Beware of bottled water

Bottled water does not have to conform to the same standards as tap water, and bottled water often has more bacteria than tap water. One of the more common bugs that grows in bottled water is called Campylobacter jejuni, which is a particularly nasty bug that causes nausea, vomiting, and diarrhea. I recommend to friends, family, patients, and readers to drink some of the lightly carbonated waters—such as Pellegrino® or Perrier®.

Avoid heavily carbonated beverages - often they are a source of many calories.

A number of patients have become obese simply by drinking high calorie liquids. Think about it—in thirteen days, two sodas a day will add an extra pound of fat (280 calories a day x 12.5 is 3500 calories, which is stored as one pound of fat). That is 29 pounds in a year. Some patients come to us drinking ten sodas a day (that is 146 pounds of fat in a year).

What about coffee, tea, and other caffeinated beverages?

Caffeine is a mild appetite suppressant. However, it is very mild and too dangerous in large quantities to use as a tool for weight loss. There are few calories in coffee or tea, however, and they can be used to supply some of the liquid that is needed. Again, a cup of coffee or tea is fine—a pot of coffee is extreme.

Some have stated that coffee or tea will cause people to lose more water (diuretic effect)– but this has not been proved. In fact it has been disproved in scientific studies. The only fluid that causes you to lose more water than you drink is alcohol. Some have stated that coffee or tea will cause people to lose more water (diuretic effect)– but this has not been proved. In fact it has been disproved in scientific studies. The only fluid that causes you to lose more water than you drink is alcohol.

Again, it is not the coffee or the tea, but often it is the things that you put in it. The latte, the syrups, the sugar, are calories that are not needed. But remember, your author is Norwegian, and like any Norwegian, coffee is an essential food group. My Norwegian grandmother was brought to the hospital after suffering a massive heart attack. She went into a coma, but came out of it a bit. She sat up and asked for a cup of coffee. The nurses didn’t want to give it to her (saying it was bad for her 89-year-old heart) but her doctor overruled them. She drank the coffee, thanked the nurses, smiled, and went to sleep—and died a few hours later.

Water loading can be a useful tool to diminish appetite

Drinking water before you know you are going to crave food is a way to decrease the appetite. The water will cause the stomach to stretch a bit and get rid of some of the hunger pains. Starting to crave something that you think might contain too many calories? Drink some water. Find that at a certain time of day you need to have a snack? Try to drink some water before you get there. Set a watch an hour before have the water and see if your daily caloric intake decreases.

Weight loss surgery patients should avoid highly carbonated beverages

Having just committed heresy, it is time to pop some myths. Believing that carbonation might stretch a pouch, many weight loss surgeons advise against drinking any form of carbonated beverages. There is no evidence of this phenomenon. However, there are plenty of reasons to avoid the highly carbonated beverages, especially early in the post-operative period.

If you cannot burp, then you might have a problem with carbonation. However, no matter how your guts were rearranged, there are two ways for the gas to escape—you will either burp or it will pass down a bit lower. Given that release valve, it is highly unlikely that the gas that comes out of the carbonated beverage will stretch the stomach. If you drink very carbonated beverages (all sodas on the market today are heavily carbonated) early in the post-operative period you will feel very uncomfortable, especially if you drink too quickly—hence, we ask that patients avoid these beverages for at least six weeks.

Drinking heavily carbonated beverages (most colas, sodas, pop) will force food out of your pouch, leaving you hungry and increasing the amount of food you will eat. Having solid food remain in your pouch is the mechanism by which you feel full is. The faster the food leaves your pouch, the faster you will become hungry again. Food will remain in your pouch for several hours if you let it.

You can force it out by gulping down water—but the fastest way to get food out of your pouch is to drink a heavily carbonated drink. Carbonated drinks contain carbon dioxide (gas) mixed in with the beverage, and when they are swallowed the warm environment of the stomach causes the gas to come out of the beverage quickly. This gas will rapidly push the food out of your pouch. You will become hungry shortly after drinking that beverage. We call this phenomenon “rapid pouch evacuation.”

We use rapid pouch evacuation as a tool when patients get food stuck in their stoma of their upper pouch. Sometimes a patient swallows too large a piece of meat, such as pork, chicken, or steak, and it becomes stuck. If the patient drinks some soda it will usually force that food out. We also use this in patients who have not had weight loss surgery, but who get food stuck in their esophagus (called a food bolus). The radiologists have “fizzies,” tablets that when exposed to liquid cause a rapid release of gas—and this usually forces the food bolus out of the esophagus and into the stomach.

Lightly carbonated beverages, such as most sparkling waters, do not have this same effect. To prove this we took some willing patients and asked them to eat some food that had been soaked with barium so we could watch it on the x-ray. The food remained in their pouch nicely for several hours. If we gave them soda at anytime, the food would be expelled from the pouch. This was not observed when we gave them the lightly carbonated waters.

One of the technical reasons that patients may need to have a surgical revision of their RNY gastric bypass is because the stoma between the upper pouch and the lower pouch enlarges. If it enlarges too much then it has to be revised. One reason the stoma becomes enlarged is because patients force too much food through the stoma— causing it to stretch. Could this have been from soda causing food to be forced through a small stoma? Yes, it could have, quite easily.

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