Nutrition After Gastric Sleeve Gastrectomy

Nutrition after sleeve gastrectomy surgery is essential for healthy weight loss, habits and lifestyle changes. Therefore, the nutrition process after sleeve gastrectomy should be supported by a specialized dietician.

With sleeve gastrectomy, the stomach is reduced by 80% and transformed into a thin long tube with a banana-like appearance. In this way, weight loss is achieved by restricting food intake. Since absorption does not change much, healthy food selection plays an important role in weight loss. Nutrition after sleeve gastrectomy gains importance due to the decrease in appetite caused by the removal of the part that secretes the ghrelin hormone (hunger hormone). However, over time, hormone secretion returns to normal and appetite returns. The weight loss process after sleeve gastrectomy is 18 months. This period, during which weight loss is expected to continue, is called the early period. The process of reaching the ideal weight may differ between individuals. In general, the first 6 months is a period of rapid weight loss and low appetite. Afterwards, as the weight to be lost decreases, weight loss begins to slow down. The late period covers the period after the weight loss stops.

Nutrition after sleeve gastrectomy surgery is divided into two as early period and late period. The aim of early period nutrition is to be able to choose the appropriate food for the healing process of the stomach, to support healthy weight loss with the right food selection, to be able to eat adequate and balanced nutrition during the weight loss process, to reach the targeted weight and to gain eating behavior / habits suitable for the sleeve gastrectomy. In late nutrition, the aim is to maintain healthy eating habits and weight control.

How should nutrition after sleeve gastrectomy be in the early period?

The recovery period after sleeve gastrectomy is the first 1 month. Nutrition is very important for the healthy healing of the incision sites of the stomach and the stapler line. In the first days of the healing process, pain in the form of intermittent cramps may be observed while feeding due to edema in the stomach wall. For this reason, the first week is spent with clear liquid foods that are easy to pass through the stomach and will not tire the stomach too much. In the 2nd week, since the stomach stitches are in the boiling stage, liquid foods are continued. The liquids are again grainless but may be more viscous than in the first week. In the 3rd week, thin pureed foods that are easy to digest are introduced. In addition to thick liquids, blenderized foods are consumed. In the 4th week, thicker pureed foods with a thicker consistency called thick puree are continued with blenderized or crushed foods.

After complete recovery, solid food is introduced. In week 5, soft solid foods are tried first. In the 6th and 7th week, more solid foods such as meats are tried. By week 8, almost every food has been tried. In this way, the nutritional status is improved by gradually moving from liquid to solid foods. If there is a problem in the transition to any stage, feeding should be continued by returning to the previous stage. The food that causes problems at any stage should be postponed for 1 week and tried again. Depending on the patient's condition, the transition to certain nutrients may be postponed for a few days or may be delayed. Patients are told by bariatric dietitians which foods, how much they should prefer and what they should pay attention to while eating in order to lose healthy weight in this process.

What should be considered in nutrition after sleeve gastrectomy surgery?

In the early period, the stapler line tries to adapt to the normal contractions of the stomach. Since the stomach cannot contract as before, some digestive difficulties may be experienced after the healing process. When there is any discomfort in nutrition after sleeve gastrectomy, food and fluid intake should be stopped. In order to minimize the discomfort that may occur, a nutrition behavior suitable for the new stomach should be acquired. Appropriate nutrition behavior should be as follows. Foods should be tried at the recommended time. Liquids should be consumed in small sips and solids in small bites at intervals. Solids, even soft ones, should be chewed very well and eating time should be extended. The feeling of saturation will be better recognized with slow eating.

Stop eating or drinking when you feel full. The remaining food should be continued after the recommended time. Solid foods and liquid foods should not be consumed together. This is to ensure adequate solid food intake at the meal. In addition, when solid and liquid foods are combined, it is difficult to maintain portion control because of swelling and there is a possibility of enlarging the stomach. For this reason, the healthiest method is to take drinks either 10 minutes before or 30 minutes after food. When forgotten and more food is consumed quickly than the stomach capacity, the person should not be forced to vomit even if there is pain. In this case, relief should be expected by taking a walk. If the pain increases or there is no relief, the nurse of your bariatric surgery team should be contacted. Vomiting usually occurs spontaneously when the stomach cannot tolerate the food or the amount is too much. After vomiting, nothing should be eaten or drunk for 2 hours and the stomach should be rested by feeding clear liquids for the next 4 hours. In addition, the reintroduction of the food causing vomiting or pain should be postponed for 1 week.

Which foods are consumed during the liquid nutrition period after sleeve gastrectomy?

On the first day after the surgery, gastric passage is visualized by drinking water with contrast material through the mouth (leakage test) and then oral food intake is started. If there is no nausea or pain, water and 100% apple juice are sipped first. Patients are asked to sip liquids in small sips at intervals without using a straw. They are asked to stop drinking if they feel bloating, gas, pain or nausea. This replaces the feeling of saturation in the first days. For the first 2 days, the amount of liquid taken should not exceed half a tea glass (50 ml) per hour. On the 2nd day, clear meat/chicken broth without grains and pulp, unsweetened compote/soup, linden or light tea are added to the diet and asked to be tried in the same way. Before discharge, the patient is told by the dietitian how to eat during the healing process and a nutrition list is given after sleeve gastrectomy surgery. On the 3rd day of discharge, yogurt juice, diluted light buttermilk, 100% fruit juices other than tangerine orange grapefruit, herbal teas other than sage tea are added to the diet. On the 5th day, light milk or lactose-free milk, soy milk, almond milk, clear strained soups are added to the diet. Strained tomato soup, strained tarhana or pea soup, strained vermicelli soup are preferred at this stage. Flour and tomato paste are not added to the soup for the first 10 days. Lentil and ezogelin soups are not preferred because they are thick and gas-forming. Day 7 Light yogurt, probiotic yogurt, light kefir are added to the diet. Protein powder is started after the first week after sleeve gastrectomy and continued until the 30th day. A measuring spoon comes out of the box of the recommended protein powder. Take 1 scoop of powder and mix it with 300 ml of water or milk and consume it in this way. On day 10, soups thickened with a small amount of flour and tomato paste, seasoned soups are added to the diet. Strained vegetable soup, strained highland soup, strained chicken soup, strained trotter soup are recommended at this stage. On day 10, unless otherwise stated, try hard boiled eggs, curd/labne/soft cheese and peeled and thinly sliced tomatoes. The foods are tried one by one. If there is no problem with any of them, they can be eaten as a mixture in the form of cheese omelette / menemenemen in the following days. If indigestion is a problem in this trial, it should be postponed to the 15th day and started again in the same way.

What Should Be Considered During the Fluid Period After Gastric Sleeve Gastrectomy?

With discharge, at least 4 cups of liquid should be consumed daily to meet the body's fluid needs. Fatigue and headache can be seen when not enough fluid is taken. From the 7th day onwards, only water, excluding other liquids, should be drunk at least 1 liter a day. You can have 8 meals a day. There should be at least 2 hours between meals. Water should be sipped throughout the day without waiting for thirst. All recommended liquids should be tried to provide nutritional variety. If drinkability is good, protein-containing liquids with the highest nutritional value should be preferred more. Liquids should be sugar-free, low-fat or fat-free and grain-free. For example, fruit juices from the supermarket should be 100%. If fruit juice is to be made at home, it should be passed through a cheesecloth and the pulp should be removed. Sugary foods such as yogurt/milk with fruit should not be consumed. When preparing meat broth, the bony parts are used, and it can be boiled with vegetables to give flavor. Then the solid grains are separated by passing through a fine strainer. No additional oil should be added to liquids containing meat broth. Excess fat should also be removed from the broth. Soups should be separated from solid grains using a strainer. A small amount of salt and lemon can be added to the soup. However, other spices should not be consumed for the first 15 days. Broth, light labneh cheese or light yogurt can be added to soups to increase protein. Creamy soups should not be consumed.

Which foods can be consumed in the puree period after sleeve gastrectomy?

From the 14th day after sleeve gastrectomy surgery, blenderized watery purees with the consistency of baby food are started. In addition to liquid foods, pumpkin, carrot and mashed potatoes are added to the diet. Mashed potatoes are opened with broth or light milk. Eggs and cheese tried on the previous days are tried again if postponed. On day 17, spinach, purslane, chard, pea (without cream) purees are added to the diet. On day 18, bananas, apples and pears are first added to the diet from fruit purees. On day 19, strawberries, apricots and peaches (peeled), pineapple puree are added to the diet. For dessert, sugar-free pudding, custard, pudding, keşkül or 1-2 scoops of light ice cream can be preferred. On the 20th day, lean baked hash browns are added to the diet. From the 21st day onwards, crushed solid purees are introduced. Boiled soft vegetables can be mashed with the back of a fork. Mushroom puree without cream is added. Tuna is added to the diet. If there is no problem with tuna digestion, seasonal fish in the form of grilled / steamed / baked is added to the diet in the following days. If it does not contain chicken or meat pieces, granular soups are consumed by blending instead of straining.

What should be considered during the puree period?

Drink at least 1.5 liters of water a day to prevent dehydration. Eat 6 meals a day, 2 hours after liquid foods and 3 hours after pureed foods. Do not forget to sip water between meals. At this point, attention should be paid to solid-liquid separation. Since the number of meals decreases during the puree period, protein intake should be increased. At this point, milk buttermilk kefir should be preferred as a snack instead of fruit juice compote as a liquid food. Daily protein intake is increased by adding meat-chicken broth, labneh cheese, milk, yogurt to pureed foods that are the main meal. A low-fat, sugar-free diet should be observed during this period. 1 recommended food should be tried every day. If there is a food that touches the stomach, it should be postponed for 1 week. The foods tried can also be consumed as a mixture in the following days. For example, after trying zucchini and carrots separately, you can try hash browns. If you are out, baby purees with less than 10 grams of sugar per serving can be preferred.

Foods to be Consumed After Sleeve Gastrectomy Surgery

Acidic and carbonated drinks such as cola, fanta, soda should not be consumed for at least 1 year after sleeve gastrectomy surgery. These drinks increase stomach acid and negatively affect the healing process. They cause bloating due to gas output in the stomach. Therefore, they are likely to enlarge the stomach. In addition, since they are high in calories, they are among the foods that negatively affect weight loss. Acidic and gas-forming fruits such as tangerines, oranges, grapefruits and their juices should not be consumed for the first 45 days. Dried fruits should not be consumed in the first month due to their solid structure. Dried legumes (lentils, chickpeas, dried beans, broad beans, dried kidney beans, soybeans) should not be consumed for the first 45 days due to their high-fiber structure and gas-forming nature. During this period, care should be taken to ensure that soups or purees do not contain dried legumes. Raw vegetables should not be consumed in the first month due to their fibrous structure. Cabbage, broccoli, asparagus, brussel sprouts, leeks, artichokes, cauliflower should not be consumed in the first month because they cause gas. Corn should not be consumed for the first 3 months as it causes obstruction. Coffee should not be consumed for the first month after sleeve gastrectomy because it causes dehydration (fluid loss). After the 1st month, coffee consumption should not exceed 1-2 cups per day. Alcohol should not be consumed for the first month after sleeve gastrectomy because it irritates the gastric mucosa, even a small amount contains high calories and causes dehydration. If alcohol is consumed after the 1st month, it should not exceed 1 glass in 2 weeks in order not to negatively affect weight loss. It is recommended not to consume alcohol during the first 6 months when weight loss is fast. Solids such as red meat, chicken meat, bread, rice pilaf, pasta, bulgur pilaf, olives, nuts should not be consumed in the first month.

How should solid foods be consumed after sleeve gastrectomy?

After the liquid and puree period is completed in a healthy way, solid foods are started. First of all, start with soft solid foods. Red meat and chicken meat are difficult to digest due to their hard structure. Meats should be consumed by making them soft with healthy cooking techniques (steaming, boiling, baking, stewing, sealing, grilling). This will make it easier for the small stomach to digest the food. Hard cooked meats that have lost their juices may cause sticking in the stomach even if they are chewed very well. In this case, pain or nausea may occur and adequate nutrition cannot be provided. Since no liquid is taken with solids, the solid food should be chewed in the mouth until it reaches a puree consistency. This also prevents swallowing difficulties. Meat should be cut into small pieces. Every day, a recommended food should be tried in order and if there is a problem, the previous food should be returned to the previous one. The problematic food should be tried again after 1 week. In the 5th week, vegetable dishes with minced meat such as carnıyarık, juicy meatballs and grilled meatballs are tried respectively. In the 6th week, tenderloin and cubed meat with the consistency of Turkish delight are tried. In the 7th week, kebabs, lamb, meat doner, chicken thighs and offal are tried. In week 8, chicken breast and cutlets are tried. From the 5th week onwards, other solid foods that were forbidden for the first month are added to the diet. Raw vegetables should be tried one by one. They should be chewed very well because they are fibrous. Bread consumption after sleeve gastrectomy should not exceed 1 slice a day. Fried bread is digested more easily. Daily consumption of some foods that replace 1 slice of bread should be 2 pieces of etimek, 3 pieces of grissini, 3 tablespoons of rice-bulgur-pasta-noodles, 2 tablespoons of oatmeal/muesli, 1 tea glass of white chickpeas. Nuts should not exceed 5-10 pieces per day.

What should be the diet after sleeve gastrectomy surgery?

Your nutrition priority should be protein sources, vegetables, fruits and cereals. Since the stomach volume is small, it is important to consume the food with the highest nutritional value first and in larger quantities to ensure adequate and balanced nutrition. For healthy weight loss, a diet high in protein, high in fiber, low in calories and low in fat, and free of simple sugars is recommended. Therefore, food selection is very important for weight loss.

After the transition to solid foods, at least 5 meals a day should be made, including 3 main and 2 snacks containing protein. At least 60 g of protein should be taken per day. If adequate protein intake cannot be achieved, the number of meals should be increased or protein powder should continue to be used for a while. The day should start early and meals should not be skipped. Going to bed early should prevent night hunger and the desire to eat. Nothing should be eaten 2 hours before bedtime. There should be a break of 4 hours after solid meats, 3 hours after a food that can be crushed with a fork and 2 hours after liquid food. Do not forget to sip water between meals. For example; breakfast at 9 o'clock (1 whole egg, 30 gr. cheese, 2 walnuts, cold cut vegetables) lunch at 12 o'clock (90 gr. soft meat and pureed vegetables) snack at 16 o'clock (200 ml kefir) snack at 18 o'clock (150 gr. yogurt and fruit) dinner at 20 o'clock (120 gr. soft meat/chicken/fish) with this type of diet, 70 gr protein is taken daily. It should be kept in mind that protein needs may vary according to the individual. In order to meet the daily requirement, protein sources should be consumed first. Animal proteins should be preferred first, followed by vegetable proteins. The reason for this is that more protein, vitamins and minerals can be taken with much smaller amounts of animal sources. Animal protein sources are red meat, chicken meat, fish, eggs, milk and dairy products. Plant protein sources include legumes, quinoa, chia seeds and buckwheat. Spinach, broccoli, peas and mushrooms are vegetables high in protein. Pistachios and pumpkin seeds are nuts with high protein content. Animal proteins are also high in fat. To limit calorie intake, lean cuts of meat, lean fish and lean dairy products should be preferred. Meat should not be fried in oil and dishes containing meat should not contain added fat. To limit calorie intake, simple carbohydrates (tea sugar, honey, jam, powdered sugar, beet sugar, etc.) are banned from the first day. One reason for this is that sugar from the small stomach enters the bloodstream more quickly and the blood sugar balance is disturbed. In this case, appetite may be negatively affected and frequent hunger may occur. In addition, excess carbohydrate consumption may cause dumping syndrome after sleeve gastrectomy. This condition manifests as abdominal pain, cramps, nausea, diarrhea, fainting, tachycardia. To prevent this, sweeteners such as canderel and splenda should be preferred instead of sugar.

Meals should be mostly protein-based. In some people, this may also occur after consuming fruit. In this case, fruit juices, including 100% fruit juice, should be discontinued and pureed fruits should be mixed with milk or yogurt. Ready-to-eat foods with high sugar and fat content and high calories, such as chocolate, should not be consumed in the first month. Dessert consumption should be planned as 1 in 15 days. Sherbet dessert consumption should be avoided for life. Milk desserts should be preferred instead. Milk dessert preferred instead of a snack should not exceed 100 grams. If chocolate is preferred for dessert, 2 pieces of chocolate containing at least 60% cocoa is sufficient. If ice cream is preferred, it should not exceed 2 balls. Fruit should not be consumed on the day dessert is consumed.

On other days, the need for dessert should be met from fruit. Fat and fatty foods are the most difficult to digest in the stomach. For this reason, fat is restricted during the healing process. In the early period, fatty foods should not be preferred in the diet as they cause digestive difficulties and negatively affect weight loss with their high calories. In particular, fried foods, chips, mayonnaise, cream, cream cheese, cream cheese, margarine, butter, whole milk / cheese, salami, sausage, sausage, hazelnut cream or shockella, fatty sauces, packaged products with unknown ingredients, nuts and oily bakery / pastry products should be avoided. After adequate protein consumption, healthy carbohydrate sources should be included. Complex carbohydrate sources that contain high fiber, are satiating, do not raise blood sugar rapidly and have high nutritional value should be preferred in the diet. These are vegetables, legumes and grains. Among the grain group, bulgur or buckwheat (instead of rice), whole grain bread (instead of white bread), integral pasta (instead of white pasta), brown flour (instead of white flour), oats and muesli should be preferred.