All those who have had a gastric bypass should be taking one multivitamin tablet each day. We currently recommend MultiADE, which is small, cheap and contains some vitamin A, a variety of vitamin Bs, vitamin C, vitamin D and vitamin E. If you wish to take a different one, check with the insert or pharmacist that it is at least as good.
The most common and predictable deficiencies develop for vitamin B12, folic acid and iron. Deficiencies of any of these lead to low energy levels. Those with B12 deficiency can become irritable and have low powers of concentration. These deficiencies come about becuase absorption of these vitamins/minerals is redued after gastric bypass. Defiiency will not normally be able to be corrected by dietary manipulation. Appropriate supplements will be required. If you need B12 or folic acid supplements at any time, these will always recur if you stop the supplements, so the supplements should be taken for life. We recommend the folllowing:
One sublingual (dissolve under the tongue) B12 dot per day. These are not generally available in chemist shops, but can be obtained from health food shops. The alternative is a vitamin B12 injection each month or sometimes each 6-12 weeks. The frequency of injection should be determined by the interval after which your tiredness/fatigue returns, not by the level in the blood. There is no harm from having a high (even very high) blood level.
We recommend one 5g folic acid tablet per day by mouth.
OneFerro-Gradumet or Ferrograd C tablet per day for three months. Repeat as necessary. If this does not work, try two tablets per day. If constipation is a major problem, you could try Carbonyl Iron. Some people will require intramuscular injections of iron each month or intravenous iron infusions periodically (e.g. once a year).
In our experience deficiency of vitamin D does not come about because of the gastric bypass, but it does seem to be common in many people, especially women. It is a good idea to have this checked periodically and if it is low it can be corrected by a once a month oral tablet. Talk with your doctor about this.
Recommended blood tests
Annual blood tests: Once your routine follow-up visits have finished (at 2 years), we recommend that you have regular blood tests performed by your doctor each year to check that all is well. Different doctors will do different tests, but we recommend that whatever is done they should include a full blood count, liver function tests, INR (which reflects Vitamin K levels), creatinine and electrolytes, ferritin, vitamin B12 and vitamin D. We usually also do glucose, HbA1c and lipids.
Weight regain after Fobi pouch gastric bypass
The advantage of the Fobi Pouch gastric bypass over all other forms of gastric bypass and other bariatric operations is that the gastric pouch is very unlikely to enlarge with time and the outlet of the pouch cannot enlarge with time because of the ring. This means the restriction to eating is going to be permanent. Minor weight regain (5- 10kg) may occur as you relax your eating patterns a little and make a few food choices that previously you did not make (especially sweet things).
More worrying weight regain can really only occur for one of two reasons, or both.
Snacking too often
Grazing all day long. While you may not be able to eat much each time you eat, if you eat more often, then you can get more calories in, and you will gain some weight.
Remember, if you feel peckish, have a drink (e.g. water, cup of soup), not food.
Poor food choices
This usually means too much bread, potato, rice or pasta. These are carbohydrates (sugars) and can do a lot of damage to your weight. Bread is the commonest problem. Most people find bread very difficult to eat after Fobi Pouch but if you are able to eat bread, we would encourage you to limit yourself to only 1 slice per day (toast or bread). Each slice can be as much as 100cal! Dont have sandwiches or filled rolls, even if you can manage them. You will gain weight!
If you can manage sweet food, this may well be the reason. You must work to avoid taking much.
The Fobi Pouch operation is a very reliable one. Most people have no or minimal feels of hunger after this surgery, which makes eating small, infrequent meals easy. If you do feel hungry, try to manage this between meals with drinks, not further food, and certainly not sweet food.
Frequent regurgitation / reflux / vomiting with weight regain
This almost always means you are eating too much and too fast. After a Fobi Pouch gastric bypass each meal should be only be one to one and a half cup of food and should take you at least 20-40 minutes to eat even up to 60 minutes. If you are regurgitating often, it is almost certainly because you are trying to eat too quickly. Slow down, and this should be much better. Food sitting above the pouch, in the oesophagus, hurts and leads you to regurgitate / salivate / vomit. Despite doing so, you may also gain weight, because you are eating too much!