Dr. Quebbemann's Tips
- It is unsafe to get pregnant during the period of rapid weight loss after bariatric surgery.
- Women may have a significant increase in fertility after bariatric surgery. This can mean that women who have previously suffered from infertility will suddenly become fertile. It is important to use birth control measures to avoid pregnancy until you have lost weight and your weight has stabilized after surgery.
- Pregnancy when you’re at a healthier weight will be safer for both the mother and for the unborn baby. However, women should be seen by a doctor who understands bariatric surgery, and have your nutritional status checked if you are pregnant or plan to become pregnant. Nutritional supplementation is strongly advised, but always consult your doctor.
- Drinking alcohol is more dangerous after Gastric Bypass and Gastric Sleeve, so be careful.
- The normal stomach breaks down alcohol. After Gastric Bypass or Gastric Sleeve your stomach will not break down alcohol effectively and this will result in increased absorption of alcohol.
- Your blood alcohol level will increase faster, and remain high for longer, after bariatric surgery. This can be dangerous, causing increased brain damage and liver damage, and could also lead to the development of alcoholism.
- Alcohol also contains a lot of calories, similar to drinking a sugary soft drink.
- I recommend that patients drink minimal alcohol after bariatric surgery.
Drink one glass of water, or calorie-free beverage, 15-30 minutes prior to all meals.
- This does not necessarily include snacks.
- There is no reason to avoid drinking for one hour before or after meals.
- The main purpose of drinking 15-30 minutes prior to a meal is to make sure that thick saliva (you are swallowing saliva all day long without thinking about it) is not sitting in your stomach before eating. I find that when patients do this, they stop experiencing episodes where foods they are usually able to eat get occasionally “stuck” when they swallow.
- “Getting stuck” can occur when thick saliva acts like gunk in a drain pipe and your first or second bite of food gets stuck trying to go through. You are NOT supposed to feel like you’re choking when you eat slowly and chew foods well.
- A secondary benefit of this is that you won’t be thirsty when you eat your meal, which means it’s much easier to not drink during the meal.
- Lastly, this will give you three glasses of water, one with each meal, to help keep you hydrated during the day.
Minimize drinking during meals.
- It is possible that drinking, or frequent sipping, during meals will result in increased food consumption. However, a recent study done on drinking during meals after bariatric surgery showed no effect on food intake.
- If you watch the speed-eating competitions, the competitors use drinking as a way of washing food through their stomach faster so that they can pack more food in over a short period of time. I tell my patients that mimicking the speed-eating techniques of the world speed-eating champions is probably not a good plan when trying to control your weight.
- I recommend minimizing drinking during a meal.
One protein supplement daily (protein drink, bar, etc.) has been shown in scientific studies to enhance weight loss after bariatric surgery. Also, for people who tend to skip meals, having a high protein nutritional supplement available may improve long-term weight control.
- Many surgeons require patients to quit smoking before bariatric surgery. I do not require this. However, I warn all patients that smoking increases their surgical risks and causes serious health problems long term.
- If you are going to quit smoking prior to surgery, it is safest to do so at least three months before your surgery date. Quitting smoking immediately before surgery could increase your surgical risks (according to published studies).
- I consider obesity and smoking to be two separate health concerns. I have found that people who have trouble quitting smoking before surgery often have an easier time quitting after surgery as their health improves, their mood improves, and they are not so worried about gaining weight from quitting tobacco.
For people with diabetes
- If you experience a situation when you think your blood sugar is starting to drop too low, try eating a spoonful of peanut butter, or something equivalent, rather than immediately eating sugar or some candy.
- Eating sugar will rapidly increase your blood sugar, but doing this will also result in larger swings (variations) in your blood sugar and your body’s insulin production, which is counterproductive for people with diabetes.
- Peanut butter, or something with a smaller amount of sugar, some complex carbohydrates, and some fat and protein, will generally increase your blood sugar quickly enough to avoid hypoglycemia without causing excessive swings in your blood sugar.
Drinking with a straw is OK.
- The “rule” that you should avoid using straws is tossed around by patients, online patient forums, and many program “experts” in an attempt to sound like they’re giving important advice. The FACT is that there is absolutely no science (zero) behind the rule to avoid straws.
- The justification for this advice varies from “You’ll swallow too much air and that will cause pain” to “It will decrease your ability to eat protein” to “It will stretch out your pouch.” None of these are true.
- If you can drink comfortably using a straw, you may do so. If you can’t, then don’t use a straw.
Chewing gum is OK.
- Avoiding gum chewing is yet another “rule” that is repeated all over the internet for various reasons, and has also made its way into many bariatric programs’ “book of rules.” Justification for this usually revolves around claiming that gum chewing will cause excess air swallowing. Other reasons to avoid chewing gum have included “it will exacerbate your Irritable Bowel Syndrome” (there is no proof of this) and “it will increase your desire to eat junk food” (probably the opposite is true).
- In fact, chewing gum has been shown to decrease the desire to eat. A study published by E. Park, et al, in Physiology and Behavior, 2016, reported “GUM compared to Control resulted in significant suppression of hunger, desire to eat and prospective consumption (p<0.05).” where GUM refers to Gum Chewing.
- Chewing gum has also been shown in research studies to reduce anxiety. One publication is by Dr. Akiyo Sasaki-Otomaru, from Tokyo Medical and Dental University in the journal Clinical Practice and Epidemiology in Mental Health 7(1):133-9 August 2011. The findings in this study showed that chewing gum on a regular basis may decrease anxiety, improve mood and decrease fatigue.
- The bottom line:
- Chewing gum for some people could result in swallowing an uncomfortable amount of air, causing intestinal gas bloat, and these people may want to avoid gum chewing.
- Chewing gum can be a useful tool to minimize hunger for some people.
- Chewing gum excessively may have some negative consequences.
- The decision to chew gum, or not, should be made by each individual based on how he feels when he does it.
Carbonated beverages are OK, in moderation.
- Yes, really, this is true.
- Carbonated beverages have been shown to increase the hunger hormone ghrelin in people with normal stomachs, but this has not been studied in people after bariatric surgery.
- Drinking carbonated beverages has not been shown to cause problems with bone mineral density.
- Carbonated beverages DO NOT stretch out the gastric pouch after Gastric Bypass or the small stomach after Vertical Sleeve Gastrectomy.
- However, the effects of a significantly increased intake of gas in your stomach or intestine may result in increased hunger.
- The bottom line:
- Drinking small amounts of carbonated beverages will not cause most people problems after bariatric surgery.
- Drinking a lot of carbonation might possibly increase your appetite.
- Drinking a lot of carbonation may cause uncomfortable gas bloat and result in more belching (burping) and the need to pass more gas (fart).
- Due to the increased burping and farting, I tell my patients, “Please don’t drink a couple of Diet Cokes on your way to a party at my house.”
Picture yourself at your goal weight, your Best Weight, and imagine that you are that person. Imagine what that person eats on a daily basis in order to maintain his or her goal weight, what exercises does that person do in order to maintain his fitness, how does that person live on a daily basis? Use this image of yourself as the goal. It is a helpful way to get in touch with what you are truly trying to achieve.
Remember, this book is about using bariatric surgery to achieve weight loss and long-term weight control. It’s not a book specifically about living longer or eating in a way to control disease processes such as high cholesterol. You will achieve numerous health benefits from achieving a healthier weight, and controlling your weight long term. However, once you’ve achieved a healthier, happier weight, you can always take it to the next level by modifying your diet in order to achieve additional health benefits. My advice is to take it one step at a time; control your weight and get fit, and once you have mastered this, think about other ways to improve your health.