Bariatric surgery, also called weight loss surgery is a well recognized way for patients who suffer from morbid obesity to lose weight.
Gastric bypass surgery works by limiting the amount of food that a person can eat, thus allowing the body to burn all the fat to produce the energy that it requires.
After having had bariatric surgery the quality of your diet is crucial.
- The procedure results in a limitation of your intake of foods. Therefore, the foods that are taken should contain all the nutrients that are necessary.
- Optimal healing after surgery requires additional nutrients.
- To make matters even more complicated, bariatric surgery may increase sensitivity to certain foods or ingredients.
Following bariatric surgery, patients need to observe a special diet and need to alter their meal plan fairly remarkably.
This is essential to maintain muscle mass and strength, prevent hair loss and maintain skin health and organ function.
The diet is initially very small as the size of the new stomach is small – this will gradually get bigger and diet portions will get bigger too, with time.
Read on to learn what foods are essential and in what quantity they need to be consumed.
High nutritional foods, especially high protein foods and beverages are essential after bariatric surgery. Also a multivitamin, calcium, iron, vitamin B12, and vitamin D supplements are recommended.
The Post Bariatric Surgery Diet
Individual food groups
- Protein intake. Maintaining a high protein intake is essential and is the most important step following bariatric surgery. Protein is essential to maintain muscle mass and can be obtained through meat, eggs, seafood, milk (and milk products) and pulses. We have already mentioned how minced (or ground) meat is better suited for patients as it is better digested. All these foods can be consumed and the aim should be to consume around 70 to 75 gm of protein a day. Most of these foods that are available in the supermarket will have their nutritional facts on them, so the right amount to eat can be easily calculated.
- Fluid intake. One of the common concerns following bariatric surgery is dehydration. Patients are recommended to increase their daily fluid intake – be it water or any low calorie drink. At least 8 cups of water a day is strongly recommended. Alcohol intake should be limited or should ideally be stopped. Many a time, the amount of alcohol that is absorbed can be a lot more and a lot faster, and its effects can be unpredictable. Furthermore, alcohol contains a high amount of calories, and can easily result in too many calories a day being consumed.
- Vitamin and mineral supplements. A large amount of the vitamins that are present in our food require the stomach to help break them down so that they are absorbed into the system. So it will come as no surprise that following bariatric surgery, patients are at risk of developing vitamin deficiencies. This is easily treated with vitamin supplements. These days, multivitamin and mineral supplements are easily available at the local drug store or supermarket. High concentration chewable multivitamin supplements – around 2 tablets a day everyday for 3 months should be taken. It is recommended that around 1000 IU of Vitamin D, 2 gm of Calcium and 500 microgram of Vitamin B12 be taken every day, in divided doses if required. Patients may also benefit from vitamin B complex, iron and folic acid supplements as these can help prevent patients from becoming anaemic.
- Fat and sugar intake. Foods that are high in fat and sugar are ideally avoided. Consumption of high sugar foods can cause a condition called dumping syndrome. High fat foods mean higher intake of calories which do not help in any way when it comes to losing weight. These days, sugar-free foods are easily available as are foods that are low fat. If eating meat, try skinless chicken and ground lean meat.
Why You Need These Supplements To Stay Healthy After Weight Loss Surgery
Weight loss surgery can render you weak and that is why you may need supplements each and every day. Taking vitamins and minerals is highly recommended because if you don’t, you will run the risk of malnourishment.
The reason behind this is that weight loss surgery or the gastric bypass surgery will lower your digestibility and absorption of essential nutrients.
This PubMed study, , shows that patients risk serious nutritional problems when they do not take required supplements after surgery.
Vitamins and minerals that are commonly deficient in this circumstance include vitamin B(12), calcium, vitamin D, thiamine, folic acid, iron, zinc, and magnesium.
A multivitamin is a must every day. Along with that, it is highly advisable, and confirmed by studies, that you take calcium supplements, iron supplements, vitamin B12 supplements, and vitamin D supplements.
You should start right from the day you reach home after surgery. Here is more information about each supplement that’s recommended.
A chewable multivitamin supplement should be taken twice a day if you had a bypass surgery or just once if you had band. This is specifically during the phase one diet when you are strictly asked to consume only liquids.
When you move onto the phase two diet, which consists of soft food, you can take these supplements with your meals. When you enter phase 3 diet, mostly after three months, you can choose non-chewable supplements.
Better not take both the tablets together. You should take one supplement with breakfast and the other with lunch for maximum absorption of the important nutrients.
It is essential for gastric bypass patients to take a good multivitamin because B-12 needs folic acid to be absorbed by the body
Multivitamins contain only trace amounts of calcium and that is the reason why you should take separate calcium supplements. 1000mg to 1500mg of calcium is recommended every day.
You should start taking these supplements when you start eating soft foods. Chewable supplements are the best in this case because the non-chewable counterparts are generally really large. You might face a problem swallowing them.
Calcium comes in various forms including calcium citrate and calcium carbonate. The prior is the best bet because calcium is absorbed best from calcium citrate especially after the bypass surgery.
If you really want to use non-chewable supplements, you should wait until you can actually swallow solid pills with ease. You should split the dosage into 500mg – 600 mg and take two pills per day. Just like multivitamins, you should take the doses separately with separate meals.
Here, please note that you should never take iron and calcium supplements together. You should give a gap of at least a couple of hours. If you take them together, they will hinder each others’ absorption and you won’t be benefited at all.
Iron deficiency is one of the most common deficiencies seen following gastric bypass surgery.
Iron pills should be taken during your phase 2 diet or when you start eating soft foods. Make sure the supplement you purchase is small enough so that you swallow it with ease. Chewable tablets are also available.
Please note that you might face side effects such as constipation and nausea while taking these supplements. Thus, you should go for ferrous gluconate, ferrous sulfate, or ferrous fumarate only. These are the ones that allow easier absorption.
If the side effects continue, take the supplements every alternate day instead of taking them every single day.
As aforementioned, please don’t take these supplements with calcium supplements. Give a gap of at least two hours so that both are absorbed efficiently.
Taking the iron supplement with food is a good idea. Try including foods rich in vitamin C such as vegetables and fruits for even better absorption.
Vitamin B12 deficiency occurs in 25% to 75% of gastric bypass patients after surgery. B12 supplementation is recommended for all patients since long-term B12 deficiency can cause irreversible neurological damage.
Vitamin B12 stands apart from the other vitamins in digestion and absorption. The gastric bypass surgery will not allow you to digest this vitamin properly. This is the reason why you need to take the vitamin such that it directly enters your blood. This can be done in three ways:
- You can go to the physician once a month for a vitamin B12 injection. Your doctor can give you a prescription for these injections.
- You can buy a nasal spray and use it weekly. Again, your doctor will write the prescription for you.
- You can take sublingual drops of a medication that will dissolve immediately. You will need to do this everyday. Daily requirement is 500 mcg. Every alternate day, you will need at least 1000 mcg.
Multivitamins and calcium supplements both have vitamin D but you will need more. That is why you should take 1000 IU of vitamin D per day. The vitamin D supplement pill is generally small but it’d be ideal to check before you purchase because the size varies with the brand.
Vitamin A deficiencies generally occur as a result of fat-soluble vitamins deficiencies. This is often due to a reduction of fat absorption. (vitamin A is a fat-soluble vitamin). Weight loss supplements with the ingredient orlistat (brand names Alli or Xenical) are also linked to vitamin A deficiencies.
Folate deficiency also frequently occurs in gastric bypass surgery patients.
Protein deficiency is a common risk. One of the biggest challenges after this surgery is to get enough protein. Your normal diet will not suffice in your protein needs.
Even with 6 meals a day you will most likely not get adequate amounts of protein. Also vomiting after surgery is common. Your GI tract has to adjust to the changes. That’s why most patients require protein supplementation during the early phases of rapid weight loss to prevent excessive loss of muscle mass. Also hair loss may occur as a result of protein deficiency.
One of the most popular proteins used after bariatric surgery is are the shakes and powders from . Nectar tastes sweet and is a whey protein isolate, which means that the fat and lactose are removed so it’s very easy to digest.
Another well-received, fast-absorbing protein among weight loss surgery patients is Allmax Nutrition Isoflex.
I would also like to recommend a little book on all kinds of aspects of protein shakes. It has a ton of really tasty and healthy shake recipes but also explains very clearly how shakes work.
It’s called the and it provides so much valuable info, it’s a must have. Not only for bariatric patients but everybody who is concerned about their health.
Another essential supplement:
Gastric bypass surgery is known to cause imbalance in the gastrointestinal tracts. The disruption to your GI tract, along with antibiotics taken post surgery to prevent infections cause damage to the balance between good and bad bacteria.
That’s why probiotics (literally, pro life) are so important. Taking probiotics has several benefits which are backed by scientific research.
For instance, studies show that bariatric patients who take probiotics have significantly greater weight loss compared to those in non-probiotics control groups.
This initially unexpected side effect comes in addition to other benefits such as better health and gut flora. More specifically less chance on diarrhea as well as less chance on vitamin B12 deficiency and inflammation of the intestines (pouchitis).
Ask your doctor for advice. Different strains of probiotics exist and not all serve the same therapeutic purposes. Inform which probiotics are most suitable for your post-surgical needs.
Read more about the benefits of probiotics after surgery here.
Bariatric Surgery Diet Stages
There are a few different stages in which diets are reintroduced following bariatric surgery. More specifically gastric bypass surgery, the most commonly performed type of bariatric surgery.
- Liquid Diet. The first days your stomach has to heal so no food intake is allowed. After these days liquid foods can be taken. Sometimes protein supplements are taken as well.
- Pureed Foods Diet . This phase commonly takes about 2 to 4 weeks. Started when liquid foods have been tolerated well for a few days. In this phase protein supplements
are commonly added.
- Adaptive/Soft Solid Foods. After a few weeks of pureed foods soft solid foods can be added. In conjunction with the doctor.
- Stabilization Diet, Solid Foods. Generally after about 8 weeks. Built-up gradually.
General Post Bariatric Surgery Guidance
There are certain general guidelines that need to be observed when it comes to dieting following bariatric surgery. These include
- Following a low calorie diet that is devoid of sugary foods and fats.
- Eating small yet balanced meals – Avoid overeating. For the first 2 to 3 months after the surgery, it is recommended that the daily intake of calories does not exceed 500 to 600 Kcal achieved through a thick liquid diet. Following that, caloric intake should ideally be less than 1000 Kcal per day. Overeating can cause food to regurgitate back into the esophagus (food pipe) causing heartburn and chest pain.
- Maintaining a food chart or diary of some sort – This can help a patient keep track of their daily food and calorie intake. Keeping a record of the food consumed and the time it was consumed at can help control calorie intake.
- Patients can have difficulty tolerating foods such as raw vegetables and fruits and tough meats. This is because these are normally broken down into digestible material by the acid in the stomach, which no longer exists following the surgery. Using minced meat is recommended and is tolerated well.
- Avoid carbonated drinks as the carbonation in them can cause distension of the structures within the abdomen and may cause discomfort. Also, avoid drinking through a straw as this can introduce air into the new stomach pouch and cause discomfort.
- Do not rush through your meal. It is recommended that a patient take around 30 minutes or more to complete their meal. More importantly, over-eating is not recommended.
- Avoid drinking fluids when having food. This can fill up the patient and can result in too few calories being consumed. In fact, it is recommended that no fluid be consumed starting 30 minutes before consuming food, all the way till the end of them meal. This is because fluids can encourage the early passage of food through the stomach to the intestine and can cause the patient discomfort.
- Avoid snacking in between meals. This can add to the total calories consumed, and can over-distend the stomach, especially if there is food still there from the last meal that was consumed.
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Study on Importance of Vitamin A Supplementation After Bariatric Surgery
Apart from the above mentioned vitamins and minerals also a depletion of carotenoids is commonplace among weight loss surgery patients. A study titled Hypocarotenemia after bariatric surgery concluded:
The hypocarotenemia observed after bariatric surgery may compromise the availability of carotenoids to tissues and the vitamin A status, reducing the fat-soluble antioxidant capacity and constituting an additional risk factor for several clinical conditions. Given the emerging role of carotenoids in disease prevention, dietary advice on carotenoid-rich and fortified foods or the use of supplements in these patients should be considered.
Hypocarotenemia is excessive carotene in the blood, often with yellowing of the skin