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Eating After Your Gastrectomy or Esophagogastrectomy

This information explains how to eat after your gastrectomy (surgery to remove your stomach) or esophagogastrectomy (surgery to remove your esophagus, or food pipe, and stomach).

After having your gastrectomy or esophagogastrectomy, the way you eat and digest food will change. Your stomach may be smaller or gone, which will make you feel full quicker than you did before your surgery. Also, the valve that controls how your food goes from your stomach to your intestines may have been removed or changed. This means that you may digest your food too quickly and not absorb nutrients as well as before your surgery.

If you have questions about your diet while you are in the hospital, ask to see your unit dietitian. After you have gone home, you can call (212) 639-7312 if you have questions. You can also call (212) 639-7071 to make an appointment with an outpatient dietitian.

Guidelines for Eating

How well you handle your diet will depend on your surgery and tolerance to certain foods. Some patients don't get enough nutrients from their food and end up losing weight. If this happens, you may have to take vitamin, mineral, and/or high-calorie supplements. The guidelines below will help you get the most from your food and help prevent any food-related problems.

  • Eat 6 or more small meals a day instead of 3 main meals. This will help you to eat the right amount of food, even though your stomach is smaller or gone. A sample meal plan is listed at the end of this resource.
  • Chew your food well. This helps with digestion.
  • Eat slowly. This way, you will stop eating before you get too full and feel uncomfortable.
  • Do not drink more than 4 ounces (½ cup) of liquid during your meals. This will allow you to eat enough solid food without getting too full and will slow down the digestion of your food.
  • Drink most of your liquids at least 1 hour before or 1 hour after your meals to prevent dehydration (not having enough liquid in your body).
  • You should drink about eight to ten, 8-ounce cups of liquid per day. Avoid carbonated (fizzy) beverages if they make you feel full.
  • Test your tolerance to sweets.
    • Sugar in sodas, fruit juices, candy, cakes, honey, and syrups may cause water to be drawn into your stomach or small intestine. Your food will then move too quickly through your small intestine. This is called dumping syndrome. It can cause cramping, stomach pain, or diarrhea. These symptoms start within about 20 minutes of eating.
    • Low blood sugar can happen 1 to 2 hours after eating a sugary meal. Symptoms include feeling weak, hungry, nauseous, anxious, shaky, and sweaty. The symptoms can be controlled by changing your diet and watching what you eat.
  • Test your tolerance to fats. You may have trouble digesting large amounts of fat. Try a small amount first and then increase it slowly. Foods high in fat include:
    • Butter, margarine, and oils
    • Mayonnaise
    • Creamy salad dressings
    • Cream cheese
    • Gravies
    • Potato and corn chips
    • Rich desserts
    • Fried foods
  • Slowly bring dairy products back into your diet. Some patients may become lactose intolerant after having a gastrectomy. This means they have trouble digesting lactose, a type of sugar found in dairy products. Sometimes, a lactose intolerance that develops after surgery will go away with time. Symptoms of lactose intolerance include gas, bloating, and diarrhea. They usually start soon after eating dairy products.
  • To test your tolerance to dairy foods, start by drinking a 4-ounce (½ cup) serving of milk. If you can handle this, you can start eating more dairy foods. Examples of foods with large amounts of lactose are milk, ice cream, and soft cheeses.
  • If you develop lactose intolerance, you may still be able to eat hard cheeses, yogurt, and butter. These foods have smaller amounts of lactose than other dairy products. If you think you may be lactose intolerant, call your dietitian for help.
  • Products such as Lactaid® milk, tablets, or drops can help you digest dairy products. You may want to try dairy products again in a couple of months to see if you can tolerate them.
  • You may need a monthly shot of vitamin B12 and vitamin and mineral supplements. If you do, your doctor or dietitian will discuss this with you.
  • Tell your doctor if you are losing weight.

Special Instructions for Patients Who Have Had an Esophagogastrectomy

If you have had an esophagogastrectomy, you will start with a liquid diet. Once you can handle this, your doctor may suggest that you try to eat soft or moist foods. If you cough or feel like the food is getting stuck in your throat when you swallow, tell your doctor and dietitian.

During an esophagogastrectomy, the valve between your esophagus and stomach is removed. This can cause reflux, which is when you throw up or bring up foods or liquids. To prevent this, follow the guidelines below in addition to the ones above.

  • Sit up straight during meals and for at least 60 minutes after you are finished.
  • Wear loose-fitting clothes around your abdominal (stomach) area.
  • Eat your last meal of the day at least 2 hours before your bedtime.
  • Always keep the head of your bed at a 45-degree angle or higher. Use a wedge to keep your upper body and head raised. You can buy a wedge at a surgical supply store.

If you are having a hard time swallowing, eat soft, moist foods. Also, be sure to tell your doctor, nurse, or dietitian you are having trouble swallowing. Some patients may need a procedure called a dilatation to correct this problem. If you need this, your doctor and nurse will explain the procedure in more detail.

Sample Menus

The sample menus below show 6 small meals with 4 ounces of liquid given at each meal and 8 ounces of liquid given in between meals. Keep in mind that soup also counts as a liquid.

The menus also include solid foods. If you are on a mechanical soft (diced food) diet when you go home, ask your doctor when you can start eating solid foods again. For more information, please read the resource Eating Guide for Puréed and Mechanical Soft Diets.

The menu items are not all sugar-free. Use sugar-free or “lite” yogurt in place of regular yogurt, limit fruit juices, and dilute fruit juices with water if you:

  • Have diabetes
  • Have high blood sugar
  • Are experiencing dumping syndrome

Foods below with an asterisk (*) have lactose. If you are lactose-intolerant, try Lactaid® milk in place of regular milk. Take Lactaid® tablets or drops to help you digest dairy products.

Meal Time

Sample Menu 1

Sample Menu 2

Breakfast
7:30 am
  • ¾ cup of corn flakes
  • ½ cup of milk*
  • ½ of a banana
  • 1 scrambled egg
  • 1 slice of toast
  • 1 teaspoon of margarine
  • ½ cup of orange juice

9:00 am

  • ½ cup of juice mixed with ½ cup of water
  • 1 cup of tomato juice
Snack
10:00 am
  • ½ cup of cottage cheese*
  • ½ cup of canned fruit
  • 1 tablespoon of peanut butter
  • 3 graham crackers
  • ½ cup of milk*

11:30 am

  • 1 cup of whole milk*
  • ½ cup of juice mixed with ½ cup of water
Lunch
12:30 pm
  • ½ cup of chicken soup
  • ½ of a turkey and cheese sandwich with lettuce and tomato
  • 2 teaspoons of mayonnaise
  • ½ of a roast beef sandwich with lettuce
  • and tomato
  • 2 teaspoons of mayonnaise
  • ½ cup of milk*

2:00 pm

  • 1 cup of tomato juice
  • 1 cup of broth
Snack
3:00 pm
  • Fruit yogurt*
  • ½ cup of cranberry juice
  • ½ cup of tuna salad
  • 6 saltine crackers
  • ½ cup of pineapple juice

4:30 pm

  • ½ cup of juice mixed with ½ cup of water
  • ½ cup of juice mixed with ½ cup of water
Dinner
5:30 pm
  • 2 ounces of baked chicken
  • 1 small baked potato with sour cream*
  • ½ cup of cooked carrots
  • ½ cup of lemonade
  • 2 ounces of baked fish
  • ½ cup of rice
  • ½ cup of green beans
  • 2 teaspoons of margarine
  • ½ cup of apple juice

7:00 pm

  • 1 cup of water
  • 1 cup of water
Snack
8:00 pm
  • 1 ounce of cheddar cheese*
  • 6 saltine crackers
  • ½ cup of apple juice
  • ¼ cup of cottage cheese
  • 1 slice of bread
  • ½ cup of cranberry juice

9:30 pm

  • ½ cup of juice mixed with ½ cup of water
  • ½ cup of juice mixed with ½ cup of water