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We encourage you to study the following information carefully.  It will answer many of the questions that you have about the By-pass and how it will affect your life.

GASTRIC BY-PASS PRE-OPERATIVE EDUCATION

12 Important Points to know before surgery

Pre-Operative Diet

This operation is THE MOST EFFECTIVE TOOL to HELP you lose weight. In the gastric by-pass, staples are use to create a small gastric pouch, which limits the amount of food that you can eat at one time. In addition, the food you eat will bypass the distal stomach and a part of the proximal intestine in order to diminish the absorption of nutrients and contribute to the control of hunger and weight loss.

You are an important part of the process. You have to take RESPONSIBILITY for choosing the right foods and a well balanced diet plus your supplements in order to prevent nutritional deficits. We will guide you in doing this, and you will see how easy and effective it can be.

Eating habits and lifestyle changes are required. Since you will be eating less, it is important that you eat good quality food in order to avoid malnutrition. Avoiding malnutrition and exercising are the 2 best tools you can use in order to enhance the cosmetic result of your weight loss.

You will start with a liquid diet and move slowly towards eating solid food again. Your stomach needs time to heal, and you have to go easy on it.

After this, you will gradually move from liquids to soft or pureed foods:

How long it will be before you can eat solid food varies. Your new diet will depend a lot on what your body can handle. But it is VERY important that you follow the diet plan laid out for you. Eating the wrong foods or eating too much will cause discomfort. This discomfort may range from bloatedness, dizziness, and cramps. It may even be as severe as nausea, vomiting, and/or diarrhea. In addition, you could also stretch or dilate the pouch, which is undesirable.

TAKING PILLS

You may need to crush or change the presentation of some medications. But you can not do this with all kinds of pills. So go down your list of pills with your physician to make sure that it is OK. Large pills can get stuck in your small stomach pouch or stoma (connection between the gastric pouch and small intestine), and you may throw it back up.

Remember to take your pills on an empty stomach and follow them with food. This will help push the pill through the stoma and avoid irritating the stomach pouch. If you do it the opposite way, food in your pouch will not allow the pill through until it dissolves. The risk or irritation increases in these cases.

Never take medications directly before lying down at night. This does not allow enough time for the pill to pass through and can irritate the esophagus and small stomach pouch.

Bariatric Advantage makes supplements specifically designed for by-pass surgery. Take the multivitamin, B12 sublingual (1000 mcg), Iron (18 or 29mg), and Calcium citrate (400mg). Other chewable multivitamin-mineral supplement are Centrum, Flinstone (2 for children), or Juice plus. You need to take iron, calcium and B12 on a daily basis to guarantee the body is receiving essential nutrients to stay healthy. You can start 2 weeks after surgery: always take your supplements with food.

DO NOT EAT ANYTHING SOLID DURING THE FIRST 2 WEEKS FOLLOWING SURGERY. And remember NOT to drink carbonated beverages for at least 4 months post-op; carbonation can cause the small stomach to stretch. Ask us later how to introduce them.

A good rule of thumb is that a liquid is anything that can be sucked through a straw. If it won’t fit, it’s probably not a liquid. Do not use a straw, it introduces a lot of air into your stomach pouch and can make you nauseated and uncomfortable.

During the first 2 weeks we want you to flush everything through the small stomach pouch by following a liquid diet.

The primary concern in the first month is allowing your stomach to heal, preparing you to start progressing your diet to thicker, denser foods.

It is important to make sure that you drink plenty of fluids. Fluids will help prevent complications like blood clots by keeping your blood thin. It will help prevent constipation, which will cause pain. It will help your lungs get rid of accumulated secretions, which could cause infection. Finally, it will help your body get rid of the toxins your body accumulated during the surgical process.

The restriction you feel after surgery is from the swelling you may have developed during the operation. We want the fluids to go through the stoma so you heal properly.

Sip liquids slowly, and drink water or other non-calorie, non-carbonated beverages between meals. Do not use a straw to drink your liquids. You may use a spoon in order to control the size of your intake.

Alcohol is very high in calories and sugars; it may cause dumping syndrome, and it prevents your body from burning fat. Additionally, it is absorbed in your stomach and is an irritant. This is not to say that you will never be able to have a cocktail or wine with dinner in the future. Moderation is the key!

DON’T eat any solid foods or soups containing solids such as meats or breads during the first 2 weeks.

DON’T gulp any liquid during the first 2 weeks.

You should eat foods which are moist and mushy and that can be crushed with your fork. However you may start to notice a difference in the amount of time you stay full following your meal. It is important to eat slowly and practice chewing your food very well. Listen to your body, and try to start picking up on the signals that you feel.

Start introducing soft food to your diet as tolerated. You can start introducing one food at a time, some solid foods from the second week and progressively increasing to the 4^th week. Take small bites and chew them well. If something doesn’t go down right, don’t be frustrated; you can try it a few days later.

EATING BEHAVIORS:

Remember to eat slowly and to try very small portions to start. You may notice a feeling of fullness after eating small portions of soft foods. Drink plenty of non-caloric beverages between meals.

Start learning the “new eating habits”;  focus on introducing protein first and at every meal followed by vegetables and a small carbohydrate last. Avoid drinking and eating at the same time; limit your portion size to less than 1 cup per meal.

DON’T eat any fibrous foods such as raw vegetables or tough meats.

DON’T eat any fast foods or concentrated sweets.

• Protein is needed in order for you to heal following surgery, and it is the fuel that your body uses to repair tissue.

• Protein carries fewer calories if it is a “lean” meat.

• Helps maintain muscle mass.

• Fills you up sooner.

• Keeps you feeling full longer because it is denser and broken down by the body more slowly.

• You do not need to strive to reach a certain amount of protein, just put it first in each meal.

• Improves immunological system.

• Helps control hunger.

• Slows down the uptake of sugars.

• Helps you lose weight.

You can start introducing solid food little by little as tolerated. It is important to move to solid foods and eat the most nutritious and solid food choices at each meal. By eating solid foods, you will maximize the effectiveness of the surgery.

 EAT protein first, followed by vegetables, and a small carbohydrate last.

 Unfriendly foods

Foods that you may find difficult to tolerate:

Remember, it is very dangerous to eat quickly without taking time to chew your food well. Too much food at one time or big chunks of food can block your small stomach pouch. You can avoid this problem by eating small bites and chewing very well. If you do not follow these directions, you are risking the possibility of a stomach obstruction or blockage, which may result in nausea, vomiting, stomach irritation, and/or stomach swelling.

 If you experience these symptoms with solid foods or suffer from nausea or vomiting, go back to a clear liquid diet; remember that liquids are your safe haven. Stay on liquids until the sensation goes away, then and only then can you start introducing soft food to your diet as tolerated. Take small bites and chew very well. Ice chips and Maalox (Maalox on the rocks) can help; take frequent small sips to comfort the pouch. It may take a few days for your stomach to heal and the swelling to go away. If it is still present after 2 days, contact us.

 CAFFEINE

We don’t advise drinking any beverage containing caffeine. If you are not a frequent caffeine user, it tends to increase the acids in the stomach, causing irritation and discomfort,  In addition caffeine is a diuretic (increases urination), which will cause loss of water, certain vitamins, and minerals such as calcium, magnesium and potassium. Try decaffeinated beverages to replace this craving or need. IF YOU HAVE TO HAVE CAFFIENE, TRY TO LIMIT IT TO 1-2 CUPS.

 CARBONATED DRINKS

Carbonation from soft drinks can build up in the small stomach pouch and cause bloating or stomach irritation, which can be very uncomfortable. The carbonation can cause the small stomach to stretch. After 3-4 months from your surgery, if you want to try carbonated drinks, let the soda sit in a glass with ice for a few minutes so that some of the gas is released. Only try sugar-free (diet) sodas.

Exercise will be an important part of your new lifestyle. We know that by increasing your activity level, you are increasing the amount of energy your body expends. This results in increased weight loss. We also know that most individuals who successfully have maintained their weight for long periods of time are usually those who exercise on a regular basis. In addition, exercise will enhance the cosmetic result of your weight loss, diminishing the need for cosmetic surgery in the future.

HOW MUCH WEIGHT CAN I EXPECT TO LOSE

Most people lose 80 to 85% of their excess weight one year post-op. In 3 months, they lose about 40% and in 6 months around 60% of their excess weight.

NON-SCALE VICTORIES (NSV´S)

It is important to see the non-scale victories like not taking medications, controlling portions, improving health problems because your weight is gone, increasing your toleration of physical activities, etc.

We hope this document is helpful to you!  If you have any questions please call us!

Download this file here.

Centro Medico Metropolitano
 Av. Del Hospital No. 110 – 104
 Colonia Sertoma
 Monterrey, NL, Mexico, 64710
 Tel: (52-81) 8347-4481 or
 (52-81) 8333-6891
 Fax: (52-81) 8347-4481<