Guest blog by: Lillian Craggs-Dino, DHA, RDN, LDN, CLT Metabolic and bariatric surgery is an effective treatment for those struggling with weight and health issues. While this surgery offers life-saving benefits, it also comes with nutritional risks. Depending on the bariatric procedure, 10-50% of patients may experience postoperative symptoms of food intolerance and nutritional challenges.1,2 These issues can arise at any point during a patient’s recovery journey.So, is there anything that can be done to combat these nutrition challenges? Yes, with time and progression throughout your weight loss journey, and as your new stomach pouch heals, food tolerance does improve, and some of these symptoms occur only sporadically.In this blog, we will discuss common nutrition challenges after bariatric surgery and provide practical tips and strategies for managing them effectively. Post-Surgery Dietary Guidelines: A Closer Look After metabolic and bariatric surgery, patients are advised to follow a specific diet that emphasizes protein, fluids, vitamins, and minerals. This is crucial for ensuring proper healing, promoting weight loss, and preventing nutritional deficiencies. Additionally, patients learn eating techniques and behaviors to improve food tolerance, helping them adjust to their new digestive system. Common Early Post-Surgery Issues In the first 30 days following surgery, patients frequently encounter several issues, including nausea, vomiting, dehydration, and food intolerance.3 Understanding and managing these challenges is essential for a smooth recovery. Nausea and Vomiting Nausea and vomiting are common during the initial recovery phase due to the significant changes in the digestive system. These symptoms can be triggered by various factors, including: Eating too quickly: Consuming food too quickly can overwhelm the new, smaller stomach pouch. Overeating: Eating larger portions than the stomach can handle can lead to discomfort and vomiting. Not chewing thoroughly: Properly chewing food helps prevent blockages and ensures smoother digestion. To help reduce nausea and vomiting after surgery, patients should: Eat slowly and take small bites. Chew food thoroughly before swallowing. Stop eating as soon as they feel full. Dehydration Dehydration is a significant concern after bariatric surgery, as the reduced stomach size limits the amount of fluid intake. Symptoms of dehydration include dizziness, dark urine, and fatigue. To prevent dehydration, patients should: Sip water throughout the day rather than drinking large amounts at once. Avoid caffeine and alcohol, as they can dehydrate the body. Aim to drink at least 64 ounces of fluids daily. Food Intolerance Food intolerance is another common issue post-surgery. Patients may find that certain foods they previously enjoyed now cause discomfort. Common triggers include high-fat and high-sugar foods, which can lead to dumping syndrome, characterized by nausea, diarrhea, and abdominal pain.To manage food intolerance: Gradually reintroduce foods to identify and avoid triggers. Focus on high-protein, low-fat, and low-sugar foods. Keep a food diary to track what foods cause adverse reactions. Gastrointestinal: Diarrhea and Constipation A chief complaint that patients experience is bowel habit changes. Patients may experience constipation or diarrhea, and reasons may be related to surgery or intake. Diarrhea can be a result of: Dumping syndrome Lactose intolerance Poor eating mechanics Constipation can be a result of: Inadequate fiber Inadequate fluid intake To manage these issues: Drink at least 64 ounces of fluids daily. Minimize sugar intake. Don’t eat and drink at the same time. Gradually increase fiber intake with a healthy variety of fruits, vegetables, and whole grains while still taking into consideration protein intake. It is recommended that patients talk to their practitioners before taking any over-the-counter laxatives or fiber supplements. Patients can also consider using a probiotic, as changes in the gut microbiota can also lead to these bowel habit changes. Managing Vitamin and Mineral Deficiencies One of the most significant nutritional challenges after bariatric surgery is the risk of micronutrient deficits. Despite having a healthy and varied diet, patients may still be at risk for these deficiencies due to changes in their digestive system. It's crucial for patients to take specific vitamin and mineral supplements as recommended and to monitor their nutrient levels through regular follow-ups with their bariatric program.Even with a balanced diet, patients are responsible for taking prescribed supplements that provide the necessary nutrients and dosages. This is essential because the type of surgery may increase the risk of deficiencies, which can affect overall health and quality of life. Common Deficiencies and Recommendations Here are some common deficiencies and the recommended vitamin supplementation: Table 1: Recommended Vitamin and Minerals Post-Surgery3,4 Micronutrient Dosage Daily adult multivitamin 100-200% DV, preferably a bariatric complete multivitamin and multimineral B-complex with thiamin 50-100mg Vitamin B12 1,000mcg inj/m OR 500mcg sublingual daily OR B12 intranasal once a week Iron 45-60mg Calcium 1,200-1,500mg OR 1,800 mg for duodenal switch Vitamin D 3,000IU (75mcg) daily Table 2: Nutrient Deficiencies: Conditions4,5 Condition Vitamin and Mineral Deficiency Recommended Dosage Anemia Iron, vitamin B12, folic acid Iron: 45-60mg or higher as recommended; Vitamin B12: 1,000mcg injection monthly or as needed; Folic acid: 800-1,000mcg daily Osteoporosis Calcium, vitamin D Calcium: 1,200-1,500mg daily (sleeve gastrectomy, gastric banding, and gastric bypass surgery) OR 1,800-2,400mg (biliopancreatic diversion, SADI, or distal bypass); Vitamin D: 3,000IU (75mcg) daily, up to 50,000IU as directed by your doctor Neurologic (peripheral neuropathy) Vitamin B12, vitamin B1 Vitamin B12: 1,000mcg injections daily, weekly, or monthly as directed; Vitamin B1: 500mg three times a day or as directed By following these guidelines and staying vigilant about nutritional needs, patients can effectively manage and prevent micronutrient deficiencies after bariatric surgery. Summary Metabolic and bariatric surgery can be a life-changing procedure that significantly improves a person’s quality of life. However, without proper attention to diet, fluids, supplements, eating behaviors, and a healthy lifestyle, there is a risk of "exchanging one problem for a worse one." While patients receive education on what to do and what to avoid, navigating this journey is highly personal.Patients should continue to: Follow-up: Maintain regular check-ins with their bariatric team. Attend support groups: Engage with support networks for additional guidance and encouragement. Seek guidance: Consult healthcare professionals whenever needed. The ultimate goal of metabolic and bariatric surgery is to enhance patients' health and quality of life. Although it requires effort and commitment post-surgery, the benefits are well worth it! References 1. Lupoli R et al. World J Diabetes. 2017;8(11):464–474.2. Stumpf MA et al. Arq Bras Cir Dig. 2015;28(Suppl 1):79–83.3. Iacobellis F et al. Diagnostics (Basel). 2022;12(11):2637.4. Mechanick JI et al. Endocr Pract. 2019;25(12):1346-1359.5. Parrott J et al. Surg Obes Relat Dis. 2017;13(5):727-741. *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 regard 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.