Gastric Bypass Diet Tips

All gastric bypass post-ops are told that Roux-en-Y and Duodenal Switch (and other malabsorptive procedures) are malabsorptive - but in hearing how many post-ops are living and eating, I don't think they fully understand what malabsorptive actually means.

Malabsorption: mal [bad, wrong or ill] + absorption [passing of nutrients] = bad passing of nutrients (Webster's New World College Dictionary)

Without nutritional supplements it is no longer possible for gastric bypass post-ops to receive all the nutrients they need to remain healthy. We can not get enough from food. We must take nutritional supplements - including protein shakes.

After looking at my list of recommended supplements, I've had many ask me which of those they could do without. I reply asking them which vital organ they want to do without, then I can answer their question. Yes, nutritional supplements for post-ops are that serious and important.

To know how much of each supplement you need to take, you first need to make sure you are having a full bloodwork panel done at minimum of every six months; but ideal is every 3 months. Why so often? Since we are not absorbing some nutrients at all from food (such as B12, and the majority of protein) the damage being done to the body is ongoing from day one after our surgeries, even if the symptoms of deficiency don't show up for months or even years - by the time symptoms are noticeable, it's possible irreversible damage could have been done.

Iron is one nutrient in particular that seems to take years to really start causing a problem in post-ops. Usually around 18 - 24 months is the most common time-frame of when I've noticed post-ops mentioning issues with their iron levels (hemoglobin, hematocrit, as well as, ferritin and total iron binding capacity or TIBC). The main reason is that the majority of iron is absorbed in the upper part of the small intestine - which we post-ops no longer have! In a proximal bypass patient, approximately 150 cm (that's 5 feet!) of upper small intestine have been removed. This is what makes our procedures malabsorptive, in addition to the removal/sectioning off of the majority of the stomach where absorption of nutrients also took place, that leaves us with the physical inability to absorb quite a few nutrients, or to absorb them to a much lesser degree in the remaining part of the small intestine. Therefore, iron supplements often do not work effectively for the gastric bypass post-op.

So what are the iron options available? One can try taking multiple iron supplements - but only after making absolutely sure what your iron levels are before you increase your dose. It is possible to overdose on iron. That said, liquid iron is one option that is in a form more readily absorbable by our bodies. Floradix Iron & Herbs is a natural liquid iron. I would recommend starting with that, watching your iron levels and see how it works for you. An adjustment in dosing may be required to 'tweak your levels' and see improvement in low levels, or to maintain good levels. Iron infusions are another options when supplements fail. If you are not seeing positive results with iron supplements, talk to your doctor about iron infusions.

The same is true for any other nutrient, tweak your dosing with the goal of reaching optimum lab results. How you look (hair, skin & nails are great indicators of nutrients) and how you feel (energy, mood & sleep patterns) can also be indicative of nutrient levels.

Good communication with your doctor is key to staying healthy as a post-op. Always ask for a copy of your labwork so you can see for yourself if levels are changing. Be your own health advocate; you had weight loss surgery for your health, so remain pro-active in staying healthy.

When I had my Roux en Y gastric bypass in 2004, I thought my annual resolve to lose weight would be over. While it's true, losing weight is no longer top on my New Year resolution list; staying true to a healthy post-op gastric bypass diet is most definitely on my to-do list for 2009.

Like most post-ops discover, the further out from our surgery date we get, our new digestive system has a way of adapting and foods we could not eat immediately after surgery, we now can. Sometimes this is good - sometimes it is not. This is when old habits can creep back into our eating and food choices; and worse, we get lax in taking our supplements.

There are four key areas where I see post-ops slipping up and start that slide downward into bad habits and weight gain.

1. Junk food & carbs. There are good and bad carbs. Vegetables, salad, fruits and even whole grains are good carbs. Chips, cookies, white breads, sugar and processed foods are bad carbs. Stick with the good carbs. Watch your portion control and cut out grazing in between meals.



2. No exercise. We need exercise for more than just weight loss, it helps strengthen our heart, muscles and mental well-being. Exercise can also help us with the ever threatening problem of constipation and insomnia that seem to plague so many post-ops.



3. Not taking supplements. This is so critical, I don't think it can be stressed enough. With a malabsorptive weight loss surgery, we no longer have the ability to absorb any nutrients 100%; and some nutrients not at all. We need to take a good quality multi-vitamin, B vitamin complex, calcium citrate, Vitamin D, Vitamin C, iron and protein shakes. B12 must be taken in either sublingual form, or via injections, as we can not absorb any B12 from food. Iron is another that we have a very hard time absorbing. Infusions may be necessary to maintain adequate levels. Additional supplements may be needed, depending on your particular blood levels acquired through blood work that should be done at least every 6 months.



4. Lack of support. Most post-ops are active in support groups, usually through the pre-op stage through about the first year after their surgery. After that time, there is a noticeable drop in their seeking support. Most assume they have arrived at their goal, they've got the hang of this whole post-op thing, and they get on with their lives. We then see a surge back to support about 3-4 years or so post-op, when many start gaining weight. I believe this lack of accountability and support lends itself to slipping back into old habits.

If you find yourself falling off the good post-op gastric bypass diet you know you should be following - stop right now. Resolve that from this moment forward, you will make healthy food choices, stop grazing, start exercising, you will faithfully take your supplements every single day and you will plug into a support group (offline is preferable, but online works too). This is critical to not only maintaining our weight loss, but maintaining our health!

To help you with the supplementation; try these resources. They are high quality, and ones I use myself.

Veriuni Advanced Liquid Nutrition - 98% absorbability liquid multi-vitamins

Supreme Whey Protein - uses hydrolyzed whey peptides for highest bioavailability

Floradix Iron & Herbs - natural liquid iron