Nutrition is critical to any healthy lifestyle, particular to gastric cancer survivors. To that end, we are including a Nutrition Q&A in the newsletter. Erika Connor is a RD and CSO who works in the Cancer Supportive Care Program at Stanford Cancer Center. If you would like to ask Erika a question for a future Q&A features, please submit it at firstname.lastname@example.org.
Q: How should survivors eat after a partial or total gastrectomy? Doctors just say eat a “normal” diet, but what does that mean?
A: The best advice after any gastrointestinal surgery, especially a partial or total gastrectomy is to NOT eat a “normal” diet, meaning all the foods you ate prior to your diagnosis/procedure. As a start, review the information on the Gastric Cancer Fund website under “Living with Gastric Cancer” that specific addresses nutrition after gastrectomy (inset link here). It’s important to start small with simple foods and fluids, and then gradually build on what you can tolerate. Keep seasonings simple, maybe just a bit of salt, basil or garlic. Avoid spicy, fatty foods and large quantities of any food. As you feel more comfortable, look to add one new food or fluid at a time to see if you can tolerate it. Also, realize that your body will eventually adapt, so if you can’t immediately tolerate a food, don’t give up on it. As your body heals, it will be able to adjust and grow regarding what it can handle.
Q: Are there certain vitamins or supplements that gastric cancer patients should explore?
A: First, it is important that each patient checks with their healthcare team and ask to speak with a dietitian for specifics. In general, there are certain vitamins/minerals that are usually recommended, especially after a gastrectomy. Anemia is the most common nutritional deficit after a gastrectomy. This can be from vitamin B12, folate or iron deficiency.
Iron deficiency can stem from preoperative anemia, or post surgically it can result from decreased food intake and/or decreased acid secretions which can affect the body’s ability to convert iron to it’s efficiently absorbable form. Oral supplementation with iron is usually effective in this scenario. Increasing consumption of iron rich foods can also help. Best iron food sources include clams, oysters, sardines, molasses and iron fortified cereals.
Folate deficiency may appear from malabsorption and the change in digestion from an altered GI tract, or along with impaired absorption of iron and vitamin B12. Folate deficiency alone has not been well documented, and folate supplementation can cover up a B12 deficiency that may go untreated. Red blood cell folate is a better indicator of body folate stores rather than serum folate, so it’s important to check with your healthcare team to see if folate supplements are appropriate.
Vitamin B12 deficiency is mostly due to the body’s inability to grab vitamin B12 from protein that’s been consumed. Bacterial overgrowth and decreased intake of vitamin B12 foods can also result in a deficiency. Deficiency can develop in as little as one year after treatment and can result in fatigue, chills, swollen tongue and even peripheral neuropathy, erectile dysfunction and irritability/depression. Supplementing can be done orally or by intramuscular injections and usually based on the compliance of the patient and response to the therapy.
Bone disease is common in gastrectomy patients. The main goal in treating bone disease is avoiding fractures. The cause of bone disease is uncertain, however, it seems that it is a result of a combination of issues: decreased intake of calcium, vitamin D, and lactose-containing foods along with altered absorption and metabolism. It is encouraged for patients to increase calcium rich foods, which include dairy products like milk and yogurt, or calcium and vitamin D enriched milk alternatives and juices. It is common for patients with bone disease to supplement with 1500mg calcium and 800 IU vitamin D daily (from Nutrition Issues in Gastroenterology, Series #18, June 2004), but it is important to check with your healthcare team before starting on any vitamin/mineral supplements.
Q: What is the role of sugar in your diet? Should patients try to limit sugar intake?
A: It is recommended to limit sugary drinks and “added” sugars from your daily regimen. Read the labels of your favorite foods and beverages: cereals, coffee, juices, jams/jellies, cookies. Look for 100% fruit juices or basic cereals that you can sweeten by adding real fruit to them. Be aware of high fructose corn syrup in many products on the shelves. Real fruit is not part of the “added” sugar category; in fact try to use real fruit to sweeten anything that may need a little flavor. You will get a bigger nutrient punch that way. Gastrectomy patients need to be very careful of simple sugars and even fruit juices. Sugars and/or sweet beverages can contribute to dumping syndrome which results in diarrhea after eating.
Q: Do you have any tips to minimize anxiety while eating. Often times I get anxious when I eat, do you have any tips to better manage this?
A: First, you should really explore why you are anxious. Scared of eating the “wrong” thing? Wondering if you will get sick or have pain? The key is to relax! Sit down, take some deep breaths. Soak in the smells and sights – wherever you are. Then, pick up your fork and eat slowly! Don’t forget to breathe. Change the ambiance of a room by dimming the lights or open the blinds; light a candle; turn on some music; plan to eat with a friend. But more importantly, try to find out WHY you get anxious.
Q: They say you should eat 5-9 serving of fruits and vegetables a day. How do you do that while only being able to eat small meals?
A: It can be done eventually, even after a gastrectomy. A typical serving is: ½ cup chopped vegetables, or 1 cup leafy greens, 1 medium potato (size of a computer mouse), 6 oz fruit or vegetable juice, ½ cup cut up fruit, 1 medium apple (size of a baseball), ½ grapefruit, ¼ cup dried fruit. One easy way of sneaking fruits and vegetables into your day is to put them in smoothies or soups and make them drinkable. The volume of food throughout your day will also depend on how many servings are realistic for you. They can certainly add up though, with 5-6 small meals.