Getting the right nutrition can be challenging when you’re living with advanced gastrointestinal stromal tumors, also known as GIST. GIST usually requires surgeries to remove tumors and certain medications. Both of those can make it difficult for your body to get the nutrition it needs from the food you eat. But there are steps you can take to stay properly nourished and healthy.
How Surgery Impacts Digestion
Gastrointestinal stromal tumors (GISTs) that have not spread are usually removed through surgery. In some cases, this surgery may require the removal of 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 your surgery, you may feel fuller more quickly than you did before. This is because your digestive organs may be smaller and have less space for food.
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. When food moves too quickly from the stomach to the small intestine, it can cause:
- Bloating
- Nausea
- Diarrhea
- Rapid heartbeat
- Dizziness
- Weakness and fatigue
- Sweating
- Belly cramps
This is called “dumping syndrome.” It’s common among GIST surgery patients and can happen between 15-30 minutes and 2-3 hours after you eat.
Changing your eating habits and your diet can cut down on or get rid of symptoms.
Eating and Drinking Habits After Surgery
After surgery, you will likely need to change the way you eat in the following ways:
Smaller meals more often
Your stomach can't hold as much food as it could before surgery, so instead of having three large meals a day, think about having six or more small meals. Spreading your food intake evenly throughout the day will help make sure you get the right amount of food. As you recover, it is possible that you will be able to eat bigger portions and eat less often. But 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 you’re having problems managing fullness, avoid foods that can cause gas, like broccoli, cauliflower, cabbage, onions, Brussels sprouts, and beans.
- Eat your last meal of the day at least 2 hours before you go to bed.
- 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.
Guidelines for drinking liquids
- 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.
Some foods may cause you to have dumping syndrome, while they may not cause it in someone else. Everyone is different, but here are some general guidelines:
Foods to choose
- Protein – Eat protein at every meal. Eggs, meat, poultry, fish, nuts, milk, yogurt, dried beans, lentils, tofu, and nut butters contain protein.
- Fiber – Have high-fiber foods often. 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.
After surgery, you may not be able to have certain kinds of foods or drinks that were no problem before surgery. You might have pain or other bad symptoms when you eat sugar, fat, or lactose (a type of sugar found in dairy products like milk). After a while, you may no longer have problems with these foods. Check with your doctor to see if you can slowly add things like dairy back into your diet in a couple of months.
Vitamins you may need 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.
GIST medications and nutrition
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).
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. If you’re not eating enough, that can mean you don’t get nutrients your body needs.
Talk with your doctor about checking your levels and taking supplements as you need them.
