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Diet after stomach surgery

Men and woman discussing stomach cancer

This page has information about how stomach cancer can affect your diet. There are sections on

 

A quick guide to what's on this page

Diet after stomach surgery

Having stomach cancer will affect your eating and drinking habits, whatever your stage or treatment. You are likely to need some specialist help. You should see a dietician before, during and after treatment.

If you have all or part of your stomach removed you will need to adjust the amount you can eat at one time. You will probably have to eat small, frequent meals (about two hourly) for quite a long time after the operation.

 

CR PDF Icon You can view and print the quick guides for all the pages in the living with stomach cancer section.

 

Problems after stomach surgery

Having stomach cancer will affect your eating and drinking habits, whatever the stage of cancer or the treatment you have. You will see your specialist dietician before, during and after treatment.

If you have all or part of your stomach removed you will need to adjust the amount you can eat at one time. You will probably have to eat small, frequent meals (about two hourly) for quite a long time after the operation.

Many people find that certain foods will upset their digestion. Which foods do this varies from person to person. Trial and error is the only way to find out if a particular food upsets you.

Suggestion

Try keeping a food diary if you are having problems you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and when on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.

You may have some particular problems after stomach surgery. You may have

A feeling of fullness

At first, even tiny meals may make you feel uncomfortably full. If you have had part of your stomach removed, it will not stretch as much as it did before. If you have had all your stomach taken away, the small bowel will need to stretch to take larger amounts of food. You will need to eat very small amounts very often at first. Then, gradually increase the amounts and then the time between meals.

At first, you may find you need to eat every hour or so in order to get enough nutrition. Very high fibre foods may make you feel uncomfortably full. These include

  • Wholemeal bread
  • Wholegrain rice and pasta
  • Cabbage and greens
  • Beans and pulses (lentils and dhals)

Try eating very small amounts of these at first and gradually increasing the amount. You should probably avoid eating more than one high fibre food at any one meal.

Fizzy drinks can make you feel full. It is probably best not to drink with meals at all, as any liquid will fill you up.

Dumping syndrome

Dumping syndrome is a particular problem that can occur after stomach surgery. It is caused by food moving too fast into the small bowel. Dumping syndrome can occur just after you have eaten or some time after.

Dumping syndrome just after a meal happens because the food is more highly concentrated than the fluids in the gut. So water is drawn into the gut to dilute the partly digested meal. This causes a sudden drop in your blood pressure, making you feel faint and dizzy. You may even have palpitations.

Dumping syndrome that comes on some time after you have eaten is due to a sudden rise in your blood sugar when the food passes into your small bowel and the sugar is absorbed. The body reacts by producing a sudden rush of the hormone, insulin. Insulin makes your blood sugar drop. When this happens, you will probably feel very faint and may need to sit or lie down.

You can reduce dumping syndrome by

  • Eating slowly
  • Reducing the amount of sugary foods you eat
  • Adding fibre as you can manage it
  • Increase the fat content of your food to replace the calories from sugary foods
  • Eating smaller more regular meals (if that is possible)
  • Avoid soup and very liquid foods

You can also try cutting down on the amount of liquids you drink and see if that helps. If you tend to get dumping syndrome some time after you have eaten, it may help to have glucose sweets between meals to keep your blood sugar up.

Diarrhoea

This is quite common after any stomach surgery. It happens because the vagus nerve is divided as part of your surgery to remove the tumour and lymph nodes. The vagus nerve controls the movement of the digestive system and the production of digestive juices. In a few people, this causes sudden urgent attacks of diarrhoea.

The diarrhoea happens occasionally and may last for about a day before your bowel habits go back to normal. Occasionally the diarrhoea can go on for longer. You may pass watery stools several times a day for several days out of each week. This can be difficult to treat. Sometimes taking anti diarrhoea medicine early each morning can help.

Morning vomiting

This can sometimes happen after removal of part of the stomach (partial gastrectomy). A build up of bile and digestive juices can occur overnight in the duodenum and can spill back into the remains of the stomach making you feel full and sick. Vomiting up the excess fluids relieves the discomfort.

Morning vomiting can sometimes be helped with an indigestion medicine (such as aluminium hydroxide) taken first thing in the morning. Or drugs which help the stomach to empty, such as domperidone or metaclopramide (Maxalon). But the medicines may just lessen the symptoms rather than get rid of them altogether. If your symptoms are severe, talk to your surgeon. In rare cases, reconstructive surgery might be possible to relieve bile vomiting.

Indigestion and colic

Wind and pain can be a problem after stomach surgery. You may get it in bouts. Peppermint water can relieve trapped wind and so relieve pain. Put a few drops of peppermint oil in hot water and sip it slowly. You can buy peppermint oil in the chemist. Foods that might cause indigestion include fizzy drinks, alcohol, very spicy food, pickles, and citrus fruits.

 

Getting the right nutrients in your diet

After stomach surgery, you may have problems eating enough of the right foods because of the physical problems mentioned on this page. Over a period of time, you may find you are having trouble maintaining your weight. If you are continuing to lose weight, you must see a dietician at the hospital. You can arrange an appointment by contacting your specialist. Your dietician will discuss your diet with you and may be able to suggest ways you could boost your calorie intake without upsetting your digestion too much.

After stomach surgery, you may need to take extra calcium, vitamin D and iron. This is because these nutrients are absorbed in the stomach. Having all or part of your stomach removed may mean you can't absorb enough from your normal diet. If you have had your whole stomach removed (total gastrectomy), you will have to have injections of a vitamin called B12. As you will no longer be able to absorb this from your food. Vitamin B12 is necessary to make red blood cells, and keep the nerves and digestive system healthy.

If you have had part of your stomach removed (a partial gastrectomy), your doctor will take regular blood samples. This is to make sure you are absorbing enough iron and vitamin B12 to keep your red blood cell count at a normal level.

 

Boosting nutrients in your diet

If you have had a partial gastrectomy, you may be able to get enough iron, calcium and vitamin D by increasing the foods in your diet that contain these nutrients.

Calcium is found in milk, cheese and bread. It is also found in eggs, sardines, cabbage and broccoli.

Vitamin D is added to margarine. It is also found in butter, eggs and oily fish such as sardines, herrings and mackerel and salmon.

Foods containing iron include

  • Red meat
  • Liver
  • Fish
  • Soya
  • Wholemeal bread
  • Egg yolk
  • Leafy green vegetables
  • Dried fruit
  • Guinness and stout

The most easily absorbed is the iron in red meat. If you are a vegetarian, you will probably need to take iron tablets. Vitamin C helps you absorb iron from food. So eat an orange, drink fresh orange juice or take vitamin C tablets with iron rich foods or iron tablets.

Dark green, leafy vegetables and liver also contain folic acid. Folic acid is another vitamin needed to keep your red blood cells healthy. You may need extra folic acid if you have had stomach surgery.

 

Food supplements

Even if you eat a really healthy diet, you may still need to take supplements. This is because you do not have enough stomach tissue left to be able to absorb particular nutrients properly. Choose a multivitamin that contains all the major vitamins and minerals. Some people find they need to drink two or three cans of a liquid food every day to get enough calories. You should be able to get supplements on prescription from your doctor if you need them.

There is more information about diet supplements in the diet problems and cancer section.

 

Tips for eating well

Experiment with the most comfortable position for eating and digesting your food. You might find that it helps to stay sitting up or semi reclining to help your food go down. Some people find it easiest to eat walking about.

Some people find it particularly difficult to eat breakfast. Try soaking porridge oats overnight in full cream milk. This softens them and makes them easier to eat. You can then add dried fruit or seeds to boost nutrients and calories. 85 grams (about 3 oz) of oats treated this way will give you about 500 calories, which is a good start to the day. But eat it slowly!

If you have bloating, pain and diarrhoea, you might be sensitive to milk products. Talk to a dietician about supplements that may not contain cows milk and may be suitable for you. 

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Updated: 24 February 2014