Gastric cancer is one of the common malignant tumors in China, and most patients need to undergo gastrectomy once they are diagnosed. In clinical work, we often encounter such questions from patients or family members: what to eat after gastrectomy? Indeed, a reasonable diet can enhance patients’ whole body nutrition, improve immunity, reduce postoperative complications and improve quality of life, while an unreasonable diet may affect patients’ postoperative recovery or cause serious complications. Today, we will talk about the diet after gastrectomy.
1.Simply speaking, the stomach has the following three major functions.
(1) The function of storing food.
(2) preliminary digestion function of the stomach cells can secrete gastric acid and pepsin, under the joint action of the two to make the initial decomposition of protein in food digestion, but also to kill bacteria and other microorganisms in food.
(3) Grinding, transporting and emptying function Once the food enters the stomach, it can stimulate gastric peristalsis, and the peristalsis of the stomach can also mix and grind the food into chyme, which can be easily digested and absorbed by the intestine.
After the surgery, because most of the stomach or the whole stomach is removed, the above-mentioned functions of the stomach will be weakened to varying degrees, such as the stomach cavity is smaller, there is less opportunity for mechanical agitation of food, less production of digestive juices, some digestive juices appear abnormal reflux, etc. Food often enters the small intestine too quickly, if the normal diet is resumed too quickly at this time, a series of complications caused by the inability to digest food can occur, and even require If the normal diet is resumed too soon, a series of complications may occur due to indigestible food and even require hospitalization again, while excessive restriction of diet may lead to insufficient absorption of nutrients and affect recovery.
In most cases, after 3-6 months of dietary adjustment, the body will gradually adapt to the changes after surgery, and most patients can gradually return to their pre-surgical diet and habits, just like a machine that has been overhauled and can run normally again after the break-in period.
Secondly, let’s talk about how to adjust the dietary habits after gastrectomy.
Generally speaking, early after surgery, you must strictly follow the principles of eating less and more meals, light, soft, high protein, low fat, low sugar, avoiding cold, spicy and acid.
2. Attention should be paid to the following points.
(1) Chew slowly to promote digestion after gastrectomy, the grinding function of the stomach is lacking, so the chewing function of teeth should play a more important role. When the patient eats coarse and indigestible food, he should chew and swallow more slowly.
(2) Try to use viscous, easily digestible foods that empty slowly in small amounts and multiple meals to gradually increase the quality and quantity in the diet according to the absorption situation. After surgery, eating more meals can ensure that the gastrointestinal tract is easily emptied and can be fully rested. Of course, there is a limit to the number of meals, usually 4-6 meals per day is appropriate, each meal to 1/3-1/4 of the amount before surgery, dinner should be less, to ensure that the residual stomach has sufficient emptying rest time.
(3) Choose a low-fat, light and soft diet. A low-fat diet can prevent fatty diarrhea, which is common after surgery, and a low-sugar diet can reduce gastrointestinal distention caused by sugar fermentation and compensate for the reduced digestive power caused by decreased secretion of digestive juices and non-physiological reflux.
(4) It is advisable to supply high-protein, high-calorie, low-carbohydrate, less residue and easily digestible food after most of the gastric resection, many patients will have the sequelae of malnutrition in the short term, so it is necessary to strengthen the intake of protein and pay attention to the supplementation of various vitamins and iron, potassium, sodium and chloride. In addition, lying down for about 30 minutes after eating is also good for preventing the occurrence of dumping syndrome.
(5) If you want to eat soups or drinks, you should pay attention to the separation of dry and thin, and try to eat soups 30 minutes before or after meals to prevent the food from being excreted too quickly to affect digestion and absorption; when eating, patients can adopt a flat position, or rest in the lateral position after eating to prolong the time of food emptying, so that it can be completely digested and absorbed.
(6) In the cooking method, we should pay attention to the cooking methods such as boiling, braising, steaming and stewing as much as possible instead of using cold, deep-fried and raw methods to facilitate the digestion and absorption of food. During the recovery period after gastrectomy, attention should be paid to slowly increase the amount of diet and gradually reduce the number of meals, and most patients can eventually return to normal diet after 3-6 months of adjustment.
3.What to eat after gastrectomy.
(1) Nutritional supplementation should be adequate carbohydrates, fats and proteins excreted with feces will increase after gastric surgery, which is due to the loss of pylorus and vagus nerve-mediated accommodative relaxation and regulation to accelerate gastric emptying; loss of pancreatic and biliary vagus nerve function causes a decrease in pancreatic juice secretion and changes in the movement of the biliary tract, thus making the chyme unable to adequately mix with pancreatic juice and bile. These reasons can lead to impaired absorption of nutrients. Therefore, a high-calorie and high-protein diet should be supplemented after gastric cancer surgery, and it is advisable to choose foods that are easy to digest and have a complete range of essential amino acids (such as eggs, fish, shrimp, lean meat, soy products, etc.).
(2) Iron supplementation should not be neglected after gastrectomy due to the decrease of iron absorption, which can lead to anemia. Therefore, the postoperative daily diet should pay attention to increase the amount of iron-rich foods, such as spinach, eggplant, black beans, enoki mushrooms, black fungus, hairy vegetables, mulberries, grapes, peaches, red dates, as well as liver, red meat, seafood, etc.
(3) Calcium supplementation should be paid attention to the fact that 15% of patients will develop osteochondrosis after gastrectomy, the cause of which is unknown and may be related to the increase of bone decalcification and insufficient calcium intake after gastrectomy. Therefore, patients after gastric cancer surgery should pay attention to calcium supplementation in their diet. Foods with high calcium content include various kinds of soy products, dairy products, oatmeal, cabbage, cabbage, carrot, celery, pumpkin, radish, spinach, gourd, leek, dandelion, winter melon, etc. Certain nuts and seeds are also high in calcium content, such as dried almonds, walnuts, hazelnuts, sunflower seeds, etc., and fruits such as orange, etc. Some vegetables such as spinach, amaranth, etc. contain oxalic acid will affect the absorption of calcium, the vegetables containing high oxalic acid can be blanched in boiling water first, so that part of the oxalic acid first dissolved in water before consumption.
(4) Pay attention to the supplementation of two kinds of vitamins. Patients after gastrectomy often have a combination of vitamin B12 and vitamin D absorption disorder, the lack of the former can lead to the occurrence of megaloblastic anemia, and the lack of the latter can affect the absorption of calcium, so patients after gastrectomy should pay attention to the supplementation of various vitamins in their daily diet. The main food sources of vitamin B12 are meat, animal offal, fish, poultry, shellfish and eggs, while vitamin D is mainly found in yeast and mushrooms, animal foods such as animal liver, egg yolk, cream, cheese, and fish and fish eggs containing a lot of fat, and vitamin D preparations can also be taken orally under the guidance of a physician if necessary.
(5) Can I eat “hairy food”?
Many patients worry that hairy food may have adverse effects on the body, in fact, hairy food is only a folk saying, and has not been recognized by modern science, in the authoritative medical textbooks and professional journals and magazines, can not find its exact definition. From the perspective of modern nutrition, hair products, which are rejected by many patients, are mostly rich in high protein and vitamins and are excellent foods. Hair products not only ensure the nutrients needed by the organism, but also increase its immunity and resistance to disease. Therefore, we believe that there is no need for patients to “talk about hair”, but to gradually try to increase the intake of various nutrients from little to much, taking into account their own physical conditions.
In conclusion, from the perspective of physiology and surgical clinical practice, the residual stomach or gastric substitutes after gastrectomy will gradually increase in size after a period of time, thus making it possible for patients to eventually resume a normal diet. Of course, the recovery process needs to vary from person to person, because the degree of health recovery at this stage varies greatly among individuals, and the specific how to eat and how much to eat should be treated differently according to individual feelings, living habits, living conditions, nature of work, etc. Generally speaking, the criteria of whether to increase the amount of food and when to transition to the normal eating habits before surgery are: no discomfort after eating, good absorption, weight gain compared to the initial period of surgery, and mental and physical strength to cope with daily work and life.