Re: Re: 3-day post-op diet literature?

[Guest guest]

Thank you for responding to my question about literature on the post-op diet of bariatric pts. I think my CNM wants literature that will serve as an evidence based justification for serving a sugar-free clear liquid diet or an article that states that a sugar-free clear liquid diet is recommended for those first couple of days post-op. "steve.huntington" <steve.huntington@...> wrote: Not sure what you're asking for . . . is she looking for evidence that RNY pts will

dump on non-SF liquids post-op? Steve Huntington, PhD, RD, LD>> Hi,> I'm trying to have our hospital change the bariatric clear liquid diet, but the CNM wants some literature on why the patients need sugar-free clears post-op to put in the diet manual.> Anyone have any literature they would suggest I give her?> > Thank you all so much for any input!> > Dana Swilley Dunn, RD

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[Guest guest]

I would voice a concern regarding the use of the term "bariatric" to describe and prescribe treatment for all WLS pts. For instance, bypass pts' needs and limitations can be very different from pts with only restrictive interventions. Generally, the restriction pts do not get dumping syndrome and, though they usually do not need the calories in products containing sugar, if they do need them they do not need to be concerned about dumping.

For instance, I have had lapband pts who had diabetes before surgery who still had it after 80-100+ pound weight loss and had not had a reduction in their diabetes meds. At times, they have experience hypoglycemic events and need glucose to bring it up. I see no reason to treat them any differently than anyone else nor would there be any other appropriate treatment that I am aware of.

Bev

Re: 3-day post-op diet literature?

I have to voice a concern about what appears to be an over-reliance by some RDs for evidence-based literature versus using knowledge of changed anatomy following surgery and a patient's own history, labs and symptoms as "evidence" when determining nutritional counseling.Why, for example, would your CMN need published articles to justify sugar-free liquids for bariatric pts? Is she unaware of dumping syndrome in RNY pts, or the need for all bariatric pts to limit sugar consumption? Seems to me the best time to start that is in the hospital. The need for evidence-based justification assumes that all pts are the same. Problem is: they're not. Each is biochemically different. Don't get me wrong--published articles assist in setting up treatment protocols and are necessary, but so does knowledge of biology, basic nutrition principles and common sense, IMO. Steve Huntington, PhD, RD, LD> >> > Hi,> > I'm trying to have our hospital change the bariatric clear liquid > diet, but the CNM wants some literature on why the patients need sugar-> free clears post-op to put in the diet manual.> > Anyone have any literature they would suggest I give her?> > > > Thank you all so much for any input!> > > > Dana Swilley Dunn, RD> > > > > > > ---------------------------------> Have a burning question? Go to Answers and get answers from real people who know.>

[Guest guest]

Hi Steve,

I agree with you comments. Why do we always have to "prove" everything? You could always refer this person to literature on diets for post gastrectomy patients that has been around for ages. See the ADA clinical diet manual for references. Beyond this, we are in the midst of actually documenting evidence based info for bariatric surgery. I believe an ADA practice group is working on this presently. We need to be more assertive in our profession and let our colleagues know we are the experts on diet. You could even reference this list serve which is monitored by a RD and a surgeon. Good luck.

paula Serafino-Cross, MS, RD, LDN

Bariatric RD

Baystate Medical Center

Springfield, MA