The digestive system is a group of organs that work together to feed the entire body by converting food into energy and basic nutrients. Food is ingested through the mouth; passed through the esophagus into the stomach; and filtered through the small intestine, pancreas and liver. Based on its particular function, each organ contributes in different ways to turn the food we eat into the nutrients we need.
The stomach allows large volumes of food to mix with digestive juices before it moves to the small intestine, which consists of the duodenum, jejunum and ileum. At this point, the process of absorption begins, which contributes to the body’s optimal function and overall good health. The small and large intestines are the body’s largest sources of nutrient storage and absorption. The intestinal walls absorb digested nutrients. Undigested “leftovers,” such as fiber, pass through the colon.
GIST patients who undergo major surgery, including partial or total gastrectomy and resection of the small or large intestines, commonly face issues such as malabsorption and dehydration as a result. Removing portions of the digestive tract can cause deficiencies in the nutrients those organs would normally absorb, as listed below.
- Duodenum: Absorbs Vitamin A, D, E, and K.
- Jejunum: Absorbs protein, carbohydrates, vitamins and minerals.
- Ileum: Passes food to the colon and absorbs Vitamin B12.
- Ileocecal valve (the junction of the small and large intestine): Controls the passage of food and increases production of nutrients and electrolytes.
- Large intestine: Absorbs fluids and electrolytes (such as sodium and potassium).
- Colon: Breaks down dietary fiber and begins development of fatty acids.
It is important for anyone who has had a surgery that modifies any stage of the digestive process to discuss ways to retain these nutrients with their physician. You can use the following information from the National Institutes of Health (NIH) and Medscape to guide your conversation.
Vitamin A is a fat-soluble vitamin used to maintain normal vision and immune system functions. It also supports organs such as the heart, lungs and kidneys. This is highly relevant to GIST patients on long-term medication, as many drugs can lead to dehydration and eventual kidney impairment. Stocking up on Vitamin A will help support the kidneys and prevent toxicity.
Vitamin D is another fat-soluble vitamin used to promote calcium in the gastrointestinal tract, enable bones to grow and strengthen, and prevent osteoporosis.
Vitamin E is a fat-soluble antioxidant that enhances immune functions, prevents cardiovascular disease and protects cognitive abilities. It is particularly valuable for GIST patients, who often have weakened immune systems that can make them more susceptible to other illnesses and co-morbidities.
Foods to promote Vitamins A, D and E include dark leafy greens, almonds, avocados, broccoli, canned tuna and salmon. Water-soluble forms are a viable option if the ileum has been removed.
Vitamin K is often associated with the process of blood clotting and even bone health. Deficiencies may occur if patients have GI disorders, therefore levels should be monitored regularly. There are a number of dietary options for increasing Vitamin K levels to discuss with your doctor. These include dark leafy greens, healthy oils (such as olive and canola), oats, beans and whole wheat. A physician may recommend administering Vitamin K intravenously if medically necessary.
Vitamin B12 supports red blood cell formation, as well as neurological functions. Vitamin B12 is found in red meat, fish and shellfish, egg yolks and cheeses (Swiss, Parmesan, Mozzarella). If necessary, B12 supplements can be taken by injection every one to three months.
Patients who experience acute and chronic side effects from surgery often take probiotics to promote a healthy immune system and optimal digestion. The Mayo Clinic, Probiotic.org and the NIH recommend these probiotic strains to maintain digestive health:
- Lactobacillus acidophilus: Aids in improving bowel regularity. Side effects may include diarrhea and antibiotic-related bowel symptoms.
- Lactobacillus reuteri: Improves the overall wellness of adults, specifically those with gastrointestinal-related infections and illnesses.
- Sachromyces boulardii: Reduces gastrointestinal disorders and symptoms of diarrhea.
- Bifidus bacteria: Enables the body to metabolize sugars and regulate pH levels in the GI tract to ultimately improve digestive functions.
Probiotics should be taken in 5.5–50M units. Since probiotics consist of live bacteria, make sure to obtain them from trusted sources. They should be sealed in blister packs and should not be exposed to heat or moisture.
Again, it’s essential to talk with your doctor before starting any preventative health treatment to avoid unnecessary complications, especially in a post-operative state. Discussing blood work and other evaluation details will give you a better understanding of how your body is changing and the available interventions to help you achieve and maintain good health.