Lifestyle Changes
Focus on Protein
Since your stomach capacity is severely restricted, you must make sure to have enough protein in your diet to keep healthy. At least 50 grams of protein is recommended. Foods that are high in protein include lean meats, poultry, fish, cheese, eggs, nuts, tofu and seafood.
You may also use protein supplement powders, drinks or protein bars as a substitute for one of three daily meals. At each meal, concentrate on eating protein foods first so you don't fill up on other foods. Protein-rich foods are more satisfying and filling than carbohydrates, and they will help you lose more weight rapidly and healthfully. A high protein intake also will promote healing after surgery.
Protect your stomach pouch
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 may block the outlet from your stomach pouch into your small intestine, causing cramps and severe vomiting. The outlet is less than 1/2 inch across. Blockage may be so severe that it must be removed using a scope instrument which is passed by mouth into the stomach pouch.
It is very important that you protect your stomach pouch by not overeating or drinking too much fluid at one time. It's normal for the pouch to stretch somewhat over time, but frequent stretching will increase stomach capacity and lead to weight gain. This defeats the purpose of gastric bypass surgery.
Keep well-hydrated
Drink at least six 8-ounce cups of fluid each day to avoid becoming dehydrated. Sip slowly, consuming at least 1/2 cup every hour between meals throughout the day. It is best not to use a straw because you will swallow excess air that may lead to discomfort.
Do not drink with meals because there is not enough room in your stomach for both food and fluids. Fluids move quickly through your stomach and can be taken up to the time you sit down to eat.
Wait 60 minutes after finishing a meal before drinking fluids. If you drink fluids with meals or have too much at one time, you will be uncomfortable and may vomit.
Recommended beverages include water (the best), sugar-free drinks, tea, coffee, natural juices with no sugar added and skim milk, if you can tolerate it. Studies show that a high water intake helps promote weight loss and wound healing, and helps prevent constipation. Avoid carbonated beverages - or allow them to go flat before drinking - because the bubbles can cause severe cramping and overstretch your stomach pouch.
Eliminate high-calorie drinks such as regular sodas, sugary fruit juices, whole milk, milkshakes and alcoholic beverages as these impair weight loss and are a common cause of weight gain.
About Dumping Syndrome
Foods or beverages that are high in refined sugar must also be carefully avoided as they may cause Dumping Syndrome. This is a very unpleasant reaction that can occur shortly after ingesting sugary items such as candy, chocolate, ice cream, pastry or colas. A large dose of sugar released rapidly into the small intestine can trigger a reaction that may cause cramps, nausea, diarrhea, perspiration, weakness and lightheadedness. A person experiencing Dumping Syndrome should lie down and rest for 30-40 minutes until the symptoms resolve. Most people who have experienced it are very careful not to eat sugary foods again. The natural sugar in fruits (fructose) is usually tolerated well.
Milk products and your digestion
After gastric bypass surgery, many people have trouble tolerating liquid milk. This is because milk needs to be curdled in the stomach to be completely digested. The gastric bypass procedure prevents milk from reaching the main part of the stomach where curdling would take place. Some people find that non-fat Lactaid milk is easier to digest. Curdled milk products such as cheese and yogurt are usually tolerated and contain a high calcium and protein content.
Avoid bread and pasta
Bread and pasta products can cause serious problems after gastric bypass because they become doughy in the stomach and may block the outlet.
Avoid bread unless it is well-toasted and chewed completely. The toasted crust of the bread is easier to digest than the soft inner portion. Low-fat crackers or other crunchy bread products usually are well tolerated. Pasta and rice should also be avoided as they are high in calories and may cause severe abdominal discomfort.
Vitamin supplements are key to health
It is very important that you take a high potency multivitamin supplement with iron every day for the rest of your life.
In the first six weeks after surgery, you should take a liquid daily vitamin such as Centrum or two childrens' chewable vitamin pills a day, if you prefer. After that, you can switch to one adult vitamin broken into several pieces. Adequate vitamin intake will help with wound healing, skin remodeling and hair growth.
You will also need lifelong vitamin B-12 supplementation. A weekly dose of Vitamin B-12 sublingually (under the tongue) is adequate for most patients. Other forms of vitamin B-12 are not absorbed as well and may lead to a deficiency.
If needed, additional calcium can be added to your diet by taking over-the-counter calcium citrate supplements daily.
Adopt successful eating habits
Minimize snacking between meals. Frequent snacking will prevent you from losing weight even though you have had the surgery. If you must snack - and are at least six weeks post-surgery - choose fruits or vegetables such as baby carrots, a peeled apple or a banana.
People who succeed at reaching and maintaining their weight goals after bypass surgery are those who 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 for most obese people, and it is the key to successful weight loss.
Tips for success
The best way to feel satisfied is to eat your meals very slowly. Chew each bite up to 30 times, and try to get maximum enjoyment from it.
Eat protein foods first as they will help you to feel full sooner. Stop eating when you first notice a sensation of fullness or abdominal pressure.
Don't worry if you have not finished the food on your plate. If you follow the dietary guidelines and take your daily vitamin supplements, you will get adequate nutrition even with a very small food intake (typically 800 to 1000 calories a day).
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.
Take at least 30-45 minutes to eat and have regular mealtimes. Eat only at the table, not in front of the television or on the run. Prepare attractive meals, and learn to savor each bite, thinking about how good you will feel when you reach your target weight.
Explain to family members and friends why you must make these changes, and ask for their support.
Take your meals 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 to package up half the meal to take home even before it's served. Many restaurants will make special accommodations if you show them the wallet card provided as part of your surgery program.
Vomiting or severe cramping
If you vomit or develop severe cramping after eating, it's probably because you ate or drank too much at one time, ate too fast, didn't chew your food thoroughly, ate foods that disagreed with you or lay down too soon after eating.
If vomiting continues through the day, stop eating solid food and sip only clear liquids for the next eight hours (water, clear juices, coffee, tea or non-carbonated, sugar-free beverages). If vomiting continues for more than 24 hours and you can't keep liquids down, call your doctor.
Continued vomiting may indicate that the outlet from your stomach pouch into your small intestine has become blocked with food. 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 digest it. In most cases, food blockage will eventually move through by itself, but you may experience several hours of discomfort and nausea, following which your stomach may be irritable for several days. Sometimes 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 cut all foods into very small pieces, chew all foods to the consistency of baby food, and avoid foods that are difficult to chew or hard to digest such as popcorn and steak.
In some cases, the outlet to the small intestine narrows over time even though you are following dietary guidelines. This condition is called stenosis. The treatment is an endoscopic procedure performed on an outpatient basis using a small balloon to stretch (dilate) the outlet so food can pass through. Sometimes a second dilatation procedure is necessary. Very frequent vomiting and difficulty keeping liquids down may be a sign of stenosis, and must be reported to your doctor.