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Dr. Doru I.E Georgescu
Dr. Doru I.E Georgescu
Dr. Doru I.E Georgescu
Obesity Surgery

Laparoscopic Sleeve Gastrectomy

Sleeve Gastrectomy :: Procedure Guide :: Risks and Complications :: Post Operative Instructions

Diet

Nutritional Expectations

After Sleeve Gastrectomy surgery you will need to make changes to your eating patterns, which is also called a diet. The diet after surgery progresses from a liquid diet to a pureed diet to a soft diet and then to a modified regular diet. The diet progression is designed to allow your body to heal. Initially, it will help you meet your protein and liquid requirements, and later, to assist you in meeting your nutritional needs. It is imperative that you follow the diet's progression and adhere to this regimen to maximize healing and minimize the risk for unnecessary complications. The size of your stomach pouch is about one ounce (or one to two tablespoons). At first your capacity will be somewhat limited, so be patient. You may find that two to three teaspoons of food fill you up. This is expected. You may also find that you are able to eat more of one type of food than another. That is okay, too. Over time, your food pouch will stretch. By six months after surgery, it may stretch to 6-8 ounces (3/4 to 1 cup). Long term, the size of your pouch is likely to be eight to twelve ounces or 1 to 1 cups. This will limit the amount of food you can eat at one time.

You may also be surprised at how the surgery changes your wants and desires for certain foods. Foods you may have previously loved you may now find you are less interested in.

The primary source of nutrition after surgery should be protein with 70 to 75% of all calories coming from protein based foods (eggs, fish, meat, etc). Carbohydrates (whole wheat bread, whole wheat pasta, brown rice, potatoes, etc.) should make up only 10 to 20%, and fats (oils, butter, etc.) only 5 to 15% of the calories that you eat.

A diet consisting of 600 to 800 calories, including 75 grams of protein, should be the goal for the first 6 months. Due to the very small pouch size at this time, almost 100% of food intake should be protein. Protein drinks (low calorie and low sugar/low carb) can be helpful to fulfill your protein requirements at the beginning. There are many to choose from, but protein drinks/shakes should be eliminated once your pouch is large enough to attain your protein goal from food alone due to fluids not being filling.


Fluids

Fluid intake is very important to prevent dehydration and constipation, but it is important not to drink with meals or close to meals, which may cause bloating, nausea or vomiting. Drinking near meals also quickly washes food through, which induces hunger and excess eating. The guideline is to avoid liquids 30-45 minutes before and 40-60 minutes after meals.

  • Sip water all day
  • Do not use a straw, which can fill your stomach with air
  • Avoid regular soft drinks and adding sugar to beverages
  • Avoid carbonated beverages for one month after surgery to prevent bloating
  • Avoid high-calorie liquids, which impart calories without making you feel full. Most fluids should be non-caloric such as water, Crystal Light, sugar-free Kool-Aid, coffee and unsweetened tea
  • Avoid alcoholic beverages


Eating Techniques

Your new motto: "slow, small, moist and easy."

Especially in the first eight weeks after surgery, you need to change your eating habits to avoid pain and vomiting, rupture of staple lines and to aid in weight loss. At this time, the tissue around the staples and sutures in the stomach pouch is very swollen and needs to heal. You also want to prevent obstruction of the area where you stomach pouch connects to your intestines. Remember that these changes will need to last a lifetime for weight loss maintenance.

Swallowing food in chunks may cause a blockage and prevent foods from passing into the intestine. It is CRITICAL that you eat slowly and chew your food well to lower the risk of getting anything caught in this area.

You may find the following tips helpful:

  • Start each stage of your diet slowly and carefully. When transitioning from each stage start slowly and eat only small amounts.

  • Set aside at least 20-30 minutes to eat each meal. Aim to chew your food 20-30 times with each bite. Put your utensils down on the table after every bite. Slow down - we have a lifelong habit of eating too fast. Slow down, enjoy the food and relax.

  • Explain to friends and family why you must eat slowly so they do not urge you to eat faster.

  • Take small bites of food and, for a visual aid, you may want to use baby spoons, cocktail forks and saucers for plates to help with portion control.

  • Always cut food into small pieces and chew food very well to prevent vomiting, cramping or blockage. Chew food to the consistency of applesauce or baby food before swallowing.

  • Eat only at meal times. Between meals, snacking or "grazing" on small amounts of food throughout the day will sabotage your weight loss and result in the inability to lose an adequate amount of weight.

  • Never drink liquids when eating solid foods. Liquids must be avoided for a period of 30 minutes before and 30 to 45 minutes after eating meals. Liquids cause food to pass through the stomach pouch quicker and decrease the feeling of fullness. Drinking with meals can decrease the effectiveness of this surgery. You may only drink your calories during Stages 1 and 2.

  • Stop eating as soon as you are full (over-eating even half an ounce can make you vomit and can lead to stretching your pouch). Listen to your body's signals, not the food left on your plate.

  • A diet consisting of 600 to 800 calories, including 75 grams of protein, should be the goal for the first 6 months. Your body needs a minimum of 75 grams of protein each day. You need the protein to preserve your lean muscle mass, which in turn is going to help you continue to lose weight. You also need adequate protein for your body to heal properly. The primary source of nutrition should be protein. Remember, the main source of protein in foods comes from animal sources. In the beginning due to the very small pouch size, this may force you to eat mostly protein in order to reach the minimum requirement of protein.

  • Do not overcook your meat as this makes it difficult to digest. Bake, grill, or broil, if possible. Do not deep-fry your food. You will notice that it is easier to eat protein rich foods if they are moist and juicy. An example would be chicken thigh meat versus breast meat or using a slow cooker with liquid to tenderize.

  • Introduce one food at a time in order to rule out food intolerance. Don't be afraid to try new foods, but start with small amounts. Many foods are going to be trial and error. What does not agree with you now may be acceptable in a few more weeks. Keep in mind that one day foods may be tolerated smoothly, while the next you may have some fullness or discomfort. These problems eventually disappear, so don't be discouraged if they happen occasionally. If you find foods that repeatedly cause you problems, write them down in your journal and discuss them with the dietitian.

  • Labels are a great source of information. They give you in-depth information about the product you are purchasing with regards to the amount of fat, protein, carbohydrates, sugar and fiber it contains (based on the serving size listed on the label). Become a label reader and become more aware of what you put into your body.


Problem Foods

Red meat such as steak, roast beef, and pork is high in muscle fiber, which is difficult to break down even with a great deal of chewing. Other problem foods include:
  • Dry meat
  • Shrimp
  • Un-toasted bread
  • Doughy bread
  • Pasta
  • Rice
  • Peanut butter
  • Membrane of citrus fruits
  • Seeds and skins of fruits and vegetables
  • Dried fruit
  • Fibrous vegetables such as corn, asparagus, and celery
  • Nuts
  • Coconut
  • Popcorn
  • Greasy or fried foods


Post-Operative Food Guide

DIET STAGES DURATION DIET
Stage 1 Week 1 (7 days) Sugar-free Clear Liquids
Stage 2 Week 2 (day 8-14) Sugar-free Full Liquids
Stage 3 Week 3-4 (day 15-28) Sugar-free Pureed/Soft Foods
Stage 4 Week 5 and on... Solid Foods (Bariatric Diet)
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