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Stage 1: The first 6 weeks
This booklet provides information on the recommended eating and drinking plan (including recommended nutritional supplements) for the first 6 weeks after having a Sleeve Gastrectomy or Gastric Bypass. We call this period Stage 1.
This information will also be explained to you by a Dietitian at the pre-operative group education session.
It is important that you follow the recommendations set out in this booklet and explained by your Dietitian to ensure you get enough of all the nutrients your body needs to recover from the surgery.
This document should not replace the advice of your relevant health care professional.
Originally authored by Austin Health and Darebin Weight Loss Surgery. Republished by Prospero Health with permission.
Stage 1 includes:
• Thin liquid diet for 2 weeks (days 1 – 14)
• Smooth puree diet for 2 weeks (days 15-28)
• Soft moist diet for 2 weeks (days 29-42)
If there are any difficulties with tolerance during this phase, please contact the Bariatric Liaison Nurses (03 9496 3750).
IMPORTANT:
This is a guide only. It is okay if you need to adjust, however if you are experiencing ongoing vomiting, regurgitation or not being able to keep anything down, especially during the Liquid/Puree phase, contact your surgeon/Bariatric liaison nurse, or go to your local emergency department.
Please eat slowly, chew your food well, and be mindful of your portion size. We encourage you to not rush through the different phases, as you may experience episodes of vomiting, regurgitation or discomfort that your new stomach cannot manage.
Thin Liquid Diet: Weeks 1 & 2
A ‘thin liquid’ diet means you are restricted to fluids only (NO solid foods) for at least two weeks. This allows the site of surgery to heal and reduces the risk of causing any damage to your new, smaller stomach. It is very important to stay on a liquid diet for 2 weeks, even if you start to feel hungry.
Fluids must be smooth and no thicker than the consistency of water or milk. It needs to be thin enough to run through a fork. There should be NO lumps.
The purpose of restricting you to thin liquids is to:
Avoid discomfort on swallowing,
Avoid stretching your stomach pouch (or ‘sleeve’),
Avoid food getting stuck and putting stress on your stitches/staples.
While you are in Hospital
Once your surgeon says so, you can start the thin liquid diet. In hospital you will be given a variety of fluids including juices, soup, low fat milk, tea / coffee and nutritional supplement drinks.
You are not expected to consume everything provided on your tray all at once.
You need to sip these slowly and regularly, aiming for 30-50ml every 20 –30 minutes.
Start taking your multivitamins if you can. Refer to page 13 for further information.
After Leaving Hospital and Until Day 14
You will stay on a liquid diet for 14 days after your surgery (end of week 2).
Initially, you may feel quite full and only able to sip small amounts at a time. By day 4 after the surgery, you should be able to drink 60ml – 125mls (¼ - ½ cup) liquid every 20 to 30 minutes. By the end of week 2, aim to drink 125-250ml (½ - 1 cup) of liquid in 30 minutes.
Hint: You will need to drink small amounts regularly (at least every hour) throughout the day to keep well hydrated. It may be helpful to start with drinking a teaspoon at a time from your cup of drink, pausing in between. Listen to your body’s cues to know when you have had enough.
Hint: If you feel hungry, distract yourself with activities that make it impossible to eat at the same time. E.g. have a shower, paint your nails, do craft, garden, brush or wash your pet, finger paint with kids.
Prioritise fluids:
High in protein (aim 25 to 30g protein per serving)
Less than 15g of sugar per 250ml
Summary of your Daily Thin Liquid Targets Until Day 14
Type of Liquids and Amount
High protein drink 750ml 3 cups
Fat free or low-fat milk (or soy/oat/almond) or drinking yoghurt 250ml 1 cup
Fruit or vegetable juice (no added sugar) 125-250ml ½ - 1 cup
(Note – no fruit juice if you have had a bypass)
Strained meat & vegetable soup (i.e. broth or consume) 250-375ml 1 – 11/2 cups
Low calorie drinks (tea*, coffee*, water, diet cordial, sugar free
sports drink, diet jelly) 250-500ml 1-2cups
TOTAL FLUID EACH DAY: 1400-2000ml 6-9 cups
TOTAL PROTEIN EACH DAY: 60-90g
* Caffeine may cause irritation to your healing stomach pouch, so limit these or use decaffeinated beverages (i.e. herbal, decaffeinated versions) for the first 6-8 weeks.
Avoid
Alcohol – may cause irritation to the stomach, provides a lot of calories, but does not provide valuable protein or nutrition.
Carbonated drinks – can cause discomfort, burping and stretch the pouch.
A Note on Protein
Having enough protein in your diet after surgery is important for your recovery and wellbeing.
Protein is important to:
Help you to recover and heal after surgery
Help you feel satisfied (control your hunger)
Prevent loss of muscle during weight loss
During Stage 1 (Weeks 1 – 6) after your surgery, you will need to use high protein drinks or nutritional supplements to provide 60-80g protein per day.
Hint: There are many high protein supplements available. Choose a product that provides approximately:
20-30g protein per 250-375ml serve, and
200-250 Calories (850-1000kJ) per 250-375ml serve
Talk to your Dietitian if you cannot find a supplement that suits you.
You can also add scoops of protein powders to your drinks, home-made soups and smoothies
Hint:
Set reminder alarms, keep a water bottle with you to make it easy, keep a log for a few weeks while building up the habit and celebrate every day when you hit your target.
Some people find plain water challenging. If this happens, try water at different temperatures, use filtered water, or add natural flavours like mint, or try herbal teas. Keep trying. Sometimes it will get easier or be hard one day and easier the next. Remember this is a new skill for life.
At the end of the 2 week thin fluid diet, if you are tolerating well (with no issues of vomiting and pain), you can carefully upgrade to the next phase.
PRIORITIES for the first 2 weeks:
Keep hydrated – drink 1.5-2L every day
Take small sips, throughout the day
Aim minimum 60g of protein from high protein supplements
Take your Multivitamins when you are able to – come back to it if feeling nauseated
Smooth Puree Diet: Weeks 3 & 4
It is now important to gradually introduce pureed foods into your diet to help satisfy your appetite and provide more nutrients. All your foods must be in a smooth puree consistency (i.e. blended with no lumps). Keep food textures runny and moist/soggy. Blend your meals using a food processor/stick blender or use foods already in a pureed form.
You might start with one or two new foods each day and increase this as you feel comfortable. Try to include a variety of foods from all of the food groups every day.
During this stage, aim for 40g of protein from High Protein Fluids.
Hint:
You need 4 – 6 small meals per day (Aim 3 small main meals and 1-2 healthy snacks a day)
Include protein at each meal
Take 30min to eat ½ cup of pureed food. Stop when you are satisfied or if 30min has passed
Use skim milk, stock, soups, low-calorie sauces/dressings to make a smooth, runny consistency
Try adding protein powder to boost your protein intake
Sample Food Ideas – Smooth Puree Diet:
Each meal should be ½ cup of food at one time.
Very moist scrambled egg (1 egg + 2 Tbsp. low fat milk)
Pureed soups (commercial or homemade) with meat/chicken and vegetables with legumes or pasta and puree in a blender (e.g. pureed ‘Chunky style’)
Low fat ricotta or smooth cottage cheese
Pureed meal of lean meat / skinless chicken + vegetables (e.g. Casserole, slow cooked)
Pureed or blended Tuna or salmon mornay made with low fat white or cheese sauce
Pureed baked beans in sauce
Hommus
Silken tofu blended in soup
Very well-cooked (steamed, boiled, microwaved) vegetables and pureed with stock/ sauce
High protein yoghurt or low fat yoghurt (no fruit pieces)
Fruche™ (fruit flavoured must be pureed), custard, or other dairy desserts (no fruit lumps)
Pureed tinned/fruit snacks (apple / apple + pear, apple + strawberry), Stewed apple/pear, pureed/mashed banana, paw paw, mango
Pureed soggy Weetbix™ or pureed porridge or semolina made smooth with low fat milk
Hint: Puree meats which have been cooked in a casserole or a ‘slow-cooker’. Meat cooked over many hours at low heat are more tender and easier to puree. Dishes can be prepared and frozen in small containers or ice block trays to be used for later meals.
Sample Menu – Smooth Puree Diet
When you get up ½ cup High protein drink
Breakfast:
½ - WeetbixTM or ½ sachet porridge with 150ml low fat milk
or ½ cup pureed fruit + 2 tbsp. low fat yoghurt
or 1 egg scrambled with 2 tbsp. low fat milk
Mid-morning:
125ml High protein drink
or ½ cup puree fruit or diet jelly + 2 Tbsp. yoghurt or custard
or ¼ cup pureed baked beans
Lunch:
125ml of pureed smooth soup
+ 125ml of low-fat milk /drinking yoghurt/soy drink
Afternoon:
½ cup High protein drink
or High Protein yoghurt pouch
Dinner:
½ cup pureed meal of meat & vegetables (see page 8)
+ 125ml of low-fat milk /drinking yoghurt/soy drink
Supper:
½ cup of hot drink / puree fruit
or diet jelly + 2 Tbsp yoghurt or custard
And additional fluids throughout the day
A Note on Fluids:
Remember to separate food and fluids
Stop fluids 10min before you eat and wait 20-30min after meals to drink again
Prioritise high protein fluids and aim to have 1.5-2L of low calorie drinks
Limit fruit juice, sweet cordial, soft drink, energy drinks, flavoured milk/milkshakes, sports drink
Avoid alcohol
PRIORITIES for weeks 3-4:
Prioritise protein foods
Separate your meals and fluids
Aim minimum 40g of protein from high protein supplements
Take your Multivitamins
Soft, Moist Diet: Weeks 5 & 6
At this stage it is important to slowly introduce soft and moist, solid foods. Start with one or two new foods each day and increase this as you feel comfortable.
You still need 4 – 6 small meals per day but the food no longer needs to be pureed.
Soft solid foods should be soft enough to easily mash or break up with a fork.
Keep foods moist by including low calorie sauces (e.g. tomato-based sauces) or gravies.
Portion size should be no more than ½-1 cup of food in total (e.g. ½ cup low carbohydrate vegetables
+ 50-100g protein + 1 tbsp rice/pasta/potato). Serve on small plate (e.g. bread and butter or child’s plate) and use small utensils.
Allow 20-30min to eat your meals by chewing well. Put down your utensils in between mouthfuls.
Continue 30g of protein from High Protein fluids.
Sample Food Ideas – Soft, Moist Diet:
Each meal should be about 125ml (½ cup) of food at one time.
Main
Eggs - scrambled, poached, soft-boiled, omelette, frittata
Tinned salmon or tuna moistened with low fat mayonnaise or low fat cheese sauce
Lightly grilled or poached boneless fish fillet
Minced meats (e.g. chicken, pork, lamb, beef, fish) or tender meats which have been
casseroled or cooked in a ‘slow-cooker’
Cooked baked beans, chickpeas, kidney beans, tofu
Sides
Serve main meals with soft cooked vegetables (able to be mashed with a fork), vegetable soup, zucchini noodles, cauliflower rice
1 tbsp of well cooked soft noodles, rice, pasta, cous cous with a sauce (e.g. tomato-based) or mashed potatoes or sweet potatoes
Snacks
Soft fresh fruit with skin removed (such as bananas, flesh of peaches, mangoes, ripe pears, nectarines, peeled sliced apple)
Tinned fruit (in natural juice, no hard skins) (except pineapple)
Instant porridge, WeetbixTM , Vitabrits or cereals (without dried fruits, coconuts, nuts) made soft with low fat milk
High protein yoghurt), Low fat yoghurt
Fruche™, custard, dairy desserts
High protein low fat milk or fruit smoothie
Foods and Drinks to AVOID until day 42 after surgery (end of week 6):
Bread and baked goods (e.g. muffins, pastries, cakes)
Hard, solid meats (e.g. steak, chicken breast)
Carbonated beverages (fizzy drinks)
Raw vegetables (e.g. carrots, celery)
Fruits/vegetables with hard skins or stringy texture (e.g. peas, corn, pineapple, oranges, celery, green beans)
Dried fruit, coconut, nuts, muesli
Hard, crunchy crackers or crisp breads with sharp edges
High calorie drinks (full sugar cordial, sweetened flavoured milk, fruit smoothies or juices)
Alcohol
Sample Menu – Soft Moist Diet Days 29 – 42 (Weeks 5-6)
When you get up: 125ml High protein drink
Breakfast:
WeetbixTM or ½ sachet porridge made with low fat milk
or 1 egg scrambled/poached or soft boiled
or 150 ml low fat milk blended with fruit + 2 tbsp. yogurt
Mid-morning:
125ml High protein drink
or High Protein yoghurt pouch
or 1 cup fruit salad
Lunch:
125ml of soup (e.g. meat, vegetable, legumes + 1 tb pasta)
PLUS 1/2 hr after meal
125ml of low fat milk /drinking yoghurt/soy drink
Afternoon:
125ml low fat yoghurt or other dairy desert
or Soft fruit (e.g. ½ banana)
Dinner:
125ml (½ cup) casseroled meat and soft, cooked vegetables
or 50-80g poached/grilled fish with soft, cooked vegetables
OR tomato-based Bolognese sauce
served on a cup of zucchini noodles or 1 tablespoon of pasta
Supper:
125ml High protein drink
PRIORITIES for the 5-6 weeks:
Take 20-30min to finish your meals, stop when satisfied
Aim minimum 30g of protein from high protein supplements
Take your daily Multivitamins
Hint: It can be hard to listen to your body, but it is a skill that can be learned with practice. Learning the skill of mindful eating can help you hear the fullness signals your body is giving you.
Important General Advice
Small serves: ½ to 1 cup of food at a time
Use small cutlery and plates
Cut food up smaller / take small mouthfuls
Chew well
Slow down: take 15-20 minutes to eat your small meal
Learn when to stop eating: stop when you are satisfied (before you feel full)
Put down your cutlery when chewing
Wait to put food on your utensil until you have finished chewing
Avoid drinks with food:
Drink 10 mins before eating
Wait 20-30 mins after eating before having a drink
Carry a small water bottle
Carry protein powders, suitable snacks in case of emergency
Avoid high calorie liquid, smooth or crunchy foods (also known as “slider foods”). These foods are easy to eat, can often still be eaten in large amounts and undo your weight loss.
Examples:High calorie drinks - e.g. milkshakes, flavoured milks, soft drinks, juices, alcohol
High calorie sweets – e.g. ice cream, chocolate, lollies, soft desserts (chocolate mousse)
Hard crunchy foods – e.g. potato/corn chips, savoury snack biscuits/crackers, sweet biscuits
Very soft/puree savouries – e.g. high fat cheeses (limit to one slice per day), dips
Dumping Syndrome – Common after Gastric Bypass (not as common in Gastric Sleeve)
This syndrome is caused by foods and fluids that are very sugary reaching your intestine too quickly. It occurs because your stomach has been ‘bypassed’ by the surgery and no longer acts as a storage pouch for food and liquids. It is not dangerous but can be very unpleasant with symptoms of nausea, cramping, dizziness, sweating, and diarrhoea.
To prevent ‘dumping syndrome’ try the following:
Avoid all juices, high sugar drinks (e.g. non diet soft drinks, cordial, flavoured mineral water, flavoured water and iced tea) and high sugar foods (e.g. pavlova, ice-cream, non diet jelly, lollies)
Avoid all foods which contain high levels of the following ingredients as listed on the labels; sucrose, fructose, dextrose, honey and corn syrup
Avoid all alcohol
Do not eat and drink at the same time (do not drink for 10 mins before your meal and 20-30 mins after your meal)
Common Problems that May Occur
Vomiting, regurgitation or discomfort should not occur during the liquid/puree phase – contact your Surgeon or Clinical Nurse Specialist immediately if this is happening.
Avoid carbonated/fizzy drinks as the excess gas can cause discomfort.
If your urine is very yellow and low in volume or you are feeling thirsty or have a head ache, you are not drinking enough and need to drink more water or low calorie drinks.
If constipation is a problem, add a 50 ml dose of prune or pear juice to your diet. If this does not help you can use a natural fibre supplement such as Benefibre™ which you can buy at the Chemist (use according to the directions on the tin). PHGG is another excellent fibre choice.
Hair loss may occur 90-100 days after surgery. This is a normal reaction to the stress of surgery and rapid weight loss. Provided you follow our dietary and vitamin and mineral supplementation, this loss should stop within 100 days and hair will start to re-grow. If you are worried about hair loss, talk to your dietitian or practice nurse.
Nausea may occur early on after having gastric sleeve surgery. You will need to continue to sip small amounts of fluid slowly over the day. If the nausea is very bad your doctor can prescribe medication to assist. Please contact the Bariatric Liaison Nurses if nausea is stopping you from eating or drinking.
Trouble Shooting:
If you experience discomfort, nausea or vomiting, try:
Slowing down
Smaller mouthfuls
Smaller portion size
If symptoms persist, go back to thin liquid diet and contact the bariatric liaison nurse as you may need to discuss with your surgeon
If you experience constipation:
Make sure you are meeting your fluid goals
Include fibre in your diet by including pureed fruit and vegetables
Try a fibre supplement (examples: Benefibre, Tasteless fibre, PHGG)
Try 50ml pear or prune juice in the morning and night time
Multivitamin Recommendations
It is essential that you take multivitamin every day.
You need to continue this for life to address changes in digestion and absorption.
Bariatric specific formulated multivitamins are highly recommended, as they are designed to meet higher and specific requirements needed post bariatric surgery. It is cost effective and designed with practicality in mind. There are chewable and capsule types to suit your preference and tolerance. Some brands have trial packs and may be beneficial to try before your surgery. Your dietitian can provide you with information on these products and advise which may be best for you.
Tips: We do not recommend the gummies type of multivitamins.
Taking daily multivitamins is not a substitute to a healthy diet.
We do not recommend Hair and Nail supplements.
NOTE:
Drug interactions - some supplements may interfere with medications and may need additional monitoring. Please consult your doctor.
You may need to take additional vitamins or minerals for your individual needs such as micronutrient deficiencies.
To avoid overdosing, we recommend a bariatric specific multivitamin. General multivitamins and dietary supplements may contain large doses of nutrients that can be harmful.
For example, excessive Vitamin B6 (also known as Pyridoxine Hydrochloride) have been found in:
Magnesium, Zinc or Iron supplements
Mega B complex
Hair, Skin and Nail supplements
Melatonin and other ‘anti-stress’ formula
Vitamin infused powders and drinks (e.g. Energy drinks, protein powders)
Although vitamin B6 is an important nutrient, only small amounts are required (e.g. 1-2mg/ per day). If the total amount of additive vitamin B6 is more than 8-10mg, you may be at risk of nerve damage (Peripheral or sensory neuropathy).
Symptoms can include tingling, numbness or burning feeling or loss of sensation in your hands, fingers, toes, arms or legs. If you are experiencing any symptoms that do not resolve after stopping excessive B6 intake, please contact your doctor for further advice.
Ramadan and Fasting After Bariatric Surgery
We advise not to fast in the first 12 – 18 months after bariatric surgery to prevent malnutrition and medical complications. We recommend an exemption from fasting for medical reasons. Patients who are stable and well beyond the first 18 months may observe the Ramadan fast. However, it is highly recommended to continue fluids, multivitamins and supplements throughout the day.
This education material was originally developed by the Dietetics Department at Austin Health. It has been adapted with permission by Austin Health. It has been produced with the support of Impact Obesity Ltd, a registered health promotion charity.