Gastric Bypass, Lap Band or REALIZE Band – A Nutritionist’s Perspective
By Karen Kelly, RD, New Jersey Bariatric Center

Frequently when I meet with patients contemplating weight loss surgery at the New Jersey Bariatric Center they’re still debating which surgery – gastric bypass, Lap Band or REALIZE Band – is right for them. Often, they ask for my opinion from a nutritional standpoint, regarding which one they should pick, or which one is “better.”  These are decisions that can only be made by patients, together with their doctor, based on their weight, lifestyle, and medical history.  However, what I can do is explain the nutritional differences between the surgeries to arm patients with the nutritional side of what life will be like post- gastric bypass, Lap Band or REALIZE Band surgery to factor into their decision.

One of the first considerations to look at nutritionally regarding weight loss surgery is vitamin and protein maintenance.  While all three procedures require a multi-vitamin, a calcium supplement and a diet high in protein, Lap Band and REALIZE Band surgery requires less vitamin and protein maintenance than the gastric bypass.  When bypassing the stomach and initial section of the small intestine as one does in gastric bypass surgery, you also bypass the area where B12, a key nutrient, is prepped [it binds with a stomach enzyme] to be absorbed in the small intestine.  It’s therefore very important that gastric bypass patients take a daily supplement of B12, which is placed under the tongue so it can be absorbed directly into the bloodstream. 

Protein supplements are also an important part of a weight loss surgery patient’s diet. It’s important for a Lap Band and REALIZE Band patients to supplement protein for the first two weeks after their surgery while they’re on a full liquid diet, and for gastric bypass patients to take a protein supplement for the rest of their life.   The mal-absorptive nature of gastric bypass results in not only preventing the absorption of part of the calories one eats, but also the absorption of the proteins and nutrients one needs to survive.  That’s why gastric bypass patients will need to supplement proteins and vitamins (Iron, Calcium, Vitamin B12) for the rest of their lives.  To ensure you’re getting the nutrients you need to stay healthy, your doctor will perform annual blood check to see if you are adequately talking these vitamins and minerals.  [Note - the side effects of not regularly taking supplemental proteins and multivitamins can take years to develop in some cases and by then it can be too late to replete the body of these essential building blocks so it’s essential you follow the supplement regimen your doctor prescribes.]

So, now it seems like the decision is simple – the Lap Band or REALIZE Band is the way to go, less vitamin and protein supplements to deal with, therefore it must be easier.  It’s actually the opposite, Lap Band and REALIZE Band patients must be more vigilant about what they eat than gastric bypass patients. 

Here’s why, let’s use liquids as an example- specifically liquid calories such as juices, sodas and fancy coffee drinks.  For weight loss in general, it’s recommended to avoid all liquid calories.  It’s even more important with weight loss surgery. Due to the mal-absorptive component of gastric bypass, liquid calories that are sweet will cause a patient to experience dumping syndrome (nausea, sweating, increased heart rate).  Dumping syndrome is unpleasant, and experiencing it once often prevents patients from consuming these high calorie beverages again.  This side effect, while unpleasant, helps curb a patient’s desire for unhealthy foods such as sweets.  However, Lap Band or REALIZE Band patients can consume liquid calories without experiencing dumping syndrome. The absence of the mal-absorptive nature of the Lap Band or REALIZE Band doesn’t give their body the signal that these beverages are not good for them, thus making compliance with dietary restrictions more rigorous. 

All surgeries – gastric bypass, Lap Band or REALIZE Band - have their pros and cons from a nutritional stand point, and choosing one is an individual decision based on your doctor’s counsel, your lifestyle and your tolerance to the different restrictive natures of both procedures.   Regardless of which procedure you decide to move forward with, adopting an overall healthy lifestyle with proper nutrition and exercise is the key to success.