How Much Should I Be Eating?

The process it takes to do the criteria your insurance requires, get in for consultation, the approval from insurance, the classes; all of the information you learn about weight loss surgery and have to try and commit to memory, it can be taxing and info overload. That’s why we are here to help with the stages of a post-op patient and where they should be food-wise.

For the first few days after surgery you will receive liquids intravenously then gradually advance to a clear liquid diet of water, broth, and Jell-O. After your stomach can tolerate these, you will begin full liquids followed by a soft food diet.

What You Should Be Eating and When:

Several Hours to Day 1 After Surgery

• Sip 1-2 ounces of water per hour beginning after surgery, or as directed by your surgeon.

Post-Op Days 2-3

• Clear liquids only
• Water
• Low or zero calorie beverages
• Sugar free Jell-O
• Sip 3-4 ounces of water per hour, between meals
• Use broth and sugar free Jell-O as meals rather than snacking throughout the day
• Multivitamin and sublingual B-12

Post-Op Days 4-6 (Gastric Bypass)
Post-Op Days 4-14 (Sleeve & Duodenal Switch)

• Full liquid diet
• Skim milk
• Light yogurt
• Cottage cheese
• String cheese
• Strained soups such as tomato, split pea, or cream soups prepared with water or skim milk
• Limit amounts to 2 ounce per meal (gastric bypass) or 2-4 ounce per meal (sleeve & DS); this is measured in volume not weight
• 2 ounce volume = 4 tbsp.; 4 ounce volume = 8 tbsp.
• 4-6 ounces of water intake between meals
• Multivitamin and sublingual B12

Post-Op Days 7-4 Weeks – Soft Food Diet (Gastric Bypass)
Post-Op Days 15-4 Weeks – Soft Food Diet (Sleeve & Duodenal Switch)

• One at a time, add other foods, such as cooked canned vegetables, deli meats, canned chicken or turkey (meat will be hard to digest initially)
• Stews with vegetables, beans or lentils cooked without fat or lard
• Take twenty full minutes to eat your meals
• Limit amounts to 2 ounces per meal (gastric bypass) or 2-4 ounces per meal (sleeve & DS)
• You may be full before you finish eating—stop eating at first sensation of fullness
• Your liquid intake should be 4-6 ounces, or more, per hour between meals
• Multivitamin, sublingual B12, calcium citrate, (ADEK vitamin for DS patients only)

Week 4-3 Months Post-Op
If you had not already had a follow-up appointment scheduled within the first 30 days, call and schedule this appointment now.

As you begin to feel better you might need to remind yourself to eat three meals a day. Don’t go longer than five hours between eating meals. You could have lost your appetite and might not feel hungry, but healthy eating gives your body the nutrients it needs to repair and heal the body. It also provides energy and will help you to feel your best. Remember to eat nutritious foods to fuel your body! Eat slowly and chew your food well. Stop eating when you’ve eaten your measured portions.

Protein during this stage is very important. It helps maintain good health and aids in the healing and repair of your body during your recovery. It gives you energy and is essential for the development of new cells. Consuming enough protein helps with the prevention of muscle loss and can help prevent hair loss. Protein found in meats provides iron which is necessary for red blood cell production and the prevention of anemia.

At four weeks post-op, you can begin to add additional meats to your daily diet. Choose meats such as thinly sliced deli meats, turkey, hamburger, boiled soft chicken, fish, tuna, salmon, cod, and halibut. Remember that chicken meats need to be very moist. If it is the least bit dry, it can get stuck right behind the breastbone area. If this does happen to you don’t try to get it down by drinking water. The water will just sit on top and cause more discomfort. Wait for 1-2 hours, if the pain persists and isn’t improving, please contact our office at (801) 268-3800.

You will follow the 70/30 rule until you have reached maintenance. DS patients should set a goal of getting 60-100 grams of protein a day. This rule is 70% protein foods and 30% vegetables to ensure that you are getting all the protein and nutrients you need after surgery. If you feel hungry, dizzy, tired, or weak during the day, add a protein snack between meals. Be sure this is planned and doesn’t become grazing. Use protein supplement drinks only when advised by your physician.

Be careful with “Head Hunger.” It results when an individual wants to eat for any reason other than being hungry. When you experience “head hunger” drink water, go for a walk, read a book, learn a new hobby, or clean your house. Do anything that will divert you from old patterns of eating that have no relation to nutrition. The sensation will be short lived, but the satisfaction of not giving into temptations will be much greater.

3-6 Months Post-Op
By this stage you should be feeling better and beginning to feel normal. It is very important at this time to stick to the guidelines. If you compromise the guidelines, your weight loss will slow down and perhaps even stop. This is the most important time to implement the dietary guidelines to achieve a long-term lifestyle of health. Sometimes, however, you may hit a “plateau” that lasts for several days or a week or longer. If this happens, ask yourself if you are following the guidelines. If you are, then don’t worry, you will begin losing weight again when your body is ready.

You may now add new protein foods that you have not tried before, or retry others that did not agree with you earlier. Aim for variety in your eating. Look for different ways to prepare your meat. Add seasonings and sauces to enhance the flavor. Still following the 70/30 rule, avoid simple carbohydrates as they will slow weight loss, interfere with maintenance, and may induce the “dumping syndrome” in some Gastric Bypass patients.

If you become hungry between your meals eat a protein-based snack, such as a cheese stick, a piece of beef jerky or a rolled-up piece of deli meat. You will still want to measure your food and eat it slowly. Patients should take twenty to thirty minutes to eat and stop at the first sign of fullness to avoid overeating and stomach discomfort, nausea or vomiting. If you don’t feel the sign of fullness, stop eating after your measured portion is consumed.

6 Months Post-Op to Maintenance
Your health has improved and the new activities you can do have enriched your life. During this time period some patients reach goal and move into maintenance. Others may still be in the weight loss stage. With practice, persistence, and patience most patients will achieve their goal weight. You aren’t in a race with anyone. Every journey is different. It may take on year, eighteen months, two years, or more to arrive at the weight you want to be. Don’t get discouraged, persevere.

Whether you are at goal and maintaining your weight, or still have some more to lose, you must follow the guidelines for the rest of your life. You haven’t been on a diet. You’ve been engaging in a healthy lifestyle that has no end point. You must always implement the principles and practices of a healthy lifestyle if you wish to maintain your weight or continue to lose.

All meals should still consist of 70% protein and 30% vegetables. Eat your protein first. Protein will stay in the gastric pouch or sleeve longer and create a longer period of fullness. Eat three meals a day with two planned snacks if you’ve increased your exercise for the day or experience low blood sugar. Snacks should be on ounce portions and should consist of high protein foods.

The initial size of the gastric pouch will allow approximately two-ounce meals and the gastric sleeve will allow approximately two to four-ounce meals. Around six to nine months after surgery patients may become concerned because they can eat more. Concerns emerge that they may have ruined their surgery and are going to fail and regain their weight. If this is your experience take a deep breath and relax. Your pouch/sleeve has just matured and will serve you well if you utilize it as a tool to control your weight. Continue to limit your portions, don’t overeat your pouch/sleeve by consuming more than 6-8 ounces of food per meal.

Maintenance
You should see your primary care physician for annual labs and have them send your results to our office. You can call our office at (801) 268-3800 and our medical assistants can send your annual lab to the facility you wish to have them drawn at.

When you have reached your goal weight or are at a weight you want to maintain, you have entered into maintenance. When maintaining your weight, you are engaged in a healthy lifestyle and must continue to follow the guidelines for the rest of your life (70/30 rule). You will always want to consume high quality proteins and vegetables at every meal. If you decide to introduce any additional complex carbohydrates into your diet, the addition must be done gradually and in small amounts while also increasing your physical activity. Examples of complex carbohydrates include whole grains, brown rice and whole grain cereals and pastas. Consuming too many carbohydrates, especially simple carbohydrates will contribute to weight regain. Simple carbohydrates are to be avoided or extremely limited in your diet. Examples include white bread, crackers, chips, ice cream, and candy of any type.

If you find yourself falling back into unhealthy habits, or have gained weight back, remember to go back to the basics.

Links to similar articles:
Ways to Curb Hunger Between Meals
How to be Portion-Wise
Back to Nutrition Basics: Some Guidelines for Life
A Lifetime of Eating Healthy

 

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124