Nutrition after the 1st month after surgery

After the first 1 month of liquids and purees, it is time to gradually introduce solids. But how...?

The new stomach should be introduced to solids gradually. For example, after the 28th day (5th week), the red meat group can be consumed, but in the first attempt, you should start with easy-to-consume and easy-to-digest meats such as vegetable dishes with minced meat, minced meat with tomato sauce or meatballs. In week 6, you can try well-cooked, soft red meats that are easy to chew. If there are no problems with consumption and digestion, red meat varieties can be consumed easily.

Chicken meat is the most difficult meat to digest, so it is the last meat group to be tried. In the 6th week, chicken meat can be tried. The point to be considered here is to prefer the soft parts of the chicken (thighs and hips). Since chicken breast is hard and difficult to digest, it is better to try it after the 8th week.

Legumes are our vegetable protein source. It is very useful to consume 1-2 times a week. However, it is necessary to start consuming them after the 45th day because they can cause gas and bloating.

Corn is one of the other foods that should not be consumed. In addition to being difficult to digest, it should not be consumed for at least 3 months because it causes blockages in the stomach.

The consumption of raw vegetables, which is forbidden in the first month, can now be started. If we talk about the bread group, there is no harm in consuming 1 slice of bread a day. The much-missed coffee can be drunk 1-2 cups a day without cream, milk powder and sugar. However, if coffee is not accompanied by plenty of water, it causes edema. For this reason, people who have difficulty in water consumption should not prefer too much. Alcohol is very high in calories and sugar. When consumed in excess, it causes weight loss to slow down and even stop. People who prefer it should pay attention to its frequency. Excessive consumption of sweets also negatively affects weight loss. It should be preferred once a week and preferences should be used mainly for milk desserts.

The volume of the stomach is restricted with surgery; however, it is still up to the individuals themselves to decide which foods to fill that stomach with. The most important food group for our health is proteins. The most important thing to do in order to maintain a good weight loss, to prevent muscle loss, to maintain our vitamin-mineral and blood values in the best way is to eat a protein-based diet.

Protein and Vitamin Use After Gastric Sleeve Gastrectomy 

After sleeve gastrectomy surgery, you need to eat a protein-based diet. Protein support is required to meet your protein needs in the early postoperative period and to prevent muscle destruction. Starting from the 7th day, additional protein support is started. Your sample nutrition plans given to you when you are discharged from the hospital have been created by calculating your daily protein need. 

To increase protein intake after sleeve gastrectomy surgery, we recommend that you prepare your soups with meat/chicken broth until the day you start protein supplementation. You should consume 30 grams of protein support by placing it in 300-350 ml of preferably light or lactose-free milk and spreading it throughout the day. Protein use after sleeve gastrectomy is also personalized. After the first 1 month of use, your usage pattern in the following periods will be adjusted by our dietician according to your diet. 

The use of vitamins after sleeve gastrectomy surgery is given as 1 piece every 3 days for support after the 1st month. 

Additional supplements are made regularly every 3 months (1-3-6-9-12th month) according to the results of your blood tests. 

B12 Deficiency After Sleeve Gastrectomy

B12 is the most commonly deficient vitamin after sleeve gastrectomy. The main reason for B12 deficiency after sleeve gastrectomy is the role of our stomach in the absorption of vitamin B12. The release of the protein (intrinsic factor) involved in the absorption of vitamin B12 is controlled by cells in the stomach (gastric parietal cells). Since there will be a decrease in these cells with the removed part of the stomach in sleeve gastrectomy surgery, the absorption of vitamin B12 decreases after sleeve gastrectomy surgery. 

Many conditions such as forgetfulness, numbness in hands and toes, and fatigue can be observed with B12 deficiency after sleeve gastrectomy. In order to continue comfortably and healthily after sleeve gastrectomy surgery, you should definitely include foods with high B12 value in your diet.

Foods of animal origin are the richest in B12. 

For example;

• Liver and kidney 
• Red meat
• Tuna fish
• Trout
• Salmon
• Egg
• Milk and dairy products
• Sardine
• Foods such as oysters are examples. 

There is also vitamin B12 in plant-based foods, but in low amounts.

In order to minimize B12 deficiency after sleeve gastrectomy surgery, it is necessary to continue with a more protein-intensive diet. In this case, since foods with high B12 value will generally be consumed, there is no rapid and serious decrease in vitamin B12 levels. Again, multi-vitamin supplements started after surgery can also reduce the levels of many vitamins such as vitamin B12. 

Vitamin B12 levels are maintained with regular blood tests and supplements if necessary.

Regular vitamin B12 supplementation is required for individuals with gastric sleeve who are vegetarian or vegan.

Iron deficiency and anemia after sleeve gastrectomy surgery

After sleeve gastrectomy, especially red meat consumption gains importance when solid food is switched to solid food. Red meat is very valuable due to its high iron content. It is normal to have a decrease in iron absorption as the stomach shrinks. You can easily overcome this deficiency with a protein-prioritized diet. Your iron value is checked in your blood tests on the 30th day after sleeve gastrectomy surgery and the tests are repeated every 3 months. If your iron deficiency cannot be corrected with nutrition, you may need to take iron tb orally 2 hours after lunch. Your iron deficiency treatment after sleeve gastrectomy surgery is organized by your doctor. In some cases, iron tb taken orally may not be enough to correct your anemia. In this case, iron treatment can be administered intravenously in serum.

Sexual intercourse after sleeve gastrectomy surgery

There is actually no restriction for sexual intercourse after sleeve gastrectomy. There is no problem in having sexual intercourse after 1 week for precautionary purposes. It is important for female patients not to get pregnant for the first 1 year.  

Diarrhea After Gastric Sleeve Gastrectomy

Diarrhea after sleeve gastrectomy is one of the complaints we rarely encounter. It may be caused by the medicated water you are given to drink during the pass test (leak test) the day after the surgery. This opaque substance is quite oily. Therefore, it makes your intestines work fast. Necessary interventions are made during the hospital process. However, if you complain of diarrhea when you go home, please contact our nurse or dietitian. Adequate water consumption is very important in this process. 

Constipation After Gastric Sleeve Gastrectomy 

Constipation is one of the most common problems after sleeve gastrectomy. The main reason for this is the decrease in fiber and water consumption.  Drinking water, moving and using foods with high fiber value (such as kiwi) in consultation with our dietitian during the puree period will reduce the problem of constipation after sleeve gastrectomy surgery. After your 1st week, you can get probiotic chewable tablet support in consultation with our dietitian or nurse. If your constipation complaint does not improve despite these, medications suitable for your feeding period are given. For constipation lasting more than 3 days, please contact us. 

Fasting After Obesity Surgery

In recent years, bariatric surgery has been performed at increasing rates in our country as well as all over the world. Fasting during Ramadan can cause difficulties in patients who have undergone bariatric surgery, especially in the first year. Again, hot and long summer months make this process even more difficult.

Many bariatric methods significantly limit the amount of food and fluids that can be taken in at one time, so patients are advised to drink fluids frequently between meals throughout the day. Fasting during the long summer days naturally puts these patients at risk of dehydration. In addition, the desire to ingest the largest possible amount of food and fluid in a short period of time due to the increased appetite following prolonged fasting at iftar time can lead to vomiting, leading to increased dehydration and malnutrition.

In a telephone follow-up study conducted in Kuwait, the fluid and food intake of 230 patients (207 sleeve, 13 gastric bypass, 7 gastric banding) who fasted between July 20 and August 19, 2012 were compared with the amount of fluid and food intake during a normal 4 week non-fasting period after Ramadan. Interestingly, while there was no difference in total fluid intake in these two periods, 18% less calories and 41% less protein intake were found during the fasting period. The group that published the study emphasizes that caution should be exercised, especially on long summer days, in people with diabetes (diabetes) and those who have undergone procedures such as duodenal switch, which have a more malabsorptive effect.

In conclusion, although there are no evidence-based scientific studies in this field, according to clinical experience, it is recommended to avoid fasting, especially in the first months after bariatric surgery. Fasting should be avoided for the first 12 to 18 months, especially in patients with diabetes mellitus or patients who have undergone a malabsorption method such as duodenal switch.

Adjusting to the New Body After Gastric Sleeve Gastrectomy

Body Dissatisfaction and Body Perception Disorder 

People with weight problems may refuse to be in contact with their bodies. They may avoid looking at their bodies and start to withdraw from social life. Some people may still think they are obese even if they lose weight.  It is not easy to get used to the new body size for someone who has accepted their body as obese for years and continued their life in this way. You may not be psychologically prepared for the rapid weight loss in the postoperative period. You should give yourself time for this. You should look in the mirror more often (including your preoperative weight) and write down your weight, waist and hip ratios on a weekly chart. As you start to buy clothes in smaller sizes, the you in your mind will start to change as you notice the numbers on your chart start to drop. Regulating body perception and resolving complex emotions will also increase your satisfaction with the surgery.

Ways of reinforcement and strengthening:

• Provide support and help from family and friends.
• Help family and friends to provide support in the form of praise and financial rewards.
• Base self-monitoring behavior on rewards.
• Give specific rewards for specific behaviors.
• Reward change in behavior, not change in weight.
• Do not reward behavior change with food.
• Choose attractive reinforcers such as money, clothes or social activities.
• Reward behavior change as soon as it reaches the target point.

Fast and Unaware Eating Behavior 

Considering the living conditions, you tried to gain time from eating that should be gained from other activities due to the fast pace of life. With the forgetting that eating behavior should be a special time, it has become a habit not only to do this behavior in eating environments, but also to add different stimuli to this time (For example; eating in front of the computer or in front of the television).  Since these habits prevent the consumption of food with awareness and automate the behavior, they cause an increase in the amount of calories you consume. The duration of a main meal should be at least 30 minutes. This time is needed for blood sugar to rise and for the brain to receive the “you are full” signal. At the same time, eating times should be specially planned and different stimuli should not be interacted with during these hours. When a main meal is consumed within 10 minutes and with too many stimuli, you may think “I am not full” at the end of the meal because the “you are full” signal has not yet been transmitted to the brain. This behavior inevitably increases the calorie intake.

Suggestions for controlling eating speed:

• Lower your fork between bites.
• Chew thoroughly before swallowing.
• Prepare only one portion for each meal.
• Leave some of the food on the plate.
• Take a break in the middle of the meal.
• Do not do anything else during the meal (such as watching TV, reading the newspaper, talking, attending a meeting).
• Psychological problems that may occur after the third month 

Developing Cross Addiction Instead of Eating Addiction

After bariatric surgery, you may feel like you have lost something. You realize how central food is to your life. You may realize that most of your time is spent planning, preparing and thinking about food. At times in the past, food may have been a comfort, a release from the day, or a reward.  It may even have been part of your social life. Nowadays, because you can't eat as much as you used to, you even think about it when you go out for lunch with your colleagues.

At such times, bariatric surgery may be a regret for you. With food not being in your life like it used to be, you may be questioning whether the surgery was a good choice. Therefore, you should be careful and seek help immediately if you sense such a tendency.

You should also find yourself some fun social activities. Instead of having lunch with your colleagues, you can invite them for short lunchtime walks. You should always fill your free time with enjoyable but healthy habits.

Being Vigilant Against Developing an Eating Disorder

If you have been suffering from weight problems for many years, the thought of having an eating disorder may seem funny to you. But there is such a risk. Some people may develop Bulimia or Anorexia Nervosa after surgery. The most common problem after surgery is vomiting after eating the wrong food quickly and without chewing. If it becomes a habit, it is a serious problem.

Spitting food out after chewing is another unhealthy habit. Some people do this just to taste and remember the taste. This behavior is very damaging and can lead to a serious eating disorder. When you notice these and similar symptoms, you should definitely seek professional support.

Avoidance Behaviors 

The realization of weight gain is a negative emotional stimulus for almost everyone. In order to avoid these negative feelings, our senior patients (2nd postoperative year9) usually try to avoid situations and environments where other people may notice their weight gain. This avoidance is called 'avoidance behavior'. Typical avoidance behaviors include not getting on the scale, wearing baggy clothes, not going to the pool/sea, not undressing in front of others, not looking in the mirror, not communicating with us. These behaviors work for the moment and prevent you from experiencing negative emotions. However, when we think about the long term, ignoring the problem causes the problem to remain unresolved and even causes the behaviors that create the problem to continue. Therefore, recognizing and addressing avoidance behaviors, accepting the problem and looking for solutions will motivate you.