​​​​​​​​​​​​​​​​Eating After Sleeve Gastrectomy Surgery

These guidelines are designed for use after laparoscopic sleeve gastrectomy surgery. The stomach pouch created by surgery will hold about 4 ounces of food. You will be on a puréed consistency diet for four weeks to allow healing of the stomach pouch. These guidelines will help keep you healthy while losing weight. ​​

It is vital that you make healthy food choices and lifestyle choices, and that you exercise after surgery. This will help you:

• achieve maximum weight loss​
• avoid gastric discomfort
• prevent nutritional deficiencies 

​Advances in your stages should be made only with the approval of your physician.

Diet Progression​

Stage 1: Clear liquids — One day after surgery

Stage 2: Puréed food — Day after surgery and follow for four weeks.

Stage 3: Semisolid food —  Start when directed by your physician and dietitian. Usually starts four weeks after surgery.

Stage 4: Low-fat solid food —​ Begin when directed by your physician and dietitian. This stage will be gradually introduced about three months after surgery.

Stage 1: Clear Liquids

About one day after surgery, you will be started on sips of clear liquids (apple juice, orange juice, water, flat diet sodas, sugar-free Jell-O, broth, etc.). Take small sips, and be aware of feeling full. If you tolerate clear liquids, the next day you will be advanced to puréed food.

Stage 2: Puréed Food

All foods must be puréed in a blender and thinned to a texture that will fit through a straw. However, do not use straws as it may increase gas.

All foods must be the consistency of applesauce for four weeks. You should consume 72 grams of protein per day.

Food Examples

• Skim or 1 percent milk
• No sugar added Carnation Breakfast Essentials Light Start^​​® made with skim milk
• Puréed soups (made with skim milk instead of water)
• Puréed fruit added to shakes (made with skim milk and light/nonfat yogurt)
• Puréed meat added to puréed low-fat cream soups or mashed potatoes
• Cooked cereal thinned with skim milk (oatmeal, grits, Cream of Wheat)
• Puréed casseroles
• Puréed beans (black, pintos, kidney, lima, northern, butter, lentils)
• Unsweetened applesauce with non-fat dry milk powder
• Fat-free refried beans with melted fat-free/reduced-fat cheese
• Mashed potatoes made with skim milk
• Puréed sugar-free yogurt
• Cottage cheese (fat-free/low-fat)
• Add nonfat dry milk powder to all foods

​Start with small amounts of liquids and puréed foods because you will feel full quickly. At first, you will have to eat small amounts frequently (2 to 4 ounces at a time and aim for six meals per day). Eventually, you will be able to eat four to six meals of 4 ounces each. Eat slowly. It should take 30 minutes to eat/drink 4 ounces (1/2 cup).

At least 8 cups of caffeine-free, low-calorie liquids should be consumed gradually throughout the day to prevent dehydration. These liquids should be sipped in between meals. Do not drink with meals, and wait 30 to 45 minutes after a meal to begin drinking fluids again.

Drink Examples

• Water, or sugar-free or zero-calorie flavored water
• Diet fruit drinks, less than 10 calories per serving
  
• Decaffeinated tea (limit to 8 ounces per day)
• Decaffeinated coffee (limit to 8 ounces per day)
• Skim milk
• Sugar-free flavored drink mix

Vitamins and Minerals

A multivitamin with minerals, which includes iron and zinc, should be taken daily for the rest of your life to prevent hair loss, improve overall nutrition and prevent any nutritional deficiencies. During the first four weeks after surgery, we recommend a chewable vitamin and mineral supplement (example: Flintstone's chewable twice a day), and then you can advance to a pill form of a multivitamin with minerals, if you desire.

You will also be required to take a calcium supplement (example: Calcium Citrate 600 milligrams, three times per day) starting during the first month after surgery and a vitamin B12 supplement (example: sublingual B12, 1,000 micrograms, three times per week) starting immediately after surgery. Additional vitamin and mineral supplements will be recommended based on lab results and food intake/tolerance to prevent any nutritional deficiencies.

Medications may be taken in chewable or pill form four weeks after surgery.

Food and Drinks to Avoid

Concentrated sugars, high-fat foods, fried foods and alcohol can cause vomiting and/or diarrhea (dumping syndrome) so avoid:

• Candy, including chocolate
• Sweets
• Regular soft drinks
• Honey
• Flavored drink mix
• Molasses
• Cakes
• Preserves
• Sherbet
• Ice cream
• Alcohol (including beer)
• Doughnuts
• Fried foods

Different people have different foods they can and cannot tolerate. Do not be disturbed if you find some foods do not agree with you at first. You may be able to tolerate those foods later.

​Sample Sleeve Gastrectomy Liquid/Semiliquid Menu

The menu below is just an example. You will work with your dietitian to learn more about foods options. At first, you may have to eat more frequent meals and consume smaller amounts at each meal. Try to take in 24 ounces (3 cups) of nutritious liquids or puréed consistency food every day.

Consistency of all food during Stage 2 should be similar to thinned mashed potatoes or applesauce.

Breakfast: 6 to 8 ounces no sugar-added Carnation Breakfast Essentials Light Start®​​ mixed with skim milk 

Snack: 1/2 cup cottage cheese​

Lunch: Purée 1/3 cup fat-free refried beans and 1 ounce of melted fat-free/reduced fat cheese

Snack: 4 ounces blended light yogurt

Supper: Purée 1/4 cup meat, 1/4 cup cream soup, 2 tablespoon nonfat skim milk powder

Snack: 1 cup skim milk with 2 tablespoon of nonfat dry milk powder 

Between meals: Slowly sip at least 8 cups of caffeine-free, low-calorie liquids ​during the day

Tips for the first four weeks:

1. Keep food records.​This will help you monitor your intake and tolerance to foods. Look for patterns of foods tolerated well and foods that are not tolerated well. The records will also be helpful for your dietitian to provide suggestions for better tolerance or nutrient balance. Track the following:

• Time you eat
• Type of food (e.g., baked chicken without skin)
• Amount eaten (e.g., 1/2 chicken breast or 1/2 cup of yogurt)
• How your food was prepared (e.g., baked with broth). Be sure to include any butter, oil, grease or margarine that was added to the food.
• Grams of protein. Look on food labels, handouts in your patient notebook, the Internet or books to determine total protein intake.
2. ​ Use ice cube trays. 
   Each cube holds about 2 ounces. This will help you control portion sizes. Try preparing reduced-fat cream soups or puréed meats and vegetables and store them in the trays.
3. Limit food to 2 to 4 ounces per meal.​​Protein comes first.
   
4. Aim for four to six small meals per day. ​​
5. Drink at least 8 cups (64 ounces) of fluid per day. Liquids should be sipped between meals. Avoid fluids with meals, and wait 30 to 45 minutes after a meal to begin your fluid intake throughout the day.

If you are having trouble tolerating puréed food:

1. Try slowing the speed of your eating.
2. Decrease your portion size.

How to blend food:

1. Cut food into small pieces about the size of your thumbnail.
2. Strain out the lumps, seeds or pieces of food.
3. Use spices and seasonings (avoid spicy ones such as hot sauce and cayenne pepper) to add flavor.
4. Blend and enjoy.
   

Puréed baby food can be used instead of blended or pureed foods. Only meat (puréed beef, pork, chicken) baby foods contain protein.

Stage 3: Semisolid Consistency Food​

Four weeks after surgery, with the approval of your physician, the dietitian will review how to successfully introduce semisolid consistency foods without nausea and vomiting. At this point, you will advance to soft and easily tolerated foods.

Focus on protein first at meals, and avoid foods that are high in fat and sugar, and difficult to digest. You may still need to consume protein from skim milk or supplements as between meal snacks until you are able to tolerate enough semisolid foods to meet your protein needs. Remember to add one new food at a time and observe your reaction to it.

Food Examples

Cut back to three meals and two snacks per day. 

• Cooked eggs, any type except fried
• Casseroles, such as macaroni and cheese, or tuna with light mayo (limited)
• Chopped lean meat (except red meat)
• Low-fat cottage cheese
• Cooked vegetables (peeled)
• Beans and legumes
• Softened cold cereal (non-sugar coated)
• Hot cereals made with skim milk
• Canned fruits (in their own juices or water)
  
• Skim milk, unsweetened instant breakfast, sugar-free low-fat yogurt
• Canned chicken
• Soft fish
• Shredded or soft low-fat cheeses
• Light yogurts
  

Eating Guidelines​ ​​​

• Eat three meals and two snacks per day.
• Each meal should not exceed the volume of 6 ounces.
• Eat and drink slowly. Take at least 1/2 hour to eat a meal.
• Take small bites, and chew very well. Sip on liquids during meals only if needed, but  don't drink large amounts during meals. Limit to 1 ounce of fluid per meal.
• Continue to drink low-calorie liquids between meals – at least 8 cups per day.
• Continue to take a vitamin and mineral supplement everyday and introduce a calcium and vitamin B12 supplement.
  
• Avoid red meats.
• Avoid raw vegetables and raw fruits with skins at this stage in your diet progression.
• Avoid nuts and popcorn.
• Avoid all fibrous foods (may cause blockage).
• Avoid high-calorie beverages such as soft drinks, juices, milkshakes and protein drinks.
• Keep in mind that you are "re-educating" your stomach. When you eat too fast, too much, or don't chew enough, you will feel discomfort and vomit.

Sample Semisolid Menu

Breakfast: 1/2 cup oatmeal made with skim milk and 2 tablespoons dry milk powder

Snack: 1 cup skim milk

Lunch: 2 ounces of lean meat (such as turkey, low-fat ham), 1 slice of reduced-fat/fat-free cheese, 1/2 whole wheat tortilla; optional: nonfat skim milk powder can be mixed in skim milk to increase protein

Snack: 1/4 cup low-fat cottage cheese with canned (no sugar added) peaches

Supper: 1/3 cup tuna and 1/4 cup cooked vegetables

Snack:  1 cup skim milk with 2 tablespoons non-fat dry milk powder (if needed)​

Between meals: Drink at least 64 ounces (8 cups) of low-calorie liquids slowly during the day.

Stage 4: Low-Fat Solid Food​