Post Operative Diet

Stage I Diet (Liquids)

The only liquids you will consume are clear, sugar free liquids. You will usually receive a liquid diet and a protein supplement after surgery. Now it is very common to be afraid to take those first few sips, but remember, the sooner you tolerate your foods the quicker you get to go home. Your tray may vary from hospital to hospital, but it will generally have some water, clear broth, diet jello, and some sugar free juice or decaffeinated tea.

The portions may be regular size, but you will be given a small medicine cup to drink out of. Usually, the standard is you can consume about ½ cup (4 ounces) every waking hour. This gradually improves with time. There will be no straws on your tray. Using straws post-operatively can increase gas problems and make you more uncomfortable.

We recommend that you try to sip small amounts of your liquids, because your health care team want to see that you are able to tolerate it. Once it is decided by your surgeon that you can advance to the next stage, you will receive Full Liquids. This includes fat free cream soup, pudding, cream of wheat cereal or oatmeal and sugar free plain yogurt (no fruit). Take your time. Be persistent.

Follow what your surgeon and nurses advise you to do and you will be discharged home. Many surgeons will send you home once you have tolerated a stage I diet. Other surgeons may keep you on liquids for awhile longer. The stages will be discussed in the next section . The recommendations for progression are individual by surgeon.

Stage II Diet (Soft, mushy and/or pureed)

This next stage can only start once you have successfully tolerated Stage I. You will only be allowed to consume foods that are NOT solids for the next 4-6 weeks (may vary by surgeon). Your goal is to eat approximately 550-700 calories a day and at least 60 grams of protein. Your new stomach pouch can only handle 1-2 ounces (the size of 1-2 ice cubes) at a time. It is up to you to try and eat a variety of foods and concentrate primarily on proteins. The following are good examples of food choices:

  • Cottage cheese
  • Yogurt
  • Egg whites beaters
  • Tofu products
  • Ricotta cheese
  • Soft cheeses
  • Hummus
  • Soft flaky fish
  • Tuna
  • Ground meats
  • Oatmeal Skim or 1% milk Pudding

These foods should meet the 5% rule for carbohydrates and fat. Some patients for convenience try jarred baby foods (meats). A general rule is to avoid red meats for the first 3-6 months. They are not easily tolerated. Ground meats such as turkey, chicken or veal should be tried, depending on your preference. Other foods that fit into this consistency are soft bananas, pureed melons, and overcooked vegetables. We do not enforce those types of foods, because they do not provide substantial protein.

Stage III (Regular)

Once again, you can only advance to this stage once Stage II has been completely tolerated.
Regular solid foods should not be tried prior to 4-6 weeks after surgery. Remember, no liquids with meals! Continue Stage II foods and slowly introduce solid foods each day. Experiment with caution and slowly so you can easily tell which
foods are tolerated and which ones are not. You should aim for three meals a day with one or more protein supplements as needed to reach your goal of 60 grams of protein daily. This stage encourages lean protein. Fruits, vegetables, whole grains, fat and sugar continue to be limited.

Tips For Beginning a Regular Diet:

  • Avoid “cheap calories” such as fats, high calorie liquids, sweets, ice cream, junk foods and cookies.
  • Remember, because the quantity of your intake is very small, it is crucial to eat highly nutritious foods.
  • Cut up each piece of meat to the size of an eraser on the end of a pencil.
  • Chew up each piece of meat individually, before swallowing.
  • Remember no liquids with meals!
  • High calorie liquids should be avoided. Consume only calorie free liquids.
  • Each meal should take an average of 30 minutes to consume. Eat slowly.
  • When in doubt about a new food, try it.
  • At least ½ of each meal should be high quality protein.
  • Quit when you are full. Do not challenge the capacity of your stomach pouch, to avoid stretching.
  • Do not smoke.
  • Do not use carbonated beverages, and avoid alcohol.

You may not feel hungry, so plan your meals by the clock to maintain adequate nutritional intake throughout the day. This will also make it easier to plan your fluid intake. Nutritional changes take place throughout the first year, and individual meal planning may be necessary with your dietitian.

Amino Acids

Amino acids are the basic structural building blocks of proteins. Your body can produce 10 of the 20 amino acids your body needs to live. The other 10 are called essential amino acids because you can only obtain them by eating food. If you miss even one amino acid your body needs, your body won’t function properly. Your body does not store excess
amino acids for later use as it does for fat and starch. Therefore, you must consume them everyday in the foods you eat. The following are two very popular amino acids that are always talked about when it comes to weight loss and
maintenance.

Arginine - This is an essential amino acid that is important for growth and proper functioning of the immune system It is one of the three building blocks of creatine. It is needed for the formation of proteins such as collagen and elastin, and the vital substances such as hemoglobin, insulin and glucagons.

I mention this in particular because with the amount of weight that you are about to lose, you want your skin to look as healthy as it can. We have all heard of collagen and elastin in lotions that you may use. The following foods are rich in arginine which will help in forming these important proteins. Peanuts, cashew nuts, walnuts, piyal seeds, and most vegetables especially green and root vegetables. It also exists in a free state in garlic and ginseng. Remember to make sure that the foods you are eating are stage appropriate.

Glutamine - This is the most abundant amino acid found in muscles. It helps to build and maintain muscle tissue, helps prevent muscle wasting, increases brain function and mental activity, helps keep the digestive tract healthy, alleviates fatigue and depression, and decreases cravings for sugar and alcohol. You can understand the need for this
amino acid with the intensity of your pending weight loss. Foods rich in glutamine are: beef, fish, poultry, eggs and dairy. Vegetarians can get glutamine by consuming legumes, hemp seeds, chia seeds, raw cabbage and beets.

Vegetarianism and Protein

Just to reassure those of you that are contemplating WLS and are practicing vegetarians of different degrees, it is easy for you to get quality protein too! Foods such as beans, grains, nuts, vegetables, beans, soy, tofu and tempeh are great examples. Plant based proteins also contain healthy fiber and complex carbohydrates. It is a great idea to consume many types of proteins because too much animal protein has been linked to formation of kidney stones and has been associated with colon and liver cancer.

Interesting fact: The human body can absorb 92% of protein found in meat and 91% of protein in soybeans. It is worth discussing the topic of soy for those of you that either do not know what it consists of, or are on the fence with the
controversy surrounding it.

Soy - Soybeans contain natural isoflavones.

Isoflavones are studied in relation to the relief of certain menopausal symptoms, cancer prevention, slowing or reversing of osteoporosis and reducing the risk of heart disease. These positives are talked about so often because they can potentially help a wide range of people. This article does not encourage or discourage the use of soy. It is purely informative in helping you to understand this topic and make an informed decision of your own.

Soy also has many negatives. Over 90% of soy is genetically modified and it also has one of the highest percent contamination by pesticides of any of the foods we eat. Soy can also block the body’s uptake of essential minerals like magnesium, calcium, iron and zinc. Soy can also block the uptake of enzymes which the body needs for protein digestion. This can cause gastric distress, reduce protein digestion, and cause problems with amino acid deficiencies. As previously mentionedthe best diet regimen is one that is varied and does not depend on one specific type of any food group as it‘s main source. The jury is still out and research is ongoing in the soy matter. Stay tuned for further updates.