Nutritional and Dietary Guidelines for Bariatric Surgery Patients: A Pre and Post-Surgery Approach
Introduction
Bariatric surgery is a significant decision. While it can positively transform lives, helping individuals achieve substantial and sustained weight loss, it also entails making essential lifestyle changes, particularly in dietary habits. Nutritional choices pre and post-surgery can greatly affect surgical outcomes and long-term health.
Pre-Surgery Dietary Guidelines
Preparing for Surgery
Pre-surgery preparation typically starts several weeks before the procedure. Patients are advised to adopt a low-calorie diet to reduce liver size, body fat, and overall surgical risks.
1. High Protein, Low Carb: Adopt a diet high in protein and low in carbohydrates. High protein intake preserves muscle tissue and promotes fat loss, while lowering carbohydrates reduces liver size, facilitating the surgery.
2. Stay Hydrated: Hydration is crucial. Drink plenty of fluids, ideally water, throughout the day.
3. Reduce Fatty Foods: Minimize intake of foods high in fat. These are calorie-dense and can contribute to a fatty liver.
4. Limit Sugary Drinks and Alcohol: Avoid sugary drinks, including fruit juices and sodas, and limit alcohol consumption. These can add empty calories and affect liver health.
5. Fiber Intake: Fiber aids digestion and can help control hunger pangs. Include fruits, vegetables, and whole grains in your diet.
Post-Surgery Dietary Guidelines
Post-surgery, patients move through several dietary phases, starting from a liquid diet and gradually reintroducing solid foods. This progression helps the body adapt to anatomical changes and prevents complications.
Post-Surgery Phases
1. Phase 1 - Liquid Diet: This phase typically lasts for a few days to a week after surgery. Consume clear liquids like broths, decaffeinated tea, and sugar-free gelatin desserts.
2. Phase 2 - Pureed Foods: After tolerating liquids, transition into pureed foods. This stage includes foods like scrambled eggs, pureed meat, and mashed fruits and vegetables.
3. Phase 3 - Soft Foods: This phase allows the introduction of soft, easily digestible foods. These include cooked cereals, soft fruits, and tender cooked vegetables.
4. Phase 4 - Regular Diet: Gradually reintroduce solid foods, focusing on high protein, low-fat, and low-sugar choices.
Nutrition Post-Surgery
1. Protein First: Protein should be the primary nutrient in every meal. It supports healing and preserves muscle tissue during rapid weight loss.
2. Smaller Portions: Smaller, frequent meals are better tolerated than large ones. Start with six small meals a day and gradually reduce to three meals with a couple of snacks.
3. Stay Hydrated: Hydration remains vital but avoid drinking fluids 30 minutes before and after meals to prevent stretching the stomach.
4. Chew Thoroughly: Eat slowly and chew thoroughly to aid digestion and prevent overeating.
5. Limit Sugar and Fat: High sugar and fat foods can cause dumping syndrome – a condition where food moves too quickly into the small intestine causing nausea, vomiting, and other discomforts.
Nutritional Supplements
Regardless of the type of surgery, all bariatric patients need nutritional supplements due to reduced food intake and changes in nutrient absorption. The most common include:
1. Multivitamin: A comprehensive multivitamin helps cover overall nutritional needs. Typically, bariatric-specific multivitamins are recommended.
2. Calcium with Vitamin D: Calcium absorption is compromised after surgery, especially in procedures like the Roux-en-Y gastric bypass and biliopancreatic diversion. It is usually recommended to take 1200-1500mg of calcium (in the form of calcium citrate) with Vitamin D daily.
3. Iron: Iron deficiency is common after bariatric surgery. An iron supplement of 18-60mg, depending on the type of surgery and individual patient characteristics, is usually advised.
4. Vitamin B12: B12 absorption is often impaired after surgery. Supplements of 350-500mcg per day, either orally or through monthly injections, may be recommended.
5. Other Nutrients: Depending on personal needs and type of surgery, additional supplements like Vitamin A, Vitamin K, Zinc, Copper, or Folate may be necessary.
It is vital to discuss with your healthcare provider the specific dosage and type of supplements best suited to your individual needs.
Conclusion
Bariatric surgery is a tool to aid weight loss and improve health, but it is not a solution in itself. Adherence to dietary guidelines and proper nutrition both pre and post-surgery is crucial to ensure successful weight loss and maintain optimal health.
Bibliography:
Mechanick, J. I., et al. "Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery." Obesity 21.S1 (2013).
Parrott, J., et al. "ASMBS integrated health nutritional guidelines for the surgical weight loss patient—2016 update: Micronutrients." Surgery for Obesity and Related Diseases 13.5 (2017): 727-741.
Schiavo, L., et al. "Nutrients. A Guide for Nutritional Care in Bariatric Surgery." Nutrients 11.10 (2019): 2264.
Aills, L., et al. "ASMBS allied health nutritional guidelines for the surgical weight loss patient." Surgery for Obesity and Related Diseases 4.5 (2008): S73-S108.
Fujioka, K. "Follow-up of nutritional and metabolic problems after bariatric surgery." Diabetes Care 28.2 (2005): 481-484.
Please note that this article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare provider for personalized advice.
