It’s six weeks since my gastric bypass surgery, and I was back in hospital today as an out-patient to have a follow-up consultation with my surgeon.
I was delighted to report that I had lost nearly 14 kg since surgery – just over 2 stones. The surgeon said that at the 6-week mark they would ideally be looking for about an 8% loss in weight, and I was more or less bang on target.
We talked about the medications and supplements I was on, and about the fact that my bloods would be checked in a few weeks before my next hospital appointment with the dietician in December. And we also talked about the vitamin B12 injection that I have to get soon.
I asked about my low levels of energy, and also about feeling cold, and she said that both of these were perfectly normal side effects of losing weight, and would rectify themselves over time.
Generally she seemed delighted by my progress, and that I could start to progress onto a more normal diet. I don’t need to restrict myself to soft foods any more, and can start to introduce new things into my diet and see how I can tollerate them.
Pretty much everyone that is having bariatric surgery is required to follow a restrictive diet for the two weeks before surgery.
The idea of the diet is primarily to help shrink the liver. The liver sits in front of the stomach and the surgeon will need to move it out of the way to perform the bariatric procedure. And an enlarged liver makes the operation more difficult for the surgeon, and potentially more risky. And so, even though the pre-op diet is hard to follow, it’s certainly worth the short-term sacrifice.
The diet itself is high-protein, low-carbohydrate, and low-calorie. The protein helps you feel full, and at the same time help maintain muscles in the body. And by cutting out fat, carbohydrates (which metabolises as sugar in the body), the liver will shrink enough to make the surgery easier.
Your nutritionist of dietician will probably give you a diet to follow, and it’ll be based either on certain foods, or on meal-replacement shakes or drinks – or a mix and match of the two. Some may also want you on a liquid diet immediately before the surgery. But the overall goal of all the different diets is to restrict you to 800 calories a day.
The average calories for an adult to maintain their weight is 2,500 for a man, and 2,000 for a woman. And as an obese person, I know that I’m used to eating and drinking a hell of a lot more calories than that every day! And so a limit of 800 will feel quite difficult.
My pre-surgery diet
In addition to limiting my intake to 800 calories, I’ll also be trying to consume at least 70g of protein a day, and I’ll also be starting on my course of multivitamins and calcium supplements to ensure I get all the nutrients my body needs.
My own surgery is just over 2 weeks away now, and so I’m about to start my pre-op diet in the next few days. My plan is to try the meal-replacement shakes for breakfast and lunch, and then have a proper meal of meat and vegetables for dinner. That’s the plan, but let’s see how it goes in practise!
A final blowout?
And with a only a couple of days left before the diet and then the operation, there’s a temptation to go crazy and eat loads of foods that I’ll not be able to eat after surgery. A bit like a last blow-out or a condemned man’s last meal! However I’m also trying to resist this urge to go crazy, as that’s just a manifestation of my food addiction, which is what got me to this point of being morbidly obese. I also think it might make transitioning onto the pre-op diet even harder.
I’ll be honest with you, the diet really scares me. I’m not sure if the meal-replacement shakes will satisfy me – physically or psychologically – and I might be tempted to eat other things. But I’m going to try my hardest to keep to it – and maybe make sure I have lot of low or zero calorie snacks available for when I might struggle.
As I prepare for my bariatric surgery, one of the things I’ve had to get my head around are vitamins and minerals.
I’ve learnt that in both the pre-surgery and post-surgery diets it’s important to have vitamins and minerals supplements, because I’m not going to get enough of them from food in the restricted diets.
Getting the right supplements
So here’s the basics of what I’ll need to start taking every day:
1 or 2 Multivitamins (with a minimum of 14g of Iron)
3 doses of Calcium Citrate, combined with Vitamin D
Some dietitians recommend special bariatric multivitamins, as they contain a balance of vitamins specially formulated for bariatric patients. However it also seems you can get away with standard multivitamins, if you can also add in an additional dose of vitamin B12 and vitamin D.
I bought a whole load of standard multivitamins before I even realised there are special bariatric ones available. I also bought calcium carbonate supplements instead of calcium citrate.
Apparently the calcium citrate is better absorbed by bariatric patients, as it doesn’t need stomach acid to breakdown, and it also helps avoid getting gallstones. So I might need to get new calcium tablets.
Pre-surgery
Pre-surgery diets seem to vary, but all of them seem to recommend starting on the multivitamin and calcium citrate supplements when the diet starts.
For two weeks before surgery I’m going to be limiting myself to just 800 calories a day. This restrictive diet helps shrink the liver and make the surgery easier and safer. But the diet also means that I’ll not be getting all the vitamins I need from food, so I need help from the supplements.
Post-surgery
For the post-surgery diet, I learned that it’s important to have chewable or liquid supplements. For the first few weeks after surgery I’m going to be on a liquid-only, and then a pureed-food diet. And during that time I’m not going to be able to swallow any pills or capsules.
I’ll need all my medication and supplements to either be crushed into powder. And some medications that are not intended to be chewed can taste really bad, so I might need to mix them with something else to disguise the taste. Or, just get them in a chewable form.
Some multivitamins are available as gummies, but I’ve heard they can cause problems unless they are chewed really well before swallowing.
For the first 2 months I’ll need to take three calcium supplements and two multivitamins – all spaced out by at least two hours.
Time / Meal
Supplement
8.00am Breakfast
Calcium Citrate (500-600 mg)
11.00am Snack
Multivitamin with Iron
1.00pm Lunch
Calcium Citrate (500-600 mg)
4.00pm Snack
Calcium Citrate (500-600 mg)
7.00pm Dinner
Multivitamin with Iron
Example pre-surgery supplement plan
After 2 months
When I’m back on real food, a couple of months after surgery, I believe I’ll be able to tolerate tablets again, so I won’t need chewable supplements. But I will need to continue taking the calcium citrate and multivitamin supplements for the rest of my life.
I’ll also need to get regular blood tests to make sure I have enough vitamins and minerals in my blood, as a gastric bypass permanently limits the absorption of iron, vitamin B12, calcium and vitamin D.
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