{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:25:57Z","timestamp":1791498357399,"version":"4.3.4"},"reference-count":30,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Bariatric surgery (BS) is the most effective long-term treatment for severe obesity, but many patients develop food intolerances that either reduce protein and micronutrient intake or shift consumption toward easily tolerated, calorie-dense \u201csafe\u201d foods (e.g., sweets, ice cream, sugar-sweetened beverages, refined-flour snacks), compromising nutrient adequacy and weight-loss maintenance. This narrative review summarizes evidence on the prevalence, mechanisms, and clinical impact of food intolerances after BS, focusing on red meat, dairy, water, cereal, and vegetables, and offers practical nutritional management strategies. Methods: A targeted literature search of PubMed and Cochrane Library from the past 10 years was conducted. Studies were selected based on relevance and quality. Results: Intolerance patterns vary by food type and surgical method. Red meat is the most frequently problematic food, with some patients symptomatic for years despite gradual improvement. Dairy products cause gastrointestinal discomfort in some cases, partly due to lactose intolerance. Cereal products may initially cause swallowing difficulties but are generally well tolerated two years postoperatively. Water intolerance mainly occurs shortly after sleeve gastrectomy (SG), linked to sleeve aperistalsis and edema, resolving within weeks. Cooked vegetables are overall well tolerated across procedures. Mechanisms behind intolerance include mechanical restriction, altered gastric emptying, exaggerated entero-hormonal responses, and new taste aversions. Conclusions: Food intolerances are a common, procedure-specific consequence of BS, requiring systematic assessment and personalized dietary management. Early management\u2014modification of consistency, portion control, and supplementation\u2014can improve product tolerance, prevent nutritional deficiencies, and support sustainable weight loss. However, further prospective studies on the mechanisms of food intolerances are needed.<\/jats:p>","DOI":"10.3390\/nu17193118","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T10:54:48Z","timestamp":1759229688000},"page":"3118","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Food Intolerance After Bariatric Surgery: A Narrative Review of Prevalence, Mechanisms, and Dietary Management"],"prefix":"10.3390","volume":"17","author":[{"given":"Karolina","family":"Brzostek","sequence":"first","affiliation":[{"name":"Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7469-914X","authenticated-orcid":false,"given":"Iwona","family":"Boniecka","sequence":"additional","affiliation":[{"name":"Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2025, July 02). Obesity and Overweight. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11695-022-06332-1","article-title":"2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery","volume":"33","author":"Eisenberg","year":"2023","journal-title":"Obes. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1007\/s11695-024-07118-3","article-title":"IFSO Worldwide Survey 2020\u20132021: Current Trends for Bariatric and Metabolic Procedures","volume":"34","author":"Angrisani","year":"2024","journal-title":"Obes. Surg."},{"key":"ref_4","first-page":"125","article-title":"Polish Expert Consensus on Metabolic and Bariatric Surgery\u20142025 Update","volume":"20","author":"Major","year":"2025","journal-title":"Videosurgery Other Miniinvasive Tech."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/bjs.10419","article-title":"Gastrointestinal Symptoms and Food Intolerance 2 Years after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity","volume":"104","author":"Boerlage","year":"2017","journal-title":"Br. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1016\/j.orcp.2013.02.002","article-title":"Food Tolerance and Diet Quality Following Adjustable Gastric Banding, Sleeve Gastrectomy and Roux-en-Y Gastric Bypass","volume":"8","author":"Freeman","year":"2014","journal-title":"Obes. Res. Clin. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"464","DOI":"10.4239\/wjd.v8.i11.464","article-title":"Bariatric Surgery and Long-Term Nutritional Issues","volume":"8","author":"Lupoli","year":"2017","journal-title":"World J. Diabetes"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.1016\/j.soard.2019.09.054","article-title":"Dehydration Risk Factors and Impact after Bariatric Surgery: An Analysis Using a National Database","volume":"15","author":"Ivanics","year":"2019","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1007\/s11695-023-06540-3","article-title":"Is Food Tolerance Different after Bariatric Surgery Depending on the Surgical Procedure?","volume":"33","year":"2023","journal-title":"Obes. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Jungert, A., Finze, A., Betzler, A., Rei\u00dffelder, C., Blank, S., Otto, M., Vassilev, G., and Betzler, J. (2025). Food Tolerance and Quality of Eating after Bariatric Surgery\u2014An Observational Study of a German Obesity Center. J. Clin. Med., 14.","DOI":"10.3390\/jcm14144961"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1007\/s11695-019-04358-6","article-title":"Water Tolerance after Laparoscopic Sleeve Gastrectomy","volume":"30","author":"Elward","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kvehaugen, A.S., and Farup, P.G. (2018). Changes in Gastrointestinal Symptoms and Food Tolerance 6 Months Following Weight Loss Surgery: Associations with Dietary Changes, Weight Loss and the Surgical Procedure. BMC Obes., 5.","DOI":"10.1186\/s40608-018-0206-4"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/j.soard.2014.10.009","article-title":"Red Meat Intolerance in Patients Submitted to Gastric Bypass: A 4-Year Follow-Up Study","volume":"11","author":"Nicoletti","year":"2015","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.ajcnut.2022.11.016","article-title":"Changes in Dietary Intake, Food Tolerance, Hedonic Hunger, Binge Eating Problems, and Gastrointestinal Symptoms after Sleeve Gastrectomy Compared with after Gastric Bypass: 1-Year Results from the Oseberg Study\u2014A Randomized Controlled Trial","volume":"117","author":"Barstad","year":"2023","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s11695-007-9016-3","article-title":"A New Questionnaire for Quick Assessment of Food Tolerance after Bariatric Surgery","volume":"17","author":"Suter","year":"2007","journal-title":"Obes. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s11695-018-3544-x","article-title":"Food Intolerance 1 Year after Banded Roux-en-Y Gastric Bypass","volume":"29","author":"Gobato","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3891","DOI":"10.1007\/s11695-020-04732-9","article-title":"Tolerance to Specific Foods after Laparoscopic Sleeve Gastrectomy","volume":"30","author":"Curtis","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1089\/lap.2017.0601","article-title":"Food Tolerance and Quality of Alimentation Following Laparoscopic Sleeve Gastrectomy Calibrated with a 50-Fr Bougie: Long-Term Results","volume":"28","author":"Bozhychko","year":"2018","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2868","DOI":"10.1007\/s11695-017-2703-9","article-title":"Long-Term Food Tolerance after Bariatric Surgery: Comparison of Three Different Surgical Techniques","volume":"27","year":"2017","journal-title":"Obes. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1007\/s11695-018-3561-9","article-title":"Gastric Emptying and Food Tolerance Following Banded and Non-Banded Roux-en-Y Gastric Bypass","volume":"29","author":"Malheiros","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1007\/s11695-017-2850-z","article-title":"Food Tolerance and Eating Behavior after Roux-en-Y Gastric Bypass Surgery","volume":"28","author":"Furtado","year":"2018","journal-title":"Obes. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1007\/s11695-014-1221-2","article-title":"Taste, Smell and Appetite Change after Roux-en-Y Gastric Bypass Surgery","volume":"24","author":"Graham","year":"2014","journal-title":"Obes. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1007\/s11154-023-09794-5","article-title":"Precision Nutrition in the Context of Bariatric Surgery","volume":"24","year":"2023","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.clnesp.2022.01.026","article-title":"Food Tolerance, Nutritional Status and Health-Related Quality of Life of Patients with Morbid Obesity after Bariatric Surgery","volume":"48","author":"Yue","year":"2022","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s11154-020-09571-8","article-title":"Diet Approach before and after Bariatric Surgery","volume":"21","author":"Bettini","year":"2020","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Frias-Toral, E., Chapela, S., Gonzalez, V., Martinuzzi, A., Locatelli, J., Llobera, N., Manrique, E., Sarno, G., Mingo, M., and Marchese, F. (2025). Optimizing Nutritional Management before and after Bariatric Surgery: A Comprehensive Guide for Sustained Weight Loss and Metabolic Health. Nutrients, 17.","DOI":"10.3390\/nu17040688"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"382","DOI":"10.3945\/an.116.014258","article-title":"Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice","volume":"8","author":"Goldenshluger","year":"2017","journal-title":"Adv. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.soard.2019.10.025","article-title":"Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures\u20142019 Update: Cosponsored by American Association of Clinical Endocrinologists\/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists","volume":"16","author":"Mechanick","year":"2020","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1080\/00365521.2020.1837927","article-title":"Lactose after Roux-en-Y Gastric Bypass for Morbid Obesity: Is It a Problem?","volume":"55","author":"Westerink","year":"2020","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Thornton, S.N. (2016). Increased Hydration Can Be Associated with Weight Loss. Front. Nutr., 3.","DOI":"10.3389\/fnut.2016.00018"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/19\/3118\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T11:34:52Z","timestamp":1759232092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/19\/3118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":30,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["nu17193118"],"URL":"https:\/\/doi.org\/10.3390\/nu17193118","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}