Post-op duodenal switch patients have a bit larger stomach, and one that functions better than most other  weight loss surgery patients. Their diet progression is usually more rapid than other patients; however, the stomach is still a bit tender. Here is the typical progression:

Clear liquid Full liquid Puree Soft Regular
The day after the weight loss surgery, if the upper GI is clear If clear liquids are tolerated then this is attempted. However no lactose for several months Often for the first two weeks after the weight loss surgery, although some progress through this in the hospital In hospital, transition to regular diet Some progress to a regular diet while in the hospital, others will progress more slowly, depending on the weight loss surgeon

Everyone is surprised at how small their stomach is after duodenal switch surgery

 

Often it is difficult to imagine that, with this four-ounce stomach, only a couple of fork loads of food will fill you up. Do not exceed what will fill you. If you do, you will find a terrible discomfort level, and that can be manifested in a number of ways: you may feel pain in the back or the shoulders, you may feel nauseated, or you may feel as if something is stuck in your throat.

With DS you will have a larger “pouch” or stomach than with lap-band surgery (a one ounce pouch), four ounces is not that much larger. If you take a bit more than you think you should, nothing good will come of it—you may be uncomfortable, start to vomit, or rupture your staple line. So, just like at the gas station—don’t top it off (those of you from Oregon and New Jersey will not understand this, as you do not have self-serve gasoline pumps, so while we acknowledge your superiority, please humor us here). Just because we say you have a four-ounce stomach does not mean you can eat four ounces—when you had a 50-ounce stomach, did you eat a 50-ounce steak?

Getting your protein after duodenal switch weight loss surgery

The stomach can be quite picky the first few weeks after duodenal switch bariatric surgery. Do not get protein in at the risk of vomiting. There are a lot of sources of protein that you can use. Sometimes, and I hate to admit this, the only way you can get in protein is through drinks or supplements.

Jim was a wonderful weight loss surgery patient of mine, whose wife kind of ruled the roost—in fact, there was no question about it. When he was getting ready to go home from the hospital, he just didn’t feel like having the typical hospital lunch (which was turkey breast that had been dried out and cooked until it was unidentifiable by most pathologists). His wife insisted that he eat that, otherwise horrible things would happen to him (after all, she took seriously that protein was important). He didn’t eat the turkey, and I assured her that if the stomach doesn’t feel like eating, it is probably better to give it a rest, than to eat something and vomit later.

Food intolerance after duodenal switch (DS) weight loss surgery

—can’t we all just get along?

You will find weight loss surgery patients who can, and will, eat anything. If they have an iron deficiency they will eat rusty nails, if they need more protein, they will chew the hide off a cow. But most duodenal switch surgery patients, after the procedure, find they are a bit touchy about some foods. What goes down easily one day may not go down the next. As you re-introduce foods into your diet, go slow. Don’t try the new recipe that combines a lot of new foods at once (the Ostrich-alligator casserole may be a bit much at first). Try one new thing at a time. If the duck doesn’t sit well—wait a week before you have quackers with your crackers again.

Lactose intolerance after duodenal switch bariatric surgery

Lactose intolerance is very common after duodenal switch bariatric surgery. Milk and milk products should be reintroduced in a gradual manner. Generally, the more firm the consistency of the dairy product, the easier it is to tolerate—hard cheese is tolerated where whole milk may cause profound cramping and diarrhea. While there are tablets that help you digest lactose, it is sometimes best to avoid milk for a few months. Then, as with all foods, go slowly.

Protein consumption – the progression is swim, fly, and then walk

Eating protein after Duodenal Switch Surgery – start with seafood (fish) progress to poultry (chicken) then red meat (beef)

As with all weight loss surgeries, the progression of food is swim, fly, and then walk. If it is in the water and swims, you can probably tolerate it pretty well after the procedure. The second month you can expand to food that flies, and finally, as you start walking more—go out and catch a bison. Now there are some unique exceptions to this, and the first has to do with seafood. Do not fry your seafood. Fried and battered seafood will not sit well after the operation.

Ketchikan salmon are the best

One more story. Once while I was having dinner with some friends in San Francisco at one of my favorite Italian restaurants, the waiter told us that salmon was the fresh fish catch-of-the-day. Three of us were from Alaska, and we immediately asked if it was caught or raised, the waiter assured us it was not raised, but caught, so the three of us ordered it as an appetizer. It was raised, not caught. You can not fool an Alaskan about salmon.

Raised salmon and wild salmon are not the same. They don’t taste the same, and raised salmon is artificially colored. So, if you hate salmon, try some salmon that is freshly caught—like troll-caught out of Ketchikan, from the Kenai River, the Russian River, or the Copper River (which means it was trying to get to my brother’s house along the river). Salmon is a great fish. If it is fresh and caught in the wild, it will be a wonderful dish—if it is farm raised, save your money and buy some tuna fish instead. Besides, I have a lot of friends in Alaska who are commercial fishermen, which is a very difficult way to make a living. The “farm” raised salmon has almost shut down their industry, as restaurants have purchased the less expensive salmon. So, if you go out to a restaurant, and the salmon was not “caught,” get the steak.

Beans are a great source of protein and have a low-glycemic index; however, they can be a source of gas. Beano® is a great product, and will decrease the malodor. So beans are not a food intolerance—just a social one.

The first month proteins that are tolerated well include:

  • Seafood – fish and shrimp are easy on the stomach.
  • Tuna fish (yes, it is a seafood, but sometimes we don’t think of it that way)
  • Tofu (there are some great tofu recipes. This is a high quality protein)
  • Bocca® burgers – available at most supermarkets and are a ready source of protein
  • Cottage cheese – a great source of protein. It is soft and easily fills you. Some new products have fruit placed in them for flavor. Low fat cottage cheese is preferred.
  • Egg whites –a great source of protein (you don’t need the yolks) and you can use them in a variety of ways.

If the stomach is just too tender and you are vomiting, talk to your weight loss surgeon. Vomiting is not our desired result (this is not the super-model diet—eat, vomit, eat, vomit). Some Duodenal Switch patients find that they must have a little food on their stomach to soak up the acid, such as a cracker or a chewable antacid. Do not overstuff your stomach. You may only tolerate a forkful or two before you have to stop. Sometimes, during the first month, you may have to take protein drinks to get in the protein you need. Over time your stomach will stretch, so don’t be alarmed if you cannot eat as much as you think you should. But do not attempt to overfill it.

The second month – proteins can expand to poultry items

  • Chicken (some can tolerate this the first month)
  • Duck (always a favorite)
  • Deli-meats

Third month – ready for red meats

  • Beef – ground, slow-cooked, tenderized. Fried foods can be difficult to tolerate, as can meats that are dry-cooked too long.
  • Elk –a great source of protein

Sometimes food doesn’t taste right after duodenal switch Surgery

Sometimes after weight loss surgery, it is just difficult to get in the protein simply because you have lost a taste for it. Your tongue wants something with more “spice” or something tart (not a Pop Tart, and not an English version of a tart). Spice is not hard on the stomach. Contrary to the old belief that spices might contribute to ulcers, they don’t. So add balsamic vinegar, capers, salsa (which is right up our alley here in the Southwest), pickles, or olives—these all add a bit of flavor to the food, make it easier to go down, and wake up the taste buds. The other is sushi—forget the rice, but add some of the ginger. Not only will your taste buds wake up, but also your sinuses will clear up faster than you can imagine. Peppers—hot, moderate, or mild, can also help spice up protein.