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Laparoscopic Vertical Sleeve Gastrectomy (VSG)
Post-Surgery Nutrition Guidelines
Laparoscopic Sleeve Gastrectomy reduces the size of the stomach by 80% of its original size. The procedure is both restrictive and malabsorptive, meaning it will limit the amount of food that you can eat as well as causing fewer nutrients and calories to be absorbed. Life-long vitamin/mineral supplementation as well as protein supplementation is necessary due to decreased intake of food as well as limited absorption of nutrients. As with any weight loss procedure, lifestyle changes are what determine long-term success. It is important that you learn how to incorporate healthy eating habits and physical activity into your daily life. Refer to your nutrition packet from the nutrition class for more details regarding the diet. Call the dietitian (713-493-7700) if you have questions about diet, supplements and vitamins. POST-SURGERY DAYS
STAGE GUIDELINES
DAYS 1 & 2 CLEAR LIQUID DIET 48 - 64 oz fluids daily DAYS 3 - 14 FULL LIQUID DIET 48 - 64 oz fluids daily +40 - 60 grams protein daily Gradually start appropriate Bariatric vitamins DAYS 15 - 30 Week 3 - 4 PUREED DIET 48 - 64 oz fluids daily +40 - 60 grams protein daily Week 5 - 6 SOFT CHOPPED DIET 48 - 64 oz low sugar fluids daily +40 - 60 grams protein daily Week 7 - 8 MAINTENANCE PHASE CHOPPED SOLIDS 48 – 64 oz low sugar fluids daily +60 – 80 grams protein daily Take bariatric vitamins every day
DAY 1 and 2: CLEAR LIQUIDS STAGE GOAL: +48-64 oz. fluids daily Sugar Free Clear Liquids Consume 1 ounce (2 Tablespoons/30 cc) clear liquid every 15 minutes in order to maintain hydration (medicine/cough syrup cups measure 1 oz. and are very helpful) Acceptable Fluids: o (^) Water/Propel Fitness Water/G2/ Powerade Zero o (^) Clear broth o (^) Decaffeinated coffee/tea, herbal tea (chamomile, mint, ginger, etc) o (^) Crystal Light/diet Snapple/Fruit-2-O/Mio o (^) Sugar free jello, sugar free popsicles Reminders: Timers are helpful to accurately track 15 min liquid consumption, and avoid dehydration. Avoid caffeine and alcohol as these act as a diuretic and may cause stomach irritation and No straws. This will cause you to drink too much volume as well as draw in air. Please remember to take small sips - no gulps. Avoid chewing gum (may swallow too much air and cause chest pain). No carbonated beverages Dehydration: Dehydration will occur if you do not drink enough fluids. Symptoms include fatigue, dark- colored urine, dizziness, fainting, lethargy, nausea, and low back pain (a constant dull ache across the back). If you become severely dehydrated, you will be admitted to the hospital so that fluids can be given through your veins. If your urine is dark and your mouth is dry, then you are not drinking enough. Carry water/low sugar/low calorie beverage with you EVERYWHERE! DAY 3 - 14: FULL LIQUID STAGE
DAY 15, WEEK 3 - 4: PUREED FOODS STAGE
GOAL: + 48-64 fluid ounces, +40 – 60 grams of protein, continue vitamins Foods in this stage are the consistency of applesauce. Mash foods very well, or place food in a blender or food processor until it is the texture of applesauce/baby food. Take 30 minutes to eat meals, stop eating after 30minutes Do not drink with meals: Wait 15 minutes after drinking, then eat. Wait 30 minutes after eating, then drink. Drinking while eating may cause an early fullness, nausea and/or vomiting Mashed/Pureed High Protein Foods:
- Fish (mashed very well)
- Cooked ground beef/turkey or chicken, pureed/blended in food processor
- Low fat Greek yogurt, fruits pieces ok (sugar <10 grams per serving)
- Soft scrambled eggs
- Mashed silken tofu
- Low-fat or Fat-free plain cottage cheese (add mashed canned fruits or sugar free jam) Other mashed/pureed foods:
- Applesauce, mashed fruits (canned fruits in 100% fruit juice, bananas, pears)
- Mashed potatoes, mashed veggies (carrots, peas, broccoli, cauliflower)
- Plain instant oatmeal, grits, malt-o-meal, cream of wheat/rice
- Mashed beans, hummus
- Mashed avocado Sample Menu for Stage 3: 8:00 am 6 oz yogurt 9:00 am 4 oz protein supplement 10:00 am 8 oz water/low calorie beverage Noon 1 oz mashed fish and ¼ cup pureed vegetable 1:00 pm 4 oz protein supplement 2:00 pm 1 oz low fat cottage cheese and ¼ cup applesauce (unsweetened) 3:00 pm-8:00 pm Vary foods and fluids as outlined above
Week 5 – 6: SOFT CHOPPED SOLIDS PHASE GOAL: +48-64 fluid ounces, +40 - 60 grams of protein, continue vitamins Choose soft and easy to chew foods, chopped into small pieces
- Tender meats, deli sliced meats
- Hardboiled eggs
- Low fat cheese (light string cheese, light Babybel)
- Well cooked vegetables
- Peeled fruits
- Soft nuts
- High fiber crackers
- Avoid bread, rice, pasta and tortillas. Foods should be chewed to applesauce consistency. Continue to avoid drinking and eating together. Avoid high fat/high sugar: foods and liquids liquid No grazing (over-snacking) Eat protein first at all meals. SAMPLE MENU FOR SOFT DIET Breakfast (^) 1 hardboiled egg 1-2 slices deli turkey Snack (optional ) ½ cup low fat greek yogurt ¼ cup chopped strawberries sprinkle stevia if needed for sweetness Lunch ¼ cup tuna with 1 tsp low fat mayo 1-2 high fiber crackers Snack (optional ) Light string cheese Grapes, sliced in half -OR- protein shake Dinner 2 ounces baked chicken (no skin) Snack ¼ cup cottage cheese ¼ cup fork tender carrots ¼ cup chopped fresh ripe peaches
Post Surgery Frequently Asked Questions, Tips, and Guidelines: Medications after Surgery · Pain medication (usually Tylenol w/Codeine elixir) to use as needed (prescription given at discharge) · You are to resume all pre-operative medication unless instructed differently by your surgeon upon discharge. Any medication you were taking that is larger than an M&M must be crushed, cut, or changed to liquid form during the first 8 weeks after surgery. Before altering (crushing) medications you must check with your physician first. Recovery Instructions When you get home, plan on taking things easy for a while.Your body is still recovering from the stresses of major surgery and weight loss occurring during the recovery period. Your activity will be restricted to no strenuous activity for 3 to 6 weeks after the operation. You may walk and perform light household duties as tolerated upon your return home. You may climb stairs. It is important to remember that you are still at risk for the development of blood clots after you are discharged from the hospital. You should not go home and sit for prolonged periods of time. Walk around for 5 minutes at a time every hour that you are awake. Changes in Digestion After the Sleeve Gastrectomy, you may experience changes in your bowel movements and gas. Diet intake has a major impact on these intestinal side effects. Reducing fat intake will usually have a beneficial effect on issues relating to diarrhea or loose stools. Sugar alcohols such as sorbitol, xylitol and maltitol (to name a few) can also contribute to intestinal discomfort and it is
usually wise to avoid them. Diarrhea, gas and bloating may also be the result of lactose intolerance, therefore, it is best to avoid milk products as a first method of treating those side effects. Hair Loss/Skin Changes Hair thinning or loss is expected after rapid weight loss. This is typically the result of having undergone surgery in general. However, during the phase of rapid weight loss, calorie intake is much less than the body needs, and protein intake is marginal. The body is in a state of stress, like what would happen during a period of starvation. In some patients, hair thinning or hair loss may occur. This is temporary and usually resolves when nutrition and weight stabilize. The hair loss usually occurs anywhere from 3 to 9 months after surgery. The same reason for the hair loss can also cause changes in your skin texture and appearance. It is not uncommon for patients to develop acne or dry skin after surgery. Protein, vitamins and water intake are also important for healthy skin. You can minimize the loss of hair by taking your all of bariatric multivitamins daily and making sure that you consume at least 80 grams of protein per day. We advise patients to avoid hair treatments. If after about 9 months you start to lose hair, this can be a sign of protein malnutrition. Always make sure you’re getting enough protein in your diet. Sex/Pregnancy You may resume sexual activity when you feel physically and emotionally stable. Sexually active women of childbearing age will need to use birth control, as fertility may be increased with weight loss. Oral contraceptives may not be fully absorbed. Discuss alternative forms of birth control with your gynecologist. Many severely obese women are also infertile because the fatty tissue soaks up the normal hormones and makes some of its own as well. However, as weight loss occurs, this situation may change quickly. You may start planning a pregnancy after 18 months, when it is safe for you to conceive. DO NOT GET PREGNANT for at least 18 MONTHS. It is imperative not to become pregnant before this time, since we want both you and the baby to be healthy
