Guest Blog By: Dr. Lillian Craggs-Dino, DHA, RDN, LDN Trouble Digesting After Bariatric Surgery? Have you experienced issues with digestion, such as occasional bloating or constipation following metabolic and bariatric surgery (MBS)? While there can be a number of factors involved, it is important to understand that digestion cannot properly occur without adequate digestive enzymes.* MBS is an effective and life-changing surgery, but it comes with great patient responsibility. After surgery, patients endeavor on a life-long journey of mindfully eating proteins, drinking adequate fluids, taking bariatric vitamin supplements, exercising, and attending follow-up visits with their bariatric healthcare providers.* You must remain motivated, engaged, and responsible for your own personal outcomes to reach your ultimate health and body weight goals. In this blog, we discuss the role digestive enzymes play after MBS, and when they may be a recommended addition to the diet.* Bariatric Diet A bariatric diet is composed of complex carbohydrates, high protein, low-fat foods, fiber, and adequate hydration. High protein intake is encouraged. This includes animal proteins (fish, poultry, eggs, and dairy) and plant proteins (legumes, lentils, and whole grains).* While low-fat foods are recommended, all animal proteins will have varying amounts of fat. Interestingly, dairy products such as milk can contain all three of the macronutrients: lactose (carb), protein, and fat (unless you drink fat-free milk). The Role Of Digestive Enzymes* To understand the role of digestive enzymes, let’s review some brief anatomy and physiology. Then, we’ll relate this knowledge to the metabolic and bariatric diet. Digestive enzymes are necessary to break down food into smaller chemical components, so your body can absorb these nutrients for growth and repair.* Digestion begins in the mouth with amylase, a digestive enzyme found in saliva that starts breaking down carbohydrates, specifically starches.* As food enters the stomach, along with digestive juices, pepsin starts the digestion of proteins. There are different types of digestive enzymes. Most of the enzymes that complete the digestion of proteins, fats, and carbohydrates are pancreatic enzymes secreted in the intestines.* Digestive chemicals ending in “-ase” typically indicate a digestive enzyme. For example, protease digests proteins, lipase digests fats, and lactase digests lactose. Digestive Symptoms After Surgery A potential challenge following metabolic and bariatric surgery (MBS) is that patients may experience occasional abdominal pain, food intolerance, and bowel habit changes. These symptoms are not atypical, even if you’re following the bariatric dietary “rules” of eating slowly, taking small bites, avoiding the consumption of foods and beverages together, and incorporating a healthy diet. Due to the anatomical and physiological changes that occur after MBS, patients may experience insufficient secretion of digestive enzymes following surgery. (1)* For this reason, they may have difficulty with digestion or nutrient absorption. Your bariatric healthcare team may suggest bariatric digestive enzymes to support the proper breakdown of the three macronutrients: carbohydrates, proteins, and fats.* Food Stuck After MBS With a limited production of digestive enzymes, food can sometimes feel stuck. In some instances, this may truly be the case! A small percentage of patients can experience a “bezoar,” which is undigested food that gets stuck along the gastrointestinal tract. (2) This can commonly occur where the stomach and intestines connect, or at the connection between the small intestine and large intestine, like in gastric bypass surgery. Food that gets stuck can be a medical and health hazard. The best thing to do is practice prevention: eat slowly, choose soft and moist foods, chew thoroughly, avoid tough fibers, and take digestive enzymes with meals.* These bariatric-friendly eating behaviors support healthy food breakdown and proper nutrient absorption, while also minimizing the risk of bezoar formation.* Summary Metabolic and bariatric surgery (MBS) can be an effective tool to help you gain control of your weight and health. Following surgery, some patients experience occasional abdominal pain, food intolerance, and bowel habit changes. These side effects can be related to improper digestion or absorption of the foods you eat.* In addition to a bariatric-friendly diet, talk to your healthcare team about taking digestive enzyme supplements with your meals to support optimal digestion and nutrient absorption from the foods you eat.* Shop Bariatric Digestive Enzymes HERE References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707713/ https://academic.oup.com/milmed/article/185/7-8/e1294/5607603 This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your physician or another qualified health provider with any questions in regards to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs. *These statements have not been evaluated by the Food and Drug Administration (FDA). This product is not intended to diagnose, treat, cure, or prevent any disease.