Your New Stomach A New Way of Eating
Diet Progression: From The Day After Surgery to The Rest of Your Life
LiquidS - 2 WEEKS
During the first 2 weeks, you will be on a liquid diet. This is important to allow the staple line to heal. You will want to make sure you are drinking plenty as well.
At Home: Weeks 3 and 4 - Pureed
On weeks 3-4, you will eat pureed foods 4-6 times a day, drink your daily allotted volume of water, and drink 60-80 grams of whey protein (or an equivalent). Pureed food is the consistency of pudding or baby food. You will only eat small amounts of food that are soft. You will need to eat four to six times a day, since your pouch or sleeve can only hold a small amount and you need to consume enough protein. You can puree foods by liquefying them in a blender mixing equal parts solid and liquid. Using milk (if you tolerate milk products) increases the nutritional value of the pureed food. Keep blenderized food in the refrigerator for up to 48 hours then discard. You may also purchase baby food if it is simpler for you. You must avoid any foods with added sugar. Never eat more than 4 grams of sugar per serving.
Eat slowly. It should take 15-20 minutes to eat one ounce of food. Most people feel full after consuming 2-3 ounces. Remember not to drink during eating, or within 30 minutes after eating.
Protein Shakes and Drinks
Protein supplements may be necessary for a few weeks to a few months after surgery and can be purchased at health food stores, drugstores, grocery stores and online. They are sold as dry whey or soy powders or in pre-mixed cans. You may want to try several before surgery so you have a good sense of what you like. The powder can be mixed into milk or sprinkled on food. Whey protein may contain lactose (if you are lactose intolerant be aware of this). Soy protein powder may have too much fiber for some patients. Be sure to check sugar content. Your choice should contain no more than 4 grams of sugar per serving. It is through trial and error that each patient figures out which type, flavor, and method works best for them.
Week 4 and Onward: Well chewed, small amounts
At week four, begin introducing soft foods such as steamed vegetables, soft fruits, fish, thinly sliced meats, ground hamburger, cheese, and eggs. Again, remember small amounts 4 -6 times each day. Sometimes a new food won’t be tolerated right away; you can always try it again in a month and see if it is tolerated. Most importantly, achieve the consistency of pureed food by chewing it well.
Pay attention to your body. Stop eating when you feel full; do not take even one more bite. By eating slowly and chewing thoroughly, you prepare the food for your pouch and you give your body time to tell your brain if the pouch is full.
What Not to Eat
Absolutely avoid candy, fried foods, chips, and soda pop. You will regret trying these foods as they may cause nausea and other unpleasant side effects.Stringy foods, raw vegetables, high fiber, fresh bread should only be consumed when approved by your surgeon. Starchy foods such as bread, potatoes, chips, crackers, and pasta should only be consumed occasionally; over-eating of starch can cause you to slowly regain weight. Shop for food in the periphery of the grocery store. Fresh veggies, fruits, lean meats, cheese, eggs, and dairy products are your key to good health.
Essential Nutritional Points
Hydration: Because your pouch can only hold one to two ounces at a time, you must sip non-calorie liquids frequently to avoid dehydration. Keeping a water bottle with you will help remind you to keep sipping. Minimize caffeinated beverages because too much caffeine may cause you to lose fluid from your body and prevent you from being properly hydrated.
Separate solids from liquids: Because your pouch is small, you should not drink liquids while you are eating. Stop sipping liquids 10 minutes before eating. Wait up to 30 minutes after a solid meal to drink liquids. Occasionally, the surgeon will give different instructions, but as a rule, the separation of solids from liquids is the second change you will make for the rest of your life. One of the reasons for sequencing your eating and drinking is to keep the solid food in your pouch so that you feel full. You do not want to wash the food out of your pouch right after you eat.
Protein first: It is important to eat adequate protein to help heal the incision, prevent hair loss, and keep your body in good repair. You need 60 to 80 grams of protein every day. Depending on your height and weight, you may need more than 80 grams of protein each day. (The dietician and surgeon will let you know.) The limited pouch size makes it difficult to eat enough protein at one time. Always eat protein first! Do not waste your pouch space with poor food choices. You will need to eat four to six small meals each day, always following this rule.
Gastric bypass patients in particular are at risk for deficiencies of iron, calcium, and B vitamins, and thus require vitamin supplements for the rest of their lives. Vitamin insufficiency can cause serious side effects and even death. You will need to take a high-potency multivitamin in chewable, liquid or powder form daily. Once a week you will need to take a Vitamin B-12 supplement (sublingual capsule or liquid). In addition, some patients need to take an iron supplement (ferrous fumerate) every day. Lastly, a calcium citrate supplement will be required if you do not drink/tolerate milk (1200-1600mg) every day. The doctor will check your vitamin levels periodically to make sure your body is receiving what it needs. Below is a chart showing the expected progression of vitamin and calcium supplements after surgery.
Vitamin Regimen For Gastric Bypass Patients
Two Months Pre Surgery
- Multivitamin daily
Immediately After Surgery to 2 Months Post Op
- 1 adult chewable Vitamin or 2 children's chewable
- 1 dose sublingual B Complex Weekly
> 2 Months Post Op
- Multivitamin daily
- 1 dose sublingual B Complex Weekly
- Vitamin D3 3000 units daily (your provider may also prescribe Calcium Citrate with Vitamin D
Tips for Staying On Track
- Avoid high calorie, sugared liquids- fruit juices, or pop. Avoid sugar by reading labels on products. DO NOT eat anything if the label indicates more than 10g of the following substances in the first three ingredients of the product: sugar, maple syrup, honey, molasses, corn syrup, corn sweeteners, glucose, lactose, maltose, dextrose, fructose, sorghum, sorbitol, or mannitol. You may use artificial sweeteners such as Equal and Splenda.
- Each meal should take twenty to thirty minutes. Any time shorter than that means you ate too fast or not enough and will get hungry again. Taking more time means you are probably eating too much. Eating slowly helps you feel full much longer.
- Liquids have to be taken before solids. Drink before a meal not during or close after the meal; you will wash your food down too quickly otherwise.
- Only use a solid food, like beef jerky, cheese, nuts, or veggies for snacking. If you eat small meals of junk foods, you will not lose weight.
- Quit when you are full. Stop at the first sign of fullness. Learn to recognize your “quit eating” signals.
- Eat from a salad plate instead of a dinner plate. The plate will be fuller with less food and provide psychological satisfaction that you are eating a full meal.
- Small portions 4 to 6 times each day
- Protein first
- Do not drink and eat together
- Drink 6-8 8oz. glasses of liquid each day
- Drink protein supplements until your surgeon allows you to stop.
- Take vitamins and calcium
- Chew thoroughly
- Eat slowly
- Limit Sugar