• Bariatric / Gastric Bypass Surgery
• Education
• Am I Obese?
• What are my risks?
• What are my weight loss options?
• Surgery
• National accreditation
• Comprehensive Care
• Taking the Next Step
• Lifestyle
• Pre-assessment
• Surgery
• Frequently Asked Questions
• Side Effects
• Diet
• Preparation For Surgery
• Surgery
• The Hospital Stay
• Life After Surgery
• Technical Questions
• Internet Resources
• Seminar Video
• Downloadable Forms
• Support Groups

Frequently Asked Questions - Diet

1.  Do I meet with a nutritionist before and after surgery?
You are required to work with a nutrition professional both before and after your surgery.

2. Will I get a copy of suggested eating patterns and food choices after surgery?
The surgeon and nutrition professionals will provide patients with materials that outline expectations regarding diet and compliance to guidelines for the best outcome based on your surgical procedure.  After surgery, health and weight loss are highly dependant on patient compliance with these guidelines.  You mist do your part by restricting high-calorie foods, by avoiding sugar, snacks and fats and by strictly following the guidelines set.

3.  Will I be miserably hungry after weight loss surgery since I?m not eating much?
Most patients say no.  In fact, for the first 4-6 weeks many patients have almost no appetite.  Over the next several months the appetite returns, but it tends not to be a ravenous ?eat everything in the cupboard? type of hunger.

4.  What if I am really hungry?
This is usually caused by the types of food you may be consuming, especially starches (rice, pasta, potatoes).  Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.

5.  How much protein do I need?
Most authorities recommend 55-60 grams of protein per day in otherwise healthy people undergoing weight loss. There is no specific data, as of yet, which specifies the recommended amount for gastric bypass patients. General surgical data indicates that slightly more than the Recommended Dietary Allowance (0.8 g/kg) is needed after most elective operations. This amount is based on the patient's weight.

Achieving the recommended amount of protein initially may be difficult. Most (at least 50%) of the protein should be of "high biological value" or be of high quality.  Meats, chicken, fish and dairy products are of high quality. Other foods, like grains and vegetables also contain protein, but the biological value of the protein is not as high.  These foods are needed, however, as part of a well-balanced diet, and should be included as tolerated.

6.  What foods contain protein?  How much?
The foods that contain the highest amounts of protein are meat and dairy products.  One ounce of meat contains 7 grams of protein and 1 cup of milk or yogurt contains 8 grams of protein.  Other foods like peanut butter, soymilk, tofu and beans also contain about 7 grams of protein per serving.  Vegetables have about 2 grams of protein per serving.  Starchy foods like pasta, rice, cereal or bread generally contain about 3 to 5 grams of protein per serving; however, protein content does vary based on food.  Fruit contains no protein.  See protein sources in stage III diet information.

7.  What foods will I not be able to tolerate?
The most important point to remember about tolerating different foods is everyone is different and you will need to figure out what foods work or do not work for you.  Remember to always chew your food well and to eat small amounts slowly, listening to your body to know when to stop.  People some times confuse a behavior modification issue with tolerance of a particular food.  With that said we know there are a few foods that may be problematic early on including red meats, over cooked meat or micro waved meats, and foods high in fats and sugars.

8.  Is there a problem with consuming milk products?
Milk contains lactose (milk sugar), which may not be well digested.  This sugar passes through undigested until bacteria in the lower bowel act on it, producing irritating byproducts as well as gas, depending on individual tolerance, some persons find even the smallest among of milk can cause cramps, gas and diarrhea.  This does not occur in all patients.

9.  Why can't I snack between meals?
Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can ad hundreds of calories a day to your intake, defeating the restrictive effect of your operation.  Snacking will slow down your weight loss and can lead to regain of weight.

10.  Why can't I eat red meat after surgery?
You can, but you will need to be very careful, and we recommend that you avoid it for the first several months.  Red meats contain a high level of meat fibers (gristle), which hold the piece of meat together, preventing you from separating it into small parts when you chew.  The gristle can plug the outlet of your stomach pouch and prevent anything from passing through, a condition that is very uncomfortable.

11. Is there any restriction on salt intake?
No, your salt intake will be unchanged unless otherwise instructed by your primary care physician.

12.  Will I be able to drink soda?
When asked, most patients who had weight loss surgery indicated they did not tolerate soda even if it was flat.  The recommendation is to avoid soda for a minimum of one year.  After that you can retry soda.  There is a concern that drinking soda may lead to an increase in food intake long term.

13.  Will I be allowed to drink alcohol?
You will find that even small amounts of alcohol will affect you quickly.  It is suggested that you drink no alcohol for the first year.  Thereafter, with you physician's approval, you may have a glass of wine or a small cocktail.

14. Will I be able to tolerate peanut butter?
Peanut butter does seem to be a well-tolerated food for some people. But some people even 2 months after surgery complain that a small amount (1 teaspoonful) was very uncomfortable.

15.  What vitamin supplements should I be taking?
People who undergo gastric bypass can become deficient in certain vitamins.  Initially you should be taking 2 children's chewable vitamins or 1 adult vitamin.  Chewable vitamins may be better tolerated at first.  You should also be taking vitamin B12, iron, and calcium.  B12 is available as tablets, sublingual tablets (taken under the tongue), and as a subcutaneous (under the skin) injection.  Iron is best taken on an empty stomach three times per day; however, it can cause irritation to the stomach.  It may be best to take iron with food (other than dairy) to prevent stomach problems and constipation. Ask your doctor or pharmacist about which vitamin is best for you. Here are some of our suggestions:

You would still need to take an additional supplement of one thousand micrograms (1mg) per day of vitamin B12 or have Vitamin B12: 1000 mcg intramuscular injections monthly.

16. Can I use TUMS as a calcium supplement or should I use calcium citrate?
Tums contains calcium carbonate and is an excellent source of calcium.  However, absorption of calcium citrate has been found to be greater than that of calcium carbonate in a less acidic environment such as your new stomach.  Very little data is available specifically for gastric bypass patients. One study found that in patients with no stomach acid, 45% of calcium from calcium citrate was absorbed, whereas only 4% of calcium from calcium carbonate was absorbed.  In patients with normal stomach acid levels, absorption was 24% and 22% respectively.  The amount of acid in your stomach falls somewhere in between.  

The bottom line is that there are many calcium supplements available, each having their own advantages and disadvantages.  As long as you are getting 1200mg-1500mg of elemental calcium a day and you are being monitored regularly for calcium deficiency during follow-up visits with your doctor, any of the following products may be used: