Guest Blog by: Tamsin Jordan, MS, RD, CDN Bariatric surgery can be an incredibly powerful weight loss tool (learn how much weight loss you should expect with a gastric bypass), but it is by no means a magic bullet for improved health. Patients need to make significant lifestyle changes before, and after it to reap the surgery benefits. 1. Increase Your Protein Protein needs increase after surgery. This nutrient helps heal tissue and grow muscles. Common side effects of surgery include hair loss, low energy, skin conditions and muscle loss in the first few weeks post-surgery. Protein deficiency is often the underlying reason. Deficiency is more common with biliopancreatic diversion or Roux-en-Y gastric bypass, but all surgery patients are susceptible. So what can you do? It's not only the amount of protein that is important, but the quality. Choose lean, low fat sources of animal and plant protein. Red meat, poultry, eggs, milk and fish are good options. High protein plant-based sources include beans, lentils, soybeans and chickpeas. Make sure your food is cooked well and is a soft consistency. Fill half of your plate with protein foods. That equates to 2-3 tablespoons based on a standard meal of 6 tablespoons. For breakfast and snacks, choose calcium-rich sources such as milk (skim, unsweetened soy or almond) and low sugar yogurt to support bone health. For lunch and dinner, choose iron-rich protein sources, such as meat and green leafy vegetables. Avoid eating calcium rich foods, such as dairy at the same time as iron-rich foods as they impair absorption. Dietary sources are important, but patients should also supplement their intake with powdered and/or ready to drink protein shakes in the form of whey powder. Choose isolated, hydrolyzed, lactose-free, gluten-free and sucrose-free options to maximize absorption and tolerance. 2. Drink More Water In the first few weeks after surgery your body is healing and adjusting to its new stomach size. Drinking lots of water will support your body's recovery process. Sip plain, uncarbonated water throughout the day, separately from food to avoid feeling too full. I recommend at least 2 liters (64 ounces or 8 cups) per day. Plain water is the best option, but you can supplement by drinking other beverages too. Decaf tea and coffee, iced popsicles, electrolyte water and flavored water all count. Avoid carbonated beverages that cause bloating and gastrointestinal issues. Pro tip: Get a reusable plastic water bottle with a flip top - it will encourage you to sip throughout the day. 3. Change How You Eat Including some mindful eating techniques into your daily routine can help you adjust to a smaller stomach size. They also increase absorption of nutrients from your food and reduce the risk of developing a food intolerance. Mindful eating involves being more aware of what, and how you eat. Stop eating when you feel full. Remember it takes 20 minutes for your stomach to register fullness to your brain. No liquids 30 minutes before meals, during meals, and for 30 minutes after your meal. Space meals out by 1-2 hours Take small bites and chew, chew, chew! Eat slowly, meals should last 20-30 minutes Do not skip meals Eat protein first, then non-starchy vegetables, fruit, and then finally carbohydrates (choose whole grains) Bake or grill your food instead of frying There are some Bariatric Support Groups that can be very helpful for you after or before the surgery. 4. Take a Multivitamin (Every Day) Your body needs extra nourishment after surgery to heal and make up for your reduced food intake. Even before surgery, studies show that overweight and obese patients are more likely to suffer from micro-nutrient deficiencies [1]. Iron, calcium, vitamins A, D, B12 and B1 (thiamin) are the most important. Iron deficiency is common after surgery, usually manifesting as anemia. Deficiency is particularly high after Roux-en-Y gastric bypass or the biliopancreatic diversion. Deficiency can happen for many reasons such as lower stomach acid, intolerance to red meat or impaired absorption. Taking medication that reduces stomach acid can also make an existing deficiency worse. Menstruating and pregnant women, and adolescents are particularly susceptible. Supplementation with 45-60 mg a day, and 100 mg elemental iron for menstruating women is recommended [2]. Eating plenty of iron-rich foods such as red meat, leafy green vegetables and iron fortified cereals will help to keep your levels within a healthy range. Bariatric patients are often recommended to get bariatric multivitamin capsule with iron. To boost your calcium, increase your intake of dairy products and leafy green vegetables. Choose lactose free dairy or alternatives (soy or almond) if you can't tolerate dairy milk. When looking for a multivitamin, make sure it provides at least 800-1500 mg calcium daily. Ideally, this would be in the form of calcium citrate to improve absorption [3]. Eating a balanced diet packed with a variety of fruits and vegetables, oily fish, eggs and whole grain cereals will increase your intake of vitamins A, D, B12 and B1 (thiamin). 5. Get Moving! Changing your diet is just one component of successful weight loss. Research indicates that patients who exercised after surgery saw their Body Mass Index (BMI) drop 4.2% more than those who did not [4]. But what type of exercise should you be doing and how much? It is important to take things slow after surgery. For the first few weeks, regular walking will help to reactivate your muscles and get your heart rate up. Use a pedometer to keep track of your daily steps or log daily activity on an app such as MyFitnessPal. Housework, walking up stairs and even mowing the lawn also count! Ask your surgeon when you are ready to increase exercise intensity. Once you get the all clear, aim for 30-45 minutes of moderate physical activity 5 days per week, such as light jogging or swimming. Alternatively, 20 minutes of vigorous - intensity activity 3 days per week, including running, circuit training or spinning. Focus on three types of activity: strength/resistance training, cardio and flexibility. Strength training, such as weightlifting or squatting, increases lean muscle mass. This tissue type burns a lot of calories, which will keep your heart and blood vessels healthy. Flexibility workouts, such as yoga and pilates, reduce injuries and build core strength. To Sum Up... Lean, low fat protein should fill half of your plate at each meal Eat slowly, chew thoroughly and separate liquids from solids Take a daily bariatric multivitamin Check in with your surgeon regularly and wait for medical clearance before exercising Tammy Jordan is a Registered Dietitian and wellness expert. She provides individualized Medical Nutrition Therapy (MNT), nutrition counseling and meal-planning services to bariatric surgery patients in New Jersey. Tammy received her undergraduate degree in Natural Sciences at Durham University in the UK, and her Masters degree in Nutrition at Hunter College, New York. Follow her on instagram @nutritionbytamsin or www.tamsinjordan.com You might be interested in our products: Chicken Soup Protein Chocolate Peanut Butter Meal Replacement Shake Also check out the blog about protein shakes after bariatric surgery. **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. References [1] Jáuregui-Lobera, I. (2013). Iron deficiency and bariatric surgery. Nutrients, 5(5), 1595-1608. [2] Love, A. L., & Billett, H. H. (2008). Obesity, bariatric surgery, and iron deficiency: True, true, true and related. American Journal of Hematology, 83(5), 403-409. [3] Via, M. A., & Mechanick, J. I. (2017). Nutritional and micronutrient care of bariatric surgery patients: Current evidence update. Current Obesity Reports, 6(3), 286-296. [4] Livhits, M., Mercado, C., Yermilov, I., Parikh, J. A., Dutson, E., Mehran, A., . . . Gibbons, M. M. (2010). Exercise following bariatric surgery: Systematic review. Obesity Surgery, 20(5), 657-665.