Article By: Whittany Gibson, RDN
Whittany is a Registered Dietitian Nutritionist who specializes in bariatric nutrition counseling, providing education and support prior to and following weight loss surgery.
Dietary and lifestyle modifications along with medications are the typical therapeutic treatments for patients who have acid reflux or GERD (gastroesophageal reflux disease). But if you have had sleeve gastrectomy, you may experience new or worsened reflux even if you follow these recommendations. Just like everything else following weight loss surgery, each individual is different and you may or may not have the same experience.
While the gastric sleeve is the preferred choice of weight loss procedures, it results in increased intra-abdominal pressure that can weaken the lower esophageal sphincter (LES). In layman's terms, there’s more pressure within the stomach that pushes against the flappy thingy at the lower end of your esophagus whose job is to keep contents like acidic digestive juices from spilling back up. If your stomach has too much pressure inside, it can weaken the flap, allowing contents like undigested foods and stomach acid to come back up. When this happens, patients can feel heartburn or acid reflux. Symptoms may include a sour taste in the mouth making foods taste metallic, regurgitation without vomiting, a feeling of having a lump in the throat, or a chronic cough with no specific cause. Alternatively, with gastric bypass, the pyloric valve which sits at the bottom of the stomach prior to your small intestine is cut away allowing the stomach to be depressurized. The gastric sleeve procedure leaves this valve intact. Patients who have significant reflux or GERD prior to weight loss surgery may opt for the gastric bypass procedure instead, helping to reduce or eliminate the symptoms. All this to say that even though you may take preventative dietary measures, you may still be left with some symptoms that warrant additional therapeutic or even surgical measures.
It is important to identify and treat the symptoms of acid reflux to avoid health complications. Did you know that you can reduce your symptoms of acid reflux by being aware of trigger foods? However, it is necessary to first be aware of your body and what you are feeling, practice mindful eating habits, and keep a food symptom journal. Yeah, I feel your eyes rolling already. But seriously, this is important. I recommend that all my patients keep a symptom journal to identify food intolerances in addition to trigger foods for reflux. Just think of it as a self-experiment. You don’t need to do it for long, perhaps 7-14 days. I specifically want to ensure my patients are never overfilling their pouch which further increases pressure within the stomach. So, eat slowly, chew well, allow a few minutes in between your bites (yes, this can feel like a lifetime), and be aware of signs of being satisfied, not full! You will soon know when you’ve taken one bite too many. This takes a lot of learning and practicing but you’ll get it! If you are reading this prior to your surgery, practice these eating behaviors to help put yourself in your post-surgery shoes. You’ll be thankful you did.
With weight loss and decrease of fat surrounding the stomach, most people can feel symptom relief while others may not. Nutrition and lifestyle changes that can help include the following:
1) Avoid high fat foods. Fried foods, full-fat dairy products, fatty cuts of meat, ice cream, potato chips, creamy sauces or gravies, oily or greasy foods. Healthy fats usually do not contribute to symptoms. Healthy sources of fats include fish, nuts, seeds, oils and butters coming from nuts and seeds, avocados.
2) Limit chocolate. It contains an ingredient that causes the smooth muscle in the LES to relax. You remember, the flappy thingy.
3) Avoid regular consumption of alcohol. Alcohol relaxes the LES and stimulates the stomach to produce more acid.
4) Limit coffee. Coffee is both acidic and caffeinated, both of which you will want to limit. Aim for lower acid coffees and dark roasts which are less caffeinated. Or opt for half-caffeinated. Try teas that are naturally lower in caffeine.
5) Limit caffeinated beverages. Caffeine relaxes the LES.
6) Avoid carbonated beverages. The bubbles cause additional pressure within the already small stomach, increasing pressure within.
7) Limit spicy foods. Common culprits include garlic, raw onions, black pepper, other spices that are “spicy”, like clear-out-your-sinuses spicy.
8) Limit acidic foods. Be aware of acidic foods and limit them if they cause symptoms. Common ones include citrus fruits and tomatoes, tomato sauce, coffee and caffeinated beverages.
9) Avoid lying down after a meal. Aim to eat earlier before you wind down for the evening or avoid lying down within 2 hours of your meal.
10) Avoid smoking. Smoking can alter the gut microbiome and cause irritation of the stomach lining, interfering with stomach acid levels. Smoking also slows down the healing process following surgery.
11) Walk for 15 minutes. It is proven that walking helps digestion and can help to reduce symptoms of reflux. Aim to walk for 15 minutes after a meal when possible.
There are many products, supplements, and pharmacological therapy options available if diet and lifestyle alone do not offer enough relief. A combination of both approaches can be beneficial. Discuss these options with your surgical team.
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BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.
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