Dietary Guidelines: Post Small Bowel Surgery

Following surgery to remove part of your small intestine, your remaining intestine may not efficiently digest and absorb the foods you eat, which can lead to diarrhea, cramping, dehydration and other problems. Although the symptoms you experience depend on the amount and location of intestine that was removed, following special dietary recommendations can minimize these possible complications.

General dietary recommendations include:

  • Eat small, frequent meals
    • 6 to 8 small meals a day may be better tolerated than 3 larger meals while your body adapts to your shortened intestine
  • Limit sugar and concentrated sweets
    • Food and drinks high in sugar can exacerbate diarrhea
  • Avoid sweet beverages like juice and soda
  • Avoid high sugar foods like candy, cookies, cakes, pastries, doughnuts, ice cream, syrup, and jelly
  • Avoid drinking with meals
    • Liquids consumed with meals can speed the passage of food from the stomach into the intestine
    • Limit fluids with meals to � cup (4 oz) and wait 30-60 minutes after meals to drink additional beverages
  • Eat slowly and chew food well
  • Avoid intestinal stimulants like alcohol and caffeine
    • Stimulants can irritate the lining of your intestine and increase symptoms
  • Use liquid or chewable vitamin/mineral supplements if necessary
    • Capsules and tablets may not be well absorbed, especially soon after surgery as your body heals
  • In general, your diet should be:
    • High in complex carbohydrates (starches) and low in sugar and sweets
  • Bread, pasta, rice, and potatoes are good sources
    • High in protein
  • Foods high in protein include meats, poultry, fish, eggs, dairy products, tofu, and peanut butter
    • Moderate in fat
  • Fat is a concentrated source of calories and can help prevent weight loss, but too much fat may be difficult for your intestine to absorb and increase diarrhea
  • Oil, butter, margarine, mayonnaise, salad dressing, and cream are examples of added fats, but foods prepared with these ingredients as well as many meats and dairy products can also be high in fat
  • If weight loss is a continued problem for you, your doctor or dietitian may recommend nutritional supplements containing a special kind of fat called medium chain triglycerides that are more easily absorbed than other types of fat

Recommended and not recommended foods:

Food Group Usually Well Tolerated - May Increase Symptoms

  • Grains Unsweetened dry cereal
  • Hot cereals
  • Plain breads, buns, rolls
  • Tortillas
  • Pasta
  • Rice and other cooked grains Sugar sweetened cereals
  • Bran/ high fiber cereals
  • Pastries, doughnuts, sweet rolls
  • Quick breads and muffins
  • Vegetables Well cooked vegetables
  • Canned vegetables
  • Potatoes without skins Peas and corn
  • Raw vegetables
  • Fried and
  • Fruits Soft fruits (bananas, melons)
  • Unsweetened canned fruit
  • Unsweetened applesauce Dried fruit
  • Fruit canned in syrup
  • Fruit juice and juice drinks
  • Dairy Milk, Lactaid milk, soymilk
  • Plain or light yogurt
  • Cheese and cottage cheese Chocolate/flavored milk
  • Sweetened yogurt and pudding
  • Ice cream and frozen yogurt
  • Protein Foods Lean meat, fish and poultry
  • Eggs, egg substitute
  • Tofu
  • Smooth peanut butter Fried meat, fish and poultry
  • Bacon and sausage
  • Beans
  • Chunky peanut butter
  • Fats All in moderation Excess fat may increase symptoms
  • Other Sugar substitutes (Equal, Sweet 'n Low, Splenda, Truvia) Sugar, brown sugar, honey, corn syrup, pancake syrup, jelly
  • Sugar alcohols (sorbitol, mannitol, erythritol, xylitol, isomalt)
  • Beverages Oral rehydration solutions
  • Broth
  • Small volumes of plain liquids (coffee, tea, milk, diluted juice) High sugar beverages (soda, juice, fruit drinks, flavored milk)

Vitamin and mineral deficiencies:

  • Taking a multivitamin and mineral supplement is a good idea to compensate for decreased vitamin and mineral absorption following surgery
  • Depending on the part of your small intestine that was removed, you may need additional specific vitamins and minerals. Your doctor may advise you to take:
    • Calcium and vitamin D
    • Vitamin B12
    • Magnesium
    • Potassium (do NOT take potassium supplements without first speaking with your doctor to avoid potentially serious heart problems)
  • Nutritional supplements like Boost and Ensure are good sources of calories and nutrients, but may increase symptoms due to their high sugar content. Always ask your doctor or dietitian before starting a nutritional supplement to make sure it is right for you

If diarrhea persists:

  • Drink oral rehydration solutions rather than plain or sweetened beverages
    • Oral rehydration solutions contain sodium and glucose and are better absorbed than other beverages
    • Examples of oral rehydration solutions include:
  • Pedialyte
  • Gerber LiquiLytes
  • Rehydralyte
    • An oral rehydration solution can also be prepared according to the following recipe (combine and stir until dissolved):
      1 liter water (4 1/2 cups)
      1 cup orange juice
      8 teaspoons sugar
      1/2 teaspoon baking soda
      1/2 teaspoon salt
      Limit foods high in insoluble fiber that speed up intestinal transit
    • Insoluble fiber is found in foods such as:
      Whole wheat and bran
      Nuts and seeds
      Fruit and vegetable skins
      Add foods high in soluble fiber or a soluble fiber supplement to add bulk to stool
    • Soluble fiber is found in foods such as:
      Beans (may cause excess gas and bloating)
      Oats
      Apples (without peel)
    • Soluble fiber supplements include
      Psyllium (Metamucil, Konsyl)
      Methylcellulose (Citrucel)
      Polycarbophil (Fibercon)
      Dextrin (Benefiber)

Other nutritional issues:

  • Lactose intolerance
    • Lactose is the naturally occurring sugar found in milk. If you are lactose intolerant, you may experience symptoms such as gas, cramping, and diarrhea after consuming dairy products. Your doctor or dietitian will discuss alternatives to dairy products with you if lactose is a problem for you.
  • Kidney stones
    • If your doctor tells you that your risk of forming kidney stones is increased after your surgery, you may need to follow a low oxalate diet. Your doctor or dietitian will discuss this diet with you if necessary.