Six Stages of Eating After a Gastric Bypass

You are likely to pass through 6 separate stages of eating after your gastric bypass operation.

Recently I saw a patient who had a laparoscopic Roux en-Y gastric bypass by me a few months ago who was quite frustrated that she could not eat and drink what she wanted to consume. She wanted to eat a regular diet but was not yet able to eat as much solid food as she had expected. She seemed to be someone who could not allow the process to proceed in the usual fashion.

The fact is you cannot rush the healing process and trying to speed things up will only make a person frustrated and could be harmful. After performing several hundred of these operations there is a natural progression I have observed after a gastric bypass operation and it usually goes like this:



1). FIRST WEEK

It seems almost impossible to get as much liquid down. The only way to stay hydrated is to sip very small amounts every 15 minutes or so all day long.

2). WEEKS 2 THOUGH 5

Slowly liquids become somewhat easier to go down. This is when a patient starts learning how much they can swallow at one time. If you drink faster than the pouch can empty fluids will back up in the esophagus and cause a pressure sensation in the chest. Slowing down even more will relieve this unpleasant sensation.

3). WEEKS 6 THROUGH 9

The patient often feels they are having more difficulty eating and drinking than they had over the previous few weeks. This is because the connection between the gastric pouch and the intestine is healing and the scar is becoming thicker resulting in a narrower outlet to the pouch. Just as you have observed when you have cut yourself the scar is relatively smooth for the first few weeks but it becomes thicker and more angry looking at about 6 to 9 weeks. As the scar is remolded the scar will slowly become softer over the next several weeks and months. The scar at the connection between the gastric pouch and intestine goes through this same process and the thickened scar is the reason that it takes more time for the food and drink to pass out of the pouch into the small intestine. We frequently call this the “window of misery” and you will find a posting by that name elsewhere in this blog.

4). WEEKS 10 THROUGH 12

The scar that I mentioned above softens and the opening between the gastric pouch and the small intestine starts to slowly open up more and food and drink passes through more easily.

5). BETWEEN 3 and 6 MONTHS Although things continue to improve, usually meat and bread is still difficult unless the meat is ground and the bread is toasted to make the fragments and particles smaller.

6). BETWEEN 6 MONTHS and 1 YEAR Things continue to Improve and sometime during this period patients begin to have less and less difficulty swallowing meats and bread. By this time the diet has returned to normal although many people tell me there food choices have changed considerably and they eat much healthier.

Hopefully this week by week description will help you as you go through the various stages and you will be more patient with yourself since you know better days are coming.

By Stephan Myers, MD, FACS, bariatric surgeon in Columbus, Ohio

To keep weight off long term after surgery, try Dr. Myers "RULE OF 30's"

Would you like a suggestion to help you maintain your weight after bariatric surgery? Most bariatric surgery patients certainly would.

In addition to the suggestion to eat solid food and avoid drinking high calorie liquids such as milk, fruit juices, cream soups and ice cream add the following to your meal routine:

APPLY DR. MYERS’ RULE of 30’s TO YOUR EATING HABITS!

1). Chew all non-liquid food 30 times before swallowing. This will slow your eating down to the correct speed and you are likely to eat less calories with each meal.

2). Swallow your food once every 30 seconds. It takes about 30 seconds for food that is swallowed to travel all of the way down your esophagus to reach your stomach. Eating more frequently than every 30 seconds means you are not waiting long enough to allow the signals from your stomach to reach your brain and you are stacking food in your esophagus. It’s the food equivalent to traveling too close to the car in front of you in bumper to bumper traffic. It does not give you enough reaction time to stop in time before you crash! Give yourself a “safe clear distance” and avoid the problem that comes with eating too close together.

3). Wait 30 minutes after a meal before you drink your non-calorie containing liquids. This will give the solid food more time to leave your gastric pouch or sleeve and you are likely to have more room for the protein you need.

If you need some encouragement and a new technique try applying the RULE OF 30’S. I want everyone that has bariatric surgery to be successful and this technique may help you stay on track.

I asked the Fresh Start Bariatrics dieticians, Joann Schaumb and Alyssa Bixler, what they recommend for patients preparing for bariatric surgery.

"This is a very key topic! These comments are an initial response. We will share more later.

I think it is helpful to have people practice before surgery, eating the types of foods they will need to eat after surgery. I like to work together with clients to find foods that they like well enough to eat regularly instead of the high fat, high sugar choices they may have enjoyed in the past. This takes some trial and error, particularly in restaurants. It is important though, because people eat what they like. To achieve long term weight loss, they need to like lower calorie foods. It may seem hard, but we are usually able to help people find these foods.

When you focus on what to eat instead of what not to eat, it puts you in a more positive frame of mind and healthy eating becomes easier. We like to help people build confidence in their ability to enjoy healthy foods.

One of the most challenging goal on our pre-op list of goals is eating small, frequent meals. People are very busy and don't always think about eating much during the day. The typical American pattern is to eat very little or nothing through the early part of the day and consume most of the calories late in the day. This pattern leads to weight gain. Stomach capacity is limited after surgery, so we strive for high quality, nutritious foods. Every bite contributes to good health.

It is helpful to plan specific times for snacks and meals and design reminders, like setting a cell phone to beep when it is time for a snack.

It is very important to drink calorie free beverages. We recommend some weight loss prior to surgery and this is a very effective way to achieve that. Liquid calories are generally not satisfying. When you drink calories, you still eat the same amount of food, so total calorie intake is higher and leads to weight gain.

Replace liquid calories with calorie free drinks such as Crystal Light, Powereade Zero, Decaf coffee or tea, diet juices, diet flavored water or water with lemon."

I think their recommedations are terific and this is a great start to help people what changes would be helpful to make before surgery!

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