Bariatric Surgery is the most effective treatment against obesity and is being recognized as a potentially valuable tool in the fight against diabetes related to obesity. Significant weight loss has been observed as a result of the surgery but latest study has shown an association of obesity with bone loss, with or without surgery. The more invasive the surgery heightened the bone turnover and the associated bone loss.
The bone loss can be caused as a result of:
- Rapid weight loss
- Absorption of fewer vital nutrients like vitamin D and calcium
- Change in hormones released by fat and the gut and their impact on the central nervous system.
The first four to six weeks after bariatric surgery are about healing and transition to solid foods. The top of your stomach is swollen where the band has been placed and needs time to heal into position. Eating solid food at this time does not allow adequate resting time, may cause discomfort, and can lead to vomiting. This can irritate the stomach and tear the sutures (stitches). It is important to go through the reintroduction of food in phases:
No matter which type of surgery you have, one of the most important things to remember is to advance at your own pace. The guidelines for dietary progression are:
- Week 1: Clear Liquid
- Week 2: Full Liquid
- Week 3: Pureed Diet
- Week 4-5: Maintenance Phase I
- Week 6: Maintenance Phase II
Dietary Guidelines after Bariatric Surgery
Eat balanced meals with small portions: After surgery patients are advised to take a diet of liquid or puréed food for 2 or 3 weeks. With slower add-ons of soft foods, and then regular food. This is because your new stomach pouch holds only a tablespoonful of food at first, about the size of a walnut.
Drink up to 8 cups of water or other calorie-free liquids every day. Fluid intake needs to be closely monitored by not drinking anything for 30 minutes after intake of food. Minimal intake of fluid while eating in order to maximize intake of healthy food. Take small sips when you are drinking. Do not gulp.
Follow a diet low in calories, fats and sweets. Base your diet on low-fat protein choices including skinless chicken, lean beef or pork, fish, whole eggs or egg whites, beans, and dairy products to promote healing. These include low-fat or nonfat hard cheeses, cottage cheese, milk, and yogurt. The daily protein goal is 60 grams for gastric banding and 60-80 grams for gastric bypass. Eliminate foods such as raw fruits and vegetables, chewy breads, fibrous cereals, popcorn, whole beans, nuts and tough meats. Rice and pasta need to be well chewed or avoided.
Keep a daily record of your food portions and of your calorie and protein intake. Keep a daily food journal to record food in-tolerances as well as emotional triggers that can result in food cravings and overeating.
Eat slowly and chew small bites of food thoroughly. Food should be chewed to the consistency of applesauce. Cooking and mashing the food may help you tolerate the consistency. Continue to sip water between meals, consuming at least 64 ounces a day.
Avoid rice, bread, raw vegetables and fresh fruits, as well as meats that are not easily chewed, such as pork and steak. Ground meats are usually better tolerated.
Do not use straws, drink carbonated beverages or chew ice. They can introduce air into your pouch and cause discomfort.
Avoid sugar, sugar-containing foods and beverages, concentrated sweets and fruit juices.
For the first two months following surgery, your calorie intake should be between 300 and 600 calories a day, with a focus on thin and thicker liquids. Your daily caloric intake should not exceed 1,000 calories.
Multivitamin Intake: Chewable and liquid multivitamins (B12, Folate, vitamin A, D etc.) are the most easily absorbed, and are recommended after all bariatric surgery procedures. They are also less likely to cause heartburn and ulcers after gastric banding and gastric bypass surgery. Do not take calcium with your iron supplements as the two interfere with one another. Calcium and iron should be taken at least two hours apart. There are many companies that manufacture supplements specifically for people who have had bariatric surgery. See if there is a specific product line that your surgeon recommends. These supplements will likely be needed for the rest of your life.
Most Important: Keep your Diet Simple. Every day should be a reflection of a new attitude that you’re important and your health matters.