Bariatric surgery is a permanent procedure which alters the body’s relationship with food. So what patients eat and believe that they should eat for the following months can make the difference between success and failure of the surgery. Dr. Harsh Sheth addresses the myths that are getting in the way.
From Dr. Harsh Sheth, Bariatric & GI Laparoscopic Surgeon in Mumbai | Listed on Practo & ClinicSpots
Bariatric surgery is, essentially, a metabolic procedure. This procedure changes the shape of the stomach, the hormones that are released and the body’s nutrient uptake. It is not, however, a single solution. The weeks, months and years following the operation are as important as what goes on in the operating theatre. And in that post-surgical state a whole set of myths has sprung up in nutrition which is subtly working against the gains of patients throughout India.
Dr. Harsh Sheth is a Bariatric & GI Laparoscopic Surgeon in Mumbai and treats the repercussions of these misconceptions on a regular basis as he has a wide practice area that includes bariatric surgery, GI surgery, hernia surgery, gallbladder surgery and colorectal surgery. Patients who are having trouble often aren’t the ones who have had difficult surgeries. These are the ones who had surgical intervention which was performed well, and then proceeded to make informed nutritional decisions from misinformation.
The protein problem: more is not always better
No doubt, protein is the most important macronutrient during the post-bariatric phase. The smaller stomach size restricts the amount of food that can be consumed at one time; and if the patient is not deliberately prioritizing their muscle development, they can also lose a significant amount of fat while building muscle — which will negatively impact the rate of their metabolism and make it much more difficult for them to maintain their weight over time. Patients are always prescribed between 60 and 80 g of protein per day in the first few months after surgery, climbing to more in active people.
Patients’ mistake is how they go about it. One thing that’s been popular since the rise of social media and fitness culture is the overuse of protein shakes and supplements as meal replacements instead of supplements as a part of a meal. The digestion of whole protein foods, such as eggs, paneer, fish, lentils, greek yoghurt, differs from that of protein isolates. There are variations in amino acid composition. They send out satiety signals that vary. And, most importantly, real food provides micronutrients that shakes lack.
“Protein shakes should be considered a supplement to the diet of whole proteins and not a replacement for the diet of whole proteins beyond the first few week’s post-surgery when solid food is being reintroduced.” Dr. Harsh Sheth
The carbohydrate confusion
In many places, post-bariatric diet guidelines have come to mean low-carb. This has resulted in a cohort of patients who view all carbohydrates as the same, and remove them all – even the fibre, micronutrient-dense, gut-friendly, bowel-regularising, and long-term metabolic health-boosting carbohydrates. As a result, in clinical practice, patients are seen with constipation, micronutrient deficiencies, and surprisingly, fatigue that deters them from exercising enough to maintain weight.
The important difference is between refined, high-glycaemic carbohydrates (white bread, rice, sweets, processed snacks) and complex, fibre-rich carbohydrates (oats, legumes, sweet potato, vegetables). The latter ones are entitled to be restricted, especially when it comes to the risk of dumping syndrome. The latter are dietary allies, not threats.
“After bariatric surgery, the fear of carbohydrate has become out of proportion and in some instances harmful – fibre is a carbohydrate and most vegetables are carbohydrates – eliminating all carbohydrates is not in line with the current evidence and can actually make the post-surgical diet less sustainable and less nutritionally complete.” Dr. Harsh Sheth
Supplements: the step patients skip
There is one rule in post-bariatric nutrition and it is the rule of supplementation. Sleeve gastrectomy and Roux-en-Y gastric bypass cause iron, vitamin B12, vitamin D, calcium and folate absorption to be significantly decreased due to the anatomical changes. These deficits can cause ill effects that may take years to become apparent and are difficult to rectify once they are present, such as anaemia, bone density loss, etc., neurological symptoms.
The misconception encountered most often in practice is that a healthy diet makes supplementation unnecessary. It does not. Even if the patient’s meals are well-structured, the absorptive surface of the modified digestive tract is unable to compensate for a decrease in food intake and disturbance of the absorption pathways, simply by improving the quality of the food consumed. There are no optional items such as bariatric specific multivitamins, calcium citrate, or regular blood monitoring. They are the scaffolding on which long-term outcomes depend.
“Patients who feel well after surgery sometimes assume their nutritional status is fine. Blood work frequently tells a different story. Deficiencies in micronutrients are a predictable, frequent post-bariatric surgery problem that can be largely prevented if patients commit to supplementation from the beginning and continue to do so forever.” Dr. Harsh Sheth
Post-bariatric nutrition is a specialised branch of nutrition and there is a tremendous difference between the general dietetics and the diet that is appropriate for this patient population. The surgery creates the conditions for transformation. That transformation is only possible if patients eat what they have been prescribed, and follow the rules for their supplementation and monitoring.
Bariatric surgery gives the body a new start. Nutrition determines what it does with it.
Contact Details:
Address: Genese Clinic, G-14/15, 8th Floor, Everest Building, Tardeo Rd, Janata Nagar, Tardeo, Mumbai – 400034
Website: https://drharshsheth.com/
This article is intended for general awareness and educational purposes and does not constitute medical advice. Individuals who have undergone or are considering bariatric surgery should consult a qualified specialist for personalised nutritional evaluation and guidance.
