Most Common Questions after Bariatric Surgery
Once you are through your initial post-op phase and diet, there are common questions that patients want to know about. Willamette Valley Medical Center Weight Loss Surgery has compiled a few of the most common questions about recovery for you.
In addition, it is good to participate in the support groups because quite often, common interests and topics are discussed. If any of these are problematic, please be sure to discuss with your surgeon.
Almost everyone at one time or another has experienced constipation but there is a difference between occasional and chronic constipation. Chronic constipation means that you are continually having 3 or less bowel movement(s) per week. They are hard and dry and may even be painful to pass. There are many things you can do to get more regular. Proper hydration as well as fiber and regular exercise can help keep things moving.
Drinking 48-64+ ounces of fluid from water and other non-caffeinated, calorie free liquids each day is adequate for most people, however if your mouth and lips feel dry, if you feel fatigued or have a headache, you may be dehydrated and therefore should increase your fluid intake. To maintain hydration, keep fluid with you at all times and continually sip on it throughout the day.
Fiber from whole grains, fruits and vegetables and from fiber supplements will help you maintain regularity. The recommendation for older children, adolescents, and adults is 20 – 35 grams per day. After weight loss surgery with your reduced portion sizes and decreased meal frequency, it may be challenging for you to be able to eat that much fiber. Some suggestions for increasing the fiber in your diet are:
- 100% whole wheat breads (toasted) and crackers
- High fiber cereals – 5 or more grams of fiber per serving such as bran flakes
- Beans, lentils and split peas
- Whole fruits and vegetables (not juice)
If you decide to add a fiber supplement, consider your options. Fiber supplements come in many different forms. You may choose capsule or pill form, chewable tablets and wafers, and powders. Other things to consider when choosing a fiber supplement:
- Grams of fiber per serving – some products are higher in fiber therefore you will need to take less.
- Calories per serving – most wafers are higher in calories than capsules, tablets and powders.
- Does it thicken? Avoid powder fiber supplements that thicken once it is mixed with a fluid as you never want to be in a rush or drink more than you should at one time.
- Are there any added benefits to my fiber supplement? For example, if a fiber supplement is made from flax, you not only get the fiber but you are also getting omega-3 fatty acids.
Adjusting to a new way of eating is easiest to do when you’re preparing your own meals at home. However, it is possible to enjoy eating out after gastric banding surgery and still follow your dietary guidelines.
Tips for Dining out After Bariatric Surgery:
- First and foremost, don’t feel pressured to eat like everyone else. Other diners may order larger portions or unhealthy meals—don’t let that deter you or make you feel bad for choosing to eat with your surgery.
- Even if they are free and on the table, avoid foods that may be difficult to swallow, such as bread, and fibrous vegetables like asparagus. If you haven’t had a successful experience with a certain food at home, it might be best to avoid trying it for the first time at a restaurant. Steak if ordered is best if done medium or medium rare and remember to chose the most tender cuts (usually a tenderloin).
- Substitute side dishes. Instead of ordering the customary French fries or mashed potatoes with your meal, ask for a salad or steamed vegetables. Most restaurants offer these substitutions at no additional cost.
- Ask for all dressings or sauces to be served on the side.
- Know how your food is prepared, and avoid foods that are fried. Instead, choose meals that are grilled, baked, broiled, roasted, steamed, stir-fried, or poached. If the menu isn’t clear, ask your server how the dish is prepared before you order.
- Order smaller portions. Because you can eat less and feel satisfied, you may find that an appetizer or a meal from the children’s menu is sufficient. If a smaller portion isn’t available, then look at your food and mentally divide your plate. You’ll have left overs for lunch or dinner the next day!
- Ask for a to-go container at the beginning of your meal. If you do order a full-sized entree, it’s almost guaranteed to be more than you can (or should) eat in one sitting. Put half of the meal away for later so you won’t be tempted to clean your plate.
- Look for “light” menu items that are prepared without extra butter or oil.
- Only order an appetizer or dessert if you can share it with someone else.
- If you want to order an adult beverage, try a glass of red wine as a lower calorie alternative to heavy, mixed drinks and carbonated beers.
- If you are at a larger chain restaurant they can provide you with a nutrition information menu. Read it and choose foods with high protein content.
Finding a healthy meal at a traditional restaurant is usually easier than eating healthy at a fast food restaurant. If you do find yourself forced to grab a meal on the run, look for a deli that offers a lot of meat and vegetable options and the opportunity for you to customize your meal. If you absolutely must resort to a traditional “burger joint,” choose grilled or baked items instead of fried or breaded, and try swapping the fries for apple slices or a side salad.
After bariatric surgery, you will be unable to obtain sufficient amount of vitamins and minerals from your diet alone. There is a potential for developing nutritional deficiencies after any type of weight loss surgery and a deficiency can lead to permanent neurologic and physical damage. Please take the recommended vitamin and mineral supplements each and every day and have your labs drawn as directed.
There may be many reasons as to why you are experiencing heartburn. What you are eating may be causing the heartburn. Avoid caffeinated beverages and spicy foods. Avoid overeating. Do not lie down after eating for at least 30 minutes to an hour.
- Go back on a liquid diet for 48 hours then slowly advance to soft foods then to solid foods. If you are also experiencing pain or if the vomiting persists while on the liquid diet, call the clinic.
- Chew food thoroughly and eat slowly
- Do not overeat
- Make sure foods are moist
- Avoid eating and drinking at the same time
Sugar alcohols, also known as polyols, are ingredients with fewer calories than sugar. They are used in a wide variety of products such as sugar-free gum or candy, toothpaste and mouthwash, ice cream, frozen desserts, frostings, yogurt, fruit spreads, breath mints, and chewable/liquid vitamins. Sugar alcohols are neither sugars nor alcohols. This term is used because part of their chemical structure resembles sugar and part is similar to alcohols.
You can identify if a product contains a sugar alcohol by looking at the ingredient label (names of sugar alcohols are listed above) and by reading the “Nutrition Facts” panel as the amount of sugar alcohol it contains will be listed under the total carbohydrate. If a manufacturer uses the term “sugar free” or “no added sugar,” they must list the grams of sugar alcohols. If only one sugar alcohol is used, the label will list the specific polyol used. However, if more than one polyol is used, the term “sugar alcohols” must be listed.
For some people, consumption of certain amounts of polyols may cause gastrointestinal effects such as bloating, gas, and even diarrhea. If you experience these symptoms and suspect that you are sensitive to the amount of polyols you consumed, try reducing the amount you consume on a single occasion. It may take a few days for your body to adapt to the amount of polyols you are consuming.
Diarrhea may occur after surgery. If your stool is more than loose, i.e. watery and continuing to occur beyond the first 5 days after surgery, please call the clinic. You may experience diarrhea as a result of your body adjusting to the liquid diet and other consistencies of the diet as you advance. Other potential causes of diarrhea:
- Lactose intolerance
- Use of laxatives and/or stool softeners
- Lack of fiber
- Sugar alcohols such as Erythritol, Mannitol, Sorbitol, Xylitol, Lactitol, Isomalt, Maltitol, Hydrogenated starch hydrolysates
- Avoid high sugar, high fat and spicy foods
- Limit caffeinated beverages
- Do not drink fluids with meals
It is normal to have some air in the digestive tract (the esophagus, stomach, small intestine and large intestine) as some air is swallowed while the process of digestion produces some air. Many people think that they have too much gas when they really have normal amounts. Most people produce 1-4 pints of gas per day and pass gas about 14 times per day.
The air that is swallowed may be from eating or drinking rapidly, carbonated beverages, gulping, gasping, sighing, talking, chewing gum and smoking. Burping is the way that most air leaves the stomach. The air that is left will travel through the digestive tract until it is released as flatulence.
The breakdown of carbohydrates in the digestive tract such as sugars (lactose from dairy, fructose from fruit and fruit juice), starches (potatoes, corn, noodles, grains) and soluble fiber foods (beans, peas, fruits and oat bran) will lead to an increased production of hydrogen, carbon dioxide and methane gases that need to leave the body through the rectum.
The most common ways to reduce gas is to drink beverages slowly, do not use a straw, chew with your mouth closed, and limit conversations when eating and change your diet.
In order to change your diet, you first need to identify the foods that are causing you gas. Because the amount of gas produced varies from person to person, you will need to keep a record of what you eat. This will help you to determine which foods cause the gas and then you can vary the amount of that food you eat to see how much you can tolerate. For example, if lactose intolerance (lactose is a type of sugar found in milk products) is suspected of causing the gas, you will probably have to limit your consumption of dairy products and/or take the enzyme lactase (caplet or chewable tablet) just before eating dairy foods.
Some doctors may suggest limiting foods that cause gas but this may mean that you are cutting out healthy foods such as fruits, vegetables and whole grains. You want to be able to eat a healthy diet, one consisting of a variety of foods so keep a food journal, identify the offending food(s) and learn how much you can tolerate.
You may also want to look at your total intake of sugar alcohols as these can contribute to abdominal gas, bloating and diarrhea.
Hair thinning/hair loss may occur in the first few months after bariatric surgery, as is true with any surgery. After six months post-surgery, nutritional deficiencies (or excess) may be contributing to continued hair loss. Please make sure that you are following the long-term vitamin and mineral supplement recommendations given to you by the dietitian. Second, please make sure that you are following the guidelines for having your labs drawn after surgery to assess for deficiencies. Last, make an appointment for evaluation.
Hiccoughs are very common and almost everyone has experienced them. Hiccups involve the involuntary contraction of the diaphragm, which is the sheet of internal muscle that extends across the bottom of the rib cage. The diaphragm separates the thoracic cavity (heart, lungs & ribs) from the abdominal cavity and performs an important function in respiration (breathing).
The most common triggers of short-term hiccups are eating too much, drinking carbonated beverages, excessive alcohol consumption, sudden temperature changes and excitement or emotional stress. To avoid hiccups avoid eating too much. Eat slowly and chew each bit thoroughly so that you may identify signs of satiety before over eating. Also avoid carbonated beverages and temperature changes in beverages or foods consumed. For instance, avoid drinking hot tea and ice water at the same time.