Will I encounter digestive problems after gastric bypass?

The headlines may sound alarming: “Weight loss surgery tied to lasting digestive issues.” “After gastric bypass surgery, many experience eating difficulties.”  

The stories were in response to a December 2016 study published in the British Journal of Surgery that followed 249 patients who had laparoscopic Roux-en-Y gastric bypass. It found that two years after surgery, gastric bypass patients were far more likely to suffer from digestive problems, such as indigestion, diarrhea and flatulence, as well as an inability to tolerate certain foods than the control group, which did not have the surgery.  

However, these results aren’t that surprising. They simply highlight what we bariatric surgeons already know. Gastric bypass changes the way your body absorbs and processes food. Before surgery, patients spend months learning about the diet and lifestyle changes to which they must commit after surgery to mitigate the effects of how their bodies will change during surgery.  

When you have gastric bypass, the surgeon reduces the size of the stomach and reconnects the small intestine to the new stomach, bypassing the original stomach and several feet of the small intestine. This will make you feel full sooner, meaning you’ll eat less, but it also affects how food is processed and the amount of nutrients including vitamins and minerals that your body absorbs.  

Our patients are usually excited to follow their dietary recommendations to the letter before and immediately after the surgery. However, as they heal and time goes on, some of them fall off the wagon a little. They pay less attention to what they eat or try to push their diet a little further than they should. That’s usually when we begin to see gastrointestinal (GI) problems surface.  

Common side effects of weight loss surgery

Dumping syndrome

This is one of the most common complications patients face after bariatric surgery. Dumping syndrome occurs when food, especially sugar, moves too rapidly from the stomach into the small intestine. This can result in diarrhea, nausea and abdominal cramps.  

Dumping syndrome can be avoided by eating smaller meals and limiting foods high in sugar, as well as not rushing through your meal. We educate our patients about this syndrome, so they can recognize it. Patients often tell us that after it happens once, they learn pretty quickly what triggered it so it doesn’t happen again.  

Small bowel bacteria overgrowth

Everyone has a certain amount of bacteria living in their intestines. However, in rare cases, gastric bypass can cause bacteria to grow unchecked. This excess bacteria may eat up the nutrients your body needs and can cause bloating, cramping, gas and diarrhea.  

In severe cases, small bowel bacteria overgrowth can inhibit the body from properly absorbing nutrients, leading to malnutrition and vitamin and electrolyte deficiencies, such as anemia.  

Small bowel bacteria overgrowth usually can be successfully treated with antibiotics.  

Food intolerance

The study found that 71 percent of gastric bypass patients developed intolerance for fried foods, pastries and carbonated drinks. However, only 14 percent of those people said the intolerance was very bothersome.  

We stress to our patients the importance of avoiding and cutting back on foods high in fat and sugar because the body just doesn’t process them as well after surgery. You’ll still be able to eat these foods, just not as often and in moderation. This is good advice for anyone, not just people who have had weight loss surgery!  

We also see some patients who “develop” lactose intolerance after surgery. They most likely were mildly lactose intolerant before surgery, but the surgical changes caused it to surge. When they switch to lactose-free products, the problems go away.    

How to reduce complications after gastric bypass

In rare cases, complications from gastric bypass, such as small bowel bacteria overgrowth, can result in GI problems. But these problems usually are related to diet.  

Our patients go through on average six months of education before surgery to learn about the diet and lifestyle changes they’ll need to make. In the weeks and months after surgery, they go through a diet progression: from liquids only, to thicker liquids, to soft food, then to solid food.  

The most important thing you can do to prevent gastrointestinal problems is to follow the dietary guidelines. They may seem overwhelming at first, but you’ll likely find they become a part of your daily routine. And don’t rush to advance your diet or experiment with new foods before your dietitian gives you the OK.  

A few general tips:

  • Eat small portions.
  • Eat slowly and chew food thoroughly.
  • Limit foods high in sugar and fat.
  • Keep a journal documenting food and portions.
  • Drink water between meals to avoid dehydration. 

Following dietary guidelines is the best way to prevent gastrointestinal problems after #bariatricsurgery. via @MedStarWHC

We’ll test your vitamin and mineral levels six months after surgery, at a year, then yearly after that. This helps us catch potential nutritional deficiencies early and address them before they become a serious problem.  

If you experience persistent gastrointestinal or eating difficulties, see a doctor. We can check for surgical complications and discuss your dietary habits. This is where a food journal can come in handy. By examining what you’re eating and how much, we usually can pinpoint the culprit and solve the problem. Even if you do experience GI symptoms at some point, for the majority of my patients, the overall benefits of the surgery outweigh them.  

Bariatric surgery is not just about weight loss. It’s about improving your overall health and reducing the risks of life-threatening conditions caused by obesity, such as diabetes, hypertension and high cholesterol. By sticking to a healthy diet and lifestyle, you can reap the many health benefits of weight loss surgery and prevent or reduce potential complications.

6 frequently asked questions about bariatric surgery

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Bariatric surgery has been available in the U.S. for more than 50 years, and surgeons are doing more every year. In fact, our team performed 336 of these procedures in 2016, compared with 257 in 2013.

Still, bariatric surgery is still not well understood, and many people have questions about it.

I’ve heard many. Two of the most frequent ones I get are, “Is bariatric surgery safe?” and “Will I be left with a lot of flabby skin?”

Bariatric surgery, such as gastric bypass or sleeve gastrectomy, can be a lifesaver for people struggling with obesity and its side effects. So let’s get to the truth of some of the most common questions.

Is bariatric surgery dangerous?

Patients often tell me that friends and family worry they will die during bariatric surgery and try to discourage them from getting a procedure. I suspect this fear is a holdover from when the surgery was new.

As with any surgical procedure, the risks from bariatric surgery were much greater when it was first developed. But with the advent of minimally invasive techniques, such as laparoscopic and robotic surgery, which come with fewer complications, the procedures’ safety has dramatically improved.

In fact, the latest data show that bariatric surgery is safer than having your gallbladder removed. The mortality rate for bariatric surgery is 0.25 percent compared with 0.7 percent for gallbladder removal.

And don’t forget that obesity also is dangerous, increasing the risk of life-threatening conditions, such as diabetes and hypertension, and even decreasing lifespan.

"The latest data shows that bariatric surgery is safer than having your gallbladder removed."

Will I be left with a lot of excess skin after bariatric surgery?

This is a complex issue and it’s specific to every individual. The bigger you are and the more weight you lose, the more excess skin you’ll have. But most patients find they have less excess skin than they expected.

The best advice I can give to avoid excess skin is to maintain and increase muscle mass, giving the skin lean tissue to contract over. I’m not saying you need to become a body builder or look like a star athlete. But developing a fitness routine that promotes healthy muscle tone will help reduce excess skin.

If you do have sagging skin that bothers you, you can explore body contouring, which is an umbrella term for procedures, such as tummy tucks and lifts to the upper arms, midsection, back, thighs, buttocks and hips.

Will I just regain  the weight after weight loss surgery? 

Everyone seems to knows someone who had bariatric surgery and gained all the weight back. But in reality, that’s pretty rare. A 2016 study found that only 3 percent of study participants who had gastric bypass regained most or all of the weight they lost after 10 years.

Weight loss after bariatric surgery occurs on a curve. Weight drops rapidly right after surgery and continues for 18 months to two years. A little weight gain is expected after that, but then it should plateau. This is normal, and we’re talking about a few pounds, not a massive amount of weight (usually about 5 percent).

When a patient does regain a considerable amount of weight, we first try to determine whether there was a problem with the surgery. For example, in gastric bypass, the surgeon reduces the size of the stomach and reconnects the small intestine to the new stomach, bypassing the original stomach and several feet of the small intestine. One rare complication of this surgery is gastrogastric fistula, in which food goes into the old stomach instead of the new stomach pouch, causing weight gain.

Most weight gain can be traced back to dietary habits. People don’t come back for after-care appointments or follow diet recommendations, or they simply fall back into old habits. And while someone might go through all the pre-surgery education, their psychological relationship with food may not change post-surgery.

Regaining all the weight can happen, but it’s rare. We’ll work with you and a dietitian to help you get back on track before you regain too much of the weight you worked so hard to lose.

Is having weight loss surgery the easy way out?

I’m amazed that in this day and age some people still think of surgery as the easy way out. There is nothing easy about bariatric surgery. People who have these procedures prepare for six months on average and then must change their lifestyle and diet after surgery. It’s a lot of work.

Attend our free information sessions to see if bariatric surgery is right for you.

The National Institutes of Health recognizes bariatric surgery as the only effective way to treat severe obesity and maintain long-term weight loss.

Losing weight through diet and exercise can be extremely difficult. Many people experience the yo-yo effect, in which they lose and gain weight multiple times. This can wreak havoc with a person’s metabolism, making losing weight even more difficult. In fact, less than 5 percent of people who lose weight by diet and exercise are able to maintain long-term weight loss.

And weight loss medications come with their own problems. Along with potential side effects, they only work as long as you take them. There’s no long-term weight loss effect.

Will I develop a vitamin deficiency after weight loss surgery?  

Vitamin deficiencies are a real concern after bariatric surgery. Your body will not be able to absorb them, as well as it used to. However, taking a daily multivitamin and following your dietary recommendations should ward off potential problems.

Severe vitamin deficiencies don’t develop overnight, and we have processes in place to catch them early. We check your vitamin levels six months after surgery, at a year, then yearly after that. If your levels are low, we’ll work on it before it becomes a problem.

Will I still be able to eat dessert or drink alcohol after bariatric surgery?  

Yes. Because your body will process and absorb foods differently after surgery, we recommend that you not eat foods high in sugar and fat immediately after surgery or drink alcohol for two years. But after a while, you can have a piece of cake at a wedding or a glass of wine for your anniversary. You’ll need to eat and drink these items in moderation, but you can have them for special occasions. This is also a good guideline for people who just want to live a healthier lifestyle.

If you have heard something fishy about bariatric surgery, don’t hesitate to ask your doctor. We’ve heard it all, and we won’t think your question is silly. If you’re considering bariatric surgery, it’s your right—and our job—to make sure you understand the ins and outs before you commit to preparing for and maintaining a healthier weight.

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