Gastric Bypass

Introduction

The long-term success of your gastric bypass operation depends on following certain dietary recommendations outlined below.

• During the four weeks following the operation no solid foods should be taken
• Instead a liquid diet followed by a soft moist diet must be followed

Why?

• Solid food can create pressure on the stitches stretch your pouch and may lead to vomiting and discomfort

It is therefore extremely important to follow the guidelines on the liquid diet.

• STEP 1. Liquid diet for 2 weeks
• STEP 2. Soft moist diet for 2 weeks
• STEP 3. Solid Food. You are aiming to follow a protein rich - low calorie healthy diet

Step 1. The First Two Weeks - The liquid diet

To ensure an adequate intake of protein, calcium and other nutrients, the liquid diet must be based on milk. Ideally low fat milk should be chosen (e.g. semi-skimmed or skimmed).

Aim for at least 2 Pints / a day of milk or milk alternative
(Milk can be flavoured with Nesquick or low calorie hot chocolate)

Other fluids allowed include:

• Slimming drinks e.g. slimfast or chemist/supermarket own
• Complan or Build up shakes or soups
• Yogurt drinks and Smoothies
• Still mineral water
• Still low sugar squashes
• Clear low calorie soups
• Smooth soups e.g. cream of tomato or chicken, oxtail
• Tea and coffee without sugar
• Unsweetened pure fruit juice
• Marmite or Bovril Drinks

Take things slowly over the first few days until you establish the amount of liquid that can be tolerated.

Suggested meal plan

Take the milky drinks first, to ensure you are getting enough nutrients, then other fluids after that as required.

Tips

• Start with a couple of sips of fluid and slowly build up the quantity until a sensation of fullness occurs
• Most people find that 50ml of fluid is the maximum amount which can be taken in one go
• It is important to stop drinking as soon as you feel full
• If stomach pain or nausea is experienced while drinking stop until the feeling passes
• If the quantity of fluid taken is too large the stomach will overfill and vomiting will occur
• Fizzy drinks are NOT permitted at any time after gastric bypass as they cause gas and bloating and an increase in stomach size

Because of the malabsorption caused by the gastric bypass, it is necessary that you take a daily vitamin and mineral supplement for the rest of your life.

Ideally a liquid or chewable version should be used or a solid tablet can be crushed or broken down into small pieces before being taken.

Recommended multi vitamin: Sanatogen Gold or Centrum or Forceval (this needs to be prescribed from your GP)

Step 2. Weeks 3-4 (after band insertion) - Soft moist diet

After 2 weeks, gradually start to introduce foods with a soft moist texture. Foods should be broken in to pieces or mashed with a fork.

Remember to stick to small portions. You may find it helps to eat from a side plate.

Step 3. Week 5 onwards - Protein rich - low calorie diet

• It is now safe to gradually start switching over to a diet of healthy, protein rich, low calorie solid foods
• As a result of the gastric bypass surgery, less dietary protein is absorbed from your intestines
• So it is very important to make sure that you eat enough protein in your diet every day
• Take things slowly until you're sure about the amounts and types of foods, which can be tolerated
• Experiment to find out what quantities and types of food work for you
• You help you achieve your goal weight loss, keep in mind that your new diet needs to be low fat, low calorie and portion controlled

Examples of Good Sources of Protein

Important rules to follow post Bypass

Keep to smooth, soft foods

• Such as low fat milk puddings, mashed potato, Ready Brek, cereal soaked in milk, cottage cheese, scrambled egg and flaked fish
  
• If these are tolerated start including solid foods of various different textures remembering to chew well until the food reaches a puree-like texture

Make sure you eat enough protein.

• Make sure protein foods are eaten first
• Drink 3 cups of skimmed or semi skimmed milk, or calcium fortified soya milk each day to provide enough protein and calcium to keep you healthy

Do not drink and eat at the same time.

• Drinking fluids with meals may overfill your small stomach, which will lead to vomiting
• It can also stretch the stomach and "wash" food through too quickly and you will not sense the early signals of fullness and may over eat
• Avoid drinking at least 30 minutes before and after each meal

Chew food very well until it feels like a puree in your mouth.

• If the food isn't chewed well you may block the outlet of your stomach and this will cause pain, discomfort, nausea and vomiting

Eat foods slowly.

• It may take 20 minutes to eat 2 tablespoons of food and most find the average meal takes about 45 minutes
• Explain to others why you must eat slowly so they don't rush you

Pay attention to your body's signals of fullness.

• As soon as you feel full or you feel pressure in the centre of your abdomen stop eating or drinking
• If you feel nauseous stop eating. One extra mouthful of food after these early signals could lead to pain, discomfort and vomiting

If you do experience problems try to think back and identify the cause.

1. Had you eaten too fast or not chewed the food well enough?
2. Had you eaten too much or taken fluids with the meal or too soon before or after the meal?
3. Had you eaten difficult to digest foods?

• Identifying the cause of your discomfort will help you make the necessary changes the next time you eat
• Keeping a food diary may help
• If you experience regular vomiting seek advice from a member of the obesity team or your GP

Eat three meals a day to ensure you are well nourished.

• Do not skip meals and eat "on the run" as this tends to result in food being eaten too quickly with inadequate chewing
• Also, the types of food, which are easy to eat "on the run", are generally those higher in fat and calories
• Continue to take your liquid or crushed multivitamin and mineral tablet unless advised differently by your dietitian or doctor

Foods that you may have problems introducing back into the diet

• There are likely to be some foods that you may now have problems introducing back into the diet
• The ability to tolerate various foods depends on how well you chew and how you cook and prepare the food
• Try a food by eating a very small amount of it
• If you can't tolerate it, wait a month and then try it again

Advice on dumping syndrome

Dumping syndrome describes a variety of symptoms that you may experience following your gastric bypass surgery. These symptoms include stomach cramps, nausea, vomiting, diarrhoea and feeling faint. After a bypass operation, if sugary foods are eaten in large quantities, the sugar is quickly absorbed into the bloodstream causing the blood sugar level to be too high and the body produces large amounts of insulin. Excess insulin causes the blood sugar to go too low, which produces the unpleasant side effects.

Dietary changes that will help:

• Limit sugary foods e.g. sweets, chocolates, biscuits, cakes
• Limit sugary drinks e.g. sugar in hot drinks, full sugar squashes, fruit juices, sugary milkshakes
• Watch out for alternative names for sugar e.g. glucose, sucrose, fructose, dextrose, honey, corn syrup
• Use artificial sweeteners instead e.g. Canderel, Hermesetas, Splenda, Sweetex, Supermarket own brand
• Use low sugar drinks e.g. Kia Ora no added sugar, Robinsons no added sugar, Ribena no added sugar, Supermarket own
• Eat six small meals daily instead of three larger meals
• Eat slowly
• Avoiding liquids for at least half an hour after a meal
• Lie down if you experience these symptoms

Advice on diarrhoea

• You may find fat and fatty foods hard to digest after gastric bypass surgery and if eaten could cause diarrhoea
• It is best to avoid high fat, fried foods and fatty foods. Cutting these out will also help with the weight loss
• If milk causes problems, try Soya milk instead

Advice on constipation

It is natural to expect some change in the frequency of your bowel habits; this is because the quantity of food now eaten is considerably smaller compared to what you were eating before the operation.

Initially you might find your bowels open less frequently i.e. every 2 to 3 days, due to the change in diet. However by including some of the following foods you should have regular bowel movements.

High fibre foods:

• Whole-wheat Breakfast Cereals e.g. All Bran, Shredded Wheat, Weetabix, Bran Flakes, Porridge Oats
• Pulses e.g. Baked beans, Kidney beans, lentils, Chick Peas
• Whole-wheat crackers e.g. Ryvita, wholemeal crispbreads, Jacob's multigrain
• Fruit and Vegetables e.g. Cauliflower, broccoli, carrots, salad, green beans, pealed fruit, tinned fruit in juice

Also make sure you are drinking an adequate amount of fluid between meals [8 to 10 cups a day].

If the problem persists visit your GP or discuss with a member of the Obesity team.

Follow the rules of healthy eating

• Once your new eating habits have become established, it is important to make sure you are following a healthy diet, which will help you maintain your weight loss in the long term
• Although your small stomach is a physical limit to the amount of food, which can be eaten, if high calorie foods are eaten too frequently weight gain can still occur
• Ask your dietitian for more advice on portion sizes
• You should try to use low calorie sweeteners and low fat spreads. Limit sugar and fats eaten
• Alcohol is high in calories and also stimulates your appetite so it is best avoided. You will also absorb it much quicker following bypass, therefore a little alcohol will have a significant effect