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Bariatric Focus: Your Water and Fluid Needs


Water is an essential nutrient in the diet. The general goal of fluid intake is 64 ounces or eight eight ounce cups per day, though needs vary based on climate, activity level, gender, and body weight. Further, regarding daily fluid intake based on gender, The Institute of Medicine Dietary Reference Intake (DRI) recommends at least nine cups water for women and 12 cups for men.

Maintaining adequate hydration may prove challenging after bariatrics weight loss surgery due to limited capacity of fluids in the new small stomach pouch. Also, post-surgery patients must space meals and fluids and are advised to drink fluids up to 30 minutes before and after eating. Water is emphasized as the primary source of fluid intake after weight loss surgery. Yet, consumers have a surplus of commercially prepared water products from which to choose that include bottled waters, (artificially) flavored waters, and enhanced waters that can contain herbal ingredients. As patients find ways to meet their daily fluid goal, it is important that patients are educated and aware of proposed benefits and possible side effects that select ingredients in enhanced water products have on the human body.

Enhanced waters containing vitamins and minerals marketed for health may be of some or no benefit depending on the timing of intake and amount in the product. Further, excessive intake resulting in oversupplementation actually can be unhealthy. These products may contain other ingredients with potential adverse side effects. Water-soluble vitamins B and C are found in most enhanced waters and are touted to improve immune function. Fat-soluble vitamins A and E added to water require the presence of fat for absorption. If a post-surgery patient is not eating and drinking at the same time, there is little absorption of these fat soluble micronutrients; thus, the benefit is negligible. Plus overtime, excess supplemental vitamin A intake over the Tolerable Upper Level (dosage greater than 10,000 IU per day) is associated with reduced bone mineral density and increased risk for hip fracture . Minerals in enhanced waters include calcium and chromium (picolinate). In these products, chromium is marketed for positive insulin action on blood glucose. Further research is warranted for the benefit and support of chromium picolinate as a supplement across the population. In general, vitamins and minerals need to be in correct balance for best utilization in the body for absorption.
Some enhanced or flavored waters contain excess calories and sugar and should be avoided to prevent weight gain and possibly ‘dumping syndrome’, gastrointestinal side effects, including nausea, cramping, diarrhea, fast heart rate, associated with intake of added sugar fluids or foods and specific to post-Roux-en-Y gastric bypass (RYGB) surgery. Waters containing carbohydrates are necessary with endurance exercise. A carbohydrate product with 4% to 8% carbohydrate solution is recommended for exercise greater than one hour. Carbohydrate concentrations greater than 8% reduce the efficacy of fluids emptying from the stomach and absorbing in the intestine. After RYGB surgery, the best fluid options for rehydration of carbohydrates with endurance exercise include carbohydrate fluids with no more than 10 grams of sugar per servings to help prevent ‘dumping syndrome’. For example, a post-surgery RYGB patient may dilute regular Gatorade® with water or consume G2® (product) that contains fewer carbohydrates per serving. Since volume of fluids able to be consumed at one time is limited after weight loss surgery, drinking approximately one cup of fluid over one hour is recommended. Depending on the duration of exercise, rehydration during and after exercise is important. Carrying a sports bottle or water bottle throughout the day is recommended after surgery as a reminder to constantly take sips of fluids in order to meet daily fluid goals.

Nearly all body processes depend on water for proper functioning and to prevent dehydration. After bariatrics weight loss surgery, water and sugar-free/diet beverages are acceptable. Fluids containing carbonation, caffeine, and alcohol should be avoided. Carbonated beverages can cause discomfort due to the small stomach pouch. Caffeine interferes with calcium absorption which is at risk for deficiency after weight loss surgery; caffeine also is a mild diuretic. Alcohol intake should be limited after weight loss surgery, especially since alcohol absorption after RYGB is significantly increased partially due to the intestinal restructuring. Caution is advised for consumption of fluids containing stimulants or any other ingredients with possible adverse side effects, including fluids that are ‘energy’ drinks. Awareness of fluid needs and making a conscious effort to drink water and other recommended fluids is essential to maintaining good nutrition and a healthy lifestyle after weight loss surgery.

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