Normally, the pyloric valve at the lower end of the stomach regulates the release of food into the bowel. When the gastric bypass patient eats a sugary food, the sugar passes rapidly into the intestine, where it gives rise to a physiological reaction called dumping syndrome. The body will flood the intestines with gastric content in an attempt to dilute the sugars.
An affected person may feel their heart beating rapidly and forcefully, break into a cold sweat, get a feeling of butterflies in the stomach, and may have an anxiety attack. The person usually has to lie down and could be very uncomfortable for 30—45 minutes. Diarrhea may then follow. Nutritional deficiencies are common after gastric bypass surgery, and are often not recognized.
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They include: . After surgery, patients feel fullness after ingesting only a small volume of food, followed soon thereafter by a sense of satiety and loss of appetite.
Total food intake is markedly reduced. Due to the reduced size of the newly created stomach pouch, and reduced food intake, adequate nutrition demands that the patient follow the surgeon's instructions for food consumption, including the number of meals to be taken daily, adequate protein intake, and the use of vitamin and mineral supplements. Calcium supplements, iron supplements, protein supplements, multi-vitamins sometimes pre-natal vitamins are best , and vitamin B 12 cyanocobalamin supplements are all very important to the post-operative bypass patient. Total food intake and absorbance rate of food will rapidly decline after gastric bypass surgery, and the number of acid-producing cells lining the stomach increases.
Doctors often prescribe acid-lowering medications to counteract the high acidity levels. Many patients then experience a condition known as achlorhydria , where there is not enough acid in the stomach. As a result of the low acidity levels, patients can develop an overgrowth of bacteria. A study conducted on 43 post-operative patients revealed that almost all of the patients tested positive for a hydrogen breath test , which indicated an overgrowth of bacteria in the small intestine.
Recurring nausea and vomiting eventually change the absorbance rate of food, contributing to the vitamin and nutrition deficiencies common in post-operative gastric bypass patients. Proteins are essential food substances, contained in foods such as vegetables, fruits, legumes, nuts, meat, fish, poultry, dairy products and eggs.
With reduced ability to eat a large volume of food, gastric bypass patients must focus on eating their protein requirements first, and with each meal. In some cases, surgeons may recommend use of a liquid protein supplement.
Powdered protein supplements added to smoothies or any food can be an important part of the post-op diet. The profound weight loss which occurs after bariatric surgery is due to taking in much less energy calories than the body needs to use every day. Fat tissue must be burned to offset the deficit, and weight loss results. Eventually, as the body becomes smaller, its energy requirements are decreased, while the patient simultaneously finds it possible to eat somewhat more food. When the energy consumed is equal to the calories eaten, weight loss will stop.
The risk of excessive weight loss is slightly greater with distal GBP. Vitamins are normally contained in foods and supplements. The amount of food eaten after GBP is severely reduced, and vitamin content is correspondingly lowered.
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Supplements should therefore be taken to complete minimum daily requirements of all vitamins and minerals. Pre-natal vitamins are sometimes suggested by doctors, as they contain more of certain vitamins than most multi-vitamins. Absorption of most vitamins is not seriously affected after proximal GBP, although vitamin B 12 may not be well-absorbed in some persons: sublingual preparations of B 12 provide adequate absorption. Some studies suggest that GBP patients who took probiotics after surgery are able to absorb and retain higher amounts of B 12 than patients who did not take probiotics after surgery.
Water-dispersed forms of these vitamins may be indicated on specific physician recommendation. For some patients, sublingual B 12 is not enough, and patients may require B 12 injections. All versions of the GBP bypass the duodenum, which is the primary site of absorption of both iron and calcium.
Iron replacement is essential in menstruating females, and supplementation of iron and calcium is preferable in all patients. Ferrous sulfate is poorly tolerated. Alternative forms of iron fumarate, gluconate , chelates are less irritating and probably better absorbed. Chewable calcium supplements that include vitamin K are sometimes recommended by doctors as a good way to get calcium.
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Post-operative gastric bypass patients develop a lowered tolerance for alcoholic beverages because their altered digestive tract absorbs alcohol at a faster rate than people who have not undergone the surgery. It also takes a post-operative patient longer to reach sober levels after consuming alcohol.
In a study conducted on 36 post-operative patients and a control group of 36 subjects who had not undergone surgery , each subject drank a 5 oz. The gastric bypass group had an average peak alcohol breath level at 0.
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It took on average minutes for the gastric bypass patients group to return to an alcohol breath of zero, while it took the control group an average of 72 minutes. There have been reported cases in which pica recurs after gastric bypass in patients with a pre-operative history of the disorder, which are possibly due to iron deficiency. Pica is a compulsive tendency to eat substances other than normal food. Some examples would be people eating paper, clay, plaster, ashes, or ice. Low levels of iron and hemoglobin are common in patients who have undergone gastric bypass.
The patient's blood test revealed iron levels of 2. This deficiency in the patient's iron levels may have led to the increase Pica activity. The patient was then given iron supplements that brought her hemoglobin and iron blood levels to normal levels. After one month, the patient's eating diminished to two to three glasses of ice per day.
After one year of taking iron supplements the patient's iron and hemoglobin levels remained in a normal range and the patient reported that she did not have any further cravings for ice. The medically more significant effects include a dramatic reduction in comorbid conditions:. Concurrently, most patients are able to enjoy greater participation in family and social activities.
The patient's out of pocket cost for Roux-en-Y gastric bypass surgery varies widely depending on method of payment, region, surgical practice and hospital in which the procedure is performed.
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Out of pocket costs for a patient with private or public insurance that specifically list bariatric surgery as a covered benefit include several insurance-policy-specific parameters such as deductible levels, coinsurance percentages, copay amounts and out of pocket limits. Patients without insurance must pay for surgery directly or through a third party lender , and total out of pocket costs will depend on the surgical practice they choose and the hospital in which the surgical practice performs the procedure.
Gastric bypass surgery has an emotional and physiological impact on the individual. Many who have undergone the surgery suffer from depression in the following months as a result of a change in the role food plays in their emotional well-being. Energy levels in the period following the surgery can be low, both due to the restriction of food intake and negative changes in emotional state.
Muscular weakness in the months following surgery is also common. This is caused by a number of factors, including a restriction on protein intake, a resulting loss in muscle mass and decline in energy levels. Muscle weakness may result in balance problems, difficulty climbing stairs or lifting heavy objects, and increased fatigue following simple physical tasks. Many of these issues pass over time as food intake gradually increases. However, the first months following the surgery can be very difficult, an issue not often mentioned by physicians suggesting the surgery.
Even if physical activity is increased, patients may still harbor long term psychological effects due to excess skin and fat. These extra surgeries have their own inherent risks but are even more dangerous when coupled with the typical nutritional deficiences that accompany convalescing gastric bypass patients. From Wikipedia, the free encyclopedia. This article includes a list of references , but its sources remain unclear because it has insufficient inline citations.
Please help to improve this article by introducing more precise citations. July Learn how and when to remove this template message. Graphic of a gastric bypass using a Roux-en-Y anastomosis.
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The transverse colon is not shown so that the Roux-en-Y can be clearly seen. Before it didn't really matter because I figured 99 percent of the time you wouldn't like me anyway because I was a big person. Maggie: You go into the surgery thinking that once you lose the weight things will get better.