Diet after Laparoscopic Sleeve Gastrectomy

Principles of diet: 

  • Energy 800 Kcals, Protein 50 g, Fat 15 g
  • Quantity = 200ml
  • Frequency = 2nd hourly.

Instructions:

  • All porridges to be in flowing consistency.
  • All juices/ coconut water to be taken fresh and no packed juices.
  • Skimmed milk only.
  • No added sugar to any juices and less than a teaspoon of salt per day.
  • Add powdered Almond (4 in no) in milk/porridge.
  • Temper soups with oil

Avoid:

  • All fats including butter/cream/cheese/ghee.
  • Sugars and artificial sweeteners.
  • Tinned/canned/processed and pre-packed food.

Recipes:

  • Optifast VLCD:
    • To 200ml water add a sachet of optifast and shake well.
  • Rava/ Ragi /Dalia Porridge:
    • Ingredients: Rava, Milk (skimmed), Water
    • Method:
      • Roast the rava.
      • In a saucepan, boil milk with water and simmer.
      • Add the roasted rava gradually with constant stirring.
      • Cook till well done.
  • Vegetable Puree:
    • Ingredients: Mixed vegetables - beans, carrot, knolkhol, green leafy vegetables like palak, methi
    • Method:
      • Wash and chop the vegetables.
      • Pressures cook the vegetables.
      • Blend to the desired consistency.
      • Filter / strain and serve with a pinch of salt.

NOTE: For lentil soup replace the vegetables in vegetable soup with lentils.

Diet after Sleeve Gastrectomy

The smaller gastric capacity will call for dietary modifications especially in the early post-operative phase. The patient must adhere to these changes for optimum weight loss.

Diet Principles:

  • Drink 6-8 cups of fluids each day
  • Sip one cup of liquid over an hour
  • Stop drinking within 30-60 minutes before a meal, during meals and 30 minutes after meals
  • Sip allowed beverages slowly
  • Do not use a straw.
  • High calorie foods, beverages and snacks to be avoided.
  • Start nutritional supplement when permitted by the doctor
  • Eat very slowly. Food needs to be thoroughly chewed
  • Stop eating when full. Indications of fullness are: a) a feeling of pressure in the centre just below your rib cage, b) a feeling of nausea, c) a pain in your shoulder area or upper chest. Contact your doctor if above symptoms persist or worsen.

In general, the patient will advance through the following diet phases, and at each phase avoid food high in sugar and fat

Phase 1Clear liquid DietInitiated about 48 hours post- surgery
Phase 2Full liquid DietInitiated about 3-4 days post- surgery
Phase 3Semi-solid DietInitiated about 15 days after surgery
Phase 4Low-fat solid DietInitiated about 4 weeks after surgery

Day 0 and 1:

You will consume nothing orally, not even water on the day of operation as well as the next day till your con-ray test is performed.  All fluids will be provided through an intravenous drip.

Phase 1 – Clear liquid Diet

On the 2nd day after your operation, we will do a con-ray test to affirm that there is no leak through the staples.

  • Low sugar diet is recommended to prevent dumping syndrome, which can occur when concentrated sweets or hydrating liquids are consumed with meals causing foods to rapidly pass in the small intestine in 10-15 minutes rather than gradually. Symptoms include rapid heartbeat, nausea, possible diarrhoea or feelings of cold and clammy
    For your clear liquids, choose from the following list - (List-1)
    • Whey water
    • Clear apple juice
    • Clear vegetable soup
    • Tender coconut water
    • Clear spring onion soup {strained}
    • Clear lemon coriander soup {strained}
    • Clear cucumber soup
    • Clear Dal water
    • Clear chicken soup
    • Fresh lemon water
    • Black tea/ coffee
    • Herbal tea (without milk)
  • When initiating intake, consume only a small amount about 15-30 ml, each time. Sip slowly and be alert to realize a feeling of fullness.
  • After a few sips, pause to check if you are comfortable enough to consume more. You constantly must be cautious not to distend the small pouch or else it would cause vomiting.  Do not use a straw since it will fill your stomach pouch with air making you feel uneasy.
  • If you can abide by the clear liquid diet, you can step up to the next phase within 2-3 days.

Phase 2– Full Liquid Diet (Day 3 to Day 15)

It is essential during this initial phase you stick to only liquids for about the next 12 days or so as chunks of food could block the opening leaving your stomach and result in vomiting and pain. Start with small amounts of above mentioned foods as you will feel full quickly.

The appropriate fluid choices during this phase are as follows. Keep your fluids thin for the first 2 weeks

  • Skimmed milk
  • Tea/coffee with skimmed milk
  • Buttermilk
  • Curd/yogurt (skimmed/ low fat and unsweetened)
  • Fruit/vegetable juices (unsweetened)
  • Soups (homemade without adding corn flour/ thickeners)
  • Dal soup (use washed dals like moong / arhar/ masoor etc)
  • Blended and strained chicken soup
  • Blended and strained vegetable soup
  • High protein meal replacement supplements (Optifast/obesigo/ positrim)- start with ½ sachet in water twice daily

Initially, drink small amounts frequently (15 - 30 ml at a time).
Do not take more than 100 ml of liquid at one time.
In addition, keep sipping 4 cups (1 cup = 60-100 ml) of low calorie liquids from list throughout the day to prevent dehydration.

Phase 3 – Semi solid diet (Day 15 to Day 30)

This is the transition phase from a liquid to a regular diet and will progress slowly. Gradually, thicken the liquids that you were consuming for the first 15 days, for instance, the soups can become thicker, the fruits and vegetables can be pureed. Begin consumption of soft foods like egg whites, mashed potatoes and paneer. Avoid bread, red meat as they are difficult to digest.

Remember to add one new food at a time and gauge your body’s response/tolerance to it. Aim at 4 – 6 small meals and no meal should exceed the volume of a measuring cup. Take your time to eat, take small bites and chew thoroughly.

Continue to sip on low calorie liquids in between meals. However, avoid any liquids 30 minutes prior to and 90 minutes post a meal. 

Avoid skin of raw vegetables and fruits at this step of your diet. The intake of liquid calories has to now be slowly reduced.  Try to moisten meats and vegetables with broth or low fat gravy as moist foods are better tolerated.

Your diet can now include:

  • Mashed potatoes made with milk
  • Cooked Egg White, any form except fried
  • Milk based Dalia / Porridges/ oats/muesli (well blended in mixer)
  • Khichri (over cooked rice and washed pulses)
  • Well cooked chicken and fish (cooked soft: use method like boiling/steaming)
  • Cottage cheese
  • Peeled and Deseeded soft textured fruits (Avoid Dry Fruits/Nuts and hard fresh fruits).
  • Well cooked vegetables without seeds or skins
  • Low fat pudding or custard, soft jellies – In Small Amounts
  • Pureed meat – Lean Chicken or fish, vegetables or fruits (Cooked soft, blenderized and sieved, use them even in soups)
  • High protein meal replacement supplements (Optifast/obesigo/ positrim)-   start with ½ sachet in water twice daily

If you still experience discomfort while eating soft textured food:

  • Slow down on the speed of your eating
  • Use smaller portion sizes
  • Remember you are re-educating your stomach. If you eat too much, too fast or don’t chew enough you are bound to feel uneasy.
  • Limit your fat intake to 2-3 tsp/day

Keep sipping water in between to avoid dehydration, also the more water you drink the better the weight loss!!!

Phase 4 - Regular Diet

Transition back to solid foods can begin from the 5th week after surgery. It is most likely that one month post bypass you may experience some vomiting or diarrhea. If either of these persists, contact the doctor. The first couple of months post the surgery may be a period of loss of appetite. This is due to a change in certain stomach hormones as well as reduced stomach capacity. This should pass in a few months.

Once you have established a diet based on solid food you will stay with that permanently. Continue adding one new food at a time to help determine what foods are tolerated. Keep breads and red meat last on your list. As a rule, you will maintain a low fat, low sugar diet with a high intake of proteins and complex carbohydrates.

Remember to chew your food completely. You will experience discomfort if you eat too fast or don’t chew well. You have to adapt to this new way of eating to stay healthy and successfully lose excess weight . . . . and keep it off.

Food guide
Aim at incorporating the foods listed under the following categories each day. Our efforts should not only be aimed at weight loss but towards a healthy weight loss.
Cereals:

  • Key – Whole grains/complex carbohydrates
  • Options – (select any 2 options each day)
  • One roti (minus the oil/ghee)
  • Two heaped tablespoons of cooked cereal like rawa, dalia, rice flakes (poha)
  • Two slices whole wheat bread
  • Two tablespoons of wholemeal breakfast cereals (cornflakes, rolled oats)
  • To be restricted – maida and its products like White bread, naan.

Pulse:

  • This food group is an important source of protein for vegetarians.
  • Key – For Vegetarians, 2 tablespoons of cooked thick dal/pulse for lunch and dinner; Non vegetarians can replace this group with chicken/fish for one meal. 

Remember
* Avoid legumes and whole pulses in the night. Dals are the best option for dinner.
* Try and incorporate at least 1 tablespoon of sprouts each day, in some form or the other. Sprouting not only increases the nutritive value of pulses but also improves digestibility.
* Make use of soy in your daily diet. Replace a part of wheat flour with soy flour while making roti’s and make use of soy chunks/nuggets in vegetable and even rice preparations.

Non vegetarian group:
Key – 30-45 g of fish, poultry or 1 egg white every day.
Remember:

  • No red meat
  • Trim all visible fat
  • Remove skin from poultry
  • Grill, bake or boil/steam
  • Avoid deep frying

Dairy Products:

  • Although milk and curds are essentially liquid form of calories, they cannot be avoided due to the calcium they provide.
  • Key – 3 measuring cups (or 600 ml) of skim milk/curds each day, inclusive of use in cooking for cereals, tea, coffee etc.
  • Options – You could reduce the daily consumption of milk/curds to about 2 cups and use 30-45 g paneer (cottage cheese) or 25 g cheese 3 times a week.

Fruits and Vegetables:

  • Now you can do away with the juices and soups. Start with peeled and deseeded soft fruits and vegetables.
  • Key – 2-3 different vegetables and 2 pieces of seasonal fresh or stewed fruit daily.
  • Remember – To include a portion of dark green or orange vegetable daily.
  • Fats and Sugars
  • Limit your daily intake to 1-2 teaspoons of sugar and 3-4 teaspoons of oil/ghee/butter.

Fluids:

  • The more the water intake, the better the weight loss as it will keep your pouch full. Optimum intake of fluids is also essential to prevent dehydration. 
  • Key – 2.5 liters of water/day
  • Remember – Do not mix solid food with fluids. Liquids will make you feel full before you have consumed enough food. Low calorie, non-carbonated liquids should not be consumed 30 minutes prior to or 90 minutes after a meal.

Food to be Restricted:

  • Sugar, honey and jaggery are ‘empty calorie’ foods that provide no other nutrient except for calories and thus should be avoided. Products containing large amounts of sugar should be omitted. e.g. jam, marmalades, preserves, soft drinks, cordials, desserts and other items that have sugar listed as one of the first three ingredients. These foods have practically no nutritive value and thus should be excluded from the diet.
  • High fat foods such as chips, chocolates, puffs, pastries, pies and carbonated drinks should be avoided.
  • Alcoholic beverages like whiskey, beer, wine, port, champagne etc are also empty calorie and thus we recommend you to stay away from them. It is recommended that you give up alcohol for the rest of your life. At minimum, you must avoid it strictly for 1 year post surgery

A few guidelines:
Eat three meals and two protein snacks per day, not more than a cupful for any meal.

No munching in between meals. The stomach pouch is created to hold the amount of food that can fit into a cup. If you consume more than your pouch size on a single occasion, you are likely to feel sick and vomit. It is therefore essential for you to learn how much your stomach can accept at one time and not exceed that.

Aim at a balanced diet and prioritize proteins.

A well balanced diet is very essential. Now that you have a smaller capacity to eat, you must eat the right foods and avoid filling your small pouch with nutritionally poor foods. Protein rich foods and complex carbohydrates are most suitable whereas foods high in fats and simple sugars should be avoided.

We have to prioritize proteins when resuming diet. Protein is important for wound healing, sparing loss of muscle mass, minimizing hair loss and preventing protein malnutrition. Foods high in protein include dairy products, eggs, fish, poultry, tofu, dried beans and legumes.

During the first month or so you might need to use a protein supplement until you can take in adequate protein from the foods you consume.  

Eat slowly, sense your satiety signals and stop.

Satiety stands for the feeling of fullness. The nerve endings in our stomach connect to the satiety centers in our brain. When the stomach is sufficiently full, these signals tell us that we should stop eating. However, it takes a good 30 minutes for this feedback mechanism. If you eat too fast, you would have eaten too much before even your body is able to signal you to stop eating. Thus we advise you to eat as slowly as possible, observe any feeling of discomfort and if not, then proceed with more. As a guideline, you should consume only 2-3 tbsp of food over a 10-15 minute period, pause to sense fullness and if not then proceed. 

Chew your foods well

Chew food until it is almost liquid in your mouth. Well-chewed food will place less stress on your gastric pouch.

Sip on plenty of zero calorie liquids and no liquids with meals.

As mentioned earlier, fluid intake is very crucial after surgery. It is essential to sip liquids slowly and constantly throughout the day. Fluid intake is important for weight loss, to prevent dehydration and also to help minimize constipation. Fluid intake should be at least 1 liter to begin with. Our ultimate target should be to consume at least 2.5 liters everyday.

The timing of fluid intake is also an important consideration. Always adhere to the following:

  1. Take no liquids with meals.
  2. Do not drink liquids 30 minutes before or 90 minutes after meals. Drinking liquids with meals, too close to mealtime, or too fast, may cause bloating or vomiting.
  3. Drink plenty of water.
  4. Do not gulp liquids. A sipper is a convenient way to get small sips and to avoid gulping.
  5. The longer you wait after meals before drinking is better. This avoids flushing out the stomach, and therefore avoids rapid hunger.
  6. Do not use a straw. This can cause your stomach pouch to fill with air.
  7. Avoid regular soda, sweetened beverages and alcoholic beverages. These have no nutritional value and could cause weight gain.
  8. Most fluids should be non-caloric such as water, coffee, unsweetened tea.

Reserve at least 30 minutes of your time for exercise each day.

With your excess weight earlier, exercise was indeed troublesome. But now that you are on a weight loss spree, it will be easier for your body to execute physical activity. Exercise is important not only from a weight loss perspective, but also to keep you healthier and fitter for life.

Set aside at least 30 minutes of your day for moderate intensity exercise. Begin with simple options like walking, swimming and slowly step up to aerobics, jogging etc. Besides, try to be as active as possible and incorporate physical activity into your lifestyle, for instance, use the stairs, instead of sitting idly in front of the T.V/computer, engage in some house hold chore, walk a street extra each day and so on.

As you shed weight, your stamina for physical activity will improve and you have to further make use of this improved state of well-being for your own good.  

Lastly, we would like to reiterate that surgery is not a one-time solution for your obesity. It is a means to provide assistance to help control your weight. It is very crucial to emphasize that you take your multivitamin, calcium and iron tablets for life. There is no substitute for that.  Further, any period of continuous vomiting for more than a week needs to be brought to our notice immediately.

Remember, your pouch is a tool to help control weight loss by enabling you to make healthy nutrition choices & lifestyle changes

Potential problems following weight loss surgery and suggested dietary modifications

  1. Nausea and vomiting
    • If nausea and vomiting occurs after eating a new food, wait for some days before trying that food again.
    • It may be necessary to return to liquids or pureed food temporarily.
    • Eating/ drinking too fast may cause nausea or vomiting.
    • Eating/drinking too much may cause nausea or vomiting.
    • Insufficient chewing may cause nausea or vomiting.
    • Avoid cold beverages and those with caffeine or carbonation.
    • If nausea and vomiting persists, call your surgeon.
  2. Dumping Syndrome (abdominal fullness, nausea, weakness, warmth, rapid pulse, cold sweat, diarrhoea)this does not occur gastric banding.
    • Avoid all sweetened foods and beverages.
    • Avoid high fat, fried,greasy foods.
    • Do not drink fluids with meals.
    • Wait at least 30 minutes to drink beverages after meals.
  3. Pain in shoulder or upper chest area(occurs when you eat too much or eat something hard to digest.)
    • Stop eating if pain occurs during eating and try to eat later after pain has resolved.
    • If pain persists, call your surgeon.
    • Dehydration
    • Dehydration can occur with inadequate fluid intake, persistent nausea, vomiting or diarrhoea.
    • At least 6-8 cups of fluid a day are recommended.
    • Avoid caffeine.
  4. Lactose Intolerance/Diarrhoea (this does not occur after gastric banding)
    • Use lactase - treated milk and lactase enzyme tablets.
    • Try low fat milk or soy milk.
  5. Constipation
    • Constipation may occur temporarily during the first post-operative month.
    • This generally resolves with adaptation to changes in volume of food.
    • Drink low calorie fluids regularly -this will help prevent constipation.
    • You may need to add a stool softener or fiber supplement speak with your dietician or surgeon about available products.
  6. Diarrhoea
    • Limit high fibre, greasy foods, milk and milk products.
    • Avoid very hot or cold foods.
    • Eat smaller meals.
    • Sip fluids between meals.
    • If diarrhoea persists, call your surgeon.    
  7. Heartburn
    • Avoid carbonated beverages.
    • Avid caffeine.
    • Do not use a straw.
    • Avoid citrus fruits and beverages such as lemonade, orange or pineapple juice.(you may resume citrus foods and beverages once on a  regular diet, you do not have to avoid citrus after gastric banding)        
  8. Bloating
    • Limit liquids to 60 ml at one time.
    • Sip slowly 
  9. Taste/Sensory changes
    • This may occur during the first few months after surgery but will resolve over time.
    • Some foods may taste too sweet or have a metallic taste.
    • Strong smells from cooking may affect you, try to avoid the kitchen while someone else is cooking
  10. Blockage of the Stoma (opening of the stomach)
    • The stoma may be temporarily blocked if foods with large particle size are eaten without thorough chewing.
    • If symptoms of pain, nausea and vomiting persist, your surgeon should be contacted.
    • Do not progress to solid foods until your surgeon tells you to
  11. Rupture of the staple line after gastric bypass
    • Rupture of the staple line is unlikely; however, avoid eating an excessive quantity of food at one time.
    • Stretching of the stomach pouch/stoma dilation
    • Avoiding large portion of food at one time can reduce the risk of stretching the stomach pouch.
    • The risk can be decreased by gradually increasing the texture of foods in the early post-operative weeks.
    • Follow the recommendations for advancing your diet to prevent this stretching.
    • Avoid carbonated beverages.
    • Weight gain or no further weight loss
    • You might be eating high calorie foods or beverages.
    • Keep a record of all foods, beverages and snacks eaten to determine the exact reason for this.
    • Measure portion sizes.
    • Avoid prolonged use of nutritional supplements like Ensure, Boost, etc.
    • Use only low calorie beverages in addition to fat free milk.
    • If you had gastric banding, you may need your band adjusted.

 

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