Managing reflux after bariatric surgery - A Dietitian's perspective

reflux post weight loss surgery

Experiencing reflux after your weight loss surgery? You're not alone. Reflux is a common complaint post-bariatric surgery and can be challenging to manage—and harder to live with! As a bariatric dietitian, I understand the discomfort and frustration that comes with this condition. My goal is to help you navigate this challenge with simple, effective strategies. In this blog, we'll explore what reflux is, why it happens after bariatric surgery, and practical tips to manage it so you can continue your weight loss journey comfortably and successfully.

Understanding Reflux: What Is It?

Reflux, also known as gastroesophageal reflux disease (GERD), occurs when stomach contents (food, fluid, and stomach acid) move out of your stomach and up into your esophagus—the tube that connects your mouth to your stomach. This backward movement can irritate the lining of your esophagus, leading to discomfort and a burning sensation commonly known as heartburn.

When you eat, food travels from your mouth, down your esophagus, and into your stomach. Normally, a ring of muscle at the bottom of your esophagus called the lower esophageal sphincter (LES), acts as a valve to keep stomach contents where they belong. However, when the LES is weakened or relaxed, it allows stomach acid and other contents to flow back up into the esophagus, causing reflux.

For those who have had bariatric surgery, this process can be exacerbated due to changes in the structure and function of the stomach and esophagus. The reduced stomach size and altered digestive pathway can lead to increased pressure and a higher likelihood of reflux. The symptoms can vary from mild to severe and can significantly impact your quality of life. Common signs of reflux include a burning feeling in the chest, regurgitation of food or sour liquid.

Why You Might Experience Reflux After Bariatric Surgery

Experiencing reflux after bariatric surgery can be both surprising and distressing, especially if you didn't have this issue before your procedure. Several factors can contribute to the development of reflux post-surgery, and understanding these can help you manage and alleviate the symptoms effectively.

Overeating

After bariatric surgery, your stomach is significantly smaller, which means it can hold much less food than before. When you eat too much in one meal, your smaller stomach becomes overly full and the excess food and stomach acid can push back up into your esophagus. This "overflow" effect is a common cause of reflux in post-surgery patients.

Eating Too Fast

Eating quickly is another culprit for reflux after bariatric surgery. When you eat too fast, you tend to swallow larger pieces of food, which are harder to process. Additionally, fast eating can lead to swallowing more air, further increasing the pressure in your stomach. Chewing your food thoroughly and eating slowly helps your stomach manage and digest food more efficiently, reducing the risk of reflux.

Eating Too Close to Bedtime

Timing your meals is crucial in managing reflux. Eating a large meal or even a small snack too close to bedtime can cause discomfort when you lie down. When you lie down with a full stomach, gravity is no longer helping keep the stomach contents down, making it easier for food and acid to move up into your esophagus. Aim to have your last meal at least 2-3 hours before you go to bed to allow your stomach enough time to digest.

Effective Strategies to Manage Reflux Post-Surgery

Managing reflux after bariatric surgery requires a combination of dietary adjustments, lifestyle changes, and sometimes medical intervention. Here are some detailed strategies to help you manage reflux and improve your quality of life post-surgery.

1. Smaller, Frequent Meals

Eating smaller, more frequent meals can help prevent your stomach from becoming too full, which reduces the likelihood of reflux. Instead of three large meals a day, aim for five to six smaller meals spaced throughout the day. This approach not only helps manage reflux but also ensures you are getting the necessary nutrients without overloading your smaller stomach.

It’s important to ensure that you are still meeting your nutritional needs, especially your daily protein requirements. Your bariatric dietitian can help you design a meal plan that includes the right amount of protein while minimizing the risk of reflux.

2. Identifying Trigger Foods and Patterns

Certain foods and eating habits can exacerbate reflux symptoms. Identifying and avoiding these triggers can make a significant difference.

Foods that are spicy, fatty, or acidic (like citrus fruits and tomatoes) can trigger reflux. Caffeine, chocolate, and carbonated beverages are also common culprits. Keep a food diary to track what you eat and note any reflux symptoms that follow. This can help you identify specific foods that cause problems.

Pay attention to how you eat as well. Eating too quickly, not chewing your food thoroughly, and eating large meals can all contribute to reflux. Make a conscious effort to eat slowly, chew your food well, and listen to your body's signals of satiety.

3. Timing Your Evening Meal

Eating your dinner at least two to three hours before bedtime can help reduce reflux symptoms at night.

Have your main evening meal early enough to allow your stomach ample time to digest before you lie down. This reduces the likelihood of stomach contents moving up into your esophagus while you sleep.

If you still experience nighttime reflux, try elevating the head of your bed by a few inches. This uses gravity to help keep stomach contents down. You can do this by placing blocks under the bedposts or using a wedge pillow.

4. Continued Weight Loss Efforts

Ongoing weight loss can significantly help in managing reflux symptoms. Excess weight, particularly around the abdomen, can increase pressure on your stomach and LES, leading to reflux.

Incorporate regular physical activity into your routine. Exercise not only supports weight loss but also improves overall digestion and reduces stress, which can contribute to reflux.

5. Medication Options

Sometimes, dietary and lifestyle changes alone may not be enough to manage reflux symptoms, and medications may be necessary.

Antacids are common over-the-counter options that can help reduce stomach acid and manage reflux symptoms. Always consult with your healthcare provider before starting any new medication.

If over-the-counter options are not effective, your doctor may prescribe stronger medications to help manage your symptoms. It's important to follow your doctor's recommendations and report any side effects.

6. Regular Follow-Ups with Your Bariatric Dietitian and Doctor

Ongoing support and monitoring from your bariatric dietitian and healthcare team are crucial in managing reflux post-surgery.

Schedule regular appointments with your dietitian to review your diet, weight loss progress, and any reflux symptoms. They can provide tailored advice and adjustments to your meal plan.

Additionally, keep your doctor informed about your reflux symptoms. They can monitor your condition, suggest appropriate medications, and ensure that no underlying issues are contributing to your reflux.

Conclusion

Managing reflux after bariatric surgery is a multifaceted process that requires a combination of dietary adjustments, lifestyle changes, and possibly medical intervention. Understanding the causes of reflux and implementing effective strategies can significantly improve your comfort and quality of life. Remember to eat smaller, more frequent meals, identify and avoid trigger foods, time your meals appropriately, and continue your weight loss efforts. Additionally, medications can provide relief when lifestyle changes are not enough. Regular follow-ups with your bariatric dietitian and healthcare team are essential to monitor your progress and make necessary adjustments.

Staying informed and motivated on your weight loss journey is crucial. Join the Bariatric Nutrition Bootcamp, a four-month program designed to help you attain your WLS goals. The Bootcamp offers custom, intensive and long-lasting support as you navigate your weight loss journey. Remember, you're not alone in this process—ongoing support from your dietitian, and bariatric community can make a significant difference.

Written by Jane Stoltze, Bariatric Dietitian, RD