After gastric bypass sugery: Possible problems

This is the result of an intolerance to foods that are high in sugar (sweets), fat or grease. When you eat these foods, they now enter your intestines without being partially digested by the gastric juices of your old stomach. When this happens, you may have nausea, vomiting, become lightheaded or dizzy, have a hot flash, cramps or diarrhea. These symptoms last about 20 to 30 minutes.

This reaction is so unpleasant you will want to avoid foods that caused the dumping syndrome.

Return to top.

Reactive hypoglycemia

Reactive hypoglycemia is a symptom, not a disease. It may occur when food is delivered from the stomach into the intestine. This causes high levels of blood glucose (sugar). The result is an imbalance between blood glucose and insulin (a hormone that allows glucose to be used.) Insulin stays in the blood after the glucose has been used, causing low blood sugar levels, or hypoglycemia.

To treat reactive hypoglycemia, take two glucose tablets, 2 oz. juice or 2 oz. milk. Then, eat a protein source and a complex carbohydrate (such as whole wheat toast, crackers or fruit).
To prevent reactive hypoglycemia, avoid sweets, desserts, candy, non-diet pop, caffeine and alcohol. Eat three well-balanced meals that include protein, whole grains, fruits and vegetables.

If the symptoms continue, contact your surgeon or bariatric nurse clinician.

Return to top.

Intoxication

Drinking alcohol after gastric bypass greatly increases your risk of intoxication (getting drunk). Alcohol is absorbed quickly into your small intestine, even when taken in small amounts.

Alcohol has no nutritional benefits and only adds empty calories.
Alcohol can cause liver damage, lead to addiction, slow your weight loss or add to weight gain.
Alcohol can block the absorption of many vitamins and minerals. Since gastric bypass surgery also limits absorption of nutrients, this blocking can add to the risk of vitamin or mineral deficiencies.

If you are struggling with alcohol or other chemical dependency problems, please contact your bariatric surgeon or nurse clinician.

Return to top.

Weight gain

Eating high-fat foods, carbohydrates and foods that have added sugars may cause you to gain weight. Drinking with meals, snacking and liquid calories can also add to weight gain.

To prevent or end weight gain, try following these tips:

Avoid all foods cooked in lard, bacon grease, CriscoŽ, butter, margarine or oil.
Try using Molly McButterŽ, Butter BudsŽ or a reduced-calorie margarine to season foods.
Read food labels carefully. The terms "sugar-free" and "fat-free" can be misleading. While they have reduced fats or sugars, they will add significant calories if eaten often, even in small amounts.
Pay attention to portion size listed on labels. Some labels list a tiny amount as one portion.
Avoid all foods and liquids with added sugar, or sugar as one of the first three ingredients listed. "Sugars" include any compound ending with "ose" (glucose, dextrose, sucrose, fructose or maltose), as well as corn syrup and hydrolyzed starch.
Watch your fat intake. People who eat a low-fat healthy diet may lose weight without watching calories. Fats have more than two times the calories of carbohydrates or protein. Try to keep your total fat intake to fewer than 30 grams each day.
Watch for hidden fats. Salad dressing, gravy, sauces and baked foods can have hidden fats.

Return to top.

Constipation

Constipation after gastric bypass surgery is common.

If it becomes uncomfortable, it is okay to take milk of magnesia.
If your stools are hard, include some high-fiber foods in your diet. (The American Dietetic Association recommends 20 to 35 grams of fiber every day.)
Be sure to drink at least six to eight cups of water each day between meals.

Because of the small amount of food you are eating, it is common to have a bowel movement only every four to five days.

Return to top.

Gas

Gas problems are also common. If you have gas pains...

Try simethicone drops, Bean-OŽ or Gas-XŽ.
Avoid dairy products (milk, cheese and ice cream), carbonated beverages, straws and chewing gum.

Return to top.

Gallstones

More than one-third of gastric bypass patients will get gallstones. These are clumps of cholesterol and other matter that form in the gallbladder.

During quick or large weight loss, your risk of getting gallstones goes up. You might feel a steady, severe pain on the right side of your stomach going to your back. This pain will start after eating a meal. You might also feel bloated or nauseated and vomit. If these symptoms continue, call your gastric bypass surgeon.

Return to top.

Problem foods

You may have problems with...

tough meats, such as beef or hamburger

Try marinating solid meats or use a tenderizer.
Cook at a lower temperature for a longer period of time.
Spit out anything that doesn’t liquefy in your mouth after chewing.

membranes of oranges and grapefruit

Use only pulp-free juice.
Spit out unchewable membranes.

skins and seeds of some fruits and vegetables (Strawberry seeds seem to be okay.)
fibrous vegetables such as corn and celery

Use a blender or strainer.

Avoid eating fresh bread, pasta and rice; fried foods; chicken skin, bratwurst skin, hot dog skin, etc.; scrambled eggs.

Return to top.

Hibernation syndrome

Two to four weeks after surgery, your body reacts to the smaller amount of food. You feel tired, lethargic and often depressed. Your body wants to slow down until the old food supply returns.

The best way to deal with this is to recognize the symptoms and know they are normal. Start to exercise so your body gets used to using body fat as a source of energy.

When your body adjusts, the hibernation syndrome will end. This may take six to eight weeks.

Return to top.

Other body changes

When you don't eat enough protein, you will notice some changes in your hair and nails because they are made of protein.

You may get flaky and weak fingernails.
You may have hair loss between the third and ninth months after your surgery. Your hair will grow back.
You may lose muscle mass.

If you are a women, your menstrual cycle may be irregular and may come right after surgery. This is normal.

You should not get pregnant for two years after surgery. Use effective birth control.

You may not be able to drink milk or eat dairy products after surgery because they have lactose (a natural sugar) your body may reject.

You may get lightheaded or dizzy when you get up from a chair or bend over. This is because your blood pressure is shifting. This can be caused by not drinking enough water and should be temporary.

You may feel shaky, faint, or have a headache.

This could be caused by hypoglycemia (low blood sugar) and can be helped by drinking milk or orange juice or by eating a graham cracker, granola bar or a piece of hard candy. It is a good idea to carry one of these products with you at all times.
It is not uncommon for people to have this feeling if they skip a meal or don’t eat something before exercising.
You may have rebound hypoglycemia if your diet is high in carbohydrates.

Return to top.

Emotional issues

As your body changes so dramatically, you will be changing emotionally, too. Some people find these changes disturbing.

Obese people have sometimes used their size to hide from life, to insulate them from the outside world. Losing weight can make you, at times, feel vulnerable.

If you are having trouble dealing with emotional issues, find someone you trust to share your feelings. If you need, please seek professional counseling. This will help you go through the changes more smoothly and help you to be more successful with your weight loss.

Depression after weight loss surgery is common.

For some women, estrogen (a hormone) is released while fat is burned to make energy. This release of estrogen may cause mood swings.

For people who eat out of emotion, they may be depressed because they can no longer eat like they used to. Being thinner may not solve all of your problems.

Partner jealousy indicates that your partner may have a hard time dealing with the new you. Not only has your body changed, but you may be more outgoing and social as a result of your increased self-confidence and self-esteem. This can cause your partner to feel insecure. He or she may become possessive or distant. If problems develop in your relationship, please see a therapist.

Divorce rates among couples in which a partner has had gastric bypass surgery are high. The surgery can make good marriages better and bad marriages worse.

It's common for a morbidly obese person to marry a partner thinking he or she can do no better. Some obese people settle for a negative relationship and may suffer through mental or verbal abuse. When patients lose weight, their self-esteem improves and they question why they're in an unhealthy marriage.

Friendship loss or disruption can be caused by losing a lot of weight. You are changing every day, and you may find that your friends are unwilling or unable to change in the friendship with you. Your friends may be feeling jealous of you or your success.

Your body image changes as your body goes through such a rapid and drastic change. You tend to lose a sense of self.

You can actually go through an identity crisis. You may not recognize yourself. You may feel like you are walking around in someone else's body.

Please remember that it will take some time getting used to the new you. Counseling may help you during these times of uncertainty.

Return to top.