A gradual progression of diet is often seen in postoperative patients with the return from an NPO (nothing per os) state to a regular diet. The length of time on each of the following therapeutic diets varies based on the patient’s medical condition. This article provides comprehensive diet progression guidelines applicable in various clinical scenarios, including post-operative care and management of specific gastrointestinal conditions.
Initial Stages: Clear Liquid Diet
Patients are typically started on a clear liquid diet after surgery. Anesthetic agents and opioid medication, along with being NPO before surgery, cause peristalsis to slow and delays gastric emptying, which leads to nausea and vomiting. Once bowel sounds return, a clear liquid diet is started.
A clear liquid diet includes only fluids that you can see through. This includes:
- Plain water
- Clear fruit juices without pulp
- Soup broth/bouillon
- Clear sodas
- Tea or coffee with no cream or milk added
- Gelatin
- Popsicles
- Sports drinks
Advancing to Full Liquid Diet
As peristalsis improves, the diet can be advanced to a full liquid. A full liquid diet adds to the clear liquid diet with the addition of smooth-textured dairy products, strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, and frozen yogurt.
Pureed Diet
A pureed diet allows for the addition of items such as pureed meats, vegetables, and fruits, or mashed potatoes and gravy. This diet is often used with patients that have dysphagia or for patients that need to conserve energy while eating. At this stage, foods need to be put in a blender to achieve a smooth baby food consistency for 3 weeks. This is necessary to avoid serious complications and to increase your tolerance to new foods. Each meal is about 2 ounces (1/4 cup) of blended protein foods.
Read also: The Hoxsey Diet
Mechanical Soft Diet
A mechanical soft diet allows for everything included in a clear liquid, full liquid and pureed diet with the addition of items such as cream soups, ground or finely diced meats, flaked fish, rice, potatoes, light breads, cooked vegetables, cooked or canned fruits, peanut butter, and cottage cheese. This diet can also be issued for patients with dysphagia.
Low-Residue (Low-Fiber) Diet
Residue refers to the food that does not digest in the GI tract, primarily fiber. In a low residue or low fiber diet, the stool bulk is reduced. This diet is used in patients with Crohn’s disease, ulcerative colitis, or diverticulitis. It includes easily digested foods such as pastas, moist tender meats, and canned cooked fruits and vegetables, and desserts, cakes, and cookies without nuts or coconut.
High-Fiber Diet
High fiber diets can be used to regulate the GI tract and help in normal elimination patterns. The majority of the fiber that is ingested does not digest and pulls water into the GI tract.
Bariatric Diet Progression
Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. The main goal after bariatric surgery is to allow the stomach to heal while providing your body with proper nutrition.
Pre-Surgery Phase
Before bariatric surgery, a supervised weight-management program, including a low-calorie diet, is recommended. Studies have found a positive correlation between preoperative and postoperative weight loss. A large-scale study based on data from the Scandinavian Obesity Registry showed that weight loss of 9.5% before RYGB was associated with a marked reduction in important postoperative complications, such as anastomotic leakage, deep infection or abscess, and minor wound complications. These findings were even more significant in patients with BMIs >45.8. Weight reduction before surgery also provides a protective effect in patients who suffer from nonalcoholic fatty liver disease, who represent 90% of patients with morbid obesity. The specific dietary components should be tailored for each patient by the bariatric medical team. Recommendations for the duration of the diet range from 2 to 6 wk for the primary aim of reducing liver volume but also to reduce visceral adipose tissue before surgery.
Read also: Walnut Keto Guide
Timeline for Bariatric Diet Progression:
- 10 days before surgery: Low-calorie general diet (dietitian will tell you what day to start)
- Day of surgery: No food or drink
- Day 1 (in the hospital): Clear liquid diet
- Days 2 to 14 (2 weeks): Full liquid diet
- Days 15 to 30 (until 1 month visit): Pureed diet (very smooth)
- Days 31 to 60 (after 1 month visit): Soft diet
- Days 61 to forever: General diet
Post-Surgery Phases
After surgery, it's important to get adequate nourishment while keeping your weight-loss goals on track. The greatest risks of the gastric bypass diet come from not following the diet properly. If you eat too much or eat food that you shouldn't, you could have complications. Your doctor or a registered dietitian will talk with you about the diet you'll need to follow after your surgery, including what types of food and how much you can eat at each meal. A gastric bypass diet follows a staged approach to help you ease back into eating solid foods. How quickly you move from one step to the next depends on how fast your body heals and adjusts to the change in eating patterns.
Clear Liquid Diet: While in the hospital you will be asked to take small sips of clear liquids. These include water, broth, sugar-free gelatin, sugar-free popsicles, decaf tea, decaf coffee, and sugar-free non-carbonated beverages. You will start by drinking 1-2 ounces every hour. Once discharged, you should increase fluid intake to 3-8 ounces every hour to avoid dehydration. The goal is for you to drink 48-64 ounces daily.
Full Liquid Diet (Days 2-14): After the first week, you will add “full liquids,” such as strained low-fat cream soups, fat-free/low-fat milk (or unsweetened non-dairy milk), low-fat yogurt, and sugar-free fat-free pudding. You will start protein shakes to help meet your daily protein goal (whey protein is typically recommended after surgery). Drink six 8 oz glasses of water each day. Take 5 to 15 minutes to drink 1 oz. Do not wait 30 minutes before or after meal to drink fluids. Sip throughout the day. Stop eating when you are full! Start taking vitamin and mineral supplements after your 1 week follow-up visit, as ordered. Follow all of the "Lifestyle Changes." Meal Portion Size: Protein:1/4 to 1/3 cup or 2 to 3 oz Carbohydrate: 1/4 cup Full liquid food ideas: Sugar- free pudding (make with Fairlife or add collagen protein powder or non-fat dry milk powder for extra protein) Cream soups (celery, mushroom, chicken, broccoli, ect.) Homemade blended liquid soups (ex. Butternut squash soup, Carrot ginger soup) Sugar-free popsicle (limit 1 per day) Lite yogurt (no fruit chunks) Other blended strained soups. You will be on a full liquid diet days 2 to 14 after your surgery. Full liquids are foods that are normally liquid and foods that turn into liquid when they are at room temperature.
Pureed Diet (Days 15-30): At this stage, foods need to be put in a blender to achieve a smooth baby food consistency for 3 weeks. This is necessary to avoid serious complications and to increase your tolerance to new foods. Each meal is about 2 ounces (1/4 cup) of blended protein foods.
Soft Diet (Days 31-60): This stage includes foods that can be easily mashed with a fork (e.g., lean ground meats, poultry, fish, canned tuna/salmon, scrambled eggs, beans, tofu, cooked soft vegetables and fruits canned in water or natural juice). You should eat protein foods first to meet your daily protein goal. Protein shakes are still an important part of your diet. You will be on a soft diet days 31 to 60 after your surgery. You will start this diet after your 1 month follow-up visit. You need to: Chew foods to a pureed consistency (chew 20 to 30 times before swallowing). Slowly add soft foods to your meals and snacks. Take 30 minutes to eat. Eat 3 milk snacks per day and 3 soft food meals. Drink six 8 oz glasses of water each day, working up to eight 8oz glasses. Stop eating when you are full! Take vitamin and mineral supplements as ordered. Start doing strength-building exercise in your daily routine, such as strength and aerobics for 60 minutes each day.
Read also: Weight Loss with Low-FODMAP
Regular Diet (Day 61 onwards): Usually patients are able to safely begin a regular, healthy diet at 9 weeks after weight-loss surgery. You will be encouraged to choose mostly high-protein foods and to avoid foods that are usually not well tolerated. You will continue practicing all the good eating habits you learned as you were preparing for surgery. Meals are about 4-8 ounces (1/2-1 cup).
- Lifelong Lifestyle Changes: Starting today, you agree to: Eat 3 meals a day. Eat protein and a carbohydrate choice at each meal. Eat your protein first. Take 30 minutes to eat your meal. Chew your food to a pureed/mush consistency. This takes 20 to 30 chews. Eat nutrient-dense foods such as vegetables, whole grains, fruits, and lean meats. Do not eat calorie-dense foods such as chips, cookies, crackers, ice cream, fried food, candy, hot dogs, brats, and bologna. Do not eat non-nutrient-dense foods such as pretzels, rice cakes, and animal crackers. Eat 3 milk snacks each day. Do not drink carbonated fluids such as pop, juice, or alcohol. Carbonation can cause stomach pain. These drinks have extra calories and sugar that is not needed. Drink 6 or more cups of plain water a day. You may drink 8oz of unsweetened coffee or tea per day. Do not drink anything with citric acid. Do not drink fluids 30 minutes before meals, with meals, or for 30 minutes after meals. Do not use tobacco or nicotine products. It slows down healing and can lead to complications. Exercise 30 minutes or more a day. Keep detailed food and activity records (bubble sheets). Bring them to each dietitian appointment. Do not use straws. Air bubbles form in your new pouch and can cause pain. The first 3 months after surgery, do not eat acidic or citrus foods such as tomatoes, lemon, orange, or lime.
Key Considerations for Bariatric Patients
Dumping Syndrome: People who had a gastric bypass can sometimes be more sensitive to high-fat and high-sugar foods. This is called “dumping syndrome”. Dumping syndrome: a feeling of fullness and cramping which can lead to diarrhea, lightheadedness, headache, shaking, sweating, hunger, and fatigue. This may occur after eating high-sugar and/or high-fat foods or drinking while eating. Eat protein foods first.
Eating Habits: Eat and drink slowly. To avoid dumping syndrome, take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup of liquid. Keep meals small. Eat several small meals a day. You might start with six small meals a day, then move to four meals and finally, when following a regular diet, three meals a day. Drink liquids between meals. To avoid dehydration, you'll need to drink at least 8 cups (1.9 liters) of fluids a day. Chew food thoroughly. The new opening that leads from your stomach into your small intestine is very narrow and can be blocked by larger pieces of food. Blockages prevent food from leaving your stomach and can cause vomiting, nausea and abdominal pain. Focus on high-protein foods. Avoid foods that are high in fat and sugar.
Vitamin and Mineral Supplementation: After surgery your body won't be able to absorb enough nutrients from your food. You must take the following supplements on a daily basis to prevent nutrient deficiencies. Please remember that all pills must be crushed or cut into six to eight small pieces. Brands that contain this formula include Trader Joe’s and Centrum Adult chewable multivitamins. Take 1,200 to 2,000 mg of calcium daily to prevent calcium deficiency and bone disease. To enhance absorption, take the calcium in two to three divided doses throughout the day - for example, a 500 to 600 mg supplement taken three times a day. This total amount should be taken in divided doses of 400 to 500 IUs twice a day. Vitamin D should be taken with your calcium supplement. Take 500 mcg of vitamin B daily. Some patients need additional folic acid or iron supplements, particularly women who are still menstruating.
Total Gastrectomy Diet Progression
On this page, we’ve broken down a recommended timeline for how and when to reintroduce certain foods and food groups into your diet after a total gastrectomy. This plan is broken down into two main phases. Your dietitian will tell you when to begin introducing foods from phase 2 into your diet. It is important that you focus not only on which foods you choose, but also on how much of those foods you eat and when and how you are eating them. This is your body’s recovery period. Your body needs foods that are high protein to help you heal and to slow weight loss. Eat often. You need at least 6-8 small meals each day. Remember that you will not feel hungry like you used to, but you need to eat often anyway. Choose high-calorie, high-protein foods and fluids for these meals to meet your nutritional needs. Chew foods completely, into puree form, before swallowing. Avoid foods high in insoluble fiber and gas-producing foods. Avoid foods and drinks with added sugars. Added sugar is different from natural sugar. Avoid sugar alcohols such as sorbitol, mannitol, erythritol and xylitol. They cause gas, bloating and diarrhea. Other artificial sweeteners do not cause dumping syndrome. Natural sugar is sugar that naturally exists in your food. For example, fruit, starchy vegetables, milk and unsweetened yogurts have natural sugar (carbohydrate) that was not added and will not be listed as an ingredient. You may find it helpful to use a food diary or app to record what you are eating and drinking. Record the specific food or drink, the amount, and any symptom you have. Bring your food diary to follow-up appointments after surgery.
Nutritional Deficiencies
The causes of nutritional deficiencies in obesity are multifactorial and include the following: high intake of calorically dense foods with low nutritional quality, limited bioavailability of some nutrients (e.g., vitamin D), chronic inflammation status that affects iron metabolism, and small intestinal bacterial overgrowth (SIBO), which can lead to deficiencies in some vitamins (e.g., thiamin, vitamin B-12, and fat-soluble vitamins). The most common preoperative deficiencies found in studies include vitamin B-12, iron, folic acid, vitamin D, and thiamin. Therefore, daily multivitamin supplementation is recommended during the preoperative diet.
Eating-Related Behaviors
Recommended eating behaviors include taking small bites, dividing food intake into 4-6 meals throughout the day, chewing well in a relaxed manner, and ending meals when feeling “comfortably full.” It is advised to eat balanced meals with a high protein content to reach the recommended daily protein intake. Solid foods should be preferred, because this helps provide greater satiety. Instructions should be given to reduce the consumption of high-calorie-dense foods and beverages (e.g., smoothies, ice cream, milkshakes, juices, chocolate, cream cakes, cookies) and to limit added sugar to avoid DS. Carbonated beverages should also be avoided. Liquids and solids should be separated by drinking 15 min before or 30 min after meals. Special attention should be paid to grazing, which is considered an undesirable, negative eating pattern. It is well established that a grazing pattern of eating behavior after surgery reduces the long-term surgical success. Eating disorders are another highly important issue to be addressed by a dietitian, because they may emerge or re-emerge postsurgery and compromise surgery outcomes.
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