Weight-loss surgery is the most effective and durable obesity treatment available, according to the American Society of Metabolic and Bariatric Surgery. No matter which surgery you have--the adjustable gastric band and the gastric bypass are the most common--meeting your nutrient needs post-operatively can be a challenge. The American Dietetic Association outlines the goals of the bariatric diet: maximize weight loss and nutrient absorption, maintain hydration and avoid symptoms of intolerance.
Diet Progression
Post-operative nutritional guidelines were published in 2008 by the ASMBS, in "Surgery for Obesity and Related Diseases." The first stage consists of clear liquids, such as sugar-free flavored water, diluted juice or broth. Mix protein powder with these liquids or use pre-mixed protein supplements. Next, start to add full liquids, which appear opaque, or milky, such as protein shakes or thin cream of wheat. Pureed foods are smooth, moist and easy to swallow. Blend refried beans, scrambled eggs, fruit and other foods to a single consistency in your food processor. In the next stage, start to add soft foods like tofu, tuna salad, soft fruits without the skin and well-cooked vegetables. The final stage is a regular diet, in which you will gradually add new foods in small amounts.
Protein Needs
All weight loss surgery patients are at risk for protein deficiency, state the authors of the ASMBS guidelines. Most surgical programs recommend a daily range of 1 to 1.5g of protein per kilogram of ideal body weight. With meal sizes of ¼ to ½ cup, it is difficult to meet this range without modular protein supplements. Soy, egg white and milk-based products contain all of the amino acids that your body can't make. Although derived from milk, whey protein isolate is well-tolerated, as it is virtually lactose-free. Protein supplements come in the form of clear liquids, shakes, powders and bars.
Fluid Needs
Consume ¼ cup of sugar-free, non-carbonated water every 15 minutes, advises the ADA. Avoid drinking at meals to prevent vomiting and dumping syndrome. The ADA recommends that you wait 30 minutes after a meal before drinking fluids. Duke University Health System lists examples of acceptable fluids: water, sugar-free popsicles and drink mixes, juice diluted 50/50 with water, broth and unsweetened decaffeinated coffee or tea.
Vitamins and Minerals
Lifelong supplementation is necessary after bariatric surgery to avoid deficiencies. ASMBS recommends that you start with chewable or liquid forms and progress to tablets, as tolerated. You'll need a daily multivitamin with 100 to 200 percent of the daily value for 23 vitamins and minerals. Calcium citrate and vitamin D supplements are imperative to prevent bone disease. After more invasive surgeries like the gastric bypass and the vertical sleeve gastrectomy, additional vitamin B12 and iron are recommended. Your registered dietitian may advise you to take a vitamin B complex, or B-50 supplement. Highly malabsorptive surgeries such as the biliopancreatic diversion/duodenal switch require additional supplementation of fat soluble vitamins A, D and K.
Symptoms of Intolerance
The potential for vomiting is greater within the first few months of surgery, according to a 2005 article by Ken Fujioka, M.D. in "Diabetes Care." You can help prevent vomiting by eating small amounts of food slowly, and chewing it thoroughly. Dumping syndrome is common after gastric bypass. Fujioka describes the uncomfortable phenomenon as an osmotic overload in the small intestine when high-sugar foods are consumed, or when fluids are combined with a solid meal. Duke University Health System provides a list of foods that may cause intolerance. Be especially cautious with fresh bread, sticky rice, over-cooked pasta and fruit and vegetable skins.
Nutrition Follow-Up
The best way to ensure that you are meeting your nutrient needs is to have regular follow-up with your registered dietitian. She may ask you to keep a log of what and how much you eat, and of the supplements you are taking. You should have laboratory values checked at regular intervals to rule out deficiencies. Your surgery center may provide a list for you to take to the lab.
References
- American Society of Metabolic and Bariatric Surgery: Bariatric Surgical Society Takes on New Name, New Mission and New Surgery
- "Surgery for Obesity and Related Diseases"; ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient; L. Aills, Blankenship, C. Buffington, M. Furtado, J. Parrott; Mar. 2008
- "American Dietetic Association Nutrition Care Manual"; Bariatric Surgery Nutrition Prescription
- American Dietetic Association: Bariatric Surgery Soft Nutrition Therapy
- "Diabetes Care"; Follow-up of Nutritional and Metabolic Problems After Bariatric Surgery; Ken Fujioka; Feb. 2005
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