page updated 4/9/2020
GIST patients often struggle with their diet and nutrient intake after a partial or total gastrectomy or an ileostomy. These procedures can cause trauma to the digestive system functions, deplete an individual’s caloric intake, and may cause a failure to absorb the necessary nutrients for optimal health. The right diet may help the affected organs recover and ultimately improve the digestive process.
After surgical intervention, patients often experience symptoms that disrupt their ability to maintain normal nutritional intake.
Dumping syndrome (DS) and diarrhea
One of the more challenging symptoms is Dumping Syndrome (DS). Dumping Syndrome occurs when food moves too rapidly to the small intestines, and may include bloating, nausea, diarrhea, rapid pulse, dizziness or light-headedness, weakness and fatigue, sweating and abdominal cramping. DS can occur anywhere from 15-30 minutes to two to three hours following a meal, and affects up to 75 percent of gastrectomy patients. DS occurs due to the partial or complete loss of the stomach, and the increased pace of processing food towards the small intestine for digestion. Combining food and liquid intake at the same time is a primary reason why diarrhea occurs, so it is helpful to avoid drinking liquids during meals, waiting 30 minutes to one hour after a meal before drinking.
The type of foods you consume can also make dumping syndrome worse. Proper diet can help reduce or allay the symptoms. Certain foods should be included, and some avoided.
Foods to eat
- Protein should be consumed in every meal: Eggs, meat, fish, poultry, nuts, milk, yogurt, dried beans, lentils, nut butters are good protein sources.
- High-fiber foods should be eaten as often as possible. Whole grains including whole wheat bread and/or pasta, fruits, vegetables, and fiber-fortified cereals are all appropriate choices.
Foods to avoid
- High-sugar foods such as soda, fruit juices, desserts, candy, fruits cooked with sugar, honey and jellies, should be limited or avoided. Simple carbohydrates should be limited or avoided.
Abdominal pain, constipation, or bloating
If a patient is experiencing these symptoms it may be due to lactose intolerance. This will typically affect patients who have had an operation near or involving the small intestine, as the enzyme for digesting lactose is located in the jejunum. It is possible that the lactose intolerance symptoms are only temporary. Once a patient has improved during the recovery process post-surgery, they can consider re-introducing dairy slowly, in smaller portions.
If a patient is experiencing these symptoms and has removed dairy from their diet, another solution may involve introducing more complex carbohydrates (see fiber list above) into their diet in order to find relief.
It is advised to eat smaller portions, and more frequently throughout the day (no fewer than six small meals per day). The smaller portions will allow the body to become re-accustomed to obtaining food by processing it and collecting its nutritional value. The frequent meals will ensure that some nutrients are being collected at all times, rather than just three times a day and quickly flushed through the system.
Water intake also plays a role involving these post-operative symptoms, please see above (DS and diarrhea) in order to create an individualized and manageable liquid intake schedule.
Foods to eat
- If dairy is removed from the diet, calcium can be sourced from green leafy vegetables, nut-based or soy milks, salmon, and tuna
Foods to avoid
- Milk, and ice cream should be avoided. Hard cheeses and yogurt have fewer lactose amounts and may be consumed by individuals transitioning dairy back into their diet. Soft cheeses such as mascarpone still have a fair amount of lactose, especially those that are aged.
Anemia can occur from a vitamin B12, folate, or iron deficiency, and may not be recognizable for up to one year post-gastrectomy. Symptoms include: chills, fatigue, numbness in extremities, and dizziness.
B12 is typically absorbed within the ilium (within the small intestine), which means if a person has a partial gastrectomy (fundus involved) or their small intestine partially removed (terminal ilium), the protein is not blending with the acid within the stomach lining and transitioning into the small intestine for optimal absorption. B12 supplements may be advantageous for individuals whom are experiencing malabsorption.
Iron and folate are absorbed through the duodenum with the help of acids produced in the stomach. In the case of gastrectomy where the stomach is removed the acid is lacking. Absorption of iron and folate is therefore hindered.
Foods to eat:
- Lean, red meats, dark green, leafy vegetables, poultry, fish, dried and citrus fruit, iron-fortified cereals (B12 and multi-vitamin supplements may be an option based on a consultation with a physician)
Although the scheduling and management of food and liquid intake, as well as side effects and health issues may seem like a daunting and time-consuming task, after time it will contribute to a higher quality of life. GIST patients will gain an overall greater understanding of their anatomy and its capabilities as they recover after a major gastrointestinal procedure.