Dietary Recommendations for Anaemia After a Gastrectomy

Anaemia is one of the important long-term after-effects following gastrectomy and may develop gradually over years. Iron-deficiency anaemia and/or megaloblastic anaemia (vitamin B12 or folic acid (B9) deficiency) is a consequence of low intake or reduced absorption of nutrients due to surgery. It is important to periodically monitor blood concentrations of iron, vitamin B12 and B9. The referring medical team will assess the need to supplement any of these vitamins.

WHAT DO WE RECOMMEND?

See the section on ‘Dietary and culinary recommendations after a gastrectomy (partial or total)’.

The following are the iron-rich animal- or plant-based foods that are most highly recommended:

Iron-rich animal-based foods
  • White (lean) meat : rabbit, turkey, chicken, etc.
  • White and oily fish: sardines, sea bass, anchovies, etc.
  • Seafood: natural mussels, clams and cockles.
  • Eggs: chicken eggs, quail eggs, etc.
In moderation: lean, non-fibrous parts of red meat (beef, horse, ox, lamb, etc.). At most one serving (125 g) per week.
Iron-rich plant-based foods
  • Grains such as wheat germ and wheat bran.
  • Legumes such as soybeans and soy by-products (tofu and tempeh), lentils, chickpeas and beans (mashed or crushed).
  • Nuts and seeds, such as sesame, sunflower seeds, pistachios and almonds, ground or in nut butter form: tahini, 100% almond butter, 100% hazelnut butter, etc.
  • Green leafy vegetables, such as spinach and chard.
  • Enriched breakfast cereals.

Preparing dishes that mix iron-rich animal- and plant-based foods will improve their absorption.
For strict vegetarians or vegans, it is essential to seek advice from a dietitian-nutritionist to ensure sufficient iron intake.

When eating foods rich in iron, it is advisable not to eat certain foods that lower its absorption at the same time. Instead, iron-rich foods should be eaten with other foods that facilitate its absorption.

Foods that limit iron absorption Foods that facilitate iron absorption
  • Whole grain foods
  • Dairy products (milk, yoghurt, cheese, etc.)
  • Chocolate and cocoa
  • Wine
  • Tea
  • Coffee
  • Food sources of vitamin A: cabbage, tomatoes*, carrots, peppers, squash, etc.
  • Food sources of vitamin C*: citrus fruits (orange, tangerine, lemon), strawberries, kiwi, red bell pepper, etc.
Avoid consumption of dairy products as a dessert at main meals, and ensure that they are consumed between meals.
Avoid consumption of coffee, tea, chocolate or cocoa with main meals.
If whole grains are consumed, soak them for one hour before cooking and discard the soaking water.		 Try to ensure that main meals contain vegetables or fruits that are a source of vitamin A or C either as a starter, main course or side dish.
Dress vegetables with lemon juice.
* Assess tolerance to acidic fruits.

Examples of iron-rich recipes that can be incorporated or adapted depending on tolerance and progression:

Some suggested recipes:

Express aromatic mussels

Warm salmon and apple salad

Creamy Mussel soup

Turkey and vegetable savory flans

Rabbit with pineapple in syrup (modified texture)

Beef casserole with mushrooms and potato puree (modified texture)

Lentil and serrano ham stew (texture modified diet)

Roasted pork with nuts and dried fruit (texture modified diet)

Quick chickpea purée and hard-boiled egg

Meat & rice noodle pies

Turkey and vegetable savory flans (enriched)

Chickpea burger

The main sources of folic acid are dark green leafy vegetables (spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli, etc.) and legumes (lentils, beans, beans, chickpeas, etc.).
Folic acid is also found to a lesser extent in fruit, nuts, sunflower seeds, eggs and fortified or enriched foods.

The absorption of vitamin B12 from food requires it to bind to a protein called intrinsic factor, which is produced in the stomach. If the stomach is removed, this protein can no longer be produced, so the vitamin B12 from food cannot be absorbed. Your medical team or dietitian-nutritionist will assess the need for non-oral supplementation.