WLS info

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Permanent Dietary Changes

For the rest of your life, you must be careful not to eat foods that

are fibrous and hard to digest, such as poorly chewed pieces of meat

or roughage. These foods can block the outlet from your stomach

pouch into your small intestine, causing cramps and severe vomiting.

What is Dumping Syndrome?

Foods or beverages that are high in sugar must also be carefully

avoided, as they will cause Dumping Syndrome.

This is a very unpleasant reaction that occurs shortly after

ingesting sugary items such as candy, pastry, colas, or fruit

juices. This large dose of sugar is released rapidly into your small

intestine, triggering your pancreas to secrete a large amount of

insulin. When the insulin drops your blood sugar, you may experience

cramps, nausea, diarrhea, perspiration, weakness, and

lightheadedness. You will have to lie down and rest for 30-40

minutes until your blood sugar gradually comes up and the feeling

passes.

Most patients who have experienced Dumping Syndrome are very careful

not to eat sugary foods again.

Protein

Since your stomach capacity is severely restricted, you must be sure

to have enough protein in your diet to keep you healthy. Foods that

are high in protein include meats, poultry, fish, cheese, eggs, and

seafood. At each meal, concentrate on eating your protein foods

first so you don't fill up on other foods and leave out the protein.

Protein-rich foods are more satisfying and filling than

carbohydrates, and will help you lose weight rapidly and

healthfully. A high protein intake will also promote healing of your

incision, and help your skin shrink as you lose weight.

Milk Products

After Gastric Bypass Surgery, many patients have trouble tolerating

milk due to a naturally occurring sugar known as lactose. It may

cause gas, cramps, and sometimes diarrhea. If sensitive you may try

100% lactose-reduced milk, use Lactaid milk or pills. Milk products

such as cottage cheese and yogurt are naturally low in lactose. If

unable to tolerate any milk products, you may supplement your

calcium intake with Calcium Citrate tablets.

Fluid Requirements

It is very important that you drink at least six 8-ounce cups of

fluid each day to avoid dehydration. You must sip your liquids

slowly, consuming about 1 cup every hour between meals throughout

the day, since your stomach capacity is so small. Do not drink

liquids for 30-45 minutes before or after your meals because there

is not enough room in your stomach for both food and fluids. If you

drink too much fluid at one time, or take fluids with your meals,

you may vomit.

Recommended beverages include water (the best), sugar-free drinks,

tea, coffee, and skim milk if you can tolerate it. Studies show that

a high water intake helps promote weight loss, wound healing, skin

shrinkage, and helps prevent constipation. Avoid carbonated

beverages or allow them to go flat before drinking because the

bubbles can cause severe cramping. Carbonated beverages containing

sugar and/or caffeine will stimulate your appetite, and should be

avoided. Eliminate high-calorie drinks such as regular sodas, sugary

fruit juices, non-skim milk, milkshakes, and alcoholic beverages as

these will impair your weight loss. These drinks are a common reason

for weight gain.

Vitamin Supplements

It is very important to your health that you take a multivitamin

supplement every day for the rest of your life. In the first six

weeks after surgery, you should take a chewable or liquid vitamin

such as Centrum each day. After that, you can switch to a daily

tablet if you prefer. Adequate vitamin intake will help with wound

healing, skin remodeling, hair growth, and energy level. You will

also need lifelong vitamin B-12 supplementation either by a small

injection every three months, or a tablet under your tongue once a

week.

Successful Eating Habits

You will need to focus on changing your eating habits immediately

after having Gastric Bypass surgery if you want to enjoy the

benefits of rapid weight loss. Most importantly, you must not snack

between meals. Frequent snacking will prevent you from losing weight

even though you have had the surgery. Successful patients eat three

small, well-balanced meals each day, and a maximum of two small, low-

fat snacks. Each meal should consist of a protein food and a fruit

or vegetable serving. This is a major change in eating habits for

most obese people, and the key to successful weight loss. Please

feel free to contact your clinical nurse specialist, dietician, or

doctor if you need dietary information or help following these

guidelines.

The best way to feel satisfied is to eat your meals very slowly,

chew each bite up to 30 times, and try to get the maximum enjoyment

from it. Make sure you eat your protein foods first as they will

help you to feel full sooner. Stop eating when you first notice a

sensation of fullness, abdominal pressure, or nausea. Don't worry if

you have not finished the food on your plate. If you follow these

dietary guidelines and take your vitamin supplements, you will be

getting adequate nutrition even with a very small food intake.

Successful habits include taking very small bites, using a small

plate, eating with a baby spoon, and placing an " EAT SLOWLY " sign in

front of you. Set aside 30-45 minutes for each meal at set times

during the day. Eat only at the table, and not in front of the TV or

on the run. Prepare attractive meals and learn to savor each bite,

thinking about how good you'll feel when you reach your target

weight. Explain to family members and friends why you must make

these changes in your eating habits and ask for their support. Take

your meals with you to work so you won't be tempted to eat fast food

or junk food. In a restaurant, ask the waiter to bring you a half

order, or package up half the meal to take home even before it's

served.

If you experience vomiting

If you vomit after eating, it is probably because you ate or drank

too much at one time. You must always stop eating as soon as you

feel full, uncomfortable, or nauseated. Vomiting can also occur if

you eat too fast, don't chew your food thoroughly, eat foods that

disagree with you, or lie down too soon after eating.

If the vomiting continues throughout the day, stop eating solid

foods and sip only clear liquids for the next 8 hours (water, clear

juices, coffee, tea, or non-carbonated beverages). If vomiting

continues for more than 24 hours, call your doctor. Continued

vomiting may indicate that the outlet from your stomach pouch into

your small intestine has become blocked. Try mixing a teaspoon of

Adolf's Meat Tenderizer in a glass of warm water and sipping it very

slowly. If there is a piece of food blocking the outlet, this may

help to dissolve it. Sometimes food blockages must be removed using

an instrument called an endoscope passed through your mouth into

your stomach. The best way to avoid this is to chew all foods to the

consistency of baby food, and avoid foods that are fibrous or hard

to digest.

In some cases, the outlet to the small intestine becomes narrowed

over time even though the patient is following the dietary

guidelines. This condition is called stenosis. The treatment is an

endoscopic procedure using a small balloon to stretch the outlet so

food can pass through. Continued vomiting over 24 hours may be a

sign of stenosis, and must be reported to your doctor.

The importance of exercise

It's extremely important for you to adopt a routine of regular

exercise a minimum of 30 minutes at least four days a week. Studies

of patients who have been successful after Gastric Bypass surgeries

indicate that over 75% of them exercise regularly to help maintain

their weight loss. Effective exercise programs can include brisk

walking, swimming, aqua exercise, low-impact aerobics or dance

classes, biking, use of exercise cycles, treadmills, and stair

machines. Believe it or not, exercise becomes easier and more

enjoyable as you lose weight and increase your endurance.

You must be cleared by your surgeon to begin your exercise program

after your six-week check-up. Before this point, do not engage in

heavy exertion activities, bending, or lifting anything over 10

pounds. If any activity or position causes you pain in the area of

your incision, don't do it. You should not sit or stand in one place

for long periods without changing position frequently as there is a

risk of blood clots forming in your legs.

During your first six weeks after surgery, it is extremely important

for you to walk as much as you can. Start slowly when you first get

home by taking short walks several times a day, preferably outside.

Increase the distance and pace of your walks each day, but expect to

tire easily at first. Walking promotes wound healing, circulation,

bowel function, weight loss, and the health of your heart and lungs.

Exposure to fresh air and sunshine can help relieve depression,

anxiety, and food cravings. By the time of your six-week checkup,

you should be able to walk one to two miles day. In order to tone

your muscles and tighten loose skin as you lose weight, you should

engage in floor exercises such as abdominal crunches, leg lifts,

weight lifting, or yoga. The worst thing you can do is spending time

sitting in front of the TV.