True or False? Bariatric Nutrition Myths

In November 2018, the American Society of Metabolic and Bariatric Surgery held its annual meeting at Obesity Week in Nashville. There were so many great presentations, and I want to share what I learned.   As a bariatric surgeon, I get these questions A LOT. It was a great opportunity to hear what the research and consensus is among my colleagues across the nation.

Myth 1:  Caffeine in a No-No after surgery, and it can increase dehydration.

The question of caffeine comes up quite frequently in my practice. There is actually not much research that supports the avoidance of caffeine after surgery. And, very little that supports the myth that it causes dehydration. While there are some diuretic properties to caffeine, most patients who ingest caffeine has developed a tolerance and a homeostasis with it. This means that if you have drinking a cup or two of coffee a day for years, then you have built up a tolerance and don’t have diuretic effects from the caffeine.

On the other hand, caffeine has been shown to be a colonic stimulator. For a lot of patients, their morning coffee or tea helps to keep them regular. For these patients, continuing caffeine AFTER surgery can potentially help with issues of constipation.

On the other hand, caffeine is a gastric stimulator and has been shown to exacerbate reflux/heartburn and acid secretion. This can aggravate an existing ulcer.

FINAL WORD: MYTH BUSTED!! Caffeine use does NOT support the dehydration myth. However, there may be some benefit to limiting caffeine while the stomach is healing. In my practice, I stop caffeine for the first two weeks after surgery. Once soft foods are started on week three, patients can resume caffeine. While this myth debunks the idea of dehydration, it does support my concerns for healing tissues and why patients should abstain in the early post-operative period.

Myth 2:   Carbonation should be avoided because it stretches the pouch.

I get the concern of a stretched pouch on an almost daily basis during clinic. There is limited research to support the clinical practice of avoiding carbonation. There is NO evidence that it stretches the pouch permanently. There is some anecdotal evidence that it can cause reflux, bloating, belching, and abdominal discomfort.

When counseling patients, I explain that carbonation can give them feelings of fullness quite quickly (because of their smaller stomach). For that reason, carbonation should be limited, because there is a greater risk of discomfort. Additionally, many carbonated beverages are high in sugar or calories. What I have found is that patients don’t stretch their pouches, but they certainly learn to “eat through” their pouches. If you sip on a high calorie drink all day, the size of your pouch doesn’t matter, you WILL GET ALL THE CALORIES IN! It doesn’t matter if it takes 4-5 hours to drink a 40-50 oz drink. If it’s loaded with calories, you will drink them all in. Patients often do not take into account the high calorie liquids that they are drinking. It’s not usually a milk shake, either. It is high calorie coffee drinks, sweet tea, fruit juices, alcohol, and even high calorie protein shakes (after they have added berries, yogurt, milk, etc).

FINAL WORD: MYTH BUSTED!!   Carbonation is okay in limited quantities, and patients should certainly avoid high calorie carbonated beverages.

Myth 3: Use of straws and chewing gum should be avoided

There is no evidence that gum can cause an obstruction or that straws should be avoided because of air inhalation. In fact, some patients report that using a straw can help them in the early post-operative period. In my practice, I don’t have an issue with patients using a straw. On the other hand, I do prohibit gum the same way that I limit certain dense foods during the six week post-operative diet. While the literature did not report obstruction from gum, I have personally had to endoscopically remove meats, bread, and pills from patients’ pouches. These patients are at a much higher risk for ulcer from the food that is lodged in the stomach and developing a subsequent stricture (or narrowing).

FINAL WORD: MIXED RESULTS: Straws are okay and may help patients take in their fluids. While there hasn’t been a study looking at obstruction from gum, I recommend that patients ABSTAIN from gum chewing. (The same way that I recommend no dense meats or breads during the post-operative period)

Myth 4: Patients always lose their hair

During my initial consult with patients, the question about hair loss always arises at some point. Research shows that hair thinning can occur within the first couple of months secondary to the sharp change in diet and calories. However, this is not typically a permanent issue. Hair loss can be related to deficiencies in iron, protein, and zinc. Bariatric patients must supplement their diet with extra protein. I recommend that bypass and sleeve patients take in 60-80 gms daily in protein supplement, and duodenal switch patients take in 100-120 gms daily. In my practice, patients complaining of hair thinning are typically non-compliant with their protein and/or iron supplementation. Often, they will take biotin but not their bariatric vitamins!   Biotin can make hair strong, but it won’t stimulate new hair growth. Hair growth will begin again once they begin to take their daily supplements. Patients experiencing hair loss/thinning should have their vitamin and protein levels checked to address any deficiencies.

FINAL WORD: TRUE…SOMEWHAT! Hair loss is not uncommon in the first couple of months. However, if hair loss continues, then patients need to have their vitamin levels checked to address deficiencies.


Bariatric Support Group

Dr. Hodges highly recommends patients attend monthly support group meetings. The meetings are led by Dr. Collins Hodges, both a licensed clinical psychologist and someone who has had bariatric surgery himself. The support groups are offered on the first Monday of every month from 6:30pm – 7:15pm CST via an online GoToMeeting. The meetings are open to the public, and there is no charge to attend.

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