MUSC Bariatric Surgery Program

bariatric surgery PROGRAM

Frequently Asked Questions

How much weight will I lose with surgical weight loss?

You will lose 60-70% of your extra weight. To work this out, subtract your ideal body weight based on your height, from your current weight. Calculate 60-70% of this and that's the amount of weight you will lose at least with surgical weight loss. You may lose more depending on your determination and on your activity level.

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How long will it take?

You will lose most of this weight in the first six months and will continue to lose for up to two years. Then the surgical weight loss will level off.

Will I keep it off following the surgical weight loss?

Statistically, you have about an 85% chance of keeping at least 50% of your extra weight off for the rest of your life. Some surgical weight loss patients will put some weight back on and an occasional patient will put all of it back on. The causes of weight gain are the staples coming undone or the pouch stretching out so much that you can eat a full meal. That is why it is so important to follow the diet guidelines after the surgery. It is also important to realize that surgical weight loss is a tool to help you, but can be undone by overeating.

How long will I be in the hospital?

The normal length of stay for open is 2-3 days and for laparoscopic gastric bypass is 1-2 days.

How long do I need to eat pureed foods?

For AT LEAST 30 days after your surgery, all foods must be pureed to the texture of baby food with no chunks or hard pieces. You may puree the foods yourself or buy commercially prepared baby food.

What kind of seasoning can I use to flavor my food?

You may season your foods with herbs, spices, lemon/lime juice, hot sauce or vinegar – essentially anything that is calorie-free and sugar-free.

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After 30 days on pureed foods, how do I transition to a regularly textured diet after surgical weight loss?

After 30 days on a pureed diet, you may slowly transition to a regularly textured diet. To do this:

  • Try new foods slowly and one at a time. Try only one new food every day.
  • Try soft foods first like eggs, cottage cheese, ground meat, well-steamed vegetables, and tender fish. If tolerated, and over the course of several weeks, work your way to cooked whole meats, toast, raw fruits and vegetables.
  • When trying a new food, chew the first bite well, until it is almost liquid in your mouth.
  • Wait 10 minutes after the first bite to see how your body will tolerate it.
  • If no pain, nausea, or vomiting, continue to the next bite.
  • Continue to chew the food well through the entire serving.
  • If you do experience unpleasant side effects, stop eating and try the food again in one week using the same procedure.

Take as many days or weeks to transition to solid food as needed.

Why do I sometimes get pain when foods first hit my stomach?

If you experience pain when eating, check both the texture and content of your foods. If you are only 30 days out from surgery, be sure your food is pureed well with no chunks or hard pieces. This may require you to push foods like meats or vegetables through strainer to remove any fibrous parts. If you are transitioning to a solid diet, start with soft foods like boiled or scrambled eggs, tender fish or mashed potatoes. Dry foods (eg: grilled chicken) may be more difficult to tolerate than foods cooked in moisture (eg: stewed chicken). Also be sure that your food contains no sugar or sugar alcohols. Go back to light soups and juices for your next meal until your stomach settles.

Do I need to call the doctor if I vomit?

You may vomit if you eat too fast or too much, drink fluids with meals, introduce a new food to your diet that you no longer tolerate or if you eat or drink something with sugar.

Look at what you have thrown up.  If it has hulls or pieces in it, this means you did not blend or strain your food well enough. Go back to light soups and juices for your next meal until your stomach settles.

Call your doctor if your vomit is black or red in color or if it looks like coffee grounds or if you throw up for more than 2 days in a row and you can not seem to keep anything down.

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How long do I need to take Pepcid?

For at least 30 days unless you are told otherwise by your doctor.

How long do I need to crush my medicines following my surgical weight loss procedure?

You need to crush any medications that are larger than a baby aspirin for AT LEAST 30 days or until you transition to a regularly textured diet. However, some medications such as enterically-coated tablets or extended release formulas may not be crushed. If you have questions about which medications are safe to crush, please ask your doctor or pharmacist.

What kind of vitamin and mineral supplements do I need to take?

You need to take a multivitamin, vitamin B12 and Calcium Citrate for the rest of your life. You may also be asked to take 325 mg of Iron Sulfate (65 mg elemental) if you have a heavy menstrual cycle or are told you need extra iron.

What do I look for in my vitamin and mineral supplements?

Your multivitamin must contain iron, folate, and vitamins A, D, & E.  Two children’s chewable vitamins such as Flintstones Complete, Children’s Chewable Centrum or any generic chewable brands are acceptable. Take the multivitamin pills at separate times of the day.

Your vitamin B12 should contain 500 mcg (“micrograms”) of B12. You may take this in a liquid/dropper or sublingual (“under the tongue”) form to avoid crushing it. You may take the vitamin B12 with your multivitamin. If your vitamin B12 contains more than 500 mcg, you may take it every other day. You may take your B12 as part of a B-complex as long as the B-complex contains at least 500 mcg of B12.

You need 1200-1500 mg (“milligrams”) of calcium citrate each day. Read the label of your supplement; the form of calcium must be citrate, NOT carbonate. Do not take more than 500 mg of calcium at a time. This means taking the calcium 3-4 times/day. Take your calcium separately from your multivitamins and iron.

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When can I switch from chewable vitamin/mineral supplements to swallow vitamin/mineral supplements?

You need take chewable, liquid or sublingual vitamin/mineral supplements for AT LEAST 30 days or until you transition to a regularly textured diet.  Chewable children’s multivitamins and liquid or sublingual vitamin B12 are readily available.

Many people have difficulty tolerating calcium citrate supplements in chewable form or crushed up. If you crush your calcium supplement, try mixing it into yogurt or applesauce. You may also wait to start your calcium supplement until after you have transitioned to a regularly-textured diet and can switch to pills that you swallow instead of chew or crush. Just be sure to start your calcium – you won’t get enough from your diet alone!

How much protein should I eat each day?

You should eat 60-80 grams of protein each day. Protein-rich foods include lean meats (7 grams per ounce), low fat dairy (8 grams per cup of milk or yogurt), peanut butter, nuts, beans and soy products.

Should I take a protein supplement?

It is best for you to strive to meet your protein needs through whole foods (lean meats, low-fat diary, nuts and beans) as these foods provide your body with many nutrients in addition to protein. However, if you are having difficulty eating at least 60 grams or protein per day, protein supplements may help you meet your needs.

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What should I look for in a protein supplement?

There are typically two sources of protein in the protein supplements: whey and soy. Whey protein may be better tolerated but both are good choices. Look for a protein supplement that offers 12-15 grams of protein per serving and no sugar or sugar alcohols (check your ingredient list). An alternative sweetener like sucralose® or aspartame is okay.

Some protein supplements are powders you mix with liquid for a shake and others you mix with your food. Choose whichever you think will work best for you. If you purchase the kind to make a shake, mix it with milk instead of water to get some extra protein and calcium. Also, dried nonfat milk offers 8 grams of protein per 1/3 cup and sugar-free carnation instant breakfast adds 4 grams of protein per packet.

Some protein supplements come in bar form. These may not be as high in protein as the powder and tend to have sugar and/or sugar alcohols in them which are not well tolerated. However, some people find the bars to be more convenient.

Don’t be fooled by added extras like herbs and vitamins. Your main goal for a protein supplement is of course protein.

bullet Examples of high protein supplements

What is dumping syndrome?

Dumping syndrome is usually caused by food emptying too quickly out of your stomach.  Sugar causes dumping syndrome. Drinking fluids too soon after a meal eating too fast or eating too much at a meal may also cause dumping.

The symptoms of dumping syndrome are diarrhea, cold sweats, nausea, vomiting, and/or light-headedness, however, each person’s symptoms are different. Dumping can occur anywhere from 30 minutes to 4 hours after eating an offending food.

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Why do I need to avoid sugar for life?

Sugar may cause dumping syndrome. Sugary foods also provide calories without any nutrition and may lessen the amount of weight you lose after surgery.

Each person will tolerate a different amount of sugar in their foods after surgery. Some people can tolerate several grams of sugar without dumping while others dump after only a few grams. The best solution: avoid ALL added sugar as much as possible!

What are sugar alcohols?

Sugar alcohols are sugar replacers that are not well digested and absorbed by the body. Most of your sugar-free products are made with sugar alcohols. They usually end with “itol” like xylitol, manitol, sorbitol, etc. Sugar alcohols cause diarrhea in many people, even if they have not had bariatric surgery. Some people will tolerate up to 10 grams of sugar alcohols while others may not tolerate sugar alcohols at all so try them cautiously.

What about the sugar in milk and fruit?

Foods like fruit, 100% fruit juice, and milk will have naturally occurring sugar. Naturally occurring sugar in food is tolerated.  If you look at the nutrition facts label on these products, you will see grams of sugar listed. You only know if sugar has been added to the product by reading the ingredient list.

If you see one of these ingredients listed in the first 3 ingredients of your food, sugar has been added and you may not tolerate the food:  

Brown sugar
Confectioner’s sugar
Corn syrup
Corn sweeteners
Fruit sugar

Granulated sugar
Inverted sugar
Maple syrup

Maple sugar
Raw sugar
Turbinado sugar

I used to drink milk and now it makes me feel bloated, gassy or have diarrhea. Why is that?

After surgery, you may no longer be able to tolerate lactose, the natural sugar in milk. If that is the case, try lactose free milk such as the brand Lactaid. Also, fat is not well tolerated after surgery so if you were drinking high fat milk like whole (“vitamin D”)  milk or 2% milk, try switching to a lower fat milk like 1% or skim milk.

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Can I have hot and cold liquids?

Yes. Just be sure your liquids are free of sugar, carbonation and alcohol and limit coffee and tea to no more than 2 servings per day.

What can I do to help with my constipation?

Constipation is common after surgery. To prevent constipation, choose high fiber foods, drink plenty of fluid and exercise regularly. Applesauce and pureed prunes may also help.

If you have not had a bowel movement in 5-7 days, you may use a dulcolax suppository, fleets enema, or milk of magnesia. Be sure to also increase your fluid intake. Tell your doctor about the constipation at your follow up visit. You may need to start a stool softener.

Gas problems are also common.  If you have gas pains, try simethicone from the drugstore.

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