Fortifying food

After surgery, dieticians recommend fortifying food by adding calories to smaller portions.

The main recommendation is to use dairy products as they pack a punch when it comes to energy from fat and protein, as well as vital minerals such as calcium and iron. Some people develop temporary lactose intolerance after oesophagectomy so dairy is out. Instead, coconut or olive oil could be used to add calories but care should be taken as too much fat can cause dumping syndrome.

I was lucky as I could eat dairy with no issues but had to go easy drinking milk to avoid an upset stomach. When I first came home I added grated cheese or butter to pureed veg, mash potato and soups. Cream is also good but I found it frequently caused me problems so even though I love cream – I give it a wide berth even now.

Marvel ingredients

Another recommended method which for me resulted in some weight gain (albeit only a pound or two) was the addition of a few spoonfuls of powdered skimmed milk (Marvel) to full fat milk. This can boost the calorific value by another third and it does not change the taste.  I had this on cereal, in tea and sometimes drank it straight in small quantities. Most supermarkets stock Marvel.

You could also mix protein powder as used by body builders into foods. Marvel has vitamins A and D and although some protein powder contain vitamins, often they contain sugar.

Homemade smoothies

Homemade smoothies are an easily way to eat fruit and vegetables that can not be eaten with meals. They can be prepared using a Nutribullet or smoothie maker or even handheld blender. You should however proceed with caution with smoothies as if they are too sweet or taken in too quickly, they may move through your intestines too fast. It is best to not overload your smoothie with fruit, especially the very sweet tropical varieties like bananas and mangoes. Keeping it to the size of a small glass like the one shown (300 ml) is also a decent volume.  So far, I have not had any problems with the following recipe, a handful of one or two types of berries (eg strawberries, raspberries and blueberries), a handful of baby spinach or kale and an avocado blended with some yoghurt/kefir. You can also add a handful of nuts or a spoonful of Marvel to add calories.

Ready Brek

Another great fortified food is Ready Brek. Before this year, I had not given Ready Brek a second thought since primary school. However it has all the goodness of porridge plus all the B vitamins, calcium and iron and is easy to make and more importantly, easy to get down. I had been having Ready Brek most mornings since my op and I do not take any supplements and my bloods are good for iron and B12. I usually stick to the recommended 30g portion. This can be weighed out and then milk added then in the microwave for 1.5 mins. If I am feeling lazy I buy the sachets.

I usually stick to 30g as more than that causes me to have a few dumping symptoms, like palpitations and being over full. Please note Ready Brek is a fine powder so will get broken down and absorbed quicker than rolled oats. However normal oats lack the fortified vitamins so in the short-medium term it is a good staple.

Sugary stuff, Complan and the abhorrent Fortisip drinks

Prior to being ill, I mostly avoided sugar but to bulk up before surgery, I slipped off the sugar wagon and had Complan, home made trifle and chocolate. After surgery, all of these gave me dumping syndrome so I have avoided them since.

I tried one Fortisip drink before surgery and thought it was truely hideous. If you can stomach them (I could not) they are the equivalent to whole meals so can sustain you. However I do not know why they make them so sweet and with so much sugar so they cause fewer issues in patients who have had gastric surgery and have issues with sugar.

I now eat the odd cake but they have to dense and not have fillings (like jam or cream) or toppings (like buttercream or icing). Scones and dense cakes like banana loaf do not seem to affect me aslong as I do not have too much and I eat them slowly.

I usually have a Nine Pumpkin and Sunflower bar in my bag and can eat them with a latte or cup of tea. They contain 220 calories per bar and are full of nuts and seeds as well as being a great source of magnesium. Flapjacks and granola bars are also really nutritious, however I would not recommend you eat these until at least 8 weeks post-op as they are quite lumpy and when you do, you must chew them many times before swallowing.

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