Nutrition Plan After the Gastric Bypass Operation

Soon after the surgery, you need time for the internal sutures to recover. Nutrition plan that you will apply after the surgery has a great importance in digestive system’s compliance with the new way your foods will follow. Therefore, you have to comply with suggested nutrition plan from first days after the surgery.

The time for everything to be okay and for digestive system to begin working regularly include a duration of 3-6 months. Some days you can take the foods easily without any problem whereas the next day same type of foods may make nausea. This is a normal case that may be encountered during the transition period. Long-term eating discomforts are extremely rare at this operation.

Between 0 – 2 weeks

You will be able to intake the liquid foods those can pass through digestive system without have been caught. This condition should be under your doctor’s control and should begin with his/her permission. We suggest you to feed with only liquid foods in particular during this one week. These liquid foods are : water, tea (prefer sweetener rather sugar), skimmed milk, low calorie fruit juices without intense consistency, grainless crushed vegetable soups, broth and foods in puree nature with low sugar, without rough grains.

Between 2 – 4 weeks

Now, you can begin to take more from the soft foods in puree case. You should eat slowly and as 4-5 mealsa day at this period. Yoghurt, paste foods with increased fluency (boiled potato plane mixing with broth and crushing in puree case and cheese), pudding with moderate fluency and in soup consistency, diluted purees of fruits like peach, pear and apricot. During a few day, after providing a well compliance with these type of purees, again as be crushed and kept the puree consistency, protein rich foods like meat, chicken, fish, bean, lentil and egg should be added to these purees and begin to intaken. All of the foods should be paid attention to be at low fat and sugar rates.

Hardness-softness degree of your foods should be at a baby can eat. Best way to provide this is to use a puree maker tool called “blender”. It is also possible with fork and spoon provided very good crashing. Boiled vegetables can be make puree by crashing them with blender. Protein sources like egg can be mixed with these vegetables and crashed with blender after bringing them into the case that could be crashed by blender. Fruits also can be eaten by being crashed with blender. Fluids like water or juices are used to provide necessary habit level at crushing of the vegetables or fruits. It is possible to use the souces those have low fat and sugar and appropriate fluency to increase the favour.

Food intake amount; foods of 100 gram or 5-6 tablespoons are the correct amount. You should eat approximately this quantity of food at this period. Check whether you can do this or not and try to provide this food intake without forcing. A copule like potato puree with fish puree can be eaten as main course. It enough for you to be serviced by a person and two type of the complamentary food at this stage.

You should stop to eat at the moment of fullness feeling. Your new stomach is above the previous one and the fullness feeling will be occur in a more different way than you have used to. The pouch that serves as new stomach is felt at the chest area since it is next to here. Some people describe this as a “tightness” or a “heaviness”. 1.5 liter of water should be drunk everyday. This amount of water should be taken between meals spreading throughout the day as parts of 100-200 ml. It’s not right to drink water with the meal.

Sample Menu to Apply During The Period

Breakfast

A small bowl of yoghurt or

fresh curd cheese or

3 tablespoons of gruel

Lunch

A cupful of warm soup or

Whipped egg

Dinner

Potato or fish puree

Chicken at white souce

Potato puree by cheese or

Mixed vegetable puree by potato puree

Between meals (once a day will preferred)

Boiled and softened apple by cream or pudding or banana puree or

Milky pudding ( rice pudding or semolina pudding) or

Yoghurt or fresh curd cheese

Liquid Foods

Water (mineral waters or bubbly, carbonated waters are not suitable), tea, skimmed milk or

Fruit juices or

Pates producted for diet

Between 4 – 6 weeks

Continue to take the food types you have taken at first four weeks, but this time they don’t have to be in puree case. A well done chewing will bring the foods as soft as to be eaten by a new begun to walking child. Soft and same amount of foods still should be taken at 4-5 meals a day at this period. You must be sure that the bites are small and well chewed.

After 6 weeks

Now your are ready to apply the long-term nutrition plan. Don’t forget that you are no longer eating only to decrase calorie intake or to loss weight, but you should also intend to take the building bloks those your body needs bu using your current new digestive system effectively. Previously, you were taking fat and sugar as weight makers by eating much with a large stomach but there were also significant building blocks like proteins and vitamins in this eaten much amount and you were taking them enougly and overly with the fat and sugar. But now, you have to prefer and choose. When you took foods with much fat and sugar, doesn’t remains any space for more necessary protein and vitamin as well as already they can not be absorbed due to duedonum doesn’t function. Although the nutrition preferences varies from person to person some gold nutrition rules should be followed after Gastric Bypass are as folllows :

Avoid sugary foods !!!

Sugary food intake at high amounts will cause the condition that has been expressed as depression, exhaustion or weakness. Excess nausea, discomfortable feeling at stomach, diarrhea, abdominal pain and weakening will acoompany to this. When too much sugar taken, large amount of insulin will be secreted but the new digestive way after the bypass has changed response mechanism of insulin against sugar. This can be interpreted as an impotant advantage of Gastric Bypass that creates an internal hate against sugar. In such a situation you should be relax laying until the sugar quantity decreases, take liquid to reduce the solution consistency of sugar and to make it leave as soon as possible and wait the insulin level to reduce. If liquid derivatives of any drug, in particular antibiotics have been prescribed, ask to your pharmacist which ones are sugar free and choose them.

Eat three meals a day !!!

You must eat three meals a day without eating anything between the meals. Don’t allow nutrition ways those will able to emerge in form of “junk foods” or “snacking” at any time during the day.

Eat healthy, solid foods !!!

Soft foods easily slip down at the digestive system and many of the soft food include high sugar and fat, so they cause you to experience the problems we mentioned above. Besides, these soft foods slow and stop weight loss because of the high calorie they have, if they taken insistently. Solid foods should be preferred without using much sauce. Garnish vegetables can be eaten (with a soupsoon of sauce or broth) by a small piece of chicken. In this way you can stay filled for longer time by eating less and qualified.

Eat slowly and stop the eating as soon as youl feel full

Most of the obese people are those used to eat hurrying and without chewing. Eat your meal slowly. Tightness of the stomach wall tells to the brain that you are full, so you must stop eating immediately in this stuation. Otherwise you will encounter with feeling pain and risk of vomiting. You should take care to this matter. Take the foods in small bites case (meat or chicken that cut into pieces as a global rubber at behind of pencils or as a largish taw) and stop eating when you feel the fullness.

Continue to intake plenty of liquid !!!

You were taking a large amount of liquid with the foods you have eaten but now, these amounts will not be enough since you can eat only small amounts of foods. You must increase this liquid intake particularly except the meal times. You must intake liquid one hour after the meals or until remains half hour to the next meal. If you intake liquid just before the meal this time, this time you will not be able to eat. High calorie liquid foods and alcohol have not any function except to increase your daily calorie intake. These should be avoided. Women need calcium. This need can be met with skimmed milk or other dairy products. Fruit juices, paste foods, and foods those called “milk-shake” and made of milk, fruit and high sugar should be avoided. If you try at first few weeks, you will be explore that gaseous and bubbled foods discomfort and cause to nausea. The best way is tocompletely avoid them rather trying.

Healthy Diet

There are five main group of foods and a healthy diet is performed by taking appropriate amounts from the each group. These foods and the amounts should be taken are :

Protein Foods

Foods like meat, fish and bean. They should taken 2-3 times a day as 60-90 gram. You should chew well the foods like meat or chicken before swallow them.

Milk and Diary Foods

You should choose low fat cheeses from this group. You can take 1-2 times a day of 30-60 gr. Skimmed milk and low fat yoghurt should be preferred. These portions of the diary products will provide you to obtain enough calcium from the diet.

Fruits and Vegetables

Try to take 4-5 portions a day. A little water glass of unsweetened tomatoes can be considered as one portion. Salads are always tend to be easily digested. Green vegetables are also easily digested generally.

Carbohydrates

Bread, potato and grains are the mainly carbohysrate sources. They should be taken 2 portions a day. It is quite difficult to digest some foods of this group for many people have underwent Gastric Bypass. Change the soft bread made of white flour and crispy bread with whole wheat bread or wholemeal bread those can be easier digested. It will be agreeable to eat a small portion (2-3 slices) of 60-90 gr at each meal.

Fats and Sugary Foods

Use small amount of olive oil for cooking process and change the puddings with low fat yoghurt. Avoid foods like chocolate, desert and icecream those will cause you to vomit and weakness of your body.

Multivitamin Intake after Gastric Bypass Surgery

Additional vitamin intake after Gastric Bypass surgery is very important. Because it is no longer possible to intake enough vitamins from your foods. Vitanin and mineral deficiency is a complication that has been encountered after Gastric Bypass surgery but can be overcome and eliminated. Unfortunately dedinition of the vitamin level at the body is too difficult. Therefore you may experience vitamin deficiency before show it’s signs or symptoms. If you can not buy or swallow or you vomit the vitamin tablets, you must ask your doctor to provide you to take the vitamins in other format in terms of not suffer vitamin deficiency after Gastric Bypass operation.

The best vitamin and mineral source is the “HEALTHY DIET”. For example the diary products those you will eat three portion a day during your diet, will meet your calcium need (1 portion = 1/3 pt milk, match box sized cheese or 1 bowl of yoghurt)

Our Suggestion for Tablet Intake

One multivitamin tablet each day that included the followed described vitamins and minerals at defined amounts :

· Vitamin B 1 (Thiamine) : over 1.4 milligram

· Vitamin B 12 : over 1 microgram

· Folacin (Folic Acid) : over 200 microgram

· If you are prone to anaemia or weak to this or your routin blood tests show you are anaemic, we suggest you to take Iron Sulphate tablet of 200 milligram additionally

· Calcium : If you can not take the dairy products mentioned above at definite amounts for any reason we suggest you to take a calcium tablet of 800 – 1000 mg a day. These tablets are generally taken by chewing.

Assoc. Prof. Halil Coskun M.D.

Nutrition Plan after the Gastric Banding Application

Adjustable Silicon Gastric Banding Surgery forms the first step of the change has been realized at the patient’s life style. The time of recovery will be advised you to maintenance yourlife more comfortable, to complete the healing due to operation you have underwent and to comply with the new stage of your life.

The patients have to learn the importance of chewing at the foods they have taken. They should also understand the importance of physical exercises and that they should bring those exercises as a part of their life. It is important to eat with the a baby spoon and to swallow as very small pieces at the beginning as you are new to the gastric band. Food intake with large pieces, may cause to pain and vomitting by making obstruction at the passage where the band is. You have to make a long time for yourself for eating. This duration must include a time period of 45-60 minutes. If you eat fast and much, this will lead to problems. The pouch above the band is very small and if you eat much the foods immediately come back. As you learn with time to eat slowly, you will better fill the band and understand when you have eaten enough and you will learn when will you end the eating without vomitting.

The patient’s diet should include only liquid foods at the first month after the surgery. Because the body needs time to heal and to provide adhesions those will fix the band at accurate position. At the patients those have hurried for solid foods intake, prolapsing of the band and expanding of the upper stomach pouch by this way are inevitable.

Liquid intake begins at the first night after the operation. A spoonful water is given at each 5-10 minutes until 250 ml (a glass of water) has been completed. Rest of the fluid need will be given by serum. Oral liquid intake is rapidly increased at following days. All fluid need at the diyet is begins to be met at 3rd day without the need to serum.

Liquid and solid food need after the patient has been discharged should be met as follows :

First 4 weeks

Liquid diet during first 4 weeks. On average 100 ml liquid is taken in small amounts with tablespoon each hour. Type of the liquid must differ and low-fat milk, yoghurt, gruel, tea, fruit or vegetable juice, warm soup or broth should be preferred. Diet supporting drinks must be added to provide balanced nutrition. It is important to spread the liquid intake to all of the day with small amounts. This period of time is very important for your stomach to heal. Fast beginning to the solid foods may damage your stomach and the band.

4 – 6 weeks

Pureed diet during 4 – 6 weeks. The puree should be taken in small amounts. Soup and nutritional supports are still added to the diet. A lot of markets sell baby food suitable to 5-6 months babies. These formulas are very useful at this period because they have included proper food ingredients.

The patients should drink water between the meals, not with the meals. The meal times can be adjusted according to the patient’s condition but recommended amounts should be checked as possible. Total liquid intake must be at least 1500 ml daily. The liquid should be taken at regular intervals and 100-200 ml at each time. Type of the liquid should be alternated and tea, milk or yoghurt, fruit – vegetable juice should be tried. Pureed food intake must be kept at 500 gr daily.The purees should include meat or fish meat and should not exceed 100-150 gr at once. The food should be eaten in small amounts and slowly everytime.

6 – 8 weeks

Normal foods in small amounts during 6 – 8 weeks. Foods with normal ingredients can be include to the diet. But they should paid attention to be in small amounts and to be taken between the meals. It is very important to eat slowly and to chew completely.The patient can take low fat milk or yoghurt.

Total liquid intake must be at least 1500 ml and the solid food intake must be kept around 500 gr. Solid foods now can be taken at normal mealtimes. However it is very important to eat slowly.

8th week and later

The patients now define their own food menu. Frequently, but slowly eating and completely chewing are still important. The liquids can be drunk only between the meals and as sugar free. The diet must mainly include boiled or crushed vegetables. Fish or low fat meat should be boiled rather than fried. Other foods also must be with low fat (milk and light cheese that have 17% fat in maximum).

FOOD LIMITATIONS

Some foods can not be easily tolerated and they should excluded from the diet unless they have converted to the alternative products those have been digested better. These are the foods which have generally got stuck on the cardia and caused to vomitting and lacking of liquid as a result of blokage.

Altough most of the patients can tolerate when they have chewed well the meats like steak they have difficulty to digest thick piece of the meat. Therefore it is recommended to avoid from eating meat and to gradually involve the meat into diet. Each patient has got his/her own eating capacity. Don’t compare yourself with the other patients eating.

LIMITED FOODS

Solid Foods

White, crusted thick bread

Dry meat, steak (boiled meat should be preferred instead of steak but it must chewed very well and digested in small pieces – after 8 weeks)

Fried potatoes

Cucumber, corn

Orange (It’s fibres may create problems when it has been digested – ATTENTION)

Fibrous Foods

Asparagus, it can be mixed in soup

Pineapple, it can be crushed for juice

Broccoli, it can be used only for it’s branches

Citrus fruits and dried fruits should be definitely avoided since they have obstructed the cardia by swelling.

Fatty Foods

Coconut

Potato chips

Popcorn

Soft white bread

Difficult to Digest Foods

Hazelnut

Almond

Peanut

Soda (carbonated drinks may make feel discomfort)

This list contains the foods which patients have experienced problems. Problem, doesn’t mean ‘imposible’. But it really required you to chew very well and eat slowly. Even so, it will be appropriate for you to make your choice in favor of the other foods.

You may harm your weight loss by taking high calorie foods (like chocolate, desert, ice cream and alcohol). Don’t wait from the band to do everything, know that the power is in you.

If you encounter a problem post operation, don’t hesitate to call your doctor and make your checks done regularly.

GOLDEN RULES

1 – You definitely must eat very very slowly. Comply with this rule even your eating a small portion takes your 45 minutes.

2 – You must chew very well.

3 – Carbonated drinks (soda, fizzy drink, cola) and effervescent drugs (Tylol Hot, Calcium Sandoz etc) are definitely forbidden. Gas bubbles in the liquids may expand the small pouch of your stomach.

4 – You must drink water between the meals. Otherwise quantity of the water that you have drunk with the meals is added to the food’s volume and it may be too much for your small pouch.

5 – You must divide the foods into small pieces before you take them to your mouth.

6 – You must chew the bite very well and swallow slowly after you have taken it to your mouth. Don’t forget to make your teeth checked to define whether your chewing is enouh or not.

7 – You must stop the eating when you have received the first signals of fullness. Even a more spoon may be too much and you may vomit (or you may feel pain at the area where the band is, your stomach pouch may expand and this can cause to form a second pouch and worthless of the band.

8 – You should joint to different exercises (swimming, gym, walking, dancing etc.) according your ability and preferences twice a week.

Assoc. Prof. Halil COSKUN M.D.