,
• Jelly, custard, ice cream. chopped or stewed foods using the
• Hot or cold drinks: tea, coffee, hot five main food groups (cereal, meat,
chocolate, plain milk (aim to avoid vegetables, fruit and dairy).
carbonated / fizzy drinks). • Moist foods: add extra sauce, gravy or
• Nutritional Supplements: Ensure liquids to soften foods.
TM TM TM
Plus , Sustagen , Resource Plus • Avoid hard foods: tough meat/gristle,
are suggested for the first few weeks seeds/pips/skins, fresh/multi-grain
bread, hard crusts, hard/stringy fruit
and vegetables (e.g. celery, beans, Beads and cereals
grapes, tomatoes, orange pith). • Add a thick spread of butter,
margarine, jam, dip, cheese, peanut
4. Normal diet butter or your favourite spread to a
You may tolerate soft foods better for a variety of bakery products.
period of time. However you should be • Choose nutrient dense sandwich
able to progress back to a normal fillings e.g. sliced meat, canned fish,
textured diet as tolerated. baked beans, cheese, avocado,
tinned spaghetti, eggs.
Making the most of what you eat
If you can’t manage a lot of food Fruit and vegetables
throughout the day, it is important to
• Add margarine, butter, oil or cheese to
make the most of what you do eat.
vegetables for extra energy e.g.
Suggestions include:
cauliflower cheese or a creamy potato
bake.
Dairy
• Add ice cream, yoghurt or custard to
• Add cream or cheese to main meals
fruit.
such as scrambled eggs, omelettes,
• Try to eat a variety of types and
casseroles.
colours to ensure you are getting a
• Add skim milk powder to your milk
good variety of nutrients.
drinks to make them doubly nutritious.
• Include fruit / vegetable juice if you
• Choose dairy snacks like custard,
have difficulty eating enough fruit and
yoghurt, ice cream, rice puddings,
vegetables.
mousse and other similar products.
Easy snacks
Meat and meat alternatives
• Supermarket freezers can provide
• Add meat, lentils or other legumes to
ready-made meals and snacks that
dishes such as soups and casseroles.
require little preparation.
• Eggs make a nutritious addition to
• Dairy foods like custard, yoghurt, rice
meals or make an easy snack.
pudding, milk desserts, milk drinks
make easy snacks. Choose full cream General rules for eating after
options where possible. Gastrectomy
• Muesli bars, pre-packaged cheese  Eat a healthy diet choosing a wide
and dips/crackers and Up & GoTM variety of foods
make good handy snacks.  Eat slowly and chew foods well
 Avoid very sugary food and drink (such
Future nutrition goals as soft drinks, cordials, lollies etc.) and
If over time, you are able to tolerate a monitor caffeine
more normal diet and your weight is  Have your fluids at different times to
stable, aim to progress back to the your meals
general healthy eating guidelines with  Include foods that contain fat and
regular exercise to aid healthy weight protein at each meal
maintenance.  Aim for 6 to 8 smaller meals/snacks
throughout the day
 Discuss alcohol use with your doctor
Sample Meal Plan in the first few weeks
Approximate Time Food or Drink

7am - On waking Glass of fruit juice (unsweetened)
9 am - Breakfast Weetbix™ softened with full cream milk + added cream and honey
10am - Early Morning Glass of Sustagen™ made on milk
11am - Mid-Morning
Mashed banana + peanut butter on bread
Snack
Sandwich with boiled egg and grated cheese and margarine/butter/
12pm - Lunch
avocado/mayonnaise
2pm - Early Afternoon Glass of Sustagen™ made on milk
3pm - Mid-Afternoon
Tub of yoghurt / rice pudding / crème caramel / sponge and custard
Snack
5pm - Late Afternoon Water / Tea / Coffee (decaffeinated) / Milk
Shepherd’s Pie - diced zucchini, carrot, pumpkin in mince with
6pm - Dinner
mashed potato and cheese topping
7pm - Supper Water / Tea / Coffee (decaffeinated) / Milk
8pm - Before Bed Snack Tinned fruit and ice cream

Gastrectomy Nutrition

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Gastrectomy Nutrition

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Nutrition Post Gastrectomy

What is a Gastrectomy? “dumping syndrome”. See advice

• Palpitations, sweating or shakiness When all or part of your stomach is

Sample Meal Plan in the first few weeks

Approximate Time Food or Drink

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