Diet After Bariatric Surgery

Bariatric/ Weight loss surgery is a lifesaving procedure. You will not only lose weight but you will also reduce your co-morbidities. You will feel better and look better. Bariatric procedures include restrictive, malabsorptive and combination surgeries of both. The standard procedures recognized are laparoscopic adjustable gastric banding (LAGB), Mini Gastric bypass (MGB) Laparoscopic sleeve gastrectomy (LSG), Laparoscopic Roux-En-Y gastric bypass (LRYGB) and Biliopancreatic diversion (BPD).  Diet plays a vital role after surgery; chances of short-term and long-term nutritional deficiencies are there due to restriction and malabsorption. The surgery also limits the types and amounts of foods and beverages you eat and drink. The quality of your diet is very very important. You need to choose the right amount and kinds of nutritious foods to stay healthy and energetic. After surgery the important step is to learn MINDFUL EATING CYCLE (When to eat? What to eat? How much to eat? When to stop eating?) The basic concept you should be aware of are:

• Have small and frequent meals.
• Eat balanced meals with small portions size.
• Follow a diet low in calories, fats and sweets and high in protein.
• Stop eating once you got signal of fullness from your body, no overeating listens to your body needs.
• Chew your food properly. Avoid gulping food.
• Avoid taking liquids with meals.
• Do not use straws, avoid drinking carbonated beverages or chew ice. They can introduce air into your pouch and cause discomfort.
• Avoid sugar, sugar-containing foods and beverages, concentrated sweets and fruit juices.
• Your diet should be healthy and balanced.

Diet plays a very important role after bariatric surgery. To take maximum benefit from your bariatric surgery it’s really important to make good food choices and eat a balanced and nutritious diet, as this will help you to shed that extra weight and also helps you to sustain it throughout your life. If you are thinking about weight loss or bariatric surgery or have already undergone it then you should know that diet plays a key role in its long-term success.

The Bariatric diet is a diet that will help your new transformed stomach to heal faster, and will make you more comfortable. Diet progression starts immediately after surgery until 3months later. Protein needs should be meet in adequate amount to allow the stomach to heal from surgery and to prevent lean tissue loss. Some patients may require more support and guidance with the progression of their diet, and follow-up with your doctor and nutritional team is very important for healthy weight loss. Eating enough protein whether you are vegetarian/Nonvegetarian or vegan after weight loss surgery is the key to stay healthy and maintaining weight loss results.

PROTEINS: Diet rich in protein help to prevent muscle loss after surgery. Preserve muscle tissue by eating foods rich in protein. Take 60-70 gms protein per day. Your every meal should have good amount of proteins in the form of egg white (avoid egg yolk), chicken, fish, milk, curd, buttermilk, almond, walnut, nuts butter, soya and its products, roasted chickpeas, broccoli, avocado, whey protein, whole pulses should be a part of your regular diet.

CARBOHYDRATES:  Carbohydrates are important source of energy and can be a part of healthy eating if chosen properly. Replace simple carbohydrates with complex carbohydrates in the form of whole grains, cereals (oats, ragi, dalia, quinoa, whole wheat), pulses, beans, legumes, whole wheat bread, brown rice, whole wheat pasta in your diet. Avoid sugar, juices, white bread, white rice, candies from your day-to-day diet.

FATS: Fat is required by body for building cell membranes and making hormones. One should choose healthy fat and in small amount. Cook with liquid oils that are high in monounsaturated fats like nuts, seeds, olive oil, canola oil, rice bran oil, coconut oil, peanut oil. Stay away from solid fats and fatty meats such as butter, sour cream, cream cheese, full-fat cheeses, full-fat sour cream and yogurt, sausage, cakes and bakery products. These are high in saturated fats and are not good for your heart.

FIBER: Fiber in diet aid in maintaining weight loss and also helps maintain weight loss. Add more of salads, sprouts, fruits (avoid high GI fruits), green leafy vegetables in your diet. This also helps to prevent constipation.

VITAMINS AND MINERALS: Most of the obese population are deficient in various vitamins and minerals because of increased adiposity and faulty food choices and if they are not corrected on time it may elevate after mini gastric bypass surgery. For this add more of fruits, vegetables, grains, milk & milk products, cereals, beans and pulses in your diet.

How do we proceed for diet after surgery?

Patients typically starts with low sugar, clear liquid diet within 24hrs of surgery. The following tables will give an idea how your diet will progress after bariatric surgery.

Diet	Duration	Goal
Clear liquid diet	Short term-1-2 days	Adequate hydration and protein intake, low sugar
Full liquid diet	7-8 days	Adequate hydration and protein intake, low sugar
Soft foods /Pureed foods	8-10 days	Adequate hydration and protein    intake, low sugar, addition of soft fruits and vegetables, low fiber foods
Modified regular diet	On going	Adequate hydration and protein    intake, low sugar, addition of soft fruits and vegetables, low fiber foods

The basic goal of the diet is to limit the amount of calories you consume, while providing balanced meals that help prevent nutrient deficiencies and preserve muscle tissue.

Recommended liquids: Clear water /Coconut water /Apple juice

As healing progresses, the patient will be able to tolerate thicker consistencies of food. A liquid diet will also allow the stomach to heal properly without adding tension to the staple line or stitches.

Thicker liquids /normal liquids:-Protein shakes/ low fat milk/ buttermilk/ curd /Dal

Note:

• Liquids should be thin, flowy and without any lumps
• Low in sugars 
• No aerated drinks

Diet for Weeks Two to Four Post-Surgery -Two weeks following surgery, you can start with properly blended or purred foods. Making use of high-protein low-calorie liquid supplement drinks or powders will help to meet your protein requirements during this period. Take very small bites and chew everything very well. Do not take more than two bites every 20 minutes when adding a new food.

Transition back to solid foods can begin after one month of the surgery or even before that. When we go back to our normal diet we need keep certain point in our minds that will help us to lose weight and keep us comfortable.

There are list of foods that should be avoided or delayed or reintroduced in a diet:-

Food type	Recommendations
Sugar,sugar-containing foods ,concentrated sweets	Avoid
Carbonated beverages	Avoid/delay
Fruit juice	Avoid
High saturated fat, fried foods	Avoid
Refined /Maida based preparations	Avoid/delay
Nuts , popcorns,other fibrous foods	Delay
Caffeine/ Alcohol	Avoid/delay

Some common nutritional complications after bariatric surgery

Dehydration-Fluid intake is must in between the meals .IV hydration is recommended if severe with adequate thiamine (B-1)

Nausea /vomiting-Recommended to be on liquid diet for 1-2 days .Decrease portion size, sit upright while eating /drinking/sip and eat slowly ,avoid highly acidic foods

Dysphasia-If you have problem in swallowing you can check on the techniques of cooking food. Avoid dry, rubbery or sticky foods in the diet.

Diarrhea-Avoid diet rich in fats and high sugary foods .Keep yourself hydrated. Include good pre and probiotics in your diet for healthy gut.

Flatulence-A very high protein and intake of whole grains and pulses/carbonated beverages &use of straw can cause flatulence.

Constipation:-keep your diet rich in soluble fiber /hydration is the key .Also check on your protein intake

Dumping syndrome –limit the amount of sugary items. Foods with high sugar content is quickly released or “dumped” into the small bowel. Early dumping syndrome included rapid heartbeat, sweating, dizziness, nausea, stomach cramps and diarrhea. Late dumping occurs 1-3 hrs afterward .Some patients with SG will have dumping syndrome.

Food intolerance/lactose intolerance:-these are temporary and with the span of time will disappear .Elimination of that particular food item and reintroduction of the food can help.

Hair loss-It is very important that we take our regular multivitamin and protein supplementation

NOTE- All these nutritional complications are temporary. Making modifications in your bariatric diet will help in coping up with them.

When can I start the normal diet after Bariatric surgery?

You can usually start eating regular foods about 1 month after surgery.Small, frequent meals and control on the portion size is the key to progress. Chew your food well in order to avoid discomfort. At each stage of the bariatric diet, you must be careful to: Drink 1.5 -2 liters of liquids in a day, to avoid dehydration. Sip liquids between meals, not with meals.

Will I be able to consume normal salt and sugar after metabolic surgeries?

In a gastric bypass diet you are recommend a low-sodium diet consisting of several small healthy meals throughout the day. Initially, it is important to control on your salt intake gradually with time and as the diet progresses you can have normal salt intake. High sodium intake has always been associated with risk of high blood pressure.

Sugar is not healthy for anyone, but it’s particularly dangerous because foods rich in sugar, or high-fructose corn syrup, can cause dumping syndrome. We would recommend you have natural sweeteners which are low in calories eg: stevia

Till when will I have to follow the diet chart after weight loss surgery?

In Order to get the most benefit out of your bariatric surgery it is important to make healthy choices so that you can loose weight and maintain it for long run. Initially the bariatric diet is for a month and then you are on your own. Diet rich in proteins/ regular and lifelong intake of multivitamins specially in gastric bypass and sleeve too /keeping yourself hydrated /eliminating from fried and sugary items and exercising is the key tips you needs to consider.

“ANY BARIATRIC SURGERY DEMANDS A COMPLTE LIFESTYLE CHANGE WHICH INCLUDES REGULAR  FOLLOW UP WITH THE DOCTOR/ DIET/ SUPPLEMENTATION/ EXERCISE/ MENTAL HEALTH AND HYDRATION”, WHICH DETERMINES THE LONG TERM SUCCESS OF THE PROCEDURE.