gastric bypass kevs doc - Homerton University Hospital

Advice following a
gastric bypass
Patient information
Bariatric Surgery
SWSH
Telephone: 0208 510 7496
Website: www.homerton.nhs.uk/our-services/obesity-surgery/
Email: [email protected]
Incorporating hospital and community health services, teaching and research
This leaflet is aimed at people who have had a gastric bypass operation for weight loss.
The leaflet provides information about eating and drinking after this operation
What is a laparoscopic gastric
bypass and how does it work?
During a laparoscopic gastric
bypass operation the stomach is
made smaller and part of the
intestine is bypassed which stops
you from absorbing some of the
food that you eat. It may also be
called a Roux-en-Y gastric
bypass.
A very small pouch about the
size of an egg cup is made out of
the upper stomach. This new
small stomach is made using
special surgical staples which
separates it from the lower part of
the stomach. The large lower part
of the stomach can no longer
hold any food. The small
stomach pouch restricts the
amount of food that can be eaten
at one time.
A section of the small intestine is
then cut, moved up and attached
to the new small stomach. Food
passing through this shortened
section of small intestine does
not stay in contact with the
digestive juices for long enough.
This means that some of the food
that you eat is not absorbed
completely.
The operation is performed
laparoscopically using keyhole
surgery under general
anaesthetic. Five small incisions
are made in the abdomen into
which a camera scope and
surgical instruments can be
introduced.
How much weight can I expect to lose?
Weight loss tends to be most rapid in the first year after your
surgery, with maximum weight loss achieved at eighteen months
to two years. You may expect to lose about 60-70% of your
excess weight, providing you work with the surgery. Your long
term weight loss success can only be achieved by making
permanent dietary and lifestyle changes in addition to the surgery.
The long term success of a gastric bypass depends upon the
individual. This surgery will aid weight loss by reducing your food
intake, producing an earlier feeling of fullness and by not
absorbing some of the food that you eat. It will not take away the
desire to eat. You must work with the surgery by changing the
way you eat and making healthy food choices whilst increasing
your physical activity. Failure to do so may lead to disappointing
weight loss and in some cases even weight gain. The specialist
bariatric team will support you in your efforts to make permanent
changes, but the responsibility to put this into practice is yours.
Vitamin and mineral supplements after surgery
It is recommended that you take a multivitamin and mineral
supplement for the rest of your life after a gastric bypass.
For four weeks after surgery you should not have any whole
tablets in case they get stuck. All your tablets should be
converted to liquid, chewable or crushable form. For the first four
weeks you should take Dalivit liquid vitamin drops 14 drops a day
and two Adcal (calcium) tablets a day.
After four weeks you should stop the Dalivit and start an A-Z
multivitamin and mineral tablet once a day, such as Centrum
Advance, Sanatogen A-Z Complete or an own brand A-Z
multivitamin and mineral for example, Tesco, Asda, Morrisons or
Sainsburys. You should continue your Adcal tablet twice a day
for the rest of your life.
Dumping syndrome
After a gastric bypass operation you may experience dumping
syndrome if you eat or drink something sugary or eat and drink at
the same time. Symptoms you can experience with dumping
syndrome are dizziness, light headedness, sweating, a racing
heart, feeling sick or diarrhoea. If you do feel any of these
symptoms then lying down usually takes them away. Try to work
out what caused you to having dumping syndrome so you can 2
avoid it in the future.
Eating and drinking after surgery
Stage one: liquid diet from day two for
two weeks
For the first two weeks you will need to take only
liquids. This is to allow your new stomach pouch
to heal and avoid it over-stretching. The stomach
can be quite swollen after surgery and it is
difficult to swallow anything thicker than a liquid.
It is most important that you are having liquids
that contain protein. Liquids should be the
consistency of thin, runny custard with no lumps
or bits.
The following liquids are good sources of
protein:
• milk (semi-skimmed) or soya milk
• clear, cream or light soups with no bits
• Build-up soups and shakes
• Complan, Ovaltine, Horlicks, Milo made
with semi-skimmed milk
• Slimfast
• thin yoghurt drinks with no bits (low fat or
diet types e.g. Flora Pro-activ yoghurt
drink, Actimel 0.1%, Benecol Light)
• thin custard (low fat)
Try fortified milk to add more protein to your diet.
Add four tablespoons of skimmed milk powder to
a pint of semi-skimmed milk.
The following are also suitable liquids:
• fruit squashes (sugar-free or low calorie
varieties)
• water or flavoured water (sugar free
varieties) but not sparkling
• tea or coffee (with sweetener if needed)
• stock cubes for example, OXO, Marmite
or Bovril in hot water
• fruit juice (diluted with water)
• fruit smoothies made with pureed fruit and
low fat or diet yoghurt
Liquids to avoid
• Fizzy or sparkling drinks (these will make
you feel bloated and uncomfortable)
• Alcohol (this can irritate the stomach and
also provides empty calories)
• Any liquid with bits or lumps
• High sugar, high calorie milky liquids
including Nourishment, Nutriment,
evaporated or condensed milk
How much and when?
• You should aim for at least two and a half
pints (1.5 litres) of fluid a day
• You should aim to have at least one pint
of semi skimmed milk or milky products
for example, Slimfast, Complan, yoghurt
drinks and one to two cups of diluted fruit
juice each day
• It is important that you only drink small
amounts of liquids at a time so you do not
cause the new stomach pouch to stretch
• You will need to drink very slowly, so take
small sips. Perhaps try using a straw
• It may take you about thirty minutes to
drink half a cup of fluid
• It is useful to carry a bottle of low calorie
fruit squash or water with you at all times
• Sucking on ice cubes can be a useful way
to get some fluid
• Sip fluids throughout the day to make sure
you stay hydrated
Suggested meal plan
Breakfast
• 1 small glass (200ml) of Slimfast or Buildup drink
Mid-morning
• 1 small glass (200ml) of milk
Lunch
• 1 small cup (200ml) of soup
•
cup (100ml) of low fat yoghurt drink
Mid afternoon
• 1 small glass (200ml) of flavoured milk
Evening meal
• 1 small cup (200ml) of soup or Complan
(savoury) or Slimfast
Supper
• 1 small cup (200ml) of chocolate or
Ovaltine (made with milk) or a small glass
of milk
You can drink small amounts of tea, coffee,
water and low-calorie fruit squashes in between
meals. Make sure they do not fill you up so much
that you cannot drink the nutritious liquids at
mealtimes.
Stage two: puree/blended
diet: weeks three and four
Foods should have a smooth
texture with no lumps, similar to
the consistency of baby food.
You will need to use a blender or
food processor.
The overall nutrition content of a
puree diet can be low when you
are only managing a few
spoonfuls of food. It is
recommended that you still try to
have one pint of protein-rich
fluids, for example milk or milky
products a day.
Stage three: textured food
diet: weeks five and six
Foods should have a soft texture
and be mashable with a fork.
You should not need to blend
foods at this stage.
Why you need to know this
information
The soft food stage continues to
allow your body to heal. Eating
large amounts of food or having
solid food at this stage may
cause you to vomit. Progression
from one stage to the next
depends on the individual. In
some cases it may take longer
than the recommended time but it
should never take less.
If you have any concerns
about your tolerance to certain
foods then you should contact
the specialist bariatric
dietitian.
Suitable foods for stage two and three
Suitable protein-rich foods are: (You must
blend the foods on stage two)
• Weetabix, Ready Brek, oat, corn or maize
porridge made with semi skimmed or
soya milk
• Minced chicken or meat blended with a
sauce, gravy or stew
• Flaked fish mashed with a sauce or stew
• Scrambled egg or soft omelette
• Cottage cheese, low-fat cream cheese or
grated reduced-fat cheese
• Well-cooked pulses such as mashed
baked beans, chick peas, kidney beans,
moi moi
• Smooth yoghurt with no bits or fromage
frais (low fat or diet varieties)
• Low fat custard.
Other foods you can eat at this stage:
• mashed potato or sweet potato
• soft cooked pasta blended with a sauce
preferably tomato
• mashed vegetables without skin such as
carrots, parsnips, swede, pumpkin,
butternut squash, aubergine, cocoyam
leaves or okra
• stewed fruit (either tinned in natural juice
or fresh) with sweetener or mashed
banana
• sugar free jelly
• soft fruit or tinned fruit in natural juice e.g.
peach, apricot, mandarins, pear, ripened
pawpaw (stage three only)
• yam, cassava, plantain or semolina
(stage three only)
• well cooked rice (stage three only)
• breadsticks, crispbreads, crackers, dry
toast or matzo (stage three only).
Foods and drinks to avoid
• Any solid food
• Stringy or fibrous vegetables such as
celery, asparagus or sweet corn
• Fizzy or sparkling drinks will make you
feel bloated and uncomfortable
• Alcohol can irritate the stomach and is
high in calories
• Any food with a tough skin such as
sausages, bacon rind, tomato skins or
apple skins
How much and when?
• On stage two, you should only have two
to three tablespoons of food at each
meal. Aim to have three to four small
meals a day.
• On stage three your meals should be
served on a small side plate. Aim to eat
three small meals a day.
• You will need to eat very slowly and chew
food well, thirty times each mouthful. Do
not forget it should take you about thirty
minutes to eat your meal.
• You must stop eating as soon as you feel
full. If you eat too much you will stretch
the new stomach pouch. It will also
become painful and you will vomit.
• You need to aim to drink at least two and
a half pints (1.5 litres) of fluid a day.
• It is important that you do not eat and
drink at the same time. Fluids will dilute
the food in the pouch and allow it to pass
through the stomach too quickly. Try not
to drink for thirty minutes before or after
eating.
• You may find that there are some foods
that you cannot manage at this time so
leave them and try again later.
Tips for preparing meals
• You will need a food processor or blender
to prepare some of your food
• Remove skin, gristle, bone or fat before
blending meat or fish. Try using minced
meat, chicken or turkey
• Meat and chicken can be dry so you will
need to add a low fat sauce, gravy or
semi skimmed milk when blending
• Add mashed potato or sweet potato to
thicken up blended foods
• Meat and chicken that has been
casseroled or stewed blends well
• Potatoes can be mashed with semi
skimmed milk and a low-fat spread or use
instant mash.
• Well cooked pasta in a sauce (preferably
a tomato based sauce) can be blended to
a smooth soft consistency.
• Most fruit and vegetables mash well
• Blended food can be put into ice cube
trays and frozen for later use.
• Small amounts of ready-made meals
such as cottage pie or fisherman’s pie
could be used with some extra mashed
vegetables
•
Make sure your meals are low in fat;
when cooking, only use one teaspoon oil
per person per meal.
Suggested meal plan - stage two
This is only a suggestion; you may want to
choose other foods from the suitable list.
When you get up
• A cup of tea or coffee or glass of fruit
juice (diluted with a small amount of
water)
Breakfast
• 1 Weetabix with 200ml of semi- skimmed
milk.
Throughout mid morning
• 1 glass of milk
a glass of Buildup/ Complan soup/
•
shake
Lunch
• 1 scrambled egg, 1 tablespoon of mashed
potato, 1 tablespoon of mashed
vegetables
Throughout mid afternoon
a pot of low fat smooth yoghurt
•
•
a glass of Buildup/ Complan soup/
shake
Evening meal
• 1 tablespoon of blended fish, chicken or
meat, 1 tablespoon of blended pasta or
rice, 1 tablespoon of mashed vegetables
Supper
• 1 tablespoon of stewed fruit or half a
mashed banana with small amount of low
fat custard or half a pot of low fat yoghurt
Bedtime
• A glass of flavoured milk
You can drink small amounts of tea, coffee,
water and low calorie fruit squashes in between
meals.
Stage four normal foods:
week seven onwards
Why you need to know this information
• This stage allows you to introduce a
greater variety of textured foods into
your diet.
• The type of eating plan that you develop
now is important for your long term
health and successful weight loss
• You will still need to chew food well in
order to prevent it getting stuck and
causing discomfort.
• You will still need to eat slowly; allowing
thirty minutes to eat your meal.
• It is important that you stop eating as
soon as you feel full so you do not
overload the stomach.
• It is still important that you do not eat
and drink at the same time.
• Eating too much and eating too quickly
will cause pain and vomiting.
• You may find that there are some foods
that you cannot manage at this time so
leave them and try again later.
Why is a balanced eating plan important?
• The amount of food that you can eat at
one time is reduced therefore it is
important that the food you do eat is
nutritious in order to provide the nutrients
that your body needs.
• A balanced eating plan will help you to
lose fat tissue rather than muscle.
• In the short term a poor diet can result in
dry skin and hair loss while in the longer
term you may be at increased risk of
osteoporosis, anaemia, protein
deficiency and vitamin and mineral
deficiencies.
Balanced eating plan
• Food provides the essential nutrients that
the body needs to stay healthy.
• No one food can provide all the nutrients
that your body needs, so it is necessary
to eat a wide variety of foods.
• Eating foods from the different food
groups ensures that you get a wide
variety of nutrients.
Food groups
Protein
• Foods such as meat, poultry, fish, eggs,
beans, pulses, tofu and Quorn
• These foods are important for the growth
and repair of the body.
• As well as providing protein they also
provide some essential vitamins and
minerals including B vitamins, iron and
zinc.
• Choose low fat varieties such as lean
meat, chicken or turkey
• You need to have a food that is high in
protein and low in fat at each meal.
Dairy
•
•
•
•
•
Foods such as cheese, milk, yoghurt and
fromage frais
These are important sources of calcium,
needed for long term bone health
They are also a useful source of protein
Choose low fat varieties such as
skimmed or semi-skimmed milk, low fat
or diet yoghurts and low fat cheese
You need to have three servings each
day. One serving is:
o 1 glass of skimmed or semiskimmed milk
o 1 matchbox size piece of reduced
fat cheese
o 1 small low fat or diet yoghurt.
Fruit and vegetables
•
•
•
These provide essential vitamins and
minerals that help protect the body
against some diseases (such as cancer
and heart disease) and infections.
They are also a valuable source of fibre
needed for a healthy gut and to prevent
constipation.
You should try to have at least three
portions of fruit and vegetables a day in
order to provide you with the fibre,
vitamins and minerals that your body
needs. As time progresses after surgery
you should aim for five portions. One
portion is:
o 1 banana, apple, orange or pear
o a small handful of grapes
o 1 tablespoon of vegetables
Carbohydrate
•
•
•
•
•
•
Foods such as breakfast cereals,
potatoes, rice, couscous, pasta, noodles,
chapattis, plantain, yam, cassava and
semolina
Doughy bread is difficult to eat after
surgery, you may find toast easier.
These foods are important because they
provide the body with energy.
They also provide fibre and some
vitamins and minerals.
They are not particularly high in calories,
providing you do not fry them (chips),
add butter to them (mashed potatoes,
bread) or sugar to breakfast cereal
You should aim to have a small amount
of starchy food at each meal.
Sugary and fatty foods
•
•
•
•
•
•
•
These include sugar, cakes, biscuits,
puddings, chocolate, sweets, sugary
drinks, ice cream, sweet and savoury
pastries, crisps, chevda, butter, ghee,
margarine, cooking oils including palm
oil, cream, salad dressings and
mayonnaise.
These foods are high in calories and can
contribute to weight gain.
It is best to keep these foods and drinks
to a minimum, as a treat, because they
will not help you lose weight.
Choose low fat alternatives such as low
fat spreads.
Try grilling, baking, poaching, steaming
and microwaving food to cut down on oil
or fat in cooking.
Use sweeteners rather than sugar in
drinks and on cereal.
Try having sugar free, no added sugar or
diet drinks.
Caution foods
There are some foods that are not well tolerated
after weight loss surgery. Every patient is
different and their tolerance to certain foods
varies from person to person. Sometimes you
may only have a temporary intolerance to a
specific food and it may be worth trying it again a
few weeks later.
The following foods are generally never well
tolerated.
•
•
•
•
•
•
•
•
Bread especially white bread and white
bread rolls (but toast and crispbreads like
Ryvita are generally better tolerated).
Starchy foods such as gari, fufu, eba,
pounded yam or kenkey.
Roast meat (casseroles and stews are
better tolerated)
Stringy vegetables, such as celery,
asparagus and sweetcorn
Skin on fruit such as apples
Nuts
Sparkling or fizzy drinks
When you are trying new foods, you
should only introduce one food at a time.
How do I know if a food is low in fat/ sugar?
Food labels often give us an important clue in
choosing foods or drinks that are suitable for us
and allow us to avoid hidden fats and sugars.
Always read food labels using per 100g.
.....Of which sugars
Aim for a product that has below 15g of sugar
per 100g, ideally less than 5g per 100g
Total fats
Aim for a product that has below 20g of total fat
per 100g, ideally less than 3g per 100g
Per 100g
High
(Try to
avoid)
Medium
Low
(Fine most (healthier
of the time) choice)
Of which Sugars 15g
5.1- 15g
5g
Fat
(Saturated fat)
3.1- 20g
(1.6- 5g)
3g
(1.5g)
20g
(5g)
Sodium
0.6g
(Salt equivalent) (1.5g)
0.1- 0.6g
0.1g
(0.31- 1.5g) (0.3g)
Suitable foods for stage 2 and 3
Advice on constipation
• After surgery, you may experience some
change in the frequency of your bowel
habits; this is because the quantity of
food you are now eating is considerably
smaller than before the operation.
• Initially you might find your bowels open
less frequently i.e. every two or three
days, due to the change in your diet.
• By including some of the foods listed
below, your bowel movements should
become more regular.
High fibre foods
• Whole wheat breakfast cereals e.g. All
Bran, Shredded Wheat, Weetabix,
porridge oats
• Pulses e.g. baked beans, kidney beans,
lentils, chick peas
• Whole wheat crackers e.g. Ryvita,
wholemeal crispbreads, Jacob’s
multigrain.
• Fruit and vegetables for example,
cauliflower, broccoli, carrots, salad, green
beans, pealed fruit, tinned fruit in juice.
• It is also important to drink plenty of fluid
between meals, aim for at least two pints
(1.2 litres) a day.
• If constipation persists, try taking Milpar
or lactulose, both available from your
local pharmacy.
• If this does not help, talk to your GP or
one of the specialist bariatric nurses
Alcohol
• Alcohol can irritate the stomach.
• It is high in calories (almost as many
calories as fat) and can slow down
weight loss.
• Alcohol is an appetite stimulant so you
may find that you are tempted to snack
or eat more when you drink.
• After weight loss surgery you will feel the
effects of alcohol much more.
Can I plan pregnancy after having weight
reducing surgery?
Weight loss can increase fertility and therefore
increases a woman’s chances of becoming
pregnant (whether planned or not). Adequate
contraception needs to be considered. Having
weight loss surgery does not prevent you from
becoming pregnant; pregnancy is not advisable
during the first eighteen months after surgery
during the period of most rapid weight loss.
In the event of pregnancy, it is important that you
contact the bariatric team. You will need to
speak to the specialist bariatric dietitian or
bariatric nurse specialist about your diet and
vitamin supplements.
Hair loss
Hair loss after bariatric surgery is quite common.
It tends to happen about three to four months
after surgery and can carry on for up to one
year. You will not lose all your hair but you may
notice it thinning around the parting and coming
out when they brush or wash their hair. The hair
loss does stop and the hair will re-grow.
Hair loss is due to rapid weight loss, it is not
related to any vitamin and mineral deficiencies.
It is important you take your vitamin and mineral
supplements as suggested but you do not need
any extra vitamins and minerals. You must also
ensure you are having plenty of protein in your
diet (for example, meat, chicken, fish, beans,
pulses, eggs, cheese, milk or yoghurts).
Homerton patient support group
Homerton bariatric surgery patient support group
is held on a monthly basis in the Education
Centre at Homerton Hospital on a Thursday
evening. It is open to patients before and after
surgery. Please contact our administrator on
0208 510 7669 to reserve your place.
Additional Notes
Additional Notes
Additional Notes
References and useful contacts
Homerton University Hospital website www.homerton.nhs.uk/our-services/obesity-surgery/
Weight Loss Surgery Information and Support
www.wlsinfo.org.uk (0151 222 4737)
British Obesity Surgery Patient Association
www.bospa.org (08456 020446)
Weight concern
www.weightconcern.org.uk
TOAST - The Obesity Awareness and Solutions Trust www.toast-uk.org.uk
NICE Guidance
www.nice.org.uk
British Obesity and Metabolic Surgery Society
www.bomss.org.uk
Bariatric Surgery Department: 0208 510 7496
Press option four for the bariatric nurses or option five for the bariatric dietitians
Patient Advice and Liaison Team (PALS)
PALS provide information and support to patients and carers and will listen to your concerns,
suggestions or queries. The service is available between 9am and 5pm.
Telephone 0208 510 7315 or email [email protected]
For information on the references used to produce this leaflet, please ring
0208 510 5302/5144 or email [email protected]
The Trust endeavours to ensure that the information given here is accurate and impartial
If you require this information in other languages, large print, audio or Braille please telephone
the Patient Information Team on 0208 510 5302/5144
Author(s): Bariatric Surgery Department
Homerton University Hospital NHS Foundation Trust
Homerton Row, London, E9 6SR
T 020 8510 5555
W www.homerton.nhs.uk
E [email protected]
Produced date: August 2013
Review date: August 2015