Feb 2021
Jacqui Lewis - BHSc Nutritional and Dietetic Medicine

Digestive Health After Weight Loss Surgery

Woman holding her chest due to pain

Before your weight loss surgery, you may encounter varying digestive issues related to the health of your digestive system. Overall the foods and drinks you choose, your stress levels, the mechanical function of your system and the types of bacteria that are housed in your gut, will have an impact on the symptoms you may experience. 

Symptoms of Digestive Issues

Overall, digestive symptoms include:

- Burping and Belching
- Bloating
- Early Satiety (feeling full even though you have not eaten much)
- Insatiable hunger
- Gas
- Constipation
- Diarrhea
- Vomiting
- Burning sensation after food

These signs can be linked to the foods you eat, your current BMI, the efficiency of your supporting organs to maintain balance in the digestive system and the blood.  

Some of these indicators can also be a sign something is not functioning well - perhaps a hernia is in the way, there's not enough of the digestive enzymes you need to effectively digest and USE the nutrients in your food for keeping your body healthy and vital. 

Making sure you have the right understanding
of the cause is a key. 

Initially the first step when you are experiencing digestive upset after Weight Loss Surgery, is to rule out a complication such as hernia, leak, stricture, scar tissue and the like.

Once these have been eliminated, you can look to what you choose to put into your body as a way to support optimal health of your digestive system - which is proven to be a key to good health, happy mood, and prevention of various cancers.

One of the most common issues Weight Loss Surgery Patients encounter is REFLUX leading to GERD (Gastro Oesophageal Reflux Disease)

The situation where the contents of the stomach are allowed to pass back up in to the esophagus, creating a burning, and uncomfortable issue that is either treated with antacid, weight loss, improved diet, removal of problematic foods and at its worst, surgical intervention.

Reflux is an unpleasant and intrusive symptom which can prevail as the BMI increases.

People with a BMI above 30 are 2.5 times more likely to suffer from Reflux or GERD. This is likely linked to the “intra abdominal pressure” of those carrying more fat tissue in the abdominal cavity (think beer gut) where the fat is actually surrounding the organs more than just beneath the skin.

The good news is, in many cases, those suffering with reflux before their Weight Loss Surgery, will find it is a solution to the problem. Generally it has been found that Bypass is almost a total success, whereas some patients who have reflux before sleeve surgery, may continue to have the same issue after.

If you are experiencing symptoms after surgery, talk to your surgeon sooner rather than later, as it may be just a tweak to your food intake that is needed, (coffee, alcohol and sugar are key players in GERD) or it might be something else that needs to be addressed to make sure you are not uncomfortable over the longer term. 

What can be done: 

Diet: Assess whether you experience reflux after certain foods and eliminate them for a period of time if you feel they are contributing. It is known that Alcohol, Processed foods such as refined flour, pastry, and gluten can contribute to reflux. So do sugar and coffee - so it will take a committed approach to reducing the intake of these foods to alleviate your condition.

Increase the whole foods: Fruit and vegetables, healthy fibres from oats, bananas, onions and asparagus will all contribute to the support of building healthy gut bacteria that will definitely help your situation if not eliminate it.

Medication - PPI or Proton Pump Inhibitor Medications such as Somac and Nexium are an effective short term solution for those who experience reflux from time to time, but ideally these meds are not for use for more than 6 weeks at a time.

Over time, these meds block iron and calcium absorption - which in bariatric patients is not ideal considering these nutrients are problematic to begin with after surgery.

Calcium and Iron rely on a healthy level of acid in the stomach to be present for optimal absorption - so suppressing acid is good for relieving reflux - but can't be problematic for your overall nutrition health

Surgery: GERD after Bariatric surgery may indicate a hiatus hernia, a twisted sleeve which may need surgical repair. Some patients who have the sleeve and still experience reflux will explore conversion to Bypass with the chance of having it resolved by the second surgery.

This is a big call - and all the contributing factors such as diet, microbiome and weight should be explored thoroughly first.

Endoscopic GERD Treatment – Stretta, a non-surgical outpatient treatment for GERD, fortifies the sphincter between the esophagus and the stomach to improve the barrier and prevent reflux. A doctor lowers the Stretta device through the mouth and down the esophagus where it applies low-heat radiofrequency energy to strengthen and thicken the muscles – thus improving GERD symptoms.

Because GERD is more serious than occasional heartburn, treating it effectively requires professional attention. If you have GERD before or after bariatric surgery, talk to your surgeon! With the right bariatric surgery or additional treatment, you can find relief from the discomfort of GERD and prevent damage to your esophagus. 

Jacqui Lewis
BHSc Nutritional and Dietetic Medicine

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