Total gastrectomy, whether for cancer or as a risk reducing measure, often results in nutrition-related complications such as weight loss, dumping syndrome, fat maldigestion, various micronutrient deficiencies, and malnutrition. Common immediate, medium and long-term complications will be covered, in particular their impact on nutritional status and quality of life. Dietary modifications and other treatment strategies will be discussed, with a particular emphasis on psychosocial considerations. Most patients can achieve a satisfactory quality of life; however close monitoring by an experienced dietitian is required. In contrast to many other prophylactic operations, which do not have significant long-term consequences, the decision to undergo risk reducing gastrectomy should be made after consultation with a nutritional expert, and ideally, discussion with other patients who have undergone total gastrectomy.