Coping with Constipation after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for achieving bowel regularity after weight loss surgery.

It may not be an appropriate topic of conversation in many circles, but constipation is relatively common among people who have had weight loss surgery, especially immediately following their surgery. Irregularity can be caused by a lot of things:

• Decreased fluid and fiber intake
• Reduced physical activity
• Narcotic painkillers
• Iron or calcium supplements
  

Many people report only having a bowel movement every two or three days following weight loss surgery. This can lead to constipation. It is important to keep track of your bowel habits and try to have a bowel movement every day.

To relieve constipation:

If it has been more than three days since your last bowel movement, you can take one dose of milk of magnesia or two Dulcolax^® tablets. Repeat every four to six hours. If you do not have results within 24 hours, you should call your bariatric nursing team to discuss.

To prevent constipation and promote bowel regularity:

• Stay hydrated. Drink adequate fluids to help soften your stool. You should drink at least 48 ounces per day.
• Exercise. Take frequent short walks throughout the day, as tolerated.
• Consume adequate fiber. Because your eating is primarily focused on high-protein foods following bariatric surgery, your consumption of high-fiber food is limited. Take fiber supplements as needed to help you get at least 15 grams of fiber per day.
• Use laxatives when necessary. Stick with Metamucil^® and other bulk-forming laxatives based on whole psyllium. Make sure to follow the mixing instructions for optimal results.
  

- Cara Stewart, RD, LDN

Versatile, Easy and Protein-Packed: Mushroom Frittata

Eggs are a versatile source of protein and are great for any meal: breakfast, lunch, or dinner. One egg contains 70 calories and 6 grams of protein. This simple recipe combines whole eggs and egg whites to decrease the calorie, fat and cholesterol content without compromising taste. Pair this dish with a salad for a light, late-summer meal.

Ingredients:

• 1 (8-ounce) package exotic mushroom blend or white button mushrooms
• 1/2 cup shredded Parmigiano-Reggiano cheese
• 1 1/2 teaspoons chopped fresh thyme
• 3 large egg whites
• 2 large eggs

Preparation:

1. Preheat broiler.
   
2. Heat an 8-inch ovenproof skillet over medium-high heat. Coat pan with cooking spray.
   
3. Add mushrooms to pan; sauté 12 minutes or until lightly browned.
   
4. Place mushrooms in a medium bowl; cool slightly.
   
5. Wipe pan clean with paper towels.
   
6. Combine mushrooms, cheese, thyme, 1/4 teaspoon freshly ground black pepper, 1/8 teaspoon salt, egg whites and eggs in a medium bowl, stirring well with a whisk.
   
7. Heat pan over medium heat. Coat pan with cooking spray.
   
8. Add mushroom mixture; cook, covered, for 3 minutes or until almost set.
   
9. Broil 3 minutes or until egg is set.
   
10. Cut into 4 wedges.
11. Enjoy!
    

Nutritional Information:
Amount per Serving

• Calories: 122
• Fat: 6.4g
• Saturated fat: 3.2g
• Monounsaturated fat: 2.2g
• Polyunsaturated fat: 0.4g
• Protein: 13.3g
• Carbohydrate: 3g
• Fiber: 0.8g
• Cholesterol: 116mg
• Iron: 0.9mg
• Sodium: 401mg
• Calcium: 195mg

The recipe makes 4 servings.

This recipe is adapted from Cooking Light (October 2009).

Taking Vitamin and Mineral Supplements: Make time even if you feel fine!

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, outlines the important vitamin and mineral supplements to take after weight loss surgery.

After weight loss surgery, you need to commit to taking a regimen of vitamin and mineral supplements for the rest of your life. Eating smaller amounts of food means your body receives fewer nutrients. In addition, after gastric bypass or sleeve gastrectomy surgery, your system does not absorb some vitamins and minerals as well.

This table highlights the functions of several key nutrients and the symptoms of their deficiency. The damage to your body from many of the deficiencies is permanent, so be sure to follow your dietician’s instructions for taking supplements and have your lab values checked routinely with your primary care physician.

NUTRIENT	WHAT IT DOES	DEFICIENCY
Vitamin B1 (thiamine)	Helps all cells of the body produce energy from carbohydrates	Fatigue, weak muscles, nerve damage
Vitamin B12	Works with folate to make red blood cells Vital part of every cell Helps body use fatty acids and some amino acids	Anemia, fatigue Permanent nerve damage including tingling or numbness in hands and feet
Folate (folic acid)	Plays essential role in making new body cells Works with B12 to form hemoglobin in red blood cells Helps reduce risk of neural tube defects (spina bifida) in developing fetus	Anemia caused by malformed blood cells that won’t carry as much oxygen Increased risk of neural tube defects in developing fetus
Vitamin A	Promotes normal vision, helps eyes see normally in the dark Promotes growth and health of all cells Keeps tissues healthy to prevent infection Works as an antioxidant	Night blindness Dry, scaly skin Reproductive problems
Vitamin D	Promotes absorption of calcium and phosphorus Regulates amount of calcium in blood	Osteoporosis (loss of bone mass) Osteomalacia: softening of bones
Calcium (**NOTE: Supplements are still needed even if blood levels are normal)	Helps bones remain strong by slowing rate of bone loss with age Helps muscles contract and heart beat Promotes normal nerve function	Osteoporosis
Iron	Essential part of hemoglobin that carries oxygen in blood Supports healthy immune system	Iron deficiency anemia Fatigue Infections

- Cara Stewart, RD, LDN