BARIATRIC AND VASCULAR SURGEON
Decalogue of a bariatric patient
At the beginning of his or her therapeutic journey, each patient who decides to undergo a surgical treatment for obesity is informed that his or her responsibility of the success of the treatment is just the same (or even greater!) than the one of the surgical team. This does not in any way stem from the willingness to transfer responsibility to the patient, but from the real need to realize that surgical treatment is only the beginning of therapy, and changes in the gastrointestinal tract made by the surgeon are only a tool for the patient to benefit from or not. The final effect of treatment depends on the daily use of a healthy diet as well as on the avoidance of errors that, when often committed, ultimately lead to disappointment of the patient.
In order not to be confined to generalizations, I would like to point out the basic principles, as well as the list of the most common errors made by patients after bariatric surgery.
Drinking water while eating
Drinking water while eating food makes the food move faster from the stomach. In this way, another portion of food is eaten during the same meal. In other words, the patient whose volume of stomach is 100 ml instead of 100 ml of solid food during the meal, will take it for example 150 or 200 ml, depending on how much liquid will be taken during the same meal.
Drinking carbonated sweetened beverages
Apart from the fact that shortly after the surgery the intake of carbonated drinks results in discomfort or even painful ailment due to the rapid stretching of the small stomach, in the distant period drinking carbonated drinks unfortunately becomes a habit that results in regular intake of "empty calories”, for example, a can of 330 ml, without indicating any of the manufacturers, can contain from 100 to 140 kcal. For comparison, 330 ml of water always contains 0 calories! Remember, drinking we need water, not sugar!
Quality of meals
You do not have to be a dietician to understand the simple rules a healthy diet is based on. A portion of fries and a burger is not the same as fish fillet with vegetable salad. A portion of strawberry ice cream is not the same as a serving of strawberries, and a glass of 18% cream is not the same as a glass of yogurt.
The pace of life results in temptation to reach highly processed products containing much more calories than we could take during a meal. On the one hand, it is a truism, but if one goes to such aggressive form of therapy, such as surgical treatment, he cannot underestimate such truisms. Food which lands on our plates cannot be there by accident, but must be a careful tactic accompanying us on a daily basis.
Firstly, alcohol also contains calories. The saying "beer muscle" did not come out of nowhere. Reflection on the subject is the same problem as mentioned at point two. Secondly, every patient after a bariatric surgery must be aware that their sensitivity to alcohol is definitely different than before surgery. The liver in the first year after surgery is very sensitive to ethanol. More visually, it is not able to neutralize the liquid percentages as quickly as it did before. What is more, in patients who have undergone gastric bypass surgery, alcohol is much more rapidly absorbed from the gastrointestinal tract, and therefore its content in blood rises dramatically. More practically, if you were able to drink 3 glasses of wine before the operation, while still holding the vertical, after bariatric surgery you can lose one after just a single glass of wine. According to some surgeons, alcohol should not be used in the first year after surgery, but if you cannot stop it, you should only drink alcohol in a reliable company.
It is also important to mention psychological studies that show a greater risk of alcohol addiction among bariatric patients.
Vitamins and micronutrients supplementation
One should not be surprised that changes made by the surgeon in the gastrointestinal tract, resulting in spectacular weight loss, will also interfere with the absorption of vitamins and micronutrients. This is not a high price, especially since not taken in sufficient quantities with food can be supplemented by oral preparations. On the other hand, if somebody trivializes the taking of these "banal" supplements, they are exposed to a number of serious consequences that can result in serious neurological, internist, or orthopedic diseases. According to the principle that better prevention than cure, considering whether I can stop supplementing the prescribed formulations should not take place at all.
Without food you can survive for even a month of time, and maybe even longer, without drinking up to a few days. The most common ailment that patients mention to the surgeon in a short time after surgical treatment is a feeling of weakness. In most cases the reason for this is not having enough fluid. Therefore, keep in mind that a bottle of water (still!) should be a fixed prop for the patient after surgery. At a later stage of treatment, by drinking water between the meals it is also easier to control the feeling of hunger, as the stomach can be deceived in this way. Good hydration also allows you to flush out all the toxic metabolites that are produced during intense weight loss.
The mechanism of operation of bariatric surgery is among others based on the fact that the "new" small stomach is able to fill up with a volume of about 100 ml of food, which results in the tension of the stomach walls, followed by the sending by the stomach of a nervous pulse informing us of filling the stomach, which we interpret as satiety. If, in between meals, our main occupation is to take small amounts of anything, there is a situation when a small amount of food, less than the volume of the stomach, stays in it at all times without causing satiety. We reach for snacks not because we are hungry, but mainly because they are tasty, and more often because they just are at hands. Let not bring them home so that we are not tempted, and if we really need to take something, let's grab a bottle of water and drink a few sips. For some time this will help, and certainly will come to health. If the feeling of hunger accompanies us despite of it, it is still much more sensible to reach for a protein snack, such as an egg or a serving of meat that will fill the stomach and cause satiety for another few hours.
Bariatric math is simple: "eat less, burn more". If you want to achieve more spectacular weight loss and improve your general physical fitness, you cannot rely solely on changes in the digestive tract and the amount of calories you take. Physical exercise will be a lot simpler over time because excess body mass will no longer be a real obstacle to sports.
"Sugar is a white death," says the slogan and is not just empty. The patient who treats obesity and still eats sweets, is more or less the same as a person suffering from atherosclerosis who continues to smoke cigarettes. I do not want to argue with the fact that all of us tend to like sweets, but it is worthwhile to think for a moment to realize that fruit, which do not lack of sweetness have an average of 10 times less calories than processed sweets, regardless of the figure.
Obesity is like alcoholism
Every person who has fallen ill with obesity must accept one sad fact with humility. Obesity is life-long, no matter how much you weigh at the moment. If you ever forget that a few years ago you weighed 100 and more kilos and you start going back to your earlier habits, then it's only a matter of time when the weight scale will pass the magical triple digit. If you do not want to go back to the time when not only you knew about your obesity problem, you should be as rigorous as an alcoholic who knows that each string starts with the first glass.