Vegans without stomachs

In cases of severe obesity some people have their stomachs or a big part of their stomachs removed surgically. This in theory leads to eating less volume of food.
A small study from Israel included five vegans who underwent this operation. The study includes some nutrient recommendations for vegans who have had their stomachs (partly) cut out.

“Among the 21 patients who declared on vegetarian diet presurgery, 57.2% (n = 12) declared on lacto-ovo pattern, 19.0% (n = 4) declared on pesco-vegetarian pattern, and 23.8% (n = 5) declared on vegan pattern.”

Table 3 [...]
Nutrient Recommendations for [..] vegan bariatric surgery patients
Protein intake requirement following BS [bariatric surgery] is 60–90 gr/day or 1.1–1.5 g/kg ideal weight (i.e., BMI = 25 kg/m2)
• Foods high in protein should be prioritized over foods high in carbohydrates or fats
• Consume a variety of plant-based proteins such as unprocessed soy products, legumes and seitan, [...]
• Patients who fail to consume adequate protein in their diet may need to increase protein intake through protein supplements to preserve muscle mass
• Vegan protein powder are currently available
• Consume plant-based (e.g. unprocessed soy products, legumes, and nuts) [...] high-iron foods [...] and adhere to iron supplementation recommendation
• Life-long supplementation with 45–60 mg/day iron by multivitamin and additional supplement as needed is required for deficiency prevention [Avoid this at all cost if you don’t have iron deficiency.]
• Vitamin C should be consumed by food or supplement with iron supplements in order to ameliorate iron absorption
• Consume high plant-based zinc foods (e.g., unprocessed soy products, legumes, grains, [.] and nut[s]) and adhere to the recommended supplementation
• Organic acids, such as citric acid, should be consumed by food in order to improve zinc absorption
• The routine daily multivitamin should contain 8–22 mg of zinc/day
• Consume [...] plant-based high calcium foods (e.g., unprocessed soy products, chick peas, kale, turnip greens, and Chinese cabbage), [...] and adhere to the recommended supplementation
• 1200–2400 mg/day of calcium by food and supplement should be consume by BS patients
• To date, gaps are present in the literature regarding the association between BS and trace element status
• Consume [a] multivitamin supplement which contains a wide variety of minerals including iodine
• Vitamin B12 absorption decreases following BS because of changes in hydrochloric acid production and decrease of intrinsic factor
• Routine B12 supplementation is required following Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) in order to prevent deficiencies; however, for LSG [laparoscopic sleeve gastrectomy] patients there is currently no such uniform guidance
• All vegetarians [including vegans] should take at least 500 μg/day of a B12 supplementation
• Adhere at least to the routine vitamin B12 supplementation recommendations for vegetarian or vegan patients
• The routine recommended dose of vitamin D post-surgery is 3000 IU, but it depends on the serum concentration (adequate serum levels are >30 ng/ml)
• Supplements of Vitamin D3 which is made from animal sources (lanolin) and vitamin D2 which is made from plant [fungal] sources (UV irradiation of ergosterol from yeast) are available; however, currently vitamin D3 from plant source [lichen] are also available
• At doses lower than 1000 IU, vitamins D2 and D3 appear equally effective; however, at doses higher than 1000 IU/day, vitamin D3 appears to be significantly more effective at raising serum D concentrations
• Adhere to vitamin D supplementation in order to preserve adequate serum levels
• Include ALA sources in the diet such as flaxseed, chia, walnuts, canola oil, and soy [...]
• In cases of supplementation use, supplements of omega-3 fatty acids based on ALA (e.g., flaxseed or clary sage [clary sage seed, Salvia sclarea, see]) or DHA-rich microalgae supplement are available“

An example for a daily meal plan for vegan bariatric surgery patients
   Soy yogurt, 1 teaspoon of flaxseeds and ½ banana
Morning snack
   Whole wheat bread with spoon of hummus salad
   Cup of chick peas, white rice and cooked vegetable
Afternoon snack
   Small apple
   100 g of tofu steak and small vegetable salad with spoon of whole sesame tahini
Night snack
   Soy protein powder with glass of soy milk“

[I have some but very limited knowledge on bariatric surgery. If you somehow can avoid it, and lose weight by eating a healthy, fibre-rich, plant-based diet, I would recommend avoiding this operation. If you regularly overeat consider counseling by a specialized psychologist.
As you can see from the sample menu – this is not a lot of food, and not a lot of fruit and vegetables, so not a lot of antioxidants and other phytonutrients that might be able to aid in the prevention of disease.
If you are a vegan who is considering bariatric surgery or has had bariatric surgery I would love to hear from you.]

Sherf-Dagan S, Hod K, Buch A, Mardy-Tilbor L, Regev Z, Ben-Porat T, Sakran N, Goitein D, Raziel A: Health and Nutritional Status of Vegetarian Candidates for Bariatric Surgery and Practical Recommendations. Obes Surg. 2017 Jul 11. doi: 10.1007/s11695-017-2810-7. [Epub ahead of print]

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