A typical problem after weight loss surgery is bloating. Hardly anyone talks about it, but once it comes up, all the barriers break down. The extent of the bloating seems to go beyond any known limit.
The causes of bloating lie in the changes made to the digestive tract as part of the surgery.
Normal digestion
During normal digestion, food is first chewed in the mouth and mixed with saliva. The enzymes present in saliva break down the starch in the food. The food passes through the oesophagus into the stomach. There, the food pulp is further digested both mechanically and with the help of enzymes. Strictly speaking, the components are acidified by the highly acidic gastric juice (hydrochloric acid) and thus activate an inactive enzyme (pesinogen) to form an active form (pepsin). This can further break down the protein components. To prevent the stomach from digesting itself, the stomach wall is coated with a protective mucus. Other enzymes and components break down the food components even further or are necessary for the absorption of vitamin B12 (intrinsic factor).
As soon as the food pulp leaves the stomach, the digestion, i.e. the breaking down of the food, is complete. After that, it is only a matter of absorbing the nutrients (carbohydrates, fats and proteins). In addition, water is absorbed from food and digestive juices.
In the following large intestine, most of the remaining water is absorbed and intestinal microorganisms ferment any remaining food particles. In the last section, the rectum, more water is absorbed. This is followed by excretion.
The reduction in stomach size achieved by both gastric bypass and gastric sleeve surgery means that food is no longer pre-digested in the stomach, or only to a limited extent. In this pre-digestion, for which the gastric juices are responsible, carbohydrates, for example, are broken down.
What causes the bloating?
Bloating is always a sign that something has ended up in the intestine that cannot be digested. For example, in the case of lactose intolerance, unsplit lactose may end up in the large intestine. This lactose intolerance may develop after weight loss surgery. This then leads to bloating. Very fatty foods can also cause bloating.
The anatomical changes in the gastrointestinal tract can also mean that food is not sufficiently prepared for digestion. In the stomach, the amount of gastric acid is no longer sufficient to break down the carbohydrates, and the mechanical ‘pretreatment’ is no longer carried out. Another effect of a shortened small intestine is that the food cannot be fully broken down. On the one hand, this is desirable because less energy (calories) is absorbed from food, but on the other hand, it can lead to the symptoms described. Finally, there may be a change in the bacterial colonisation of the intestine. This also has an effect on digestion.
How can I treat bloating?
There are two approaches here: firstly, you can treat bloating and, secondly, you can try to prevent it. There are many home remedies for treating bloating.
- add fennel seeds or caraway seeds to your cooking or drink a corresponding tea.
- chew cloves, pour over hot water and drink or cook
- movement (e.g. in the fresh air, then you’re not disturbing anyone else)
- abdominal massages
- activated charcoal (from the pharmacy)
- aniseed tea
- apple cider vinegar (4 teaspoons in a glass of water, 3 times a day)
- probiotics
- heat (e.g. with a hot water bottle)
How can I prevent bloating?
To prevent bloating, you should start by keeping an accurate food diary or even a poop diary. This should include all food and drink, and any bloating should be recorded to see if a connection can be made between certain foods and the bloating. If such a connection can be established, then of course you should avoid that food. Typical causes are lactose and carbohydrate-rich foods. But even carbonated drinks can at least cause bloating.
- avoid classic ‘bloaters’ (onions, garlic, cabbage, beans, legumes)
- milk and dairy products that contain lactose
- sugar and sugary foods
- yeast
- unripe fruit, berries
- fatty foods (sausages, soups)
- muesli and wholegrain bread
If you leave out the above products and your symptoms improve, you can gradually reintroduce individual products to see if the bloating returns.
