Bariatric surgery is a significant step toward substantial weight loss, but surgery alone is not enough to ensure long-term success. Preparing for bariatric surgery involves significant lifestyle changes, including adhering to specific pre-surgical diet guidelines. These guidelines are designed to optimize your health, reduce surgical risks, and promote a smoother recovery. This article provides a comprehensive overview of pre-surgical bariatric diet guidelines to ensure you are well-prepared for your weight loss journey.
The Importance of a Pre-Surgical Diet
A pre-surgical bariatric diet is essential for several reasons:
Liver Shrinkage: A primary goal of the pre-op diet is to reduce the size of the liver. Fat and sugar increase the size of the liver, which can complicate the surgery. By following a low-sugar, low-fat diet, the body uses stored carbohydrates (glycogen) from the liver, effectively shrinking it. During laparoscopic surgery, the liver must be lifted to access the stomach. A smaller liver makes it easier and safer for the surgeon to access the stomach, reducing the duration of surgery and the risk of complications such as bleeding or injury to other organs.
Weight Loss: The pre-op diet helps you lose some weight before surgery. This weight loss can reduce the risk of needing to convert a laparoscopic surgery to an open surgery.
Reducing Abdominal Fat: The pre-op diet reduces abdominal fat, making access to the stomach safer and easier during surgery.
Read also: Weight Loss Without Surgery
Thins Out the Stomach Wall: The pre-op diet thins out the wall of the stomach, making the stapling portion of the surgery easier.
Establishing New Habits: Beginning dietary changes before surgery helps establish routines that will be necessary after the procedure. It is about behavior modification. It allows you to adapt to the changes needed for a healthier lifestyle post-surgery.
Ensuring Compliance: Compliance with the pre-op diet demonstrates your commitment to the lifestyle changes necessary for success after bariatric surgery. Non-compliance can lead to cancellation of the surgery.
General Guidelines for the Pre-Surgical Diet
The typical pre-op diet is high in protein and low in fat and carbohydrates. Here are the general guidelines to follow:
High Protein Intake: Consume 70 to 120 grams of protein per day. Protein is crucial for preserving muscle mass and promoting healing.
Read also: Weight Loss Options: Riverside Guide
Low Fat and Carbohydrate Intake: Reduce your intake of fats and carbohydrates to help shrink the liver and promote weight loss.
Liquid Diet: About two weeks before surgery, you will switch to a full-liquid, low-carbohydrate diet. This typically involves consuming protein shakes and other approved liquids.
Hydration: Aim for a fluid intake of at least 64 ounces of water per day. Staying hydrated is essential for overall health and can help prevent complications.
Components of a Pre-Surgical Bariatric Diet
1. Meal Replacement and Solid Food Meal Plan
This plan includes consuming four meal replacements and one solid food meal per day, except for the day before surgery, when only liquids are allowed. It is important to space your meal replacement shakes and solid food meal evenly throughout the day.
2. Liquid Diet Phase
A week or two before surgery, transition to a low-sugar, low-fat, full-liquid diet, consuming 64 ounces per day of fluids high in protein and low in carbs.
Read also: Bariatric Surgery Options
3. The Day Before Surgery
On the day before surgery, you must only consume liquids. Avoid any solid food to ensure your stomach is empty and to minimize the risk of complications.
Specific Dietary Recommendations
Here is a more detailed breakdown of what to eat and drink during the pre-surgical diet:
Protein Shakes
- Quantity: Drink two high-protein, low-carbohydrate shakes per day.
- Protein Content: Shakes should have at least 20 grams of protein per serving.
- Carbohydrate Content: Limit shakes to 10 grams of carbs or less per serving.
- Examples:
- Premier Protein®: 30 grams of protein, 4-6 grams of carbohydrates.
- Pure Protein® 100% Whey Protein Powder or Shakes: 30 grams of protein, 6 grams of carbohydrates.
- Fairlife® Nutrition Plan: 30 grams of protein, 3-4 grams of carbohydrates.
- Muscle Milk® (various options): 20-40 grams of protein, 7 grams of carbohydrates.
- Vital Proteins® Collagen Peptides: 20 grams of protein, 0-4 grams of carbohydrates.
Solid Food Meal
- Frequency: Eat one solid food meal per day during the initial phase of the pre-op diet.
- Composition: Choose a 4-6 oz portion of lean protein, add up to ½ cup of starchy vegetables, and fill in with unlimited non-starchy vegetables.
Lean Protein Choices:
- Fish
- Chicken
- Turkey
- 2-3 large eggs
- ¾ cup liquid egg whites
- 93/7 ground meat
- Venison (deer)
- Extra firm tofu
Starchy Vegetable Choices (up to ½ cup):
- Potatoes
- Sweet potatoes
- Corn
- Beans (not BBQ-style)
- Peas
Non-Starchy Vegetables (unlimited):
- Carrots
- Leafy greens (spinach, lettuce, kale)
- Green Beans
- Peppers
- Tomatoes
- Asparagus
- Broccoli
- Cabbage
- Celery
- Radishes
- Eggplant
- Brussels sprouts
- Squash / zucchini
- Mushrooms
- Cucumbers
- Cauliflower
Snacks
- Frequency: Eat 1-2 snacks per day.
- Carbohydrate Limit: Limit snacks to no more than 10g of carbs per snack.
- Examples:
- ½ cup fresh berries
- ¼ cup nuts
- String cheese with 2-3 crackers
Fluids
- Water: Consume a minimum of 64 ounces of water per day.
- Other Fluids: Include other fluids as long as they are uncarbonated, sugar-free, and caffeine-free.
- Examples: Crystal Light, Powerade Zero, decaf unsweet tea
Example Meal Plan
Here is an example of a pre-op diet meal plan:
- Breakfast: Protein shake (at least 20 grams of protein, 10 grams of carbs or less)
- Snack: Celery with 1 Tbsp peanut butter
- Lunch: Protein shake (at least 20 grams of protein, 10 grams of carbs or less)
- Dinner: 4-6 oz grilled chicken breast, ½ cup baked sweet potato, small salad of spinach, tomatoes, and shredded carrots with light drizzle of infused olive oil dressing (~2tsp)
Foods to Avoid
During the pre-surgical diet, it is important to avoid certain foods that can hinder your progress or increase surgical risks. These include:
- Sugary Drinks: Avoid sodas, juices, and other beverages high in sugar.
- High-Fat Foods: Limit your intake of fried foods, processed snacks, and high-fat meats.
- Alcohol: Alcohol can interfere with the liver shrinkage process and should be avoided.
- Caffeine: Wean off caffeine-containing drinks over the two weeks leading up to the liquid diet phase. You will need to avoid caffeine for the first two weeks after surgery as well.
- Creamy or Ready-Made Sauces: Avoid creamy or ready-made pasta or meal sauces.
Additional Lifestyle Changes
In addition to dietary changes, several other lifestyle adjustments are crucial for preparing for bariatric surgery:
Smoking Cessation: Quit smoking at least 4 to 6 weeks before your surgery. Smoking increases the risk of complications during and after weight loss surgery. Nicotine testing will be conducted to confirm compliance.
Exercise: Increase your cardiopulmonary function and muscle strength before surgery. A pre-surgical fitness plan can reduce your hospital stay and enhance your overall recovery.
Medication Adjustments: Talk with your doctor about how to adjust medications, including insulin, during this low-calorie, low-carbohydrate diet phase.
Discontinue Certain Medications and Supplements:
- Discontinue all hormonal therapy (testosterone, birth control pills) one month before surgery to reduce the risk of blood clots.
- Discontinue phentermine, Ozempic®, or any other diet medication 2 weeks before surgery due to potential interactions with anesthesia.
- Discontinue all herbal supplements other than vitamins two weeks before surgery.
- Start bariatric vitamins at least two weeks before surgery.
Post-Operative Diet Progression
After bariatric surgery, you will progress through several stages of dietary changes to allow your stomach to heal and to adapt to your new anatomy. The typical stages include:
Stage 1: Clear Liquid Diet: This stage typically lasts for the first few days after surgery. You will consume only clear liquids such as water, broth, and sugar-free gelatin.
Stage 2: Full Liquid Diet: This stage involves consuming liquids that are slightly thicker, such as protein shakes, yogurt, and strained soups.
Stage 3: Pureed Foods: During this stage, you will eat foods that have the consistency of a smooth paste or thick liquid.
Stage 4: Soft Foods: Anything that can be easily mashed with a fork is considered a soft food.
Stage 5: Solid Foods: Gradually introduce firmer foods into your diet, chopping or dicing them and adding one new food per day to assess your body’s reaction.
Key Considerations for Post-Operative Success
Portion Control: After surgery, you will have a smaller stomach, so it’s crucial to eat small, frequent meals. Meals should be about ¾ cup in total volume (6 ounces).
Protein First: Eat protein at every meal and prioritize it to meet your protein goals.
Hydration: Continue to drink at least 64 ounces of fluids per day to avoid dehydration.
Separate Liquids from Meals: Do not drink any liquids for 30 minutes before a meal, during the meal, and for 30 minutes after a meal. This prevents you from feeling full too quickly before you’ve finished eating your protein.
Vitamin and Mineral Supplementation: You will need to take a multivitamin and mineral supplementation once daily as this diet is not nutritionally complete.
Addressing Potential Issues
Constipation: Constipation can occur due to the low fiber content of the diet. You may need to take a fiber supplement or laxative to prevent this.
Menstrual Cycle Changes: Female patients may experience changes in their menstrual cycle during the liver shrinkage diet due to weight loss.
Diabetes Management: Patients on insulin or gliclazide (tablets) should contact their healthcare provider for adjustments, as these medications may need to be reduced due to the low carbohydrate content of the diet.
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