Bariatric Surgery: Diet and Exercise

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What is “dumping syndrome” and how can I avoid it?

Dumping syndrome can occur in patients who’ve undergone a gastric bypass procedure or duodenal switch surgery. Dumping syndrome occurs when food leaves the stomach and enters the intestines too quickly; especially if these foods are high in simple sugar or fat. After having the gastric bypass or duodenal switch you will no longer have a sphincter, “a door” which regulates how much and how quickly food can leave the stomach. Once the food reaches your intestines, your intestines will pull water from other parts of your body in an attempt to dilute the concentration of sugars or fats in your digestive system. This process can create numerous symptoms. Dumping syndrome can occur while you are eating a meal or within five to ten minutes of finishing your meal. Dumping syndrome can be accompanied by diarrhea. 85% of gastric bypass and duodenal switch patients experience dumping syndrome at some point.

Early symptoms can include:

  • Abdominal cramping

  • Abdominal fullness

  • Cold sweats

  • Dizziness

  • Feeling faint

  • Nausea

  • Rapid heart rate

  • Warmth

  • Weakness

Late symptoms can be very similar to symptoms of having low blood sugar. These symptoms can occur 1 to 3 hours after the original dumping episode and can include:

  • Nausea

  • Shakiness

  • Weakness

Dumping syndrome prevention:

  • Avoid eating too much simple sugars and/or fat (5-7 grams of sugar should be tolerated)

  • Choose low fat foods

  • Eat slowly

Should I take iron supplements?

Yes. After bariatric surgery, it’s important to remember that multivitamins don’t usually contain enough iron to provide sufficient amounts. After surgery, you are at risk for developing vitamin/mineral deficiencies due to surgery as well as drastically reduced caloric intake. Therefore it is mandatory to commit to a lifetime of vitamin/mineral supplementation including 18-27 mg elemental iron daily or 325 mg iron sulfate three times daily. If you experience constipation, take iron with a stool softener.

Should I take calcium supplements?

Yes. Calcium is extremely important for good health, especially in women. Be sure your calcium supplements also contain Vitamin D, a substance that’s important in helping the body absorb calcium.

Should I drink alcohol after the surgery?

No. Postoperative alcohol use should be avoided as it can cause gastric irritation and lead to ulcer formation. Patients who have been through the procedure will notice that even relatively small amounts of alcohol can have a large impact, and quickly. Alcohol is highly caloric and may impede weight loss and/or maintenance. Doctors recommend that patients stay away from alcohol completely during the first year. After that, with your physician’s approval, small amounts of wine or an occasional cocktail may be enjoyed without harm.

Can I eat spicy or heavily seasoned foods?

The good news is that after about six months, such foods can be enjoyed by most patients without significant risk.

Will I need to watch my intake of salt?

Unless advised differently by your primary care doctor, you should be able to use salt.

I know I should eat enough protein. How much is right?

Sixty to 80 grams of protein a day are generally sufficient. Check with your surgeon to determine the right amount for your type of surgery.

I’ve been told that I shouldn’t consume much red meat after surgery. Why not?

Tough or dry meats such as steak can be difficult to tolerate early after surgery. Red meat carries a high percentage of gristle. When gristle isn’t chewed thoroughly it can block the outlet of your stomach pouch causing significant discomfort. For that reason, most patients should avoid red meat entirely – or at least for several months after surgery.

Should I avoid snacks between meals?

Yes. Snacking on fat-rich foods between meals can add hundreds of calories to your intake each day. It could also slow down your weight loss program. For many patients, keeping a bottle of flavored, sugar-free water nearby is the best way to stop the “snack-craving."

Are there any potential problems with consuming milk products?

Unfortunately, the answer is often “yes.” Because milk contains a sugar that isn’t easily digested (lactose), it remains intact until it reaches the lower bowel, where certain types of bacteria metabolize it. Depending on the individual reaction to lactose, some patients will experience gas, cramps and diarrhea after consuming even small amounts of milk.

How soon should I begin taking vitamins after the surgery?

You should begin multivitamin and calcium supplements about two weeks before your surgery. Remember that you should take the adult chewable version, and that they should be taken as directed.

Why do I need to drink large volumes of water?

It’s simple: when you shed excess pounds, your body needs to eliminate many waste products, and most of the elimination is carried out via urine. But these waste products can cause crystals to form in the kidney, resulting in painful kidney stones. Drinking plenty of water helps your body to eliminate effectively, protecting against stones. This strategy also helps promote weight loss. Water fills the stomach, triggering the “full” feeling that will help you eat less. Also, some patients experience sharp fatigue after surgery, frequently caused by dehydration. Staying properly hydrated is extremely important.

What are the best sources of protein?

Eggs, low-fat cheese and cottage cheese, tofu, fish, dark-meat chicken and turkey are all good protein sources.

How long will I have to forego solid foods after gastric bypass surgery?

About four weeks without solid foods is the usual recommendation from surgeons. A liquid diet will be required in order to promote healing. Diet progression is as follows:

Liquid diet to full liquid diet to soft/pureed foods to regular diet

Consult with your registered dietician and your surgeon to obtain dietary guidelines that will ensure the best possible outcome.

We’re here to help. Call 877-834-7264 for more information or to request an appointment with a bariatric specialist at MacNeal Hospital.