Gastric cancer treatment is mainly surgical, no matter it is total or subtotal gastrectomy, due to the reduction of gastric capacity and the influence of chemotherapy and radiotherapy, it is often accompanied by different degrees of nutritional problems, such as: nausea, fullness, indigestion, significant loss of appetite and weight, some have dumping syndrome and diarrhea. In response to these symptoms, the dietary adjustments that must be made are described below.
Three stages of gradual diet after surgery
After surgery, a three-stage gradual diet should be adopted, from clear liquid, liquid to soft. Even if you return to a solid diet, you should still eat small meals, chew slowly, and choose foods that are low in oil and easy to digest. Avoid fried, coarse, high-fiber (e.g., bamboo shoots, glutinous rice), hard, or irritating foods.
Leaning food syndrome
In the initial period after gastrectomy, the phenomenon of “dumping syndrome” is often observed. This is a neurological reflex symptom caused by the rapid passage of undigested food through the stomach into the small intestine and the expansion of the intestinal cavity, such as dizziness, bloating, abdominal pain, cramps, rapid heartbeat, and cold sweat, etc. It usually occurs 10-15 minutes after a meal. Sometimes, 1-2 hours after eating, the symptoms of “digestive hypoglycemia” may further occur due to abnormal insulin secretion, such as nausea, tremors, and night sweats.
To avoid “dumping syndrome”, we should pay attention to
1. Eat small and frequent meals (divided into six small meals a day), chew and swallow slowly.
2, eating “wet and dry” way: eat dry solid food first, soup and water until 30-60 minutes after the meal and then drink in small amounts in small portions.
3.Eating in a semi-sitting position, lying down for 20-30 minutes after meals to slow down the time for food to enter the intestines and stomach emptying.
4. Limit concentrated sweets (e.g., sugar, cola, desserts, ice cream, etc.). The main sources of carbohydrates are whole grains, vegetables and fruits, which should be evenly distributed in each meal.
5.Limit coffee, tea or other stimulating drinks containing caffeine if not necessary.
Steatorrhea
Gastrectomy surgery often causes damage to the vagus nerve and affects bile secretion, often accompanied by steatorrhea or chronic diarrhea. Dietary improvements include
1. Avoid excessive greasy food, such as fatty meat or fried food, and control the amount of oil used for stir-fry.
2, avoid drinking too hot and too cold drinks, so as not to stimulate the intestinal mucosa, worsen the diarrhea.
3. For patients with severe steatorrhea, it is advisable to follow the advice of physicians and dietitians to replace fatty foods with medium-chain fatty acids (e.g. coconut oil), but the amount should be discussed with physicians first.
Supplementation of high quality protein
In terms of dietary priorities, attention should be paid to the intake of adequate calories and protein during treatment. High-quality protein (e.g. milk, eggs, fish, meat, beans) is the preferred choice.
Pay attention to iron, calcium and vitamin B12 supplementation
Good sources of iron can be obtained from egg yolk, red meat, algae and dark green vegetables. Foods rich in vitamin B12 include: lean meat, eggs, milk and dairy products. Patients with total gastrectomy need regular injections of vitamin B12 as prescribed by their doctors.
Moderate exercise
As most gastric cancer patients suffer from weight loss after surgery, in addition to diet, we remind middle-aged and elderly gastric cancer patients not to forget to exercise moderately and include muscle strength training to avoid worsening of sarcopenia.