A Patient’s guide to Eating well before and after surgery

The body needs protein, energy (calories), vitamins and minerals (such as vitamin C, iron and zinc), and plenty of fluids to support recovery and the wound healing process.

The Eatwell Guide can be used to help plan your meals. It shows how much of what you eat overall, should come from each food group.

• Try to choose a variety of different foods from each of the 5 food groups to help you get the balance right
• Try to eat a variety of fruit and vegetables – at least five servings a day
• Base your meals on starchy foods like potatoes, bread, rice, pasta – choosing wholegrain versions where possible
• Eat moderate portions from the protein and dairy or dairy-alternative groups. You will need extra protein if you are still healing. High protein foods include lean cuts of meat, chicken, fish, eggs, soya/tofu, beans, lentils and nuts. Dairy products including milk, cheese, yoghurt, custard and milky puddings are also good sources of protein.

REMEMBER: After surgery or when recovering from an infection, your body uses up a lot more energy and protein than normal to help repair itself. So if you are not eating enough, the body breaks down protein from your muscles. This can be from the muscles in the arms and legs but also important muscles used in breathing and circulation, such as the heart and lungs.

• Iron - Important for the healing process by helping to maintain adequate blood haemoglobin (a protein that carries oxygen in red blood cells) levels. Iron-rich animal-based sources include red meat, fish and eggs. Plant-based sources of iron include: beans, pulses, dark green leafy vegetables, dried fruit, nuts, seeds and iron-fortified breakfast cereals, but these are less easily absorbed than animal-based sources
  • Food preparation can enhance iron absorption from plantbased foods, such as, cooking beans and pulses, soaking nuts and seeds, and using sprouted seeds and grains. Including vitamin C-rich food and drinks (e.g. citrus fruits) in your meals, can also help increase the absorption of iron from food.
• Vitamin C - Helps with iron absorption from your food and also directly with the healing process. Vitamin C is found in a wide variety of fruit and vegetables. It is not stored in the body so a daily supply is needed. Vitamin C is destroyed during the cooking process, so it is important not to overcook your vegetables, and if possible, steam them. Drinking a small glass of fruit juice (150ml) with your meal is a good way to improve your intake.
• Zinc - Important for the formation of new skin tissue and wound healing. Zinc-rich foods include: lean red meat, shell fish, milk, cheese, bread, beans, lentils, fermented soya (e.g. miso and tempeh), wholegrains, nuts and seeds.

If you cannot eat enough foods containing key vitamins and minerals then you may need to take a supplement. If you are unable to manage a varied diet, or have a poor appetite, an “A to Z” type vitamin and mineral supplement may be necessary. These are available from many high street chemists.

Read the label - look for a supplement that does not exceed 100% of the daily requirements for each vitamin and mineral.

If you are managing to eat a full and varied diet then there is no benefit in taking high levels of vitamins and mineral supplements as this can be harmful.

It is important to avoid dehydration. Dehydrated skin can become dry and fragile. You may also be losing fluids from your wounds. Aim for 1.5 to 2 litres per day (6-8 cups). This could include any liquid (e.g. tea, coffee, milk, water and juice) except alcohol. Lower-calorie options include sugar-free alternatives or using low-calorie sweeteners in hot drinks.

1. Eat “little and often” (every 2-3 hours) - try a small, high energy/ high protein snack or drink between meals (i.e. mid-morning and mid-afternoon) and before bed.
2. Try having a dessert after meals, e.g. cake, custard, yoghurt, rice pudding or cheese and crackers.
3. If you are not able to eat all of your meal, try to eat the higher protein foods first and then some of the other foods such as potatoes, pasta, rice and vegetables.
4. Try not to fill up on drinks just before or during your meals.
5. If you are too tired to cook, try using ready-meals or freeze extra portions of food to use another day.
6. Try pre-cooked sachets of rice and pasta and heat in the microwave.
7. Choose meals that you enjoy, are easy to prepare and eat, and are high in energy and protein.
8. Have your favourite snacks close to hand – place foods/drinks in areas where you spend a lot of time and where they are easy to access.
9. Try to drink nourishing fluids such as milk, juices and full-sugar squash or soft drinks, which contain much more energy than water, tea and coffee.

• Choose the high energy/high protein foods from the menu. These are labelled with an ‘E’ sign.
• Soups are generally low in energy and protein and are not suitable as a meal replacement. A higher calorie/higher protein soup can be requested from your ward hostess, such as Meritene Soup or tinned Heinz soups.
• If you find you fill up quickly at mealtimes, ask the ward hostess for extra foods such as cold desserts, biscuits, sandwiches or cheese and crackers that can be eaten as snacks in-between meals.
• Don’t be afraid to ask for help with your meal especially if you have trouble cutting up your food, opening packets or feeding yourself. The nurse or healthcare assistant can help you at mealtimes.

If you are really struggling to eat and drink, the nurse can refer you to a dietitian. The dietitian can offer you advice, suggest other foods or offer nutritional supplements to help boost your energy levels.

This is a common side effect after an operation. The doctors may be able to give you medication to help ease the sickness and settle your stomach before eating.

• Eating small amounts regularly throughout the day is more likely to prevent nausea, rather than over-eating or going without food for long periods.
• When first starting to eat after feeling sick, you may like to try dry, plain ‘snacks’ such as crackers, toast, sandwiches, crisps or other savoury items, rather than a full main/hot meal.
• If you find that the smell of cooked food is causing you to feel sick, try cold foods such as sandwiches, salads and cold desserts without strong smells.
• Foods with ginger have been known to have anti-sickness properties. You could try fresh root ginger, ginger biscuits, ginger tea or flat non-alcoholic ginger beer/ale. Ask someone to bring these foods and drinks in from home, if able.
• Try sipping cold flat fizzy drinks such as cola or lemonade, which can help with sickness.
• Keep your mouth clean by regularly brushing your teeth or using a mouthwash to prevent bacteria growing in your mouth, and to encourage you to eat.

Some medications can affect your sense of smell and/or cause taste changes, which may improve slowly over time. You might go off certain foods because of this, which can affect your appetite and may lead to weight loss.

• Keep experimenting with flavours to find food or drinks that you can take the best.
• Choose foods with strong flavours if all your food tastes the same. e.g., garlic, lemon juice, herbs, spices and marinades. Also try using chutneys, pickle or relish to add flavour.

Constipation is another common side effect after an operation, usually related to your pain relief and sedation used in the surgery. Constipation can reduce your appetite and increase nausea so it is important to tell the doctors if you feel constipated. There may be medication changes they can recommend to help relieve this.

• Drinking plenty of fluid throughout the day can stimulate your bowels to move. Most people will require at least 6-8 glasses of fluid per day (1.5-2.0 litres per day).
• Taking laxative medications may be needed to soften the stools, stimulate your bowel muscles or add extra liquid or bulk to your stools.
• Changing your position from lying in bed to sitting in a more upright position and moving around, if you are able to, may help to stimulate your bowels.

Once discharged home you are still likely to be in the ‘recovery phase’ of your operation. You may still need to have high energy/high protein foods, snacks in between meals, and nourishing drinks at home until your normal appetite and strength return.

Fortifying food means to add extra energy (calories) and protein to your normal food. This way, food can be made more nutritious without increasing the portion size. I.e. each spoonful of fortified food is more nourishing than normal food.

• Add a swirl of cream to porridge, soups, sauces and savoury dishes
• Add cheese to scrambled eggs, pasta dishes, mash potato, jacket potato, creamy sauces, soups, beans on toast, or sandwiches
• Add an extra drizzle of oil to your individual portion of food, e.g. soups and savoury dishes
• Try dips like meat pâté, hummus, guacamole, olive tapenade or baba ganoush with your food
• Add mayonnaise or salad cream to sandwiches, or have two fillings, e.g. egg mayonnaise, tuna mayonnaise, cheese and ham etc.
• Add mince (meat or soya), lentils, beans and pulses to soups, stews and other savoury dishes
• Add ground nuts, nut butter (e.g. peanut or almond butter), seeds (e.g. flax, hemp or chia) or cream to porridge and smoothies
• Add tinned coconut milk or coconut cream to soups, rice and peas dishes, curries, milkshakes or puddings
• Add nut butter, yoghurt, cream or ice cream to milkshakes
• Add a drizzle of syrup e.g. maple syrup or golden syrup, honey or jam to porridge, milkshakes or desserts
• Avoid lower-fat or lower-calorie versions of foods and use full-fat and full-sugar products instead.

• Roast meats/chicken with rice or potatoes, vegetables and gravy
• Sausages and cheesy mash with vegetables
• Jacket potatoes topped with tuna mayo, savoury mince, cheese or baked beans
• Protein-filled sandwiches – prawn, chicken, fish, ham, egg, cheese, peanut butter, or falafel and hummus. Add generous amounts of spread to the bread
• Lasagne, spaghetti bolognaise or macaroni cheese
• Omelette with ham, cheese and potatoes
• Cooked breakfast of bacon, sausages, eggs, fried mushrooms, hash browns and/or beans
• Salmon in parsley sauce with potatoes and vegetables
• Shepherd’s pie, fish pie or cottage pie with vegetables
• Dhaal or chickpea/kidney beans/pulses curry with fried rice, roti with spread, or naan bread
• Khichdi, dosa or dhokla
• Noodles or rice with seafood/meat/tofu and vegetables in a rich sauce

Savoury snacks

• Sausage rolls, mini quiches, Scotch eggs, Cornish pasties, fish bites, meat skewers or falafels
• Cheese, nuts, olives, dips and crackers
• Protein-filled sandwiches – prawn, chicken, fish, ham, egg, cheese, peanut butter, or falafel and hummus
• Crackers, oat cakes, pitta bread, bread sticks or toast with dips e.g. hummus, guacamole, olive tapenade or baba ganoush
• Toast with butter, poached egg, baked beans, cheese, mashed avocado or nut butter
• Nibble platter: cold cuts of meat, chicken, tinned fish, cheese and crackers
• Crumpets with butter/margarine, cream cheese, jam or honey
• Sausage sandwich or hot dog with cheese
• Crisps
• Nuts and seeds trail mix
• Fried bread, pakoras, samosas, cassava chips or potato cakes (e.g. aloo tikki)
• Bombay mix or chevra

Sweet snacks

• Crème caramel, custard, full-fat yoghurt, rice pudding, mousse or ice-cream
• Fruit salad with full-fat custard, yoghurt or ice-cream
• Dried fruit/dates
• Fruit & nut or cereal bars
• Doughnuts, biscuits, chocolate or sweets
• Toast with nut butter, sliced banana and syrup or cinnamon
• Cake slices
• Dessert pots
• Sweet puddings like spiced bread pudding or semolina pudding

• Hot milky drinks e.g. hot chocolate, milky coffee, milky tea, Horlicks or Ovaltine with full-fat milk, condensed milk or extra milk-powder
• Cold milky drinks e.g. flavoured milkshakes, smoothies and malted drinks
• Sweet lassi or falooda made with ice cream and milk
• Homemade fruit smoothie, e.g. berries, mango, pineapple or bananas blended with full-fat milk, yoghurt, cream or ice cream

Choose full-fat (i.e. whole milk/full-cream milk) and avoid low-fat milk (e.g. skimmed or semi-skimmed milk). You can also increase the energy and protein content by making fortified milk.

Fortified milk

Try making fortified milk using the recipe below. Dried milk powder is found in most supermarkets, usually on the shelves close to the tea and coffee section.

Fortified milk can be used in drinks and foods such as fruit smoothies, hot chocolate, malted milk, milky coffee, porridge or cereal, custard, milky puddings, or white/cheese sauces.

Single recipe

½ pint full cream milk 
2 tablespoons dried milk powder 
Mix thoroughly

Larger recipe

1 pint full cream milk
4 tablespoons dried milk powder
Mix thoroughly

Other ideas to flavour the milky drinks include: mixing with fresh or tinned fruit, ice-cream, vanilla essence, syrups or milkshake powder.

• Choose soya or oat milk (these are higher in energy and protein than coconut, rice, almond and other nut-based drinks). These can be fortified with soya, oat or coconut cream too. Aim to drink 1 pint per day.
• Add a swirl of soya/oat/coconut cream or coconut milk to porridge, soups, curries or other savoury dishes
• Add dairy-free cheese to soups, creamy sauces, pasta dishes, mash potato, jacket potato, beans on toast, or sandwiches
• Add an extra drizzle of oil (e.g. olive, vegetable or rapeseed) or a spoon of plant-based margarines to your individual portion of food – e.g. soups, salads and savoury dishes
• Spread dairy-free margarine thickly on bread or melt into vegetables.
• Try dairy-free dips like hummus, guacamole, olive tapenade or baba ganoush with your food
• Add lentils, beans, pulses, tofu and/or soya chunks or soya mince in salads, soups, stews, pasta and other savoury dishes
• Add tahini (sesame seed paste) into salad dressings
• Add desiccated coconut, ground nuts, nut butter or seeds (e.g. flax, hemp or chia seeds) to porridge and smoothies
• Add nut butter, dairy-free yoghurt, dairy-free cream and/or dairy-free/ice cream to milkshakes.
• Add a drizzle of syrup, e.g. maple syrup or golden syrup to porridge, milkshakes or desserts

If you are overweight, the time immediately after surgery is not usually the time to lose weight. It is important to maintain a balanced diet so that your body continues to get all the nutrients it needs. Restricting your intake too much could lead to losing muscle mass, delay wound healing and delay your recovery.

We recommend, eating to maintain your current weight and muscle strength until you fully recover, before addressing your weight. Additionally, eating to gain extra weight is not recommended as this can make it more difficult for you to move around and could affect the equipment you have been provided with.

Websites you can look at to help you lose weight once you have fully recovered, include:

• British Dietetic Association: www.bda.uk.com/resource/weight-loss.html
• NHS: www.nhs.uk/livewell/goodfood
• Change 4 Life: www.nhs.uk/Change4Life

Once you have fully healed, you should go back to a healthy, balanced diet, following the Eatwell Guide. At this stage it is easy to gain weight rapidly, especially if you stay on a high energy/high protein diet and your physical activity levels are low.