Surgical Specialists of Washington Township

Bariatric Problem Guide


Considerations Causes Treatment /Prevention

Drinking carbonated beverages

Eating while talking/laughing

Gulping fluids

Using a straw

Chewing gum

Fibrous veggies

Avoid straws and gum

Avoid carbonation

Sip fluids

Gas x strips

Beano tabs


Lactose Intolerance There are not enough enzymes available after surgery to digest lactose in dairy products and lactose intolerance results Use thicker dairy like yogurt or cheese. Add Lactaid to your dairy products. You can but it in any store.

Lactose intolerance


Disruption of good vs bad organisms in your GI tract

Eat binding foods like unsweetened applesauce. Switch to lactose free dairy

Cut out high carb/sugary foods

Add a Probiotic


Dumping Caused by eating simple sugars, too many starches, foods high in fat, drinking while eating

Eat protein every meal

Avoid high sugar/carb/fat foods

DO NOT eat and drink together

If you also get a low blood sugar addition to diarrhea, use glucose tablets that you can get at any store

* Constipation Low fiber diet, dehydration, narcotic use See constipation article to left of this table
Vitamin deficiencies Mostly due to not complying with the vitamin recommendations Take all supplements as directed. Get labs checked when ordered.

Eating too much

Eating too quickly

Eating and drinking together

Not chewing well

Advancing the diet too quickly

Eating the wrong foods


Must follow the bariatric rules! We do not expect nausea and vomiting. Examine your eating and make changes. 
Acid reflux/heartburn Can be an issue after a sleeve gastrectomy see hand-out below to the left.   Over the counter products can be used such as Omeprazole, Zantac, Tums,  Maalox.
Dehydration Caused by not drinking enough fluids or using diuretics. Urine may be a dark yellow. It should be straw to clear.  Must drink an ounce every 10 minutes. First few days after surgery strive for MINIMALLY 3 bottles of fluid. Work up to 4 to 5 bottles.
Foaming/sliming Caused by the same issues above that cause nausea/vomiting Follow bariatric rules!  Use warm salt water mouth rinses.
Hiccups Common after surgery. some irritation caused by many of the same issues that cause nausea and vomiting Examine your eating and make adjustments
Bad breath Caused by your body burning fat for fuel. This can give you a distinct odor Hydrate well. Keep mouth moist. As you advance  your diet, this will improve.
Hair loss Hard to prevent totally. Caused by the stress of surgery and stress of weight loss. It can be made worse by iron and protein deficiency. It's ok to take additional hair vitamins
Noisy stomach and feeling cold Noisy stomach is caused by a much smaller stomach and your stomach content being closer to your esophagus. being cold is a constant complaint. Thermoregulation changes and decrease insulation are causes

Join the cold, noisy clavicle club.


Clavicle club:  When you clavicle bones appear, you're in the club! :-

Please use the problem table to assess when you are
experiencing symptoms.  


There are growth and resting phases of hair. Generally, 90% of hairs are in the growth phase and 10% are resting. Because of that ratio, you really don't notice the hair loss since you are growing a lot more hair than you are losing (you lose hair in the resting phase). Some things can change this around.
Hair is obviously important to us. Hair is a part of our self-image.
Hair loss is a concern after weight loss surgery. That's because nutrition plays a significant role in hair health. When the body is threatened (as by surgery) it prioritizes how nutrition is used, preferring to be used by vital organs like the brain and heart etc.
and not the hair or nails.
Hair can be lost for a number of reasons, and after weight loss surgery, it is due to the stress of the surgery itself.
It is normal to lose up to about 100 hairs a day. This is the result of the normal hair growth cycle. Hairs will grow for a few years, then
rest for a few months, shed, and regrow. "Telogen effluvium" is the fancy word that describes when some stress causes hair roots to be pushed prematurely into resting phase. This is typically what
happens after surgery.
If there is some "shock to the body", a person can lose as much as 70% of the scalp hair about 2 to 3 months after the "shock". Most don't lose that much, however. So, it can feel like handfuls of hair
are coming out! Hair loss rarely lasts more than 6 months. If it does, than we would need to examine some other causes.

Some stresses that can cause hair loss are:

High fever
Severe infection
Major surgery
Sudden physical trauma
Chronic debilitating illness (such as cancer or end-stage liver disease)
Hormonal disruption (such as pregnancy, childbirth menopause) 
Sudden weight-loss
Crash dieting (your diet after surgery is kind of like this)
Heavy metal toxicity
Some medications
Nutritionally, deficiencies in protein, iron and zinc can be held culprit. Other nutrients associated with hair health include vitamin A, inositol, folate, B-6 and essential fatty acids. Hair loss can also be caused by certain diseases, including thyroid disease and polycystic ovarian syndrome (PCOS).


Though Hair loss is distressing to our patients, there is not enough evidence that hair loss is preventable because it is most likely caused by surgery and rapid weight-loss.
But if hair loss continues, it can be indicative of a nutritional problem, especially iron deficiency.
Taking additional supplements above what is recommended might just be a waste of money. Some hair products too can be quite expensive and probably won't transfer hair follicles out of the resting stage any sooner.
My advice would be to make sure you follow up with your surgeon, dietitian and bariatric nurse for continued assessment of your nutritional health. This includes getting your required labs done as ordered.
If an issue is identified, it can be corrected and you won't suffer from unnecessary excessive hair loss after surgery.
If there are additional supplements that you might want to try like biotin, discuss this with a health care practitioner for advice and guidance and to choose appropriate dosing. An informed hair stylist can be helpful as well

The FIVE major causes of symptoms:

1. Eating too fast
2. Eating and drinking together
3. Eating too much
4. Not chewing food well
5. Advancing the diet too quickly
6. Eating the WRONG foods