Dear Kaye:

Why does eating sometimes cause vomiting?

Dear Kaye, I'm pre-op and I've heard that WLS patients vomit a lot. Is this true and what causes it?
Evelyn, Kansas City

This is a good question, Evelyn, and one I think of often as I have become a “frequent puker.” I always wonder what’s wrong with me, especially when I hear other weight loss surgery patients say, “I never get sick.” I get sick a lot. Just this last weekend I vomited my water first thing in the morning – I guess I gulped it to fast. So, here’s what bariatric science has to say:

Most pre-operative bariatric patients have heard woeful tales of post-op patients with severe vomiting problems. Vomiting is caused for two reasons: first, not chewing food thoroughly and second, overfilling the tiny tummy. Doing either of these causes immediate and violent vomiting. It can be painful. It can cause loss of bladder control. For some, the retching and vomiting can be quite loud and embarrassing. It is equally painful to allow the food to sit in the tiny tummy waiting to digest.

When vomiting results from swallowing poorly chewed food, particularly red meat, it is because the passageway leaving the tiny tummy has been blocked. The exit from the stomach to the intestine is only a half-inch opening – that’s roughly the diameter of your little finger! Food that lodges in this narrow passage will digest eventually or be evicted from the body by vomiting. When food is lodged in the passageway it is quite uncomfortable, the pain is in the upper abdomen just behind the sternum. Some people report large pills becoming lodged in this opening. For me, the most common cause of blockage is swallowing salad greens without chewing well.
When we were obese we habitually took big bites and ate rapidly. We didn’t chew our food well. We were fast eaters. As soon as one bite was in our mouth we had our forks loaded to dish in the next bite. When we revert to big bites and rapid eating after surgery vomiting is inevitable. It is good to form the habit of eating slowly and chewing thoroughly. This not only prevents a blockage, but also improves the overall eating experience. If you find a specific food that consistently causes a blockage you may wish to avoid it.

The other reason for vomiting is overfilling the tiny tummy. Just like filling a pail with sand at the beach, once the pail is full excess sand spills over the top. If you fill the tiny tummy too full the excess food will spill out by way of vomiting.

I have found that measuring portions is an effective way to avoid vomiting, particularly with a soup or pasta dish. With these kinds of soft foods, it is very easy to get ahead of myself and suddenly I’ve overloaded my pouch and I’m in a hurry to the bathroom. For example, if I were having spaghetti and meat sauce I would measure one-quarter cup of pasta and one-half cup of sauce. And that would be it. I now know better then to dip back into the bowl for “just one more bite.” That just one more bite has sent me retching more times than I care to admit. I monitor my eating every day to stop eating and not take that last bite.

Do not try to suppress vomiting. The sooner you purge your stomach, the sooner you will feel better. It’s embarrassing and unpleasant to vomit but this is your tiny system’s method of managing mistreatment. It doesn’t take many episodes of nausea before chewing food completely and eating slowly is a habit.