From the Guidelines
After gastric bypass surgery, patients should follow a strict dietary progression and take prescribed supplements to prevent nutritional deficiencies and ensure successful weight loss. The dietary progression should start with clear liquids for 1-2 days, then full liquids for 1-2 weeks, pureed foods for 2-3 weeks, and soft foods for 4-6 weeks before gradually introducing regular foods 1. Patients should take small, frequent meals (4-6 daily) of 1/4 to 1/2 cup portions, chew thoroughly, and separate eating from drinking by 30 minutes 1.
Some key points to consider:
- Stay hydrated with 64 ounces of sugar-free, non-carbonated fluids daily
- Take prescribed supplements including a multivitamin, calcium citrate (1200-1500mg daily), vitamin D (800-1000 IU daily), vitamin B12 (500mcg daily), and iron if recommended 1
- For pain management, take medications as prescribed, typically acetaminophen or prescribed opioids, avoiding NSAIDs which can cause ulcers
- Gradually increase physical activity starting with short walks and progressing over 4-6 weeks
- Monitor for complications like nausea, vomiting, severe pain, fever, incision problems, or shortness of breath, and contact your healthcare provider immediately if these occur
It is also important to note that patients are at risk of developing protein deficiency after gastric bypass surgery, and a tailored list of high-protein foods and/or protein supplementation may be necessary 1. Patients should reduce the consumption of high-calorie–dense foods and beverages and limit added sugar to avoid dumping syndrome. Carbonated beverages should also be avoided.
Patients should attend all follow-up appointments for proper monitoring, as the altered digestive anatomy requires lifelong nutritional vigilance to prevent deficiencies and ensure successful weight loss. The most recent and highest quality study on this topic is from 2020, which provides guidelines for post-gastrectomy complications and treatment recommendations 1. However, the study from 2017 provides more detailed information on nutritional recommendations for adult bariatric surgery patients, including supplementation for the prevention and treatment of nutritional deficiencies 1.
From the Research
Post-Operative Instructions after Gastric Bypass Surgery
- The importance of preoperative assessment and treatment of nutritional deficiencies in morbidly obese patients undergoing gastric bypass surgery is emphasized 2.
- Post-operative oral supplementation should be encouraged as it decreases the incidence of deficiencies, despite limited efficacy 2.
- Patients with marginal ulceration after gastric bypass surgery who receive opened proton pump inhibitor (PPI) capsules have shorter ulcer healing times, fewer endoscopic procedures, and use less health care resources compared with patients who receive intact PPI capsules 3.
- Prophylactic PPI use can help reduce marginal ulcers after gastric bypass surgery, with a significant incremental benefit in reducing marginal ulcer formation 4.
Dietary Management and Supplementation
- Gastric bypass patients must make dramatic dietary changes, and their personal food systems guide food and eating behaviors 5.
- Patients use goal-strategy-monitoring networks to achieve their main goals, including weight management, overall health, avoiding negative reactions to eating, and integrating dietary changes with daily life 5.
- Monitoring behaviors are used to assess strategy effectiveness towards goal achievement, and individuals' weight management networks can be compared to uncover similarities and differences among strategy use and monitoring methods 5.
Medication Use and Interactions
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients, and if use is inevitable, a proton pump inhibitor (PPI) should also be used 6.
- Informing patients and their general practitioners by letter, in addition to care-as-usual, is not an effective intervention to reduce the use of NSAIDs after bariatric surgery 6.