How do I eat after digestive tract surgery?

This is such an EXCELLENT topic! I too am very interested as I worked hard to lower my AIC down out of even prediabetes last year and hopeful I can stay here. I had 1/2 my pancreas removed and it apparently looks good it has enough to work with however my reactions to foods has changed. I did have a consultation with dietician but because my A1C was good, I really got no help and to be fair I wasn't released yet so didn't know how I'd feel. My stomach also collapsed during surgery so had hunger but no capacity for food. I had to force myself to eat to 'reinflate' my stomach. I ate food one food at a time...like a baby and allergies. One food...waited to see how I felt eating it, then another. All whole foods no combined foods. Proteins to start as I needed protein to recover. Almonds did me well...only tried walnuts otherwise and no they did not go down well. So think it is a real individualized thing. You also just have your own preferences. So my advice is slow...what you like...and only one whole food at a time. I have now been approved to join a Diabetes Clinic only due to losing half my pancreas as I am not even pre diabetic anymore. Hoping to get more choices of foods as I am limiting myself mostly to what I've eaten and been ok with. All the best to everyone going through this journey!

Entirely agree, especially with the trial and error. I have migraines, and I've never been able to persist with a trigger diary or app, which is pretty much similar. To make it really work, you need to capture too much data about both the food/beverage intake and symptoms, and even then, you need to move on to trial and error to confirm the statistical results. As annoying as it is and how much time it takes, I found an elimination diet much easier: you start with a handful of whatever foods/drinks you find "safe", and add new foods/drinks one at a time, with at least a couple of days in between each new item.

The virtue of using the FODMAP pattern for me -- aside from determining whether the problem really was FODMAPs -- is that the food pattern came pre-clustered. If you don't cluster somehow but instead do foods entirely one at a time, an elimination diet goes on forever. However, you can create your own clusters to add back in. Start with a week eating only the foods/drinks that you know are "safe", ignoring everything else you care about in your diet -- heck, you can do it with Ensure. Once your system has calmed down, then you can say, hypothetically: "On Monday I'm going to add back in foods with gluten. If I don't react by Thursday or Friday, I'm going to add back in cruciferous vegetables. If I do react by Thursday or Friday, I'm going to have smaller amounts of gluten foods, or just white toast, or whatever, until I nail the gluten food situation down. After that, I'll move on to cruciferous vegetables." (I invented those examples -- you get the drift.)

That way, it's just a day-to-day dialog between your GI tract and specific foods, not something you need to sort out statistically from weeks or months of a diary or an app. Because, ugh.

Hello @roch,

Your summary, "...very individualized with a lot of trial and error. I eventually learn from my mistakes of what I can eat and what I should not" is so true! I appreciate you contributing your experiences.

@hopeful33250
Great topic. I have been treated for ulcers, SIBO, had gallbladder removed and Roux-en-Y gastric bypass (RYGB). Every one of them or the combination has definitely changed by eating habits and food tolerance.

@projfan , gave some great suggestions as bariatric surgery patient that I think can apply to many people with digestive issues.

I have seen a dietitians and they ussually suggest a food diary. Logically it makes sense, but I start and then quickly quit. Many suggest applications on phone, I have not tried any.

I cannot tolerate most dairy. That started after gallbladder, but has gotten worse. A simple ice cream cone or milk in cereal has a negative effect.

If I had to sum it up, it is very individualized with a lot of trial and error. I eventually learn from my mistakes of what I can eat and what I should not.

I'm looking forward to hearing some ideas from other members, @linda82.

I have that same craving for "a little something" and it usually is something sweet. My last surgery was in 2016, and small meals still work best for me, so the time in-between can create cravings that are a challenge.

I do have a habit now that I really need to kick!
Because of small meals and trying to get all the nutrition I can.
I have started having cherry tootsie pops and hard candy. You know it won't fill you up and then then you say to yourself HOW much sugar did I consume today?

I DO NOT like or can tolerate any form of "fake substitute sugar) I have always had hypoglycemia and never had a problem. But, now the craving for "something" that is less feeling is hard.

Any ideas?

I'm now 2 years post resection of the small intestine due to NETs. I did have a dietician to start with, but I found that I could eat what I wanted most of the time. Smaller meals help. Easier to get bloated now. I have had an occasional GI flareup (maybe Carcinoma syndrome or Crisis) if you will, but I never have been able to connect it with anything in my diet. I've learned that recovery from surgery can take a good long time. Only now, after 2 years, do I have consistent 90% normal bowel movements! I have not changed my diet, but my body has finally got things sorted for now.

About a decade. As is typical of this surgery but not for most other GI surgery, there was a fair amount of behavioral prep and post-surgical behavioral support, which was helpful for several years until it pretty much became same-old, same-old. It's actually not that hard for old behaviors to defeat the effectiveness of the surgery over time if you don't truly embed new behaviors, so both the insurance companies and the surgical teams have found it to be good business to target that problem. I have a friend who dealt with that by lying her way through the process and not doing any of the work -- turned out to be a bad idea, but hey, we all get to own our choices.

Hello @projfan,

Thanks for responding about post-bariatric surgery eating. You've provided some very helpful information! It sounds like you worked to solve the new eating plan. How long ago was your surgery?

I've posted before about my eating experience after bariatric surgery, but to sum it up:
-- If you haven't explored the instructions given to bariatric surgery patients for how to eat for the first several months after surgery, you might want to do that just to see if there are any tips you might find useful. A lot of work has gone into building this guidance over the years, so you might as well benefit from those studies.
-- If you can't eat a balanced diet, it isn't the end of the world. Prioritize protein (make your own protein shakes if necessary, which gives you total control, and consider tossing in whole frozen fruit or green vegetables if you can handle them). Consider the key supplements: iron, calcium+D, multivitamin, B12, and B1. (Don't take iron and calcium at the same time, since they fight each other.) Ask your PCP to order blood tests for all of those several months after the surgery, and make sure you keep asking for updates to guide your supplement choices over time.
-- There were many foods that triggered nausea for me during the first year or so, but most of them have become gradually less problematic. If you find you can't eat something, try again with a small amount in six months, a year, etc.
-- Consider going through a FODMAP exclusion diet if you are really having difficulty pinning it down. Importantly, it doesn't actually have to be a FODMAP problem (turned out that it wasn't for me) for the diet to be helpful, because it gives you a systematic way to identify challenging foods. The FODMAP exclusion diet is not for everyone, though, since it's very disciplined and takes a long time to get through.
-- I lost the ability to handle garlic, but shallots are fine and make a reasonable substitute. That problem appears to be permanent, but my ability to handle chilis seems to be returning, although it's taken about a decade. It really helps to explain to the wait staff in restaurants that the issue is NOT an allergy and is just a strong preference, because kitchen staff these days are trained to panic about allergies and my issues won't actually kill me, which is very different.
-- Insurance reimbursement rates for dieticians are so low that it's hard to find them. If you do, make sure that they have experience with patients who have had your specific procedure or are have dealt with your specific symptoms.
-- You may find that smaller meals are better, which means multiple snacks instead of full meals. I now manage meal sizes by when I start sneezing; apparently it's a vagus nerve thing, and I know that if I try to push past it, I'm guaranteed to head to nausea and potentially vomiting. I'm not saying sneezing will happen to you (pretty sure it happens to almost nobody), but you can absolutely watch for the earliest signs that enough is turning into too much, and just rigorously stop there.
-- Don't let yourself get dehydrated, which will make it all worse. Track whether you are better off drinking with meals or between meals, since this might impact your symptoms.

Hope something here helps!