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Nutritional
Guidelines After
Bariatric Surgery
Introduction
In order to succeed in the weight loss process and maintain your perfect weight you will have to change your nutritional lifestyle permanently. The goal of bariatric surgery is to help you change your eating habits in order to promote a healthy loss of weight and it`s maintenance.
Surgery itself is only a part of treatment. Gastric Sleeve and Gastric Bypass do not constitute a cure for morbid obesity; they are great tools that we need to teach you how to apply. The most important part of treatment is your adherence to a healthy diet. This is what determines your ability to keep your weight under control – following a diet after the surgery as well as for the rest of your life.
This diet is different from any other diet that you might have followed in the past. It will progress through a series of stages; you will be eating much smaller portions compared to what you are probably used to, and you will have to eat and drink regularly according to the schedule. Nevertheless, you will have to learn to listen to your body in order to determine whether it got in a starvation mode. If you overeat it can cause stomachache and/or vomiting. After surgery most of the patients get full by eating very small portions. Eventually you will learn when to stop in order to get full and not overdo it.
A permanent change of eating habits is necessary in order to insure both an adequate nourishment and successful weight loss on the long run. The surgery will help you make the changes. If your body does not get an adequate nutrition, it becomes vulnerable to fatigue, depression, infections and other diseases that can affect your organism, compromise your health, and even put your life in danger.
It is important not to be obsessed with the calorie or nutritional value, since it is not a regular diet.
The key is to get well-nourished through a well-balanced diet. The surgery is going to restrict the amount of food one can eat, but not the choices you make.
It is very important to attend all the appointments with your nutritionist and surgeon. Patients that keep their regular meetings with the doctors are more successful in losing weight and staying healthy.
What to expect
Common Symptoms Post Surgery
• Nausea and Vomiting
You may experience nausea the first day after surgery. Pay attention to the precise timing of symptoms and identify the reason, thus avoiding discomfort in the future. The most common cause of nausea and vomiting is accelerated food intake, including liquids. Make sure to chew very slowly and thoroughly when you start the solid food stage; lack of proper chewing is a common cause of these symptoms. If you are experiencing discomfort while progressing from one stage to another, continue with the previous stage without progressing for 3-5 days until you feel more confident to move on.
• Gastro Esophageal Reflux
Reflux is the partial return of stomach contents into the esophagus, this symptom is typical for gastric sleeve patients and appears when you eat food or drink rapidly. To prevent gastro esophageal reflux you have to drink and eat staying straight, avoid lying down immediately after eating as this promotes reflux; if you want to rest you have to wait for at least half an hour after your last intake to prevent symptoms. This symptom is rare for Gastric Bypass patients, but it can also appear.
• Dumping Syndrome
Dumping Syndrome is unique to patients undergoing gastric bypass. High intake of carbohydrates and simple sugars is the reason for this phenomenon that causes several unpleasant side-effects. The intestine gets a load of carbohydrates that causes a cascade of hormonal changes, and this in turn causes diarrhea, abdominal pain, nausea, dizziness, tachycardia, fainting, sweating, and fatigue. These symptoms appear within the first half hr. after a high sugar intake. A small percentage of patients have this syndrome later for up to 3 hours after ingestion, these patients tend to develop hypoglycemia, sweating, tachycardia, and fatigue. You should avoid high intakes of sugars at one time; if these symptoms appear call your doctor.
• Dehydration
Besides the substantial restriction because you have decreased your stomach capacity, there is an inflammatory process in the gastric remnant tissue that reduces even more the ability to meet your nutritional requirements. The inflammatory process is more noticeable in the first weeks after surgery, and there is a possibility of dehydration if you do not intake the appropriate amounts of liquids. Patients who live in hot climate are under increased risk of getting dehydrated and their water needs are even greater. Try to drink lots of liquids, small portions but frequently; this will prevent early satiety, nausea and vomiting. Learn to notice satiety and stop fluid intake once feeling full; continue when satiety has ceased.
• Constipation
Drastic changes in your diet will affect your digestive habits; the absence of need to defecate in the first weeks is common, remember that your diet is based on full liquids for this short period of time and no solid matter may form along the intestine. Normal digestive habits return in three weeks post-op. Consult your doctor if symptoms persist.
• Diarrhea
You received broad-spectrum antibiotics during hospitalization and in the first week post-op. The optimal functioning of our gut bacterial flora is compromised by the presence of these antibiotics; this also affects the optimal intestinal function. Taking Lactobacillus Prophylaxis prior and after surgery reduces the risk of diarrhea in the postoperative period.
• Fatigue
It is one of the most common symptoms after a bariatric procedure. Remember that your caloric intake drastically decreases, therefore our body energy needs will not be met and you will feel tired early in the day. It is common for this symptom to last for 1–2 months and you should regain vitality after this period.
• Lactose Intolerance
This phenomenon is typical for patients undergoing gastric bypass: changes in bacterial flora to subsequent exposure to antibiotics produce alterations in the metabolism of lactose. Avoid dairy products that cause symptoms such as constipation, flatulence and abdominal pain. Try to use Lactobacilli supplementation and consult your physician.
Dietary Evolution
Stage 1: Clear Liquids Days 1 to 3 Post-op
The day after surgery you will be put on a clear liquid, non-carbonated and sugar-free diet. You will be required to drink at least 64 ounces (2 liters) of fluids per day in order to avoid dehydration. It might be necessary to drink even more during the hot weather. In the first few days drink your liquids with calm until you determine the amount of fluids that can be tolerated. Your first consumption will be ground ice only; make sure to drink it slowly as it will be your first intake experience after the surgery.
Begin with little sips. Avoid using a straw; this will prevent gas entering into your stomach. The amount of clear liquids you are allowed to drink is not limited. At the beginning it will be easier to tolerate water rather than juices. If you take medication in a form of pills they will have to be crushed or changed to a liquid form.
· Water
· Ground ice
· Jell-o sugar free
· Isopure protein cocktails with electrolytes and zero carbohydrates
· Gatorade low in sugar
Stage 2: Full Liquid Diet Days 3 to 17 Post-op
During the first two weeks after your discharge from the hospital you will have to drink liquids only. Solid foods could cause pressure on the sutured line of the stomach and stretch the new stomach pouch. This might cause vomiting and pain. Liquid diet will also give enough time for the stomach tissue to heal. To insure an adequate intake of protein, calcium and other nutrients, the liquid diet has to be based on foods that contain protein.
Calorie daily intake: 500 – 600 Cal
Type of exercising: walking
Time: 30 minutes
Calorie expenditure with exercise: 50 – 100 Cal
· Liquids included in Stage 1 / · Chicken Broth
· Fish Broth / · Greek Yoghurt
· Protein Cocktail / · Low fat milk and/or lactose free milk
Recommendations
1. Use your kitchen scales to weigh and measure food portions.
2. Take 100g (3.5 ounces) of chicken/fish in its own broth and blend it. After thorough blending strain it and remove the solids, consume pure liquid. This type of processing will make the nutrients contained in chicken/fish remain in its prepared broth.
3. Start your protein supplement; remember that your daily need of protein is 70–100 g.
4. Consume approximately 64 ounces (2 liters) of fluids daily.
5. Have a minimum of 5 liquid meals per day (including the protein supplement).
6. Start taking your vitamins, preferably chewable and/or liquid.
Example of a Meal Schedule
Breakfast / Snack / Lunch / Snack / Dinner* 4 oz. Greek Yogurt
* Protein shake
* Multivitamins / *Protein shake
*B-complex (Sublingual or liquid)
*Jell-o with protein added, unflavored / *Chicken broth 3.5 oz. (100 g of solids blended and strained)
*Fish broth, tilapia 3.5 oz. (100 g of solids blended and strained)
* Vit. D + calcium / *Protein shake *Jell-o with protein added, unflavored / *Chicken broth 3.5 oz. (100 g of solids blended and strained)
Fish broth, tilapia 3.5 oz. (100 g of solids blended and strained).
*Greek Yogurt
Notes
1. * An asterisk implies one option, it doesn`t mean that all of the offered options have to be applied at the same time.
2. Chicken or fish broth has to be made from 100g (3.5 ounces) of solids blended with 120 ml of prepared broth (liquid) and strained.
3. You are not obligated to finish the portion of broth if you cannot; remember that during the first post-op months your stomach tissue remains inflamed, so do not get discouraged, it is totally normal.
4. You can finish the meal later or have it as a snack.
5. Do not forget to include your drinks 30 minutes before or after each meal.
Stage 3: Blended or Pureed Diet Days 17 to 30 Post-op
At this point you can start eating pureed and soft foods that require minimum chewing. Solid food is not allowed at this stage; slowly, day by day start introducing moist and soft textured foods into your diet. This stage includes all kinds of fluids from the previous stage: clear and full liquids. Again preference will be given to the nourishment rich in protein, but low in sugar and fat. In a few more weeks after surgery the capacity of the new gastric pouch will increase. Stop eating as soon as you feel satisfied, and always eat foods rich in protein first.
Calorie daily intake: 550 – 650 Cal
Type of exercising: Walking
Time: 30 minutes
Calorie expenditure with exercise: 50 – 100 Cal
· Liquids from the stage 1 – 2
· Pureed salmon
· Pureed tuna
· Pureed tilapia
· Scrambled eggs (no yolk)
· Bean broth (do not eat solid beans, only blended and strained)
· Lentil broth (do not eat solid lentils, only blended and strained)
· Cottage cheese
· Pureed salmon
Recommendations
1. During this stage food requires minimum chewing: scrambled eggs, cottage cheese etc.
2. Continue drinking liquids slowly as at stage 2; increase the amount to a minimum of 6 to 8 cups per day.
3. Drink protein supplement (also as an appetizer) between meals.
4. Keep taking chewable or liquid vitamins.
5. Eat slowly, taking very little bites.
6. Bread, rice, pasta, fruit and raw vegetables should not be consumed during Stage 3.
7. It is important to have a meal schedule. Keep a diary of what you eat, use Bariatricapp in your advantage.
8. If you do not feel hungry have only a few bites of food in order to keep your nutritional schedule completed.
9. Eat and chew slowly, beware of your limits.
10. Stop eating once you feel full, you can finish your meal later.
11. Do not force yourself to eat a whole dish at one time; your stomach capacity is still considerably restricted.
Meal / Calories / Fat / Carbohydrates / Protein/ Calories / Calories / Fat / Carbohydrates / Protein
/ Fat / Calories / Fat / Carbohydrates / Protein
/ Carbohydrates / Calories / Fat / Carbohydrates / Protein
/ Protein / Calories / Fat / Carbohydrates / Protein
Breakfast
4 oz. Greek Yogurt
(DANONE brand Greek Light) /
53 Cal / 0 g / 5.3 g / 8 g
Snack
Protein shake (1 scoop) Isopure brand, unflavored / 110 Cal / 0 g / 0 g / 26 g
Lunch
Tuna (Dolores brand, canned in water) pureed 3.5 oz. (100 g) / 150 Cal / 6 g / 0 g / 24 g
Snack
Bean soup
(120 ml) / 106 Cal / 3 g / 14.5 g / 6 g
Dinner
Fish broth, tilapia 3.5 oz. (100 g blended in 120 ml of broth, strained) / 131 cal / 1.9 g / 0 g / 26 g
Total / Calories
500 / Fat
4.9 g / Carbohydrates
19.8 g / Protein
90 g
This graphic shows that out of the total amount of calories 75% come from protein, 20% from carbohydrates and only 5% of calories come from fat.
Stage 4: Solid Food Days 30 to 60 Post-op
You can start Stage 4 in 4 weeks after surgery assuming that you can tolerate foods from Stage 3 with no difficulty. If not stop progressing in your diet and continue Stage 3. As you are progressing to a normal diet, you will have to make your food choices very carefully. At this point it is safe to start experimenting with certain kinds of solid foods that have different textures. Make sure that what you eat is very tender and chew it thoroughly; you should be able to eat regular food now.