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Stage 2: 7 weeks and beyond
This information provides a guide to eating and drinking well after having a Sleeve Gastrectomy or Gastric Bypass surgery. This document should not replace the advice of your Dietitian.
Originally authored by Austin Health and Darebin Weight Loss Surgery. Republished by Prospero Health with permission.
Moving onto Solid Foods
7 weeks after your surgery, you should be ready to progress onto a solid diet (foods that are not pureed or mashed) and a long-term, healthy eating plan. It is very important to eat solid foods because solid foods will:
Be more satisfying than liquids. You can feel satisfied with less food and reduce the calories you take in
Keep you on track towards your health goals
Help you enjoy a balanced diet with a wide variety of different foods
Allow you to enjoy the same foods everybody else is eating, only in much smaller amounts
Remember the surgery is a tool to help you lose weight, and can work well if you follow these tips:
Mindful eating
Small serves
Chew well
Slow down
Learn when to stop
Avoid drinks with food
Beware of high calorie foods that can pass through your sleeve easily
Focus on enjoyment of food
Mindful Eating
Mindful eating is the process of concentrating on your eating behaviour, your food and your environment during your meals. Paying close attention to the experience of eating is a crucial part of helping you to feel physically comfortable with eating a wide range of foods and gaining satisfaction from smaller portions. The focus should be on the quality and enjoyment of food, not quantity.
To improve mindfulness when eating:
Make a conscious decision to pay close attention to what you are doing
Avoid distractions while you are eating (e.g. do not eat whilst watching TV, using the computer)
Avoid stressful or anxiety-provoking environments when you are eating. Choose a pleasant, calm place to eat
When you eat mindfully, you consciously think about:
Serving smaller portions
Taking smaller mouthfuls
Tasting and enjoying your food
Chewing more thoroughly
Pausing between mouthfuls
Stopping when you feel satisfied or comfortable (not when you are full!)
Small Serves
In the first 2-3 months you may have very little appetite and feel full very quickly. You may only be able to eat ½ cup of food at a time. Eventually, you will be able to tolerate 1 –1.5 cups of food at a time. Using a bread-and-butter plate or cereal bowl may help you to serve smaller amounts.
Chew Well
This is important so you can eat comfortably.
Cut food into small pieces (the size of a 20 cent piece)
Try using smaller cutlery (e.g. entrée fork or teaspoon)
Try tender cuts of meat
Use cooking methods that keep the food moist so it does not dry out with chewing (e.g. casseroles, slow cooked meat dishes, minced meat dishes, well-cooked pasta/rice)
Slow Down
The message of satisfaction can take as long as 20 minutes to travel from your stomach to your brain. Slowing down will help you to recognise you are satisfied and stop eating before you are too full.
Try putting your knife and fork down on the table in between each mouthful of food
It should take between 15 and 20 minutes to get through your small meal
Learning When to Stop
Your stomach is now so small it can over-fill easily. Over-filling may lead to the food regurgitating (vomiting) and if you continue to over consume over a longer period of time, you may stretch the size of your stomach. It may help if you take a pause during your meal after 20 minutes to re-assess how you are feeling. If you are satisfied, that is the time to stop.
Avoid Drinking Liquids with Food
Avoid following each mouthful with a drink. If you drink while eating you could:
Over-fill your gastric sleeve pouch, which may cause pain and even vomiting.
Wash food through the sleeve and result in more calories being consumed than you want.
It is important to drink adequate fluids throughout the day, so focus on drinks between meals.
Have a drink 10-15 minutes before eating
Wait 20 minutes after eating before having a drink
Aim for 1.5 – 2.0L fluid/day and remember: water is your best choice!
Avoid High Calorie Liquids and Foods
While the surgery may reduce your appetite, it does not stop you from snacking on high calorie foods. Some high calorie foods are easy to eat and add unnecessary calories to your diet. If you have had a gastric bypass, some of these foods may cause dumping syndrome (see page 15).
These foods include:
High calorie drinks - E.g. milkshakes, smoothies, soft drinks, juices, alcohol.
High calorie sweets – E.g. ice cream, chocolate, lollies, soft desserts (chocolate mousse).
Hard crunchy foods – E.g. potato or corn chips, savoury snack biscuits/crackers, sweet biscuits
Very soft/puree savouries – E.g. high fat cheeses (limit to one slice per day), dips.
Keep your intake of these foods to a minimum
Good Nutrition after Your Surgery
To get the best nutrition, choose a variety of nutritious foods every day.
This is particularly important when you are eating much smaller quantities of food.
The food group plan on page 5 is a guide to how much you should aim to eat each day in order to meet your basic nutritional needs.
Focus on quality NOT quantity!
Sample Meal Plan
This is only a guide. The total amount of food you should be eating at each meal is ½ - 1 cup
Breakfast
Small bowl (1/2 cup) high fibre cereal or porridge (1 sachet) + low fat milk
Or 1 poached egg + ½ - 1 slice toast + margarine / butter + spread
Or 150ml high protein low sugar yoghurt + fresh fruit
Lunch
Lean meat / tuna or low fat cheese and salad in a mini wrap or 2 ryvita/vitawheat
Or small tin of baked beans on ½ - 1 slice toast
Or small bowl thick soup with chunks of meat / chicken / beans and vegetables and ½ - 1 slice toast
Or ½ - 1 cup of left-overs
Dinner
Lean meat (beef, lamb, pork, chicken) or fish – approx. ½ the size of your palm
+ 3 different types of vegetables or salad
+ ½ medium size potato OR 1 tbs of cooked pasta / rice / quinoa
Between-meal snacks
(if needed)
You may or may not need snacks between your meals.
If you feel hungry in-between meals, it is best to have a small snack which is high in protein. This will satisfy you and stop over-eating at the next meal or eating too quickly and over-filling.
Good choices are foods that are solid, high in protein and filling e.g.
30g unsalted nuts or 40g roasted chickpeas/fava beans
90g tin tuna/salmon (canned in spring water NOT oil)
150g high protein, low sugar yoghurt
35g low fat cheese
½ slice of toast or 1 wholegrain crispbread (with cheese as above)
Slice of lean meat / chicken breast (20-30g)
Hard-boiled egg
Small tin baked beans
Other snack ideas include:
½ piece fresh fruit / small serve canned (no added sugar) fruit
Vegetable sticks e.g. carrot / cucumber / celery + 20-30g (2 Tablespoon) low fat cottage cheese, hummus or yoghurt dip
½ cup fresh or frozen berries
There are many snack options on the market. We recommend you choose a product that provides: 100-150 calories per serve, 5-10g protein per serve.
A Balanced Eating Plan
Milk, Yoghurt, Cheese and alternatives
Aim for 2 serves each day
1 serve =
250mls low fat milk or soy milk
150-170g High protein, low sugar yoghurt
1 slice (35g) low fat cheese
½ cup low fat ricotta or cottage cheese
Lean Meat, Fish, Chicken, Eggs, & other Protein
Aim for 2 serves each day
1 serve =
80g lean red meat/chicken
80-100g fish or chicken cooked or small tin tuna / salmon
2 Large eggs
½ cup cooked beans/lentils/other legumes or a small tin baked beans
100g Tofu
Non-Starchy Vegetables
Aim for 3-4 serves each day
All vegetables except potato, sweet potato and corn (keep these to <½ cup)
1 serve =
1/3 cup (50g) green or orange vegetable
1 medium tomato
1 cup leafy raw salad vegetables
Fruit
Aim for 1-2 serves each day
1 serve =
1 medium size piece of fruit (e.g.: orange, apple, nectarine, pear)
2 small size pieces of fruit (e.g.: apricots, kiwi fruit)
½ cup of tinned or fresh chopped fruit
1 cup berries
Grain foods & Starchy Vegetables
No more than 3 serves each day (choose wholegrain)
1 serve =
1/3 cup (30g) high fibre cereal flakes / Porridge or oats
1 slice bread or ½ bread roll
1/3 cup well cooked pasta or rice
½ medium size potato
1/3 cup cooked sweet potato or sweet corn
3 whole grain crisp breads
Fats & Oils
Aim to include no more than:
1 Tablespoon (20ml) Olive or Canola oil
or 4 teaspoons margarine
Discuss with your dietitian if you:
follow a vegetarian or vegan diet, or
have food intolerances or food allergies
A Note on Protein
You need 60-80g of dietary protein each day to meet your needs.
Protein is important to assist with feeling satisfied, and to maintain muscle during weight loss. Following the balanced eating plan on page 5 will help you meet your protein needs.
The highest protein food groups are dairy and meat.
One serve of meat, chicken or fish provides 20g dietary protein.
One serve of dairy provides 10g dietary protein
Can’t Get Enough Protein in with Food?
You may need to supplement your diet with high protein drinks. If this is the case, your Dietitian will discuss appropriate high protein drink options with you.
Fluid: 1.5 - 2 litres per day
Water is the best choice. If you do not like the flavour of plain water, try adding a small amount of freshly squeezed lemon/lime juice. Try filtered water.
Other choices include:
Low calorie drinks such as plain mineral water, soda water, diet cordial, diet soft drinks,
Tea/coffee with low fat milk
Wherever possible do not add sugar to drinks or use artificial sweetener.
Limit alcohol as it provides a lot of calories and can slow down your weight loss.
Problems that can occur
Dumping Syndrome
Can be Common after Gastric Bypass (not as common after gastric sleeve). This syndrome is caused by sugar-rich foods and fluids reaching your intestine too quickly. It occurs because your stomach has been ‘bypassed’ by the surgery and no longer acts as a reservoir 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. These are sugars.
Avoid all alcohol
Do not eat and drink at the same time. Do not drink for 10 minutes before your meal and 20-30 minutes after your meal.
Hair Loss
Hair loss may start to 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. We do not recommend hair and nail supplements. If you are worried about hair loss, talk to your dietitian or surgeon.
Vomiting/Regurgitation
Usually occurs due to eating too quickly, over-filling the small stomach, or not chewing well enough.
Try to stop eating before you think you are full and notice the difference this makes
Put your knife and fork down between each mouthful to slow your meals down
Ongoing vomiting is not normal or expected. Contact you surgeon if vomiting is an ongoing problem (lasts for more than 8 hours).
Food Intolerance
There may be foods you find difficult or uncomfortable to eat. These are usually foods that are harder to chew (such as red meat), or foods that take on a lot of water and swell in the small stomach (such as fresh white bread and rice). With practice and following the eating behaviour guidelines carefully, over time you can learn to eat these foods.
The following guidelines may assist. Talk to your dietitian or surgeon if there are many foods you cannot tolerate, as you may not be getting all the nutrition your body needs.
Always use tender cuts of meat and keep the food moist by casseroling, roasting or stir-frying
Use a low-fat sauce or gravy to help keep the food moist whilst you are chewing
If bread is a problem, try toast, multigrain or rye breads or stale bread, as these are easier to eat
Pasta and rice needs to be well cooked
Fruit may need to be peeled and chopped up into a fruit salad
Constipation
How often you use your bowels is likely to change after the operation. You may only need to go to the toilet every 3–4 days, and if this is comfortable for you there is no problem. However, if you are having pain or straining to use your bowels, the following may help:
Eat foods containing fibre e.g. Wholegrain cereals such as Weeties™ /Weetbix™ / bran, multigrain breads, legumes, baked beans, fruit and vegetables
Make sure you are drinking enough water
Make sure you are getting some regular exercise
If constipation remains a problem, you may take a soluble fibre supplement (e.g.: Benefibre™) available from your local Chemist or supermarket. Speak to your doctor if you need more help.
Dizziness
As you lose weight your blood pressure will come down, sometimes this can make you feel dizzy.
If this happens:
Make sure you are drinking enough fluid (aim for about 2 litres per day)
Rise slowly from lying to standing. Go from lying to sitting and pause before standing up
If you are on blood pressure tablets, speak to your doctor who may review your dose
Tired or have No Energy
Make sure you are eating a varied diet and taking the vitamin / mineral tablets as recommended every day
Blood tests may be needed to check for nutritional deficiencies if this continues
Pregnancy Planning
Avoid getting pregnant for 12-18 months after surgery. Talk to your GP about reliable contraception.
If an unplanned pregnancy occurs tell the specialist managing your pregnancy that you have had weight loss surgery (and the type of surgery).
If you fall pregnant it is important to be taking the right vitamin and mineral supplements. Pregnant women have different and special needs. Contact the clinic for an appointment with your surgeon and dietitian for advice.
Physical Activity
Exercise helps maintain a healthier weight and helps tone and firm muscles.
Great activities include walking, swimming, team sports, gardening and cycling.
It is important to increase your exercise and activity to help with your weight loss success. Be active every day in everything you do. For example, take the stairs instead of the lift, walk to the shops instead of driving.
The National Heart Foundation recommends 10,000 steps per day to help keep weight stable.
The Australian Government recommendations for Adults recommends being active most days, preferably every day.
Each week, adults should do either:
2.5 - 5 hours of moderate intensity physical activity (brisk walk, golf, mowing the lawn, swimming)
1.25 - 2.5 hours of vigorous intensity physical activity (jogging, aerobics, fast cycling, soccer or netball), or an equivalent combination of moderate and vigorous activities.
Include muscle-strengthening activities as part of your daily physical activity on at least 2 days each week. This can be:
push-ups
pull-ups
squats or lunges
lifting weights
household tasks that involve lifting, carrying or digging.
Doing any physical activity is better than doing none. If you do no physical activity right now, start by doing some, then slowly build up to the recommended amount. If you experience any sharp pain, chest pressure, nausea, or extreme shortness of breath, stop immediately.
These are long term goals. We recommend discussing with an Exercise Physiologist and/or Physiotherapist who can tailor exercise to your individual needs.
If you have had any complications following your surgery, always follow your surgeon’s recommendation.
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.
Multivitamin Recommendations
It is essential that you take multivitamins 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. 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
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.
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.
Multivitamins recommended by your Dietitian:
Brand: _______________________ Amount:_______________
Brand: _______________________ Amount:_______________
Ongoing Support
For your best chance at long-term success it is important that you keep in regular contact with your healthcare team.
The minimum contact we suggest with the Dietitian after having gastric sleeve or gastric bypass surgery is at 3 months and 6-12 months after your surgery.
We highly recommend seeking dietetic services in the community when you have been discharged from your surgical clinic dietitian. Speak to your GP for a referral.