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Avoid Fluids with Meals

After surgery it is important not to drink fluids with meals and up to 30 minutes after meals. Drinking fluids during a meal or soon after flushes food through too fast and can cause regurgitation. High- carbohydrate foods like juices, ice cream, fast food milkshakes, and sodas go down quickly but can cause bloating and nausea, in addition to not being good for weight loss.

Encourage Eating Slowly and Chewing Thoroughly

Once the liquid diet stage is passed, patients need to relearn how to eat slowly and mindfully. They need to start by taking a pencil eraser size bite of scrambled egg or cottage cheese and chewing it thoroughly. Keeping the food in the mouth until it is a liquid consistency is important for digestion and bioavailability of nutrients from the food. Mindful eating means they stop eating when they feel full.

Mindful Eating

Long-term success for a bariatric surgery patient depends on lifestyle changes that include mindful and sustainable new eating habits, along with physical activity and nutrition repletion. People hate counting calories and being scolded when they splurge on the wrong foods. Each patient needs to make peace with food and get support to reinvigorate their healthy food choices in order to prevent regaining weight.

Medical professionals seldom learn about the satiety and physiological mechanisms that influence food intake. Appetite is a multiphase process occurring numerous times a day for an individual and it influences the desire to eat. Hunger is the primary component of appetite. Satiety is the feeling achieved when the need for energy has been fulfilled.

Hormonal regulation controls much of the digestive process with ghrelin signaling the brain to eat based on smell, sight of food, or to maintain energy. Cholecystokinin (CCK) also signals satiation by activating receptors to reduce gastric emptying by the pyloric sphincter. Proteins and complex carbohydrates effectively stimulate CCK while a meal rich in glucose or lactose does not [14].

Glucose-dependent insulinotropic polypeptide (GIP) is released within 5 minutes after food ingestion and peaks 30-60 minutes later, depending on the meal size and composition. Mans et al. found that SG accelerated gastric emptying, enhanced CCK and GIP levels, plus reduced ghrelin release which helped patients lose weight and improve their glucose metabolism [15]. GIP regulates pancreatic secretions like insulin and lipase for carbohydrate and lipid metabolism.

Gastric motility is stimulated by food moving through the digestive tract and signaling release of digestive enzymes like peptide tyrosine-tyrosine (PYY) and glucagon-like peptide (GLP-1). Yan et al. reported that meal size had a significant impact on PYY and GLP-1 secretion after RYGB [16]. Meal sizes, as small as 75-300 kcal, were significantly effective in increasing levels of these peptides and affecting weight loss. Both PYY and GLP-1 are released by intestinal enteroendocrine cells and have a role in reducing gastric motility and probably appetite.

Crosstalk between GIP and GLP-1 is speculated since carbohydrates influence pancreatic insulin hormone release, and PYY assists in reducing motility so brakes can be applied to allow satiety signal transmission to the brain [14].

There were no major differences in food preferences or intake between RYGB and SG groups studied by El Labban [17]. However, a trend in eating sweets by SG subjects was identified. Mindful eating means cutting added sugars which add no micronutrients to the diet. Eating for health instead of consuming sweets and fatty foods requires discipline. As Ferris Jabr wrote in Scientific American, “extremely sweet or fatty foods captivate the brain’s reward circuit in much the same way that cocaine and gambling do” [18].

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