Understanding and Minimizing Potential Side Effects of Bariatric Surgery
Bariatric surgery can provide you with the necessary tools to finally lose excess pounds and keep them off, but many patients are concerned about the potential side effects.
Surgeons coordinating with the Tijuana Bariatrics℠ network can perform safe, successful procedures while minimizing the chance of bariatric surgery side effects.*
Learning more about possible complications can help you prepare...
Common Side Effects
Patients may experience some short-term side effects following their procedure. Fortunately, these conditions should improve over the first two to three weeks:
- Body aches – Most patients can manage aches with over-the-counter medications. However, non-steroidal anti-inflammatory drugs, such as ibuprofen, should be avoided.
- Constipation – Although constipation affects many bariatric patients, the condition can be improved or altogether avoided by following certain guidelines. Be sure to drink plenty of fluids, stay active once you have been cleared for physical activity, and eat plenty of fiber.
- Diarrhea and gas – Patients should be aware of which foods trigger bowel irritation. Identifying and avoiding foods that cause discomfort can help keep the digestive tract healthy.
- Nausea or vomiting – Part of a patient’s post-operative recovery will include paying attention to which foods cause an upset stomach. Patients are encouraged to take small bites and thoroughly chew food before swallowing.
- Weakness or fatigue – These side effects are common after nearly any surgery. Following a healthy diet and maintaining an exercise routine is a great way to improve energy levels and fight fatigue.
- Feeling cold – As you lose weight after your procedure, your metabolism will change. These changes can lead to fluctuations in body temperature, often making patients feel colder than they are used to.
- Dumping syndrome – Bariatric procedures alter your digestive tract, which results in food moving through the intestine much more quickly. Dumping syndrome results when the stomach empties rapidly after eating. Patients may feel weak, dizzy, nauseous, or have heart palpitations shortly after a meal. This condition can be avoided if patients follow good eating habits and post-operative instructions.
- Nutrition deficiencies – Some bariatric procedures rely on malabsorption to help the patient lose weight. This means that the absorption of calories from food is reduced, and that patients do not receive as many nutrients. Patients can maintain good health by eating a balanced diet, and taking vitamins and nutritional supplements.
Some bariatric procedures, such as gastric bypass surgery, alter the digestive tract, meaning patients may experience a side effect called rapid gastric emptying, or dumping syndrome. Dumping syndrome can typically be avoided if patients adopt healthy eating habits and do not eat and drink at the same time.*
What Causes Dumping Syndrome?
The anatomical changes caused by certain types of bariatric surgery mean that the food patients eat does not follow the normal course of the gastrointestinal (GI) tract. Dumping syndrome occurs when food, especially sugar, moves too quickly from the stomach to the first part of the small intestine (duodenum).
Dumping syndrome can typically be avoided if patients adopt healthy eating habits, such as choosing whole grains over refined starches.
Depending on when the symptoms occur, the condition is categorized as either early dumping syndrome and late dumping syndrome.
Early Dumping Syndrome
This form of the condition occurs when the patient eats a large amount of food and undigested particles enter the small intestine too quickly. During normal digestion, food is broken down and regulated by the valves at the top and bottom of the stomach, then pass into the small intestine at a controlled rate. After bariatric surgery, food mixes with saliva instead of stomach acid, and fluids flush into the small intestine to dilute the food. This rapid movement of fluid typically causes symptoms 10 to 30 minutes after a meal.
Late Dumping Syndrome
Late dumping syndrome occurs two to three hours after a meal, when foods which are high in sugar move rapidly into the intestine. This raises the patient's glucose level and causes the pancreas to release additional insulin. The increased insulin level results in a rapid drop in blood glucose levels, causing hypoglycemia or low blood sugar. Patients may experience symptoms such as hunger, shaking, anxiety, perspiration, exhaustion, and fainting.
Minimizing the Effects
Patients should be aware that dumping syndrome is one of the possible side effects of bariatric surgery. Although some individuals will require treatment such as medication, many patients find that simple dietary changes can provide relief:
- Avoid foods and beverages which are high in sugar such as cookies, baked goods, and soda.
- Do not eat too much at once. Instead, consider having five to six smaller meals throughout the day.
- Avoid simple carbohydrates such as white bread and pasta.
- Incorporate more fiber into your diet with whole wheat and grains.
- Do not drink fluids 30 minutes prior to or after a meal.
- Eat more protein such as chicken, turkey, and tofu.
- Chew food thoroughly to aid digestion.
You should steer clear of foods marked as "sugar-free" as the sugar substitutes contain ingredients that can trigger symptoms. Patients should also be careful about avoiding nutritional deficiencies since dumping syndrome can affect the body's ability to properly absorb nutrients from food. Your doctor can provide further guidance in this area.
Many bariatric surgeries alter the digestive system to make patients feel satiated faster and eat less, but these techniques can also reduce the body's natural ability to absorb sufficient vitamins and minerals from the diet.* In many cases, patients have to maintain a life-long intake of supplements to prevent nutritional deficiencies after bariatric surgery. Working with a nutritional counselor after your procedure will be necessary to determine whether you require nutritional supplements to maintain optimal health.
What Causes Nutritional Deficiencies After Bariatric Surgery?
Nutritional deficiencies can be present even before treatment begins. Obese individuals sometimes suffer from vital deficiencies due to poor diet choices and may require certain supplements or diet modifications before undergoing surgery.
After surgery, patients will need to commit to a disciplined lifestyle which includes a nutritional diet and in many cases, supplements.
It should be noted that not all types of bariatric procedures result in the same risk of nutritional deficiency. The impact depends largely on whether the surgery utilizes a restrictive or malabsorptive technique, or a combination of both:
Gastric banding, such as LAP-BAND® surgery, reduces food intake by simply restricting the stomach's capacity. This procedure does not bypass any of the intestines and, therefore, associated nutritional deficiencies are not as pronounced as with other procedures.
Gastric Sleeve Surgery
Gastric sleeve surgery removes more than 80 percent of the stomach, and the remaining stomach portion takes the form of a "sleeve" shape. The reduction in stomach acids can lead to a deficiency of nutrients such as vitamin B12.
Gastric Bypass Surgery
This surgery involves a combination of restrictive and malabsorptive techniques as the stomach is divided into two pouches and the intestines are rearranged to connect to both. As the food passes through only the lower portion of the bowels, nutritional and caloric processing is reduced. Gastric bypass surgery typically leads to significant weight loss but can also result in malnutrition if patients do not take certain precautions.
Duodenal Switch Surgery
During duodenal switch surgery, a new, smaller stomach pouch is created, which is connected to the small intestine. The surgery also rearranges the small intestine to separate the flow of food from the flow of digestive juices, allowing them to mix in a smaller section of the intestine. Malabsorption then promotes weight loss, which can also lead to a reduction in nutrient levels.
Studies have found that nutritional deficiencies are the most likely long-term adverse side effect of bariatric surgery. This can lead to wide-ranging symptoms, including anemia and neurological dysfunction. Bariatric surgery patients may become deficient in:
- Vitamin B1
- Vitamin B12
- Folic Acid
- Vitamin D
- Vitamins A, E, and K
It is important for patients to be screened regularly, at least once a year, for micronutrient deficiencies. This screening becomes critical among women who become pregnant after bariatric surgery, and any deficiencies should be treated before and during the pregnancy.
The long-term success of bariatric surgery requires a multi-disciplinary approach. In addition to consulting with your surgeon and general physician, a dietician can provide instructions and tips for a healthy, nutrient-rich diet and supplements that can counter these deficiencies. Throughout the recovery process and after, patients will need to commit to a disciplined lifestyle in this way.
Rare Side Effects
In rare instances, patients may experience:
- Gastritis - This condition involves the irritation or inflammation of stomach lining. Certain factors can increase a patient's risk of developing gastritis, including smoking, stress, and excessive alcohol consumption.
- Bowel obstructions - When a blockage in the digestive tract prevents food from passing through, it is called a bowel obstruction. After surgery, a band of tissue, which is known as an adhesion, may form in the abdomen. Most adhesions do not cause symptoms or problems, but in some cases, an adhesion can cause bowel obstruction. Patients should seek medical attention if they experience symptoms such as severe nausea, diarrhea, vomiting, or abdominal pain.
- Blood clots - All surgeries carry the risk of blood clots. Smokers and individuals in poor health are at an elevated risk of clotting. To reduce your chances of developing blood clots, patients should begin walking after surgery as soon as they are strong enough. Your doctor may also prescribe blood thinners.
Bariatric surgery is generally considered safe as the associated complications and side effects have decreased significantly in recent years.* However, bariatric procedures, like other types of surgery, carry some inherent risks including a rare condition called bowel obstruction. This condition occurs when food cannot properly pass through the body, causing abdominal pain, cramps, and other serious symptoms. Treatment for bowel obstruction after gastric bypass surgery may require hospitalization as it is a serious health threat. The doctors coordinating with Tijuana Bariatrics take measures to minimize patients' risk of bowel obstruction. Using advanced laparoscopic techniques, for example, has been shown to decrease the prevalence of this concern.*
What Causes Bowel Obstruction after Bariatric Surgery?
Bowel obstruction can be caused due to many factors, including eating a large piece of food that gets stuck in the intestines, severe constipation, scar tissue (adhesions) formed after abdominal operations, hernia (either internal or on the abdominal wall), or intussusceptions (twisted intestines). The bowels can even become obstructed due to adhesions or hernias years after surgery.
Gastric bypass surgery alters the anatomy of the gastrointestinal (GI) tract in a way that gastric sleeve and LAP-BAND® surgery do not. This modification increases the chances of developing a bowel obstruction. Studies show that small bowel obstruction after gastric bypass occurs in approximately three percent of patients. Additionally, small bowel obstruction has also been observed as a late complication (30 days after surgery) of duodenal switch surgery.
Symptoms of Bowel Obstruction
A blocked intestine or bowel can take two forms: partially or fully blocked. Both forms can cause debilitating abdominal pain, and also result in symptoms such as severe nausea, diarrhea, vomiting, constipation, bloating, or an enlarged abdomen. Bariatric patients should seek immediate medical attention if they experience any of these indicators. It is important to note that several of these symptoms are also associated with conditions such as hernias, Crohn's disease, severe constipation, diverticulitis, inflammatory bowel disease, and cancer.
A thorough medical examination is required in order to properly diagnose bowel obstruction. You should stop eating and drinking until you can be examined. Your doctor may take abdominal x-rays or computed tomography (CT) scans to determine if the symptoms are being caused by bowel obstruction, and will then plan the treatment accordingly.
Partial obstruction, in which some food and fluids can still move through the intestines, does not usually necessitate surgical intervention if the patient has been hydrated and stabilized. You will be provided with appropriate medications to ease any discomfort and often be advised to follow a low-fiber diet until your condition improves.
Surgery becomes necessary in cases of a complete obstruction. The surgeon will treat the cause of the blockage, such as excising scar tissue, to provide relief. In some cases, the doctor may remove a section of the blocked intestine as well.