Gastric Sleeve Diet

At the hospital, you will be served water on the first postoperative day, sugar-free clear liquids on day two, and protein drinks on day three as your new stomach pouch begins to heal. If you are doing well with no adverse signs, you will go home on day two and move on to protein drinks the next day at home. Most likely, you will not feel hungry the first week or so after surgery. This is normal with no reason for concern and may last a few weeks. However, it is very important to keep drinking water and to consume protein when at home to prevent dehydration and to promote healing.

The Basics Since bariatric surgery will reduce the size of your stomach to 1-ounce (about the size of a ping-pong ball), there will be a reduction in your food consumption. Portion control and food texture is crucial to your success after surgery. The goal of surgery and your diet is to maximize your nutrient intake using meals and snacks in small quantities while preventing “Dumping Syndrome” and/or vomiting. Controlling food texture is very important in the first weeks of your diet to allow for complete healing after surgery.

The 4 Stages of the Bariatric Diet There are 4 stages of the diet. The diet will transition from liquids to purees to solids by the fourth and final stage. Upon reaching the 4th stage, your diet will consist of small, low fat, low sugar meals to be consumed over a 30-minute interval. Fluid continues to be important and a goal of 64 ounces per day is recommended upon reaching the final stage of the diet. It is recommended to avoid using a straw when consuming your liquids since volume is difficult to control with a straw. Drink fluids 30 minutes before or after a meal. REMEMBER: Do not drink quickly/STOP if you feel full

Stage 1: (Days 1-3 after Gastric Bypass surgery, sleeve gastrectomy, or BPD) • 1 ounce of water or ice chips slowly over each hour • Sips only – do not drink entire ounce at once • Sugar Free Clear Liquids • Consume up to 2 ounces of fluid each waking hour Acceptable Fluids: - Water, broth, coffee/decaffeinated coffee or tea with sugar substitute - Crystal Light/diet Snapple/Fruit –2 – O/Propel - Diet gelatin/“no sugar added”, sugar-free popsicles (Do not use regular Italian ices or fruit bars)

Stage 2: (Liquids + Protein Supplements) This stage is to be followed day 3 after surgery for the gastric banding procedure and fourth day after surgery after the Gastric Bypass, BPD, or sleeve gastrectomy. • To be 1 week after banding and 2 weeks for bypass, BPD, or sleeve • Goal: 48 ounces of fluid (minimum of 45 grams of protein / goal of 60 grams) • Sip slowly – NO more than 8 ounce of any fluid/hour • Avoid fruit juices • Possible Protein Supplements: (approximate protein content) • Atkins Advantage Shake (21 grams protein/can) • Pure Protein Shake (21-35 grams/can • Resource Optisource (12 grams/4 ounce box) • No Sugar/No Carb Carnation Instant Breakfast mixed with 8 ounces of skim milk (12 grams/8 oz) • Bariatric advantage (27 gms/2 scoops)- mix with water Other Acceptable Fluids: • Any clear liquid listed in Stage 2 • Tomato or V-8 juice (vegetable juice only – no fruit juice) • Skim milk, Lactaid, soy milk • “No sugar added”/sugar-free, fat free fudgicles Sample Meal (Hourly) :00 2 ounces protein shake :15 2 ounces protein shake :30 2 ounces fluid :45 2 ounces fluid

GASTRIC SLEEVE STAGE 3: (Puree + 8 ounces Protein Supplement) (Gastric band weeks 2-3, bypass, sleeve, BPD weeks 3-6) • DO NOT chew Gum – if swallowed could cause an obstruction • Daily fluid / protein goals: 56 ounces of fluids and 60 grams protein • Take 30 minutes at meals and no fluids with meals – 30 minutes before and after • Soft cooked or poached egg only • Always eat protein first – start with 1 ounce of protein and increase gradually to 2 ounces • Avoid very hot or cold foods if they upset your stomach • High Protein Foods: - Lean beef/pork/fish (blenderized or pureed) - Skinless chicken or turkey (blenderized or pureed) - Low fat cheese (< 5grams fat / serving) - Lite yogurt (sweetened with aspartame & fructose) - Low fat cottage / ricotta cheese - Eggs, egg whites or egg substitute – after 2 weeks on stage 3 Stage 3 - Sample Meal Plan 2 ounces pureed meat 2 ounces pureed vegetable or ½ cup lite yogurt or low fat cottage cheese

GASTRIC SLEEVE 4: (Soft solids progressing to regular foods) • Goal of 3 meals daily • Snacks of 100-150 calories if you are hungry between meals • Continue to limit fats. Try fat free or low fat products. • Eat protein first at every meal • Drink 30 minutes before or after meal • Chew food to applesauce consistency • Stop eating when full • No liquid calories Stage 4 – Sample Meal Plan 3-2 ounces of meat/fish/poultry ¼ cup pasta or potato ¼ cup vegetable Stage 4 – Snacks (100-150 calories each) Low fat string cheese Protein bars with 100-150 calories and 6 or more grams of protein We recommend that you introduce one new food at a time while beginning Stages 3 and 4 of the diet to ensure that you are able to tolerate that food item. If you develop a food intolerance, discontinue that food for a week or two and then reintroduce it again. Keep in mind, that for some patients certain food intolerances may be permanent. REMEMBER: It is still possible to over stretch your pouch, so watch your portion sizes. Also continue to limit fats, sweets, and sugar intake to maximize your weight loss and maintenance. It is important NOT to advance yourself early. One must wait until your surgeon/dietitian visit to be advanced.

Foods to Avoid

Here is a list of popular foods that are filled with empty calories and that can provoke “dumping syndrome”. The products provide mainly calories with limited nutritional value (protein, fiber, minerals and vitamins). Every bite counts after surgery. Avoid foods that contain sugar. Not only will they slow down your weight loss, but they may make you. Filling up on concentrated sweets and other simple carbohydrates can prevent weight loss and good nutrition. • Ice cream, sherbet/sorbet, pudding • Sweetened, fruited or frozen yogurt • Candied fruit • Sweet pickles or relish • Canned or frozen fruit in heavy syrup • Sugar coated or sweetened cereal • Cakes, pies and cookies • Sweet rolls and doughnuts • Pancakes/waffles with syrup • Candy and chocolate • Popsicles • Regular Jell-O® • Jellies and jams • Table sugar/honey • Flavored soy milk • Molasses and syrups • Milkshakes and chocolate milk • Sweetened fruit juice • Regular soft drinks/lemonade • Kool aid • Sugared ice tea • Snapple/fruit drinks • Sports drinks • Alcohol • Regular chewing gum

Mediations after Surgery • Pain medication (usually Lortab elixir) to use as needed (prescription given at discharge) • Chewable multivitamin- chew daily as directed • Chewable calcium • Sublingual vitamin B12 (placed under your tongue every day if 500mcg, every other day if 1000mcg, once weekly if 25000mcg) • Medication to prevent ulcer formation (You must continue this medication for 6 months. A small percentage of people need to take these the rest of their life). Medication to prevent the formation of gallstones if you still have your gallbladder (you must also continue this medication for 6 months after surgery) • You are to resume all pre-operative medication unless instructed differently by your surgeon upon discharge. Any medication your were taking that is larger than an M&M must be crushed, cut, or changed to liquid form during the first 8 weeks after surgery. Before altering (crushing) any medication you must check with your pharmacist or physician first.

Dehydration

Dehydration will occur if you do not drink enough fluids. Symptoms include fatigue, dark colored urine, dizziness, fainting, lethargy, nausea, low back pain (a constant dull ache across the back), and a whitish coating on the tongue. Dehydration may lead to bladder and kidney infections. Contact your Surgeon if you believe that you may be dehydrated. In some cases you will need to be admitted to the hospital so that fluids can be given through your veins. If your urine is dark and your mouth is dry, you are not drinking enough. This is what you can do in order to prevent dehydration: • Buy a sports bottle and take it with you everywhere so you can sip water all day • Drink at least 48 to 64 ounces of fluids per day. Increase this amount if you are sweating • Follow the Dietary Guidelines • Avoid caffeine-containing beverages – they can act as a diuretic and cause dehydration. Unsweetened herbal iced tea or decaffeinated coffee are okay to use if you have difficulties drinking due to nausea, suck on ice chips or make popsicles out of Crystal Light. Regular Gatorade contains sugar and may cause dumping syndrome.

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