New Image Bariatric Surgical Associates John L Coon, MD FACS POST OP DIET #2 (GASTRIC SLEEVE MUSHY FOODS) Your surgeons and staff at New Image Bariatric Surgical Associates are well aware that that many patients would like to eat more than we recommend. However, your adherence to these diet instructions is very important in the first several weeks. Adhering to the items we believe will decrease your chance of complications and help keep your recovery process smooth and uneventful. It is now possible to advance your diet to the next stage, which is Post Op Diet #2. In addition to Post Op Diet #1 (Gastric Sleeve Liquids), you can now add soft, mushy type foods. Some examples are: Mashed potatoes, instant or regular. Hot cereals without added sugars, fruit or anything solid (plain Cream of Wheat, plain oatmeal, etc.). Refried beans without lumps (no solid beans). Sugar free pudding/yogurt without fruit. Various flavors are acceptable, just no solids or chunks. Cheese in small amounts melted over refried beans or mashed potatoes. Baby food without solid chunks. Applesauce. Mushy ripe bananas. Cottage cheese - soft and moist. Scrambled eggs - moist, not overcooked and dry. Pureed meats, as in baby food. Please note that well cooked mushy vegetables are acceptable and that pureed or cooked fruits without pulp are also acceptable. While permissible now, you should be very careful eating: Rice Pasta Bread. These foods tend to congeal in the pouch and block the pouch outlet, thus causing vomiting. On occasion the congealed rice, pasta, or bread will cause a severe enough obstruction of the stomach pouch outlet that you will be unable to tolerate even liquids. This can lead to dehydration within just one day. REMEMBER - MUSHY!!! General Instruction for Eating. Gastric Sleeve surgery is designed to help you lose weight. It is a tool to help you control the amount of food you take. However, it is not magic and it takes a lot of work
and a major change in your eating habits. Your doctor and your dietitian can both answer additional questions you may have. Gastric Sleeve surgery will help you reduce your weight and ultimately improve your health. Staying within the guidelines will help you maximize the benefits of your surgery. It is extremely important that you follow these diet instructions just as they are written. Not only your success in losing weight, but also the proper healing of the pouch, your nutritional health, and even your life, depend on your memorizing these rules and adhering to them at all times. Cheating will not necessarily cause you to lose less weight. But more importantly, it can lead to vomiting, pain, ulcers, bleeding, and strictures of the pouch outlet. This can result in the need for further procedures, even surgery, to repair the damage. Post these instructions somewhere that you will see them everyday. Reread them frequently. They will be your road map to success. Your diet following gastric bypass surgery will greatly change. Not only will the quantity of food change, but also the consistency and types of foods you choose. Our goal is to help you choose a diet that will help you succeed with weight loss and provide you with adequate nutrition. The lower portion of your stomach is where your food is ground up. After surgery, this portion has been bypassed. It is for this reason that you must chew your food thoroughly. If unchewed food tries to pass from the stomach pouch to the intestine, it may cause a blockage. Also, be very sure you do not put anything indigestible in your mouth like coins or gum. If they are accidentally swallowed, it could cause a blockage that would require surgery to open. It will take six weeks for your new stomach pouch to heal. During this time you will need to be very aware of your eating habits. Overeating is possible, and can be very dangerous. Overeating may cause your stomach to stretch to the point that the weight loss benefit from surgery can be lost. Also, on rare occasion, eating too much after the pouch is full can cause the pouch to rupture from the pressure. That is incredibly not good! It will require an emergency trip to the operating room. Some patients will not survive this complication. For the first six weeks after surgery we want you to avoid any type of carbonated beverage. Everyone will find different things that taste good. As long as you stay within the guidelines of your particular diet, it is OK to experiment with various foods. As long as it tastes good and does not cause diarrhea, nausea, vomiting, or pain, it is OK to eat. Again, it is necessary to stay within the guidelines of your particular diet during the first six weeks after your operation. Let's start with your new pouch. With your new stomach pouch, food will bypass the majority of your stomach and variable amounts of small intestine. Although the pouch is created to be 1-2 ounces in size, that does not mean that it will always hold that much. Due to swelling, or partial filling with mucus or saliva, it may, at times only hold one small swallow. Other times it may hold considerably more. These wide variations are common in first 3 months. In time, you will be able to consume a small meal over 20 to 30 minutes. To some extent this will be due to the pouch stretching as time progresses. However, most of this increased ability to eat is because food is moving out of the
pouch and into the intestine more efficiently as your pouch heals. And it is that hold up of food in the pouch for prolonged periods of time that gives you the nausea, the "lump" under your breastbone, or the feeling of heartburn. These are the new messages that your pouch is using to tell you that it is full. A very important concept is to take small sips of liquid all day long. Don't gulp large amounts. You can use a small shot glass or something similar to remind you to drink small amounts. The optimum amount of fluid to drink in a day is 64 ounces (two quarts). But it is almost impossible to take in that much in during the first few weeks. Just do the best you can. As long as you urinate 2-3 times a day, you are getting enough fluid. There is really no maximum amount to which you are restricted. Just do it slowly. Also, you should refrain from alcohol use for the first few months. When you are advanced to soft foods, the same general rule applies: tiny bites, very slow. Chew each bite 20-30 times. Only eat 2-3 bites; then wait for a while; then eat again. We call this grazing and it is how you should eat for the next 6 months. Continue to avoid food that is high in fiber such as skins of fruit, seeds, fruit pulp, and salads. Remember to chew your food well as the new opening from your stomach to the intestines is very small and will not allow chunks of food to pass easily. The old feeling of fullness will often times be replaced by a feeling of pain or pressure or a knot in the upper abdomen, or heartburn. If you get these sensations, then stop eating and allow your pouch to empty, which can take fifteen minutes to an hour. Continuing to eat will often cause you to vomit. And on rare occasion eating too much after the pouch is full can cause the pouch to rupture from the pressure. That is incredibly not good! Before you know it, you will be able to eat anything that you want. Everyone advances at a different pace; so don't compare yourself to others! You will eventually get there. At first, just stick to the foods that go down well, and try something new every few days. Remember, you can't see into your pouch. It's going to have good days and bad days. One day you will be able to eat just about anything you want with no problem and the next day you may vomit everything you try. This is normal. Just remember to go back to liquids for a day. There is really no food that is "bad" for your pouch. While we encourage you to wait on certain foods and beverages, eventually everything is fair game. An example of this is carbonated beverages. In the beginning, the gas they produce can fill the pouch and result in your not eating enough. Later on though, you can try them and will probably be able to tolerate them. Nausea. The bad news is that almost one third of sleeve patients will experience severe and or persistent nausea. And almost everyone will have some vomiting in the first few months after surgery. The good news is that it will always go away by itself, usually no longer than four months after the surgery. We know how distressing this can be for you and we will do everything we can to make you more comfortable. But only time will make it
finally go away. Above all, be sure that you are not eating or drinking too much or too fast. Be sure to follow these guidelines: Sip your fluids. Do not gulp them. Take baby sized bites of food. Chew your baby sized bites of food well, about 30 times. Take only 2-3 bites at a time. There are several prescription and home remedies that will help. Here are some: Sip on hot water or tea with lemon. This is especially helpful if you are particularly nauseated in the morning. It can be due to mucus and saliva that have accumulated in the pouch overnight. The heat and the lemon will break it up and allow it to pass out of the pouch. Take some peppermint. This is a very old and effective method of combating nausea. You can suck on hard candies or put peppermint extract into tea and drink that. Try adding ginger. Sometimes you can find candy made with it. You can also grate fresh ginger root from the supermarket and put about 1/4th teaspoon into a cup of tea. Try Pepto Bismol. Take 1 teaspoon every 4 hours as needed. Try antacids, such as Maalox or Gelusil. Please! Oh Please! Oh please stick to the diets we advise. Have faith, things will continue to improve. Remember, carbonated beverages are not advised. The carbonation in them can cause too much pressure on the pouch, interfere with your ability to tolerate additional foods, and cause bloating. Non-carbonated beverages with caffeine, such as tea or coffee, are acceptable. Red meat is difficult to digest and you should avoid it for now. Vitamins.
This is a good time to start taking vitamins. While there are specific vitamin preparations that we recommend, what is important is that the vitamins be multivitamins, either liquid or chewable, and have iron in them. At this time is imperative you continue taking vitamins for the rest of your life. Failure to get adequate vitamins can cause many complications including but not limited to dementia, paralysis, and rarely even death. We recommend: One chewable Flintstones Complete a day. The Complete version is necessary because it has iron in it. Be sure, if you choose another vitamin, that it has iron in it. Liquid Centrum is OK but you will need to add an iron supplement. If you do need to add an iron supplement, we recommend Vitron C once a day. One sublingual (under the tongue) B-12 tablet twice a week. Taking one every day will not hurt you but is not needed. These may be found at Trader Joes and are really inexpensive. Also very important. Two Viactiv calcium supplements a day. Again, one chewable tablet in the morning and one at bedtime. They are also an important source of Vitamin K. If you use other sources of calcium supplements, you will need to be sure to get 1000 mg per day and 80 mcg of Vitamin K per day. All of these vitamins can be purchased at most pharmacies, grocery stores, Costco warehouses, and Sam s Club warehouses. Of particular interest to women is how to control or avoid hair loss. This can start as soon as a month after surgery. It is variable in how long it lasts and how severe it is. While no one knows how to stop hair loss completely, we believe that the following will help you keep your hair: Take in lots of protein as soon as you can. We do not usually advise extra protein until Gastric Sleeve Semi-Solids. Early on you may not be able to tolerate much extra protein. It can cause gas, nausea, bloating, if taken too early in the post operative course. Proceed as tolerated. In addition to your usual multi-vitamin, take a special vitamin supplement called Hair, Skin, and Nails or its generic equivalent. This supplement contains additional amounts of the vitamin Biotin and the mineral Zinc, which are often not present in normal multi-vitamins in high enough amounts for bypass patients.