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Nutrition Guidelines After Laparoscopic Sleeve Gastrectomy

The Way to a Healthier Lifestyle

These guidelines are designed for use after laparoscopic sleeve gastrectomy. The stomach pouch created by surgery will hold about four ounces of food. You will be on a puréed consistency diet for four weeks to allow healing of the stomach pouch. These guidelines will help keep you healthy while losing weight. It is vital for you to make healthy food choices and exercise after surgery to help you achieve the maximum amount of weight loss and to maintain your nutritional health. A commitment to change eating habits and lifestyle is essential to achieve substantial weight loss, avoid gastric discomfort and to prevent nutritional deficiencies.

Advances in your stages should be made only with the approval of your physician.

Diet Progression

Stage 1 Clear liquids – Start the day after surgery.
Stage 2 Puréed consistency – Start the afternoon after surgery and follow for four weeks after surgery.
Stage 3 Semi-solid consistency – Start when directed by your physician (usually four weeks after surgery).
Stage 4 Low-fat solid – Start when directed by your physician and dietitian. Begin gradually introducing low-fat foods about three months after surgery.

Stage 1 - Clear LiquidsTop

About one day after your surgery, you will begin sipping clear liquids (apple juice, orange juice, water, flat diet sodas, sugar-free jello, broth, etc.). Take small sips and be aware of feelings of fullness. If you tolerate clear liquids, the next day you will be advanced to Stage 2- Puréed Consistency.

Stage 2 - PuréedTop Consistency

All foods must be puréed in a blender and thinned to a texture that will fit through a straw. However, do not use straws as it may increase gas.

All foods must be the consistency of applesauce for four weeks.

Protein Goal = 72 grams per day

Examples

  • Skim or 1 percent milk
  • No sugar added CARNATION® INSTANT BREAKFAST ESSENTIALS™ made with skim milk
  • Blenderized soups (made with skim milk instead of water)
  • Blenderized fruit added to shakes (made with skim milk and light/nonfat yogurt)
  • Blenderized meat added to blenderized cream soups or mashed potatoes
  • Cooked cereal thinned with skim milk (oatmeal, grits, Cream of Wheat)
  • Thin blenderized casseroles
  • Blenderized beans (black, pintos, kidney, lima, northern, butter, lentils)
  • Unsweetened applesauce with non-fat dry milk powder
  • Fat-free refried beans with melted fat-free/reduced-fat cheese
  • Mashed potatoes made with skim milk
  • Blended sugar-free yogurt
  • Cottage cheese (fat-free/low-fat)
  • Add non-fat dry milk powder to all foods


You will start with small amounts of these liquids and puréed foods because you will feel full quickly. At first, you will have to eat small amounts frequently (two to four ounces at a time and aim for six meals per day). Eventually, you will be able to eat four to six meals of four ounces each. Eat slowly. It should take 30 minutes to eat/drink four ounces (1/2 cup).

At least eight cups of caffeine-free, low-calorie liquids should be consumed gradually throughout the day to prevent dehydration. These liquids should be sipped in between meals. Do not drink with meals, and wait 30 to 45 minutes after a meal to begin drinking fluids again.

Examples

  • Water or sugar-free or zero calorie flavored water
  • Diet fruit drinks, less than 10 calories per serving
  • Decaffeinated tea (limit to 8 ounces per day)
  • D ecaffeinated coffee (limit to 8 ounces per day)
  • Skim milk
  • Sugar-free flavored drink mix


A multivitamin with minerals, which includes iron and zinc, should be taken daily for the rest of your life to prevent hair loss, improve overall nutrition and prevent any nutritional deficiencies. During the first four weeks after surgery, we recommend a chewable vitamin and mineral supplement (example: Flintstone's chewable twice a day) and then advance to pill form of a multivitamin with minerals if you desire.

You will also be required to take a calcium supplement (example: Calcium Citrate 1,000 to 1,200 mg per day) starting during the first month after surgery and a B12 supplement (example: sublingual B12, 1,000 µcg three times per week) starting immediately after surgery. Additional vitamin and mineral supplements will be recommended based on lab results and food intake/tolerance to prevent any nutritional deficiencies.

Medications may be taken in chewable or pill form four weeks after surgery.

Concentrated sugars; high-fat, fried foods; and alcohol can sabotage your weight loss. Be sure to avoid things such as :

  • Candy, including chocolate
  • Sweets
  • Regular sodas
  • Honey
  • Flavored drink mix
  • Molasses
  • Cakes
  • Preserves
  • Sherbet
  • Ice cream
  • Alcohol (including beer)
  • Doughnuts
  • Fried foods


Different people have different foods they can and cannot tolerate. Do not be disturbed if you find some foods do not agree with you at first. You may be able to tolerate those foods later.

If you are having trouble tolerating puréed food:

  1. Try slowing the speed of your eating.
  2. Decrease your portion size.

How to blenderize food:

  1. Cut food into small pieces about the size of your thumbnail.
  2. Strain out the lumps, seeds or pieces of food.
  3. Use spices and seasonings (avoid spicy ones such as hot sauce and cayenne pepper) to add flavor.
  4. Blend and enjoy!

Puréed baby food can be used instead of blenderized foods. Only meat (puréed beef, pork, chicken) baby foods contain protein.

Sample Sleeve Gastrectomy Liquid/Semi-Liquid Menu
Consistency of thinned mashed potatoes or applesauce

Breakfast 6 to 8 ounces No Sugar Added CARNATION® INSTANT BREAKFAST ESSENTIALS™ mixed with skim milk
Snack #1 ½ cup cottage cheese
Lunch Blenderize - 1/3 cup fat-free refried beans and 1 ounce of melted fat-free or reduced fat cheese
Snack #2 4 ounces blended light yogurt
Supper Blenderize - ¼ cup meat, ¼ cup cream soup 2 tablespoons nonfat skim milk powder
Snack #3 1 cup skim milk with 2 tablespoons of non-fat dry milk powder

You may have to eat more frequent meals and consume smaller amounts at each meal at first. But try to take in 24 ounces (three cups) of nutritious liquids or puréed consistency food every day.

Between meals: at least eight cups caffeine-free, low-calorie liquids should be sipped slowly during the day.

Tips for the first four weeks:

  1. Keep food records. This will help you monitor your intake and tolerance to foods. Look for patterns of foods tolerated well and foods that are not tolerated well. The records will also be helpful for your dietitian to provide suggestions for better tolerance or nutrient balance.

    Record the:

    1. Time
    2. Type of food (e.g. baked chicken without skin)
    3. Amount eaten (e.g. ½ chicken breast or ½ cup)
    4. How your food was prepared (e.g. baked with broth). Be sure to include any butter, oil, grease or margarine that was added to the food.
    5. Protein grams - Look on food labels, handout in patient notebook, Internet or books to determine total protein intake.

    Please bring these records with you during all your follow up visits for the dietitian to review.

  2. Use ice cube trays. Each cube holds about two ounces. This will help you control portion sizes. Try preparing reduced-fat cream soups or puréed meats and vegetables and store them in the trays.
  3. Limit food to two to four ounces per meal. Protein comes first.
  4. Aim for four to six small meals per day.
  5. Drink at least eight cups (64 ounces) of fluid per day. Liquids should be sipped between meals. Avoid fluids with meals, and wait 30 to 45 minutes after a meal to begin your fluid intake throughout the day.

Stage 3 - Semi-Solid ConsistencyTop

Four weeks after surgery, with the approval of your physician, the dietitian will review guidelines on how to successfully introduce semi-solid consistency foods without nausea and vomiting. At this point, you will advance to soft and easily tolerated foods.

Focus on protein first at meals, and avoid foods that are high in fat and sugar and difficult to digest. You may still need to consume protein from skim milk or supplements as between meal snacks until you are able to tolerate enough semi-solid foods to meet your protein needs. Remember to add one new food at a time and observe your reaction to it.

Cut back to three meals and two snacks per day.

  • Cooked eggs, any type except fried
  • Casseroles, such as macaroni & cheese or tuna with light mayo (limited)
  • Chopped lean meat (except red meat)
  • Low-fat cottage cheese
  • Cooked vegetables (peeled)
  • Beans and legumes
  • Softened cold cereal (non-sugar coated)
  • Hot cereals made with skim milk
  • Canned fruits (in their own juices or water)
  • Crackers, pretzels, hard rolls, bread (toasted)
  • Skim milk, unsweetened instant breakfast, sugar-free low-fat yogurt
  • Canned chicken
  • Soft fish
  • Shredded or soft low-fat cheeses
  • Light yogurts


Specific Information:

  • Eat three meals and two snacks per day.
  • Each meal should not exceed the volume of six ounces.
  • Eat and drink slowly. Take at least ½ hour to eat a meal.
  • Take small bites, and chew very well. Sip on liquids during meals only if needed, but  don't drink large amounts during meals. Limit to one ounce of fluid per meal.
  • Continue to drink low-calorie liquids between meals – at least eight cups per day.
  • Continue to take a vitamin and mineral supplement everyday and introduce a calcium and B12 supplement.
  • Avoid red meats.
  • Avoid raw vegetables and raw fruits with skins at this stage in your diet progression.
  • Avoid nuts and popcorn.
  • Avoid all fibrous foods (may cause blockage).
  • Avoid high-calorie beverages such as colas, juices, milkshakes and protein drinks.
  • Keep in mind that you are "re-educating" your stomach. When you eat too fast, too much, or don't chew enough, you will feel discomfort and vomit.


Sample Semi-Solid Menu

Breakfast ½ cup oatmeal made with skim milk and 2 tablespoons dry milk powder
Snack 1 cup skim milk
Lunch 2 ounces of lean meat (such as turkey, low-fat ham)
1 slice of reduced-fat/fat-free cheese
½ of whole wheat tortilla
optional: nonfat skim milk powder can be mixed in skim milk to increase protein
Snack ¼ cup low-fat cottage cheese with canned (no sugar added) peaches
Supper 1/3 cup tuna
¼ cup cooked vegetables
Snack 1 cup skim milk with 2 tablespoons non-fat dry milk powder (if needed)
Between meals Drink at least 64 ounces (8 cups) of low-calorie liquids slowly during the day.

Stage 4 - Low-Fat Solid FoodTop

Begin this stage when directed by your physician and dietitian, generally about three months after surgery. Again, add one new food at a time and observe your reaction to it. Add breads last because they tend to form a ball, which will not go through the pouch easily. You can experiment with red meat, raw vegetables, and raw fruits with skins. Remember to chew all food very well, and sip limited amounts of liquids with meals (less than one ounce, if necessary).

Select a balanced meal plan, choosing foods from all groups in MyPlate (www.choosemyplate.gov), which has replaced the Food Guide Pyramid. This is the time to develop your lifelong meal plan and exercise routine. Avoid sugar, sweets and desserts. Also avoid high-fat foods such as cream soups, gravy, butter, fried foods and fast foods.

Nutrition Information

A well-balanced meal plan is very important. Eat foods from all food groups:

  • Dairy products (low-fat milk and light yogurt)
  • Beans and legumes
  • Fruits and vegetables
  • Lean meat and eggs
  • Whole wheat bread and whole grain products, such as cereals, brown rice, oatmeal

Protein

Protein is important, especially, to help with healing after surgery, and to help prevent hair loss and the loss of lean muscle mass. As your body adjusts to the change made during surgery and to rapid weight loss, you may experience some hair loss three to six months after surgery. Also, hair loss is related to poor protein, iron and zinc intake and certain medications. To improve nutrition and help avoid hair loss, focus on eating protein first at meals from sources including:

  • Skim or 1 percent milk
  • Low-fat cottage cheese
  • Low-fat or nonfat yogurt with artificial sweeteners
  • Egg whites
  • Low-fat cheese
  • Oatmeal and Cream of Wheat made with skim milk
  • Fish
  • Chicken and turkey (poultry)
  • Other lean meats (pork tenderloin, extra lean ground beef)
  • Legumes (dried beans)
  • Nonfat dry milk powder (added to casseroles, soups, hot cereals, etc.)
  • Soy products


You may not be able to tolerate meat or poultry after your surgery. Until you are able to eat meat and poultry, you must get protein from the other protein sources.

Remember to take a vitamin and mineral supplement with iron and zinc daily.

Any additional vitamin and mineral supplements will be recommended by your surgeon and dietitian based on your food intake and lab values.

Fat

To help with weight loss and lifelong weight maintenance, remember to limit your fat and calorie intake.

Limit/avoid these high-fat foods and beverages except in small amounts:

  • Olives (healthy fat)
  • Nuts (healthy fat)
  • Avocados (healthy fat)
  • Regular mayonnaise
  • Sour cream
  • Cream cheese
  • Pie crust
  • Whole milk
  • Butter, margarine
  • Hot dogs
  • Peanut butter (healthy fat)
  • Granola (some are high fat)
  • Muffins
  • Coleslaw
  • Whole milk cheese
  • Potato salad, pasta salads
  • Snack crackers
  • Ice cream
  • Shortening, lard
  • Fatback
  • Regular salad dressings
  • Sauces
  • Fried foods
  • Bacon, sausage, bologna
  • Potato chips
  • Doughnuts
  • All oils (use olive or canola oil - use in moderation)
  • Gravy
  • Regular sodas, high sugar drinks


Learn to read food labels for fat content. Aim for no more than 35 grams of fat per day. If you do not understand food labels, our dietitian will teach you.