Bariatric Surgery

(Weight Loss Surgery)

Bariatric Surgeries or Weight Loss Surgeries result in weight reduction caused from the restriction one is able to consume, the decreased absorption of one’s intake or a combination of both.  Restrictive weight loss surgeries limit the consumption portion by reducing the stomach size.  A malabsorptive procedure surgically re routes and ‘bypasses’ a section of the small intestine.  This results in the food passing through a smaller segment of intestine and decreased absorption of calories and nutrients.  Some weight loss surgeries are a combination of food restriction and malabsorption.  No matter what type of surgery you have had or are having, it is important to remember that permanent dietary and lifestyle modifications must be made for a successful weight loss and long term maintenance.  The surgical and lifestyle changes often lead to decreased nutrition being consumed and absorbed.  To avoid malnutrition, it is vital to consume foods of superior nutritional quality and follow the supplement regimen set by your Registered Dietitian and/or Surgeon.

Common Post Surgery Nutrition Complications

Protein is essential for—

·        Muscle building and repair

·        Structure of red blood cells

·        Proper functioning of immune defense

·        Regulation of enzymes and hormones

·        Aids in wound healing, recovery time and decreased risk of infection

·        Prevention of or decrease hair loss

·        Good Protein sources include eggs, fish, poultry, lean meats, dairy products, nuts, dried beans, peas and soy products

A common recommendation of daily protein intake is approximately 1.5 g/kg of IDEAL BODY WEIGHT

Protein supplementation is typically required for the first 6 months after surgery (you are unable to consume enough food to provide adequate protein amounts).  However, many recommend protein supplementation with shakes for as long as weight loss is desired.  Approximately 20-30 grams of protein can be absorbed at 1 time; therefore, it is better to spread your protein through out the day and aim for a goal of approximately 50 grams total from protein shakes. 

**Recent research is indicating that individuals who use protein shakes/meal replacements long term appear to have better weight loss and maintenance.**

Calcium—

·        Prevention of Osteoporosis (building and maintaining strong bones)

·        Healthy teeth

·        Regulating heartbeat and muscle contractions

·        Proper blood clotting

·        Aids in maintaining healthy blood pressure

·        Plays an active role in the prevention of certain types of cancer

·        Good Calcium sources includes milk and dairy products, green leafy vegetables, canned salmon and sardines with bones and tofu

A common recommendation of Calcium supplementation is 1200-1500 mg daily.  Approximately 500-600mg is able to be absorbed a one time; therefore, you will be required to take Calcium a minimum of twice a day.  Calcium supplements should contain Calcium Citrate which is a form of Calcium that can be absorbed without the requirement of stomach acids.  A calcium supplement that includes Vitamin D will also aid absorption.  Magnesium added to the Calcium supplement may help to prevent constipation that can occur with Calcium supplementation.

Vitamin D—

·        Prevention of bone fractures

·        Enhances calcium and phosphorus absorption

·        Plays an active role in calcium transport within the small intestine and colon

·        Good Vitamin D sources include fortified milk, fortified cereals, salmon, fish liver oils and exposure to sunlight

Generally post surgery, you will be able to meet your Vitamin D requirements with daily exposure to sunlight and the use of a Calcium supplement which includes Vitamin D; however, recent literature and results from laboratory evaluations has increased the concern of Vitamin D deficiency in the weight loss surgery patient.  It is recommended to maintain close follow up with your health care team and regular lab evaluations in order to diagnose low Vitamin D levels which would then often require increased supplementation.  Vitamin D is a fat soluble vitamin which means it is stored in the body and can be acquired in toxic amounts being hazardous to your health—separate Vitamin D supplementation should not be implemented without the recommendation from your health care provider and regular lab evaluations.

Iron—

·        Prevention of Iron deficiency anemia

·        Good sources of Iron includes red meats, eggs, dried beans and peas, fortified cereals, dried fruits, and green leafy vegetables

·        Good sources of Vitamin C includes citrus fruits, strawberries, kiwi, broccoli, bell peppers, cabbage, tomatoes

Typically all post weight loss surgery females who have a regular menstrual cycle are recommended to supplement with Iron; however, there are many programs that recommend Iron supplementation for ALL weight loss surgery patients.  Vitamin C (usually in the dose of 500 mg) is very helpful in the absorption of Iron.  Iron absorption is blocked if taken too close to a consumption of Calcium, Coffee, Tea or many medications and other supplements.  It is recommended to maintain close follow up with your health care team and regular lab evaluations in order to monitor for low levels of Iron.  Please discuss your iron supplement and dose with your health care provider before adding iron to your supplement regimen in order to avoid toxicity.

Vitamin B₁₂ (Cobalamin)_—

·        Prevention of pernicious anemia

·        Blood cell formation

·        Nerve function

·        Good sources of Vitamin B₁₂ include meat, fish, eggs, dairy products and liver.

Vitamin B₁₂ is bound to protein in foods and requires Hydrochloric acid in the stomach to be released. Following, it combines with the gastric intrinsic factor in order to be absorbed by the intestinal tract.  Following many weight loss surgeries there may be decreased Hydrochloric acid and no contact with the intrinsic factor.  Therefore, you may require lifelong supplementation and it should be in the form of sublingual (under the tongue), nasogel spray or injection.  Common dose recommendation is 500-1000 micrograms sublingual tablet daily.

There has not been a toxicity level identified.

Folic Acid—

·        Prevention of neural tube defects (vital to have adequate folic acid levels prior to pregnancy)

·        Supports digestion and utilization of proteins

·        Production of red blood cells

·        Tissue growth and cell function

·        Stimulates digestive acid formation

·        DNA synthesis

·        Good sources of Folic Acid includes citrus fruits, legumes, whole grains, green leafy vegetables, fortified cereals, poultry, pork, shellfish and liver

Folic Acid requirements are usually able to be met with a balanced food intake.  However, on the occasion that deficiency occurs a sublingual Vitamin B₁₂ supplement that also contains Folic Acid is one of the easiest supplement methods.  Please discuss the recommended dose and supplement frequency with your health care team.

Vitamin B1 (Thiamin)—

·        Aids the conversion of carbohydrates into energy.

·        Heart, muscle and nervous system function

·        Good sources of Thiamin include fortified breads and cereals, lean meats, pork, fish, dried beans and peas.

Recent thiamin deficiency has been identified in pre and post weight loss surgery patients.  A common dosage recommendation is 50 mg daily.

It is recommended to maintain close follow up with your health care team and regular lab evaluations in order to diagnose low thiamin levels which may require increased supplementation.

Essential fatty Acids (Omega 3 and Omega 6)—

·        Function of all body tissues

·        Immune function

·        Skin and hair health

·        Proper bowel movement

·        Blood pressure regulation

·        Blood clotting and inflammation response influence

·        Prevention of atherosclerosis

·        Good sources of Essential Fatty Acids fish, shellfish, flaxseed, legumes , sesame oil, sunflower oil, soy bean oil, cottonseed oil, safflower oil, canola oil, hemp oil, pumpkin seeds, green leafy vegetables, tub margarines, mayonnaise  and nuts.

Essential Fatty Acid requirements are usually able to be met with a balanced food intake.  Please discuss the recommended dose and supplement frequency with your health care team.

Basic Post Surgery Rules

v     Consume small, frequent portions.

v     Intake should begin within 1 hour of being awake and approximately every 2 ½ to 3 hours there after for a total of 5-6 small meals.

v     All meal times should consist of protein.  A variety of high quality nutrition foods should be regularly consumed with the protein.  High fiber intake with vegetables, fruits and whole grains is recommended as able.

v     Do not drink with meals.  Fluids should be stopped 30 minutes before meals and not resumed until 30-60 minutes after meals are completed.

v     Eat very slowly allowing 20-30 minutes per meal.  Do not graze throughout the day—allow 30 minutes for each designated meal time and then nothing until the next meal time, except for fluids.

v     Chew very thoroughly…everything should be a smooth texture before swallowing…FOREVER.

v     Avoid straws and carbonated beverages to prevent gas pockets and stretching the anastomosis (the outlet from the pouch to the intestines).

v     Exercise daily! 

v     Journaling experiences, before and after weights, measurements and pictures can be very helpful with maintaining motivation and focus.

v     Drink a minimum of 8 cups of non carbonated, sugar free, limited caffeinated fluids daily.

v     Maintain your supplement schedule DAILY.

v     Follow up with your health care team regularly and have lab work monitored closely.

Enjoy your new lifestyle!  We hope this information and what we have to offer with our nutritional supplement products will help to make your lifestyle transitions easier.