Many patients report food intolerances after a gastric sleeve or gastric bypass, especially in the period immediately after surgery once you are allowed to progress to normal eating. Some foods may not sit well and cause an uncomfortable feeling or even discomfort for a while. What should you expect as a pre-op or early post-op patient? What are normal food intolerances, and are there other causes?
Key takeaways
- Commonly not tolerated: pasta, bread, rice, meat, eggs, stringy vegetables, fruit membranes, seeds and lactose.
- Every patient – and every day – is different.
- Try one new food at a time, a bite or two, preferably at home; wait a few weeks before trying again.
- Portion size and pace of eating are often the real cause.
Common food intolerances
Foods that are commonly not tolerated well after bariatric surgery may include, but are not limited to:
- Pasta, bread and rice
- Beef, chicken and pork
- Eggs
- Stringy vegetables
- Fruit with membranes
- Foods with seeds
- Cow's milk (or other dairy foods with lactose)
However, every patient is different in what they can and cannot tolerate, and each day may be different: one day you may tolerate a food that you cannot tolerate a few days later. Some patients also experience taste changes after bariatric surgery and simply no longer want certain foods they liked before surgery.
Why are certain foods not tolerated?
Some food intolerances are temporary and occur because your new "baby stomach" is not ready to handle that particular food yet. It is similar to feeding a new baby: start with one new food at a time, see how it is tolerated and advance from there. Trying only one new food at a time helps you determine which food was not tolerated. Eat only a bite or two of a new food at first, and consider trying all new foods at home until you know better what you can and cannot tolerate. If you experience a food intolerance, many professionals recommend waiting a few weeks before trying that food again.
Another reason a food may not be tolerated is advancing through the diet stages too quickly. Some patients need longer than the average recommended time in a diet stage before moving on. You can discuss this with your surgeon and/or dietitian.
From a physiological standpoint, food intolerances (in general, not only after bariatric surgery) may occur because you lack the enzymes or chemicals needed to digest a particular food. This may cause symptoms ranging from gastrointestinal symptoms, such as diarrhoea, bloating and gas, to headaches, changes in mood and certain skin conditions. Symptoms may be immediate or take some time.
Tips to reduce food intolerances
There are several tricks of the trade that may reduce your risk of a food intolerance. Talk to your surgeon, dietitian and/or programme before trying any of these, to make sure your programme is comfortable with your eating plan.
| Food | Tips |
|---|---|
| Pasta and rice | Some patients do well with slightly undercooking or overcooking. Most patients do not tolerate these foods until 9–12 months post-op. |
| Fresh bread | Try toasting it to make it more tolerable. Most patients do not tolerate bread until about 6–12 months post-op. |
| Beef, chicken, pork | Use a cooking method that maintains moisture and only cook to the safe temperature – overcooking dries food out, making it less tolerable. You can also try a meat tenderiser or a marinade (watch the sugar and fat content). |
| Prawns | Many patients say the smaller the prawns, the better they tolerate them. It may be best to avoid them until you are further out from surgery. |
| Eggs | This one is tricky: some patients tolerate hard-boiled eggs and others do not; the same goes for scrambled eggs. Try varying how you cook your eggs. |
| Stringy vegetables | Use a blender and a sieve to separate indigestible fibre. Some patients need to wait until 6–12 months post-op for foods such as celery and asparagus. |
| Fruit membranes | Remove the membranes of oranges, grapefruit and other citrus fruits to increase tolerance. |
| Skins of fruit and vegetables | Remove the skin until better tolerated, e.g. apples, plums, peaches, pears, cucumbers and potatoes. |
| Lettuce | Some patients do not tolerate lettuce well. Although dark, leafy greens are more nutritious, some tolerate iceberg lettuce better at first and try greener lettuce further out from surgery. Others find that the fresher the lettuce, the better it is tolerated. |
| Foods with seeds | Avoid eating the seeds if possible, or wait until further out from surgery (e.g. strawberries). |
| Cow's milk (or other dairy foods) | Try soya milk, lactose-free milk, rice milk or almond milk (look for light or lower-calorie options) instead. |
- Portion size: often it is not the food itself that is not tolerated, but the portion size. Many "not tolerated" foods are actually foods that fill us up faster, so you need to eat less of them. It takes time and practice to figure out how much of each food you can tolerate. For example, chicken is a common food that is not well tolerated: even if you can eat 6 bites of yoghurt, you most likely cannot eat 6 bites of chicken. Chicken is a more solid protein, and 1–2 bites may be all you can tolerate early after surgery. Even 1 bite extra is overeating, which can cause its own discomfort. Work on retraining your mind to recognise the feeling of fullness, so you avoid the uncomfortable "stuffed" feeling.
- Pace of eating: keep in mind how fast you are eating. You may tolerate a food much better if you eat it more slowly and chew properly.
This list is not all-inclusive and every patient is different. Every programme has different recommendations, and something that works for you may not work for your bariatric buddy. We hope this makes your transition to your new eating plan a little easier – and we look forward to CELEBRATING with you as you transition to your normal eating plan!
This article is for general information only and does not replace personal medical advice. Always discuss your situation, blood test results and supplementation with your bariatric team or healthcare provider.