Stomach Cancer and Gastrectomy Diet

How do I make the best food choices throughout cancer treatment?

When you are faced with a cancer diagnosis, nutrition can be an important part of your journey. Eating a well-balanced diet before, during, and after cancer treatment can help you feel better, maintain your strength, and speed your recovery.

  • Maintain a healthy weight. Aim to avoid losing or gaining much weight during treatment. Strict dieting is not recommended during cancer treatment. Losing weight can lower your energy level and decrease your body’s ability to fight infection.
  • Eat small, frequent meals throughout the day. Eating frequent small meals will ensure your body is getting enough calories, protein, and nutrients to tolerate treatment. Smaller meals may also help to reduce treatment-related side effects such as nausea. Try eating 5- 6 small meals or “mini” meals about every three hours.
  • Choose protein-rich foods. Protein helps the body to repair cells and tissues.  It also helps your immune system recover from illness. Include a source of lean protein at all meals and snacks.  Good sources of lean protein include:
    • Lean meats such as chicken, fish, or turkey
    • Eggs
    • Low fat dairy products such as milk, yogurt, and cheese or dairy substitutes
    • Nuts and nut butters
    • Beans
    • Soy foods
  • Include whole grain foods. Whole grain foods provide a good source of carbohydrate and fiber, which help keep your energy levels up. Good sources of whole grain foods include:
    • Oatmeal
    • Whole wheat breads
    • Brown rice
    • Whole grain pastas
  • Eat a variety of fruits and vegetables every day. Fruits and vegetables offer the body antioxidants, which can help fight against cancer. Choose a variety of colorful fruits and vegetables to get the greatest benefit.  Aim to eat a minimum of 5 servings of whole fruits and vegetables daily.
  • Choose sources of healthy fat. Avoid fried, greasy, and fatty foods, Choose baked, broiled, or grilled foods instead. Healthy fats include:
    • Olive oil
    • Avocados
    • Nuts
    • Seeds
  • Limit sweets and added sugars. Foods high in added sugars like desserts and sweets provide little nutritional benefit and often take the place of other foods that are better for you.
  • Stay hydrated. Drinking enough fluids during cancer treatment is important for preventing dehydration. Aim to drink 64 ounces of fluid daily. Avoid drinking large amounts of caffeinated beverages. Too much caffeine can lead to dehydration.
  • Practice good food safety. Wash your hands often while preparing food. Use different knives and cutting boards for raw meat and raw vegetables. Be sure to cook all foods to their proper temperature and refrigerate leftovers right away.
  • Talk to your healthcare team before taking any vitamins or supplements.  Some medications and cancer treatments may interact with vitamins and supplements.  Choose food first as the main source for nutrients.
  • Drink alcohol in moderation, if at all.  Alcohol may contribute to dehydration, can lower the abilities of your immune system, and provides no beneficial nutrients.
  • Most importantly, know that your cancer journey is unique to you and your treatment. You may experience side effects that affect your ability to follow these suggestions. If you are struggling with any side effects, such as loss of appetite, nausea, diarrhea, vomiting, or any other nutrition concerns, your needs may be different. A registered dietitian can suggest nutrition guidelines that will be appropriate for your cancer journey.

What is a Gastrectomy?

A gastrectomy is the removal of some or all of your stomach that holds food at the beginning of digestion. After surgery, your stomach will hold much less food. Your food will also not stay in your stomach as long. It is very common to have symptoms of dumping syndrome.

What is dumping syndrome?

Dumping syndrome is a condition where your food leaves your stomach too quickly. This causes food to “dump” into the small intestine.

Up to one half of people have dumping syndrome after a gastrectomy.

You can have either early or late dumping syndrome. Early dumping syndrome is caused by a shift of fluid in the small intestine. Later dumping syndrome is caused by a drop in blood sugar.

How do I know if I have dumping syndrome?

You may have early dumping syndrome if half an hour after eating you experience the following: nausea, vomiting, abdominal pain, cramping, diarrhea, dizziness, burping, fatigue, or rapid heart rate.

You may have late dumping syndrome if four hours after eating you experience the following: sweating, fatigue, dizziness, shakiness, anxiety, rapid heart rate, fainting, confusion, diarrhea, or low blood sugar.

Preventing Dumping Syndrome?

  • Eat smaller meals 5-6 times a day.
    • Your stomach cannot hold as much food after surgery.
    • Eat no more than 1 cup of food at each meal or snack.
    • Add new foods slowly to lower side effects of dumping syndrome.
    • Chew food really well.
  • Eat protein at every meal.
    • Proteins include chicken, turkey, beef, pork, fish, cheese, eggs, nuts, seeds, and soy foods.
  • Choose low fiber grains.
    • Low fiber grains are often grains from white, refined flour.
    • Read the food labels and do not eat food with more than 2g of fiber per serving.
  • Do not eat a lot of sugar.
    • Avoid sweets such as cakes, candy, pies, and cookies.
  • Limit carbohydrates.
    • If you are experience dumping syndrome, limiting carbohydrates might help.
    • Avoid, bread, cereal, rice, pasta, crackers, potatoes, corn, peas, squash, fruit, and fruit juices.
  • Avoid foods with natural laxatives.
    • Do not eat prunes, figs, licorice, caffeinated foods/drinks, and sugar alcohols.Do not eat or drink very hot or very cold foods.Drink only unsweetened drinks and do not drink a lot with meals.
  • Do not drink with snacks and meals.
  • Wait 30 to 60 minutes after a meal before drinking.
    • Avoid alcohol.
    • Alcohol increases the risk of cancer recurrence and does not provide the body with any nutrients.
  • Rest after eating.
    • Lie down for 20-30 minutes after eating.

What else do I need to know?

A gastrectomy may cause lactose intolerance. Avoiding dairy products such as milk, creamy soups, ice cream, yogurt and cheese may help. You may still be able to eat yogurt. Try yogurt with “live, active cultures” on the label.

You may need to take fiber, calcium, iron, or vitamin B-12 supplements. Iron can prevent anemia, calcium prevents osteoporosis, and fiber supplements may lessen symptoms of dumping syndrome. Your body may not be getting enough nutrients from food alone. Ask your surgeon or a registered dietitian what is best for you.

If you experience rapid weight loss, talk to your surgeon or a registered dietitian immediately. Losing more than 1-2lbs per week is rapid weight loss. Rapid weight loss is dangerous even if you are overweight. Your body may not be getting the nutrients it needs.

What food should I choose and avoid eat after a gastrectomy?

  • Milk and Dairy
    • Choose buttermilk, evaporated milk, 1% or skim milk. Eat plain yogurt without added sugar, powdered milk, low fat cheese, and no sugar added ice cream.
    • Avoid chocolate milk. Avoid any milk product with added sugar.
    • If you are lactose intolerant, try lactose-free milk or soymilk.
  • Meat and Protein
    • Choose tender meats cooked without added fat including chicken, turkey, beef, pork, and lamb. Eat soy based meat products, eggs, fish, and smooth nut butters.
    • Avoid fried meats. Avoid processed meats like salami, bologna, bacon, sausages, or hot dogs. Avoid tough or chewy meats. Avoid beans, peas, lentils, nuts, or chunky nut butters.
  • Grains
    • Choose white breads and cereals made with white flour.
    • Avoid high fiber grains and cereals or foods with more than 2g of fiber per serving.
  • Vegetables
    • Choose cooked vegetables without seeds or skin. Eat potatoes without the skin.
    • Eat lettuce. Drink strained vegetable juice.
    • Avoid vegetables except iceberg lettuce. Avoid cooked vegetables with seeds or skin. Avoid beets, broccoli, cauliflower, cabbage, brussels sprouts, collard greens, mustard, greens, turnip greens, and corn.
  • Fruits
    • Choose canned and soft fruits without added sugar. Choose bananas and melons.
    • Avoid any fruits except bananas and melons. Avoid dried fruits such as raisins and prunes. Avoid fruit juices. Do not eat canned fruit in syrup with added sugar.
  • Fats
    • Choose oils, butter, trans fat free tub margarine, cream, cream cheese, and mayonnaise.
  • Drinks
    • Choose water, decaf coffee and decaf tea and diet, sugar free, and caffeine free soft drinks.
    • Avoid caffeinated tea, coffee, or sodas. Avoid alcohol. Avoid fruit juice. Avoid sweetened drinks that contain sugar, corn syrup, or honey.
  • Sweeteners
    • Use stevia as a natural artificial sweetener.
    • Avoid any foods made with artificial sweeteners. Saccharin, aspartame, sucralose, and acesulfame potassium are artificial sweeteners. Avoid food with sugar, honey, syrup, sorbitol, or xylitol listed as one of the first 3 ingredients.

What is nutrition therapy by tube or IV and WHY is it important?

Cancer and cancer treatments can affect the way you eat and drink. Nutrition therapy, also known as nutrition support, involves finding ways to get nutrients and fluids when cancer or its treatment changes your ability to eat. Nutrition therapy is often used for a short time to help you heal while taking treatments or for a longer time if your ability to eat is permanently affected. The goal of nutrition therapy is to offer enough nourishment to avoid unhealthy weight loss and/or dehydration.

Who might need nutrition therapy?

  • People who have significant weight loss due to low desire or difficulty eating
  • People with low food intake for more than a week
  • People who need to improve nutrition before a surgery

How is nutrition therapy given? (feeding types)

If the gastrointestinal tract (gut) is working and can still move food through the body, a tube feeding is used. An IV feeding is used if the gut does not work or is not working well.

Parenteral nutrition – Feeding through a large IV (intravenous catheter) into the bloodstream. Parenteral nutrition therapy is usually recommended when nutrition therapy will be required for a longer time.

Enteral nutrition – Feeding liquid nutrition through a tube into the stomach or intestines. Enteral nutrition therapy can be used for either a short or long time period.

An enteral feeding tube can be placed in a number of different locations depending on you and your health. The most common sites are described below.

  • Nasogastric tube (NG tube or NGT) – A tube is placed from the nose into the stomach.
  • Gastrostomy (G tube) – A tube is placed from the skin surface directly into the stomach.
  • Jejunostomy (J tube) – A tube is placed from the skin surface directly into the intestine.

Where is nutrition therapy given?

While nutrition therapy may be used in a hospital setting, it is most often given at home through a nutrition therapy service (home health). If you or a loved one is thinking about home health, you may be worried about tube feeding or intravenous feeding. Either can be an intimidating thought. But with proper information and preparation, home feedings can be done and can even be rewarding. Below are some details to understand before you begin home feedings.

Formula

There are many different types of formula available. Each has certain components that are good for your nutritional needs. It is important to understand the amount (volume or feeding rate) and frequency (hang time) of the formula planned. Talk to your healthcare team about your feeding plan. Be sure to know where you can buy the formula and how it should be stored (some formulas need refrigeration).

Water Flushes

Water flushes clear the feeding tube and give you enough fluids. Know when flushes are needed (before, after, or during feedings) and how much water to use. It is important to follow the directions closely to prevent dryness or excess fluids.

Sanitation

Sanitation is very important in stopping infection and maintaining good health. Make sure to wash your hands properly before feedings. Also, wash the top of the formula can before opening to decrease possible contamination. Follow any other directions given by your healthcare team.

Sitting

Patients receiving enteral nutrition should try to sit up straight during tube feeding and for at least 30 minutes after feeding to stop backward flow of the food and possible aspiration (taking food particles or liquids into the lungs through the windpipe). If you are receiving parenteral nutrition, you do not need to worry about sitting.

Possible Side Effects

The benefits of nutrition therapy are often greater than the side effects, but you may have some problems. You will be able to handle some issues on your own, but always ask your healthcare team what they recommend. Be sure to have an emergency number to use when something happens outside your team’s regular office hours.

Possible Side Effects of Enteral Nutrition:

  • Constipation – Difficult bowel movements due to lack of activity, poor fluids and fiber intakes, or use of pain medication
  • Dehydration – Lack of fluids that can be due to concentrated formulas, not enough free water flushes, too high protein intake, or high blood sugar levels
  • Diarrhea – Loose bowel movements that can be from medications, feeding too quickly, sorbitol-containing formula, or infection
  • Gastrointestinal reflux and aspiration – Reflux is the backward flow of gut contents into the throat. Aspiration results when these food items get into the lungs. This can lead to infection and pneumonia. Feeding while lying down is the most common cause. The bed should be elevated to at least 45°.
  • High gastric residuals – Gastric residuals are the food particles that remain in the gut after feedings. Your doctor or registered dietitian can assist if residuals are too high. They may try to order a low-fat and low-fiber formula or decrease feeding rate.
  • Malabsorption – Occurs when the gut can’t absorb the nutrients from food, which can lead to diarrhea and lack of proper nutrition
  • Re-feeding syndrome – When a starved body receives feeding too quickly, issues can arise. If you have been without food or only taking a small amount, be sure to begin feeding slowly and with the direction of a healthcare team.
  • Infection – Infections can occur at the feeding site because of poor sanitation or can enter the body through the feedings if handled improperly.
  • Overfeeding – Too much feeding can cause the body to receive more nutrients than needed which can lead to other issues such as overworking the lungs.
  • Re-feeding syndrome – When a starved body receives feeding too quickly, issues can arise. If you have been without food or only taking a small amount, be sure to begin feeding slowly and with the direction of a healthcare team.

Food Safety

The immune system is weakened during all types of cancer treatment. Unfortunately, chemotherapy medications are not able to tell the difference between healthy cells and cancer cells. For this reason, perfectly healthy red and white blood cells are damaged or killed during treatment and shortly thereafter. The result of this is that body is not as good at fighting illness and infection. A common term used to refer to a very low neutrophil (white blood cell) count is neutropenia. Paying special attention to food safety during cancer treatment to reduce the risk of exposure to food borne illness may also be referred to a neutropenic diet. The following are some simple tips to reduce exposure and avoid unnecessary infection and/or illness during the time the immune system is compromised.

Keep EVERYTHING Clean

  • Wash hands often and thoroughly especially before handling any food as well as after. Be sure to wash hands with warm water and soap for at least 20 seconds. Pay special attention to finger nails and the backs of the hands.
  • Keep raw and cooked foods separate. Do not reuse any utensils, cutting boards, plates, dishes, etc. once they have been touched by raw meat or eggs. Utensils, cutting boards, plates, dishes, etc. that have been used for preparing raw meats or eggs should be washed in hot, soapy water. It is best to keep a separate cutting board for meat and fruits/vegetables. Have an extra clean cutting board available for additional preparation as well.
  • When shopping for and storing raw meats, keep them away from other foods and cover the packages with extra plastic wrap or use plastic bags. This will prevent any liquids from leaking onto other foods or surfaces. Store meats and eggs toward the bottom of the refrigerator to prevent any dripping on other foods below.

Cook Food Thoroughly

  • Avoid raw meat such as sushi, undercooked eggs (make sure eggs are at least “over easy” and not “sunny side up”), and other meats that have not been cooked to a proper internal temperature.
  • Cook all eggs until both the white and the yolk are firm.

Foods To Avoid

  • Raw or undercooked meats
  • Unpasteurized milk and juices
  • Soft cheeses made with unpasteurized milk such as feta, blue cheese, Roquefort, Stilton, brie, or Farmer’s cheese
  • Processed meats such as luncheon meats as well as anything else from a deli counter
  • Refrigerated meat spreads or paté
  • Smoked fish or precooked shrimp or crab meat
  • Sprouts such as bean sprouts, alfalfa sprouts, or broccoli sprouts
  • Pre-cut fresh fruit and vegetables. Buy them whole, wash, and cut them yourself using proper sanitary techniques as outlined above.
  • Unwashed fresh fruits and vegetables
  • Unroasted or raw nuts and seeds
  • Raw tofu or tempeh
  • Food from salad bars of buffets
  • “Fresh” salad dressings, salsas, sauces, etc. sold in the refrigerated section of the grocery store.
  • Raw apple cider
  • Raw honey
  • Unrefrigerated cream filled pastries

The guidelines above were created with those who have severely weakened immune systems in mind. Consult your physician or health care team for regular updates on your blood counts and the status of your immune system.