Total Gastrectomy

No Stomach Nutrition: Keep A Healthy Microbiome After Total Gastrectomy

If you have no stomach, nutrition is compromised, right? Gastrectomy patients often worry about diet and nutrition following removal of a portion of – or the entire stomach – due to cancer or other disease process, as well as an obesity surgical procedure.

After all, your stomach is an important organ that hosts an environment designed to perform certain nutritional functions necessary for life itself. If you have no stomach, it stands to reason that your body can no longer get the nutrients it needs to function, or so some think.

Not so fast. The stomach is just one part of your gut. So long as the remainder of your gut remains healthy, you should be fine with no stomach.

With No Stomach, Nutrition Does Not Need To Suffer 

Importance of nutrition for gastrectomy patients

Your gut health is important to overall health and wellness. According to John Hopkins University, a major proportion of the immune system’s ability to function at optimal levels is found in the gut microbiome. At the end of this article, we provide you a few tips to help your microbiome flourish.

no-stomach-nutrition
no-stomach-nutrition

What is a microbiome? 

A microbiome is as an internal environment of microorganisms that promote the ability of an organ system – like the GI tract – to function properly. In other words, a microbiome is a community of sorts within which a number of microorganisms share a body space. Each of those microorganisms within the microbiome has a specific job to perform. 

What kinds of microorganisms? In the gut, a vast number of microscopic organisms thrive and work together; bacteria, fungi, and viruses. Each serves a precise purposes when it comes to digestion and nutritional needs of the body.

Such microbiomes as those found in the digestive system are vital for maintaining our internal ‘ecosystem’ and play a role in transforming food into micronutrients that are then absorbed by the body for energy.

Trillions of such organisms maintain optimal gut health. So what happens when a person has a total stomach removal? What happens to that microbial environment? If all those microorganisms that live in the stomach are gone, how does that affect nutritional needs of the body?

A gastrectomy doesn’t mean an end to foods you love

Even with a portion of or the entire stomach removed, you still have the ability to ‘feed’ your body. How? It’s all about the microbiome. The gut’s microbiome continues to function appropriately in the GI tract (primarily in the small intestine), minus the stomach, as it ordinarily would, with a few exceptions.

Most people who have not experienced stomach surgery believe that diet and lifestyle will be seriously compromised afterward. After all, how can the body be ‘fed’ without a stomach? 

Read about foods to eat after your total gastrectomy

Even after a portion of or the entire stomach is removed, a person is eventually able to digest most liquids and foods. Some changes to diet may be recommended for optimal nutritional needs, but keep in mind that the stomach is merely an organ that temporarily holds food. 

Gastrectomy, in its simplest terms, defines the removal of a part or all of the stomach. The primary reason for such a drastic surgical procedure is treatment for stomach cancer or life-threatening obesity. Four primary types of gastrectomy include:

  • Total – the entire stomach is removed. In this case, the base of the esophagus is connected directly to the small intestine.
  • Partial – the lower portion of the stomach is removed.
  • Sleeve – The left portion of the stomach is removed.
  • Esophagogastrectomy – the lower portion of the esophagus and the upper part of the stomach is removed.
no-stomach-nutrition
no-stomach-nutrition

Without a stomach, how does food digest?

Actually, not much nutritional absorption actually occurs in the stomach. The duodenum (the upper portion of the small intestine that normally connects to the base of the stomach) releases hormones that encourage glands in the small intestine to secrete gastric ‘juices’. These juices promote actions needed for digestion and absorption of nutrients from food. They also aid in maintaining intestinal microbiome balances.

While the stomach starts the process of protein and carbohydrate breakdown, the small intestine is the heavy hitter in this action. Actually, it is in the small intestine where most of the water and virtually all nutrients are absorbed into the body.

Enzymes responsible for digestion don’t rely as heavily on the stomach as they do the pancreas and the liver for them. Damage to those organs, not the stomach, are the primary culprits of a body’s reduced ability to digest food and absorb nutrients.

Chemical breakdown of protein begins in the stomach. There, food is converted into a paste-like substance called chyme. Stomach secretions create a highly acidic environment in the organ, which triggers secretions of pepsin, a protein-digesting enzyme, as well as intrinsic factor and other fat-digesting enzymes. 

In addition to breaking down protein, pepsin also breaks down plant foods and destroys many bacteria ingested with food. 

no-stomach-nutrition
no-stomach-nutrition

Because a stomachless person no longer has a stomach to start the breakdown of food (chyme), a person without a stomach must consume smaller portions of food at a time to allow the upper portion of the small intestine to ‘catch up’ with the enzymatic breakdown of food. Without a stomach, you must also be more careful about ingesting harmful bacteria because the stomach is no longer there to serve that function.

Intrinsic factor, a protein produced by the stomach, is an important glycoprotein required by the body for absorption of vitamin B12 in the small intestine. In turn, vitamin B12 is necessary for the production of erythrocytes, more commonly known as red blood cells. Without a stomach, you will need to take vitamin B12 injections or orally dissolvable tablets.

What about microbiome and other nutritional imbalances?

The potential of microbiome imbalance (known as dysbiosis in medical terms) varies among patients following total or partial stomach removal. Even if you no longer have a stomach, you have options for improving gut microbiome levels and function, important for overall health.  

Patients undergoing cancer treatments involving partial or total gastrectomy may experience interruption of normal gastric acid production. Plus, without a stomach, your body will not absorb sufficient amounts of vitamin B12. In the absence of vitamin B12, chronic anemia can occur. Also, eating enough calories in a day can be challenging.

Hence, one of the primary challenges for a gastrectomy patient is getting enough nutritional value out of foods to maintain or gain weight. Inadequate nutrition can lead to loss of muscle mass.

So what can you do about that?

no-stomach-nutrition
no-stomach-nutrition

If ‘no stomach, nutrition suffers’ is not a given – what you can do to optimize gut health

Even with no stomach, nutrition substitutes such as vitamin B12 injections fill the void. Few digestive problems (with proper nutritional intake) occur for those who have undergone a total gastrectomy – although every individual case is different.

No stomach simply means no ‘holding tank’ for consumed foods. A person with no stomach must eat smaller portions of food throughout the day not only to maintain adequate caloric intake but also avoiding ‘over-filling’ the small intestine with too much food at once. The smaller portions allow the small intestine to break down and digest food more efficiently.

Not every gastrectomy patient experiences the same challenges with food. Some can’t process sugar while some can. Some may be able to consume dairy products while others become lactose intolerant. For many, it’s a matter for trial and error, but before too long, your body will adapt to your re-routed gut.

Optimize your health and wellness through optimal nutrition.

Other influences on your microbiome

In addition to ‘losing’ part of or the entire stomach, other influences on your gut microbiome and processes adapt based on age, stress levels, diet and overall health condition. Components of the gut microbiome (such as peptides, proteins, enzymes, and metabolites) are released locally (in the gut) and other sites of the body and have an influence on homeostasis – the state of equilibrium between body organs and systems necessary for survival.

Failure to achieve this balance through proper nutritional intake can have a negative effect on gastrectomy patient that may contribute to irritable bowel syndrome (IBS) or disease (IBD), diabetes, and other disorders.

Tips to help your microbiome flourish

Keep your gut healthy by consuming foods that promote the microbiome – even if you have no stomach. Talk to your doctor about your situation, your current gut health, and strategies that will increase or enhance your microbiome environment.

  • Probiotics: Some food benefits for microbiome optimization include probiotics, but stick to those that deliver 20 to 50 billion live organisms per dose. The probiotic of choice should also contain Lactobacillus and Bifidobacterium for best results. Bifidobacterium make up the portion of gut microbiota.
no-stomach-nutrition
no-stomach-nutrition
  • Enhance probiotic benefits by going ‘pre-probiotic’ with fermented foods (if tolerated) like sauerkraut, pickled vegetables, kimchi and kombucha.
no-stomach-nutrition
no-stomach-nutrition
  • Consume adequate amounts of plant fibers such as those found in artichokes, beans, oats, asparagus, and garlic.
no-stomach-nutrition
no-stomach-nutrition
  • Eat your greens! Green plant-based vegetables promote microbial variety into your diet. Fresh produce increases fiber content and gives your GI tract something from which to break down, digest, and then extract vital nutrients. These nutrients are absorbed in the small intestine to nourish your body. If you’re not big on eating your veggies, opt for ‘green’ smoothies.
no-stomach-nutrition
no-stomach-nutrition

Post-surgical gastrectomy side effects such as diabetes and/or metabolic syndrome occurred in low numbers of cancer patients, according to a 2019 study. The study suggests that a rich and diverse microbiome can be restored – and thrive – post-gastrectomy. This goes along with a diet rich in polysaccharides and lower in fat.

Conclusion

The importance of nutrition following a gastrectomy cannot be ignored. Even with no stomach, nutrition is not only beneficial but vital to long-term health and wellness. Just because you lose your stomach doesn’t mean you lose your gut microbiome. With a little TLC and some adaption to diet and nutritional intake, you can live an otherwise perfectly healthy, active life.

With No Stomach, Nutrition Does Not Need To Suffer

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Denise Stern

Denise Stern is a freelance writer specializing in medical/health content development. With a degree in Health Information Management and AHIMA member, she works with healthcare professionals and brands through her Colorado-based Gemini Writing Services business.

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