Gastric sleeve surgery, also known as sleeve gastrectomy, is a clinically proven method for reducing body weight. The procedure involves removing a large portion of the stomach, leaving a narrow "sleeve" that restricts food intake and promotes weight loss. However, surgery is just the beginning. To achieve lasting success, a lifelong commitment to a specific diet and exercise regimen is essential.
Understanding the Gastric Sleeve Procedure
During a gastric sleeve procedure, a large portion of the stomach is removed, leaving the remainder in the shape of a tube or sleeve. This drastically reduces the amount of food a person can eat to feel full. It also decreases the production of ghrelin, a hormone that causes hunger, thus reducing food cravings.
To qualify for a sleeve gastrectomy, a patient must typically have a Body Mass Index (BMI) of at least 40, or a BMI of 35 with obesity-related health conditions. This is because obesity is recognized as a chronic and life-threatening disease.
The Importance of a Long-Term Diet
Bariatric surgery assists with weight loss by reducing the stomach’s size and potentially altering how the digestive system handles calories. This helps patients feel full longer and reduces constant hunger. However, without a serious commitment to a healthy long-term diet, weight loss results may be less significant, or weight regain can occur.
Adapting to Dietary Changes
After gastric bypass surgery, your diet completely changes, requiring you to alter your eating habits to provide your body with the necessary nutrients while working within the parameters of your altered digestive system. The post-bariatric diet will gradually change as you move forward, adapting from clear liquids to solids in the initial months.
Read also: Comprehensive Guide to Gastric Bypass Diet
Your body naturally adapts to caloric intake, slowing down or speeding up metabolism to maintain a certain "set point." Therefore, it's essential to combat these slowdown periods with a pre-determined strategy. How you eat immediately after the procedure will not be the same as after a year, two years, or even five years. Your preparation to modify and adjust eating habits will significantly influence your weight loss progress and maintenance.
Three Dietary Phases After Bariatric Surgery
- Phase 1: This phase consists of four steps, starting with clear liquids, progressing to opaque liquids and purees, soft foods, and then solids. It can take three to six months while your stomach heals, resulting in rapid weight loss due to appetite suppression and limited food intake.
- Phase 2: Considered the long-term diet, this phase focuses on continually losing excess body weight until your goal weight is achieved. This weight loss will be slower but consistent if you develop maintainable long-term dietary habits.
- Phase 3: This phase begins after you reach your "goal" or "ideal" weight, transitioning into maintaining this weight. The objective is to stay at the same weight without gaining or losing.
The Post-Sleeve Diet: A Staged Approach
The 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.
Immediately After Surgery
In the initial days following surgery, the diet is restrictive. For the first day or so after surgery, you'll only be allowed to drink clear liquids. Within a week of recovery, however, patients will visit their surgeon in the office and likely be cleared to slowly increase what they can eat.
One Week After Surgery
After about a week of tolerating liquids, you can begin to eat strained and blended, or mashed up, foods. You can eat 3 to 6 small meals a day. Each meal should consist of 4 to 6 tablespoons of food.
A Few Weeks After Surgery
After a few weeks of pureed foods, and with your doctor's OK, you can add soft foods to your diet. You can eat 3 to 5 small meals a day. Each meal should consist of one-third to one-half cup of food.
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Eight Weeks After Surgery
After about eight weeks on the gastric bypass diet, you can gradually return to eating firmer foods. Start with eating three meals a day, with each meal consisting of 1 to 1-1/2 cups of food. Depending on how you tolerate solid food, you may be able to vary the number of meals and amount of food at each meal.
Long-Term Dietary Guidelines
After about eight weeks on the gastric bypass diet, you can gradually return to eating firmer foods. Start with eating three meals a day, with each meal consisting of 1 to 1-1/2 cups of food. Depending on how you tolerate solid food, you may be able to vary the number of meals and amount of food at each meal.
General Recommendations
- Eat and drink slowly: Take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup of liquid to avoid dumping syndrome.
- 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. Sip liquids between meals, not with meals.
- 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: Your goal should be a minimum of 65 to 75 grams of protein a day. You must take the following supplements on a daily basis to prevent nutrient deficiencies.
- Avoid foods that are high in fat and sugar.
- Take recommended vitamin and mineral supplements: 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.
- Try new foods one at a time.
Nutritional Guidelines for Long-Term Diet
During Phase 2, the long-term diet phase, aim for the following nutritional guidelines:
- Calorie Intake: Approximately 900 to 1200 calories per day.
- Fat Intake: Limit dietary fat to under 30 grams a day.
- Carb Intake: Limit carb intake to 60 grams or less each day.
- Begin initially with 1-2 ounce meals and gradually work up to 3-4 ounce meals at each sitting.
- You need to stop eating when you feel full. You do not want to stretch out your stomach which will lead to ineffective weight loss or even weight gain.
- Do not forget to take your vitamins and supplements every day. This is the only way you will get everything your body needs since you are on a reduced diet.
- Eat 3 meals a day that are balanced with foods rich in nutrients. Lean meats or fish, low-fat dairy products, whole grains, low-fat starches, fruits, and vegetables.
- Eat as slowly as you can, taking tiny bites and chewing each piece about 20 times. You no longer have to feel guilty about clearing your plate! Stop when you are full.
- Avoid foods that are high in fat, refined carbs, and sugar. These foods are high in calories, do not provide nutritional benefits, can cause malnutrition, and prevent weight loss. Choices like cookies, cake, and processed foods utilize much-needed space in the stomach without providing any nutritional value.
- You must consume enough protein each day. If you are unable to meet your protein requirements through the food you may need to drink a protein shake in between meals. The recommended guidelines for protein intake are about 75 grams per day for men and 60 grams per day for women. Good sources of protein include seafood and fish, chicken, turkey, lean beef*, eggs, cottage cheese, Greek yogurt, beans, legumes, lentils, quinoa, protein bars, and shakes.
Hydration Guidelines
Stay hydrated! Dehydration is the number one reason bariatric surgery patients are admitted to the hospital after surgery. Although it is often a challenge for patients after weight loss surgery, it is important to remain hydrated. Many doctors recommend patients carry around a 64 oz container of water and take sips on it throughout the day except for 30 minutes before and after meals.
- Drink 64 oz of water a day.
- Do not drink anything 30 minutes before or after each meal.
- An 8-ounce protein supplement or shake can be used to meet protein goals.
Dietary Golden Rule
To ensure your body gets what it needs to function without ending up with a deficiency, here is the Golden Rule of Eating Order. Eat your protein first! Anything on your plate that is protein, such as meat, poultry, eggs, or fish; and then eat your vegetables, followed by fruit and finally, any low-fat starches.
Read also: Guide to Pureed Foods Post-Surgery
Foods to Avoid
Many bariatric doctors recommend no carbonated drinks or chewing gum ever again after bariatric surgery. There are also cautionary foods that weight loss surgery patients may find they cannot tolerate short-term and possibly long-term. You may wish to consult your doctor before proceeding with adding these foods. Some of the foods patients reported having issues with include:
- Pineapple
- Sweet corn
- Dried fruits
- Fibrous red meat
- Seeds, nuts, popcorn
- Fruit and veggie skins
- Boiled rice or soft sticky pasta
- Mushrooms with a tough texture
- Raw vegetables that are stringy like celery
- Soft bread that is not toasted, especially white bread
Potential Complications of Not Following the Diet
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.
- Dumping syndrome: If too much food enters your small intestine quickly, you are likely to experience nausea, vomiting, dizziness, sweating and diarrhea.
- Dehydration: Because you're not supposed to drink fluids with your meals, some people become dehydrated.
- Constipation.
- Blocked opening of your stomach pouch: Food can become lodged at the opening of your stomach pouch, even if you carefully follow the diet. Symptoms of a blocked stomach opening include ongoing nausea, vomiting and abdominal pain.
- Weight gain or failure to lose weight.
Long-Term Follow-Up and Support
Long-term bariatric follow-up requires a team approach and attention to several aspects of care. Nutrition is the most important aspect of follow-up to safely maximize weight loss and prevent weight gain. Exercise helps to maintain weight loss. Complications need to be identified early and can result from improper behavior or from surgical complications. Emotional difficulties occur in many patients.
Regular Monitoring
In the early postoperative period, the main goals of office visits are to assess proper nutrition status, identify maladaptive eating disorders, evaluate potential complications (internal hernia, ulcers, etc), monitor status of comorbidities, encourage regular exercise, discuss weight loss progress, and check laboratory values (vitamin B1, vitamin B12, magnesium, phosphorous, blood counts, albumin, and a metabolic profile).
Addressing Weight Regain
The most common factors leading to weight gain after weight loss surgery are decreased exercise and a return to preoperative eating habits. It is best for patients to return to the bariatric team at the earliest signs of weight regain. If weight regain is caught in its early stages, it is easier for patients to get back on track.
Psychological Support
Many patients have difficulty with the extreme and instant lifestyle changes. Symptoms of depression should be monitored closely at the first few appointments. If patients were previous stress eaters and become stressed after surgery, they no longer have the ability to eat for stress relief.