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Does Bariatric Surgery Change Taste Buds Post-Operatively?

August 13, 2018

It’s so rewarding to be a part of an individual’s journey through weight loss surgery and to be able to share in their excitement as they improve quality of life so quickly after surgery. Through the excitement, I still like to remind my patients that bariatric surgery does not produce “cookie cutter” results for everyone and there are often obstacles and challenges that pop up along the way. One of those challenges can be a difference in their taste buds.

My usual mantra to early post-op patients is: “ride the wave” and “embrace those learning lessons.”

Most patients are prepared for expecting some degree of abdominal pain and discomfort or even some nausea or vomiting during the recovery period.  Patients also have to find creative ways to trick their minds into thinking that eating pureed foods for weeks after surgery is at least a little bit enticing and eventually rejoice when they can be “over the mush!”

Does Bariatric Surgery Change Taste Buds?

Despite these expectations, the obstacles that patients seem to have challenges with navigating are reported “taste changes”  and a heightened sense of smell, combined with a lack of hunger and/or desire to actually want to eat.  More often than not, the initial thought amongst many is that bariatric surgery induces changes in the way the taste buds on the tongue operate.  This can leave many feeling somewhat frustrated when engaging in social situations involving food is not the same as it once was.

"Taste changes” has been a phenomenon that does not seem to be a widespread experience that all RYGB or SG patients have. It often becomes noticeable for patients within the first few weeks after surgery and can last for several weeks, months or even a year or more for some.

As a Registered Dietitian, it is difficult to counsel a patient on the potential to experience these changes after surgery until they are actually experiencing it first-hand. Throughout my years of practice, I often hear these common statements from post-op patients regarding changes to taste and even sense of smell:

  1. Sensitivity to sweet tasting items becomes heightened to the point that said foods can taste “sickeningly sweet”
  2. Foods that once were enjoyable to eat prior to surgery are no longer enjoyable or vice versa
  3. Plain water, even the fancy water collected from the flowing streams of a natural jungle waterfall that cost you $8.39 for a 16 oz. bottle tastes horribly disgusting
  4. The aromas coming from the foods that a family member is cooking in the kitchen are so intense that you physically need to leave the house and not return for at least five hours or more until the smell has completely dissipated.

Effects Of Both RYGB And SG Surgeries

In order to gain some traction with identifying how to navigate through these annoyances, it may help to learn that there may be some physiological explanation for why this may occur after RYGB (RNY, Gastric Bypass) and SG (VSG, Sleeve Gastrectomy) surgeries.

A recently published study by Nance et. al. researched the effects of both RYGB and SG surgeries on eating behaviors and potential changes to taste preferences of 31 subjects (23 RYGB and 8 SG) [1]. Results of the study found no link between surgical changes to the anatomy in potentially causing the taste changes.

Instead, the study revealed that taste changes, or more specifically changes in taste preferences, were simply due to the drastic changes in dietary intake accompanied by significant weight loss following bariatric surgery.

In fact, there have been other studies that have demonstrated that taste preferences can be altered even after non-surgical weight loss approaches.

Additionally, Nance et.al. found that both the RYGB and SG study subjects received less pleasure after tasting sucrose (representing sweet tasting items) but there were no significant increases or changes to taste sensitivity or even changes to the actual taste buds on the tongue. This helps to support the basis of the hedonic component of taste perception, or more simply, the “brain reward” we get from eating foods.

Other potential mechanisms of actions that can be used to explain these effects have been studied over the years and involve biochemical changes in gut hormones after RYGB and SG surgeries. Numerous gut hormones influence our feeling behaviors through several body systems, including the hypothalamus and amygdala brain centers.  Studies from both Peterli et. al. and Karamanakos et. al. had found that after both RYGB and SG surgeries, satiety gut hormones glucagon-like peptide 1 (GLP-1) and peptide tyrosine-tyrosine YY (PYY) are both  enhanced [2, 3] which could help to explain why the hedonic component of taste perception is altered after RYGB and SG surgeries.

Embrace The Notion Of A Healthier Relationship With Food

In realizing that these changes can occur, it is helpful to embrace the notion that life after bariatric surgery can also be a time for developing a healthier relationship with food and to explore the role that food can play in promoting complete wellness.

I encourage my patients to make time to purchase their own groceries (whether at a supermarket or even at a local farmers market) and spend time in the kitchen cooking. For some, it may all seem trivial, time-consuming or even overwhelming, but when the time is invested into these lifestyle habits, one can become more connected to the food that is fueling the body.

Time and practice in the kitchen can enhance and promote greater confidence to experiment with using a variety of seasonings, herbs, spices and cooking techniques.  Not only can this build a new healthy lifestyle habit, but it can help to elevate the palatability of the food and may possibly blunt the effects of those changes in taste perception after surgery.

Strategies to Navigate Taste Bud Changes

Try these strategies to navigate the changes (especially during the early post-op period):

  • The temperature of the food/meal: Cool/cold foods can take on a much different flavor as opposed to when it is hot which may increase the intensity of the flavor.
  • Spice it up: Considering adding seasonings/spices after the meal had been cooked so amounts can be adjusted to taste.
  • Artificial sweeteners:  The presence of artificial sweeteners (such as aspartame, saccharin, sucralose, etc.) can taste significantly sweeter, so aiming to limit many “sugar-free” or “diet” labeled products in the diet can be best. Be mindful of the selection of protein supplement powders/drinks which often use artificial sweeteners and instead look for natural, calorie-free sweeteners such as stevia which may be better tolerated.
  • Appearance: When following the puree diet stage during the recovery period, find ways to make the small meal look at least a little more appealing despite having those changes in taste. Opt for plating the small puree meal in a martini glass or small dish and top with a garnish such as chopped fresh basil.
  • Flavor water: For flavoring water without using any products made with artificial sweetener/other chemicals: Place fresh fruit, cucumber slices or even fresh basil or mint leaves in a fruit infuser bottle to naturally flavor the water. Many fruit infuser water bottles can be found for less than $20 from a variety of retail stores.
  • Straws: Consider using a straw if staying hydrated has been a challenge due to significant changes in taste.
  • Mix it up:  Be sure to choose a variety of meals/food choices throughout the day to avoid getting bored with limited variety.
  • Try ginger:  Ginger tea can be helpful settle an upset stomach...especially if the changes in taste have induced any nausea.
  • Options for protein:  Do not stress about having to drink protein shakes daily, especially if gagging on them is the typical reaction that occurs. Although muscle mass breakdown can be a concern after bariatric surgery, it is usually the result of the rapid weight loss from very low-calorie intake and can still occur even if one is meeting the recommended 60-80 gram daily protein goal.  There are plenty of ways to make a homemade protein-rich smoothie without any processed protein powders.  Consider ingredients such as plain Greek yogurt, cow’s milk or soymilk, ground flaxseed, smooth nut butters or powdered peanut butter to use in the smoothie.  Further progression to eating solid foods again will allow for the ability to get protein needs met from whole foods sources without having to rely solely on protein supplements.  Beans/lentils, lean animal meats or seafood, eggs, low-fat dairy products, whole grains, nuts/seeds and many vegetables are all great sources of protein.

Summary

For most, these changes in taste preference and perception seem to subside with time, or at least most patients evolve their adaptation to it.

I would imagine that at the end of the day, being able to climb stairs and go for walks easily with friends and family becomes more important to focus on.

A patient that is surrounded by a strong and encouraging support system can be a key foundation piece for embarking on any new chapter in life, especially one that involves improving quality of life and health.  The key is to develop lifestyle changes that can stand the test of time to promote long-term weight management.

References

  1. Nance, K.; Eagon, J.C.; Klein, S.; Pepino, M.Y. Effects of sleeve gastrectomy vs. Roux-en-Y gastric bypass on eating behavior and sweet taste perception in subjects with obesity. Nutrients 2017, 10, 1-12.
  2. Peterli, R.; Wolnerhanssen, B.; Peters, T.; Devaux, N.; Kern, B.; Christoffel-Courtin, C.; Drewe, J.; von Flue, M.; Beglinger, C.; Improvement in glucose metabolism after bariatric surgery: Comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy; A prospective randomized trial. Surg. 2009, 250, 234-241.
  3. Karamanakos, S.N.; Vagenas, K.; Kalfarentos, F.; Alexandrides, T. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide- YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: A prospective, double-blind study. Surg. 2008, 247, 401-407.

ABOUT THE AUTHOR

Sara Stiles, RD, CSOWM, LDN is a Registered Dietitian with The Center for Bariatric Surgery at The Miriam Hospital in Providence, RI. Sara earned her Bachelor of Science in Nutrition and Dietetics from Framingham State University in 2009. She is a Board-Certified Specialist as an Interdisciplinary Specialist in Obesity and Weight Management (CSOWM) and shares a passion in encouraging a whole foods, plant-based lifestyle.