Management of Nutrition Complications from Gastric Bypass

Gastric bypass surgery is an increasingly common procedure designed to limit food intake by decreasing the size of the stomach. While the procedure is typically successful in achieving weight loss, it introduces a number of problems due to the restricted intake of vitamins and other essential nutrients. Dietary programs have been created to help deal with these complications, but there is growing concern that effective nutrition management may be more difficult than previously realized.

Understanding Gastric Bypass

• In gastric bypass surgery, doctors staple the top portion of your stomach, leaving a small pouch to receive food. Part of the small intestine is then cut and attached directly to this new pouch. Instead of passing through the first section of the small intestine (the duodenum), food from the stomach enters directly into the second section, called the jejunum. Processing food in this manner decreases your body's ability to absorb calories and nutrients.

Dietary Management

• If you undergo gastric bypass surgery, your ability to process food will initially be drastically diminished. Patients typically eat no more than one cup's worth of food per meal in the aftermath of surgery, although this amount increases gradually as the stomach pouch expands over time. To make sure you receive an adequate food intake, you will be asked to eat more frequently throughout the day. You will also need to chew your food thoroughly, and avoid drinking liquids with meals. Certain foods may induce nausea, vomiting or pain, or even obstruct your stomach opening. While you will need to experiment to see which foods cause you problems, common culprits include bread, meat, milk, rice, raw vegetables, past and carbonated drinks. Additionally, your doctor may ask you to avoid fried or high-fat foods.

Nutritional Supplements

• Up to 40 percent of gastric bypass patients experience nutritional deficiencies. In order to compensate for dietary complications---as well as for the absorption deficiencies created by bypassing the duodenum---your doctor will recommend vitamin and mineral supplements. Typical supplementation includes vitamin D, vitamin B-12, iron and calcium. Multivitamin and multimineral products are also used. In order to ensure that no major deficiencies are developing, you will also need to see your doctor regularly for follow-up examination.

Potential Complications

• While these steps may be sufficient to avoid complications, be aware that managing nutritional effects may present serious difficulties. In 2007, two studies performed at Washington Hospital Center pointed to the likelihood of problems resulting from bacterial overgrowth in the small intestine. This overgrowth, caused by diminished acid production in the surgically altered stomach, can produce enough bacteria to effectively hijack nutrients meant for the body. Researchers found that calcium and zinc in particular are commonly underabsorbed. Potential side effects of unaddressed deficiency include osteoporosis, osteopenia (low bone mineral density) and osteomalacia (softening of the bones). Additional deficiencies (including low thiamine intake) may develop, leading to seizures, paralysis and other neurological disorders.

  In order to safeguard yourself, make sure you thoroughly understand the risks associated with bypass surgery. If you have already had surgery, consult your doctor for the best methods to manage your nutritional needs.