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What To Expect

Choose your sources of information carefully

Some sources are likely to be reliable, some less so. Use the ones most likely to be reliable, and try to ignore those less likely to help.

Examples of MORE reliable sources:

  • Bariatric surgeons usually have information meetings you can attend, often at support groups. These are often good sources.
  • Nurses and dietitians at the surgeons’ practices can also be very helpful. They are close to the patients’ experiences and are often accessible.
  • All of the information at BariBest.com is reviewed by medical professionals and you can submit questions in the Help and Advice section of this website.

Examples of LESS reliable sources:

Online chat rooms and bulletin boards are one of the least trustworthy sources of information because people don’t even have to identify themselves. So you can have companies disguised as a member. For example, a company can create the realistic-sounding identity with the user name “Cathy-in-Ohio” who has a dog and a cat, and raves about the company’s products or services, or talk about how bad the competitor’s products are. In reality, Cathy is a company employee.

Let’s say “Yellow-Rosie-of-TX” is a real person, you still have to remember that she is another human with her own set of biases. We all want to believe our choices are right for us…and for other people too. Maybe so, maybe not, but you decide what is right for you. Everyone wants to be an expert, regardless of their level of expertise. It’s human nature.

That is true of family members and friends too. They are often well-meaning, but they might not be medical experts, and they might not be experts in what is right for you. Listen to them, but weigh everything carefully.


Learn about each option before you decide.

There are always pro’s and con’s for every option. Learn about each option first. Get the all the facts before you exclude an option. When you know the pro’s and con’s for each surgery, then make a separate list of your goals. Goals can include both what you want, and what you want to avoid. Decide which goals are most important.

Then compare the pro’s and con’s of each option with your goals.

If you make the decision to have the surgery, make the commitment too.

We talk with many patients who are successful…and many who aren’t as successful as they hoped.

Some patients don’t lose as much as they want or regain most of their weight three or five years later. The less successful patients are the ones who don’t make the lifelong commitment to:

  • Healthy eating, especially protein supplements and vitamins
  • Exercise as much as their health allows
  • Check-ups to monitor their health and nutrition status

The successful patients decide what they need to do, and keep track of how well they are doing. They keep a sheet of paper on their fridge and record each day they get exercise, and how much protein they got, and whether they took all of their vitamins.

Because we talk with patients about protein every day, we know that it is hard to get enough protein to lose weight, and maintain weight loss success, without protein supplements. Many foods have protein, but most come with lots of other calories. See our Nutrition section on this website.

  • Remember. Weight Loss Surgery changes your digestive tract. It is about changing how you handle food and the nutrients in it. So the surgery is all about Nutrition. Nutrition, for the rest of your life, is the foundation of your success.

Other Questions?

If you have more questions about surgery choices, please refer to the Help and Advice section of our website. You can see many answers to questions others are asking, and if you don’t find what you want, you can send us your question directly.



Pre-Surgery

Pre-surgery information sessions conducted by your surgeon’s office will give you a lot of important information.

It is important to know and remember that information for the rest of your life.

Take the information home, and review it, and commit it to memory. Review it again after surgery, and again in six months.

Pre-Surgical Weight Loss

Often you will be required to lose some weight prior to the surgery. Some practices require it, and some medical insurance companies require it.

Don’t worry. You can do it. Your surgeon and dietitian will tell you how. The research shows that getting enough protein is effective (compared to watching or limiting carbs and fat).


As you get closer to surgery, you will be given a Pre-Surgical Diet. Commonly you will follow this diet in the two weeks immediately before surgery. You can see a sample pre-surgical diet by clicking here. The purpose of the diet is to shrink the liver, which makes the surgery easier and safer.

These diets usually include either:

  • Protein supplements combined with vitamins and minerals, or
  • High protein "meal replacements"

We recommend that you don’t combine a meal replacement and a multivitamin because the meal replacement has vitamins, and so you can end up taking more vitamins than are recommended. Meal replacement products can be expensive and they don’t give you anything special. Protein supplements let you manage your protein and multivitamins to fit your own needs, and some protein supplements taste good.

Follow the Pre-Surgical diet closely, and if you have any trouble with this diet, tell your dietitian or surgeon.

One other tip. As soon as you decide to have weight loss surgery, or any other surgery, be sure you are getting good levels of protein, vitamins and minerals, particularly protein. Medical research indicates that if your “protein status” is good at the time of surgery, the surgery itself tends to go a little better.

While your body cannot store up protein in the same way that a squirrel stores nuts for the winter, you can still improve your protein status gradually if it is low.

Other Questions?

If you have more questions about surgery choices, please refer to the Help and Advice section of our website. You can see many answers to questions others are asking, and if you don’t find what you want, you can send us your question directly.


Special Diets Before and After

As you get closer to your surgery date, your surgeon’s office will advise when to begin your pre-surgical diet. Usually it starts about two weeks before your surgery date. There is a set of diets you will follow after your surgery date as well, commonly starting with:

  • Pre-Surgical Diet
  • Clear Liquid Diet, then
  • Full Liquid Diet, then
  • Pureed Diet, then
  • Solid Foods

Pre-Surgical Diet

  • High protein, low carbohydrate, low sugar, calorie-controlled diet
  • Time frame may vary by clinic, but is typically a minimum of 2 weeks before surgery
  • Purpose is to reduce the risk and difficulty of the surgery by reducing the liver size.
  • If you need more information, contact the dietitian at your surgeon’s office or email to Nutrition@BariBest.com

Post Surgery Diets: Overview

  • The time you stay on each post-surgical diet will vary by surgical practice and your surgeon’s assessment of your own specific needs
  • Consume liquids and solids separately, wait at least 30 minutes between eating and drinking -- to help leave space for nutrient-rich foods
  • Limit or avoid added sugar, fruit juice, fried foods, carbonation, caffeine, and alcohol.
  • Protein supplements are recommended at each stage of the diet following surgery

Clear Liquids

  • This stage of the diet typically lasts 1-2 days
  • Choose clear Liquids which are non-carbonated, caffeine free, low calorie, sugar-free or low-sugar
  • Examples of foods typically allowed on the clear liquid diet include:
    • Clear liquid high-quality protein supplements – (examples: these flavors of UNJURY® Protein: Chicken Soup flavor, Strawberry Sorbet flavor, Unflavored mixed in fruit-flavored Crystal Light. Caution: Lower quality protein supplements can be high in lactose, which could be dangerous.)
    • Sugar-Free Jell-O
    • Broth
    • Sugar-free popsicles
    • Artificially sweetened beverages
    • ecaf/herbal teas

Full Liquids

  • This stage of the diet typically lasts 10-14 days
  • Goals: 80 grams of high quality protein, 48-64 ounces of fluid
  • Allows everything on the clear liquid diet, PLUS Full liquids which are sugar-free or low-sugar. Examples include:
    • High Quality Protein Supplements, all flavors– important to meet protein needs
    • Skim Milk
    • Milk Alternatives (i.e. soy milk, almond milk)
    • Strained soups
    • Vegetable Juice
    • Plain or Artificially sweetened yogurt (Many fruit flavored yogurts have high sugar content. It is important for gastric bypass patients to avoid these.)

Pureed Foods

  • This stage of the diet typically lasts 10-14+ days
  • Goals: 80 grams of high quality protein, 48-64 ounces of fluid
  • Pureed foods which have been blended or liquefied
  • Allows everything on the full liquid diet, PLUS
    • Pureed meat or fish (using chicken broth UNJURY® Chicken Soup flavor instead of water provides flavor)
    • Scrambled eggs or egg substitute
    • Plain or Artificially sweetened yogurt
    • Sugar-free Pudding
    • Peeled pureed fruits or vegetables (chicken using broth instead of water provides flavor)
    • Oatmeal, cream of wheat

Soft Foods

  • This stage of the diet typically lasts 14 days or more.
  • Requires minimal chewing. Food can be chopped, ground, mashed, or pureed
  • Goals: 80 grams of high quality protein, 48-64 ounces of fluid
  • Allows everything on the pureed diet, PLUS
    • Ground chicken, turkey or lean meat
    • Cottage cheese or soft cheese such as low fat string cheese
    • Baked fish
    • Scrambled or poached eggs
    • Tuna with light mayonnaise
    • Soft canned fruit or vegetables

Solid Foods Diet

  • Balanced diet with protein, fruits, vegetables as tolerated
  • Goals: 80 grams of high quality protein, 48-64 ounces of fluid

Caution:

when the doctor’s office says you can move on to solid foods after surgery, that doesn’t automatically mean to stop using supplements. In fact, it can be difficult to meet protein goals without supplements. Here’s how to meet your protein goal:

Know how much quality protein is in foods. Many foods have 7 grams of protein per unit or per ounce. Examples:

  • 7 grams of protein per one egg
  • 7 grams of protein per ounce of beef, chicken, pork, fish
  • (1 ounce after cooking and shrinking)
  • (a common serving size is 3 ounces)
  • Skim milk has 1 gram per ounce of milk, so 8 grams per cup (almost 7)
  • Other dairy products will show the grams of protein on the label.

If you do a little arithmetic, you can see that getting enough protein from foods isn’t so easy. If you want 80 grams of quality protein, here are the amounts of one food you would need per day:

How much of this food

To get 80 grams of protein

2Beef, Pork, Chicken or Fish

12 ounces after cooking,
(almost a pound before cooking)

Eggs

12 eggs

Milk

10 cups of milk


Clearly you can combine some of each, but with much-reduced capacity after surgery, it isn’t easy.

That’s how protein supplements can help. One scoop of a high quality supplement powder typically provides about 20 grams of protein depending on the scoop size. If you mix the scoop of protein into 8 ounces of skim milk, that increases the total protein to about 28 grams.


Long-term Post-surgery Diet

  • Have lean protein or protein supplement with every meal/snack
    • Minimum protein needs 60-80 grams per day
    • Plan meals and snacks, eating 3 meals and 1-2 snacks per day.
    • Eat protein first at a meal or snack, then eat fruits, vegetables
  • Balanced diet as tolerated
  • 48-64 ounces of fluid per day (minimum)
  • Take small bites and chew, chew, chew
  • Daily vitamins and calcium citrate as directed by your bariatric clinic
  • Follow-up with your bariatric clinic or primary care physician every year to check your blood work and make sure you do not have any vitamin/mineral or protein deficiencies.


The First Year after Surgery

Coming home after surgery

When you come home after surgery, you will have important instructions from the nurse, the dietitian, and the surgeon. Be sure that those who are helping you in those first days know those instructions.

The first few months

During the first two weeks after surgery, many practices recommend that you follow a “Clear Liquid Diet”. Follow the instructions you are given for what is on the Clear Liquid Diet. What is included can vary; click here for an example of a good Clear Liquid Diet.

Following the Clear Liquid diet, typically you will progress through the Full Liquid Diet, then a Pureed Diet, then a Soft Diet. Don’t cut these short; don’t move to the next stage faster than recommended.

Key to Success: Protein

Eventually you will be advised when you can move on to solid foods. This is a time to be very careful. You still need to get the recommended level of high quality protein, e.g. 80 grams per day. You need to get about that much for the rest of your life.

The problem is, solid foods generally they don’t have a high enough protein content to let you get that 80 grams. For example to get that much protein from meat, you would have to start with about a pound of uncooked meat. After the surgery, you won’t have the capacity for that, even over the course of the day.

Of course you will mix up your protein sources, but to some degree they all pose the same capacity question. Another example: a dozen eggs would give you 84 grams of protein, but few people can do that.

That’s why protein shakes are an important protein source, long term. Three shakes, two made with skim milk and the third with water, will usually give you about 75 grams of protein.


Protein

Protein Grams per Day: You need to know how many grams of protein you need to get each day – for the rest of your life. You surgeon’s office will have a specific recommendation for you. To give you an estimate, The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends 60 to 80 grams of quality protein per day.

We recommend more. We recommend at least:

  • 80 grams of protein per day for gastric bypass and gastric sleeve patients,
  • and 90 grams of protein per day gastric band

Here’s why we recommend more protein per day than ASMBS:

  • There isn’t a lot of research on the protein needs of gastric bypass and gastric sleeve patients after surgery. This is particularly true for the first year after surgery.
  • Because there isn’t a lot of research, we believe it is much safer to risk a recommendation that is a little high than one that is a little low. A recommendation that is a little low might result in slow muscle loss throughout the body, including the heart muscle. At the same time, a recommendation of 80 grams is within the safe level recommendations of the Institute of Medicine for the general population who can absorb the protein they consume at least as well.
  • For most gastric band patients, we believe the medical research on weight loss applies; a growing body of research specifically recommends 25% to 30% of calories from protein for weight loss success. Ninety grams of protein per day is 30% of calories from protein when the diet is 1200 calories per day, and we anticipate that most band patients will consume 1200 calories or more.
  • It is much easier to figure out whether you are getting 90 grams of protein than it is to figure out whether you are getting 30% of your calories from protein.

How do I get in 80 grams of quality protein (90 grams for band patients) per day?

It is important to record your protein intake over the course of every day. An easy way to do this is with a simple sheet of paper that has 31 lines on your refrigerator, one line for each day of a month. Make a note every time you get in protein, and add up the total at the end of each day.

Know how much quality protein is in foods. Many foods have 7 grams of protein per unit or per ounce. Examples:

  • 7 grams of protein per one egg
  • 7 grams of protein per ounce of beef, chicken, pork, fish
    • (1 ounce after cooking and shrinking)
    • (a common serving size is 3 ounces)
  • Skim milk has 1 gram per ounce of milk, so 8 grams per cup (almost 7)
  • Other dairy products will show the grams of protein on the label.

If you do a little arithmetic, you can see that getting enough protein from foods isn’t so easy. If you want 80 grams of quality protein, here are the amounts of one food you would need per day:

How much of this food

To get 80 grams of protein

2Beef, Pork, Chicken or Fish

12 ounces after cooking,
(almost a pound before cooking)

Eggs

12 eggs

Milk

10 cups of milk


Clearly you can combine some of each, but with much-reduced capacity after surgery, it isn’t easy.

That’s how protein supplements can help. One scoop of a high quality supplement powder typically provides about 20 grams of protein depending on the scoop size. If you mix the scoop of protein into 8 ounces of skim milk, that increases the total protein to about 28 grams.

Track your protein. Here’s a free tool you will find as valuable as anything else you find on this website – IF you use it: a printable page that helps you track your protein.

When you track it, you will do it. Just download and print copies of the UNJURY Easy Protein Tracker and tape on your refrigerator. Start today! When you track it, you will do it.


Vitamins and Minerals

The choice of vitamins and minerals is one of the important decisions a bariatric patient makes.

The choice is important for these four reasons:

  • Bariatric surgery reduces the intake of foods, and the nutrients they contain.
  • Bariatric surgery increases sensitivity to some foods and ingredients.
  • For bypass patients, absorption of some vital nutrients is reduced, in some cases reduced a great deal.
  • Some deficiencies can damage your health severely.

To avoid deficiencies, at minimum we recommend:

  • A complete high quality multi-vitamin multi-mineral supplement for bariatric patients. A chewable multivitamin with a formula that is specifically optimized for your surgery is a much better choice than vitamins for the general population. Your surgery creates special needs.
  • Calcium citrate that provides 1200 to 1500 mg of calcium each day. If possible, separate taking your calcium from your multivitamin by two hours: a high dose of calcium will interfere with your getting the iron in your multivitamin. Also, it is best to split your calcium into two doses, one in the morning, one later in the day.
  • Note that calcium citrate, not calcium carbonate, is required for gastric bypass patients, and generally recommended for gastric sleeve patients. The reason for this is that these two surgeries result in lower stomach acid production, which is important for good absorption of calcium carbonate. In fact, it is superior choice for everyone, because calcium citrate tends to be lower in heavy metals than calcium carbonate.
  • Vitamin B-12 - for Bypass and Sleeve patients. We recommend either a sublingual (under the tongue) tablet, or a monthly injection. While many bariatric multivitamins have very high doses of B-12, we don’t believe that that approach is sufficiently proven by the limited research available to date. The health effects of a Vitamin B-12 deficiency are quite serious, including potential nerve damage.

Also pay special attention to these vitamins:

Vitamin D

Why is it Important?

Vitamin D is important for calcium absorption, bone health and plays a role in prevention of certain types of cancer, heart disease and other chronic disorders. Supplemental Vitamin D, combined with calcium, is essential because bone loss is a common problem following weight loss surgery.

Studies have found that 60% to 80% of bariatric pre-op candidates have low Vitamin D.

Folic Acid

Folic acid is an important B-complex vitamin. Deficiencies can lead to weakness, fatigue, difficulty with concentration, and irritability. However, overdoses have risks as well. Overdoses can mask a Vitamin B-12 deficiency.

Iron

Iron deficiency anemia is the most common nutritional deficiency in the world.

Your entire body needs oxygen, and every cell depends on red blood cells to deliver that oxygen. To build red blood cells, iron is essential.

Supplemental iron is needed to prevent anemia, a common side effect of weight loss surgery.

Common symptoms of anemia are fatigue, and reduced capacity to exercise. Getting enough iron is difficult because the body normally absorbs only 10% of iron from foods. Iron absorption is greatest in an acidic environment. Weight loss surgery reduces the size of the stomach and its ability to make enough acid for the best iron absorption. Plus, gastric bypass usually bypasses the duodenum and proximal jejunum, the most efficient absorption sites.

A note about Iron in multivitamins and calcium: Calcium blocks iron absorption when certain higher levels of calcium are also present.

Vitamin A

Vitamin A is important to maintaining good vision, gene expression, growth and immune function and more. At the same time, excessive Vitamin A can be toxic as well; chronic toxicity can cause reduced bone density, disorders of the brain and spinal cord, and liver abnormalities. For these reasons, it is most important to get Vitamin A dosage right.

Vitamin C

A 2009 study in Obesity Surgery reports that almost 50% of pre-surgery patients are deficient in Vitamin C. Vitamin C deficiency has also been reported after gastric bypass surgery.

You need to have your vitamin – and protein – status monitored by labwork at least annually. Know the deficiency risks for each vitamin, mineral and for protein.

Other Questions?

If you have more questions about surgery choices, please refer to the Help and Advice section of our website. You can see many answers to questions others are asking, and if you don’t find what you want, you can send us your question directly.



Long-Term Success

Overview

Usually, most of the weight loss from gastric bypass and gastric sleeve surgeries happens during the first 12 months after the surgery. What happens after that?

For gastric band patients, how should they continue to lose until they reach their goal weight?

There are many things you can do to maintain your health and keep your weight where you want it. Exercise, eating right, daily vitamins, keeping a log, check-ups and continuing to go to a support group – all of these can help.

What you need to do is stay committed for the rest of your life. If you don’t remember this from your pre-surgery education, contact us at Success@BariBest.com.

In our experience, while all of those other steps are important, the single biggest key to long term success is protein. Protein satisfies you better, and longer, with fewer calories. That is how you keep your weight down.

  • The single biggest key to long term success is protein.
  • Start your day with protein.
  • Use protein to crowd out snacks that are higher in sugar and fat.

We talk with many patients who have had great loss success, and then they seem to let the plan slip away. All the things that worked so well – it’s almost human nature to say "Maybe I don’t HAVE to do all that every single day". That is the day Weight Regain begins. Stay on the plan for the rest of your life.

We want you to be successful. You can be successful, and it isn’t hard. You just have to make adjustments to stay healthy and keep the weight off. Please do go now to our full Long Term Success section. Just click here.

Other Questions?

If you have more questions about surgery choices, please refer to the Help and Advice section of our website. You can see many answers to questions others are asking, and if you don’t find what you want, you can send us your question directly.



Plastic Surgery

If you have stayed on track with your protein, vitamins and your total plan, chances are you have lost a lot of weight. You might find that your skin is not the same as it used to be. Think of your skin as a balloon that can blow up or deflate. After losing a large amount of weight your skin will deflate which may result in sagging, hanging, or stretch marks.

Extra skin may also cause uncomfortable side effects such as yeast infections and chaffing. You may choose to treat these problems with powders, or by wearing different clothing to prevent skin from rubbing and breaking down. If these changes are bothersome, there are a number of procedures that can be done to help take care of them.

Not everyone needs, or chooses to have plastic surgery after weight loss surgery. It is difficult to know whether you will experience changes to your skin before losing weight. Here are some things that may determine if you’ll need surgery:

  • Age: If you are younger, your skin will adjust more easily to weight loss
  • Amount of weight lost: The heavier you are, the more your skin will stretch
  • How often you have lost weight: If you have gained and lost weight many times, your skin may not “snap” back as quickly
  • Where you carry your weight: When the majority of weight is located in one area, such as the belly, rather than throughout the body you may experience more stretching
  • If you have smoked: Smoking causes breakdown of collagen (which provides structure to skin)
  • Spending a lot of time in the sun: Long periods of time in the sun causes skin to become loose
  • Skin type: Some types of skin are naturally more elastic than others

Many individuals who have lost a lot of weight choose to have plastic surgery. Plastic surgery is something that is very individualized based on the patient and their goals.


Preparing for Plastic Surgery:

If you decide to have plastic surgery here are things that you can do to prepare:

  • Drink plenty of water! The more hydrated you are the more elasticity your skin will have.
  • Exercise. Exercise will help to tone the muscles under the skin and reduce the sagging appearance.
  • Eat plenty of protein. Be sure to track your dietary protein intake. Protein will help you to heal from surgery.
  • Take your vitamins. Taking vitamins and minerals will help prevent deficiencies before surgery.
  • No Smoking. Smoking stops oxygen from reaching your skin which slows the healing process.
  • When to have Plastic Surgery:

    It is best to have plastic surgery after you reach your goal weight. You want to be in the best shape possible before having plastic surgery. It is also important to be consuming enough nutrients including protein, vitamins and minerals to ensure healing after surgery.

    You want to be sure that you have stopped losing and haven’t just hit a plateau before plastic surgery. If you rush plastic surgery and continue to lose weight, your skin may begin to sag.

    Choosing a Plastic Surgeon:

    It is best to have your plastic surgery performed by a plastic surgeon who is experienced in operating on weight loss surgery patients.

    Here are a few ways to find a good plastic surgeon:

    • Ask your weight loss surgeon for a recommendation
    • Talk with other patients at support group meetings
    • Find a local support group where a plastic surgeon will be presenting information
    • Contact the American Society of Plastic Surgeons (www.plasticsurgery.org)
    • Look for a surgeon who has a lot of experience with the procedure you are considering.