Reduce Nausea and Vomiting After Bariatric Surgery ©

We have all heard that some nausea and vomiting may be common following your bariatric surgery, but there are some things you can do to lessen these side effects.  Here we will review some helpful tips to make the transition to life after surgery a little easier for you.

Surgery – Anesthesia and surgery itself may cause nausea.  It is important to remember that is one of the “normal” side effects of having weight loss surgery (WLS).  However, we all know there are many things that can contribute to nausea and/or vomiting.

Pace of Eating Remember t o eat slowly to reduce nausea and/or vomiting following WLS.  Some surgeons recommend trying to take 30 minutes to eat your meal.  However, we all know this all depends on what you are eating and how far you are out from your surgery.  Some of my patients even ate with baby silverware to slow down their pace of eating and remind them to eat slower.

Chewing Proper chewing helps to slow your eating.  Some programs recommend chewing each bite of food 30 times or to an applesauce consistency.  This slowing down of eating helps for two reasons: 1) helps the brain to realize how full the stomach is and prevent overeating and 2) helps to prevent food from getting stuck.

Food Intolerances Please remember you have to re-learn what works for you and which foods are well tolerated and when after bariatric surgery (and each day may be different).  Please visit this previous blog post for more specifics about food intolerances:  http://thegoodcalorie.com/common-food-intolerances-with-bariatric-surgery/.

Fullness/Overeating Almost every post-op WLS patient can share an experience where just one bite too much caused him or her to get sick.  You have to re-learn not only what foods you can eat, but how much.  Keep in mind if you can eat 4 bites of Greek yogurt, this does not necessarily mean you can eat 4 bites of grilled chicken breast.  The more solid/dense a protein (chicken breast for example) is, it is likely you will not be able to eat as much as softer proteins (Greek yogurt for example) before you feel full.

Food Stuck As mentioned above chewing will help to ensure that food does not get stuck, but this can be a common cause of vomiting.  Simple physics – if a food is not going down, it has to go somewhere so it is going to come back up most likely.  Not only is your stomach smaller, but for most patients the esophagus feels tighter too.  This makes chewing so much more important than it was prior to surgery.  You have to be kind and gentle to your “new baby stomach.

Lying Down Too Quickly Not only does lying down too quickly following a meal increase your chances of heartburn (acid reflux), but it may also increase your risk of nausea and/or vomiting.  You should wait 30-60 minutes after eating to lie down.

Drinking Certainly it is important to stay well-hydrated following WLS, but some patients report vomiting if they drink too closely following a meal as that will make them feel too full and they may vomit.  Some programs recommend waiting 30-60 minutes after eating to drink fluids.

Another concern with drinking fluids is the amount and pace.  Just as eating too fast may induce vomiting, drinking fluids too fast or too much may do the same thing.  Remember to drink slowly and try to get used to your new feeling of fullness.

Advancing Stages Too Quickly Most programs have diet stages that they recommend you follow after your WLS.  These stages will vary from program to program, but in general may go from liquids to pureed (applesauce consistency), to soft, to regular.  These diet stages are important to allow your stomach to heal properly, but also to help reduce the nausea and vomiting that may be common following weight loss surgery.  If you eat a food too soon and are not following your surgeon’s plan, you may find yourself getting sick or increasing your risk of surgical complications.

Taking Vitamins without Food Some patients have no problems taking vitamins, but there is a subset of patients that must take their vitamins with food to reduce the nausea that vitamins and/or minerals may cause.  Every person responds differently to this and you have to determine what works for you.  With this said though, keep in mind, immediately following WLS you may not be eating enough to counteract the nausea.  Or you may feel full just from taking your chewable vitamins and are not able to combine this with your meal.

Chewable Vitamins vs. Liquid Vitamins Most patients do fine starting on chewable vitamins, however, there is a small percentage that do not tolerate chewable vitamins immediately following WLS.  If you find that you are one of these patients, you may want to try liquid vitamins (such as our ENS or ENS+Protein!).  By doing a liquid vitamin you are taking this vitamin over a period of 15-30 minutes and lowering the dose that is hitting the bloodstream over a period of time, thereby reducing the risk of nausea.

Is it Dumping Syndrome?  Gastric bypass patients may experience dumping syndrome.  Eating foods or meals high in sugar or fat may cause dumping syndrome.  Is your nausea or vomiting combined with an increase in heart rate?  Do you have any abdominal pain or cramps?  Do you feel dizzy or light-headed?  Do you have any diarrhea?  These are some of the common symptoms associated with dumping syndrome, however, patients may respond differently to dumping syndrome.  One way to avoid dumping syndrome is to work to keep fat less than 10 grams per serving and sugar less than 10 grams per serving.  Although, there are some patients I used to work with that had to lower those number to less than 5 or 6 grams per serving.  So, keep in mind not all patients are the same and you have to figure out what works for you.

Ginger It is theorized by some that ginger may reduce nausea in some individuals.  I’m not sure if this works or not, but some patients swear by it, so I think it is worth mentioning.  The research on ginger produces mixed results.  Please talk to your doctor before starting any new supplements as there may be interactions with other medications or it may not be safe for you to take certain supplements.  Also, keep in mind, as with anything, more is not always better.  Most importantly, talk to your physician.

Ulcers Some patients may develop an ulcer at the new connection between the stomach and small intestine (gastric bypass or biliopancreatic diversion with duodenal switch) and this may cause nausea and/or vomiting.  Smoking, taking aspirin, ibuprofen, and H. Pylori (a bacteria in the stomach) may increase your risk of ulcers.

Stricture Another cause of nausea and/or vomiting following gastric bypass may be a stricture.  A stricture is when the new connection between the stomach and small intestine heal and scar tissue forms making the opening of this new connection smaller than your surgeon intended.

Obstruction Another cause of nausea and vomiting is an intestinal obstruction.  Any abdominal surgery may result in scarring in the abdominal cavity, called adhesions.  The small intestine can become twisted from the adhesion and cause a blockage (or obstruction), but this is rare.  This can occur even years after surgery.

The latter are all something that would need to be diagnosed by your surgeon.  Most surgeons tell their patients to call the office if they are nauseous and/or vomiting a certain amount of times per day or for a certain number of days.  The best recommendation is to talk to your surgeon if you have any concerns or are not feeling well.

I hope this helps provide a few tips on reducing nausea and vomiting following bariatric surgery.  Please keep in mind this is not intended to serve as medical advice.  Please contact your physician with your specific concerns and/or questions.

By Heather K. Mackie, MS, RD, LD

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