Surgery

Have you had surgery to manage your IBD? If you have, you are not alone. Up to every second person with Crohn’s disease and every fifth person with ulcerative colitis needs surgery at some point in their life. This month I saw two clients who had resections to manage Crohn’s disease but they had very different nutritional experiences in the lead up to surgery. One client could afford to delay surgery for a few months and we worked together to improve their nutritional state and they had increased energy levels and gained 5kg prior to surgery. Whereas, the other client had lost 10kg in the months leading up to their surgery and were referred to work with me to improve their nutritional status after their surgery.

As you probably know all surgery comes with its risks and the risks are higher the more complex the surgery, unfortunately, many IBD surgeries are complex. But your surgical or IBD team aim to reduce the surgical risks through their choice of surgical technique, management of medications, reduction of gut inflammation, and by considering your nutritional state.

nutrition & surgery

We know that people who are well-nourished at the time of surgery recover better than people who are malnourished. This is true for all types of surgery, not just IBD surgery. If surgery is not urgent, there is usually time to optimise nutrition prior to surgery. How do you know if you might be malnourished?

Are you struggling to eat as much as normal? Have you lost 5 or more kilos in the last few months? Do your blood tests show micronutrient (zinc, iron, folate, vitamin D) deficiencies? Do you feel weaker than normal? If you experience any of these symptoms you may be malnourished. Discuss your nutrition with your doctor or surgeon and if you are struggling to eat well and have lost weight please ask to be referred to a dietitian. A dietitian can provide you with practical food and drink ideas, support and, if needed, a prescription for nutritional supplements. These strategies can help you to optimise your nutritional status.

What should I eat before surgery?

This is a common question. In general food and drinks that contain a combination of protein, healthy fats and complex carbohydrates that are packed with micronutrients are going to nourish your body. It is still important to try and eat a variety of foods. If you stick to eating/drinking a small range of foods day in day out you may be missing out on some essential nutrients. Many people find softer textured foods easier to digest, especially if there is narrowing of the bowel (e.g. strictures) or fistulas or ongoing inflammation. Unfortunately, a poor appetite is common and makes it difficult to enjoy food and eat enough to maintain weight. If this is the case, using liquid nutrition supplements or soups and smoothies with added protein, in conjunction with usual foods, can help reduce symptoms and make it easier to meet nutritional needs. Below I have a recipe for the ultimate soft textured comfort food Kumara Fish Cakes, yummy!

What should i eat if I have strictures? 

A tight stricture means that the area for the food to pass through is narrow. There are some types of food that are more likely to get stuck than others and not be able to pass through the bowel. These are foods that tend to go through the bowel without changing e.g. corn, tomato skin, sticky bits of food such as tough or raw plant fibres, fruit skin, whole seeds and nuts. Another food that many of my clients feel they cannot digest well is tough meat. Many people find that eating smaller meals more often are easier to digest than large meals. Remember to chew your food well! The digestive process starts in the mouth. Chewing food well enables digestive enzymes in saliva to come in contact with the food and start breaking it down. If strictures are very tight, choosing well cooked, soft food and even mashed or pureed meals, can reduce the likelihood of a bowel obstruction. In some cases we may use a complete liquid diet (exclusively enteral nutrition) for 3 - 6 weeks prior to surgery.

Kumara fish cakes

This is a recipe I made last weekend while visiting Lis, one of my best friends, in London. This is a dish she always asks her mum to make when she visits New Zealand. It is her comfort food. I hope you enjoy it too!

~ 1 kg of kumara (orange or purple skinned or a mix), peeled. Kumara is sweet potato in te reo Māori (the indigenous language of New Zealand).
~ 700g of potatoes (mashing varieties), peeled
1/2 onion, grated
1 egg, whisked
1 can tuna or salmon in spring water
1 tsp curry powder
handful of fresh herbs e.g. coriander or parsley
1/2 tsp iodised salt or celery salt
wheat or rice flour for dusting

1. Chop kumara and potato into 1 cm square pieces and boil until soft

2. Saute onion until soft

3. Mash cooked kumara and potato

4. Add cooked onion, curry powder, salt, canned fish and egg to mashed kumara and potato and mix well

5. Heat a frying with a tablespoon of olive oil

6. Shape one heaped tablespoon of mash into a pattie cake shape, dust liberally with flour and put into the hot pan.

7. Fry the cakes until a crust forms, then flip and cook until a crust forms on the other side.

8. Place cooked cakes onto a lined oven tray, sprinkle with a little salt and keep warm in an oven heated to 80˚C

9. Add other tablespoon of oil to the pan and shape and cook another batch of cakes as per steps 6 & 7.

10. Serve fish cakes warm with your favourite sauce e.g. hot sauce and mayonnaise or a fruit chutney

    Notes: steps 1 - 4 can be done ahead of time. Store the mash mixture in the fridge until you are ready to cook the fish cakes.

    The fish cakes also taste great reheated the next day for an easy lunch or dinner.