After Bariatric surgery, success is in your hands. The changes you make need to be lifelong commitments. Follow any instructions on nutrition and activity. Be aware that how you see yourself and how others see you may change. Turn to those close to you for support. They can help you adjust to your new life.
Most patients will experience rapid weight loss in the first few months after the operation. This of course, depends on how they use the tool to maintain intake of low calorie healthy foods. It is further influenced in a very strong way by whether or not they exercise with regularity.
In general, weight loss becomes maximal at 12 to 18 months after Bariatric surgery, 36 months after lap-band surgery. A patient’s weight then stabilizes or may increase slightly. It is not uncommon to gain back 10 or 15 pounds. Most people will lose 65 to 80% of their excess body weight after gastric bypass.
Example
A person who weighs 200 pounds more than ideal would be expected to lose 100 to 150 pounds. This total overall weight loss is more variable after lap-band surgery. Individual discipline and effort influence the final result.
Although weight loss is a desired effect of this procedure, the true benefit is seen in over-all improvement of health. Many of the severe medical problems associated with obesity are diminished after bariatric surgery. 90% of people with diabetes, sleep apnea, GERD, hypercholesterolemia, or obesity hypoventilation syndrome experience major improvements in these medical problems. In fact, in most of these patients the problem is completely eradicated. Hypertension, arthritis, asthma, headaches and depression are other conditions that can be expected to improve after successful batriatric surgery. Overall, 95% of patients report that their quality of life has improved or greatly improved.
Hydration And Fluid Balance
The first priority is getting sufficient fluid to maintain good hydration. You need 48 to 64 ounces of fluid a day to maintain an optimal fluid balance. There is no upper limit on how much fluid you can drink. When your diet advances, it will be extremely important to time your fluid intake around your mealtime. You can drink liquids up until your mealtime, but avoid liquids during meals and for one hour after eating. By avoiding fluids after meals, you will decrease your risk of dumping syndrome and the food will be retained in the pouch to create the feeling of fullness (satiety).
Diet Progression After Bariatric Surgery
Week One
In the first week post bariatric surgery, you can drink any kind of clear liquids you desire without regard to meal timings. The clear liquids allowed include:
- Diluted apple, cranberry or grape juice
- Clear broth (chicken, beef or vegetable)
- Plain sugar-free gelatin
- Clear liquid supplements (Enlive)
- Sugar-free Popsicles
Your serving sizes should be approximately one-ounce. This will be all your new pouch will be able to hold initially. It is important to sip liquids slowly and stop sipping just as soon as you feel full to avoid overload. Remember to continue to include an adequate amount of plain water to prevent dehydration. The clear liquids can be counted as part of your 64 ounces of fluid.
Week Two
The second week post bariatric surgery, you can begin to include full liquids. Full liquids include:
- Smooth hot cereal (Cream of Wheat, etc.)
- Skim Milk
- High protein drinks
- Sugar-free puddings or custards
- Strained soup
- Any diluted fruit or vegetable juice
Your goal this week is to increase your protein intake to at least 30 grams per day. This can be accomplished through:
- The use of the suggested high protein powders and milk products.
- You can add protein powders to sugar-free puddings, soups, etc. To boost the protein content.
- Record your fluid, food and protein intake.
- Again, eat slowly and stop eating as soon as you begin to feel full to avoid overload.
- Always begin your meal with a protein source.
This will become one of your new eating habits to help ensure you get adequate protein in your diet.
Week Three
The third week post bariatric surgery, you may slowly begin to introduce soft pureed foods. These foods may include:
- Smooth sugar-free, fat-free yogurt
- Blenderized (pureed) meat, fish or poultry
- Cottage cheese
- Soft cooked eggs
- Pureed fruits and vegetables
Your protein goal should now be increased to 60 to 70 grams per day. To accomplish this you need to add two high protein drinks per day between meals. To boost the protein intake of the foods, you can mix in an unflavored protein powder. Again, you can drink up until meals, but do not drink during meals or until one hour after meals. If you drink fluids with your meals, your food, and all the nutrients it contains will be washed out of your stomach pouch and through your digestive tract before they have a chance to be absorbed. This is known as dumping syndrome. You may not feel hungry, so time your meals and fluid intake.
Example:
- Eat breakfast at 7:00 am, begin drinking fluids at 8:00.
- Then lunch at noon, begin drinking fluids at 1:00.
- Eat dinner at 6:00, and begin drinking fluids at 7:00.
Again begin each meal with a protein source and stop eating just as soon as you feel full.
Eat slowly! Chew Foods Well! Mealtimes should last 30 minutes. Avoid foods with lumps or fibers that can cause blockage of the small openings from your esophagus to your stomach pouch and from your stomach pouch to the duodenum.
Week Four
Your dietitian will give you additional instructions regarding diet progression and long-term goals to maximize your success at your first post-surgery visit.
Concepts:
- Advance to solid food
- Very small bites
- Chew food well
- Protein
- Separate Liquids and Solids
- Exercise
Foods must be well chewed to a mushy consistency before swallowing. Cut each bite up into small pieces no bigger than a dime. This includes finger foods to gauge the size of your bites. Bites that are too large may lead to overload and/or outlet blockage that can lead to hours of pain and discomfort.
Eat three meals per day:
At least 1/2 of each meal should be high quality protein. Your pouch can only hold 1-2 ounces of food at one time. If you still feel hungry after eating one ounce of food, wait 10 minutes, monitor your hunger cues, and if still hungry, eat another ounce of food. If you repeatedly challenge the capacity of your stomach pouch with larger quantities of food than it can hold, you will stretch your pouch and defeat the purpose of thebariatric surgery, interfering with long-term weight loss.
Watch your calories
You will defeat the purpose of the bariatric surgery if you eat high-fat, high-calorie foods and interfere with weight loss. Always select low-fat, low-calorie foods. You will gradually be able to increase the amount of food you can eat. Use the basic four food groups as your guide, always eating protein first.
Meals should take 30 minutes to eat. Eat slowly and chew well. Stop eating as soon as you begin to feel full.
Beverages
The use of caffeinated and carbonated beverages and alcohol is discouraged. These substances can irritate the small gastric pouch. Small amounts of weak decaf tea, herbal tea or decaf coffee are okay. Non-carbonated, sugar-free beverages such as Crystal Lite are also okay.
Do not smoke
General Tips
You may not feel hungry, so it is necessary to take your meals by the clock. Meal timing is important so you can plan your fluid intake.
Overload
If you feel uncomfortably full, stop drinking or eating until the feeling goes away. When you feel nauseated wait until the nausea resolves before resuming food or beverage intake. If the nausea lasts 15 minutes or more, your stomach pouch is sending you a strong message to stop any further intake by mouth. Wait two hours before you attempt to eat or drink anything. Reintroduce intake slowly. You may want to begin with some clear liquids at first and slowly advance to full liquids. Evaluate your food/beverage diary for any possible food intolerances or over consumption that may have caused the nausea.
If food is not well chewed or pureed, you may block the outlet from your stomach pouch and your pouch overstretches. Even very tiny pieces or fibers of food can result in blockage. Fullness and nausea will follow and can progress to pain. Heartburn can result as fluid backs up and as the lower esophagus stretches. If you do experience pain, it is usually felt in the front just below your breastbone but can also radiate through to the middle of your back. If this happens, you should stop all intake by mouth, remembering to spit out saliva, sit down and try to relax. The pain should go away in 10 to 30 minutes. Vomiting may help, though not recommended. If the pain persists or reoccurs frequently, notify your physician.
Tip: To avoid blockage make sure any foods eaten are pureed smooth or very well chewed. Take very small bites and chew your foods thoroughly, until a very smooth consistency is achieved before swallowing. Eat slowly! Your mealtimes should last around 30 minutes. You will feel satisfied and full very early resulting in skipped meals.
Heartburn
Some persons experience the sensation of heartburn after their bypass. In the first few days this may be due to previous heartburn irritation. If you experience heartburn after the first few days it may be caused by overload of your stomach pouch. Antacids will not solve the problem, they will only add to the stomach overload. Ingesting anything will make the heartburn worse.
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Constipation and Diarrhea
If you become constipated, use a stool softener daily. Our physicians recommend taking 1/2 to 1 ounce mineral oil as needed.
Diarrhea typically is not a problem following gastric bypass surgery. If diarrhea does occur, it may be caused by the lack of smooth muscle coordination of the large bowel. The diarrhea should resolve in 7 to 10 days post-operative. Diarrhea may also occur if you also had your gallbladder removed. The bowel must become accustomed to having bile present all the time. About 30% of the patients do have some diarrhea initially following the removal of the gallbladder. The diarrhea is caused by bile intolerance and will resolve over time.
Vitamin Supplementation
Use chewable or liquid multivitamins. Take one in the morning and one in the evening. Avoid taking with liquids as the vitamins may be washed through before they have the chance to be absorbed. If taking children’s vitamins (Flintstone’s or Centrum Kids plus calcium, etc.) you will take two in the morning and two in the evening. Read the label carefully. Make sure it contains more than 100% RDI for all vitamins and minerals. Calcium in the form of Tums (2-3 per day) is also recommended to prevent bone loss. Additional B12 Thiamin or Folate supplementation may be recommended if your blood tests indicate deficiencies. Our physicians or your primary care physician will monitor your blood work at follow-up visits for any deficiencies that may develop.
Medications
Do not take aspirin or other anti-inflammatory medications after bariatric surgery. Consult with your physician for appropriate medications, if needed.
Exercise
Exercise burns calories and counteracts the fall in basal metabolic rate that occurs when your food intake is minimal. Aerobic exercise will help increase your basal metabolic rate. Your physical therapist will advise you on the type and duration of exercise that is right for you.
Treatment of Symptoms After Gastric Bypass:
- Eat slowly (30 min. each meal)
- Chew thoroughly
- Avoid high-fat foods and refined carbohydrate (sugar) foods
- Portion foods in 1-ounce cups to avoid overload
- Avoid dry foods
- Consume 48 to 64 ounces of fluid per day
- Add soy sauce or tomato juice to meat to add sodium
- Drink bouillon as a portion of between meal liquids
- Constipation
- Limit intake of cheese and peanut butter
- You may use 1/2- to 1-ounce of mineral oil as needed
Foods to Limit or Avoid
- Block cheese – high in calories and fat, choose low fat cheeses instead or use cheese as a garnish on other foods.
- Peanut butter (high in fat)
- Tough meats (hard to chew, may block outlet)
- Membranes of citrus fruits (again, danger of fibers blocking outlet)
- Seeds and skins of fresh fruits and vegetables (may block outlet)
- Fibrous vegetables (string beans & celery etc. – may block outlet)
- Spicy foods (may irritate new stomach pouch)
- Fried foods (high in calories and may irritate new stomach pouch)
- Popcorn (may block outlet)
- Nuts & Seeds (limit as they are high in fat and some may block outlet)
