How to Manage Your Diet After Gastric Bypass Surgery

Gastric Bypass Surgery

Carol after surgery

Carol after surgery

Food writer Carol Bowen Ball has over 35 years experience in the food arena, and since her own weight loss surgery in 2009 she has turned her hand to bariatric cookery. Here she discusses her journey and gives her tips for managing your diet after surgery.

A Life of Diets

“One glimpse at my before and after photos shows something of my staggering weight-loss. However what they don’t tell you is how I did it. For over the years, I had yo-yoed my way through countless diets, some sensible, some crazy, and lost the same pounds over and over again. I became something of a diet ‘expert’ by nature of the fact that I had tried them all! But here’s the spoiler – they all ultimately failed because, for every pound I lost, I then gained back again and sometimes with some additional ones for company. So why did this one last? The answer lies in the procedure and tool that I used.

“Many will know this simply as weight-loss surgery and relate to it via celebrity stories of weight-loss with gastric bands. Mine was a little more complex and radical because it was gastric bypass surgery and involved re-routing of my gastric tract and reducing my stomach to one the size of an egg, and is irreversible. I was therefore able to lose weight by two proven methods; restriction with a reduced sized-stomach (which means I can’t eat as much); and reduced food absorption (my digestive system has been shortened so that whatever I eat isn’t fully absorbed). In a nutshell this means I have been able to lose about 100 lbs in weight, and more importantly for me, sustain it for almost 6 years. There are other surgeries such as lap band, gastric sleeve, gastric balloon, and even more invasive such as duodenal switch, available for patients and surgeons to consider in consultation together that work in similar ways.”

Why surgery?

“I opted for surgery back in November 2009 after thoroughly researching the procedure and had the operation privately (or self-funded) because I didn’t meet the NHS criteria in my region (and which has subsequently become even more difficult to obtain). I enjoyed reasonably good health prior to surgery and only suffered the usual problems associated with obesity such as aching joints. On reflection they didn’t seem too bad but I now know how limiting these problems were. I didn’t have diabetes, sleep apnoea or any other related co-morbidities which are now taken into account for funding, but my BMI was over 40 and therefore classified as morbidly obese.

Carol before surgery

Carol before surgery

“Quite simply I had run out of options and needed some help to regain control – surgery gave me that possibility. My surgeon promised me the opportunity of re-setting my body and would provide the tool to do this. But it is just a tool, I was under no illusion this would be a magical fix, and that I would need to make some very big changes to my eating habits and lifestyle for it to work. These would also need to be implemented for life – weight-loss surgery is not a bus you jump on to get off several stops later, this was a journey for life. As such I see myself always as a work in progress and someone recovering from obesity rather than a cured patient.

“It was a pretty big deal for me to consider such surgery – hardly surprising when you consider I was a food writer and so not only made my career out of food (and a livelihood from it) but also used food as a way of expressing myself and love to friends and family. I had to be sure that if food was to take on a different role in my life that I was totally committed to that change and what the repercussions might be. Food had been a friend, a comfort, and no doubt a way of life for me.  I had, over the years, written some 100 cookery books, been a food stylist, thrown lavish parties, extolled the virtues of not being a skinny cook, and now I was jettisoning this for a life I hoped would be so much better, so I had to be sure.”

Researching the Diet Change

“I can’t express enough the need to research this option, which I did. I asked about what I could be able to eat after surgery; what it would comprise of; what wouldn’t I be able to eat; what the risks were; what changes in diet and exercise I would need to employ; and what were the success rates. I did this at one-to-one sessions with my surgeon and his team; at seminars for would-be patients; on forums for those who had undergone surgery; and with a friend who had recently had a procedure (my bariatric buddy). I think being realistic and honest with these considerations and always being aware of them has been part and parcel of my success. Yes, I was fortunate that I didn’t have any post-surgery complications, but I also have steadfastly stuck to the rules and often look back at the basics as much as possible to ensure I stay on track and focussed. It isn’t always easy.”

Post Surgery Diet Rules

“The rules are seemingly simple – stick to a high-protein, low-fat and low-sugar regime after going through the 3 stages of eating after surgery. These are akin to weaning a baby – you start with fluids and then go on to soft and puréed foods (whilst the gut is repairing and settling down) then adding texture little by little until you’re pretty much eating food of the same consistency you had prior to surgery. During this time you also have to follow rules of no drinking with meals; chewing very, very thoroughly; and checking on portion size as well as meal time duration, as well as avoiding problematic foods such as stringy vegetables, tough meat, stodgy bread and others. Following these rules means that you reduce the risks of poor nutrition; over-eating of poor food choices which can lead to weight regain; and hopefully get better control over enjoying your food!

“It can be a steep learning curve to recognise the ideal food choices; foods to avoid; how to cook for maximum nutrition; what you can eat out or when socialising; and how to pack in all that you require to keep your body fit and well. This is one of the reasons why patients are also required to follow a strict daily vitamin and supplement regime every day for life. In my case this means taking 2 high-quality multi-vitamins, 2 calcium supplements, an easy-iron capsule and a spray for additional vitamin D and B12. A patient’s bariatric team along with their GP will advise on this since it is personal and ideally will involve regular blood tests and monitoring.

“If this sounds a little grim then let me assure you it isn’t! I have rarely eaten better in my life than I do now. I still eat well, with enthusiasm, have some treats, and socialise by eating out on a regular basis. I don’t believe that any of my friends even notice anymore what I eat (or what I don’t) they’re usually too busy looking at what is on their own plates! The only giveaway might be that I order 2 starters rather than starter and main meal and will forego dessert for cheese or share a dessert with someone else – nothing earth-shattering and what lots of other people do anyway. I also make good use of doggy-bags when portion sizes are super-sized for my appetite and tolerance.”

Bariatric Cookery books

“One unexpected benefit has been that my working life has taken a surprising twist and upturn as a result of my surgery. For, recognising the need for advice and recipes that are bariatric-friendly, I developed my own Bariatric Cookery Books (called ‘Return to Slender’ and Return 2 Slender … Second Helpings’) and a website that is devoted to giving advice to all would-be and post-op patients about their food choices and options. It has grown over the last 5 years and now helps some 7,500 people throughout the world on this subject. With more and more patients, many long-term, I also address problems relating to weight regain, excess skin removal and body sculpting after surgery. If there is a downside then it can be excess skin left over as the flesh shrinks.

“Alongside the website I also get involved with working groups advising Public Health England and other bodies, several obesity related charities such as HOOP, WLSINFO.ORG and BOSPA, visit support groups at hospitals (both private and NHS) and try to be part of the voice and face alerting the media and authorities about the realities of weight-loss surgery. My Facebook and Twitter feeds are often busy with obesity being very much in the news.

“I also work hard to develop and produce some products that will assist the WLS patient that might not attract the commercially-driven suppliers of general slimming aids. So I have a Bariatric Portion Plate which helps not only with the ideal portion size for a bariatric patient but also what the proportions of nutrients they should have. Likewise for those who take in a packed lunch or eat a meal on the move I have a Bariatric Bento Box. Mixed and matched with other products specially chosen for bariatrics the website is a one-stop-shop to cater for the pre-surgery and post-surgery patient who wants to prepare well for, or live life well after, this life-changing procedure.

“My life as a food writer undoubtedly helped with all of this – I have a background in food journalism (working on magazines such as Good Housekeeping and Homes & Gardens); and also a degree that has its roots in food preparation, marketing and nutrition. My career has also included stints on radio stations, TV programmes and public speaking events so I have been lucky to be able to nurture and feed my curious mind about food, nutrition and its impact on society and well-being. This helps my information and food ideas to be current and relevant for today.”

Life After the Operation

“I’m often asked if there is anything I miss? Anything I would have done differently? What’s the trickiest part of being a WLS patient? The truth is I don’t miss much – I tend to focus more on what I can eat rather than what I can’t. My tastes have changed so I don’t hanker after a huge bag of crisps, mammoth bar of chocolate or big plate of greasy chips (and truthfully I could have, and do occasionally enjoy, a few crisps, a square of chocolate and a handful of chips) but the key is in moderation. I am thankful that I can now do what ‘normal’ people do which is to enjoy these foods as the ‘treats’ they were intended to be. What I don’t do is diet anymore – I have a diet but I am not on one and that is such a relief. Sounds silly but I get such great and more joy from being able to cross my legs easily, cut my own toe-nails comfortably, and run for the bus instead!

“As for anything I would have done differently now that is a different matter. I am not proud to have had to go down the surgery route (although I don’t apologise for it – ever). I wish I had been able to control my weight without the need for surgery but I couldn’t and so accepted responsibility for it and made a critical decision. It was my problem, my choice and my solution (even if still on-going). This is one of the reasons why I try to get involved with research and developing strategies for helping those who are in the earlier stages of obesity so they might not have to go ‘under the knife’.

“As for the trickiest part of being a WLS patient – on a practical level this has to be learning not to drink with meals so that foods don’t quickly flush through my system (don’t drink for 20 minutes before and 20 minutes after a meal is the mantra on this) and forget the fizz (carbonated drinks are on the NO list). I am also sugar-sensitive so have to check food labels like a zealot, otherwise I suffer from what is called ‘dumping syndrome’ which sounds awful and feels worse.”

Negative Stereotypes

“On a different level is overcoming the stigma and prejudice of obesity and the surgery to address it. Fat people are still open to ridicule, bad-mouthing and negative publicity – I won’t ever forget how this felt and if I can encourage greater empathy and understanding and that obesity doesn’t have a simple solution, then I will feel in some way that I have made a bit of a difference. There is no one solution that fits all and WLS is just one of them.

“My weight problem really hit home about 4 months before surgery when I took a tumble and broke my wrist in 3 places. My weight wasn’t the reason for the fall but I’m certain I wouldn’t have fallen so heavily if I weighed less. It was a turning point, pretty much like some people just see a photograph or a reflection of themselves in a mirror or shop window which acts as their ‘wake-up call’. This was my trigger and during my convalescence I researched surgery with the new-found time on my hands.

“It was the penultimate time I went into a hospital – the next was for my elected bypass. I haven’t needed to go again since, nor have my previously high level of visits to see my GP returned. I feel fit, well, healthy and happier with my lot in life. But I do remember that accidents happen when you least expect them and that I now have a duty to ensure if I have to attend A & E they know how to deal with me. I’m not allowed certain things as a bypass patient and the only way I can ensure this is to wear a medical bracelet or necklace. In my case this says the date and type of surgery I had; No Blind NG Tubes, No NSAIDS and I have added No Sugars too to the information on my band. Others I know also say fluid capacity 60cc or less. Hopefully this will mean no time is lost or wasted when dealing effectively with me. I lost too much time to poor health and well-being in the years leading up to my surgery to want to lose anymore.”

Carol shared one of her favourite recipes with us that she has tweaked to fit a bariatric diet.

Bariatric egg custard

Bariatric egg custard

VANILLA EGG CUSTARDS

I first made these custards about 1 week after surgery and they have featured on our weekly menu ever since. They are very gently set egg custards so I found they could be eaten in the full FLUIDS stage post-op. Later on I added a fruit base of chopped cherries, apricots and pears for variety.

INGREDIENTS:

4 large eggs

410 g can light evaporated milk

5 tbsp granulated low-calorie artificial sweetener

2 tsp vanilla extract

150 ml skimmed milk

Ground nutmeg to sprinkle (optional)

METHOD:

  1. Preheat the oven to 170 C/gas mark 3.
  2. Beat the eggs with the evaporated milk, sweetener, vanilla extract and skimmed milk. Sieve and pour into about 7 ramekin or heatproof cups.
  3. Put inside a heatproof baking dish and add hand-hot water to come halfway up the sides of the ramekins or cups. Sprinkle the tops with a little ground nutmeg if liked.
  4. Bake in the oven for 20-25 minutes until just set but still a bit wobbly.
  5. Remove from the baking dish and allow to cool. Refrigerate to chill before serving.

PER PORTION:

Calories:  135

Protein:  9.3 g

Carbohydrate:  9.8 g

Fat:  6.4 g

MAKES 7

WLS PORTION: ½-1

V suitable for Vegetarians