Owner of a pasta store after her gastrectomy (female)

How to handle your diet after gastrectomy (advice from an experienced patient)

Meats: Chicken and pork are the best as they contain much Vitamin B. To soften the meats when cooking them, soak them in Japanese sake and knead them well.

Fish: Use defrosted fish as far as possible. The trick is to add two to three measures of Japanese sake or vinegar to boiled soup stock (any kind of stock) and pickle the fish in the mixture until it softens.

Vegetables: Use fresh vegetables as far as possible. Do not use frozen products. As they contain much fiber, heat them up in the microwave, or season with olive oil and add Japanese sake to soften them before stir-frying them.

To avoid placing a burden on your stomach, use quality Italian olive oil and Japanese sake for all ingredients. This will mellow out the flavors. As strong flavors place a burden on your stomach, it would be a good idea to keep all flavors light. When using butter, keep the amount of salt low and use unsalted butter as far as possible.

< Comments from the viewpoint of a nutritionist >

Olive oil contains a high level of oleic acid. Oleic acid has the following two functions.

1. It brings down the level of LDL (bad) cholesterol, which is the most significant factor in the prevention of the hardening of the arteries, without bringing down the level of HDL (good) cholesterol.
2. It does not oxidize easily, and reduces the production of lipid peroxide, which heightens the risk of cancer. Virgin olive oil is made from the first pressing of olives through cold pressing, and has not been subjected to heat processing.

• Food containing extra virgin olive oil, which has a high content of oleic acid, is good.
• However, it is necessary to be careful of overconsumption.
• Start by taking small amounts, corresponding with your own physical condition.
• Meat and fish dishes contain a high level of Vitamin B12 and iron, which are nutrients that your body tends to lack after a gastrectomy.
• I recommend taking liver and shellfish, etc. together with Vitamin C (found in vegetables and fruits), which help in the absorption of iron.
• Chew shellfish well and consume it in a way that aids digestion.

Male, 66 years old, stomach cancer
(Underwent surgery more than two years ago)

I was able to return to my normal life (work) and diet more quickly than I had expected.

In 2009, I underwent a gastrectomy through laparoscopic surgery, and a different part of my stomach was removed through endoscopic surgery three years later. I was able to return to my normal life (work) and diet more quickly than I had expected.

1．Positive effects after the gastrectomy

• The pain that I had experienced before surgery (indigestion and sharp pains) improved dramatically.
• I lost weight and my body felt lighter. My stomach became flatter, and I am able to wear L-sized clothes from my previous size of XL. However, due to the weight loss, I feel colder in the winter.

2．Problems faced after the gastrectomy

• I feel that my appetite has declined somewhat. In particular, I worry about having diarrhea from oil foods and grilled meat, so I refrain a little from eating such foods.
• The timing of my bowel movements has become a little irregular, and I sometimes have sudden bowel movements especially when it is cold in the winter.
• As alcohol is not absorbed through the stomach, it is necessary to be careful about the amount of alcohol consumed.

3．To those who will be undergoing a gastrectomy

• Laparoscopic surgery and endoscopic surgery are carried out based on proper diagnosis and treatment.
  It is important to consult with your doctor and obtain information before making a choice.
• When going through the surgery, beware of complications with other illnesses. It is a commonly known fact that infections in the oral cavity, such as periodontal disease, can increase the risk of diabetes and pneumonia, so maintain good oral health at all times.
• Controlling stress is one of the important ways of preventing malignant tumors from forming in the digestive system. When admitted into hospital and undergoing surgery, I felt that it was important to receive emotional support from my family.

Male, 72 years old, stomach cancer
(Underwent surgery 1 – 2 years ago)

Troubled by diet rather than efforts or solutions

1．Body weight did not increase even after half a year

It would be useful to refer to the videos on reasons for not increasing the amount of food intake after gastrectomy, and on wanting to increase the body weight lost after the gastrectomy,(YouTube) from the workshop held on Saturday, December 6, 2014.

2．Noodles are impossible to consume, especially ramen noodles, which get stuck quickly

As they are regurgitated, they make me throw up and I feel bad for about two hours. Incidentally, I went through a total gastrectomy.
It would be useful to refer to the items related to Chinese food in the information gallery on the website.

Q．Since it has been some time (1 – 3 months) since I returned to work, my colleagues from work have invited me to a Chinese meal, which is one of my favorites. Since this is my first Chinese meal after the gastrectomy, I want to go for the meal. What should I be aware of and be careful about?

A．If you are in good physical condition, there is no food in particular that you must not eat.
Basically, it is most important to enjoy your food, savor the flavors, and maintain a balanced diet. However, as the secretion of gastric acid and digestive enzymes decline after gastrectomy, your digestive ability will also decline. For that reason, beware of taking oily foods as they can cause indigestion.

For foods that you have not been eating after the surgery, consume them based on your own physical condition and appetite, and start by eating small amounts. Dishes such as Chinese porridge, hanamaki (steamed bread), soups, shumai (steamed Chinese meat dumplings), boiled gyoza, and crab and egg are recommended. Be careful of eating the Chinese noodles used in ramen, as they contain an agent known as kansui (alkaline salt solution) and is bad for digestion.

Female, 79 years old, stomach cancer
(Underwent gastrectomy 22 years ago)

< Spent four months in anxiety after becoming aware of changes in physical condition >

It took about four months from the point when I became aware of changes in my physical condition to receiving a diagnosis. The first physical change that I noticed was a significant drop in my body weight, which fell by 6 kg from 52 kg to 46 kg. After that, my feet felt heavy, and I had to rest twice after walking for 15 minutes. I felt that my physical strength had declines. After that, I experienced stomach discomfort and visited the hospital, where various tests were carried out. I was diagnosed and informed that I was in the early stages of stomach cancer.

< Meeting a doctor I could trust >

Even after receiving the cancer diagnosis, I continued with my everyday life as usual and felt a strong sense of disbelief. However, preparations for the surgery proceeded gradually. On the first meeting, my appointed doctor explained, “I used to work at a cancer center. Since this is the early stage of the cancer, you do not have to worry.” This made me feel that I could rely completely on this doctor. My doctor told me all the details kindly, and I have trusted him greatly since then.

< To undergo a gall bladder surgery at the same time as a gastrectomy… >

My stomach surgery involved removing the bottom two-thirds of my stomach, and connecting the remaining one-third of the stomach to the duodenum. My doctor explained that one in every three people who undergo stomach surgery suffer from gall bladder problems later and end up having surgery on their gall bladders as well. Hence, in consideration of a decline in physical strength after surgery, it was recommended that I undergo a gall bladder surgery at the same time. I was shocked at first, but the detailed and careful explanation convinced me to accept the surgery. After hearing the words “Let’s pray together” from my pastor, my fear disappeared and I felt more light-hearted, and was able to confront the day of the surgery.

< One week of surviving only on a drip post-surgery >

After the surgery, I was able to walk indoors on the second day. I could not expel the phlegm and it was difficult to breathe, but I felt slightly better after getting up, and at the same time, it became easier to breathe. I survived only on a drip after the surgery, and when I measured my weight on the sixth day, I found that it had dropped by 2 kg from before the surgery.

< Began to eat in the second to third week post-surgery, and signs of gradual recovery were observed >

During the second week, I took a shower for the first time with the help of a nurse, and dropped a lot of hair. When I sighed, the nurse consoled me by saying that it will grow again, and that everyone loses hair when they wash it. When I went off the painkillers, the pain would not go away. I felt queasy. I began taking liquid food on the ninth day after the operation, but I was mostly unable to eat. On the evening of the same day, I moved on to watery rice porridge, and I was able to eat half of it. I lost 2 kg during the first week after surgery, and lost a further 2 kg two weeks later. Although I moved on to thicker rice porridge, I continued to feel as if it was getting stuck. Two weeks later, I entered the bath for the first time. It felt really good. I was instructed by my doctor to move my body as far as possible, so I would go up and down the stairs or take walks in the park nearby. I gradually became able to take my meals. Although I would feel as if the food were stuck in my stomach or wake up in the middle of the night with gastric pains, I felt fine after moving my bowels.

< Experienced much difficulty eating immediately after being discharged from hospital >

I was discharged from hospital about one month after the surgery. After meals, I experienced tightening of the chest, tiredness, and nausea, and these symptoms would last for two hours. Hence, I would eat slowly then lie down right away for about 30 minutes. For my meals, I was told to chew 50 – 70 times each time, to think of eating as work, and to eat one serving over two meals. It was difficult…
Although I had weighed 52 kg when I was healthy, my weight had now dropped to 38 kg.

< Appendicitis surgery as an additional blow >

10 days after I was discharged, I experienced much stomach discomfort from morning, and could not sleep even at night. The next day, I was admitted to hospital. The pain was concentrated in the bottom right side of my abdomen. At first, the doctor seemed worried that it may be intestinal obstruction, but it turned out to be appendicitis. I underwent the surgery the next day.
After the surgery, I could not eat anything for two to three days. I felt very cold even though it was August, and had to use a heating pad. Although I was discharged one week later, I felt faint when I started walking. I had no appetite and did not want to do any housework. I had less physical strength than after my gastrectomy. I went to church and tried to sing the hymns, but my voice became hoarse and gave out.
One month later, I began to recover gradually.

< Suddenly, a world of black and white… >

About five months after the surgery, I became unable to identify colors while I was shopping, and could see only black and white. After I sat down to rest, my sight was restored. The same time happened three times in a row, so I became worried and consulted with my doctor. My doctor explained that it was the result of dumping syndrome. About two hours after a meal, blood pressure would drop suddenly, leading to symptoms such as palpitations, nausea, diarrhea, and drowsiness. The signs are the same as for diabetic patients suffering from low blood sugar. At such times, the condition will improve by eating chocolate or caramel and staying still for a while.

< Today, 22 years after the surgery >

Although I do not like meat anymore, I try to eat everything without being picky. Although 22 years have passed since my surgery, I suffer from continuous diarrhea if I let my guard down, and experience difficulties in managing my own health. I thank the Lord every day that I am alive.

Male, 64 years old, stomach cancer
(Underwent gastrectomy more than two years ago)

It is now four years since I underwent the gastrectomy. I am grateful to my surgeon, the teachers who gave me advice, and everyone at the hospital for the fact that I am healthy and able to work today.

It was a shock to me when I heard my diagnosis, but I accepted it without protest and prepared myself for the surgery. I did not change my attitude toward life or lifestyle habits in particular, but paid attention to the following when preparing for the surgery.

1．Stop drinking alcohol.
2．Be careful to avoid catching colds, etc.

After the surgery (as before the surgery), I followed the advice of the nurses with simple honesty.

1．In addition to following the dietary menu as a matter of course, the body remembers the amount of food consumed before the surgery, so I took care to prevent overeating and kept the flavors light.

Even now, I record changes in my body weight and take care to avoid becoming overweight.

When I met people, they would tell me that it is advisable to take nutritious food. Although I was very grateful for their concern, I was careful not to be confused or misled by their advice.

2．I engaged in slightly more rehabilitation activities, such as walking, than dictated.
3．Once month after the surgery and 20 days after being discharged from hospital, I returned to work.

(1) Initially, I did about 3 – 5 hours’ worth of work, then increased the volume of work every two weeks thereafter.

(2) Three months later, I had returned to the work volume and hours that I had been doing before the surgery.

(3) I have now stopped drinking alcohol. (I abstain from alcohol because I do not feel like drinking.)
My wife has told me to avoid stimulants or irritating foods, so I do not take any. Some of the changes I have made after the surgery are abstaining from alcohol and reducing the amount of irritating foods that I take. Although the doctor has not given me any particular instructions to avoid such foods, I avoid them because I want to.

(4) I think of my work as rehabilitation, and try to walk as far as possible. On days when I go to work, I walk 13,000 steps, and even up to as many as 17,000 steps at times.

(5) I have not experienced any particular difficulties in returning to work, but in my case, I became very sensitive about moving my bowels when commuting to work.

Compared to before the surgery, I would suddenly feel the need to move my bowels, so I cope with it by collecting all information about the locations of toilets and ease of use of these toilets.

Female, 68 years old, stomach cancer
(Underwent gastrectomy more than two years ago)

Putting effort into improving mood and physical strength

Two years after the surgery, I visited the sports club once every two weeks to do aerobics for 15 – 20 minutes and move my body in yoga sessions, so as to refresh and improve my mood.

Six years after the surgery, I maintain my physical condition by cycling for 3o minutes, and methods such as core healing and qigong (breathing exercises). I gave up walking in the pool as I was unable to move forward due to water pressure.

As I am unable to absorb iron efficiently, I received iron through an intravenous drip. In my case, however, I had an allergic reaction and broke out in red, itchy rashes.

Male, 65 years old, stomach cancer
(Underwent gastrectomy more than two years ago)

Necessary to visit the hospital regularly and manage your health

About 40% of my stomach was removed through laparoscopic surgery. At the time, I underwent a surgery that did not involve the removal of the entrance and exit (cardiac orifice and pylorus) to my stomach (segmental gastrectomy accompanying sentinel lymph node biopsy). For that reason, my recovery after surgery was surprisingly quick, and I was able to return to my present job two weeks after the surgery. I also did not need to undergo any invasive tests. Everything has gone smoothly for me after that.

I continued to undergo regular gastroscopy examinations, and that was when it was discovered that I had early esophageal cancer. In this case as well, the infected area was removed through an endoscopic submucosal dissection (ESD: Surgery that involves inserting an electric scalpel from an endoscope and removing the cancerous mucosa without removing the esophagus).

I stayed in the hospital for only five days, and was able to return to work soon after I was discharged. I am truly grateful to have been able to return to work soon after undergoing treatment twice.

When I underwent gastrectomy, I received surgery through treatment as clinical research, instead of the recommended treatment for routine medical care under the guidelines for stomach cancer treatment. As a result, I was able to return to my daily life without any decline in quality of life. I think my case was a rare example, so I have submitted a post about my experience.