The Things to do and Nutrition after Laparoscopic Sleeve Gastrectomy

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  • By having surgery, you have taken the first step towards getting rid of all the difficulties that morbid obesity has brought to your life. First of all, congratulations! The “sleeve gastrectomy” procedure seen on the figure has been performed on you. It is worthwhile to remind once again that morbid obesity treatment does not end with only surgery, and you have some tasks, as well.

Now you have a key in your hand, for a much healthier and happier life. In fact, using this key in the best way is completely in your ability.

We will have some suggestions, reminders and warnings for you about your nourishment and what you will do after surgery, so as to enable you to shape your new life much more comfortable by always keeping in touch with the surgical team and by constantly being followed up by us.

The explanations made here are important in terms of being able to live in the healthiest way and without regaining weight in the post-operative long term.

Within the first year after your surgery (more obvious in the first months), you will lose weight quickly. Your weight loss process will last but 1.5 years, and then it will end. Do not worry even if you will not be able to eat everything you want for the first few months. You will then be able to consume almost everything in reasonable and healthy quantities.

Immediately after your surgery and within the first postoperative day, you may have “minimal” shoulder pain as well as easily tolerable pains due to holes in the anterior abdominal wall. You will be in hospital in at this stage, and will ensure you to feel almost no pain. You may have mild nausea and very rarely belching on the first postoperative day again but these will end within 1-2 days. We will look at the created “tubular stomach” through an X-ray image on the first postoperative day. You will then immediately begin to intake fluid foods orally. After taking fluid for several days, you may feel a pain just behind the chest bone but do not worry about it because it will end as well.
Before making recommendation about your diet, let’s have a look at the points you will need to consider after discharged on the 3rd post-operative day.

After Discharged from the Hospital

Our patients are discharged on the 3rd post-operative day.

  • Be physically active as much as possible at home, walk too often, use your breathing device, and do not abstain from coughing. You can take a shower after the th3rd post-operative day, and can take short walks outside on the 5th post-operative day.
  • If you have diabetes, your need for medications or “insulin” will decrease after “sleeve gastrectomy”. You may even not need them at all, and this effect will occur immediately, not after weight loss. Therefore, keep your blood sugar under control for the first ten postoperative days at home.
  • In case of mild pains, you can take a “Felden Flash” tablet that melts in the mouth.
  • After discharged, continue to have Clexane 0.4 or 0.6 ml (which was administered subcutaneously on a daily basis in the hospital) subcutaneously for a period of 7 days at home.
  • Continue to wear your compression socks, which you wore in the hospital, for 4 more days until you become physically completely active.

Contact us immediately if you experience unexplained fever, newly beginning abdominal pain or increasing swelling and pain in your calves (below the knee) in the first postoperative month.

 

  •  Do not drive for a period of one month, and abstain from vigorous physical exercises for 2 months. Take care to do mild exercises such as 20-30 minute walking, or cycling at home, or swimming, for a period of 2 months starting from the 7th postoperative day. In the long term, more vigorous regular exercise programs are very important in terms of reshaping your body in a healthier way and avoiding “muscle” loss. Do not consume alcohol for a period of 2 months. If your job does not require physical activity, can return to work after 8-9 days.
  •  If you suffer from constipation, you can take a dose of “MAGNESIE CALCINEE POWDER” by melting it in half a cup of water, before going to bed at night.
  •  After discharged from the hospital, you will need to take a multi-vitamin that melts in the mouth throughout your life. You can also take it in the form of tablet after the 2nd month.
    You should definitely take “protein” supplements, which will also be mentioned under the heading “Nutrition (Nutritional Supplements) and Liquids” below, for the first three months (preferably for 6 months). Various “powder” or “liquid” protein formulas intended for this purpose are available. Various examples of such products available in our country, the use of which are approved by us as well, are listed on the following pages. Protein supplements can reduce certain side effects such as hair loss and weakness, and their use is an extremely important precaution taken to prevent unwanted loss of “protein”. After 5-6 months, you will not need protein supplements because you will be able to eat adequate amount of meat.
  •  Your blood tests will be performed and your vitamin and mineral levels will be checked definitely in the 3rd and 12th postoperative months. Therefore, please do not neglect these two control examinations.

 

Nutrition After Sleeve Gastrectomy

In the early postoperative period, your diet, which you were previously accustomed to, will completely change. We can roughly say that you will first consume clear liquids, and then soups. Afterward, you will begin to consume mashed and soft foods. After the second month, you will be able to eat almost everything, as long as you keep certain rules in your mind. Especially in the first postoperative weeks, your diet will be intended for ensuring you to receive adequate amount of fluid and protein, and this approach will enable you to recover quickly. Afterwards, you will need to follow a nutrition protocol rich in protein and fiber that contains low carbohydrates, by which your nutritional needs will be met in a healthy way.

Please follow the “gradual” diet program explained to you! In this way, you will be protected from unwanted complications, and will lose weight in the healthiest way

The day after surgery: After an x-ray examination, you will begin to take small amounts of clear liquids (water, tea, linden tea, beef/chicken broth, apple juice etc.) in the hospital. It will be adequate to consume 5-6 “pet” cups of liquid until the end of the first postoperative day. At that stage, you will already be receiving liquids intravenously.

  • You should drink the liquids sip by sip and intermittently.
  •  Do not use a straw because it can lead you to swallow air unnecessarily.
  • All liquids taken should be “sugar-free”, “low-calorie”, “gasless” and “decaffeinated”.

The 1st postoperative week: Clear liquid diet

From the second postoperative day, continue to take nourishment with at least 7-8 “pet” cups of low-consistency clear liquids per day, throughout the first postoperative week, by gradually increasing the daily volume. In addition to the liquids mentioned above, you can begin to consume “fully skimmed” cow’s milk or dietary “soy milk” on the second postoperative day. It is also very important for you to start consuming “protein powder” on the second postoperative day again. You should also begin to take multi-vitamins in the form of liquids or chewable tablets (e.g.: chewable GNC MultiBite vitamin tablets) on the 2nd or 3rd day. All such liquids should definitely not contain solid food pieces. You should drink such liquids sip by sip in small volumes. In other words, they should not be quaffed! Or you can consume 1/4 or 1/2 glass of liquid per hour. Do not use straw when consuming liquids because it may lead to gas problem. Carbonated drinks are prohibited! Choose all liquids from sugar-free and “diet” products. Despite being rare, your diabetes condition may require you to pay more attention to the rate of sugar content of such liquids. This will be explained to you.

 

  • On the 4th and 5th postoperative days, you can begin to consume “fully skimmed” diet yogurt.
  • On the 6th postoperative day, you can begin to have relatively consistent soups made with “blendered” ingredients.

Do not forget to start consuming each new foodstuff by testing it in small portions and measuring your tolerance.

The 2nd postoperative week: Consistent liquid diet (progressing to consistent soups)

Of course, everything you can drink in the first week can be consumed in this period as well. After the 2nd week, more consistent fruit juices (such as orange juice, apricot juice, and peach juice) and some soups (such as tomato soup, filtered unseasoned tarhana soup [A Turkish soup made with sundried curd, tomato and flour], pea soup, broccoli soup, yogurt soup) can be consumed in addition to low-consistency clear liquids. Lentil soup and ezo gelin soup (a Turkish soup made with red lentil and mint), which can cause gas, should not be consumed at the beginning of this stage and until the 12th-13rd day. Strained yogurt can be a good source of protein at this stage as well. You can eat “cilbir” (a Turkish dish made of poached eggs and yogurt) on the 9th-10th day. Cilbir contains soft-poached eggs. It should be made without adding oil or spices. If desired, it can be served with diet yogurt. “Hummus” can also be added to the diet on the 10th day and on the following days.

  • Taking protein and vitamin supplements will continue in the 2nd week.

The 3rd postoperative week: Eating mashed foods is starting!

The diet in this period involves adding the following “mashed” foods to the diet that includes liquids, milk, egg, and soups, slowly and in small portions, depending on the tolerance of the person. Starting to eat mashed foods does not deduce your need for liquids; on the contrary, you should also get about 2 liters of liquids per day. Mashed food portions should be taken 3-4 times a day, and the amount of each portion should not exceed two or three tablespoons. Liquids should be consumed sip by sip again, 30 minutes before or after eating mashed foods.

  • At this stage, mashed dry legumes in addition to various mashed vegetables and fruits will be a rich protein source. Therefore, mashed chickpea (hummus), watery mashed broad beans, and mashed beans are appropriate options. Sugar-free mashed apple and banana can also be eaten at this stage.
  • Soft cottage cheese.
  • Curd cheese mixed with yoghurt.
  • Unsalted, fat-free soft cottage cheese for “breakfast”
  • Baby formulas (it should contain less than 10 grams of sugar per service—please check the contents).
  • Oil-free scrambled eggs (not too hard)
  • Oatmeal (with watery consistency) boiled in whole milk.
  • Small amount of mashed potato powder diluted with broth.
  •  Consumption of additional protein and vitamin supplements should also be continued. 
  • The 30-Minute Rule: Approximately 30 minutes should be added between solid food (mashed) and liquid intakes.

The 4th postoperative week: Switching to consistent mashed foods and soft chewable foods.

When you are about to enter the 4th week, speaking to our dietitian will be very heart-warming and useful for you because the number of your options will considerably increase. If you can tolerate all the foods outlined above, you can switch to more consistent mashed (but not too mashed) foods prepared using the back of the fork; as well as to some soft foods, slowly and by testing your tolerance. You should take care to consume about 2 liters of clear sugar-free liquids (of course, also contains “water”) per day and keep in mind the 30-minute rule. Your reduced stomach or tubular stomach will heal in the healthiest way, if you strictly follow these rules and if you do not strain your body. The foods you can start to consume:

  • Well-boiled and peeled fruits and vegetables that can be easily mashed with a fork.
  • Mashed chicken or turkey “dark meat”
  • Ground meat that has not completely boil down or dried out (it can be mixed into mashed vegetables or soups).
  • White boneless fish meat (e.g. sole fish).
  • Fat fish meat (e.g. salmon fish).
  •  Tuna fish dressed with diet mayonnaise or egg salad.

At each meal in this week, consume first the protein source and then vegetables and fruits. At each meal in this week, again, consume one unit volume of vegetable source for every two unit volumes of protein sources.

Always consume high-protein foods before all other foods. Vegetables and fruits should be consumed after these.

The 5th postoperative week: Good news! Eating normal foods is starting!

First, we should start by emphasizing the fact that every person has different tolerances to various foods. Therefore, a person should not begin to consume more than one type of food at the same time. In this way, it will be easier to ascertain which ones of the foods newly began to be consumed can be tolerated most comfortably. Starting to consume everything in small portions by eating slowly and chewing thoroughly is the most basic rule again. Besides the type of the food, the way of cooking is also very important in terms of tolerance. For example, over-cooked (extremely dry) chicken or fried chicken cannot be tolerated, whereas chicken boiled or cooked in sauce can be tolerated. You still need to consume 2 liters of fluid every day. In this regard, the 30-minute rule is still applicable. This stage is actually the period, in which new and different protein sources are included in the diet. The foods that you can begin to consume at this stage:

  • Well-boiled chicken or turkey “dark” meat.
  •  Fish, shrimp, other than shellfish products.
  •  Meats that can be easily crashed in the mouth (e.g. watery meatballs, and low-fat doner kebap made of ground meat)
  • Small amounts of “whole-grain” crackers (e.g. WASA Crispbread, available in our country as well) can be included in the diet.
  •  Peeled raw fruits and salads can also be started to be consumed if they can be tolerated.

Meats difficult to chew, such as tenderloin, rib steak, and beefsteak should not be consumed until the stomach function completely recovers, in other words, for a period of 5 months. The 30-minute rule should also be kept in mind.

Diet And Exercise Tips for The Long Postoperative Period

A very detailed list and information about what you should do on a daily basis, what you should eat and drink, and the points that you should consider in the early postoperative period are presented above. As you have been told many times, it largely depends on you to be successful in your long postoperative period, i.e. become able to remain healthy without regaining weight over the years. There are basically two things to consider. The first is to get adapted to a healthy and appropriate diet throughout your life; and the second is to do moderate exercise on a regular basis. What you should first know is that you have now a very small stomach. In the early postoperative period, our main goal is to ensure you to receive adequate amount of liquids and protein; and then in the long postoperative period, our main goal is to ensure you to meet your daily nutritional requirement in the highest quality way. Since your stomach is very small, you will feel satiety immediately after consuming very small amount of liquid or food. Therefore, you should not consume any “useless” or “poor quality” products.

You should create a definite and regular “table culture”

Always eat three main meals and 2-3 snack meals. If you have a “snacking” habit, quit it. Never skip the main meals, and preferably allocate at least 30 minutes for sitting at a table for these meals. You should consider the main meals as a “ritual”, and after getting up from the table, you should not think about eating. Not only what you eat but also how you eat is very important. Never snack unconsciously in front of the computer or television.

Always eat “slowly”

The meals should take at least 20 minutes and the meal times should be a pleasure for you. Have a look at the foods and your meal at your table by keeping in mind your “small stomach”, in order to understand how much volume your small stomach can tolerate comfortably. You should avoid severe tolerance and nausea problems during any meal period, and you can ensure this only by eating slowly and in small portions, and by waiting when you feel uncomfortable.

Chewing well is essential

Chewing the foods thoroughly before swallowing will improve your tolerance to new foods when they will be included in your diet, and will also contribute to your eating pleasure. It will be more important to eat slowly and chew thoroughly in the following months, when you begin to eat solid foods, especially large pieces of red “meat” (such as tenderloin, rib steak, and beefsteak). This is because meat pieces that have not been chewed thoroughly may block the outlet of the reduced stomach, and this inevitably results in vomiting. Therefore, specialists at some medical centers even recommend not to start consuming large “red meat” in the first 6 postoperative months. On the other hand; since meat is a very important and high-quality protein source, it can actually be tried after the 4th month, by observing certain rules. The meat should not be dried during cooking; instead, it should be left watery, or they should be cooked in sauces; and after divided into small pieces, they should be eaten slowly and by chewing thoroughly and carefully. Cooked meat should never be reheated! The meat reheated next day gets dry and becomes difficult to chew.

Avoid desserts and sugar

After surgery, sugary foods consumed when your stomach is empty may cause you to feel “strange”. Foods with high sugar content are actually poor quality and “noncaloric” foods. Therefore, staying away from them would be the most reasonable approach. Such simple carbohydrate (sugar) containing foods may also impede your effort to lose weight, by leading you to feel hunger shortly after eating. Consuming sugary foods triggers greater amount of sugar consumption, which may lead to a vicious cycle.

The sugar content of any commercial product you consume should not exceed 10 g per serving. Read the “LABEL” information about the contents of the products you consume!

The indispensable nutrient of every meal: Protein

At each meal, protein source foods should constitute at least half of your plate. Or you need to intake about 60-80 grams of protein per day. Proteins are irreplaceable building blocks used to enable the body to repair itself and maintain its healthy condition. On the other hand, proteins are foods, digestion and metabolization of which take long time. For this reason, they provide you with a long-lasting satiety. Proteins are essential for ensuring the normal functioning of the body. Every protein molecule in the body has a vital function, and even the loss of a single protein molecule will lead to a loss of function. On the other hand, when losing weight rapidly after bariatric surgeries, the main goal is to ensure that the achieved weight loss is the result of losing fat tissues only.

However, since patients cannot receive adequate amount of protein from natural sources, and since they cannot consume important protein sources like meat in the early postoperative period, they may inevitably suffer loss of protein. Therefore, the use of additional protein sources is of great importance in this period, i.e. throughout the first 5-6 postoperative months. In this way, weight loss will be achieved more healthily, and losses of muscle mass and protein as well as many other unfavorable effects will be avoided. If protein powder is used in an adequate amount and for an appropriate period of time, and if the exercise programs are continued, optimal and healthy weight loss can be achieved.

The support of protein powder supplement is essential in the early postoperative period!!

  • The use of protein powder starts on the 2nd day after surgery.
  • The amount of carbohydrate contained in the protein powder is very important. The optimal protein supplements should contain carbohydrate in as little amount as possible.
  • Minimum 60-80 grams of protein supplement per day will be adequate in the first weeks. Make sure you receive the amount you need to receive on a daily basis, by considering the scoop (scale) amount of the protein source you use.
  • If the protein supplement is in the form of powder, it can be received after mixed into cold solid foods and liquids such as water, skimmed milk, and yoghurt (5 days after surgery). If it will be received with liquid foods or soups, it should never be added into them while it they are boiling, and it should be added even after the liquid has completely cooled down and become lukewarm.
  • There is a usability limit for protein taken with foods, and protein supplements are not used when the protein intake exceeds a certain dose.
  • Therefore, you should not receive the amount of your daily protein powder at a time; instead, you should divide the amount by the number of meals.
  •  If you mix the protein powder into milk or yogurt, you should not leave it outside, and should keep it in a tightly closed refrigerator. If consuming it cold causes you to feel uncomfortable, you can take it out of the refrigerator half an hour earlier, and can leave it at room temperature.

Protein supplements that can be easily found in our country:

CARNIVOR (with chocolate flavor, mostly used with water, milk and yogurt)

  •  It contains 25 grams of protein per scoop. Receiving 3 scoops of product per day is adequate.
    GNC PRO PERFORMANCE AMP WHEYBOLIC (vanilla flavored)
  • It contains 20 grams of protein per scoop. Receiving 3 scoops of product per day is adequate.
    NC Pro Performance WHEY PROTEIN -UNFLAVORED (unflavored, can be added to sweet and salty mixtures)
  • It contains 21 grams of protein per scoop. Receiving 3 scoops of product per day is adequate.
    GNC Pro Performance WHEY PROTEIN -CHOCOLATE (Chocolate flavored.)
  • It contains 20 grams of protein per scoop. 3 scoops of product per day should be consumed.
    Optimum Nutrition ON GOLD STANDARD CASEIN POWDER, CHOCOLATE SUPREME (chocolate flavored.)
  • It contains 24 grams of protein per scoop. Receiving 3 scoops of product per day is adequate.
    Optimum Nutrition ON GOLD STANDARD WHEY IN DOUBLE RICH CHOCOLATE (chocolate flavored.)
  • It contains 24 grams of protein per scoop. Receiving 3 scoops of product per day is adequate.
    Optimum Nutrition ON GOLD STANDART WHEY DOUBLE RICH CHOCOLATE SACHET (chocolate flavored)
  • The product in single use bags contains 24 grams of protein per bag. It can be preferred for out-of-home use.
    QNT METAPURE WHEY PROTEIN ISOLATE (chocolate flavored.)
  • It contains 50 grams of protein per scoop.
    MULTIPOWER 100% WHEY PROTEIN-STRAWBERRY CREAM (strawberry flavored.)
  • It contains 23 grams of protein per scoop. Receiving 3 scoops of product per day is adequate.
    ULTIMATE NUTRITION PROSTAR WHEY PROTEIN-BANANA (banana flavored.)
  •  It contains 25 grams of protein per scoop. Receiving 3 scoops of product per day is adequate.
    QNT PRO SHAKE BELGIAN CHOCOLATE 500 ML (chocolate flavored.)
  • It contains 50 grams of protein per bottle. Drinking 1 bottle of product per day is adequate.
    QNT PRO SHAKE STRAWBERRY CREAM 500 ML (strawberry flavored.)
  • It contains 50 grams of protein per bottle. Drinking 1 bottle of product per day is adequate.
    QNT PROTEIN SHAKE CHOCOLATE FLAVOUR (chocolate flavored.)
  • It contains 30 grams of protein per bottle. Drinking 2 bottle of product per day is adequate.
    QNT WHEY AMINOS
  • It contains 11 grams of protein per vial. It is recommended to be consumed after diluted with 150 ml liquid. It can be recommended for out-of-home use.