What should I do if I have diarrhoea?
Diarrhoea can be a problem after any gastric surgery. This can be caused by the movement of your digestive tract being upset. If this occurs, try sticking to bland foods and ensure you are drinking sufficient fluid. Loperamide (e.g. Imodium) can also be used. If you have had a gastric bypass, it can also occur due to eating too much fat, so take measures to reduce your fat intake, e.g. remove fat from meat, use 1% fat or skimmed milk, try reduced-fat or half-fat cheese instead of full-fat, limit oil when cooking and spread on toast/bread/crackers.
How do I prevent constipation?
There will be a reduction in the volume of your stools after surgery, which is caused by a decrease in food volume, ingesting less fibre during the fluid/pureed phase and/or consuming insufficient fluid. The main method of prevention is to drink sufficient amounts of fluid. The following general principles will help you to restore a normal bowel pattern after surgery:
- Drink plenty of fluids – this does not have to be just water – include sugar-free/no-
added-sugar flavoured water, tea/coffee, herbal/fruit teas, sugar-free/no-added-sugar squash. During the fluid stage, meal replacements, milk and soup all count.
- Exercise regularly in accordance with the guidelines in section 17.
- Include prunes or unsweetened prune juice in your diet daily. Dilute juice 50:50 with water to prevent consuming too much sugar at once, as this could cause Dumping Syndrome if you have had a gastric bypass (see section 15).
- Start eating high fibre foods such as high fibre crackers (e.g. Ryvita, Finncrisp), cereals, potato skins and whole-wheat pasta as soon as you progress back onto textured/solid foods 8 weeks post-op. During the puree and soft food stages (weeks 5 & 6 and 7 & 8 respectively), you can include soft, high fibre foods such as Weetabix and porridge (pureed during the puree stage).
- Include fruit and vegetables in your diet every day, taking into account the stage you are on (see section 8).
If constipation persists, you may need to try taking a natural laxative such as Senna (remember to take in liquid form in the first 8 weeks). If this is ineffective, see your GP for a prescription of lactulose, but it is best if you contact us to speak with a dietitian or nurse in the first instance.
Why am I having regurgitation?
Pain on eating and regurgitation are common complications that can occur specifically in the first few months after gastric bypass and sleeve surgery. During the liquid stage, they are usually triggered by drinking too much or too quickly. See “How should I drink?” in section 8. Once you start to introduce foods, ensure you take small mouthfuls, eat slowly and chew properly. See “How to Eat” in section 8.
Is pain on my left-hand side normal?
Pain on your left-hand side can be related to wind. During surgery, some gas is pumped into the abdomen to increase the area inside and allow the surgeon to see clearly. Whilst most of the air is removed at the end of the operation, some can remain and can produce ‘referred’ pain which radiates to your left shoulder because of the way that the nerves are connected to your diaphragm. Wind remedies may be effective, i.e. peppermint tea, gripe water, Deflatine/Wind-eze. Further down the line, wind only usually occurs due to poor eating technique. Make sure you are taking small mouthfuls, chewing well and eating slowly.
How can I get rid of flatulence?
It is not uncommon to suffer from excess flatulence with these types of surgery, especially gastric bypass. This is due to undigested food reaching the large intestine and fermentation occurring. It can also be due to eating too quickly, which can mean you ingest air while you eat. Another reason for this symptom could be intolerance to a specific food, so contact us to arrange a consultation with a dietitian who will be able to provide further advice; keeping a food and symptom diary can also be useful.
Will I have hair loss?
Hair loss is a relatively commonly reported issue after gastric bypass and sleeve surgery.
It is usually due to:
- Rapid weight loss
- The body’s “protein pool” being vastly reduced as a result of reduced food intake and the body needing to use it for enzymes, hormones and for transporting substances around the body in the bloodstream, rather than to produce hair. After around 6 months it usually begins to correct itself, but you need to ensure that:
- You take all the recommended supplements as described in section 16.
- You are having regular blood tests as described in section 16. It may be worth bringing them forward. You may need additional supplements.
- You are eating enough protein – 60g per day
Hair loss can also be a symptom of selenium deficiency. An easy way of increasing your selenium intake is eating 2-3 Brazil nuts every day (only once you are onto a solid diet).
Can I drink alcohol?
After the first 4 weeks, but remember that due to your vastly reduced food intake, your tolerance to alcohol will be significantly reduced. In gastric bypass patients, alcohol is absorbed a lot quicker which further contributes to this. Remember fizzy drinks are not allowed and alcohol is high in calories! See section 8.
What is dumping syndrome?
Dumping syndrome, or rapid gastric emptying, is relatively common following bariatric surgery procedures that bypass the majority of the stomach, such as the gastric bypass. It describes the symptoms that occur when food moves too quickly through the stomach and is “dumped” into the small intestine. There are two types of dumping syndrome: early and late. Early dumping syndrome symptoms are caused because food is “dumped” into the small intestine too soon. The food is too concentrated, so fluid moves from the bloodstream into the intestines. The intestines then become fuller and bloated - diarrhoea can often occur 30 to 60 minutes later. Some substances are released by the small intestines that affect heart rate and blood pressure. Symptoms can include diarrhoea, bloating, sweating, abdominal cramps and pain, nausea and stomach growling or rumbling. Late dumping syndrome symptoms occur one to three hours after eating a meal containing lots of carbohydrates. The blood glucose levels rise dramatically, causing the pancreas to release a lot of insulin. Insulin works by bringing the levels of blood glucose back down to what is considered normal. However, in late dumping syndrome the levels fall too low – this is called reactive hypoglycaemia. Symptoms can include sweating, fainting, fatigue, tremors, confusion, heart palpitations or rapid heart rate, or an urge to lie down.
Should I be taking supplements?
Yes, this is very important. See supplements section.
Will I get any nutrient deficiencies?
Nutrient deficiencies are a possible risk of gastric bypass surgery – see section 5. In order to reduce the risk of developing deficiencies, you will need to take lifelong supplements as described in section 16. A healthy, varied and balanced diet will also help prevent the risks of developing any deficiencies. Regular blood tests as described in section 16 are very important as they can identify if you are lacking in any vitamins and minerals.
When can I exercise?
Exercise is an important part of living a healthy lifestyle and losing weight. After gastric bypass or sleeve surgery you should not do anything too strenuous until at least 6 weeks post-surgery.
Can I become pregnant?
Yes, but we would advise you to wait for at least 18 months post procedure or until your weight has stabilised before planning a pregnancy. An ideal weight at conception will be healthier for you and your baby. See section 17 for more details.
When can I introduce meat, bread and rice?
Once you have started solid foods again, but these foods can be more difficult to tolerate and are best left until you have tried all other foods. Remember to eat small amounts, chew slowly and take your time between mouthfuls.
Can I have fizzy drinks?
No – they can cause reflux and stretch the stomach. Fizzy drinks can stretch the gastro-jejunal anastomosis (the join between the newly created pouch and the small bowel) and allow you to eat more. They can also make you feel very bloated and cause heartburn.
Can I have chewing gum?
We recommend you avoid chewing gum as chewing can create trapped wind, which can be uncomfortable. More importantly, should you accidentally swallow the gum, this could get stuck and cause problems.
Where can I get extra support?
Our philosophy is to treat every patient as an individual. Once we are confident that you have a good understanding of how the surgery works and what you need to do to make it work, we tend to ask that you contact us as and when you feel you need support and advice. If you need extra support, please contact us! We won’t know you are struggling unless you tell us.
Should I join a slimming club like Weight Watchers or Slimming World?
The gastric band is merely a tool you can use to help you to lose weight and keep it off. So long as you follow the required eating behaviours, eat a well-balanced diet and exercise, there should be no need to join a slimming club. On the other hand, some patients find that attending a regular group weekly can really help their motivation and help them stay on track with an overall healthy mindset.
Will I lose too much weight and become too thin?
The operation is designed to reduce your food intake, improve your food choices and alter your eating habits, leading you to a healthy weight. Your body will soon adjust to your new regime, weight and metabolic rate whilst your dietary intake and activity levels adjust accordingly. Your dietitian will monitor your progress and guide you throughout your weight loss journey. If you follow our guidance, you should not lose too much weight. Once you reach your goal weight, your weight should stabilise; if it doesn’t, we can provide advice on increasing your calorie intake whilst maintaining a balanced diet. Our aim is to assist you to a healthy weight and improve any obesity-related comorbidities; the surgery is NOT a tool to enhance the chances of an ultra-low Body Mass Index!
Can I extend my aftercare?
We realise that having Weight Loss Surgery is a lifetime commitment and some patients need and want ongoing support once their initial aftercare package has expired. We offer pay-as-you go dietitian appointments along with a range of packages to suit your requirements. Please contact our Weight Loss Surgery Support team with any queries.