Immediately after your surgery it is very important to follow the eating and drinking instruction to allow the procedure you underwent time to heal completely at the surgical site.
This has been estimated to take a month or more. It is also important, especially in the first weeks after surgery, not to overeat or swallow large bites of food that have not been chewed extremely well. Problems may occur if these instructions are not strictly followed. When vomiting occurs the stomach may rise up about the band placement causing slippage of the band requiring re-operation.
Your nutrition plan is divided into four (4) phases – each phase allowing you to adjust to your new gastric pouch.
- PHASE I – First week after surgery. CLEAR LIQUID DIET
- PHASE II – Second Week After Surgery. FULL LIQUID DIET
- PHASE III – Week 3 to 4 after Surgery. BLENDED/PUREED DIET
- PHASE IV – Week 4 to 5 after Surgery – Soft Solid Foods
- PHASE V – Week 5 to 6 After Surgery. COMPLETE DIET
A clear liquid diet allows for healing time and to make sure that your body can tolerate anything by mouth. This diet usually lasts for only 7 days after your operation.
At first, take in liquids every ½ hour – about 2 ounces at a time. Then gradually increase your intake of liquids to 6 to 8 ounces every hour. Drink very slowly and refrain from gulping.
Because this diet does not contain enough nutrients, it is important to take your multivitamins, calcium, B12 and iron as directed.
CLEAR LIQUIDS LIST
- WATER: Plain or flavored, non-carbonated, non- sparkling*
- CLEAR BROTHS or bouillons, fat-free**
- CAFFEINE – FREE COFFEES AND TEAS – no milk, cream or artificial creamers
- APPLE JUICE – CRANBERRY JUICE – GRAPE JUICE – ORANGE JUICE (no pulp)
Mix your juice with water. Equal amounts of juice and water to make it ½ strength
- CRYSTAL LIGHT – or equivalent sugar-free Kool-aid type drinks
- SUGAR FREE GELATIN
- SUGAR FREE POPSICLES
* You may drink regular tap water or drink any of the many bottled waters available.
There are flavored waters that are sugar-free, non-carbonated, with few to no calories
called FRUITE 2-0 or PROPEL or FUZE SPLENDERIZE. Available at Wal-mart, Sam’s
Club, and grocery or health food stores.
** You can get these broths and bouillons either already made in the can that are 99%
fat free – e.g. Swanson, College Inn, Banquet or store brand, or you can find them in
cube or powdered form – Herb-Ox, Wyler’s, Knorr, etc.
The second week after surgery begin the Full Liquid Diet and protein supplements. This diet allows for a broad range of liquids. Anything that has the consistency that can be consumed through a straw is a good rule of thumb for what is allowed. However, do not sip through a straw! A suggested list of full liquids follows. Begin taking your multi-vitamins, calcium and iron daily as directed.
FULL LIQUID DIET
THIS DIET ALLOWS A BROAD RANGE OF LIQUIDS AND PROTEIN SUPPLEMENTS. YOU WILL REMAIN ON THIS DIET FOR THE FIRST FOUR (4) WEEKS POST-OPERATIVELY. THIS WILL GIVE YOUR NEW STOMACH POUCH AND DIGESTIVE SYSTEM TIME TO HEAL PROPERLY AND ALLOW YOU TIME TO ADJUST TO YOUR NEW STOMACH POUCH.
We highly recommend Focus 28 supplements and foods which are formulated specifically for bariatric patients both with restrictive and combination restrictive and malabsorption procedures. You may also use the following:
- Optifast, Optisource, HMR, Revival, Permalen, 100% Whey Protein, Beneprotein
- Low Carb Slim-Fast, Atkins Advantage, Carb Solutions, Worldwide Pure Protein meal replacement protein shakes. Available at grocery, health food and drug stores.
- Carnation Instant Breakfast Powder or Ready to Drink – Sugar Free Only
Milk, Skim/Fat Free – regular and lactose free
- Milk, instant Non-fat Dry – any brand, great to add to other food to boost protein.
- Puddings and Egg Custards, Sugar Free Only
- Jello – Sugar Free Only
- Yogurt – Fat Free or Low Carb without Fruit
- Vegetable Juices – including V-8, V-8 Diet Splash, tomato juice or fresh squeezed.
- Soups, stained – remove vegetables, meat, poultry, seafood and noodles, rice or other pasta first.
- Hot cereals, made thin and soupy – Cream of Wheat, Cream of Rice, Oatmeal, Grits
It is critical at this stage that you are taking in enough protein each day. You should have at least two (2) of your three meals consist of a protein supplement added to other foods. A protein supplement packet or 1/3 cup instant non-fat dry soups, cereals, yogurt or puddings to boost the amount of protein consumed.
You will now progress to a blended/pureed diet. You can now add foods to your full liquid diet. The following is a list of what would be acceptable at this point.
- Thicker Soups: Split pea, Lentil, Vegetable, 98% Fat-free Cream soups.
- Fruits: Very ripe banana, applesauce (no sugar added) cooked fruit.
- Vegetables: Cooked well, so that they are very soft – peas, beans, beets, carrots, squash. Avoid potatoes as they are high in carbohydrates.
- Soy Protein: Boca Burger or Gardenburger blended or pureed or Tofu which can be blenderized into shakes or soups to add protein.
- Poultry or Fish: Blended to the consistency of pate or chopped liver
- Eggs, Whole or Whites: soft boiled, poached or scrambled very easy
- Egg Substitutes: Eggbeaters, Better than Eggs, etc.
- Cottage Cheese: 1% or fat free
- Nut Butters: Peanut butter, almond butter, soy butter: natural without added sugar.
Chew all your food well at least 25 times. If you have dentures, be sure to cut your food into very small pieces and chew it thoroughly. If you don’t follow these precautions, you may experience vomiting, stomach irritation and swelling. You could also have obstruction of the small gastric pouch. If solid foods cause nausea and vomiting, go back to the liquid diet you had earlier. Then you can slowly add soft foods and eventually transition to solid foods. Vomiting may increase the incidence of band slippage, stomach slippage or stretching of the small stomach pouch above the band.
Think of your new pouch as shaped like a funnel. You can pour any liquid into this funnel and it will run through and out the bottom. The same thing happens with your pouch when you only consume liquids. So you do not want to drink your calories or overeat.
You have gotten through the most critical stage of your post-op care and you can now return to a more normal diet of solid foods. Keep in mind that you should select soft, moist, easily chewable food as you transition into this phase. Always begin your meal with high protein choices (see list) followed by vegetables, fruit and carbohydrates. This will assure that you have received the most essential vitamins and nutrients to maintain optimal health.
Important Reminders: Remember to eat slowly. Cut your food into small bite-sized pieces. Chew each bite thoroughly, at least 25 times, before swallowing. Do not drink any liquids ½ hour before you eat and during your solid meal. Do not drink any liquids for 1 hour after your meal. Liquids will pass through your new stomach pouch quickly and will not make you feel full. Consuming only solids at each meal will give you the proper feeling of fullness (satiety) while limiting the amount you eat. Take at least 20 minute to eat your meal.
Always read labels to determine how many calories each food contains and how those calories are broken down (% from fat/protein/carbohydrates). Choose mainly nutrient dense foods containing protein, complex carbohydrates, fiber (greater than 5 grams per serving) and low in fat (less than 3 grams per every 100 calories).
Begin the Soft Solid Diet when you are at approximately Week 5 postoperatively. This diet includes all foods previously mentioned and adds the following:
- Eggs – including whole eggs, egg whites and egg substitutes.
- Mild Cheeses – Low Fat or Fat-Free: Cottage cheese, Farmers cheese, Ricotta, Muenster, Havarti, American, Mild Cheddar, Mozzarella (sliced, shredded and string)
- Poultry – Chicken and Turkey – white meat only – baked, broiled, grilled, boiled or canned. White meat chicken in the can is an easy and tasty choice.
- Fish – baked, broiled, poached, grilled or canned. Salmon, Tuna and sardines are all good canned choices.
- Nut Butters – Peanut, almond, soy or sunflower. Smooth variety only – preferable natural, since the brand names have added sugar.
- Lean, Tender Meats – Preferably pork or veal. Red meats tend to be harder to digest at this stage – however, you can have any of the prepared baby food meats as they have already been pureed for easy digestion and come in small 4 oz jar servings.
- Soy Protein/Tofu – Boca Burger, Gardenburger, Morningstar Farms
- Vegetables – cooked or canned – green beans, wax beans, beets, peas, carrots, squash or any other non-starchy vegetables. Try to refrain from fibrous and raw vegetables at this time as they are much harder to digest and can cause obstruction of the digestive system. If you are using canned vegetables, check for sodium content – you want to choose those lower in sodium.
- Fruit – Cooked or canned – applesauce (unsweetened), peaches, pears, fruit cocktail, apricots, cherries (if canned, choose those packed in water, in their own juice or in light syrup only), bananas, grapefruit and orange sections with membranes removed, ripe melons (eat infrequently as they contain high amounts of natural sugars)
- Cereals/Starches – Oatmeal, Cream of Wheat, Cream of Rice, grits and sparing use of barley, whole wheat crackers, 100% whole wheat pastas and brown rice.
At this point if you have tolerated all of the earlier phases well, you will advance to this phase – a regular diet. Please read the list below for instructions:
- Add fruits, vegetables and carbohydrates with fiber i.e. Kashi cereal, shredded wheat with bran, 100% whole wheat pasta, brown rice, round flax seed.
- Eat foods of normal consistency – you no longer have to puree or blend your foods
- Go slowly with dense foods, high fiber foods, doughy breads or stringy, touch meats.
- Eat 6 small meals a day
- MAINTAIN ADEQUATE PROTEIN – Women: 60 + grams per day. Men: 70 + grams per day
- Always eat your protein first
- Still avoid sweets, fatty foods and calorie dense (high calorie) foods that have no nutrients.
- Health lifelong awareness of your diet will serve you well.
- Maintain your fluid intake, 9 – 10 glasses of fluid a day
- Continue with your multi-vitamins, B12, calcium, iron and protein supplements