Dietary-culinary recommendations after a partial gastrectomy

It is recommended to consume about 1.5 litres of liquid per day, but because that is not always easy, it is preferable to try to reach the maximum that each person can tolerate.
In many cases, water alone is not well tolerated, so other liquids should be drunk, such as broth, diluted juice or diluted vegetable and fruit smoothies. Jellies and popsicles are also an option.
It is advisable to always drink outside of meals and in small amounts, and not to drink within 30 to 60 minutes before and after meals.

• Start with small amounts and sips.
• Avoid sugary, carbonated or alcoholic beverages.

Due to the lower stomach capacity, the amount of food per meal should be much smaller. It is important to eat more meals per day to incorporate different foods and a higher proportion of nutrients. Thus, at a minimum, the feeding should be divided into breakfast, mid-morning snack, lunch, afternoon snack, dinner and after-dinner snack.
In some cases, even more small meals eaten every two hours may be needed. Even if you do not feel hungry, you should eat several times a day to maintain adequate weight and nutrition. This will also help the digestive system to adapt to the new situation.

It is essential to chew food very well and mash it into a purée before swallowing.

It is important to learn to listen to the body, its sensations and reactions when eating, and to stop eating before feeling full to avoid discomfort later.

Fruits, dairy, starchy foods (cereals, tubers, legumes*, etc.), protein-rich foods (eggs, fish, meat, tofu, tempeh, seitan, texturised protein) and healthy fats (virgin olive oil, nuts**), depending on tolerance and dietary progression.
Incorporate vegetables in small amounts at the beginning, since they are very filling and provide few calories.
*Legumes should be incorporated in puréed form (creams, purées, etc.) or mashed with a fork to facilitate digestion.
** Nuts should be incorporated ground or mashed.

It is common for the patient to eat a liquid diet during the hospital stay and then to progress to a puréed diet when released. At home, a diet with soft-textured foods can be started, which can be mashed if they are not tolerated in a solid form. The type of food and textures needed may progress day to day, depending on the specifications of the medical team.

Because the stomach capacity is lower, you have to eat small amounts frequently. It is advisable to avoid prolonged fasting, so ideally you should have a snack before bedtime in order to lower the fasting time.

Always ensure the presence of starchy, protein-rich foods, vegetables in small amounts and fruit at lunch and dinner, even in small amounts, as indicated in the plate method. A dessert dish can be used as the basis for a main course, a first or second course or a tapas-style meal.
It is preferable to incorporate the food groups according to the indications of the following points.

White rice, pasta, potato, carrot, toast, oatmeal or legumes.

• Puréed legumes.
• Bread is usually better if it is toasted.
• Thoroughly cooked pasta and rice. Not al dente.
• Avoid wholegrain or wholemeal versions (brown rice, wholegrain pasta, wholegrain bread, etc.).

Initially after surgery, it is advisable to avoid very fibrous or flatulence-causing vegetables such as leeks, asparagus, artichokes, cauliflower or broccoli.
After a while, other cooked vegetables can be introduced in small amounts, and new ones, like salads, can be added depending on tolerance to raw vegetables.
Keep in mind that vegetables provide few calories, so it is important to consume them in small amounts and always well-seasoned and/or accompanied by more nutritious foods.

Meat, fish, seafood, eggs and soy are the highest quality protein-rich foods. At least the main meals, lunch and dinner, should contain these proteins, such as any dish containing white fish, seafood, meat (mainly lean), eggs, soy or soy by-products (tofu, texturised soy, etc.), depending on tolerance. Other foods that are also a good source of protein, such as dairy products, can be included in the other meals, depending on tolerance.

It is preferable to avoid very tough or fibrous meats, as they do not tend sit well. Texture is important, so dishes based on minced meat, mixed with sauce, etc. are usually better tolerated (high-quality hamburgers, meatballs with sauce, etc.).

Include oily fish (sardines, mackerel, salmon, etc.), as other foods become tolerated and digestion has stabilised.

Examples of protein-rich foods:

People who follow an exclusively plant-based diet, with very little or no animal-based food (vegan, strict vegetarian, etc.), should check with their referring dietician-nutritionist to study how to adequately cover the proteins, vitamins and minerals that the organism needs to deal with the whole oncological process.

During the first few days, it is advisable to prioritise mild dishes with little fat, such as boiled, microwaved, baked en papillote or very mild stews.
Grilled, baked and low-fat stews and casseroles can be added later.
Try to avoid battered, breaded, fried and very fatty stews.

In many cases, room-temperature dishes (neither too cold nor too hot) are best tolerated.

Try to start with lactose-free dairy products. Subsequently, tolerance to natural skimmed yoghurt and later to natural yoghurt, cottage cheese and fresh cheese can be tested. Finally, tolerance to other dairy products can be tested.

Try to incorporate protein-rich natural yoghurt (with or without lactose, depending on tolerance and progression).

Sugary dairy products, such as sweetened or flavoured yoghurt, custard, flan, mousse, etc., should be avoided.

It is important to consume two or three pieces of fruit a day. Initially they should always be cooked, mashed (without skin or seeds) or in a compote.

Later, test tolerance to small amounts of fresh fruit (without skin and seeds), such as apples, grapes, pears and bananas. Wait until digestive function has returned to normal before trying acidic fruits (pineapples, oranges, grapefruits, tangerines, strawberries).

Small amounts of fruit and vegetable smoothies can also be eaten.

An easy-to-digest, puréed diet will be necessary to cope with the consequences of gastroparesis for the first few weeks after surgery. Try to follow the above recommendations, but adapting meals to a mashed texture.

For further information, please refer to the following section.
Generally, one month after the intervention (or depending on tolerance), a more normal diet can be gradually introduced.

• Avoid drinking one hour before or after meals.
• Lie down for about 30 minutes after meals (if there is acid reflux, recline without lying prone).
• Avoid alcoholic beverages, caffeinated beverages (coffee, stimulating soft drinks) and tea, because they increase the speed of gastric emptying.
• Avoid eating foods with simple sugars:
  • Do not add sugar (white or brown sugar, honey, agave, syrup, etc.) to dishes.
  • Avoid foods containing simple sugars (white or brown sugar, honey, agave, syrup), such as commercial juices, soft drinks, cakes or pastries, commercial sauces, sweetened yoghurt or dairy desserts (flan, custard, mousse, ice cream, etc.).
  • Limit the intake of natural fruit juices.

Follow the above recommendations and the following table of recommended and inadvisable foods in the first month of eating at home.

After the first month, if the patient is evolving properly and not suffering from aerophagia, acid reflux, vomiting and/or pain after eating, different foods can gradually be introduced, including the following:

• Dairy aged cheese, plain yoghurt, yoghurt with fruit.
• Meats more elaborate dishes with limited fat content.
• Oily fish and seafood start introducing them in mild dishes like those cooked en papillote, microwaved or boiled.
• Vegetables mild sautéed sauces to season pasta and rice dishes. Raw, in small amounts and slowly cooked as a garnish: tomato, asparagus tips, lettuce, cucumber, onion. Flatulent vegetables should be tested and introduced depending on tolerance.
• Legumes in mild dishes, chewing them very well.
• Fruit acidic, depending on individual tolerance. Do not eat too many loquats, plums with skin, raisins, pineapples, persimmons, oranges and tangerines.

Sweets: depending on the evolution of the dumping syndrome, small amounts of jam or fruit in syrup can be introduced.