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preventing nutritional deficiencies long term

You require extra vitamins and minerals after surgery as you will not only be eating far less food, but will also absorb fewer nutrients. The following vitamin and mineral supplements are required for the rest of your life in order to prevent deficiencies.

MULTIVITAMIN:

  • A good multivitamin that provides sufficient amounts of all the vitamins and minerals required.
  • Do not take supplements of individual vitamins (e.g. vitamin C or E, by itself), unless you are advised to do so by your doctor or dietician.

CALCIUM:

  • Daily requirements: 800-1000mg daily.
  • Initially chewable calcium is tolerated best (for the first 1-2 months).
  • Calcium citrate is absorbed best, and should be taken long-term.

IRON:

  • This will be prescribed by your doctor – the exact formulation depends upon your iron stores, which will be checked after the operation.

VITAMIN B12:

  • Vitamin B12 injections are required every 3-4 months after bypass surgery.

PROTEIN:

  • You will require a protein supplement for the first 3 months post surgery.
  • This will most likely be in the form of a protein powder that can be mixed into foods, or a high protein drink.
  • Regular assessment of your diet by a dietician is essential in order to ensure that you do not develop a protein deficiency.

FREQUENTLY ASKED QUESTIONS

Q: Are there foods that can block the opening of the stomach pouch?
A: Yes. The foods listed below should be avoided:

  • Prawns with shells
  • Coconut
  • Nuts and peanut brittle
  • Dried fruit and dates, dried fruit sweets (‘mebos’)
  • Biltong and big chunks of meat (mince is usually fine)
  • Muesli and granola-type cereals
  • Muesli and high fibre bars e.g. seed bars and Granola bars
  • Popcorn

Q: Won’t I get constipated after the operation?
A: Constipation can be a problem for a few weeks after surgery, especially whilst eating a pureed diet. However, with the careful introduction of soft, fibre-containing foods, an increase in the amount of fruit consumed, and plenty of fluid, the condition can usually be managed. In severe cases, a gentle laxative bulking agent may be needed temporarily.

Q: I have heard that many people suffer from terrible diarrhoea after a gastric bypass. Is this true?
A: Severe diarrhoea is usually a sign of malabsorption, especially of fat. If you limit your fat intake (which should be done to prevent dumping and speed weight loss), you should not suffer from diarrhoea.

Q: How do I prevent my hair from falling out after the operation?
A: 3 common causes of hair loss are:

  • anaemia: regular blood tests after surgery will identify whether or not you are anaemic, so that you can be treated appropriately.
  • underactive thyroid gland: once again, blood tests after surgery will identify this condition, which can be effectively treated.
  • too little dietary protein: appropriate dietetic assessment, advice to help you maintain your protein intake, the use of high protein supplements, and a diet containing adequate calories should prevent or minimize any hair loss.

Q: What is dumping syndrome?
A: Dumping syndrome occurs when food passes rapidly from the stomach into the small intestine. Normally after food has been swallowed it is gradually released in small amounts from the stomach into the small intestine. After a gastric bypass, food is ‘dumped’ quickly into the small intestine. When food (especially sugar), is dumped like this, water is absorbed from the bloodstream and blood volume decreases suddenly, causing the blood pressure to drop. Symptoms usually occur within 20 to 90 minutes after eating and include abdominal cramps, fullness or bloating, nausea and vomiting, pallor, flushing, sweating, dizziness and diarrhoea. Dumping can be provoked by eating sugary foods, overeating, consuming beverages with meals, or consuming foods high in salt and fat.

Q: What if I go out to eat?
A: Order only a small amount of food, such as an appetizer, and eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.

Q: What about alcohol?
A: Alcohol has a high number of calories. Try to avoid it, although an occasional glass of wine or other alcoholic beverage is not considered harmful to weight loss. You will absorb alcohol much faster after the operation, so consume it slowly, in small amounts.

Q: What about other medication?
A: You should be able to take prescribed medication. You may need to take capsules or break big tablets in half or dissolve them in water. You should always ask the doctor who prescribes the drugs about this. Your surgeon may tell you to avoid taking aspirin or other non-steroidal anti-inflammatory pain relievers, as they irritate the lining of the stomach.