Dietary Recommendations After Gastric Bypass Surgery
When obesity gets out of hand, unresponsive to dietary, lifestyle and medical interventions, drastic measures are needed to cut down calorie intake. Morbid obesity with a BMI (body mass index, a measure of malnutrition) above 40 kg/m2 is an indication for surgical procedures such as gastric bypass surgery. Gastric bypass is now a well-trodden path to lower BMI’s and achieve healthier lives in 18 months or so. First used in the 1950’s, only the last two decades have seen safe and successful gastric bypass surgery with any consistency. Half a century of meticulous observations and patient follow-up has led to the formulation of strict guidelines to ensure desired results.
Gastric bypass is a series of steps initiated starting with the decision to undergo the procedure. Identifying existing nutritional deficiencies is the first step towards surgery. Vitamin and mineral deficiency often occur in obesity, and need to be addressed before the procedure. The surgery itself has two goals; to reduce the volume of the stomach and shorten the food transit time in the intestine. After surgery the stomach cannot receive large meals or participate in digestion. This by itself limits food intake. Food also bypasses a large part of the intestine and has little time to interact with liver and pancreatic enzymes. As a result, nutrition absorbed from diet drops drastically. In most types of gastric bypass surgeries done today only 50 cm of the intestine is allowed to function in normal fashion. Compare this to food absorption taking over 7 feet of small and large intestine before surgery.
With such a radical reduction in the capacity to assimilate food, the postoperative period can be rather tricky. Only clear fluids are advised for the first two days while waiting for gut to recover. The gut is then re-trained for about two months before it can go back to a normal diet. During the recovery period the limitations imposed by the gastric bypass procedure should be kept in mind. After surgery the stomach has become much smaller and can only hold approximately eight ounces at a time. The stomach has also lost its ability to pulverize food to initiate digestion. Consequently the appropriate diet for postoperative recovery would be a liquid to soft solid diet that can be taken six to eight times a day in small quantities. Nutrient fluids are preferable since they can provide hydration and energy at the same time. Non-nutrient fluids are best avoided or at least restricted to in-between meals.
The type of nutrient chosen also deserves due consideration. The chosen macronutrient should not affect the stomach emptying time while providing enough energy to recover from the surgery. In this regard carbohydrates and fats are at either end of a spectrum and neither is suitable. Carbohydrates pass through very quickly and produce very uncomfortable symptoms like vomiting, bloating, diarrhea and sweating. Fat slows the gut considerably, and it is oftentimes ruled out because of its direct link to obesity. Research suggests that the macronutrients of choice after gastric bypass surgery are proteins. Proteins do not change gastric transit time significantly. A high-protein diet can also provide enough amino acids for repair and growth after a major surgical procedure like gastric bypass.
Apart from these advantages, a high-protein diet has a special role in the treatment of obesity. Gastric bypass restricts excessive calorie intake to prevent weight gain. However, accumulated adipose tissue also needs to be expended to achieve the desired weight loss. The basal metabolic rate (energy expenditure) should be increased simultaneously to burn stored fat and reduce BMI. This can be achieved by a high-protein diet since proteins in diet increase the basal metabolic rate by stimulating protein synthesis. Observations made during the postoperative period also confirm this proposition. Unless a high-protein diet is provided, weight loss often ceases despite controlled consumption.
Currently, a protein intake of up to 90 grams per day is recommended in the post-operative period. Given the trauma and the limitations the gut is subjected to during the procedure, such a high protein intake can be difficult to maintain. The gut is hardly ready and often fails to assimilate proteins and energy from traditional foods and diets. Therefore, a sugar-free fluid protein concentrate with a high bioavailability, adequate essential amino acids, vitamins and minerals is the most appropriate diet in the post-operative period. Digestion is further facilitated if the protein concentrate is already pre-digested, or hydrolyzed. Such a nutrient fluid can simultaneously supply concentrated energy and hydration even when taken in small quantities.
After recovery and return to a normal diet divided over 3 to 4 meals per day, a high-protein concentrate is still a relevant supplement between or during meals. The protein supplement continues to provide thermogenic action necessary to lose weight essential to sustain weight loss. It also compensates for any amino acid deficiency in the diet and maintains nutrition on bad days not uncommon in the months and years after a major surgery.
ABOUT PROTICA
Founded in 2001, Protica, Inc. is a nutritional research firm with offices in Lafayette Hill and Conshohocken, Pennsylvania. Protica manufactures capsulized foods, including Profect, a compact, hypoallergenic, ready-to-drink protein beverage containing zero carbohydrates and zero fat. Information on Protica is available at protica.com
You can also learn about Profect at profect.com
REFERENCES
1. Kellum JM, DeMaria EJ, Sugarman HJ. The surgical treatment of morbid obesity. Curr Prob Surg. 1998;35:791-858.
2. MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann of Surg. 2000. 231:524-528.
3. Nutritional Implications of Bariatric Surgery: Perspectives of Practitioners Audiotape/Handout packages available post-conference.
4. Weight management-Position of ADA. J Am Diet Assoc. 2002;102:1145-1155
5. Faintuch J, Matsuda M, Cruz ME, et al. Severe protein-calorie malnutrition after bariatric procedures. Obes Surg 2004; 14:175-181.
6. Alvarez-Leite J.I. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care 7:569-575.
Copyright Protica Research – protica.com
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Fitness Wars: Revenge of the Girth
As of the writing of this article, May 16, 2005, we are all almost 5 months into our New Year’s Resolutions.
Are you skinny yet?
Did you find your six-pack?
Does your butt look like you wanted it to in those jeans?
For a lot of you, the answers to these questions are going to be “No, No, and, I took the jeans back to the store”.
Why? You are a victim of the Fitness Wars, that’s why. Your Girth is winning out over your Resolution, and you are probably more frustrated now than you were when you started!
Is there some master conspiracy that is keeping you from getting in shape? Do the rules of energy in vs. energy out not apply to you? Are you in a fat-loss vacuum where the normal laws of weight loss don’t work?
Of course not. Yet, you still can’t lose the bodyfat, and it is likely because you are simply confused.
If you are like most people, you have gotten fitness advice from the radio, TV, friends, family members, magazines, maybe even a Personal Trainer. Who had the most to gain from giving you fitness advice?
The radio, TV, magazines, and even your trainer are all interested in getting paid for handing out advice to you. Does that make them the most qualified to help you? With the possible exception of your personal trainer, no, it really doesn’t.
What about your friends and family? Let’s answer this question first: Was the person who gave you the advice in good shape? If not, then the point of that question should be clear!
Fitness Wars – all of these different people and agencies trying to get you to do something or buy something.
How about a little thing that some people like to call “Back to Basics”? Prepare Thyself! You are about to be shown the true secrets to fitness success!!
1. Proper Nutrition. For those of you who don’t know what that is, a good rule of thumb is that if man made it, don’t eat it! If that isn’t enough information for you, then consult a professional nutritionist, or do free research online. If you pay a professional, make sure they are properly credentialed. If you do the research yourself, don’t believe what you find if that site is obviously more interested in your money than in your health.
2. Eat 5 to 6 small meals a day. You say that you’ve heard this a thousand times already? Well, that should tell you something – it works! Your body is a calorie burning machine. If you are an average female, you can only burn about 300 calories at a time. An average male can burn about 400. It doesn’t matter how much you exercise – if you eat more than that during any one sitting, some of it is going to be stored as bodyfat.
3. Exercise – at least 60 minutes a day. It doesn’t matter what the magazines say, or what you hear on the “1-Second Abs” commercial, or who tells you anything else. Exercise – at least 60 minutes a day. It bears repeating, so feel free at this time to keep saying it out loud until you feel that you have it memorized.
4. Believe. This final step is really the most important. Most people have self-limiting beliefs. In a nutshell, that means that no matter how much education or assistance that they receive, they don’t BELIEVE that they can lose weight! Let’s see?. how does that saying go? “Whether you think you can, or think you can’t, you’re right!” Believe it can happen, because it can. Then you will be only 3 short steps away from success.
Wow, what a revelation this article has been! In fewer words than it takes to list the dozens of unhealthy circumstances and afflictions related to being overweight, you have just been given a guaranteed 4-step system for fitness success!
Are you willing to take care of yourself and finally meet those fitness goals, or do you have another 5 months to waste?
Do yourself this one small favor. Count to four, beat the Girth, and remember that January 1st is just another day!
Aaron Potts is a Personal Trainer and Fitness Success Coach whose customers include both consumers as well as other fitness professionals. Sign up for his free Fitness Journal at fitnessdestinations.com or visit his coaching site at ptsuccesscoach.com
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