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GASTRIC SLEEVE

POST-OP DIET

Post-Op DietThe final aim of gastric sleeve surgery is to achieve weight loss and after surgery that starts and with a diet after surgery. Thus, the diet post gastric sleeve surgery is designed to achieve this optimum results while helping new patients speed up recovery. The principles include a high protein and low carbohydrate and fat diet, avoidance of refined sugars, avoidance of alcohol, liberal fluid intake, minimal or no ‘junks.’

High protein diet will help reduce muscle breakdown and accelerates healing, while low carbohydrate will help reduce weight. Refined sugars are high in calories and deficient in nutrients and therefore affect the adequacy of the nutrients in your diet.

As part of your preparation for surgery, our nutritionist will send out our complete dietary plan for you. It is important to have started this dietary modification (pre-op diet) well enough before surgery. This would help reduce the operative complications, accelerates wound healing and ensure sustainability post-surgery.

Following gastric sleeve surgery, your stomach would have reduced by 80-90%, and you will experience early satiety following intake of little amount of meal. A gastroesophageal reflux with the risk of vomiting may follow excessive/too rapid eating. This can be avoided by eating a small meal at a time and eating slowly. Chew thoroughly and drink only at least 30 minutes before or after eating.

Never eat when it’s time to go to bed.

Due to some hormonal changes following gastric sleeve surgery, the appetite reduces, and you may be tempted not to eat. This may also be reinforced by the false belief that avoiding meals post op will speed up the weight loss. However, not eating following gastric sleeve surgery may make you malnourished and possibly slow down your recovery.

Our surgeon will determine when it is safe for you to eat. Usually, the oral intake post gastric sleeve is commenced with clear liquid (sips of water) followed by a gradual transition to a liquid diet, and later to semi-solid and solid food. Here is the sample plan of our post-op diet.

Guidelines for PostOperative Diet Stages First Eight Weeks

  • Do not chew gum
  • Do not use a straw
  • Avoid carbonated beverages (unless flat, diet, and caffeine-free)
  • No juice or sweetened beverages
  • No honey, sugar, syrup
  • Avoid protein bars, rice, fresh bread, lettuce, nuts, seeds
  • Avoid skin and seeds of fruit (because of nuts)
  • Avoid spicy and acidic foods, drinks for 8 weeks, including:
    • Pineapple Juice
    • Grapefruit Juice
    • Orange Juice
    • Hot Sauce
    • Peppers
    • Tomato, Vegetables Juice
    • Tomato Sauce, Soup

Gastric Sleeve Post-Op Diet Stages

There are five regular stages of the postoperative diet for gastric sleeve:

  • Clear Liquids Diet – Phase, Stage 1 (while in hospital)
  • Protein-Based Liquids – Phase, Stage 2 (2-3 days post surgery, 2-week duration)
  • Pureed Foods – Phase, Stage 3 (day 15, weeks 3 and 4)
  • Soft Foods – Phase, Stage 4 (weeks 5 and 6)
  • Regular Foods – Phase, Stage 5 (week 7 and beyond)

Diet Phase, Stage 1: Clear Liquids

Duration: While in Hospital

In this phase, the goal is to sip 1 ounce of fluid over 15 minutes. Which means taking only small sips of liquid over 15 minutes. In the stage 1 diet the only foods, drinks allowed are:

  • Water
  • Ice chips
  • Broth
  • Sugar-free gelatin and popsicles
  • Calorie-free, non-carbonated, caffeine-free or decaffeinated beverages
    • Some examples: Crystal Light, Sugar-free Kool-Aid

Diet Phase, Stage 2: Protein-based Liquids

Duration: Starts 2 or 3 days after surgery, lasts during 1 and 2 weeks

Phase Goals: 60 to 80 grams per day and 56 to 65 ounces of fluid per day

The first week is characterized by thin liquid foods. Begin with sips and gradually increase it. It is advisable that you take at least 3 liters of liquid diet per day to avoid getting dehydrated and to prevent constipation. Liquid diet during this period includes unsweetened fruit juice, skimmed milk, and blended fruit juice. The quantity of these foods should be as prescribed by your surgeon.

General Guidelines for Diet Phase 2:

  • Consume a chewable multivitamin with minerals twice daily (12-hour difference)
  • All liquids should be thinner than milk shakes
  • All medications should be liquid, crushable, or chewable
  • Sip 1 ounce over 15 minutes. (your tolerance will increase over time)
Foods Allowed:
  • All Foods in Phase 1
  • Protein Drinks
  • Fat-free or 1% milk, soy milk, Lactaid milk
  • Low-carb, light yogurt
  • Lentil or Spilt Pea Soup
  • Sugar-free pudding (thinned-out)
  • Reduced fat cream soups (no tomato)
Sample Meal Plan: Phase 2

Here is a sample meal plan that you can use. It’s important to achieve the field goals and protein goals per day. The sample meal plan is roughly 550 calories.

Breakfast
  • 8oz of Protein Drink (over 2 hours
  • 8oz of water (2 hours)
Mid-Morning
  • 8oz of water (2 hours)
  • 2oz sugar-free gelatin (30min)
Lunch
  • 8oz of water (2 hours)
  • 4oz blenderized split pea soup (1 hour)
Mid-Afternoon
  • 8oz of water (2 hours)
  • 4oz of protein drink (1 hour)
Dinner
  • 8oz of protein drink (2 hours)
  • 1 sugar-free popsicle (30 min)

Diet Phase, Stage 3: Puree (Blenderized)

Duration: Starts on day 15 after surgery, lasts during 3 and 4 weeks

Phase Goals: 60 to 80 grams per day and 56 to 65 ounces of fluid per day

During the 2nd-3rd week post-surgery, the diet should be composed of soft foods with no lumps. Examples include fats free yogurt, mashed potatoes, blended, baked bean, thick, smooth soup, etc. you can eat small quantity at a time for about 4-5 times daily.

General Guidelines of Diet Stage 3:
  • Introduce one new food at a time
  • Start with 1/8 to 1/4 cup portions
  • Aim for 3 to 4 servings of food per day with liquids in-between
  • No liquids 20-30 minutes before or after foods
  • Do not eat while distracted
  • Start taking calcium with D and B12 supplements
  • You may begin taking whole pills, capsules, and multivitamins.
  • You may continue your chewable multivitamins if you prefer
  • To consume a meal should take as much as 45 minutes.
Food Allowed:
  • All foods in phases 1 and 2
  • Small Curd fat-free or low-fat cottage cheese
  • Pureed beef, chicken, turkey, pork, fish (blend twice while dry, then add broth)
  • Fat-free or low-fat refried beans
  • Tofu
  • Pureed lentils and peas
  • Hummus
  • Fat-free or low-fat ricotta cheese
  • Canned tuna or chicken mashed with a fork
  • Mashed potatoes
  • Pureed fruit, such as no sugar added applesauce
  • Cooked and mashed vegetables
  • Baby food
Sample Meal Plan: Phase 3

Here is a sample meal plan that you can use. It’s important to achieve the fluid goals and protein goals per day. Wait for 20 to 30 minutes before or after meals before drinking liquids.

Food Allowed:
  • 1/4 cup non-fat cottage cheese
  • 8oz of caffeine-free tea
Mid-Morning
  • 8oz of protein drink
  • 16oz of water
Lunch
  • 8oz of protein drink
  • 16oz of water
Mid-Afternoon
  • 8oz of protein drink
  • 16oz of water
Dinner
  • 1/8 cup mashed tuna
  • 3 bites no sugar added applesauce
  • 8oz of water

Diet Phase, Stage 4: Soft Foods

Duration: Starts on day 29 after surgery, lasts during 5 and 6 weeks

Phase Goals: 60 to 80 grams per day and 56 to 65 ounces of fluid per day

Foods soft diet for gastric sleeve surgery include beans, cooked vegetables, fish, eggs, etc. can be considered during this stage. By 5th-week post gastric sleeve, you may start taking solid diets. At this juncture, your stomach should be fit to handle solid foods, and you can return to three meals per day with a little snack.

General Guidelines of Diet Stage 4:
  • Start with 1/4 to 1/2 cup portions
  • Aim for 3 to 4 servings of food per day with protein drinks used as snacks
  • To consume a meal should take as much as 45 minutes
  • Eat slowly and chew food thoroughly
Food Allowed:
  • All foods in phases 1, 2 and 3
  • Finely chopped, moist and soft foods (size of an eraser head on pencil)
  • Lean ground chicken, ground turkey, ground beef, ground pork
  • Fish
  • Beans, lentils, bean soups
  • Low-fat cheese
  • Boiled, poached, and scrambled eggs
  • Hot cereals
  • Well-cooked vegetables
  • Boil potatoes without the skin
  • Canned fruit in light syrup or its own juice (rinse both)
  • Soft fruits without skin ( banana, peaches, pears)
  • Crackers (whole grains w/ 3 grams of fiber per serving)
  • Toast (whole grain w/ 3 grams of fiber per serving)
Sample Meal Plan: Phase 4

Here is a sample meal plan that you can use. It’s important to achieve the fluid goals and protein goals per day. Wait for 20 to 30 minutes before or after meals before drinking liquids.

Breakfast
  • 1/2 cup cream of wheat with 1 scoop of protein powder added
  • 8oz of water
Mid-Morning
  • 4oz protein drink
  • 16oz of water
Lunch
  • 1-2oz chicken
  • 3 bites green beans
Mid-Afternoon
  • 8oz fat-free or 1% milk
  • 16oz of water or Crystal Light
Dinner
  • 1/2 cup refried beans with 1 oz melted cheese
  • 2 bites of a banana
  • 8oz of water

Diet Phase, Stage 5: Regular Diet After Surgery

Duration: Starts on day 50 after surgery, lasts the rest of your life

Phase Goals: 60 to 80 grams per day and 56 to 65 ounces of fluid per day

A typical meal for a bariatric surgery diet includes protein-rich foods such as lean meat, eggs, beans, low-fat dairy products, and high-fiber foods including vegetables and fruits. Whole grains are eaten in moderation – i.e., with “My Plate” whole grains would fill no more than 1/4 of the plate. Eating protein and high fiber foods help you feel fuller longer. You will be able to eat a variety of foods – but low fat, low sugar, and in smaller portions.

General Guidelines of Diet Stage 5:
  • Slowly introduce a greater variety of foods. Not one food or food group provides all of the nutrients needed for good health.
  • Continue to wait 20-30 minutes before and after meals to drink.
  • Aim for 3 meals and 2 snacks per day. Protein drinks may be used as a meal replacement or as a snack.
  • Eat slowly and chew foods well.
Protein Foods
  • Choose low-fat protein foods to eat at every meal
  • Cook meat in low-fat sauces and gravies to keep it moist for better tolerance.
  • Avoid meats that are roasted or barbecued with crisp edges.
  • Avoid teriyaki and barbeque sauces as these contain sugar.
  • Choose low fat or fat-free cheese and limit to 2oz per day
Dairy
  • Goal: choose low-fat dairy foods 2-3 times per day
  • Low-fat dairy foods are good sources of protein, vitamin D, and calcium
  • Trying mixing protein powder with cow’s milk or soy milk (lactose intolerance)
  • Light yogurt or 1 oz low-fat cheese with fruit may be a good snack
Vegetables
  • Goal: eat 3-5 servings of vegetables per day
  • Add vegetables to each meal and snack
  • Start with well-cooked steamed vegetables before trying raw crisp vegetables
  • Chop all vegetables before you eat them. You may not try chopped lettuce.
  • To get more servings of vegetables between meals consider having vegetable juice, such as v8, and vegetable soups
Fruit
  • Goal: eat 2-3 servings of fruit per day
  • Start with soft fruits without the peel for better tolerance
  • Introduce crisp, fresh fruits last, such as apples
  • Avoid 100% fruit juice and other sugar sweetened juice beverages for the rest of your life
Grains and Cereals
  • Choose whole grains, such as oatmeal, quinoa, brown rice, whole wheat pasta, and whole wheat tortillas
  • You may introduce cold whole grain cereals now. Avoid sugar coated cereals
  • White bread and rice may still not be well-tolerated, and calories can add up fast with these foods.
Fats and Oils
  • avoid most added fats such as butter, margarine, mayonnaise, salad dressings, cream, lard, bacon grease, shortening, and sour cream
  • Limit the following to 1-2 teaspoons per day: olive oil, canola oil, peanut oil, low-fat salad dressing, low-fat mayonnaise.
Sugar

Avoid simple sugars, which are found in candy, cookies, ice cream, table sugar, doughnuts, cake, honey, syrup, pies, sherbet, jelly, and fruit juice.

Avoid carbonated beverages. They contain refined sugar and will be counterproductive in your weight reduction goal. They also cause diuresis and may tilt you toward dehydration. Coffee should be avoided as it is acidic and may cause gastric reflux.

Multivitamins (vitamins B12, vitamin D) and mineral supplements (zinc, iron, and calcium) may be essential in the early postoperative period of the gastric sleeve as you may be struggling to eat and your diet may not supply the appropriate quantity of those micronutrients. However, as your meals become more regular, you may no longer need those supplements.

Some people find certain foods difficult to eat following bariatric surgery. Such foods should be avoided. They can be reintroduced once the patient is more comfortable with them.

Always remember that post gastric sleeve the dietary plan varies from one surgeon to the other. Thus, it’s essential that you adhere to your doctor’s schedule of when to transit from the different dietary stages. If you vomit or get constipated at any time, call your doctor.