Gastric Bypass Info

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Purpose

Gastric bypass is a type of surgery in which the stomach is reduced

in size by one of several methods. This smaller stomach is then

reconnected or bypassed to the small intestine. Having a gastric

bypass can help speed weight loss by making it difficult to eat too

much food at one time and to feel satisfied after very small meals.

After a gastric bypass, the volume the new, smaller stomach can hold

is reduced from about 1 quart to about 1 ounce, or 2 tablespoons.

Over time, the stomach pouch will stretch until it can hold 4 to 8

ounces, or about 1/2 to 1 cup, at a time. The size of the opening

created between the stomach and small intestine is smaller,

too;roughly 1/4 inch wide;which slows the rate at which food is

emptied from the stomach into the small intestine.

Gastric bypass is usually performed only after many other methods of

weight loss have been tried and failed. However, the surgery is not

an end in itself. It is important to work closely with a physician

and registered dietitian (R.D.) to start a program of new eating

habits to ensure that weight loss is safe and successful. A regular,

simple exercise program and psychological support are often

recommended to create a better self-image and a whole new attitude

to food.

Vitamin and Mineral Supplements

Since the gastric bypass diet does not provide enough vitamins and

minerals on its own, most physicians recommend taking:

1 adult or 2 children's chewable multivitamin tablets

Extra iron, calcium, or vitamin B-12 if needed

Nutrition Facts

The gastric bypass diet is designed to bring about significant

weight loss. Learning new eating habits and following the diet

correctly will help to maintain this weight loss over time. In

general, the gastric bypass diet includes foods that are high in

protein, and low in fat, fiber, calories, and sugar. Important

vitamins and minerals are provided as supplements.

Protein is the nutrient that the body uses to build new tissue. It

is important to get enough protein right after surgery, to make sure

that wounds heal properly. Over the long term, protein in the diet

will help preserve muscle tissue, so that weight can be lost as fat

instead. Foods like lean red meat or pork, chicken or turkey without

the skin, fish of almost any type, eggs, and cottage cheese are high

in protein and low in fat.

Sugary foods include candy, cookies, ice cream, milkshakes or

slushes, soda pop, sweetened juices or gelatin, and most desserts.

The gastric bypass diet is low in sweet and sugary foods for three

reasons. First, these foods are high in calories and fat. Even in

small amounts, they could make weight loss difficult. Second, eating

sweet or sugary foods promotes " dumping, " a reaction which can occur

after the gastric bypass operation. Experiencing the unpleasant

symptoms of dumping syndrome may limit the desire to eat sweet

foods. Finally, most sweet and sugary foods don't provide many

vitamins or minerals for the calories they take up;and since

calories are so limited on the gastric bypass diet, it is important

that every food contribute its fair share of nutrients.

Fat may be difficult to digest after gastric bypass surgery. Too

much fat delays emptying of the stomach and may cause reflux, a back-

up of stomach acid and food into the esophagus that causes

heartburn. Fat may also cause diarrhea, nausea, or stomach

discomfort. High-fat, fried foods and fatty meats are common

offenders.

Fiber, found in foods like bran, popcorn, raw vegetables, and dried

beans, is also limited on the gastric bypass diet. There is less

space in the stomach to hold these bulky foods, and less gastric

acid available to digest them. Some kinds of fiber could get stuck

in the pouch itself, or block the narrow opening into the small

intestine. Do not take any fiber pills or laxatives without the

advice of a physician.

Vitamins & Minerals are an important part of the gastric bypass

diet. Since the diet allows only small amounts of a limited variety

of foods, it may be difficult to get enough vitamins and minerals

from food alone. Deficiencies can develop in a matter of months.

Iron, folate, vitamin B-12, and calcium are the nutrients most

affected. Most physicians require their gastric bypass patients to

take a multivitamin/mineral supplement.

Special Considerations

Gastric bypass surgery creates dramatic changes in the size and

shape of the stomach. It may take awhile to get used to these

changes. Patients report a wide variety of complications after

surgery. Some of these will go away with time, while others can be

lessened with adjustment of the diet.

Nausea and vomiting are the most common complications occurring in

the first few months after gastric bypass surgery. They may occur

after eating too fast, drinking liquids while eating, not chewing

enough, or eating more than the pouch can comfortably hold. It is

necessary to learn to eat very slowly and chew foods thoroughly.

Nausea and vomiting can also be triggered after trying new foods. If

this happens, allow a few days to pass before trying a new food

again. Notify a physician if frequent vomiting becomes a problem.

Dehydration (loss of body fluids) is also an important concern,

especially if vomiting or diarrhea is frequent. Prevent dehydration

by drinking water or low-calorie beverages between meals (when there

is no food in the stomach), but remember that the stomach can only

hold 3-4 ounces at a time.

Dumping Syndrome occurs when food passes too quickly from the

stomach into the small intestine. Symptoms may include a combination

of nausea, uncomfortable fullness, cramping, and diarrhea, or

weakness, sweating, and fast heart rate. Dumping can be provoked by

eating very sweet or sugary foods. Reduce intake of sweets and

notify a physician if these symptoms occur.

Food Intolerances, especially to red meat, milk, and high-fiber

foods, are experienced by many patients. Since food intolerances

vary with the individual, a dietitian can help with sorting out food

choices to minimize symptoms such as stomach discomfort, nausea, or

diarrhea.

Overeating -- Almost all people who require gastric bypass surgery

have had problems with overeating. The causes for this are complex,

involving genetics, emotions, upbringing, and even the functions of

the brain. None of this changes after bypass surgery, except that

the stomach is now much smaller. Eating more than the new stomach

can hold may cause vomiting, expansion of the pouch, weight gain, or

even rupture of the stomach. Education, counseling, group support,

and certain medications can help to prevent overeating and are just

as important as diet to the success of the operation.

Others: Stomach pain, ulcers, and gastritis (an inflammation of the

stomach lining) are complications which may require medical

attention. Notify a physician if frequent stomach pain becomes a

problem.

Fluids

At every stage of the gastric bypass diet, it is important to

prevent dehydration by drinking enough fluids. Tips for doing it

right:

Drink 1 cup of water or low-calorie beverage between each meal

Fluids should add up to at least 6 cups (48 ounces) each day

Sip slowly;make beverages last 30 minutes or more

Finish drinking 45-60 minutes before meals

The Gastric Bypass Diet

The gastric bypass diet unfolds in several stages, from " liquids

only " to small meals of soft, high-protein foods. Meals on the new

menu will be much smaller than normal, and the foods eaten must be

very smooth in texture. On all stages of the diet, it is especially

important to drink enough water, and to take vitamin and mineral

supplements as prescribed.

Clear Liquids -- The first stage of the gastric bypass diet, clear

liquids (meaning beverages that you can almost see through), usually

lasts for a day or two after the operation. The clear liquid diet

starts with sips of water, and then allows foods like sugar-free

juice, diet gelatin, boullion or clear broth, and flat (no fizz)

diet soda in small amounts, usually 2-3 ounces at a time.

Low-Fat Full Liquids -- If no problems are experienced with clear

liquids, the gastric bypass diet advances to high-protein liquids

like diet Carnation Instant Breakfast™, Ensure™, or Sustacal™. This

stage of the diet is started before discharge from the hospital and

lasts for 1 to 2 weeks. Most patients also begin taking a chewable

multivitamin/ mineral supplement at this stage.

Soft/Purée Diet -- The physician will indicate when it is time to

advance to the soft or purée diet. Some patients are able to start

this diet after they have been out of the hospital for about two

weeks. Others may need to wait longer. The purée diet includes very

soft, high-protein foods like scrambled egg, low-fat cheese or

cottage cheese, or blenderized lean meats like tuna fish, chicken,

or pork. Some patients find it more convenient to use strained baby

foods. It is important to make sure that all foods are puréed or

extremely soft and smooth in texture.

Regular Diet -- The regular diet starts about 8 weeks or later after

gastric bypass surgery. While this diet includes all 5 food groups,

it is important to start with high-protein foods, like lean meats or

milk, at every meal. Each meal or snack should be small, with

liquids consumed in between meals. Ask a dietitian for advice on

planning an individualized regular diet pattern.

The ABC's of Eating Right

In all stages of the gastric bypass diet, the way to eat is just as

important as what to eat. Things to remember:

The new stomach can only hold 1/2 cup at a time

Eat 3 to 6 small meals a day

Chew food thoroughly and eat slowly

Avoid chewing gum;it could block the stomach outlet if swallowed

Do not overeat

Relax and enjoy your new life