A look at why your tastes change after gastric bypass, gastric sleeve and LAP-BAND^® and what weight loss surgery patients can do about it.

Is it possible to not like bacon? If you’re a patient who’s had gastric bypass, gastric sleeve or LAP-BAND^® surgeries, bacon may be one of those foods you just don’t like anymore. Add dairy, sweets and fried foods to that list of dislikes and you may be wondering if the surgeons operated on your tongue as well as your stomach.

Rest assured you’re not alone in this phenomenon. Changes in the way food tastes, smells or is tolerated are incredibly common following weight loss surgery. In fact, a recent study found a whopping 97% of participants reported at least one change following their procedure. Much to the delight of dietitians everywhere, these changes in taste tend to work to the patient’s advantage! Studies indicate patients who reported food aversions had significantly greater weight loss and reduced BMI following surgery compared to those who experienced no food aversions.

As a registered dietitian who works with bariatric patients, I hear about my patients’ evolving relationship with foods, satiety (the feeling of fullness), taste and digestion daily. Counseling patients to anticipate and effectively manage these changes is part of the pre-surgical nutrition program for all New Jersey Bariatric Center^® patients. So let’s get a better understanding of the most common changes, why they are likely to occur and ways to best manage any that don’t work in your favor.

What are some of the most common changes?

Researchers at the University Hospitals of Leicester looked at the relationship between taste, smell and appetite among 103 patients who’d undergone gastric bypass surgery between 2000 and 2011. Nearly half of the patients polled reported their sense of smell changed following weight loss surgery and 73 percent noticed changes in the way food tasted. Topping the list for patients experiencing taste changes is increased sensitivity to sweet foods and sour foods.

Reduced tolerance and cravings for sweets and fast foods are common changes reported by many of my patients, and one I don’t mind hearing since sugary and fried foods are a big no-no after surgery. Some patients may become so sensitized that even protein shakes and powders taste overly sweet and are difficult to tolerate. If this occurs, especially during the liquid-only portion of the post-operative diet, be sure to consult with your doctor or dietitian to ensure daily protein needs are being met.  Some tips that may help include thoroughly chilling the protein shakes to improve taste. Patients can also try savory options like unflavored protein powder in clear broth or a bariatric soup mix.

What food aversions occur most often?

Almost daily I have a patient report in amazement how their once-favorite food is no longer appealing to them. Food aversions usually develop immediately following surgery and may lessen or disappear over time. In studies, animal proteins top this list with patients steering clear of chicken, steak, ground beef, lamb and cured meats like bacon, sausage and ham. Eggs, dairy products including ice cream, cheese and milk and starches such as rice, pasta or bread also ranked high on the list of disliked foods. Interestingly, very few patients reported aversions to fruits or vegetables. Some New Jersey Bariatric Center^® patients even report loving veggies like broccoli or cauliflower like never before.

In my experience, patients may feel turned off to foods for a variety of reasons including smell, appearance, texture or consistency. Sometimes a change in preparation method can help improve tolerance. Simple adjustments like stewing meat instead of baking or grilling and poaching eggs instead of frying may prevent the often-reported feeling of food “sticking” on the way down. Even patients who experience multiple aversions or dislikes are able to meet their daily protein goals with some guidance and modifications.

What are some other common food-related post-op changes?

Eating behaviors may also be impacted following surgery. These include reduced emotional eating and less influence of external eating cues. It makes sense that these changes may be related to the above-mentioned aversions or altered taste perceptions, especially if overly sweet and greasy foods are less appealing. There is also a growing body of research to support the idea that the mood-altering effect of sweets, that infamous sugar high, is decreased following surgery. And while I can’t promise you’ll start craving kale instead of chocolate, it is possible that eating out of habit or because a food is “just there” might become a thing of the past.

What are some tips for dealing with food intolerances?

• Meats like beef, chicken, turkey and pork are best cooked with liquids or marinades that maintain moisture. Drier preparations are frequently not tolerated well and leftovers may be challenging.
• Fish and shellfish are also best steamed or sautéed to maintain moistness, and patients sometimes report preferring smaller, more tender shrimp to larger ones. Additionally, the higher fat content of fish such as salmon and dark tuna may take longer to tolerate compared with other varieties.
• Cow’s milk and dairy foods may be difficult to tolerate due to the lactose, protein or both. If milk, yogurt or cheese aren’t sitting well, look for unsweetened alternatives made from almonds, soy, rice and hemp.
• For grains such as rice or pasta, try overcooking slightly or undercooking depending on your taste. Breads may be better tolerated toasted as opposed to soft.  Remember, however, that keeping carbohydrate foods to a minimum will optimize nutrient status and weight loss totals following surgery.
• Eggs are a great source of protein and may be tolerated differently depending on preparation. Try hard-boiled, scrambled, soft-boiled, poached or fried to determine which ways work best for you.
• Stringy or membranous vegetables and fruits can be difficult to digest with a shorter transit time.  It’s advisable to wait several months following surgery to try things like celery, asparagus or grapefruit, and even then they may require blending and straining or removal of the membranes. Peeling fruits and veggies with thick skins such as apples, peaches and cucumbers can also be helpful.
• Experiment with different salad greens to determine if one type is better tolerated than another. As with all raw veggies, waiting at least a month to try these foods is generally a good idea.
• Portion size and the rate of eating may affect the perceived tolerance of a food.  Be very conscious of keeping portions small and chewing bites to a pureed consistency before swallowing. Liquid-type foods such as yogurt or soft cooked eggs might allow for larger portions and less chewing than drier, more solid foods like chicken. Progress slowly and carefully when introducing new foods and learn to recognize feelings of satiety. A much smaller stomach means even one extra bite is too much!

What causes all these changes following weight loss surgery?

While the exact cause is unknown, many experts believe sensory changes occur as a result of fluctuating hormones in the gut and their effects on the central nervous system. This gut-brain axis as it’s known and its relationship to bariatric surgery is a subject of much research and speculation. In a nutshell, your nervous system relays countless transmissions about your hunger, satiety and cravings each day between your GI tract and your brain. Because the carriers of these messages are affected by changes in weight and the removal of a portion of the stomach, it is highly likely they have an impact on taste, smell, gratification and other sensory perceptions.

Leptin and ghrelin are hormones that  are known to have a prominent role in the relationship between hunger and satiety. Ghrelin also plays a role in determining how much of what we eat is burned for fuel versus stored as fat. Weight loss alone results in an increase in ghrelin, which explains why we tend to feel hungry as soon as we restrict calories and begin to shed pounds. Surgically induced weight loss, however, in which a portion of the stomach is removed or bypassed, reduces the production of ghrelin while restricting the volume of food consumed. This unique combination explains, at least in part, why bariatric patients are able to eat less but not feel hungrier as a result.

Leptin also plays an important role in telling your body when you are full and how calories are stored.   It is believed that weight loss improves the body’s  sensitivity to the messages leptin delivers to the gut and brain. This in turn may result in greater food satisfaction with smaller quantities and less flavor intensity (think those sweet, savory and greasy foods we discussed earlier).

Remember, no two patients are the same and everybody’s post-weight-loss-surgery experience is unique. I hope this information has helped you to better understand some of the whys behind commonly experienced aversions and sensory changes and how to work with them while you transition to a new way of eating.