Living with gastrointestinal stromal tumors (GIST) presents unique nutritional challenges. GIST often necessitates surgical removal of tumors and medication, both of which can hinder the body's ability to absorb essential nutrients from food. Implementing specific dietary strategies is crucial for maintaining proper nourishment and overall health.
How Surgery Impacts Digestion
Surgery is a primary treatment for gastrointestinal stromal tumors (GISTs) that haven't spread. These surgeries sometimes involve removing all or part of the stomach or portions of other organs, such as the intestine. Because these organs work together to digest food and absorb nutrients, surgery impacts your body’s ability to do so. After surgery, patients may experience a sensation of fullness more quickly due to the reduced size of digestive organs.
Dumping Syndrome
Surgery may also include the removal of the valve that controls how quickly food moves from your stomach to your intestines. As a result, your body may process the food you eat too fast to absorb nutrients well. The removal of this valve, which regulates the movement of food from the stomach to the intestines, can lead to a condition called "dumping syndrome." This condition arises when food passes too rapidly into the small intestine, causing symptoms such as:
- Bloating
- Nausea
- Diarrhea
- Rapid heartbeat
- Dizziness
- Weakness and fatigue
- Sweating
- Belly cramps
Dumping syndrome is common among GIST surgery patients and can happen between 15-30 minutes and 2-3 hours after you eat. Modifying eating habits and dietary choices can significantly reduce or eliminate these symptoms.
Establishing New Eating and Drinking Habits After Surgery
Post-surgery, adapting eating habits is essential for managing digestive changes and ensuring adequate nutrition.
Read also: The Hoxsey Diet
Smaller, More Frequent Meals
Since the stomach's capacity is reduced after surgery, consuming six or more small meals throughout the day is preferable to three large meals. This approach ensures a consistent intake of nutrients. It is possible that you will be able to eat bigger portions and eat less often as you recover. However, everyone is different, and you may need to keep eating smaller, more frequent meals. Chew your food well, eat slowly, and relax. This will make it easier to digest your food and help you to stop eating before you get too full. Sit upright as you eat.
If managing fullness is a problem, avoid foods that can cause gas, like broccoli, cauliflower, cabbage, onions, Brussels sprouts, and beans.
Liquid Consumption Guidelines
Drink most of your liquids at least an hour before and after meals. This helps keep you from getting too full. Limit yourself to half a cup of water with meals. This will keep food from moving too quickly into your intestine. If your mouth feels dry or you’re coughing, it’s OK to take extra sips of water. Remember that soup and protein shakes are liquids, too. Try to drink eight to 10 glasses of liquid every day. If carbonated (fizzy) drinks make you feel too full, avoid them.
Keeping a Food Diary
Keep track of what you eat and drink, along with your symptoms. Keeping a log will help you figure out which foods and portion sizes are easiest for you to digest. If you realize you’re losing weight without meaning to, tell your doctor.
Food Choices: What to Include and Limit
Individual reactions to foods can vary, but some general guidelines can help in making informed dietary choices:
Read also: Walnut Keto Guide
Foods to Choose:
- Protein: Consume protein at every meal. Eggs, meat, poultry, fish, nuts, milk, yogurt, dried beans, lentils, tofu, and nut butters contain protein.
- Fiber: Incorporate high-fiber foods frequently. These include whole-wheat bread and pasta, vegetables, fruits, oatmeal, bran, whole grains, and cereal that has fiber added.
- Fresh and Frozen Vegetables and Unsweetened Vegetable Juice
- Fresh and Frozen Fruit
- Dairy: Milk, fortified unflavored soy milk, cream soups, pudding with artificial sweetener, cottage cheese, and other cheeses
- Beverages: Water, beverages that are either sugar-free or artificially sweetened, and tea and coffee without sugar
- Unsweetened Condiments: Soy sauce, lemon juice, vinegar, salsa, salad dressings, and other condiments that don’t have sugar
- Artificial sweeteners and foods containing them
Foods to Limit or Avoid:
- Foods High in Sugar: Candy, desserts, soda, fruit juices, honey, jellies, 100% fruit juice, sweet baked goods like doughnuts and sweet rolls, chocolate milk, ice cream, cookies, cake, flavored syrups containing sugar for drinks, and alcoholic beverages with sugar. Simple carbohydrates like white sugar should also be avoided.
- Fatty Foods: Avoid these if they cause discomfort.
- Spicy and Peppery Foods: Avoid these soon after your surgery.
Post-surgery, previously tolerated foods may cause adverse reactions. Pain or other symptoms may arise when consuming sugar, fat, or lactose. Over time, tolerance to these foods may improve. Consult with your doctor to determine when and how to reintroduce dairy and other potentially problematic foods.
Essential Vitamins After Surgery
Because the organs that absorb certain vitamins have been removed or made smaller, you may need to eat more food that have these vitamins, take vitamin supplements, or get shots containing these vitamins.
- Vitamin A: Helps support organs like the eyes, kidneys, heart, and lungs
- Vitamin D: Supports the growth of bones and keeps your bones from getting brittle (osteoporosis)
- Vitamin E: Improves your body’s immune system. This is especially important to people with GIST, since your immune system may be weakened, making it easier for you to get sick.
- Vitamin K: Helps support blood clotting and bone health
- Vitamin B12: Supports the creation of red blood cells and brain function. A lack of B12, folate, or iron can cause anemia. Symptoms of anemia include chills, fatigue, numbness in your hands or feet, and dizziness. Foods that have B12 Include lean red meats, poultry, fish, and some fortified cereals.
You may also need to take other vitamin or mineral supplements. Talk with your doctor to figure out a plan that works for your needs.
Probiotics
After surgery, you may find that taking probiotics helps you digest your food better. Probiotics are beneficial bacteria found in foods such as yogurt and in certain supplements. But before taking probiotics, be sure to talk with your doctor, especially just after surgery.
Managing Nutrition While on GIST Medications
Certain medications used in treatment for GIST that help shrink the tumor and make it easier to remove before surgery can also impact your body’s ability to maintain vitamins and minerals. These include imatinib (Gleevec) and sunitinib (Sutent).
Read also: Weight Loss with Low-FODMAP
- Imatinib reduces the body’s levels of calcium and magnesium, which can cause muscle aches and cramps. It can also cause a deficiency of vitamin D and B12.
- Sunitinib can also cause vitamin B12 deficiency.
- Ripretinib (Qinlock), like many other cancer treatments, can cause a drop-off in your appetite. And foods just might not taste right to you.
Dietary Phases After Total Gastrectomy
Following a total gastrectomy, a structured approach to reintroducing foods is recommended, typically divided into two phases. A dietitian will guide you on when to transition between these phases. Focus on the types and quantities of food, and the timing of meals. This is your body’s recovery period. Your body needs foods that are high protein to help you heal and to slow weight loss. Eat often. You need at least 6-8 small meals each day. Remember that you will not feel hungry like you used to, but you need to eat often anyway. Choose high-calorie, high-protein foods and fluids for these meals to meet your nutritional needs. Chew foods completely, into puree form, before swallowing. Avoid foods high in insoluble fiber and gas-producing foods. Avoid foods and drinks with added sugars. Added sugar is different from natural sugar. Avoid sugar alcohols such as sorbitol, mannitol, erythritol and xylitol. They cause gas, bloating and diarrhea. Other artificial sweeteners do not cause dumping syndrome. Natural sugar is sugar that naturally exists in your food. For example, fruit, starchy vegetables, milk and unsweetened yogurts have natural sugar (carbohydrate) that was not added and will not be listed as an ingredient. You may find it helpful to use a food diary or app to record what you are eating and drinking. Record the specific food or drink, the amount, and any symptom you have. Bring your food diary to follow-up appointments after surgery.
Note: Caffeinated fluids can contribute to dehydration.
Once your weight loss slows and you are tolerating phase 1 foods well, you can begin phase 2. You must eat these foods with a protein.
Additional Considerations
The Role of Surgery in GIST Treatment
Surgery is a highly effective treatment option for gastrointestinal stromal tumors (GIST). For more advanced cases where the GIST has spread in or near the gastrointestinal tract, a combination of surgery and chemotherapy may provide the best possible outcomes. The goal of surgery is to remove as much of the tumor as possible. If your tumor is smaller than 2 cm and not causing symptoms, we may observe it to see if it grows or changes before recommending a course of action.
Types of GIST Surgery
The surgical approach chosen for your case is based on the size, location, and severity of the tumor. Here are the primary techniques used for GIST:
- Laparoscopic Surgery: It is a minimally invasive method that removes small tumors through tiny incisions, allowing for quicker recovery times.
- Local Wide Excision: Ideal for small GISTs, this procedure involves removing the tumor along with a small margin of surrounding tissue.
- Partial Gastrectomy: This type of surgery removes a portion of the stomach affected by the tumor.
- Partial Intestine Resection: This type of surgery targets GISTs in the bowel by removing the tumor along with the affected section of the intestine.
- Abdominoperineal Resection: This procedure removes the rectum and anus in cases where tumors are located in these areas.
- Whipple Procedure (Pancreaticoduodenectomy): It is a complex surgery that removes parts of the pancreas, small intestine, stomach, bile duct, and gallbladder, depending on tumor involvement.
Recovery and Follow-Up
Recovery timelines after a GIST surgery can vary depending on factors like the surgery type, tumor location, and your overall health. Most patients begin to feel better within 4-6 weeks, but complete recovery can take several months. Regular check-ups ensure proper healing and monitor for any signs of recurrence or complications.
Addressing Specific Nutritional Concerns
Following surgery for gastrointestinal stromal tumor (GIST), several nutritional concerns may arise.
Digestion and Absorption: The digestive system breaks down different types of food in specific organs, and various nutrients are absorbed in different parts of the GI tract. Understanding which organs were affected by surgery is crucial.
Sugar Intolerance: Different types of sugar (fructose, lactose, etc.) can pose particular problems after gastrectomy. Sugary foods often cause "dumping syndrome" because the normal pyloric mechanism, which controls the rate of sugar release into the intestine, is disrupted. Patients can prevent this by limiting sugary foods and eating smaller, more frequent meals.
Acid Reflux: Coping with acid indigestion and/or acid reflux after gastrectomy can be challenging. The general comments given below is not for everyone. Indigestion has many causes but is not due to excessive acid unless the esophageal sphincter to the stomach is resected (upper gastrectomy or esopahgogastectomy) . In this case drugs of the family of Proton Pump Inhibitors may be used. In other cases small solid meals with complex carbohydrates, avoiding sugars and separating fluids from solids should be considered.
Digestive Enzyme Supplements: Some patients, based on the type of surgery and organs removed, might benefit from digestive enzyme supplements.
Food Intolerance: Patients should identify foods that are easiest to digest after gastrectomy, while avoiding "indigestible" foods that cause discomfort. In patients with a partial gastrectomy, vegetable and fruit fibre may form so called bezoars (balls of undigested plant fiber) in the remnant stomach. Again there is no generalization possible. Many patients ultimately can eat most foods.
Nausea: Strategies to help patients overcome profound nausea after gastrectomy include addressing dumping syndrome sensitivity and slow motility with retention. Each person needs to be investigated to determine if there is retention or not.
Nutrient Monitoring: Regular nutrient monitoring tests should be conducted to detect deficiencies after GI surgery, particularly for iron, Vitamin B12, Vitamin D, and calcium.
Medications: Certain drugs like metoclopramide may be helpful for patients after GI surgery, either as a temporary "jumpstart" or a permanent aid, depending on the specific problem. Slow motility responds to metoclopromide, but this drug may cause neurological symptoms.
tags: #diet #after #GIST #surgery #recommendations