Esophagectomy Nutrition Guidelines

Your esophagus is the tube that connects your throat to your stomach. Food enters your stomach through your esophagus. An esophagectomy is a surgery that removes part or all of this tube. Your stomach is often pulled up so there is no longer a long distance for your food to travel after you swallow. This makes it difficult to eat a lot of food a one time. After an esophagectomy you need to change what and how you eat so you can be as healthy as possible.

How should I eat after my surgery?     

Here are ten guidelines to help you maximize your nutrition and adjust to a new eating style.

Chew all food really well.

  • Remember that digestion begins in the mouth. The smaller the food particles, the easier they will go down.
  • If it feels as if food is still getting stuck, sip water or another liquid with meals to encourage food to go down.

Avoid foods that tend to be difficult to swallow.

  • Soft breads and rolls have a tendency to get stuck.
  • Tough, more fibrous meats such as steak should be avoided.
  • Take note of specific foods that bother you. The foods that are problematic are not the same for everyone.

Choose soft foods with a sauce, gravy, or other liquid.

  • Soups and stews are typically a good choice as long as meats are soft and cut into small pieces.
  • Ground meats and soft protein choices such as eggs or cheese are also good options.
  • Macaroni and cheese or other pasta dishes with a mild sauce are often well tolerated.

Eat small, frequent meals 5 or 6 times per day.

  •  After surgery, your stomach can hold much less food than before.
  • Smaller meals will minimize discomfort and reduce risk for heartburn or reflux.

Introduce foods slowly.

  • Some foods that were well tolerated before surgery may not be well tolerated now.
  • If a food is not well tolerated, wait 1-2 weeks and try it again.

Drink at least six (8 ounce) cups of fluids per day.

  • Sip fluids with meals and drink fluids in between meals to make sure that you stay properly hydrated.
  • Be careful not to drink too many fluids. If you are feeling too full to eat meals, decrease fluid intake.

Stop eating when you begin to feel full.

  • Overeating will lead to discomfort from heartburn or reflux.
  • It is ideal to stop eating after a small amount of food, and eat again 1-2 hours later.

Eat to avoid reflux or heartburn.

  • Wear loose clothing that is not tight fitting around your midsection.
  • Limit caffeine intake. Too much coffee, tea, and soda containing caffeine may trigger heartburn.
  • Avoid chocolate, mint, vinegar, and hot peppers.
  • Creamy, higher fat foods made with cream or whole milk may trigger reflux.
  • Citrus fruits/juices (orange, grapefruit, tangerine) and other highly acidic foods like tomatoes and tomato sauces may lead to heartburn.
  • Salty or extremely hot or cold foods may trigger heartburn.
  • Avoid alcohol.
  • Do not lie down after eating.Wait at least 3 hours before going to bed after eating.

Limit gas forming foods and behaviors.

  • Gas forming foods include: broccoli, cauliflower, brussel sprouts, cabbage, corn, turnips, onions, peas, garlic, cantaloupe, watermelon, apples, avocado, beans, lentils, and nuts.
  • Eliminate activities that involve swallowing extra air such as sucking on ice or candy, chewing gum, and drinking through a straw. Do not drink carbonated beverages.

Be aware of symptoms for dumping syndrome.

  • Dumping syndrome is a condition where food that is not fully digested “dumps” quickly into the small intestine from the stomach.
  • Dumping syndrome is accompanied by nausea, cramping, fullness, and diarrhea about 15 minutes after eating.
  • You may experience a low blood sugar 1-2 hours after a meal. Weakness, sweating, hunger, shaking, and lightheadedness are all symptoms of a low blood sugar.
  • If you have symptoms of dumping syndrome, it is best to consult a registered dietitian for the most individualized recommendations.
  • To prevent dumping syndrome:
  • Drink only unsweetened liquids limited to ½ cup before or after meals
  • Eat small and frequent meals.
  • Avoid extremely hot or cold foods
  • Relax and eat slowly.
  • Eat lean, high protein foods with a small amount of added fat
  • Avoid foods high in sugar
  • Avoid foods that have a natural laxative effect such as caffeine, prunes, licorice, figs and sugar alcohols.
  • Lying down for 20-30 minutes after eating may ease the symptoms of dumping syndrome.  Laying down does conflict with the recommendations for acid reflux.  Use your best judgment as to which guidelines to follow based on your symptoms.
  • You may develop lactose intolerance associated with dumping syndrome.  Avoiding dairy products (milk, cheese, ice cream, and yogurt) may ease gas, pain, bloating, or diarrhea as a result of not being able to digest lactose.
  • Due to malabsorption of nutrients your surgeon may recommend a multivitamin or other nutrition supplement. It is best to consult with a registered dietitian for the most appropriate supplement recommendations

Which foods should I eat and which foods should I avoid after an esophagectomy?

Breads

  • Choose pancakes, waffles, French toast, crackers, toasted breads.
  • Avoid breads with nuts, seeds, coconut or dried fruits. Avoid highly seasoned crackers or breads (garlic, onion, etc.) Avoid sweet rolls, coffee cakes, and doughnuts.

Cereals

  • Choose softer, easy-to-chew cereals, oatmeal, or cream of wheat.
  • Avoid hard, coarse cereals. Avoid high fiber cereals such as bran, barley, or granola. Avoid cereals with dried fruit, nuts, or coconut.

Desserts

  • Choose cakes, pies, and cookies without nuts or chocolate. Try puddings, custard, ice cream, frozen yogurt, or sherbet.
  • Avoid desserts made with chocolate, nuts, dried fruit, coconut, peppermint, or spearmint.

 Drinks

  • Choose water, caffeine-free tea, caffeine-free coffee, and milk. Choosen one-citrus juices such as apple, grape, and cranberry.
  • Avoid carbonated drinks, alcoholic beverages, caffeinated drinks, or citrus juices such as orange, grapefruit, lemonade, or limeade.

Eggs

  • Choose any type of eggs as long as they are not fried or heavily seasoned.
  • Avoid deviled eggs and heavily seasoned egg salad.

Fats

  • Choose butter or trans-fat free tub margarine, mayonnaise, mild salad dressings, olive or canola oil, or plain cream cheese.
  • Avoid highly seasoned salad dressings, cream sauces, gravies, bacon, bacon fat, ham fat, salt pork, lard, nuts, and fried foods.

Fruits

  • Choose canned fruit, cooked fruit, and non-citrus fruit juices.
  • Avoid fresh fruits, dried fruits, ripe bananas, and fruits with seeds including berries and figs. Avoid citrus fruits and citrus fruit juices.

Meats, Fish, Poultry, Cheese, and other protein

  • Choose finely ground meats including beef, chicken, turkey, fish or lamb. Choose ricotta or cottage cheese, or mild cheeses such as Swiss, mozzarella, or American. Try creamy peanut butter. Try plain yogurt without seeds.
  • Avoid tough meats with hard fat. Avoid fried, heavily seasoned, or smoked meats including hot dogs, sausages, bacon, ribs, and lunch meats. Avoid anchovies, sardines, duck, goose, and shell fish such as clams and shrimp. Avoid strong, sharp, and hot pepper cheeses. Avoid chili and spicy Mexican food. Avoid crunchy peanut butter.

Starches

  • Choose regular or sweet potatoes (peeled with no skins). Choose white rice, barley, and pasta.
  • Avoid fried potatoes, potato skins, and potato chips. Avoid fried rice, brown rice, and wild rice. Avoid popcorn.

Soups

  • Choose mild soups and low-fat cream soups.
  • Avoid heavily seasoned and tomato-based soups.

Sweets (If you have symptoms of dumping syndrome, avoid sweets entirely)

  • Choose sugar, syrup, honey, jelly, seedless jam, and molasses. Try hard candy without fillings, nuts, or seeds.
  • Avoid preserves, marmalade, and jams with seeds. Avoid marshmallows and any candy with nuts, seeds, dried fruit, coconut, peppermint, or spearmint.

Vegetables

  • Choose cooked vegetables without seeds or skins including asparagus, peas, carrots, chopped spinach, beans, and winter squash.
  • Avoid raw vegetables. Avoid tomato and vegetable juices. Avoid tomatoes and tomato sauces. Avoid broccoli, brussel sprouts, cabbage, cauliflower, corn, cucumbers, onions, green pepper, radishes, rutabaga, turnips, beans and lentils because all these foods can cause gas.

Spices and Condiments

  • Choose mild spices, herbs, and condiments as tolerated.
  • Avoid heavy spices, chili sauce, barbeque sauce, horseradish, pepper, chili powder, onion, and garlic.

For more help choosing soft foods, use the Soft Foods Chart.