Diet for a Gastrectomized Patient: What Should It Include?

In the patient who has undergone a gastrectomy, the dietary pattern must be optimized to ensure good digestion and to avoid deficiencies of essential nutrients.

Written and verified by the nutritionist Saúl Sánchez Arias.

Last update: 21 September, 2022

The gastrectomized patient must consider a series of dietary changes to improve their state of health and to prevent symptoms and alterations in their digestive functions.

With this term, we refer to a person who has undergone surgery in which certain parts of the stomach have been removed, usually due to ulcers or gastric cancer. In the worst case, it involves the removal of the entire stomach pouch.

It should be noted that all invasive interventions in which the functionality or surface area of an organ is reduced require adaptations in subsequent lifestyles. Although it may be possible to return to a situation of normality, certain precautions must be maintained over time.

Common alterations in the gastrectomized patient

When a gastrectomy is performed, the following alterations may be experienced in the few months after the operation.

• Reduction of gastric capacity
• Decrease in the production of gastric juices
• Increased speed of bowel movements

In the event of the entire stomach being removed, there will need to be significant dietary adjustments. Otherwise, a serious nutritional deficit could occur. We mustn’t forget that important nutrient absorption or activation processes also take place in this area.

For this reason, it’s necessary to compensate with other strategies to avoid disturbance in the digestion of carbohydrates and proteins. As a general rule, more digestible foods should be prioritized in these situations, including supplementation with enzyme supplements.

Postoperative nutrition

Postoperative nutrition is often initiated by fluids to precisely control volumes and timing. At first, only water, chamomile, defatted broths, and rice water are given.

Then, the amount is increased and, little by little, foods with a more complex digestion are included by means of a feeding tube. Ideally, you would start with low-fat crackers, white bread, and vegetable smoothies.

Later on, the patient’s digestive tolerance will increase. When this happens, protein-rich foods will be included in the diet to avoid catabolism and maintain physiological functions. It’s normal to opt for chicken, fish, and even rice. Soft fruits will also have a place at this time.

From this point on, a process of transition to a normal diet begins. Food should always be offered at a warm temperature, not hot, and great attention should be paid to individual tolerance. If any product causes discomfort, it should be permanently removed from the diet.

Dumping management

It should be borne in mind that food reaches the intestine more quickly in patients who have undergone a gastrectomy – in larger quantities than normal. It isn’t surprising that 20 to 40% of those who have undergone this procedure suffer from dumping syndrome. Symptoms include the following:

• Nausea and vomiting
• Abdominal pain
• Diarrhea
• Weakness
• Fainting
• Tremors

In general, these manifestations occur during meals or about 30 minutes after. To prevent this, the portions consumed at each meal should be controlled.

Likewise, irritating foods that may stimulate peristalsis, such as those with a spicy taste, should be avoided. Nor is it advisable to eat culinary spices in large quantities.

Nutritional recommendations for the gastrectomized patient

As a general rule, a couple of servings of simple carbohydrates a day should be eaten. Be careful though, because overdoing it could lead to a higher incidence of metabolic pathologies. This is confirmed by a study published in the journal Current Diabetes Reports. A couple of spoonfuls of honey or sugar will suffice.

At the same time, it’s crucial to increase protein intake to avoid weight loss. We’re talking about nutrients that have been shown to be decisive in stopping catabolism. At least 0.8 grams of protein per kilogram of weight per day would be necessary to ensure that physiological functions are carried out efficiently.

Among other things, the consumption of fatty acids of the omega 3 series should be emphasized. These lipids have anti-inflammatory power, according to recent evidence. Therefore, they can reduce many digestive symptoms and improve the patient’s quality of life.

As far as meal distribution is concerned, it’s better to have small meals every 2 or 3 hours. Extreme food temperatures should always be avoided and it’s recommended to eat slowly and chew well. Lactose tolerance should be evaluated on an individual basis.

Improving the diet of the gastrectomized patient

Improving the diet of the gastrectomized patient is essential for the patient to recover good quality of life. This will avoid alterations in the state of health and future gastrointestinal symptoms. It’s essential to follow the above recommendations and, if in doubt, always consult a specialist.

Finally, it should be noted that sometimes it may be necessary to include certain supplements in the diet to correct or avoid deficiencies. In this case, it’s necessary to first consult a nutritionist to assess whether you are suffering from any deficiencies.