A common problem, so how do we get the calcium?
Foods that contain lactose:
- Ice Cream
- Many sauces, soups, salad dressings, and prepared foods (check the labels for “lactose”)
- Lactose is also used in some prescription drugs and medicines
It is very common after any operation on the gut to develop what we call “lactose intolerance.” Lactose is “milk sugar” and is broken down by enzymes in the gut. After weight loss surgery these enzymes (called lactase) may take a vacation and may not come back.
Lactose intolerance is common among many people. Symptoms are cramps, bloating, diarrhea, nausea, lots of gas, and a noisy gut. The undigested milk sugar (lactose) becomes food for bacteria that live in the colon. The bacteria break down the lactose and you start to feel the symptoms. Usually symptoms occur thirty minutes to two hours after you have the lactose containing foods.
You can purchase “lactase” tablets, or milk which has had much of the lactose removed, or broken down. This is something you will have to experiment with. Some weight loss surgery patients have such problems with lactose intolerance that the slightest bit of milk sugar will cause them to have severe cramping and pain in the stomach. Other weight loss surgery patients find they can eat yogurt, cottage cheese, and hard cheeses, but cannot tolerate milk or ice cream. Yogurt is very low in lactose.
Lactose intolerance is common among Native Americans. When I worked at the Indian Hospital and weight loss surgery patients became constipated they would drink a glass of milk to relieve the constipation. Being one quarter Native American and one half Norwegian my body still doesn’t know what it is suppose to do—but I find I can get by if I don’t drink milk and I limit my ice cream to four scoops!
Calcium is present in high quantities in dairy foods but they also contain lactose. If you have lactose intolerance you should supplement your diet with calcium. Some vegetables have a lot of calcium such as Kale, Collard greens, Broccoli, and Turnip greens—I prefer to take Tums®.
Roux en Y (RNY) gastric bypass weight loss surgery causes gluten intolerance
Celiac Disease is caused by an allergy to gluten. Gluten is a substance found in wheat, barley, and rye. It can be difficult to diagnose Celiac disease even though it causes multiple symptoms. Weight loss surgery patients can suffer from diarrhea, weight loss, and nutritional deficiencies (making it difficult to determine from a lot of other things that post operative bariatric patients develop). This is a disease that can become unmasked by weight loss surgery. Treatment is important because if people continue to eat a diet with gluten they have a risk of developing gastrointestinal cancer 40 times more often than anyone else.
Perhaps the most famous weight loss surgery patient with this is an author of cookbooks. She was such a good cook that she weighed 185 pounds more than she should have. She had successful Roux en Y bypass, done by a good friend of mine, and did spectacularly well. She was religious in her avoidance of high Glycemic index carbohydrates (which also happen to contain gluten). She was full of energy and traveling. She slowly reintroduced carbohydrates into her diet, always watching her scale to make certain she maintained herself around 130 pounds, and then became chronically ill.
She suffered from severe diarrhea, bloating, and intestinal pain. She was hospitalized several times and even had her gallbladder out, which everyone thought would cure her. However, she continued to become weaker and weaker. After passing out a few times from dehydration she thought she might need some medical attention. Multiple endoscopies were performed, one of which showed she had severe bile salt diarrhea (which they thought was a consequence of having her gallbladder removed). Every time she ate, she became sick.
Her diarrhea was so bad she was confined to her home, and the odor from the gas was so bad that she refused to travel except for short distances to the store. She was given multiple diagnoses, including irritable bowel syndrome, post-cholecystectomy syndrome, bacterial overgrowth, and bile salt diarrhea. Finally she became so ill that the physicians decided to place her on total bowel rest, placed a special intravenous line in her and fed her through her vein with total Parentral nutrition (TPN).
Within a week she was feeling energetic again, and within two weeks she was feeling even better. It took almost two months of total intravenous nutrition to get her back to normal. The support system of post operative weight loss surgery patients is world-wide, and she had, through the internet, discussed her situation with some close friends, one of whom happened to be a physician. He suggested celiac disease might be the problem, and told her to watch what happened when she ate gluten products. Being an internet savvy individual, she looked up every website and learned as much as she could.
A gluten-free diet worked
Her primary care physician checked her blood for the disease, but it was negative (which was, by the way, entirely expected, as she had been off all food for several weeks). She had a pretzel with peanut butter and cramped for a day. She then discovered a store nearby that specialized in gluten free products and is probably now re-writing a cookbook with her famous recipes made gluten free.
This young woman nearly died, as some do, but now is back to her usual spunky self—and no doubt will be America’s replacement for Julia Child (but if she has a television program you can bet the food she puts in her mouth will be gluten free). In reading about some patients who have become progressively malnourished and died following weight loss surgery, I cannot help but wonder if they are included in the one-in-133 people who have Celiac disease unmasked by a bariatric operation.