Roux-en-y Bypass & Sleeve Gastrectomy Post-op Diet Information

Roux-en-y Bypass & Sleeve Gastrectomy Post-op Diet Information ~Reduced Volume of Stomach Normally the stomach can hold up to 48 ounces of food and fluids. Gastric surgery greatly reduces that amount. Your new stomach will be referred to as a pouch. Due to the smaller capacity of your stomach, portions will be very small. The amount and timing of your meals will be very important. You should avoid drinking liquids 30 minutes before a meal, during your meal, and for 30 after your meal. Drinking with meals can cause nausea, vomiting, pain and potentially the dumping syndrome. This will be a life long change. Keep in mind the first few weeks, your protein s, although liquid, are your meal. Once you begin soft foods, you will need to chew each bite 15 to 20 times before swallowing. Large pieces of food will not easily pass through your digestive system. Put your utensil down between each bite. This will force you to slow down your eating. Each meal should take 15-20 minutes to finish. Sleeve Gastrectomy Roux-en-y Bypass Heather Neely, RD, CDN Rev: 1/2015 Page 1

~Risk of Dehydration Since your stomach is much smaller, only a limited amount of liquids can be consumed at one time. Right after surgery, it may be hard to remember to sip continuously throughout the day. Sip in-between meals, remembering to stop 30 minutes before a meal and not to start sipping again until 30 minutes after. Signs of dehydration include: dry mouth, dark urine, fatigue, headaches, and constipation. Lightheadedness, confusion, and fainting can occur is dehydration becomes severe. Fluid is essential for moving nutrients in to your cells, flushing out waste and maintaining mental performance. Fluids include water, calorie-free, carbonated-free beverages, sugar-free gelatin, sugar-free popsicles and broth. ~Bloating and pressure Carbonated beverages, gum and straws should all be avoided. Carbonated beverages can cause uncomfortable pressure once swallowed. Gum and straws can cause you to swallow air, which results in uncomfortable abdominal pressure as well. ~Vomiting Take every precaution not to vomit. Excess vomiting initially after surgery can cause a tear at the staple line. You will be given an anti-nausea medication if needed. Avoid vomiting by sipping liquids slowly and chewing food thoroughly. Carbonated beverages and high fat foods can contribute to vomiting. ~Dumping Syndrome There are 2 types of dumping syndrome: Early and Late Early: Rapid onset, usually within 15 minutes. This happens when food does not stay in the stomach long enough and is dumped into the small intestine. The main symptoms are diarrhea and low blood pressure, which is often accompanied by nausea, vomiting, rapid heartbeat, abdominal pain and dizziness. It feels similar to a low blood sugar. Maintaining a diet that is high in protein and fiber, limiting simple sugars, fats and avoiding liquids before, during and after meals should help to reduce the risk of this syndrome. Heather Neely, RD, CDN Rev: 1/2015 Page 2

Late: Usually occurs 2-3 hours after a meal due to a high blood sugar followed by a low blood sugar. Symptoms include dizziness, fatigue, sweating and weakness. Maintaining a diet that is high in protein and fiber, should help to reduce the risk of this syndrome. Although more common in the Roux-en-y bypass, the dumping syndrome can occur with any surgery. Eating or drinking too quickly can contribute to the dumping syndrome in either surgery. ~Protein Protein is essential to heal the surgical wounds and minimize loss of lean muscle mass. Protein should be eaten first at each meal and snack. Be sure to choose supplements that are adequate in protein (15grams or more per serving). Protein takes 3-4 hours to be digested, where carbohydrates only take 1-2 hours to digest. Protein will help you stay full for longer periods between meals. Your daily goal is 65-75 grams of protein per day. ~Supplementation You will need to take supplements life-long. After surgery the body absorbs fewer vitamins and minerals, plus your consumption of food is altered. It is important that you have been taking your supplements prior to surgery, and you can start them up again once you are discharged home after your operation. All supplements will need to be liquid, chewable, powdered or crushed for the first 3 months following surgery. ***Multivitamins - DAILY Examples of over-the-counter vitamins: -Centrum Chewable -One-A-Day Chewable -Flintstones Complete For the Roux-en-y Bypass, you will need to take 2 multivitamins a day (at different times). The supplements will need to be taken at least 2 hours apart for proper absorption. For the Sleeve Gastrectomy, you will need to take one multivitamin a day. Heather Neely, RD, CDN Rev: 1/2015 Page 3

Examples of bariatric-specific vitamins: -BariActive Multi (via prescription from MD office) -Bariatric Support (sold at The Vitamin Shoppe and Natur-Tyme) -Opurity Bypass Optimized Multi (www.opurity.com) -Celebrate Multivitamin (www.celebratevitamin.com) -Bariatric Fusion (www.bariatricfusion.com) You can follow the dosage on the bottle exactly, since these are made specifically for bariatric patients ***Calcium Citrate with Vitamin D DAILY In addition to a multivitamin, you will need daily calcium with vitamin D. Calcium citrate is the best option after surgery, since it does not require stomach acid to be absorbed. Your body can only absorb a small amount of calcium at one time. You will need to take your calcium at a separate time than your multivitamin. Examples include: -BariActive Calcium Citrate (via prescription from MD office) -Citracal + Vitamin D -Calcium Citrate with Vitamin D Lozenges -Opurity Calcium Citrate Plus D chewables (www.opurity.com) ***Vitamin B-12 In addition to your multivitamin and calcium, you will need 350-500 mcg of vitamin B-12 a day in a sublingual form (dissolves under the tongue). You may choose to take a 500 mg nasal mist once a week, or a 1,000 mcg intramuscular shot once a month. Heather Neely, RD, CDN Rev: 1/2015 Page 4

Bariatric Stage 1: Water Immediately following surgery you will be allowed sips of water. You will be drinking about 1 oz per hour. You are in Stage 1 for approximately 4 hours. This stage allows you to test out your new stomach. The day of surgery, your diet is limited to allow for you stomach to start the healing process. Bariatric Stage 2: Sugar-free, Clear Liquids You will be on this diet the first day in the hospital. Options include dairyfree, caffeine-free and sugar-free non-carbonated beverages. At the hospital we provide: Water Decaf Tea Decaf Coffee Crystal Light Broth Sugar-free Gelatin Sugar-free popsicles Throughout the stages of your diet, you should continue sugar-free, clear liquids to get adequate fluids. Additional options include but are not limited to: Diet Ocean Spray Diet Snapple Isopure Plus Zero Fruit 2O G2 MIO PowerAde Zero Special K Protein Water Sugar-free Wyler s Sugar-free Kool-Aid Sugar-Free Italian Ice Crystal Light Pure You should be able to sip about 2-3 ounces per half hour. This will gradually increase. Remember to sip slowly and stop drinking if you feel full. Do not gulp. Do not use a straw. Do not drink carbonated beverages Do not wait to sip until you feel thirsty. You should be continuously sipping throughout the day. The nursing staff will deliver all of your fluids. You will not receive a tray. Heather Neely, RD, CDN Rev: 1/2015 Page 5

Bariatric Stage 3 High Protein, Full Liquids **This is the diet you will go home on** This diet may be started as soon as the day after surgery. Your surgeon will decide when you can advance to this diet. At the hospital, options include: Clear liquids Skim milk Lactaid milk Ensure Active High Protein Once you are home, for the first 2 weeks, you will be able to also have: Unsweetened Almond milk Unsweetened Soy milk Blended Greek yogurt Sugar-free Pudding Unsweetened Coconut milk Protein Shakes of your choice Blended Light Yogurt Strained soups (broth only) In Stage 3, you should be drinking about 3 protein s a day, or the equivalent of at least 60 grams of protein. You should be able to sip 2-3 ounces per half hour. It may take you an hour to finish a protein. Try using a spoon to sip liquids, or putting your into a 2-3 ounce paper/plastic bathroom cup. These techniques will help slow down your drinking. Your primary nutrition goal is Stage 3 is to get enough fluid to avoid dehydration/constipation and adequate protein to heal from surgery. Your daily protein goal is 60-75 grams of protein a day. Your daily fluid goal is 48+ ounces a day. Keeping a food and fluid journal is helpful. Heather Neely, RD, CDN Rev: 1/2015 Page 6

Stage 3 (High Protein, Full Liquids) Sample Diet Time Food/fluid Protein (g) Fluid (oz) 8:00-8:30 4 oz water 4 oz 9:00-10:00 15-30 g 8 oz 11:00-4 oz sugar-free Jell-o 4 oz 11:45 12:30-1:30 15-30 g 8 oz 2:00-2:30 4 oz water 4 oz 3:00-3:30 2-3 oz Blended 5-10 g light/greek yogurt 4:15-5:15 8 oz sugar-free 8 oz beverage (ex: Crystal Light) 6:00-7:00 15-30 g 8 oz 7:45-8:15 3 oz Sugar-free 3 oz popsicle 8:30- bed 6 oz skim milk 7 g 6 oz Totals: 57-80 g 53 oz Once your nausea has subsided and you can get adequate fluids, you can start adding in your multivitamins, calcium and B-12. Adding them to your food journal helps you remember what you have taken or need to take. Heather Neely, RD, CDN Rev: 1/2015 Page 7

Bariatric Stage 4 High Protein Purees You may start this stage about 10-14 days after surgery. You should be seeing your surgeon for a follow-up visit at this time, and they will let you know if you are able to advance your diet. In Stage 4, you may be able to eat approximately 2 oz of food (1/4 cup) at a time, but the key is to listen to your body and stop eating/drinking when you feel full. Eat the protein portion of your meal first. That way if you are full and cannot finish your meal, at least you are getting adequate protein. The progression of your meal should go: Protein, non-starchy vegetables, fruit, and lastly starches. Acceptable foods to add in Stage 4 include: Cottage cheese Ricotta cheese Scrambled eggs Pureed meats Pureed vegetables Pureed fruits Applesauce Mashed potatoes Protein s Blended yogurt Sugar-free pudding Stage 1 baby foods You should remain on 2 protein s a day. You continue to need 60-75 grams of protein a day. Continue to drink fluids throughout the day to strive for 64 ounces or more daily. Work on mindful eating. Do not sit in front of the TV or computer while eating or drinking your protein. The amount of food you can eat/drink, the pace at which you can eat/drink and the types of foods you can tolerate is a function of healing. Making sure you are taking small bites and chewing thoroughly will help in your success as your diet advances. Your digestive system may be sensitive to spicy or acidic foods. You may want to avoid these foods for now. Certain foods may cause pain, nausea or Heather Neely, RD, CDN Rev: 1/2015 Page 8

vomiting. When introducing new foods, try them one at a time and be sure to chew thoroughly. Over time, you may be able to enjoy offending foods. Stage 4 (pureed) Sample Diet for Bypass/Sleeve Breakfast Protein Lunch Protein Dinner Optional Snack Day 1 Day 2 Day 3 Day 4 Day 5 1 oz small curd cottage cheese, 1 oz unsweetened applesauce 2 oz light yogurt, 1 oz pureed peaches 2 oz pureed beef stew 4 oz diet Jell-o 1 scrambled egg, 1 oz ricotta cheese 2 oz pureed chicken soup 3 oz Greek yogurt 4 oz sugarfree popsicle ¼ cup Cream of Wheat made with milk 2 oz light yogurt, 1 oz pureed carrots 2 oz pureed chicken, 1 oz pureed green beans 2 oz light yogurt 1 scrambled egg, 1 oz pureed pears 2 oz pureed vegetable beef soup 3 oz pureed black bean soup 4 oz skim milk 2 oz small curd cottage cheese, 1 oz pureed banana 2 oz fat-free refried beans, 1 oz pureed avocado 3 oz pureed tuna fish made with light mayo 4 oz sugarfree pudding Continue to get adequate fluids. Aim for 64 ounces a day or more. Aim to have protein at each meal and most snacks. Your daily protein goal is 60-75 grams of protein a day. You may only be able to tolerate a couple of tablespoons at each meal/snack. Do not drink 30 minutes before a meal/snack. Do not drink with your meals. Wait 30 minutes after a meal/snack before having a beverage. Heather Neely, RD, CDN Rev: 1/2015 Page 9

Bariatric Stage 5 High Protein Soft Foods Stage 5 may be started about 4 weeks/1 month after surgery. You will be in this stage for approximately 2 weeks. At this stage, you start to add more variety and texture to your diet. To get adequate protein, you should continue with at least 1 protein a day. There may be some foods that do not agree with you. When trying a new food, try one new food per meal. If a food does not agree with you, wait a few weeks and try it again. Acceptable foods in Stage 5 include: Well-cooked, soft vegetables Banana or seedless watermelon String cheese or thin cheese slices Tuna/chicken/egg salad made with Light mayo (no raw veggies) Lean ground meats Lite canned fruit (drained & rinsed) Oatmeal or cream of wheat Smooth Peanut Butter Toasted whole wheat bread Thin, flaky white fish Thinly sliced lunch meat Be sure to eat the protein portion of your meal first. You goal remains to get 60-75 grams of protein a day. You should be eating 3 meals a day, with 1-3 oz of protein at each meal. Your total meal portion should be ¼ - ½ cup per meal. You may need 1-2 snacks in order to get adequate protein. Continuing to keep a food journal can be helpful. Avoid rice, pasta and potatoes. Focus on protein, dairy, fruit and vegetables. Avoid dry foods, as they may cause vomiting. Staying hydrated is a priority. Remember to drink 64 ounces of fluid a day. Heather Neely, RD, CDN Rev: 1/2015 Page 10

Stop drinking 30 minutes before a meal/snack. No drinking with your meal. Wait to drink until 30 minutes after a meal. Stage 5 (Soft) Sample Diet for Bypass/Sleeve Breakfast: 1 scrambled egg, 1 oz shredded cheese, ½ slice wheat toast Protein: Lunch: Snack: Dinner: Day 1 Day 2 Day 3 Day 4 Day 5 3 oz tuna salad made with light mayo, 1 oz cooked spinach String cheese ¼ cup black bean soup (liquid drained and discarded) 4 oz plain oatmeal (made with skim milk) 2 oz sliced deli roast beef, 2 slice cheeses, 1 oz cooked green beans 4 oz light yogurt 3 oz ground beef, 1 oz mashed sweet potato 2 oz small curd cottage cheese, 2 oz canned pears in water, drained 3 oz canned salmon mixed with 1 oz mashed avocado 4 oz sugarfree pudding 3 oz canned chicken, 1 oz cooked broccoli 2 oz Greek yogurt, ½ banana 2 oz sliced deli turkey, 2 slices cheese, 1 oz cooked carrots 4 oz diet Jell-o 2 oz canned baby shrimp, 2 oz applesauce 3 oz partskim ricotta cheese, 2 oz canned peaches in water, drained 2 oz egg salad made with light mayo, 2 oz light yogurt ½ cup canned fruit cocktail, drained 3 oz ground turkey breast, 1 oz cooked green beans Heather Neely, RD, CDN Rev: 1/2015 Page 11

Solid Foods You can begin adding solid pieces of food about 6 weeks after surgery. At this stage your diet should consist of healthy, low-fat, high-protein foods that are portion controlled. You should be eating about ½ cup 1 cup of food at each meal. Eat the protein portion of your meal first, followed by non-starchy vegetables, fruit, and lastly starches (if you still have room). A meal should take you 15-30 minutes to finish. If it takes less than 15 minutes, you are eating too fast and not chewing adequately. If it takes you more than 30 minutes to feel full, you may not be getting enough protein. Do not feel that you have to finish an entire meal. Stop when you start to feel full. Otherwise you will be very uncomfortable. Acceptable foods in the final stage include: Tender cuts of beef /pork Skinless poultry Baked/broiled fish Cooked vegetables Canned fruits Banana, melons Smooth peanut butter Eggs Cheeses Whole wheat toast Whole grain crackers Low-fat Dairy Any acceptable foods in Stages 1, 2, 3, 4 & 5 You should wait 2 months before starting raw fruits and vegetables. When initially starting raw produce, peel the veggie/fruit if it is able to be peeled. Certain foods should be avoided as they are hard to digest and may cause your digestive system to be upset. These include: Nuts and seeds Popcorn Dried fruits Carbonated beverages Granola Breads Heather Neely, RD, CDN Rev: 1/2015 Page 12

Stringy vegetables (celery) Corn Tough meats Avoid any foods that are high in sugar or fat. These foods are high in calories and low in nutrients. They may also cause some stomach distress and uncomfortable side effects. Avoid grazing. Plan your meals and snacks ahead of time to limit impulse choices. If you are having any trouble progressing through your diet, call the office. Remember that there are many factors that go into the amount of weight and the time frame in which you will lose your weight. The type of surgery you choose, the amount of weight that you have to lose, and the lifestyle changes you make all factor into your weight loss. Try not to compare yourself to others. Bariatric surgery is an excellent tool for weight loss. It is important to remember that the surgery will not fix mental hunger. Some things that can trigger mental hunger are: Stress, depression, boredom, social events (holidays, work, family), watching TV, unhealthy food in eyesight, and life-long unhealthy eating habits. Work on changing the mental hunger well before surgery and have a plan in place if you feel that you may be in a situation that may be stressful. Almost all patients have continuous satiety for the first 6 months after surgery. You may develop a more normal appetite 6-12 months postoperatively. As your meals become more solid, you will find that you stay full for longer. Returning to previous lifestyle habits or unhealthy food choices can contribute to weight regain. If you find that you are re-gaining weight, you may be eating too many calories. You can make a nutrition appointment at any time with me after your surgery. Sometimes revamping your diet can get you back on track for weight loss. Helpful resources: Heather Neely, RD, CDN Rev: 1/2015 Page 13

www.livingafterwls.com Weight Loss Surgery for Dummies Eating Right for Life By Renee Gurley (available at Amazon, Barnes & Noble) Heather Neely, RD, CDN Rev: 1/2015 Page 14