The benefits of eating slowly: Bariatric Surgery

Speed before and after surgery

"Eating Slowly" is a dietary guideline in the context of bariatric surgery

"Eating slowly" is a strong dietary guideline in the context of bariatric surgery (Sleeve, By Pass)

« Eat slowly and chew small bites of food thoroughly » UCSF Health

«Eat and drink slowly, to avoid dumping syndrome — which occurs when foods and liquids enter your small intestine rapidly and in larger amounts than normal, causing nausea, vomiting, dizziness, sweating and diarrhea" Mayo Clinic

« Eat slowly: put a small amount of food in your mouth at a time and chew this very well.“NHS- Bristol

This recommendation occurs both before the surgery in the pre operative context (PRE OP) and after the surgery in the post operative context (POST OP).

You will find in this article reasons which explain this recommendation

PRE OP: prepare your body

Before the surgery, by eating slower you will prepare your body and work on your physiological parameters, namely

on your weight see (https://slowcontrol.com/en-us/mag/science/science/the-benefits-of-eating-slowly-obesity). There are numerous studies that demonstrate a link between weight gain and eating quickly. Other Study also shows how spcifically eating slower with a smart fork helps you lose weight (https://slowcontrol.com/en-us/mag/science/science/publications-with-the-slow-control-fork)

• on your hypertension see (Slow Down, You Eat Too Fast: Fast Eating Associate With Obesity and Future Prevalence of Metabolic Syndrome study). Feeding speed is significantly and positively correlated with the risk of metabolic syndrome (hypertension, type 2 diabetes, stroke, heart attack) see study (The group with metabolic syndrome (obesity, high blood pressure, low high density lipoprotein cholesterol, high triglycerides and high fasting blood sugar) was more likely to eat fast (Korea, 2009, 7081 adults)

Physiological parameters, which the authorities recommend to stabilize or lower when entering into the surgery protocol.

PRE OP: prepare your eating automatisms

The principle of the bariatric surgery (Sleeve, By pass) is to operate a mechanical restriction (reduction in volume or section of your digestive circuit). This mechanical restriction will automatically constraint you to eat more slowly. If you do not yet have the reflexes or the tools to help you, and if you are a fast eater, then you will suddenly face the difficulty of resuming your habits of fast eaters which will no longer be tolerated by your body. The body tolerates them badly because the bits of food become too large or too agglomerated in terms of the mechanical restrictions operated by the surgery. This is manifested by a series of annoyances (vomiting, pain…) that you probably want to avoid. A 2018 study even assesses these difficulties in the absence of tools to help eating slowly: "12% of patients have gastroesophageal reflux, 11% of transit disorders, 10% of nausea / vomiting, 7% a dyspepsia, 7% a feeling of fullness to the point of discomfort, 6% pain when swallowing, and 2% dumping syndrome. "

Studies show that surgical candidates are largely fast eaters, if not very fast. Proportion estimated at 55% according to a first American study (1) and 66% according to a second Australian study (2). In short, the braking effort will be all the more brutal, by asking to slow down from a very fast rhythm to a very slow rhythm if the preparation for the change of automatism is insufficient and not prepared.

· At least one episode of binge eating in the week for 66% of the preoperative candidates (USA, 2017, 343 adults)

· Prevalence of self-reported binge eating disorder is 55% (Australia, 2015, 197 women pre-operative)

POST OP : Esophageal peristalsis constraints the minimum interval in between two mouthfull

When you swallow your food, it first goes into the esophagus, a tube that is about 10 inches long. Food is pushed by muscle contractions throughout its journey. This movement is called esophageal peristalsis. The duration of descent of food is approximately 20 seconds to reach the stomach. If the stomach has undergone a mechanical restriction (bypass, gastric sleeve, sleeve gastroplasty), it is easy to understand that it will be necessary after the operation to space at least more than 20 seconds the time between two mouthfuls to prevent food from bottling up in the esophagus or at the level of the stomach restriction.

See this excellent video (in English, 6 minutes with illustrations) this video of surgeon Dr. Paul O'Brien of the Center for Bariatric Surgery in Melbourne for more explanation.

POST OP: Beware of speed recovery

A Swedish *** study of 2012 measures the average POST OP feeding speed recovery after a by pass surgery. It appears that after the operation the meal speed is significantly slowed down, but that over time and fairly quickly the old habits are reinstalled. After two years on average, in the absence of speed control assistance, candidates practice an estimated meal speed of 72% of the initial meal speed. Meal speed is at 45% of the preoperative speed at 6 weeks after the operation, at 65% at 1 year, at 72% at 2 years *** (Sweden, 2012, 74 adults).

This represents in the long term an obstacle to the success of the surgery which initially proposes a mechanical restriction. If after the operation, the resumption of the feeding speed remains too fast, then mechanically, the food will agglomerate during digestion and operate pressures on the tissues which will relax the mechanical restriction and therefore alter the benefit of the operation. Meals are then faster than the dietary guidelines. Indeed if a very fast or fast eater resumes a speed at 72% of its initial speed two years after the operation he does not eat slowly as recommended, but moderately quickly which remains too fast for the case of a PRE OP.

At the start, right after the operation, the body signals well to the patient by pain and various unpleasantness (vomiting,) that he (she) eats too quickly, which helps to slow down. But over time, the tissues slowly relax and without realizing it the patient picks up higher and higher speeds without the body notifying it. The body warns less and less because it has adapted to the mechanical pressure which initially generated pain and warnings.

Conclusion

Eating slower in PRE OP means giving yourself the best chance of getting well through the surgery

Eating slower in POST OP means giving yourself the best chance of retaining the benefit of the surgery

The Slow Control fork : your ally for eating slower

Do you know the Slow Control fork?

Its effectiveness in helping to eat more slowly has been scientifically demonstrated (see studies)

Published by Slow Control on