How to proceed after bariatric gastric surgery.

The important objectives after any bariatric gastric surgery are threefold: (1) to maximize weight loss and absorption of nutrients, (2) to maintain adequate hydration, and (3) to avoid vomiting and dumping syndrome.

To assess proper nutrition, we ask our patients to bring a 24-hour recall of dietary intake to their appointment. We ask them to consume at least 64 oz of fluids daily, while avoiding sugary beverages and alcohol. Diet after gastric surgery may be inadequate because of the limiting size of the stomach pouch, which results in the patient eating smaller amounts of food. Protein intake is often a problem and is likely less than the 1.5 g/kg of ideal body weight. Most patients are able to consume 0.8–1 g of protein/kg of ideal body weight from a combination of foods and liquid supplements, which ends up being about 60–80 g of protein daily. Much of the nutritionist's work is related to informing patients how to eat properly and how to judge fluid, protein, carbohydrate, and fat intake. The importance of self-monitoring by means of keeping daily food records is emphasized from the initial visit.
*No liquids at meals; wait at least 30 minutes after a meal to start fluids. It is important to avoid overfilling and stretching the stomach pouch.
*Sip beverages; do not use a straw, which increases swallowed air.
*The daily goal is at least 1.4 L (6 cups) of fluids. This should include high-protein liquid supplement, skim milk, and sugar-free noncarbonated beverages. Decaffeinated coffee or tea is preferred.
*Stop eating and drinking when a full feeling occurs. Overfilling the stomach pouch will cause it to stretch, which often leads to increased intake.
*Avoid carbonated beverages, as the gas bubbles may stretch the pouch.

All patients with bariatric gastric procedures are at risk for nutrient deficiencies. Because Roux-en-Y gastric bypass is a malabsorptive operation, it carries greater risk for nutritional deficiencies than the restrictive procedures. This is because malabsorptive procedures cause food to bypass parts of the duodenum and jejunum, where most iron and calcium are absorbed. Menstruating women are especially prone to developing anemia because insufficient vitamin B12 and iron are absorbed. Decreased absorption of calcium may cause osteoporosis and metabolic bone disease. Patients are required to take nutritional supplements that usually prevent these deficiencies.