Guest Blog By: Dr. Lillian Craggs-Dino, DHA, RDN, LDN Whether you are a newly post-op patient or already several years into your journey, understanding bariatric nutrition basics is an essential foundation for lifelong health and wellness. After metabolic and bariatric surgery, you are not necessarily following a diet; instead, you are adapting to lifestyle changes. You work hard to develop and incorporate healthy behaviors to support long-term success with your weight loss goals. Metabolic and bariatric surgery is only a tool to jumpstart weight loss. It’s up to you to develop healthy habits for weight maintenance and quality of life. Metabolic and bariatric patients should live a healthy lifestyle with wholesome food choices, meet daily fluid goals, take bariatric vitamin and mineral supplements, and engage in physical activity. This blog discusses three bariatric nutrition basics for a healthy foundation after metabolic and bariatric surgery. Bariatric Nutritional Risks It is prudent to remember that those who have undergone metabolic and bariatric surgery have specific nutritional requirements to achieve and maintain weight loss and to prevent potential complications post-surgery. Potential nutritional risks include, but are not limited to: Protein deficiency Loss of lean body mass (LBM) Vitamin and mineral deficiencies Dehydration Fortunately, these conditions are all easily preventable with proper lifestyle and eating habits. Top 3 Bariatric Nutrition Basics Making dietary and lifestyle adjustments after metabolic and bariatric surgery can be overwhelming. No one is perfect, and it’s not uncommon for previous eating habits to sneak back into your life. If you are in a rut post-surgery, always circle back to your bariatric nutrition basics. 1. High Protein The function of dietary protein after metabolic and bariatric surgery is to help support lean body mass, weight management efforts, and healthy body functions. When protein intake is less than optimal, you may have difficulty losing weight post-op, affecting your quality of life. According to bariatric nutrition guidelines, a minimum of 60 grams of protein daily and up to 1.5-2.0 grams of protein per kg of ideal body weight is recommended but can be assessed on an individualized basis. (1) Choose lean meats and wholesome protein food choices to ensure you consume adequate protein while adhering to your new bariatric meal plan. High-quality protein supplements, like whey protein powder, can be used for support if you struggle to reach your daily protein intake goals due to portion sizes or food tolerance issues.* You can keep a food diary or use an electronic food-tracking system for self-monitoring and accountability. Always remember to follow the recommendations of your surgeon and bariatric team. If you have difficulty with protein intake, consult your dietitian for post-surgery support. Bariatric Fusion also offers Vegan Protein Powder for those looking for non dairy options. 2. Drinking Fluids A study with 99 post-operative patients identified that almost 25% were readmitted for dehydration. (2) Dehydration can be life-threatening and cause damage to your kidneys. Proper hydration is an essential factor in post-op recovery and life-long health. The goal is to drink a minimum of 64 ounces of fluid daily. The best option to stay hydrated is with water, but any clear liquid that is sugar-free, carbonation-free, alcohol-free, and caffeine-free counts toward your fluid goals. Even your daily protein shake can be counted towards your fluid intake. However, keep in mind that if you have an 8-ounce protein shake, only 4 ounces can be counted toward your daily fluids since about half of the fluids are needed for protein digestion. If you have difficulty with fluid intake, remember to take small sips, do not use a straw to avoid gas, and do not eat and drink together since your stomach pouch is smaller after surgery and can only hold so much volume. Similar to self-monitoring protein intake, you can also monitor fluid intake. 3. Bariatric Multivitamin and Mineral Supplements Even if your diet is nutritionally balanced and you have reached your health and weight goals, you will still need a lifelong multivitamin and mineral supplement. This is due to nutrient malabsorption and dietary restriction caused by procedures like gastric bypass and sleeve gastrectomy. Vitamin and mineral deficiencies can be harmful to your health and, at times, debilitating. Severe deficiencies, such as vitamin B1 (thiamine), can even cause permanent damage to your health. The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends that patients take a daily multivitamin and multimineral supplement with bariatric-specific dosages for iron, calcium, vitamin D, B-complex, and vitamin B12. It is prudent and advised to follow up with labs at least once a year so your healthcare team can review for potential deficiencies or abnormal levels. You will find a variety of supplemental forms available, such as chewables, soft chews, capsules, or liquids; however, always consult with your healthcare team regarding the most suitable dietary supplements for your individual needs. You also should never stop taking your bariatric supplements unless recommended to do so by your healthcare provider. Follow your bariatric program’s recommendations for vitamin and mineral supplementation, monitor your life-long labs, and adjust dosages as your healthcare team recommends. Supplements will likely be the most important responsibility for life after metabolic and bariatric surgery to support health and wellness.* Summary Your decision to undergo metabolic and bariatric surgery was difficult, so a round of applause is in order for taking control of your health and life! Remember your reasons for making this life-changing decision. Continue to work hard and enjoy the beneficial results of meeting your goals. Utilize the resources provided to you, such as support groups, recipes, and blogs. Lastly, remember that follow-ups are necessary to enjoy long-term success. References 1. Endocr Pract. 2019; 25(12):1346-1359 [PMID: 31682518] 2. Rev Gastroenterol Mex (Engl Ed). 2021 [PMID: 34972678] *These statements have not been evaluated by the Food & Drug Administration (FDA). These products are not intended to diagnose, treat, cure, or prevent any disease. This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your bariatric surgeon or another qualified healthcare provider with any questions in regards to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs. Dr. Lillian Craggs-Dino is a retained consultant for Bariatric Fusion.