Acid Reflux after Gastric Sleeve and Bypass

Gastroesophageal Reflux Disease (GERD) and Acid Reflux after Gastric Sleeve, Bypass, or other bariatric surgery procedures.

Guest post by Erica Perusse, Bariatric Food Coach Dietetic Assistant. Read her full-author biography at the end of the post! 

Taming the Bariatric Burn (the raging fire of GERD)

You settle in after a meal, ready to unwind, and BAM! There it is, creeping up your throat like an unwelcome guest at a party. The burning sensation, the sour taste, the relentless coughing – it’s like a tag team of discomfort hitting you all at once. Is it a heart attack? Heartburn? Indigestion? You’re left questioning what triggered it – too much food, too fast?

All you know is it’s downright unpleasant, and something’s brewing in your throat or chest (food, liquid, maybe even a fire alarm!). Yep, it’s that dreaded feeling, and if you’ve been there, you know exactly what I’m talking about.

But hey, you’re not alone in this battle!

Why does acid reflux happen after Gastric Sleeve or Bypass?

We tend to see more acid reflux issues in Gastric Sleeve patients. Explanations have included the postoperative angle and the increase in intragastric pressure. For that reason, a patient with a history of reflux might be recommended to have a Gastric Bypass. For some, pre-existing reflux will improve after bariatric surgery and weight loss. More on that soon.

So, here’s the deal: What you’re going through might be a sign of something called gastroesophageal reflux disease (GERD). It’s not the easiest thing to talk about, but it happens when the acid from your stomach (breaking down your food) comes back into your esophagus.

There’s this muscle at the bottom of your esophagus that is supposed to open up when you swallow food, letting it into your stomach. Then, it’s supposed to close up tight to keep everything where it belongs.

This muscle? It’s called the lower esophageal sphincter (LES). But sometimes, when it relaxes too often or too long, stomach acid can sneak its way back into your esophagus. And that’s when you get hit with that burning sensation, which can even cause some damage to your esophagus. Ouch, right?

We can do plenty to calm this fiery troublemaker and restore harmony to our digestive tracts. Here are some strategies to help tackle this fiery dragon head-on and find some relief for that bariatric burn! (the GERD burn).

Menu Management 101:

Eating right for GERD does not have to mean that you will need to cut out all of your favorite foods. It means that you will be making small modifications to your Gastric Sleeve or Bypass menu to help reduce your discomfort. It is about building your plate with a variety of foods that include lean protein, veggies, fruit, healthy fats, and possibly complex carbs depending on your post-op diet stage.

While, yes, certain foods have the potential to trigger GERD symptoms, it’s essential to be mindful of what you eat. There’s a whole lineup of trigger foods and beverages that can spark flares, and the more tuned in you are to your body’s reactions, the better.

The usual suspects are typically spicy dishes, acidic fruits, caffeine, and chocolate. We can categorize foods along the pH scale, which measures acidity levels. Those with a low pH are often acidic and might stir up reflux problems. On the other end of the scoop, foods with higher pH levels, aka alkaline foods, can help neutralize stomach acid. Think bananas, melons, cauliflower, fennel, and nuts. However, we are unique, so what sets off a flare for one might not for another. Go for lighter, less acidic options like lean proteins, veggies, and whole grains whenever possible.

Foods that might trigger acid reflux after Gastric Sleeve or Bypass

Alcohol
High-fat foods
Coffee
Mint
Onions
Citrus and tomato products
Carbonated drinks
Caffeine drinks

Seeking recipe ideas to manage GERD symptoms? Give these bariatric-friendly suggestions a shot!

(As with all recipes, if a specific ingredient is a trigger for your GERD, omit or sub it for something else.)

Sheet Pan Lemon Chicken with Green Beans
Skillet Roasted Carrots
Egg Roll Salad Jars
Chicken or The Egg Salad
Chocolate Mousse Dip – Bariatric Dessert
Shrimp and Cauliflower Grits
Non-Alcoholic Watermelon Margarita 

You may be wondering why a watermelon drink?  Watermelon is considered to be a low-acid fruit that won’t provoke your symptoms. And there’s nothing quite like enjoying a juicy wedge of ripe watermelon on a scorching summer day. Cantaloupe and honeydew are also excellent low-acid options, too.

Let’s talk about eggs. They’re packed with protein, which is great. But if eggs give you trouble, consider sticking to the whites and avoiding the yolks, which are higher in fat and more likely to cause symptoms.

Now, onto lean meat. High-fat meals and fried foods can lower pressure on the LES and slow down stomach emptying, upping the chances of reflux. Opt for lean meats cooked by grilling, poaching, broiling, or baking to keep things easier on your stomach.

Eating behaviors that can help manage acid reflux after bariatric surgery

How you eat can be just as important as what you eat to manage acid reflux.

Bites and Speed:

Take small bites, chew your bites well, and slow the pace of your eating. Rushing through meals can lead to your bites backing up instead of fitting comfortably into your gastric sleeve or bypass pouch. Eating too fast or too big of bites are BIG culprits of making GERD symptoms worse. Plus, taking your time to chew thoroughly can help your digestion and ease discomfort.

For more guidance on bites and speed, visit this blog post.

Grab this freebie for help on eating more mindfully and slowly!

Stay Hydrated:

Get in some water throughout the day to dilute stomach acid and keep things flowing smoothly. Just avoid chugging large amounts of liquid with meals, as it can increase stomach pressure.  It’s also best to steer clear of drinking during meals after bariatric surgery, as it might overload the restricted stomach pouch, leading to reflux and increased hunger between meals.

I know it feels like if you lean too much in one direction with your water (or anything really), you are falling towards trouble.  Am I right?  Just like with any adjustments, I will say, it gets easier to understand how your body responds to what you are doing.  If you find yourself needing a little support or encouragement, remember, that’s exactly what our Bariatric Food Coach Premier Membership community is here for.

Ditch the Tight Threads:

This is something you may not realize, but there is importance to giving yourself a little breathing room. Give your belly some space by opting for looser-fitting clothing. Tight clothing attire can squeeze your abdomen, leading to more reflux.

Be Mindful:

Pay attention to how different foods impact your body. Observe your bite sizes and portion sizes during meals, pay attention to your drinking habits, and tune into your body’s hunger and fullness cues. It’s not just about what you eat, but how much. Taking larger bites or consuming larger portions can exert pressure on your stomach, increasing the likelihood of reflux. Keeping a food diary can be a helpful tool to identify trigger foods and patterns, empowering you to make informed choices.

Also, be mindful of what you do after eating. While timing can vary from person to person, it’s generally not recommended for GERD sufferers to have a full meal less than three or four hours before bedtime. This is because digestion boosts the production of gastric acid in the stomach. When you lie down, the lower esophageal sphincter’s ability to prevent stomach contents from flowing up the esophagus diminishes. When combined, increased stomach acid and a reclined position create a recipe for reflux.

Consider taking a leisurely walk after eating to aid digestion and incorporate some movement before settling in for the evening. Staying upright allows gravity to assist in keeping stomach acid where it belongs.

Seek Medical Care:

If you’re dealing with GERD or acid reflux, we strongly encourage you to connect with your bariatric team or provider. Seriously, don’t hesitate as we would not want you to experience any more distress. Whether you’ve been actively tweaking your lifestyle habits or not, it’s vital to clue them in on what you’re going through and what you’ve been trying to ease the discomfort.

There are over-the-counter options or you may have your PPI (protein pump inhibitor) started up again or increase the dosage.  These are solid option, but we still strongly recommend looping in your provider for top-notch medical advice. If you do not have a bariatric team, please reach out to Steph, and she can point you in the direction of someone in your area. Remember, every patient is unique, so collaborating closely with your doctor is key. Your provider might adjust medications, tweak dosages, or suggest other medical interventions tailored to your body and situation.

Here’s the scoop on GERD and specific bariatric surgeries:

Research has found that after Gastric Bypass, 70% of patients with GERD saw either remission or significant improvement, compared to 55% after Sleeve surgery.* So, it’s common for folks with a history of GERD to lean towards Gastric Bypass. But if GERD persists post-surgery, especially for Sleeve patients despite trying proton pump inhibitors (PPIs), switching to Gastric Bypass might be recommended by your medical care team.

Remember, managing GERD is about finding what works for you. It may take some trial and error, but with patience and perseverance, you can tame the flames and reclaim peace in your gut. Here’s to happy bellies, joyful hearts, and a reflux-free life

Disclaimer: Information provided on the BFC site is for educational purposes only, and does not substitute for professional medical advice. Bariatric Food Coach aims to be another layer of support on your bariatric journey.  

*Source: Pocket Guide to Bariatric Surgery, Academy of Nutrition and Dietetics 

Additional Sources :

Duyff, R. L. (2017). Academy of Nutrition and Dietetics Complete Food and Nutrition Guide (5th ed.). Boston, MA: Houghton Mifflin Harcourt.

Mayo Clinic Staff. (n.d.). Heartburn: Lifestyle and home remedies. Mayo Clinic.

Read Erica’s post on her meal planning style here! 

About Erica

Hey there, I’m Erica, your reliable BFC Virtual Dietetic Assistant! You might recognize me from Steph’s LIVE sessions, where I’ve helped out with graphics, handouts, social posts, presentations, or spotted me hanging out in the Premier Membership Community.

I proudly graduated from Kansas State University in May 2023, holding a Bachelor of Science in Nutrition and Health, another in Dietetics, and a Minor in gerontology. When I’m not working, I’ve been enjoying married life with my husband Tj for almost 21 years. We’re proud parents to amazing boys named Jarett and Tyler, and have three fur babies, Annabelle, Sadie, and Malakie.

I’ve got a double dose of military pride at home with my husband and eldest son both serving! Working remotely for two dietitian practices is such a blessing. This year, I’m aiming to tackle my dietetic internship and Master’s degree program. Busy times ahead, but I’m ready to dive in!