Trouble Shooting After Bariatric Surgery
This page has been prepared to give you insight about the variety of problem you might face in your weight loss journey after surgery. If any of your problems is making you very uncomfortable or persisting after following the tips mentioned in these pages, please contact your surgeon immediately.
Bloating
- Limit liquids to 60ml at one time
- Sip slowly
- Avoid carbonated beverages and drinking from a straw for approximately 6 weeks after surgery. Doing this can help you to avoid excess gas and pressure.
Constipation
True constipation happens when stool is hard, dry, painful or difficult to pass.
Some people think they are constipated when they have fewer bowel movements then they had before surgery. This is not true constipation. This is probably happening because you are eating less food.
It is normal to have 1 to 3 bowel movements of soft stool every 1 to 3 days.
Why does this happen?
This happens because you are:
- Eating less fiber
- Not drinking enough fluids
- Taking pain control medicine
What can you do?
- Ensure you are getting adequate fluid (minimum of 2 liter per day) between meals
- Increase your fiber intake as your diet progressions allows
- Bran cereal
- Fruits and vegetables
- Legumes (beans and lentils)
- Whole grain bread
- Getting adequate exercise often helps
- You may need to add a stool softener or fiber supplement, speak with your dietitian or surgeon about available products
If these suggestions do not resolve the problem, you can consider taking a fiber supplement or flaxseed meal.
Fiber Supplements: Available in most of pharmacy.
Flaxseed
Flaxseed is a good source of heart healthy omega-3 fatty acids and an excellent source of both insoluble & soluble fiber. Adding 1-2 tablespoons daily to your diet may help with bowel regularity.
Dehydration
Why does this happen?
This is a common problem after gastric bypass surgery. This is because it is difficult to drink enough water with the size of your new stomach pouch.
What are the signs and symptoms?
- thirst
- dry mouth, lips, skin, eyes
- headache
- feeling dizzy or lightheaded
- feeling irritable or tired
- not urinating very often
- dark coloured urine
What can you do?
- Keep yourself hydrated by sipping water or other low-calorie fluids all day long.
- Try to drink 6 to 8 cups of fluid every day.
- Drink out of the same container, like a 500ml water bottle. This can help you keep track of how much fluid you are getting.
- Try sucking on ice chips or a sugar-free Popsicle, these count as fluid too.
Finding it hard to drink enough water? Try these tasty tips!
Add flavor with fruit
- Add lemon or lime slices for a tart freshness
- Add a few frozen berries, try blueberries or raspberries
- Orange slices and a pinch of cinnamon give your water an exotic flare
- Fresh mint and strawberries give water a refreshing zing – release the flavor of the mint by crushing it a little before adding
Add flavor with cucumber
- Add 6 to 8 slices of cucumber and 5 to 6 slices of lemon or lime to a pitcher of water. Keep refrigerated and strain before serving
Cool off with iced green tea
- Make green tea using one cup of boiling water and 3 tea bags or 5 teaspoons of leaves. Steam for 3 to 5 minutes, and then pour into a pitcher. Add ice and top with water, enough to make 4 cups. Want more flavour? Add lemon and a sugar substitute
Relax with an herbal fruit tea
- Brew the tea and enjoy hot or cold. These teas give great fruity flavour and natural sweetness with zero calories and no caffeine
Spice it up
- Add grated fresh ginger, lemon wedges and a sugar substitute to your water for a great zing! Want even more flavour? Pour boiling water over the ginger first and let it steep for 5 minutes
Ice cubes with zest
- Use a fine grater and zest your favorite citrus fruit. Add a little zest to each part of an ice cube tray and fill with water. Freeze and add to your water just before sipping
Flavour on the go
- Add sugar free flavour crystals or drops to your water
DIZZY OR GETTING HEADACHES
- Drink 2 liters water every day.
- Add salt, broth or soy sauce to your foods.
- Drink regular tomato juice.
- Eat meals on a regular schedule. If you experience acidity in between meals, try nibbling on some dry fat-free crackers.
Diarrhea
Some people have soft or liquid stool for a few months after surgery.
Why does this happen?
This can happen because your body is getting used to digesting food in a new way. It can also happen when you have dumping syndrome.
What can you do?
Step 1 – Avoid these foods:
- foods that cause dumping syndrome (see under dumping syndrome)
- fatty foods
- foods high in sugar alcohols
- caffeinated beverages
- milk products (see under lactose intolerance)
Step 2 – Increase the amount of soluble fiber in your diet.
You can do this by:
- Take a fiber supplement
- Eating Bananas, applesauce or oatmeal
If you have Diarrhea make sure you drink extra fluid.
Consult your Doctor if
- You have diarrhea that continues for more than 3days
- You have diarrhea that is so serious it is interfering with your daily life
DIARRHEA (Not related to eating dairy products)
- Eat more slowly. Stop eating when full.
- Avoid having beverages with meals.
- Avoid sugar, fat, alcohol and spicy foods.
- Keep eating well-tolerated foods until you feel better, or go back to clear liquids for a day.
- Limit the amount of sorbitol or mannitol in foods (these sugar alcohols are usually found in sugar-free candies and sugar-free ice cream products).
- Limit beverages containing caffeine to 2 cups per day including regular coffee, tea and flat diet colas.
- Quit smoking if you resumed it after surgery.
- If the diarrhea continues, we may need to check for a bacterial infection. Do not take anti-diarrheal medication without checking first with your surgeon.
Food Intolerance
After Bariatric surgery you may find you are not able to tolerate certain foods. Food intolerance varies widely and one individual may tolerate a food that disagrees with another person. Therefore, it is important to try a variety of foods. Each individual must try new foods carefully (introduce one new item at a time) to test his or her reactions after surgery.
Some foods that patients find hard to digest are:
- Bread products- fresh, doughy bread can form a ball and “gum up” the opening from the stomach
- Red meat or chicken – Dry, gristly meats may be difficult to digest. Meats (chicken, steak, burger, ham) should be moist and cut into very small pieces about the size of a pencil eraser. Go slowly
- milk and milk alternatives
- pasta – pasta may form a paste and be more difficult to pass
- rice
- fatty foods and fried foods
- candy and chocolate
- sugary foods and beverages
- dried fruit and skins of fresh fruit
Why does this happen?
Your digestive tract has been changed by surgery. These changes can make it difficult for your body to digest certain foods.
What are the signs and symptoms?
You may experience a feeling of pain or pressure in your stomach or a feeling of food being “stuck”, these are signs of food intolerances.
What can you do?
Do not be discouraged if a certain food does not agree with you once. Wait a few weeks and try it again. Your stomach just might not have been ready for the food yet. Make a note of signs of food intolerance & the food item. Discuss with your Doctor in next meeting.
Gastroesophageal Reflux Disease (GERD) – Burp, eructation
Patients may experience GERD symptoms following sleeve Gastrectomy. GERD occurs when gastric contents reflux (backward motion) in to the esophagus. It is recommended that a trial of limiting or eliminating the following foods may reduce the symptoms of GERD:
- Carbonated beverages
- Chocolate
- Alcohol
- Caffeinated beverages (regular tea, coffee, colas, energy drinks)
- Pepper
- High fat foods, including:
- 2% milk, whole milk, cream, high fat cheeses, high fat yogurt, chocolate milk, cocoa
- Fried meats, bacon, sausage, pepperoni, salami, bologna, frankfurters/hot dogs
- Other fried foods (doughnuts, French toast, French fries, deep fried vegetables)
- Nuts and nut butters
- Pastries and other high fat desserts
- More than 8 teaspoons of oil, butter, shortening per day
- Any fruits or vegetables that cause symptoms (these will vary from person to person)
- Avoid drinking from a straw
- Avoid overeating
Gas
After surgery it is normal to have pain or discomfort from gas in your abdomen.
Why does this happen?
Swallowing air can happen when you eat and drink. With the new small stomach pouch, even a small amount of swallowed air can cause painful gas.
After surgery; you also digest food differently, this can cause your body to produce gas.
What can you do?
- Eat slowly
- Do not use straws
- Do not chew gum
- Eat protein with carbohydrate food
- use an over-the-counter product recommended by your pharmacist
If you have gas pains with specific foods, avoid those foods for a few weeks. Try them again later in small amounts.
Remember: Use a food journal to keep track of foods that cause you discomfort.
Hypoglycemia
Hypoglycemia is low blood sugar. Even if you did not have diabetes before surgery you may experience hypoglycemia after surgery. The type of low blood sugar you can get after surgery is called reactive hypoglycemia. Reactive hypoglycemia is low blood sugar that usually happens after you eat a meal or a snack that is high in sugar.
What are the signs and symptoms?
- Hunger
- Dizziness
- Cold and clammy skin
- Weakness or shakiness
- Nervousness
- Feeling confused or anxious
These signs happen after you eat. Symptoms usually happen a few hours after eating. They usually go away after you eat again.
Why does this happen?
Foods high in sugar may pass into the small intestine before they have been adequately broken down. This causes the pancreas to secrete more insulin than is needed which brings the blood sugar level down too low.
How can you prevent it from happening?
- eat balanced meals
- eat meals on time
- have protein with each meal and snack
- choose carbohydrates that are high in fiber and low in sugar
- avoid sugar and high sugar foods
- avoid alcohol
- avoid skipping meals
To help control your blood sugar, eat the protein portion of your meal first.
What should you do if your blood sugar is low?
If you think you have reactive hypoglycemia get a blood glucose meter and measure your blood sugars.
If your blood sugar goes below 72 mg/dl you need to:
1. Have 15g of fast acting sugar.
This sugar can be in the form of:
- 3/4 cup of juice
- 3 dextrose tablets
- 1 tablespoon of honey
- 1 tablespoon of sugar in 2 tablespoons of water
2. Wait 15 minutes and check your blood sugar again.
3. If your blood sugar is still below 72mg/dl or 4 mmol/L, repeat steps 1 and 2 until your Blood sugar is above 72mg/dl or4 mmol/L.
4. Eat a snack that contains protein and carbohydrate.
Some examples are:
- apple and peanut butter
- melba toast and cheese
- Greek yogurt and fruit
- hummus and carrots
Do not do this if you have low blood sugar:
Do not eat foods that are high in sugar, like cookies or candies, to raise your blood sugar. It is important that you have a controlled amount of fast acting sugars. Trying to raise your blood sugar with cookies or candies can be unsafe because they can have different amounts of sugar depending on what kind you buy.
Hair Loss
Hair loss is a common side effect of weight loss surgery. Usually this happens between 4 months and 9 months after surgery.
Why does this happen?
Hair loss can happen for many reasons. Sometimes it is related to nutrition and sometimes it is not.
Reasons related to nutrition are:
- Iron deficiency
- Zinc deficiency
- Low protein intake
Reasons not related to nutrition are:
- Major surgery
- Rapid weight loss
Hair loss not related to nutrition cannot be avoided after weight loss surgery. Usually, this kind of hair loss will happen very soon after surgery.
Hair loss that happens much later after surgery is often caused by vitamin and mineral deficiencies. Follow the diet and supplement schedules you learn about in this book to prevent this kind of hair loss. Your Registered Dietitian can help you manage any deficiencies. This is why it is important to complete your blood work before appointments with the Registered Dietitian.
What can you do?
There is no way to prevent hair loss. But, you can do these 3 things to minimize it:
1. Make sure you are eating at least 60-80 g of protein a day
2. Make sure you are taking all of your vitamin/mineral supplements
3. Complete your blood work on time. This will allow your Registered Dietitian to see if you have any vitamin or mineral deficiencies
When your weight begins to stabilize your hair will grow back. Your hair may grow back differently from before. For example, if you had straight hair it may grow back curly.
LEG CRAMPS
- Make sure you are following the diet as advised by your surgeon and dietitian.
- Remember to take your multivitamin every day. Try to increase your activity. Do not sit in the same position for more than a half hour. Try putting your legs up on a chair if they look swollen. Avoid crossing your legs. Don’t wear socks or knee high stockings that have tight bands
Lactose intolerance
Lactose intolerance is a common kind of food intolerance.
People who are lactose intolerant will feel these symptoms when they eat or drink milk:
- cramping and stomach pain
- bloating and gas
- diarrhea
Why does this happen?
Lactose intolerance is common.
Lactose is the natural sugar found in milk products. It is digested in the small intestine. If your body does not produce enough enzymes to breakdown lactose you will be lactose intolerant.
What can you do?
- Stop drinking milk. You may be able to eat yogurt and cheese without any symptoms
- Try lactose free milk.
Nausea, vomiting and stomach pain
You may have nausea, vomiting and stomach pain after bariatric surgery. Nausea in the first week may be your body’s reaction to the anesthetic used during surgery. Later on, nausea, vomiting and stomach pain may happen for many reasons.
Here are some common examples:
| Why does this happen? | What can you do? |
| Eating too much | Measure your food |
| Eating too fast | Put your fork down between bites Time your meals |
| Not chewing enough | Chew your food 20 to 30 times for each bite |
| Eating foods that are too dry or too tough | Add a gravy or sauce to moisten your food |
| Taking bites that are too large | Cut food into the size of a pencil eraser |
| Eating and drinking at the same time | Do not drink 30 minutes before or after a meal Do not drink during your meal |
| Swallowing air | Do not drink carbonated beverages Do not use a straw |
| Dehydration | Drink 6 to 8 cups of low calorie fluid everyday Keep track of how much you drink on your food journal |
Pain in shoulder or upper chest area (occurs when you eat too much or eat something hard to digest)
- Stop eating if pain occurs during eating and try to eat later after pain has resolved
- If pain persists, call your surgeon
Overeating
The purpose of bariatric surgery is to create a smaller stomach so that it is unable to hold the large volumes of food it had held previously. Constant overeating can stretch your stomach.
To prevent stretching the pouch:
- Eat only small meals, and measure your food before you eat to prevent overfilling the stomach.
- Eat slowly so that the nerve receptors in your stomach area can relay the message to your brain that your stomach is full. It takes approximately 15-20 minutes for the message of fullness to reach the brain. Take time between bites of food and stop eating as soon as fullness is experienced.
- Recognize when you are full, which can feel like pain or pressure in the center just below your rib cage, nausea, or a pain in your shoulder or upper chest. The next step is to stop eating when you feel full.
- Constant nibbling/grazing/snacking may not stretch your stomach pouch, but it is a common bad food behavior among people who do not meet their weight loss goals and/or regain significant amounts of weight after surgery.
- Avoid carbonated beverages
SUDDEN LIGHT-HEADEDNESS
- Make sure you are getting enough protein in your diet. Are you eating enough food? If you do not get sufficient protein calories, your body will burn fat as well as muscle for fuel, making you feel very tired. Keep food records and show them to your dietitian.
- Limit caffeine-containing beverages to 2 cups per day including regular coffee, tea and colas.
- Take all recommended vitamins and minerals.
- Remember to drink at least 64 fluid ounces of water per day.
- Are your getting enough sleep? Are you trying to do too much too soon? Be realistic about exercise and other activities.
- Check your medications with your surgeon or internist.
- Make an appointment to have blood work done. After gastric bypass, anemia secondary to iron or B-12 deficiency can occur. It is natural to feel tired after surgery; however, you should start to feel better over time.
Taste/Sensory Changes
- This may occur during the first few months after surgery but will resolve over time
- Some foods may taste too sweet or have a metallic taste
- Strong smells from cooking may affect you, try to avoid the kitchen while someone else is cooking
Under nutrition
Total food consumption is reduced after surgery, and therefore, intake may be nutritionally inadequate.
To compensate for reduced nutrient intake:
- Consume nutrient-dense foods daily, including a variety of lean meats, low-fat dairy, fruits and vegetables, and high fiber breads and cereals.
- Look for breads that have at least 3g of fiber per slice, and cereals that have at least 5g.of fiber per cup.
- Avoid empty calorie foods, including soda pop, Kool-Aid, chips, pretzels, and popcorn, candy, pastries, sweets, and rice cakes.
- Avoid foods that are breaded and fried.
- Consume adequate high biological value protein foods each day.
- Take the recommended vitamins (multivitamins, calcium, vitamin D, iron, and vitamin B12 supplements) every day. THIS IS IMPORTANT!
Weight gain or no further weight loss
- You might be eating high calorie foods or beverages
- Keep a record of all foods, beverages and snacks eaten to determine the exact reason for this
- Measure portions sizes
- Avoid prolonged use of nutritional supplements such as Ensure, Boost, etc.
- Use only low calorie beverages in addition to fat free milk
- Increase physical activity