If you’re considering gastric sleeve surgery, also known as sleeve gastrectomy, you likely have questions about the pre-op diet. The pre-op diet is an essential part of preparing for successful weight loss surgery. This article will walk you through what the pre-op diet is, why it’s important, and what to expect.
What is the Pre-Op Diet?
In the weeks before you undergo sleeve gastrectomy surgery, you will need to adhere to a strict pre-op diet. This specialized diet is not merely a preliminary measure but a vital element of the surgical journey. The pre-op bariatric diet is not one-size-fits-all. Healthcare professionals customize the regimen based on your BMI and individual health needs. For instance, patients with a BMI between 46-49 often require a three-week plan, while those with a BMI over 60 may follow an extended eight-week liver shrinkage diet.
Why is a Pre-Op Diet Important?
Adopting the pre-op diet before undergoing gastric sleeve surgery is a vital element of the surgical journey. The purpose of this specialized diet is to reduce potential surgical risks by decreasing liver size and fat, improving accessibility for the surgeon, and instilling good habits. Here’s a breakdown of the key reasons:
Liver Shrinkage
First, this diet will help to shrink your liver. This is essential because the liver sits on top of the stomach, and an enlarged fatty liver can make it harder for the bariatric surgeon to get underneath the liver to operate on the patient’s stomach; which can increase the risk of complications (this is especially important if the patient suffers from fatty liver disease). Reducing the size of your liver before surgery is essential to improve surgical outcomes. The liver’s position directly over the stomach can complicate the procedure if excess fat is present. The primary reason is to reduce the size of the liver so it’s easier to perform surgery. Fat and sugar increase the size of the liver.
Training Good Habits
Second, this diet will help you to start training good habits when it comes to diet. A short-term diet, coupled with an achievable goal, can help you to start to ingrain good habits around eating and drinking. Establishing certain routines in the months and weeks before your procedure can make the transition easier. As soon as you’ve made the decision to have surgery, you should start modifying your behavior. Honestly, 90% of the success a patient achieves depends on behavior modification. The first step in healthier eating is cutting down to appropriate portion sizes and following the “MyPlate” concept.
Read also: The Hoxsey Diet
Wound Healing
Third, this diet is high in protein, which is necessary for wound healing. During the pre-op phase, following a professionally crafted diet plan is essential. Such plans are rich in proteins to preserve muscle and enhance recovery.
What to Expect During the Pre-Op Diet
Typically, a pre-op diet for gastric sleeve surgery involves several phases, each with specific guidelines. Professional dietary consultations focus on crafting a personalized plan to target these critical areas effectively.
Initial Dietary Adjustments
About three months before surgery, you’ll begin changing your diet in consultation with a dietitian and start losing weight. “The better you do in this stage, the better your chances of success after surgery,” said Lisa Micetich, a dietitian and manager of Food & Nutrition Services at OSF HealthCare Little Company of Mary Medical Center in Evergreen Park, Illinois.
Three Weeks Before Surgery
Three weeks before your surgery, you will need to adopt a new diet. Dietitians create a high-protein, low-carbohydrate meal plan tailored to your needs, helping you reach at least 60 grams of protein daily. Incorporating healthy fats from sources like fish and nuts is also monitored to support the transition to later phases of the diet.
Eat healthy, unsaturated fats. Eat one meal per day. Pick a 4-6 oz protein, add up to ½ cup of starchy vegetables, and fill in with unlimited non-starchy vegetables. Eat 1-2 snacks per day. Limit to no more than 10g of carbs per snack (example:½ cup fresh berries, ¼ cup nuts, or string cheese with 2-3 crackers).
Read also: Walnut Keto Guide
Lean Protein Options (4-6 oz):
- Fish
- Chicken
- Turkey
- 2-3 large eggs
- ¾ cup liquid egg whites
- 93/7 ground meat
- Venison (deer)
- Extra firm tofu
Starchy Vegetable Options (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
One Week Before Surgery
A week or two before surgery, you’ll switch to a low-sugar, low-fat, full-liquid diet (64 ounces per day) that’s high in protein and low in carbs. As you transition to a liquid diet one week before surgery, medical teams closely guide your intake. Protein shakes are recommended, each providing at least 20 grams of protein and minimal sugar. Professionals monitor for side effects like nausea or fatigue, offering tailored solutions to address these issues. The day before surgery you must only consume liquids. Do not eat any solid food the day before surgery.
Protein Shake Options (two per day):
Protein shakes should be low carbohydrate (10g carbs or less) and should provide at least 20 grams of protein per serving. Options may include ready-to-drink bottles or powders that mix with water to make a shake. Here are a few options to consider:
- Premier Protein®: Milk-based protein, lactose free, 30 grams of protein per serving; 4-6 grams of carbohydrates per serving
- Pure Protein® 100% Whey Protein Powder or Shakes: Whey Protein/Milk Protein Isolate, 30 grams of protein per serving; 6 grams of carbohydrates per serving
- Fairlife® Nutrition Plan: Milk-based protein, lactose free, 30 grams of protein per serving; 3-4 grams of carbohydrates per serving
- Muscle Milk® (various options): Milk-based protein, 20-40 grams of protein per serving; 7 grams of carbohydrates per serving
- Vital Proteins® Collagen Peptides:
- Unflavored: 20 grams of protein per serving; 0 grams of carbohydrates
- Chocolate: 20 grams of protein per serving; 4 grams of carbohydrates
48 Hours Before Surgery: Clear Liquid Phase
The clear liquid phase begins 48 hours before surgery. Under professional guidance, this phase includes approved liquids such as water, tea, broth, and sugar-free beverages. Commence a clear liquid diet 48 hours prior to your surgery, which is essential for preparing your body properly. Appropriate choices for this diet are chicken or vegetable broth, flavored water without sugar, and other sugar-free beverages. Medical teams provide detailed instructions on pre-surgical preparation, such as limiting liquids within four hours of the procedure.
The Day of Surgery
The day of your surgery, about 4 hours before your surgery, you will be asked to drink 12 ounces of Gatorade or another electrolyte solution that can enhance your recovery. After this, you should not eat or drink anything other than a small sip of clear liquids to take medications. This is to prevent food or liquid in the stomach, which could increase the risk of anesthesia complications.
Strategies for Success
Adhering to the pre-op diet can be challenging, but professional guidance significantly eases the process. Here are some strategies to help you succeed:
Read also: Weight Loss with Low-FODMAP
- Stay Hydrated: Healthcare teams emphasize staying hydrated, recommending a minimum intake of one gallon of approved liquids daily. Drinking at least 92 ounces of fluids daily, including water, broth, and sugar-free beverages, helps curb hunger.
- Choose High-Protein, Low-Sugar Shakes: Opt for shakes with at least 20 grams of protein per serving and low sugar content.
- Manage Hunger: The low-calorie pre-op diet may cause hunger. High-protein foods like Greek yogurt and lean meats are included in your plan to promote satiety.
- Address Fatigue and Mood Swings: Fatigue and mood swings are common as your body adjusts to the lower calorie intake. Staying hydrated and consuming nutrient-rich liquids can help.
- Medication Management: Proper medication management is a critical component of pre-op preparation. Healthcare professionals provide detailed instructions regarding which medications to continue or stop.
Medications and Substances to Avoid
To minimize the risk of complications, it’s crucial to avoid certain medications and substances before undergoing bariatric surgery. Typically, these include anticoagulants, aspirin, ibuprofen, and most arthritis medications. Additionally, steer clear of alcohol, marijuana, THC products, over-the-counter medications, and herbal supplements.
- Discontinue all hormonal therapy (testosterone, birth control pills) one month before surgery to reduce the risk of blood clots. If you have implantable birth control or an IUD, you do not have to have this removed. Thyroid medication should continue to be taken.
- 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.
If you are diabetic, contact your prescribing physician to discuss managing your diabetes medication during these 3 weeks. Patients with diabetes need to meticulously control their medication intake prior to undergoing gastric sleeve surgery.
Smoking, vaping, dipping chewing tobacco or any form of nicotine are strictly prohibited, due to the increased risks of surgical complications. You will undergo nicotine testing for confirmation before surgery will be scheduled. You will be required to commit to avoid nicotine completely after surgery as well, due to the increased risks of stomach ulcers.
Potential Side Effects and How to Manage Them
If you experience these symptoms, please know that they are completely normal. They are a temporary reaction to your body getting fewer calories and carbohydrates than it is used to, and they should subside within 2-3 days. Here are some common side effects and how to manage them:
- Hunger: Stay hydrated by drinking plenty of water and approved liquids.
- Low Energy Levels: Consume nutrient-rich liquids and ensure adequate protein intake.
- Fatigue and Mood Swings: Maintain hydration and seek support from your healthcare team.
Consequences of Not Following the Pre-Op Diet
Adhering to the pre-op diet can significantly lower the risk of complications during surgery. Failure to follow the diet can prevent the liver from shrinking, complicating the surgical procedure. Not following the pre-op diet can lead to a possible cancellation of the scheduled surgery. Increased surgical risks and potential postponement of the procedure occur when the pre-op diet is ignored.
Sample Meal Plan
Adhering to a well-organized meal plan is essential when undertaking the various stages of a pre-op diet. This regimen transitions methodically from eating solid foods to embracing liquids.
Three Weeks Before Surgery (Solid Foods)
Focus on protein-rich foods and avoid refined sugars.
- Breakfast Options: Whole eggs, avocado, spinach, and protein shakes.
- Snack Option: Apple slices with almond butter.
- Solid Foods: Include lean meats like chicken or fish and non-starchy vegetables.
One Week Before Surgery (Liquids)
The diet should consist primarily of liquids, including broth and sugar-free drinks. This transition ensures your digestive system is prepared for the procedure.
- Include Options: Protein shakes, broth, and gelatins in your liquid diet.
48 Hours Before Surgery (Clear Liquids)
- Appropriate Choices: Chicken or vegetable broth, flavored water without sugar, and other sugar-free beverages.
Psychological Preparation
Preparing oneself mentally and emotionally for the pre-op diet is as vital as the physical aspect. Crafting realistic objectives that one can reach helps maintain drive throughout the pre-op phase. Maintaining a journal or monitoring your advancement allows you to remain concentrated and contemplate your mental voyage during the diet. This path isn’t solely about readying yourself for an operation.
Post-Operative Diet
Your diet and eating habits will change significantly after weight loss surgery. 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.
Initial Stage: Clear Liquids
For the first day or so after surgery, you'll only be allowed to drink clear liquids.
Week 1: Strained and Blended Foods
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 Later: Soft Foods
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.
About Eight Weeks Later: Firmer Foods
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. Try new foods one at a time.
Important Post-Op Considerations
- Sip liquids between meals, not with meals.
- 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.
- 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.
- Take recommended vitamin and mineral supplements. After surgery your body won't be able to absorb enough nutrients from your food.
Potential Post-Op Complications
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.
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