Our stomach fulfills numerous tasks.

It is a stretchable muscle tube with a capacity of around 2.5 liters for adults. By stretching it, the feeling of satiety is created. First, it stores the food and then gradually releases it to the small intestine. The stomach acid (contains hydrochloric acid) can kill bacteria. It forms a factor (intrinsic factor) that enables vitamin B12 to be absorbed from food. Hydrochloric acid from the stomach also makes iron more readily available to our bodies. It also produces a hormone that makes you feel hungry.

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Why is nutritional therapy essential for stomach removal?

After an operation, various mechanisms are disturbed or no longer present, depending on the extent of the operation (partial or full removal (gastrectomy). Nutritional therapy supports you in reducing your symptoms overall and thereby having a positive effect on your health Supervision of a certified nutritionist can thus lead to your long-term success. The diet is adapted to your current weight & jointly defined goals for your future weight. The goal is all fatty acids, micronutrients (vitamins and minerals), energy and protein in the measure so that your body is optimally supplied. For this purpose, anti-inflammatory foods are specifically avoided and plenty of anti-inflammatory foods are consumed.

Goals:

1. Constant increase in diet after the operation up to full-fledged permanent nutrition

2. Improvement of your nutritional status: albumin level, immune status, (your albumin level should not be below 3 in your blood count)

3. fewer complaints & complications

4. Food selection for lactose intolerance

5. Cooking and kitchen information

6. Aids and food selection for diarrhea, dumping syndrome

7. Counteract malnutrition

8. Pancreatic enzymes and MCT fat can help with symptoms such as diarrhea, unwanted weight loss, fat in the stool (= steatorrhea). Please only use this after receiving qualified advice, as there are important things to consider and both products do not have to be used in parallel at the beginning.

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The reduced (= partial resection (e.g. sleeve or stomach reduction)

or completely distant stomach (= gastrectomy)

Stomach reductions / removal of the stomach lead to a feeling of fullness too quickly, which can lead to the fact that you can only eat smaller portions or that you cannot finish your portion completely. This carries the risk of losing too much weight. It is therefore important that you supply your body with enough energy. Many patients hardly ever feel hungry, which also results in less food consumption. One way around this problem is to keep a strict meal intake by the clock. Your daily energy requirement is much higher than before the operation, but this is precisely calculated during the consultation by including your height, current weight and other factors that influence the energy requirement (exercise - calorie consumption, energy consumption for other activities). It is also important for you that you get enough protein. The protein requirement as well as the coverage of the requirement according to your individual situation is an important part of nutritional therapy.

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Common hazards / complications after gastric surgery

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1. Agastric dystrophy, unwanted weight loss due to a lack of hunger and satiety

2. Malnutrition (lack of energy - falling weight and / or lack of protein (muscle breakdown, note an albumin value of at least 3 (see blood count)

3. Underweight, unwanted weight loss

4. Lack of vitamins and minerals

5. low reservoir function

6. Dumping syndrome (early and late dumping) -> symptoms of diarrhea

7. Shortened food path / contact time -> risk of diarrhea

8. Further effects on digestion: e.g. Grehlin hunger hormone is less / no longer available -> lack of feeling of hunger -> fewer meals or smaller portions -> unwanted weight loss

9. possibly a lactose intolerance can develop

10. Danger of germ colonization (stomach acid and therefore no hydrochloric acid) -> pay attention to hygiene when preparing and storing food and meals.

11. Blind loop syndrome (after a Billroth 2 operation) Mash can get into the feeding loop and there is a risk of inflammation

12. Insufficient stimulation of the enteric hormones -> poorer utilization of food -> unwanted weight loss

13. Fat in the stool - steatorrhea -> shows poor utilization of the food components

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Vitamin B12 : This vitamin can no longer be absorbed after the stomach has been removed - an injection (at least every three months or even weekly (very tall people) is necessary.

Iron : The absorption of iron from food is improved by stomach acid. If this is missing, a deficiency can arise.

Vitamin D and calcium : the administration of a combination preparation optimizes the supply.   

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Dumping syndrome

Dumping syndrome is a common complication after gastric surgery.

Literally translated means “to dump” = “to fall”.

This syndrome can be divided into two phases:

Early dumping:

starts approx. 15-20 min  after eating and manifests itself in the form of a feeling of fullness, abdominal cramps, nausea, vomiting or diarrhea. These symptoms may go away after a few months.

Late dumping:

starts approx. 1-1.5 hours after the meal. Signs are sweating, nausea, restlessness,  Tremors and or cravings.

It occurs less often than early dumping and the symptoms subside relatively quickly.

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I would be happy to explain to you in the consultation how you can avoid the dumping syndrome and how you can counteract it from a dietary point of view.

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Classification of your weight - definition and classification of weight in relation to height.

Special percentile curves apply to children and adolescents; the BMI cannot simply be used here.

BMI and interpretation: BMI: body mass index

Formula: Body weight in kg : (body height in m) 2 (results in the unit kg / m2)

Normal weight: 18.5 - 24.9

Overweight = pre-obesity: 25-29.9

Obesity grade I: 30 - 34.9

Obesity grade II: 35-39.9

Obesity grade III:> 40 = per magna

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Underweight: <18.5

BMI 17 - 18.5 slightly underweight

BMI 16 - 17 moderately underweight

BMI <16 severely underweight (grade 1 and 2)

BMI 15 - 16 severely underweight

BMI <15 extremely underweight

Blood count:

It is advisable to have your Omega 3 index checked regularly.

This provides information about the supply of valuable omega 3 fatty acids (alpha-linolenic acid, eicosapentaenoic acid and docosahexaenoic acid), which can significantly counteract inflammatory processes in the body.

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Nutritional therapy

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• Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?

• Energy-appropriate & protein-based wholesome nutrition, calculate your needs

• an energy-enriched / or protein-enriched diet may be useful for you.

• Energy & protein to enrich your meals can be obtained through natural foods or supplements, I would be happy to advise you on this. There are also nutritional supplements that your doctor can prescribe for you if you are severely underweight.

• Avoid micronutrient deficiencies and mineral deficiencies & possibly counteract them with nutrient preparations

• Prevent protein deficiency

• anti-inflammatory diets for disease prevention

• Prevent malnutrition, keep an eye on weight, check weekly

• Which nutrients do I need in which ratio?

• Take in sufficient fiber (> 30 g / day would be desirable, possibly fiber supplements / natural fiber sources can be used for enrichment.

• Sufficient fluid: total fluid per day: 30 - 35 ml per kg body weight and day. Attention, this is not just a drinking liquid. The liquid from food (approx. 500 - 800 ml) must still be subtracted from this, so that an amount of approx. 1.3 - 2 l of drinking liquid is created.

• Counteract fat in stool (steatorrhea)

• A selection of foods tailored to your needs with cooking and technical information (for breakfast, snacks, lunch, dinner)

• Do you like to eat your warm meal in the evening? I am happy to cater to your individual situation and we will create a plan on how you can implement your wholesome diet into your everyday life.

• which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?

• How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?

• Get enough Omgea-3 fatty acids and essential fatty acids

• Coordinate sensible meal frequency for your individual case - meal allocation

• Define the desired weight stabilization / normalization & the estimated period for this

• what should be considered with beverages and alcoholic beverages?

• How does exercise affect your body and thus also your diet?

• Avoid blood sugar fluctuations

• Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?

• what should be considered when baking and cooking?

• what are cheap snacks / main meals

• Eating out - what should you watch out for?

• Vacation, boat trip or hospital stay, what should be considered?

• Complications / side effects (e.g. fat in stool, unwanted weight loss, bloating, etc.) what can I do about it?

• Daily plans as an example for practical implementation in everyday life

• Enjoyment training

• Optimizing your eating situation

• How can I boost and support my metabolism with natural foods?

• long-term maintenance of a jointly defined weight

• Adjusting the consistency (soft food, mashed food) may be useful or necessary

• Additional therapy options

• Food supplements - under certain circumstances, a supplement can be useful

• and other topics

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Other digestive effects

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Less hydrochloric acid

A smaller stomach no longer produces as much hydrochloric acid, which is why you should pay particular attention to the hygienic preparation of the food. Enjoy raw materials such as salami, raw milk cheese, tartare or sushi with caution. These foods are raw and therefore less suitable for you.

Reduced storage volume

As a result of the operation, the stomach was made smaller and can no longer store so much food. The food leaves your stomach faster and thus reaches the small intestine more quickly. I therefore recommend that you lie down shortly after eating in order to prevent the food from passing through too quickly.

Decreased food utilization

I also recommend that you eat a small slice of mixed bread or a cup of high-fat meat broth at lunchtime about 15 minutes before the main course, so that your enzymes are stimulated to digest the food, as food utilization is often poorer after gastric operations. In view of this aspect, too, a sufficient supply of energy is essential.

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Any questions? I look forward to your call or email. To contact form

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Assistance:

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• Gastro league

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