Gastric sleeve surgery is a life-changing procedure for individuals seeking significant weight loss and improvements in obesity-related health issues. Preparing for life after gastric sleeve surgery involves learning how to eat in a whole new way, which can be both exciting and challenging. The diet you’ll be required to follow both before and after surgery is very specific and geared toward aiding recovery and avoiding complications. The effectiveness of gastric sleeve surgery depends a great deal on your pre-op and post-op diet. Following your post-op diet is essential if you want to realize the benefits of a bariatric procedure. It will also help you avoid potential health complications, including diarrhea, nausea, vomiting, constipation, and gastric leaks. This article provides a comprehensive overview of the dietary guidelines for the first week after gastric sleeve surgery and beyond, emphasizing the importance of each stage for optimal recovery and long-term success.
Pre-Surgery Dietary Goals
A main, presurgery dietary goal is shrinking your liver. If you’re obese, your liver most likely has an accumulation of fat cells both in and around it. This makes it larger than it should be. Your liver is located right next to your stomach. A too-large liver makes gastric sleeve surgery harder for your doctor to do, and more dangerous for you to have done. To prepare for the procedure, you’ll be given a specific diet to follow, beginning two weeks before your scheduled surgery date. It’s a strict diet that reduces calories as well as carbohydrates, such as sweets, potatoes, and pasta. You will eat primarily lean protein, vegetables, and low- or no-calorie fluids. Your doctor may give you a caloric goal to stick to daily. Drinking more water and eliminating other beverages like carbonated drinks will help get your body used to the post-op diet.Eliminating alcohol and tobacco use will aid your body's natural healing ability and help reduce the risk of complications during and after surgery.
Week 1: Clear Liquid Diet
For the first week after the procedure, you’ll continue with the same clear liquid diet you followed in the days leading up to surgery. Immediately following surgery, patients will be on a special diet explained by their bariatric surgery team. Most patients will start out on a liquid diet for some weeks, then will slowly start to take soft foods, and then eventually solid foods. This initial phase is crucial for allowing your body to heal and preventing postoperative complications such as bowel obstruction, gastric leakage, diarrhea, constipation, and dehydration.
Acceptable Clear Liquids
During this period, you can consume:
- Water
- Clear broth
- Decaffeinated coffee or tea
- Sugar-free Jell-O
- Sugar-free popsicles
- Clear protein supplements
What to Avoid
It’s equally important to avoid certain beverages:
Read also: Comprehensive Guide to Gastric Bypass Diet
- Drinks with sugar: Sugar can contribute to dumping syndrome, a complication caused by too much sugar entering the small intestine quickly, leading to severe nausea, fatigue, diarrhea, and vomiting. Sugar is also full of empty calories. It should be avoided now and minimized in the long term.
- Caffeinated beverages: Caffeine may contribute to acid reflux and dehydration. Some surgeons recommend that caffeine in all forms (coffee, tea, energy drinks) be avoided forever after surgery. Caffeine causes the body to increase urination and the flushing of water out of the body. Consider avoiding or limiting decaf coffee as well. Limit coffee or tea to 1 small cup (12 ounces or 200 mg of caffeine) a day and observe your tolerance.
- Carbonated beverages: These can contribute to gas and bloating.
Hydration is Key
Make sure to drink plenty of clear liquids to stay hydrated. If you have trouble remaining hydrated, talk to your doctor about electrolyte drinks to try, such as low-calorie Gatorade.
Week 2: Full Liquid Diet
During the second week after surgery, you will graduate to a full-liquid diet to introduce some more calories and nutrients.
Acceptable Full Liquids
Options include:
- No-sugar nutrition shakes, such as Ensure Light
- Instant breakfast drinks
- Shakes made with protein powder
- Thin broth and cream-based soups with no chunks - soft soup noodles are ok in very small amounts
- Unsweetened milk
- Sugar-free, nonfat pudding
- Sugar-free, nonfat frozen yogurt, ice cream, and sorbet
- Nonfat plain Greek yogurt
- Fruit juices with no pulp, diluted with water
- Thinned, hot cereal, such as Cream of Wheat, or oatmeal
Important Considerations
During this period, you may feel your appetite increase. That is perfectly natural, but not a reason to eat solid food. Your system is still unable to handle solids. Vomiting and other complications can result. Filling up on liquids and avoiding sugar and fat will help prepare you for the next stage of your diet. Carbonated beverages and caffeine should still be avoided.
Week 3: Pureed Foods
When you get to the third week, incorporate pureed foods. You can have a bit more variety while still keeping everything gentle on your healing stomach. During week three, you can add soft, pureed foods to your diet. Make sure to eat slowly and chew food thoroughly - at least 25 times, if possible. Any low-fat, sugar-free food that you can puree, including lean protein sources and nonfibrous vegetables, are acceptable.
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Recommended Pureed Foods
Foods to eat include:
- Jarred baby food
- Silken tofu
- Cooked, pureed white fish
- Soft-scrambled or soft-boiled eggs
- Soup
- Cottage cheese
- Canned fruit in juice
- Mashed bananas or very ripe mango
- Hummus
- Pureed or mashed avocado
- Plain Greek yogurt
Foods to Avoid
Continue to avoid chunked and solid foods, as well as caffeine, during this time. You should also stick to bland food with mild or no seasoning. Spices may contribute to heartburn. Use a blender or food processor to puree foods.
Week 4: Soft Foods
Going into week four, start adding soft foods that are easy to chew and digest. Now that you’re one month post-surgery, you can start adding solid foods to your diet. This is the time to put your new healthy-eating skills into action, full force. Sugar and fat, including high-fat dairy, should still be avoided, as should hard-to-digest foods such as steak, fibrous vegetables, and nuts.
Suitable Soft Foods
Foods you can add to your list include:
- Well-cooked chicken and fish
- Well-cooked vegetables
- Sweet potatoes
- Low-fat cheese
- Fruit
- Low-sugar cereal
Continued Restrictions
Other foods to avoid include pasta, white potatoes, and other high-carb options. Caffeinated beverages can usually be reintroduced, in moderation, at this time.
Read also: Guide to Pureed Foods Post-Surgery
Week 5 and Beyond: Transitioning to Solid Foods
After the fifth week, start transitioning to more solid foods. Focus on fiber, lean proteins, vegetables, and low-fat dairy, and introduce new foods one at a time. Now that you can eat solid food safely, it’s time to put your new-normal eating plan into long-term effect. Keep the emphasis on lean protein and vegetables, introducing one food at a time so that you can monitor your body’s reaction.
Long-Term Dietary Guidelines
- Prioritize Protein: Aim for a minimum of 65 to 75 grams of protein a day to preserve muscle tissue. High-protein foods include eggs, meats, fish, seafood, tuna, poultry, soy milk, tofu, cottage cheese, yogurt and other milk products.
- Emphasize Nutrient-Dense Foods: Choose your foods wisely, picking nutrient-dense options, and avoid empty calories.
- Eat Small, Frequent Meals: Eating three small meals a day, with minimal snacks, may help you stick to your plan. You can eat 3 to 6 small meals a day.
- Stay Hydrated: Drink at least 8 cups (1.9 liters) of fluids a day.
- Avoid Certain Foods: Foods you should avoid entirely, or only eat on occasion from this point forward, include sugary sweets and soda. All other foods can be incorporated back in unless they trigger symptoms.
Foods to Be Cautious Of
There are some key foods and drinks to be cautious of for the rest of your life. Eating these foods can make you very uncomfortable and lead to diarrhea and vomiting. These foods have limited nutritional value, may cause pain and discomfort, and take up a lot of space in your tiny stomach pouch. This leaves less room for the important nutrients you need to get after surgery.
- Alcohol is high in calories. Tolerance of alcohol changes.
- Consider avoiding or limiting decaf coffee as well. Limit coffee or tea to 1 small cup (12 ounces or 200 mg of caffeine) a day and observe your tolerance. Stay hydrated.
Post-Surgical Recovery Tips
Post-surgical recovery tips that can help you stay on track include:
- Learn to recognize the difference between hunger (physical) and appetite (mental/emotional).
- Don’t overeat - your stomach will stretch in time and stabilize in size.
- Chew slowly, and eat slowly.
- Avoid non-nutrient calories.
- Avoid concentrated sugars.
- Avoid trans fats and fried, processed, and fast foods.
- Avoid dehydration by sipping water or low-calorie versions of Gatorade.
- Don’t eat and drink at the same time.
- Talk to your doctor about bariatric vitamins and supplements to decide what you should take, and when.
- Build movement into your life. Start with walking, and explore other exercises that you enjoy, such as swimming, dancing, and yoga. Light physical activity, such as walking, is recommended twenty minutes twice a day after surgery. Strength training and more intense cardio routines can be incorporated after full recovery, typically 4 weeks post-surgery.
- Avoid alcohol. Gastric sleeve surgery and other types of bariatric surgeries may increase, and quicken, alcohol’s effects. Alcohol is absorbed more quickly into the blood stream after surgery, and bariatric surgery patients will have higher levels of alcohol in their system for a longer period of time after drinking compared to before surgery.
- Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, aspirin, and naproxen. These types of over-the-counter pain medications may reduce your stomach’s natural, protective coating.
Common Challenges and How to Address Them
- Nausea and Vomiting: Eat slowly, chew thoroughly, and avoid drinking liquids with meals.
- Dumping Syndrome: Limit sugar intake and avoid high-fat meals to prevent dizziness, nausea, and cramping. 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. 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.
- 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. 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. Chew food thoroughly.
- Plateaus in Weight Loss: Reassess your diet and exercise habits with a healthcare provider.
- Feelings of Frustration or Depression: Significant weight loss can bring emotional highs and lows.
- Weight gain or failure to lose weight:
The Importance of Supplements
After any weight loss surgery, patients will need to take over the counter vitamins and minerals for life. 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. These typically include: a multivitamin, Vitamin B12, Calcium, Vitamin D, and Iron. Please remember that all pills must be crushed or cut into six to eight small pieces. Some patients will need chewable vitamins, but some can take pills if tolerated.
- 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.
Long-Term Follow-Up and Support
Early after surgery, patients will follow up every few months for the first year. They should have yearly visits with a bariatric specialist for life. These are important visits, since obesity is a chronic disease, and can continue or even return after surgery.