Download Can You Be Vegan/Vegetarian after Bariatric Surgery

Can You Be Vegan/Vegetarian after Bariatric Surgery?
By Laurie Shank, RD, LDN
Bariatric Dietitian
All Bariatric surgery patients know that we must be diligent
with our nutrient intake after surgery. It just makes sense
that we would need supplementation once a large portion
of our digestive system is bypassed. As a bariatric patient,
your vitamin regimen becomes a way of life: multivitamin,
Calcium, Vitamin B12, Iron, Vitamin D, etc. We should
also remember: Protein! Protein! Protein!
But what about those who follow a diet that is already
typically difficult to reach proper intake of these key
nutrients? Many Americans believe that vegetarian or
vegan diets are lacking in many nutrients; the most easily
identifiable being protein. Without meat, how do you get
enough protein in?
This is a common question in our meat-based society. And with the malabsorption after
surgery, plus the limited choices of vegetarian diets, is it possible for a vegetarian to
have bariatric surgery and stay healthy?
Let’s start by clarifying a few key definitions: Vegetarian refers to those who abstain
from animal products. There are several types: lacto-ovo vegetarians eat eggs and
dairy, but no meat. Lacto-vegetarians eat dairy, but not eggs or meat. Vegans are
stricter, abstaining from meat, dairy, eggs, and sometimes other animal-derived
products such as gelatin and honey. There are also pescatarians, who abstain from
meat, but do eat seafood, as well as varying degrees of vegetarianism such as those
who eat white meat but not red meat.
People choose a vegetarian diet for many different reasons. They may be vegetarian
out of concern for cruelty to animals or other similar ethical reasons. Others may be
vegetarian for religious reasons. People may also choose the vegetarian lifestyle for
health reasons. The Academy of Nutrition and Dietetics notes that vegetarians tend to
have lower risk of death from ischemic heart disease, lower LDL-Cholesterol (bad
cholesterol), lower blood pressure, lower rates of hypertension and type II Diabetes,
“Can You Be Vegan/Vegetarian after Bariatric Surgery?”
By Laurie Shank, RD, LDN
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lower BMI’s, and overall lower cancer rates. Still others may choose a vegetarian
lifestyle because they do not prefer the taste of meat.
For time’s sake, let’s focus on the strictest form, veganism, so we can cover all of our
nutrient bases in one shot. The most typical nutrients which are difficult to achieve
optimal levels in the vegan diet include: Protein, Vitamin B12, Iron, Calcium, Vitamin D,
Omega-3 Fatty Acids, Zinc, and Iodine.
Protein
It is true that meat is a good source of protein. After bariatric surgery, we emphasize to
concentrate on lean meats for protein, and always eat your protein food first. Almost all
unrefined foods contain some amount of protein. Vegetables, beans, whole grains,
nuts, and seeds all contain protein. Fruits, sugars, and fats do not contain protein. It is
very easy to meet daily protein needs if these foods are incorporated at each meal daily.
I’m sure some people have heard the concept of “complete proteins.” This refers to a
protein that contains all of the essential amino acids that our body needs. Amino acids
are the building blocks that make up a whole protein. Each serves different functions in
our body. Many amino acids our bodies can make ourselves. However, there are nine
of them that we need to consume from food. Studies have found that isolated soy
protein can meet protein needs just as effectively as animal-based proteins. However,
most whole-grain sources of protein such as cereals tend to be low in the essential
amino acid lysine. To ensure adequate lysine intake, include more beans and soy
products in your diet. The protein recommendation after bariatric surgery is 60-70
grams per day for women and 75-85 grams per day for men. This is easier to meet
than you may think. 1 cup of cooked soybeans is 29 grams of protein. 1 cup of cooked
lentils is 18 grams of protein. Most beans contain 15 grams of protein per cup. 2
tablespoons peanut butter contains 8 grams protein, 1 cup broccoli or spinach contains
4 or 5 grams. Two slices of whole wheat bread contain 7 grams protein. A medium
bagel contains 10 grams. Again, the bariatric patient wants to make sure that half of
their plate is filled with these high-protein foods, and the protein food is always the first
eaten during a meal.
“Can You Be Vegan/Vegetarian after Bariatric Surgery?”
By Laurie Shank, RD, LDN
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Vitamin B12 and Iron
Vitamin B12 (Cyanocobalamin) and Iron are also commonly thought of as being
deficient in vegetarians. It is true that red meats are the most well recognized source of
both Vitamin B12 and Iron. Iron from meat sources is mostly “heme iron.” This kind is
more readily absorbed than the “non-heme iron” found in plant sources. Due to this
decreased bioavailability of the Iron found in plant sources, the recommended Iron
intake for vegetarians is 1.8 times higher than those for non-vegetarians. Absorption is
also a concern for the bariatric patient, which is why we recommend lifelong
supplementation. The enzymes responsible for breaking down Iron and B12 for
absorption are located in the stomach. It makes sense that a person with 85-95 percent
of their stomach removed would have inhibited absorption. How can you combat this
decreased absorption? There are some things which help to increase Iron absorption,
such as Vitamin C. Also, it is important to remember that some foods inhibit Iron
absorption, such as the tannins in coffee and tea. You can maximize your Iron
absorption by avoiding coffee and teas with meals. Vegetarian sources of Iron include
dried beans and dark green leafy vegetables such as spinach and kale. Make sure to
include a food source of vitamin C with your meal. This can increase non-heme Iron
absorption up to six-fold, which makes it just as absorbable as heme Iron. Some
vegetables, such as broccoli and bok choy, are high in both Iron and vitamin C.
Unfortunately, there is no significant source of Vitamin B12 in the vegan diet. Lacto-ovo
vegetarians can obtain vitamin B12 from dairy and eggs. Vegans must consistently
consume foods fortified with vitamin B12 such as fortified soy and rice beverages, some
breakfast cereals, and meat analogs. The RDA for B12 intake is 2.4 micrograms per
day. However, the stomach is also responsible for producing the acidic environment
and the enzymes responsible for absorbing vitamin B12. Therefore, the recommended
supplementation for bariatric surgery patients is 500 micrograms per day, up to 1,000
micrograms per day if deficient and in need of repletion. This is higher than the nonsurgical vegan supplementation recommendation of 50-100 micrograms daily.
“Can You Be Vegan/Vegetarian after Bariatric Surgery?”
By Laurie Shank, RD, LDN
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Calcium
The general view of the American public is that dairy products are the only way to get
enough calcium in your diet. The RDA for calcium is 1,000 mg per day, 1,200 mg per
day for women. However, the bariatric patient needs 1200-1500 mg per day. It is true,
dairy sources are good sources of calcium, with approximately 200 mg of calcium in an
8 ounce glass of milk. Good plant sources of calcium include dark green leafy
vegetables, tofu made with calcium sulfate, and fortified soy milk or orange juice.
Soybeans and soy nuts, broccoli, bok choy, collards, okra, and kale are also good
sources. Some higher calcium dark leafy greens contain oxalates, which greatly
decrease calcium absorption. These include spinach, rhubarb and chard. Other leafy
greens do not have this effect. Plant milks such as soy milk contain 300-400 mg per 8
oz., while tofu contains approximately 200-400 mg calcium in 4 oz. Dark green leafy
vegetables contain anywhere from 100-200 mg calcium per cup. As a bariatric patient,
it remains important to take additional calcium daily due to the limited absorption from
your post-surgical stomach. But what else can you do to help increase absorption? For
one, get adequate Vitamin D, which helps Calcium absorption. Following a low sodium
diet also helps maximize calcium absorption, as high sodium intake increases kidney
calcium excretion. Weight bearing exercises also help to increase Calcium absorption
into your bones. So keep up that exercise routine!
Vitamin D
The main source of natural vitamin D is sunlight exposure. Our bodies produce vitamin
D. The only real food source of vitamin D are foods that are supplemented with it, such
as fortified orange juice, soy milk, rice milk, and some breakfast cereals. Vegans or
vegetarians need to make a conscious effort to include foods fortified with vitamin D if
sunlight exposure is inadequate to maintain body stores. If supplementation is
necessary, Vitamin D-3 (Cholecalciferol), and Vitamin D-2 (Ergocalciferol) are available.
Vitamin D3 is made from animal sources. Vitamin D2 is made from plant sources.
Because Vitamin D3 is absorbed more efficiently than Vitamin D2, vegans who choose
supplementation with Vitamin D2 may need to take higher doses.
“Can You Be Vegan/Vegetarian after Bariatric Surgery?”
By Laurie Shank, RD, LDN
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Overall, a vegan or vegetarian diet can meet all nutritional needs of the average person.
However, due to the decreased bioavailability of some plant forms of vitamins, along
with the decreased absorption that follows bariatric surgery, the bariatric patient will
require careful meal planning to include rich sources of these key nutrients and may
require additional supplementation.
Sources:
1) Vegetarian Resource Group; Simply Vegan 5th Edition.
2) Position of the American Dietetic Association: Vegetarian Diets.
“Can You Be Vegan/Vegetarian after Bariatric Surgery?”
By Laurie Shank, RD, LDN
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