After the stomach is partially or completely removed, intake will be affected by lack of appetite due to changes in hormones secreted by the stomach combined with a significantly reduced capacity due to the smaller, surgically created pouch/stomach. The recommendations reviewed for the pre-surgery patient will continue to be useful here. Although the gastric pouch will expand to some degree over time, smaller, more frequent meals will be always be essential.
Additional concerns include the following:
Lack of stomach acid production leads to increased risk of several deficiencies and of food poisoning.
- Decreased absorption of iron, with risk of anemia. Work with your doctor to monitor the blood levels that measure iron status. Iron is absorbed best from protein sources (heme-iron) such as liver, red meats, poultry and fish. For plant based sources (beans, fortified cereals, tofu, greens, dried fruits and seeds) or iron containing supplements, absorption is improved if taken with a vitamin C source at the same time. Vitamin C containing foods include citrus/juices, tomato/juices, broccoli, cantaloupe, strawberries and spinach. In contrast, iron is poorly absorbed when taken with tea, calcium supplements/antacids and egg yolk.
- Calcium, with risk of osteoporosis. Other risk factors for osteoporosis include significant weight loss, a low BMI, older age, early menopause and family history. If present, bone density tests should be done every two years. It is helpful to avoid smoking, limit both alcohol and sodium/salt in the diet, and increase weight-bearing exercise (like walking). Serum vitamin D levels should be normal and can be checked by your doctor, and supplemented as needed. Total calcium intake from diet and supplements should total 1500 mg a day, supplements should be calcium citrate which can be absorbed without acid in the stomach, and be taken in divided doses of 500 mg/dose, separate from iron rich foods.
- Combined with lack of intrinsic factor from the stomach causes malabsorption of vitamin B 12. Follow blood levels annually and supplement with sublingual B 12 or injections as recommended by your doctor.
- Increased risk of food poisoning due to survival of bacterial contamination of food. See recommendations included in the first blog.