Basic Principles of Nutrition after Gastrectomy

Maintaining / Gaining Weight

Achieving a healthy body weight can be a challenge when you don’t have a stomach. Dumping syndrome, malabsorption and early satiety can make it difficult to get enough calories to maintain or regain weight. Often the rapid weight loss associated with a gastrectomy is often associated with a loss of muscle mass as well. This can increase fatigue and affect your immune system. The goal is to minimize weight loss if you are at a healthy weight or prevent loss of more than 2 lbs per week if you are overweight.

The physiological effects of having a gastrectomy may vary greatly between individuals. Some may suffer from dumping syndrome and need to avoid all sweets. Others can eat some sweets as part of a healthy diet. Some will be lactose intolerant and others will have no problems drinking milk products. For this reason, it is a good idea to keep a journal of what you eat for several weeks along with side effects such as dizziness, nausea, diarrhea etc. so you can tailor your diet to your individual needs. If you are not having a problem with lactose, you do not need to restrict this from your diet just because many people may have lactose intolerance following their gastrectomy. The key is to add new items to your diet one at a time to see if it is something that you can tolerate.

Tips for promoting weight gain

  • Eat calorie dense foods.  Make every bite and sip count by eating calorie dense foods.  Your goal is to maintain your weight.  Calories are your body’s first priority. You will not be able to eat the same quantity of food as before so it is important to get the calories in smaller amounts of high calorie foods.  Limit foods and beverages low in calories.
  • Eat a variety of foods. Gradually add foods to your diet so it includes fruits, vegetables, whole grains, protein rich foods, dairy products etc.  Be sure to include fruits and vegetables in addition to high calories foods.
  • Eat small frequent meals – six to eight times per day.  Try not to go for more than 2 or 3 hours without eating something during the day.  It will be difficult to get the nutrition you need if you focus on just three meals per day.  Carry food with you at all times so you can snack while driving in the car, waiting for appointments etc.
  • Add calories whenever possible.  Before you eat ask yourself “What can I add to this to give it more calories?”  You might add butter, oil, cheese, etc.
  • Drink only nutritious beverages.  Nutrient dense liquids can provide a lot of calories and are sometimes easier to get down than solid foods especially just after surgery. Try milk, eggnog, or unsweetened juice instead of coffee, tea, diet soda or water.
  • Think of food as medicine.   Remember your appetite is not going to be as reliable as it used to be. You may not feel hungry. Also, without your stomach you will not be able to handle regular portions of food. Even if your are not hungary, it is important to remeber that nutrition is a vital part of your health.  Schedule your meals and snacks as you would your medications. During this time, it is important to concentrate on eating food for the healing and health properties.   

The following is a list of suggestions and nutrient dense foods that may help you gain or maintain your weight. These should be added to your diet based on your individual situation. Increasing fats is one way to increase calories without adding volume. However, many people have difficulty tolerating foods high in fat after a gastrectomy. If you are not able to tolerate foods high in fat, you may want to choose lower fat products. If you are unsure how you will tolerate a food, start with a very small portion and gradually increase the amount.

Nutrient Dense (High Calorie, High Protein) Foods

Food Calories Protein g
Super Protein Power Smoothie 435 20
Cinnamon Peach Smoothie 390 6.5
Fish Chowder 1 cup 376 18.4
Banana Apple Shake 274 8.75
Raspberry Smoothie Delight 372 13
Bursting Blueberry Smoothie 360 15
Berry Blast Shake 347 10
Banana Oat Shake 323 10
Pumpkin Pie Pudding 288 3.5
Sweet Potato Power 250 4.5
6 oz Greek yogurt (unsweetened) 240 14
1 cup cream of broccoli soup 200 varies
Hot Chocolate (SF) 207 10
…made with 8 oz whole milk 135 4
2 scrambled eggs 180 14
1 cup (8oz) whole milk 150 8
½ cup diet pudding made with whole milk 125 1
High Protein Jello 115 8.8
¼ cup premium ice cream 100 2
½ cup 2% cottage cheese 100 14
½ cup canned fruit in own juice 60 0

Try increasing calories in foods by adding…

Food Calories
Butter/Margarine, 1 tbsp 100
Mayonnaise, 1 tbsp 100
Half and Half, 2 oz. 80
Oil, 1 tbsp 120
Cream Cheese, 2 tbsp 100
Peanut Butter, 1 tbsp 100
Salad Dressing, 2 tbsp 170
Cheese, 1 oz 100
Ricotta Cheese, ½ cup 216

Nutrient Dense Meal and Snack Ideas

  • Oatmeal with whole milk or half & half, and butter
  • Super milk – made add powdered milk to whole milk and drink or use in recipes in place of milk
  • Scrambled eggs cooked with butter or oil with added cheese or small pieces of ham
  • Mashed potatoes made with liberal amount of whole milk and butter and toped with gravy
  • Banana and peanut butter
  • Tunafish or egg salad with liberal amount of mayonnaise – alone or on sandwich
  • Noodles with alfredo sauce
  • Spaghetti or pasta – add olive oil to noodles and extra oil to sauce, top with parmesan cheese.
  • Fruit with cottage cheese, sour cream, whipped cream or mayonnaise
  • Hard boiled egg

Commercial Nutrition Supplements

Sometimes it is difficult to get all the calories and protein you need and a nutritional supplement may be needed to augment your diet. These commercial supplements should be available at your local supermarket or pharmacy. They can also be purchased online at http://www.nestlenutritionstore.com/ or www.abbotstore.com

Supplement Calories Protein g
Boost / Ensure Plus 4 oz (1/2 bottle) 180 7.5
Boost Glucose Control* 4 oz (1/2 bottle) 80 8.0
Boost / Ensure 4 oz (1/2 bottle) 125 3.0
Carnation Instant Breakfast, 1/2 pkg w 4 oz whole milk 155 6.5
Carnation Instant Breakfast Low Sugar*, 1 pkg w 8 oz whole milk 120 6.5
Benecalorie 1.5 oz serving 330 7.0
Beneprotein or other whey protein, 1 scoop or 7 g 25 7.0

*If you are having issues with dumping syndrome, you may want to choose the supplements that are lower in sugar such as the Ensure Glucose Control or the Carnation Instant Breakfast Low Sugar.

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