Fasting for Religious Purposes After Surgery

Publication Date: May 6, 2022
Last Updated: July 5, 2022

General and Nutrition Guidelines for Fasting After Bariatric Surgery

1. It is recommended that patientswho underwent bariatric surgery follow up with their surgeon and interdisciplinary bariatric team prior to fasting for assessment and guidance with safe fasting practices after bariatric surgery.
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2. Patients with diabetes are encouraged to consult with their healthcare clinicians to make appropriate medication adjustments of oral hypoglycemic agents and/or insulin.
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3. All patientswho want to fast should be prescribed a proton pump inhibitor to be taken daily for the duration of the fasting period. Fasting patients during Ramadan have been reported to complain of new-onset or exacerbation of existing GI complaints, among the most common being dyspepsia and heartburn. Additionally, patients with diabetes have been found to have higher rates of reflux esophagitis. Ramadan fasting has been found to modify the circadian rhythm, leading to an increase in gastric acidity during the daytime. The number of duodenal ulcers and duodenitis during Ramadan has been shown to be higher on upper endoscopy. Proton pump inhibitors have been used empirically on fasting patients because such patients have reported good control of their symptoms with these medications.
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4. Drink adequate fluids, preferably water, and maintain adequate hydration of .1.5 L/d.
  • When breaking the fast or preparing before the fast, eat hydrating foods such as vegetables, salads, fresh fruit, clear broths, and soups.
  • Consider sugar-free, electrolyte-containing beverages if fasting days are during high temperatures or high humidity, which may cause increased perspiration and increased risk of dehydration.
  • Avoid alcohol, caffeine, carbonation, and sugary beverages. Despite the lack of empirical research supporting the avoidance of carbonation after bariatric surgery, it was the consensus of these authors to continue the recommendation to avoid carbonation. There is some evidence presented in the nonbariatric literature that carbonation or ingredients found in carbonated beverages may have a detrimental effect on bone health, GI health, and oral health. A patient-centered approach to dietary guidance is highly supported.
  • Avoid excessively salty or spicy foods because they may contribute to dehydration.
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5. Limit intake of sweets (<10% of daily calories per day) to avoid dumping syndrome, consumption of empty calories, and increased risk of dehydration.
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6. Pre- or postfasting meals should be nutritionally balanced and incorporate whole grains, lean proteins, and unsaturated fats. Recommended protein intake is 60–120 g/d, or individual assessment may consider increased protein intake especially for patients with more malabsorptive bariatric procedures or if actively losing weight. Protein intake may be assessed with a range of 0.8–2.0 g/kg body weight per day.
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7. Avoid excessively fatty foods such as those which are fried, processed, or contain high amounts of saturated fats.
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8. At the postfasting meals, rather than having one large meal, consider smaller, more frequent eating times to increase nutritional protein intake while avoiding overfilling the pouch.
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9. Choose leaner cooking methods such as grilling, poaching, baking, sauteing, and stewing rather than deep frying.
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10. Take the recommended dosages of vitamin and mineral supplements as prescribed by your practitioner.
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Recommendation Grading

Overview

Title

Fasting for Religious Purposes After Surgery

Authoring Organization

Publication Month/Year

May 6, 2022

Last Updated Month/Year

February 12, 2024

Document Type

Consensus

Country of Publication

US

Document Objectives

This review article is issued by the American Society for Metabolic and Bariatric Surgery (ASMBS) in response to numerous inquiries made to ASMBS by patients, physicians, ASMBS members, hospitals, health insurance payors, the media, and others regarding the safety and recommendations for fasting for religious purposes after undergoing metabolic and bariatric surgery. 

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D050110 - Bariatric Surgery, D005215 - Fasting, D012067 - Religion

Keywords

bariatric surgery, fasting, religion

Source Citation

Craggs-Dino L, El Chaar M, Husain FA, Rogers AM, Lima AG, Sadegh M, Bashiti J, Chapmon K; American Society for Metabolic and Bariatric Surgery Integrated Health Clinical Issues Committee. American Society for Metabolic and Bariatric Surgery review on fasting for religious purposes after surgery. Surg Obes Relat Dis. 2022 Jul;18(7):861-871. doi: 10.1016/j.soard.2022.04.020. Epub 2022 May 6. PMID: 35668020.

Methodology

Number of Source Documents
76
Literature Search Start Date
January 1, 1996
Literature Search End Date
January 1, 2005