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JAMA Patient Page
March 14, 2017

Revisiting Your Diet After Weight Loss Surgery

JAMA. 2017;317(10):1090. doi:10.1001/jama.2017.0185

Bariatric surgery can help you lose weight, but maintaining a proper diet after the operation is essential for good health.

Eating After Bariatric Surgery

After you have had bariatric surgery, you must chew your food thoroughly to a pureed or baby-food consistency and eat slowly. The food will be less likely to get stuck when you swallow and will be absorbed more easily. Meals should take at least 30 minutes. A good approach is to eat protein first, vegetables second (excluding potatoes, peas, and corn), fruit third (choose fruits you can eat with the skin because these have more fiber), and starches last. Avoid fried foods and avoid drinking within 30 minutes of meals. Drink minimally, ideally only when having trouble swallowing food.

Getting enough protein is always difficult after weight loss surgery. Most patients require 60 to 120 grams of protein daily depending on lean body weight. In addition to dietary protein, protein shakes can help you get enough protein. However, all protein shakes are not the same; product labels can provide helpful information about content. Protein shakes should have less than 200 calories, 6 grams of sugar, and 4 grams of fat and should have between 20 and 30 grams of protein. Whey protein is easily absorbed and should be first on the ingredient list. Avoid products with collagen within the first 3 ingredients because it is poorly absorbed.

What to Do If You Have Problems Eating After Bariatric Surgery

Some people have difficulty eating for months to years after weight loss surgery. These problems can be due to food choices, speed of eating, or not absorbing nutrients properly. Patients who have had Roux-en-Y gastric or biliopancreatic bypass operations may develop dumping syndrome (nausea, abdominal cramps, diarrhea, and sweating) after eating sweets, such as cookies, cakes, candy, and sweetened beverages.

If you have severe nausea or are not tolerating solids or liquids or have severe pain that will not go away, call your doctor. If your nausea is mild and you cannot tolerate solids but can drink liquids, try a clear-liquid, low-sugar diet (water, tea, dilute juices) for 2 to 3 days. If that is tolerated, then try full liquids (low or nonfat milk, protein shakes, puddings) in small volumes. If that works, add “slimy white” proteins (yogurt, eggs, cottage cheese, tofu) followed by soft proteins (fish, cheeses, soup meat) and then denser proteins (chicken, pork, other meats). You should be eating a minimum of 60 grams of protein per day. If with these foods nausea and abdominal cramps do not return, add fruits and vegetables to your diet.

In general, you should avoid “white foods” (white starches such as bread, pasta, rice, potatoes, and corn) because these can cause dumping syndrome and are very fattening. Drinking alcohol is allowable, but it may have a greater intoxicating effect than it had before the surgery.

If you have periodic abdominal pain, bloating, and gas, you may have developed intolerance to lactose, gluten, red meat, or sugar substitutes like sucralose or erythritol. Keeping a food and symptom diary may help you discover and avoid foods associated with the discomfort. Constipation can also cause abdominal discomfort. If you are constipated, try increasing your water and vegetable intake.

Vitamins After Bariatric Surgery

If you had a Roux-en-Y gastric bypass, biliopancreatic diversion, or duodenal switch procedure, you are at risk of not absorbing certain nutrients. You should take lifelong vitamin supplements as recommended by your doctor. See your primary care doctor or your surgeon every year for blood tests to make sure that these vitamin levels are within normal limits.

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Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: AACE/TOS/ASMBS bariatric surgery clinical practice guidelines. Endocr Prac. 2013;19(2):e9-e10.

Topic: Food and Nutrition