Fasts after bariatric surgeryBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3706 (Published 21 July 2010) Cite this as: BMJ 2010;341:c3706
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People who observe total fasts (abstaining from all forms of nourishment including liquids) for religious reasons or as a lifestyle choice after having undergone bariatric surgery face several challenges, including the risk of dehydration, poor nutritional intake, decreased concordance with medications and nutrient supplements, and adverse symptoms such as dumping syndrome and steatorrhoea . We undertook a telephone survey of 230 Kuwaiti residents (186 women), including 35 people with diabetes, who had undergone bariatric surgery (207 sleeve gastrectomy, 13 gastric bypass, seven gastric banding and three other procedures) on a day of fasting in the month of Ramadan (20th July – 19th August, 2012) to assess 24-hour intake of food and fluids, concordance with medications and adverse symptoms, and compared with a non-fasting day 4 – 8 weeks after Ramadan.
Whereas there were no significant differences in the total daily intake of fluids or incidence of adverse gastrointestinal, hypoglycaemic and sympathoadrenal symptoms, men and women consumed 18% and 14% fewer calories and 41% and 31% lesser protein during fasting, respectively. Of participants who were on pharmacotherapy, 91% took their prescribed medications; whilst 84% of them made no changes to the doses, 83% changed the timing of the medications to fit around dusk-to-dawn mealtimes.
We conclude that fasting is well tolerated in otherwise healthy individuals who have undergone common bariatric procedures such as sleeve gastrectomy, gastric bypass or gastric banding. However, we would advise caution in patients taking therapies such as insulin, those observing fasts during long summer days in northern latitudes and those who have undergone procedures such as duodenal switch and biliopancreatic diversion which pose a greater risk of malabsorption and dehydration. Patients should be advised on adequate intake of fluids and nutrients, with particular emphasis on intake of high quality proteins (at least 60 g daily ), and the doses and timings of prescribed medications and nutrient supplements should be reviewed.
Ebaa Al-Ozairi, consultant endocrinologist and assistant professor, Kuwait University, Safat 13110, Kuwait
Jumana Al-Kandari, registered dietitian, Dasman Diabetes Institute, Dasman 15462, Kuwait
Akheel A. Syed, consultant endocrinologist and honorary senior lecturer, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford and The University of Manchester, Manchester, UK
We thank all participants; Dalal Al-Haqqan and Yusuf Masters, medical students, Kuwait University; and Obaid Al-Harbi, consultant surgeon, Farwaniya Hospital, Kuwait, for their contributions without which this work would not have been possible.
Ethical approval was granted by the Institutional Review Board, Dasman Diabetes Institute.
Ramadan begins 9th July, 2013.
1. Chan F, Slater C, Syed AA. Fasts after bariatric surgery. Bmj 2010;341:c3706.
2. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery*. Obesity (Silver Spring) 2013;21 Suppl 1:S1-S27.
Competing interests: No competing interests