General Considerations

As a result of surgery, the functional stomach is significantly smaller and its emptying pathway is also narrower.

1. It is very important that you stop eating or drinking at the very first sensation of fullness. This may present as pain in your stomach or chest, or the sensation of food ÒstickingÓ in the middle of your esophagus. The volume and the consistency of your diet will be advanced slowly as your tolerance increases.

2. It is important that you follow the dietary guidelines closely. If you exceed these recommendations, vomiting may ensue. If you do not drink to meet your minimum fluid requirement (6-8 cups of fluids per day), you may become dehydrated. Sip, do not gulp liquids, and always eat slowly.

3. Dumping Syndrome: This is a condition caused by the rapid infusion of concentrated sugars into the small intestine from the stomach pouch. After eating concentrated sugars you can develop nausea, vomiting, stomach cramping and pain, loose stools, dizziness, flushing and/or sweating. To avoid Dumping Syndrome do not ingest foods with a high sugar content (ie cake, cookies, candy, pies, pudding, etc); especially in liquid form (ie sweetened beverages) because liquids will more rapidly enter the small intestines. The total amount of sugar you take in is less important than the rates you ingest it. If dumping does occur, the symptoms will improve over several hours. If severe symptoms persist, call your surgeon. One way to avoid dumping is to not drink fluid with your meals, but rather drink fluids 30-45 minutes AFTER MEALS so that food will more slowly reach the intestines.

4. You will need to get a feel for what you can, and cannot, tolerate to prevent vomiting or dumping syndrome. Each individual is different. Introduce new foods slowly and see how you respond. If you do not tolerate certain foods, avoid them for a week or two, and then retry them. Specifically, avoid highly spicy, seasoned, or gas forming foods such as broccoli, cabbage, onions, and garlic in the first few months. You may gradually reintroduce them into your diet after several months, as tolerated.

5. Pills ingested must be less than one half inch in diameter. Larger pills need to be crushed or broken in half. Ask your surgeon if you have specific concerns regarding your medications.

6. Avoid aspirin and anti-inflammatory medications unless approved by your surgeon. Examples include: Ibuprofen (Advil, Motrin), Naproxen (Aleve. Naprosyn), Celebrex and Relafen. These medications will irritate and may cause bleeding from your new stomach pouch.

7. A Multi-Vitamin with Iron should be taken every day to provide you necessary vitamins and minerals. A pill may be taken, but must be less than one half inch in diameter. Chewable Vitamins are often well-tolerated. Liquid vitamins are available but often are unpalatable.

8. Avoid carbonates beverages. The bubbles will fill you up much too quickly.

Other Issues

REMEMBER TO TAKE YOUR MULTIVITAMIN EACH DAY!

Other Important Nutritional Considerations:

PROTEIN:  During your weight loss, you will lose both fat and lean body mass regardless of protein intake. You should eat balanced meals that include protein, carbohydrate and fat. A minimum of 60 grams of protein per day is required, but more may be required depending on your individual needs. While you may not be able to achieve the minimal protein requirement in the first few weeks after surgery, close supervision by a Registered Dietitian is important to help you avoid long-term protein deficiencies.

Tips For Increasing Protein

Note: The elements and vitamins listed below are very hard to obtain in sufficient quantities when ingesting the kinds and quantities of food available after bariatric surgery. Although it is wise to follow the suggestions given to maximize your intake, it is very important to remember the importance of dietary supplementation as prescribed by your doctor or dietitian.

CALCIUM:  This is usually absorbed in the duodenum (which is bypassed after the operation). Over time the remaining bowel will adapt and absorb nutrients in adequate amounts, but the risk of deficiencies may persist if you do not consistent consume enough calcium. At least 400 IU of Vitamin D must also be included in your vitamin/mineral supplements for optimal calcium absorption. Milk and dairy foods (cheese, yogurt) are the best sources of calcium. Depending on your ability to consume dairy products after surgery, an additional 500-1000 mg of calcium may be prescribed for you.

Calcium Sources

IRON:  A multiple vitamin with iron daily should provide you with an adequate amount of iron. Since absorption can be reduced, an additional iron supplement may be required depending on your blood values. Women will generally need this extra supplement to offset the iron they loose due to menstrual bleeding. Men can ordinarily limit themselves to the iron in the multivitamin.

Iron Sources

B12:  Clinical B12 deficiencies are rare after surgery, but they are possible. Routine blood level tests by your internist/primary physician or surgeon can be performed to check your B12 levels. While a multivitamin/mineral contains some B12, an additional 500-600 mcg is recommended.

B12 Sources

FOLIC ACID:  Folic Acid is a vitamin that, along with vitamin B12, is essential to the formation of red and white blood cells. It helps prevent birth defects during pregnancy and to prevent heart disease. Since absorption of Folic Acid may be impaired with gastric bypass surgery, supplementation of 800-1000 mcg of folic acid is recommended. This is particularly important for the female patient.

Folic Acid Sources

GALLSTONES:  During the period of rapid weight loss your gallbladder is prone to develop gallstones. After surgery, patients who still have their gallbladder are prescribed a medication for 6 months to prevent or reduce the likelihood of gallstone formation (Actigall 300 mg tabs twice a day).

PREGNANCY:  It is recommended that women of childbearing age not get pregnant for 1 to 2 years following surgery. This is because of the continued rapid weight loss that occurs during this period. Although there is no clinical evidence, it is thought that carrying a child during a period of rapid weight loss may not allow the child to receive adequate nutrition and therefore may affect his or her development. It is recommended that after surgery, women of childbearing age use a barrier form of contraceptive for a 1 to 2-year period.