Less than a year ago, before I had my stomach and esophagus removed, I could swallow a hamburger in 15 minutes. I could also eat a salad AND a steak in 20 minutes. I could drink soup, wine, and coffee within the same one-hour meal. It’s a little harder to do these things now. It’s hard to believe that a stomach can facilitate some of life’s simplest pleasures: being able to eat whatever I wanted, whenever I wanted, and however I wanted. Like all things precious in life, we take them for granted until they’re gone.
Nowadays, instead of eating 3 meals a day, I eat one full-course dinner consisting of 12 to 15 courses, with the courses carefully planned to complement each other gastronomically (or rather, to prevent nausea and diarrhea):
9:00 AM to 10:00 AM
- 2 fried eggs: 155 Ccal
- Cheedar cheese (30g): 120 Cal
10:00 AM to 11:00 AM
- Toast with butter and peanut butter: 200 Cal
- Milk 3.25%, 1 cup: 160 Cal
1:00 PM to 3:00 PM
- Shepherd’s Pie: 400 Cal
4:00 PM to 4:30 PM
- 1 large orange: 90 Cal
- Yogurt (9% fat), ¾ cup: 240 Cal
6:00 PM to 8:00 PM
- Rice, 1 cup: 200 Cal
- Chicken thigh: 200 Cal
- Steamed Vegetables, 1 cup: 40 Cal
- Avocado: 360 Cal
10:00 PM to 10:30 PM
- 2 Gourmet chocolate chunk cookies: 420 Cal
11:00 PM to 12:00 AM
- Protein supplement beverage: 130 Cal
Total: 2685 Cal
Why do I keep close track of the calories? Because I need to know when to eat, and when to stop. The hunger hormone, ghrelin, is primarily produced in the stomach. This means that without a stomach, I don’t feel hungry. I do feel weak and light-headed if I wait too long before eating, but I have never felt hungry since my surgery. This means that I had to convert a natural body process, eating and digestion, and somehow try to artificially regulate it. In my past life, I would stop eating when I got full. Now, I stop eating when I reach my calorie quota.
After months of practice, I have come to a few realizations:
- High-fat, high-calorie selection: Against conventional wisdom, I end up with a meal that is rather unhealthy for the average (not stomach-less) person. I try to squeeze out as many calories as I can out of my meals, which means prioritizing high-fat diets, as I get full very quickly. Vegetables and other high-fiber items have taken a backseat.
- Eating around the clock: Since I’ve lost the ability to feel hunger, I must eat every 1-2 hours. If I skip a snack, those calories are lost, as there simply isn’t enough time in the day to catch up. This means that day trips or long periods of time away from home are particularly challenging, as I don’t have a steady supply of food. I usually end up forgetting to eat.
- The chewing marathon: to have a chance at adequate digestion and absorption, food must be chewed to a pulp. My teeth are the last quality-control safeguards, and can make the difference between an uneventful post-meal rest or an afternoon of nausea or diarrhea. Chewing consistency is key. I wish I could adopt a mindful eating mindset, taking my time and savoring every bite, but alas, I’m under a bit of a time crunch to try to eat as much as I can during my waking hours.
- Neglecting hydration: the focus on high-calorie foods means that water, soups and other fluids, which tend to be low-calorie, are neglected. In addition, fluids fill the gut very rapidly, which means I have to drink very small sips at a time. I also can’t mix liquids and solids, since this causes diarrhea. This means that I either choose a solid or a liquid, but not both at the same time. When forced to choose between a cup of water or a cookie, the cookie always wins. The result is that I tend to be under-hydrated. I’ll eventually figure out the right balance.
Knowing what to eat is only half the battle. Knowing how to eat is equally challenging. I could be eating the same food items during the week, and I could end up with different digestive outcomes depending on how much I chew, how I space out my snacks/meals, and how I incorporate liquids and solids. Despite my current challenges, I’m much better off than I was just a few months ago after surgery. At the time, EVERY meal had an unpredictable digestive outcome. Recovery from a gastrectomy/esophagectomy is measured in years, not in months.