Diet after removal of the stomach for cancer: what is prohibited and allowed to eat. Diet after gastrectomy: nutritional features, recommended foods, menu Diet after longitudinal gastrectomy for weight loss

Light, quickly digestible, in small portions - this is exactly what nutrition should be like after gastric resection. A surgical intervention involving the removal of the stomach or part of it is a difficult change in the functioning of the body. Preparing for it and for a long time after the operation itself require a serious approach and adherence to clear medical recommendations. Resection is required for oncology and peptic ulcer disease, when the damage cannot be cured with medication. When part of the stomach is removed, food passes into the intestines very quickly, and because of this, the patient may experience unpleasant symptoms: bloating, heaviness, fatigue and dizziness. To prevent such conditions from occurring, you need to create a meal schedule and review your diet.

How does digestion occur after resection?

A reduced stomach cannot cope with digesting food in full, so poorly processed food goes straight to the intestines, which are unable to absorb all the useful substances and nutrients. Because of this, the digestive system is overloaded, and the person is in an uncomfortable state, expressed by drowsiness, heaviness in the stomach, and increased gas formation. The result is a lack of vitamins in the body, exhaustion, and rapid weight loss. To avoid such manifestations, both the stomach and intestines need to be “helped” by eating according to a special system.

Nutrition rules after gastric resection

After surgery to remove part of the stomach, the patient faces a long recovery period, during which he must adhere to strict eating rules. Basic nutritional recommendations:

• eat 5-6 times a day in small portions, because the stomach has become smaller and is not able to accept and digest large portions of food;
• chew food well, eat slowly;
• limit or completely eliminate foods high in carbohydrates (sugar, honey, jam, baked goods);
• increase protein consumption (lean meat, fish, eggs, cottage cheese);
• After taking the first 2, do not eat the third dish immediately, but after at least 30 minutes, that is, drink milk, kefir, jelly or compote over time, so as not to burden the stomach.

These rules must be strictly followed for the first 3 months after surgery so that the digestive system adapts correctly. All food must be ground; it is better to use recipes that involve steaming. The patient may refuse to eat for fear of pain. Such situations should not be allowed, otherwise malnutrition will lead to exhaustion of the body.

Menu for the first week

The menu for the first 7 postoperative days is usually prescribed by the doctor, taking into account the individual characteristics of the patient. The patient's diet is approximately as follows:

• The first day is fasting. You can take 30 milliliters of water every 3 hours or jelly without sugar.
• After 3 days, the patient is allowed a steamed omelette and half a cup of tea for breakfast. The snack consists of jelly and grated rice boiled in water. For lunch - rice soup and pureed meat. After an hour and a half, you can drink a rosehip drink. For dinner - meat or cottage cheese soufflé. Before going to bed, take jelly (no more than half a glass). The same composition of products is on the 4th day.
• Over the next 2 days, the diet expands. Breakfast already consists of soft-boiled eggs, mashed meat and tea with milk. As a snack, you can eat grated porridge (rice or buckwheat - your choice), and you can have steamed meat soufflé for lunch. Afternoon snack - unsweetened curd mass. Allowed for dinner: carrot puree and steamed meatballs. At night - jelly again.
• On the 7th day after the operation, doctors recommend eating 2 boiled eggs for breakfast, as well as pureed porridge. The second breakfast consists of steamed whipped cottage cheese. For lunch you can have potato and rice soup, plus a steam cutlet and mashed potatoes. Afternoon snack - steamed fish. For dinner you can try jelly and cottage cheese. White bread croutons are allowed.

The first week after surgery is the most difficult. The patient will just begin to get used to the new diet. When introducing each new product, you need to carefully monitor the reaction of the digestive system to it, so as not to harm the weakened body. If the stomach reacts with severe pain, nausea, weakness and dizziness, you need to stop taking this product for a while.

Diet No. 1 after resection

A patient after gastric resection is prescribed diet No. 1. It is also used to compile different types of menus intended for people with stomach and duodenal ulcers, after gastritis. It is based on simple and gentle foods for the body. Recipes include steaming, boiling and baking (not crisping). Then everything is thoroughly crushed and ground. You should eat warm food - neither too hot nor too cold. When following this diet, you need to count calories: the daily norm is 3000 Kcal.

Authorized Products

Following a diet is not difficult, because it allows you to eat a lot of tasty and healthy foods. First courses can be cooked in vegetable broth, with the addition of potatoes and cereals, pasta. Meat can be baked, boiled, steamed. But both meat and fish should be only low-fat varieties (chicken, turkey, cod, pike perch, perch). Vegetables should also be grated: pumpkin, potatoes, zucchini, carrots. They are usually used to prepare puree and vegetable stew, which is then ground. Fruits and berries cannot be eaten raw; they will have to be boiled or baked (for example, apples). Fruit jelly, berry and juices, rosehip drink, tea (only weakly brewed) are allowed.

You should include up to 100 grams of protein food per day in your diet, but you should avoid carbohydrate foods (sweets and honey). The amount of fat should be at the usual level or reduced (if the patient does not tolerate it well). With this diet, you should also take vitamins and supplements containing iron. Doctors also usually prescribe enzyme preparations to activate digestive processes.

In chapter Diet after gastrectomy After the description of the diet, recipes for dishes recommended by nutritionists for the diet after gastrectomy are presented.

Gastric resection is performed for gastric ulcers, polyposis and gastric cancer.

Diet after gastrectomy:

1 day- hunger.

Day 2- 1 glass of sweet warm tea and 50 ml of rosehip infusion, take 1 teaspoon every 15-20 minutes.

Day 3- 4 glasses of sweet warm tea and 50 ml of rosehip infusion, drink from a spoon.

4-5 day- prescribe diet No. 0a (with normal intestinal function, passage of gases, absence of bloating) - additional 2 soft-boiled eggs.

Chemical composition of diet 0a: proteins 5g, fats 15-20g, carbohydrates 150g, calorie content 750-800kcal, salt 1g, free liquid 1.8-2.2l. Up to 200 g of vitamin C is added to the dish (other vitamins are administered as prescribed by the doctor).

Diet No. 0a, diet: food must be taken 7-8 times a day, food temperature no higher than 45 degrees. No more than 200-300g of food per meal.

Low-fat weak meat broth, liquid berry jelly, rosehip decoction with sugar, strained compote, rice decoction with butter or cream, fruit jelly, tea with sugar and lemon, freshly prepared fruit and berry juices, diluted with sweet water 2-3 times (up to 50ml per appointment).

Diet No. 0a, exclude:

1. Whole milk and cream

2.Grape juice.

3.Vegetable juices.

4. Any dense and puree-like dishes.

5. Carbonated drinks.

6-8 day- diet No. 0b (1a surgical).

Chemical composition of diet No. 0b: proteins 40-50g, fats 40-50g, carbohydrates 250g, calorie content 1550-1650kcal, liquid up to 2 liters.

Food is taken 6 times a day in an amount of no more than 350-400g per meal.

The diet after gastric resection No. 0b includes liquid pureed porridges from buckwheat, rice, oatmeal in water with the addition of 1\4-1\2 milk or meat broth, slimy cereal soups in vegetable broth, weak low-fat broths with semolina, soft-boiled eggs, protein steam omelettes, puree or steam soufflé from lean meat and fish, up to 100g of cream, mousses, jelly from sweet berries.

9-11 days- diet No. 0c (1b surgical).

Chemical composition of diet No. 0c: proteins 80-90g, fats 65-70g, carbohydrates 320-350g, calorie content 2200-2300kcal. Food is taken 6 times a day. Hot and cold foods are not allowed.

Recommended for diet after gastrectomy No. 0c: puree soups, cream soups, dishes from boiled pureed meat, fish, steamed chicken, fermented milk drinks, steamed dishes from cottage cheese, fresh pureed cottage cheese diluted with milk or cream to the consistency of sour cream , up to 100g of white crackers, vegetable and fruit purees, well pureed, baked apples, pureed milk porridge, tea with milk.

In 12-14 days after the operation, the patient is prescribed diet No. 1 (1 surgical), which differs from diet No. 1 by the inclusion of weak meat and fish broths and vegetable broths and the limitation of whole milk.

The amount of food eaten at one time is limited to 250 g of soup or 1 glass of liquid.

Only 2 dishes are allowed for lunch.

Eating 5-6 times a day.

The amount of protein is increased to 130-140g per day.

The amount of carbohydrates is limited to 350-400g due to easily digestible ones - sugar, jam, honey, sweet drinks.

The amount of fat is given within the normal range or slightly above the norm - 100-110g (of which 15-20g of vegetable oil is recommended as an additive to dishes if tolerated). If the patient experiences bitterness, regurgitation, diarrhea, the amount of fat is reduced to 70-90g.

Be sure to include vitamins in the form of rosehip decoction and wheat bran in the diet after gastrectomy.

If milk is intolerant, it is included in dishes or replaced with other products.

Diet No. 1 is followed for 3-4 months (sometimes, taking into account the patient’s condition, diets No. 5 or 4b are prescribed), then, if the condition is good, they gradually switch to the unprocessed version of diet No. 1 or diet No. 5.

Further in 6-12 months after surgery, if the condition is satisfactory, diets No. 2 or No. 15 are recommended.

With reduced secretion of the gastric stump and slow movement of gastric contents into the intestine, vegetable and fruit juices, weak fish and meat broths, which moderately stimulate gastric secretion, are carefully introduced into the diet after gastric resection.

Dumping syndrome- a complication after gastric resection, which manifests itself in weakness, dizziness, palpitations, chills after eating, sometimes fainting, bloating, abdominal pain, belching, most often after eating easily digestible carbohydrates.

To prevent dumping syndrome, an unprocessed version of diet No. 1 is prescribed containing 130 g of proteins, 350-400 g of carbohydrates, of which only 30 g of sugar or 300 g of carbohydrates and a complete replacement of sugar with sorbitol (25-30 g), 100 g of fat. It is recommended to eat jelly-like and viscous dishes to reduce the rate of evacuation of food from the stomach, separate meals of liquid and solid foods, starting with dense foods, eat 6 times a day while lying in bed, after eating, lie in bed or recline in a chair for 30 minutes.

When peptic ulcer or inflammation of the stomach stump A pureed version of diet No. 1 is recommended, in case of exacerbation - diet No. 1a, then No. 1b and changes, since patients after gastrectomy may not tolerate milk and other products.

Esophagitis- inflammation of the esophagus - a complication after gastric resection as a result of the reflux of pancreatic juice and bile into the esophagus.

Diet for esophagitis is prescribed No. 1 - pureed version, containing 100-110g of proteins, 80-90g of fats, 80-90g of carbohydrates, limited to 250-300g, primarily limited to sugar. Meals for esophagitis 6 times a day. Dishes are given in a liquid, mushy, jelly-like state, the last meal is 2-3 hours before bedtime, you must eat standing or sitting with your spine not bent forward, you cannot take large amounts of food at one time and drink free liquid between meals, you cannot lie down after food 40-45 minutes.

For anemia, which occurs after gastrectomy, meat, liver, juices, purees of fresh fruits, vegetables, and hematogen dishes are introduced into the diet after gastrectomy if tolerated.

When losing weight in the diet after gastrectomy, the content of proteins, fats, and carbohydrates is increased by 15-20%.

Gastric resection and its consequences

The first resection was performed in Germany in 1881, and the technique was named after the surgeon - the Billroth method. There are other methods; the choice of the appropriate one depends on the size of the affected area, the location of the pathology and the general diagnosis. An operation to remove the stomach or part of it is performed for the following indications:

• Malignant neoplasms.
• Perforation and perforated stomach ulcer.
• In the presence of a perforated ulcer in the walls of the stomach.
• Precancerous polyps.
• Extreme obesity.
• Pyloric stenosis.

The following are considered contraindications:

• Presence of metastases.
• Serious diseases of the cardiovascular system.
• Kidney and liver failure.
• Open form of tuberculosis.
• General weak condition of the body.

Classification of resections:

• Economical (up to half the volume of the stomach is removed). Prescribed, for example, for stomach ulcers.
• Extensive (approximately two-thirds removed).
• Subtotal (4/5 organ volume).
• Total (90% of stomach tissue is excised).

If it is possible to do without surgery, drug treatment and diet therapy are prescribed.

The diet after gastrectomy is quite strict, and the recommendations must be followed strictly. As a rule, it is prescribed by the attending physician, taking into account the characteristics of the patient’s condition after surgery. Its general rules are:

• Frequent split meals (5-6 times a day), serving size – up to 150 ml.
• Food should be easily digestible, excluding coarse and difficult to digest.
• Heat treatment is required.
• After eating the main course, you can drink water or a drink at least one hour later.
• The nutritional content of the diet should be as follows: at least 140g of protein, 70g of carbohydrates, 40g of fat (preferably of vegetable origin).
• For the first 6-8 weeks it is better to cook only by steaming or boiling.
• It is advisable to lie down for 30-40 minutes after eating.
• The first meal should consist of predominantly carbohydrate foods - they give the body energy; for dinner it is better to prepare food rich in fiber and proteins.
• Try to eat at the same time: the body gets used to the regime, gastric juice begins to be released in advance and the digestion process goes faster. If you skipped lunch, the enzymes will needlessly irritate the stomach lining.
• Avoid very cold or hot food; the recommended temperature is 50-55 degrees.
• Junk food (fried, smoked, marinades, pickles, fast food) is your worst enemy. Not only the stomach suffers from them, but also the liver, spleen and other internal organs.
• You need to take mineral and vitamin supplements for 1-2 months. Your doctor may prescribe enzyme preparations.
• Chew your food thoroughly. The fact is that under the influence of saliva the process of breakdown and primary digestion has already begun.
• Leave bad eating habits in the past: dry food, eating on the go, fast food snacks. Any action can harm a sore stomach.
• Adaptation to the new diet will take up to 8 months. At first you may lose weight (the so-called dumping syndrome), but gradually your body will adapt.
• The diet should be varied, taking into account allergies and individual intolerances. It is better to immediately discuss your diet plan after gastric ulcer surgery with your doctor.

Prohibited and permitted products

During the initial rehabilitation period (8-15 weeks), the following products are recommended:

• Dietary wheat bread (stale), crackers.
• Soups (cereals, vegetables, but without cabbage).
• Meat (tendons and cartilage are first removed and skin removed) - veal, chicken and beef.
• Fish – pike perch, pike, hake, carp, bream, carp.
• Eggs (1 piece per day, soft-boiled or steam omelet).
• In small quantities milk, kefir, cottage cheese, mild cheese.
• Boiled vegetables (potatoes, pumpkin, zucchini, cauliflower, carrots).
• Fruits and berries (except coarse fiber). Compotes and jellies are made from them.
• Viscous porridges, casseroles made from rice, buckwheat, oatmeal, finely chopped pasta.
• You can add olive or sunflower oil little by little, up to 10g of butter.
• Drinks – tea with milk, diluted vegetable and unsweetened fruit juices, rosehip decoction.

Prohibited products include:

• Pastries and sweets.
• Spices, seasonings, sauces, mayonnaise.
• Marinades, pickles, preserves.
• Fried and smoked food.
• Fast food.
• Canned food.
• Alcohol.
• Cocoa, coffee, carbonated drinks.
• Cabbage, radish, radish, sorrel, spinach, onion.
• Fruits and berries with rough skin.

After 3-4 months after consultation with your doctor, you can include the following products:

• Rye bread, unsweetened cookies.
• Cabbage soup, borscht, beetroot soup, low-fat broth.
• Turkey, rabbit meat.
• Sauerkraut, sour cabbage, greens, tomatoes, cucumbers, green peas.
• A little bit of jam, marmalade, sugar, honey.
• Curdled milk, yogurt.
• Sour cream and spice sauces.

Menu for the first week

Surgeries on the stomach are difficult for the body to tolerate, because this organ performs a number of functions. So, for example, the first rule of the diet after removal of a polyp in the stomach is fasting and gradually increasing the volume of portions. After resection, the patient is fed through a tube with nutrient solutions for 1-2 days. Glucose solutions, saline, and amino acids are also administered intravenously. After examination by a doctor and control tests, from the third day you can give broth and rosehip decoction in small portions.

From the fourth day, slimy porridges, curd and fish purees are prescribed, from the sixth day - vegetable purees and eggs (1 serving no more than 50g). From the 8th day, the serving volume is already 150-200, on the 10th day – up to 400 ml.

Table 1. Indicative menu for the week

An operation to remove the stomach or part of it is considered a serious intervention in the human body and must be carried out with careful preparation and observance of the postoperative period. Before resection (removal of part of the stomach) and after it, the patient must eat properly and follow a special diet. Before surgery, the patient undergoes restorative treatment and takes more tonics, protein foods and fluids.

Features of digestion after gastrectomy

The main indication for gastric resection is cancer. A peptic ulcer can be treated with gastric vagotomy. In the presence of benign tumors, their size, structure and other factors are taken into account.

Advice: For the first two months, it is very important to eat according to the rules and take into account all the doctor’s recommendations, because it is during this period that the body and digestive system adapt to new conditions.

How to create a menu

After surgery, the patient must eat properly and adhere to the following menu, which is just an example and should be recommended by the attending physician:

• The first day is a fasting diet.
• On the second day, you are allowed to drink still water or fruit jelly every couple of hours in the amount of 30 ml.
• Three days after surgical treatment, you are allowed to eat a steamed omelet, a soft-boiled egg and drink 0.5 cups of tea for breakfast. For second breakfast, jelly or juice and pureed rice porridge. Lunch may consist of a slimy soup with rice and mashed meat. In the afternoon, drink rosehip decoction. For dinner, meat or cottage cheese soufflé. Before going to bed, it is advisable to drink 0.5 cups of unsweetened jelly.
• On days 5 and 6, breakfast should consist of a soft-boiled egg, meat soufflé and tea with milk. The second breakfast consists of grated porridge (buckwheat, rice), and for lunch there is a steamed meat soufflé. In the afternoon it is recommended to eat unsweetened curd soufflé. For dinner, carrot puree and steamed meat quenelles. Before going to bed, you are allowed to drink fruit jelly without added sugar.
• On the 7th day after surgery, breakfast should consist of two soft-boiled eggs, chopped or mashed rice porridge (buckwheat porridge). The second breakfast is made from steamed cottage cheese soufflé. At lunch you are allowed to eat soup with potatoes and rice (mashed), meat cutlet and mashed potatoes. In the afternoon you can eat steamed fish. Dinner should consist of jelly and calcined cottage cheese, to which you can add white crackers.

A week after surgery, diet No. 1 with carbohydrate restriction is applied.

List of unwanted products: 1) vegetables (zucchini, carrots, beets); 2) jam, marshmallow and honey; 3) lean meat (chicken, rabbit); 4) sour cream and cream; 5) fish (hake, cod); 6) pasta.

Prohibited Products: 1) fatty meat (duck, pork); 2) broths made from mushrooms, meat or fish; 3) fried foods; 4) smoked meats, marinade; 5) too salty food; 6) raw vegetables; 7) spicy dishes; 8) seasonings, spices, pepper; 9) baked goods.

Diet with pureed food

Breakfast includes one soft-boiled egg, coffee with milk and buckwheat porridge (rice porridge). The second breakfast consists of one baked apple and rose hip decoction. For lunch you are allowed to eat potato soup without meat, a steamed cutlet in milk sauce and unsweetened fresh fruit compote.

In the afternoon, milk and unsweetened cookies. For dinner, steamed or boiled fish with potatoes is recommended. Before going to bed, you need to drink kefir or tea with milk. After 3 months of such a diet, the patient is allowed to eat unprocessed food from table No. 1 or No. 5.

Unprocessed diet

Allowed:

• prepare beetroot soup, pasta, vegetable broth, milk rice soup and fruits;
• lean meat that was baked in the oven, stewed or boiled;
• For vegetables, tomatoes, beets, carrots, cauliflower and fresh herbs are recommended;
• to prepare porridge, it is recommended to take cereals: buckwheat, rice, millet, oats;
• soft-boiled eggs or steamed omelet.

Six months after the operation, the patient can already eat low-fat ham, Doctor’s sausage, juice with fruit, butter, wheat bread and well-soaked herring.

Despite the fact that the life of a patient who has undergone gastrectomy changes dramatically in terms of nutrition, it is possible to make the menu tasty and varied without consuming prohibited foods.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

Gastrectomy is a serious surgical intervention in the digestive system of the body, when part of the stomach or the entire organ is removed. The postoperative recovery treatment process is not only drug treatment. Diet after gastrectomy is an important part of this process. This operation is performed according to certain indications:

• stomach cancer;
• complication of a stomach ulcer in the form of perforation;
• polyps that are precancerous in nature;
• pyloric stenosis;
• obesity.

After gastrectomy, the recovery period begins, which takes a long time and takes months. This is a very important moment in the patient’s rehabilitation, which determines the future quality of his life.

Why do you need a diet after gastric resection?

Removing part or all of the stomach radically changes the digestion process. In order to restore this process, it takes time and a special strict diet that will spare the sore stomach. The slightest error in food will immediately give rise to pathological symptoms in the form of abdominal pain, heaviness in the stomach, and belching. Often after surgery a complication develops in the form of dumping syndrome.

Due to the reduction in the volume of the stomach, food immediately passes in large quantities from the esophagus into the “small” stomach and small intestine. For successful absorption of nutrients, this area of ​​​​digestion begins to be intensively supplied with blood. The pathological condition develops quickly and is accompanied by headache, dizziness, low blood pressure, tachycardia, which leads to fainting.

To avoid complications and restore normal digestive function, diet plays a paramount role during the recovery period.

Basic principles of nutrition

In order for the rehabilitation of patients after gastrectomy to proceed normally, it is necessary to follow certain principles in the diet:

• food and drinks must be warm, no higher than 24 degrees;
• split meals are required - up to seven times a day;
• the volume of a single serving of food or liquid should be from 30-50 to 200 grams;
• cooking food only by steaming, stewing or baking;
• consumption of food products only in crushed form;
• food should be rich in proteins;
• it is necessary to chew food thoroughly;
• follow a daily routine and try to eat at the same time;
• After eating, it is recommended to rest for half an hour.

Important! Strict adherence to the basic principles of nutrition after gastrectomy is the key to the rapid restoration of the body’s digestive system.

Authorized Products

After the operation, the patient in the hospital immediately begins to receive dietary nutrition. Before discharge, a consultation with a dietitian is required, followed by a recommendation on how to follow a diet. The products that can be eaten and those that must be excluded from consumption must be indicated.

• soft-boiled chicken eggs;
• steamed omelette;
• low fat dairy products;
• yesterday's dried white bread;
• “light” poultry, lean beef;
• crackers, biscuits;
• semi-liquid porridge from rice, buckwheat, oatmeal;
• low-fat varieties of fish;
• vegetables - pumpkin, zucchini, potatoes, eggplants, bell peppers;
• weak black or green tea;
• compotes with a small amount of sugar from dried fruits.

Prohibited Products

In order for the recovery period after removal of the stomach to proceed smoothly, it is necessary to exclude the following foods from the diet:

• fatty meats;
• confectionery;
• smoked and canned products;
• salted and pickled vegetables;
• fresh pastries and soft wheat bread;
• carbonated drinks;
• coffee and strong black and green tea;
• peas, beans.

It is necessary to be especially careful when choosing foods and strictly adhering to a diet during oncology surgery.

Nutrition during stomach cancer removal has its own characteristics. In the first two days after surgery, nutrition is provided parenterally. The patient should not consume any food or drink by mouth. After 48-72 hours, you are allowed to drink 20 grams of weak meat or vegetable broth . The menu is gradually starting to expand. After a week, you can eat pureed soups with pureed vegetables.

After two weeks, the diet expands even further, and dishes are added in the form of slimy crushed porridges cooked in water, pureed boiled vegetables, chopped meat in a blender, steamed, and pasta.

Gradually, the patient gets used to eating certain foods after cancer surgery. The most difficult period of recovery occurs within two months, when the patient adapts to the “new” life. During this period, the patient, in addition to therapeutic nutrition under the supervision of a nutritionist, undergoes drug treatment recommended by a gastroenterologist.

Correction of the diet is carried out by a nutritionist taking into account the general condition of the patient, the nature and extent of the surgical intervention. Often, when asked how long it is necessary to follow a diet after surgery, doctors say that for a long time, perhaps more than one year.

Sample menu

In order to gain the required amount of calories, food must be varied, nutritious and dietary, subject to certain processing.

An approximate diet indicated during the rehabilitation of a patient after a removed stomach:

• before breakfast on an empty stomach, drink non-carbonated mineral water at a temperature of 24 degrees;
• first breakfast – 50-100 grams of boiled, pureed carrots and half a glass of low-fat kefir;
• second breakfast - freshly squeezed carrot juice, diluted with water in a 1:1 ratio in the amount of 100 grams with the addition of walnut kernel flour;
• lunch – vegetable puree soup with croutons, boiled chopped chicken with mashed potatoes without milk, compote;
• afternoon snack - biscuits with weak green tea;
• dinner - grated carrot and beet salad with steamed fish;
• unsweetened cracker with still mineral water.

The entire diet is fully controlled and adjusted by a nutritionist. The patient will have to eat properly and follow a diet for a long time, for a year or more, depending on the general condition. The prognosis for life, provided all rules and recommendations are followed, is positive.