Dietary Guidelines for Post-Bariatric Surgery

Dietary Guidelines For Post Bariatric Surgery

Remember that every individual is unique. Although your stomach volume after the operation is same as our other patients, the amount of your food and liquid consumption may be different. This difference is related to the anatomical structure of each patient. For this reason, you should not compare the amount of your portions. You should not apply nutrition programs that are not based on scientific sources.

You should inform our team about your weight loss progress every month after your operation. You should be cautious in your food selection during the nutrition adjustment period, which you will progress gradually so that both you and your body get used to your new stomach. Even if most ready-to-eat foods contain the inscription ‘’high protein’’ or ‘’no added sugar’’, the content may not be suitable for you. Therefore, you should not consume food or beverage without confirming it with our dietitian.

Everybody’s metabolism is unique. Your weight loss may not be the same as the amount of weight lost by a patient with the same weight or BMI, at the same time as you. Remember that this is a process and it may give different results for each of you. You shouldn't expect to lose the weight you haven't gained in a day, a week or a month at the same rate. This is a process; you have to be patient.

Your goal in nutrition for the post-operative period is to lose fat tissue and preserve muscle mass during weight loss. Therefore, your priority should be protein foods and liquids. Your nutrition after the surgery is divided into three stages as the LIQUID PERIOD, which you will apply for the first 15 days, the PUREE PERIOD, which you will apply between the 15th and 30th days, and the SOLID PERIOD, which you will apply after the 30th day (the first month is over).

POSTOPERATIVE PERIOD / First 15 days

Liquid Period

The liquid diet period is also divided into 2 in itself:

1. Clear Liquid Diet (DAY 1-3)

• A leakage test will be performed the next day of your surgery. After the leakage test is done, you can start your fluid intake. Since your stomach is very sensitive during this period, you will need to be careful and consume liquids slowly and take small sips. • We do not recommend the consumption of green tea after your bariatric operation as it may cause serious constipation due to its diuretic (water-losing) effect.
• Starting from the time you are discharged from the hospital, you should increase your water consumption step by step, and you should consume 1.5 liters of water, that is, 7-8 glasses of water, during the day.
• On average, you need to drink 96ml of water with a sip every half hour; this is equivalent to 1 glass of water every hour and allows you to reach the target without forcing you.
• Do not use a straw when you consume water and other liquids.

2. Full Liquid Diet (DAY 3-14)

Free to consume

• Meat/chicken/fish broth, bone broth
• Boiled vegetable juice for vegetarians
• Unsweetened fruit juice
• Lactose-free milk
• Lactose-free yogurt
• Lactose-free buttermilk
• Lactose-free kefir
• Soy milk
• Almond milk
• Rice milk
• Coconut milk
• High protein skim milks
• High protein nonfat yogurts
• Grain-free and sugar-free compote
• Sugar free jelly
• Herbal teas (cinnamon, chamomile, linden)
• Protein powder

What should you pay attention to?

• Avoid consuming all acidic and carbonated drinks as they may upset your stomach.
• Avoid all alcohol-containing beverages as they will adversely affect the healing process; because alcohol has a toxic effect on the gastrointestinal surface and liver with surgery and triggers an increase in liver fat.
• Avoid consuming liquids containing caffeine (such as coffee, green tea).
• You can add vegetables while preparing soup from options such as red meat, chicken, fish. Some vegetables may cause bloating. You can find these vegetables by trying them first.
• After boiling the meat, vegetables and water in the pot, strain it with the help of a strainer.
• Soups you will consume at this stage should be grain-free.
• You can sweeten your soups by adding salt, lemon and vinegar. We do not recommend using ready-made soups.
• Stay away from all sweet derivatives, including sugar-added and starchy puddings, packaged desserts, creams, sugar-added fruit yoghurts and milks, kefir, dairy desserts and ice cream.
• Bread derivatives; high-carbohydrate noodles, rice, rusk, etc. moreover to avoid, pretzels, biscuits, pastries and bakery products.
• Added sugar derivatives, you may come across additional sugar variations and artificial sweeteners that may come in different names. Stay away from all packaged products with high processed/added sugar content.
• Avoid packaged (instant) fruit juices with high sugar content.
• You will have some discomfort until your body and hormones adapt to the shrinking stomach volume after the surgery. This may give you discomfort. Examples include heartburn, and vomiting. In order to avoid these complaints, you should not add spices to your meals for the first two months.
• Your soups should be daily and fresh. Preparing large quantities and heating-boiling every day may cause your food to spoil.
• Since problems such as bloating, gas, nausea, cramps and diarrhea may occur after consuming normal milk and dairy products, you should choose lactose-free products for the first 15 days in order not to increase the gas problems that occur after the surgery. You can sweeten your water and milk with cinnamon sticks.
• You can also prepare compotes by straining the fruit and water after boiling them in the pot. Do not add sugar to your compotes. In order to sweeten; While boiling, you can add cinnamon sticks, fresh mint, lemon, persimmon or a very small amount of honey. •
• The herbal teas you will consume should definitely not be any type of slimming tea.
• Do not consume drinks in large sips at once. Sip slowly and little. • During the liquid period, you should consume water until the color of your urine turns bright yellow. If you have trouble drinking water, you can flavor the water with fresh mint, cinnamon sticks or various fruits.
• Some foods may cause nausea and vomiting in the first postoperative period, this may vary from patient to patient. You can remove foods that cause such discomfort from your diet.
• Whether you feel hungry or not, you should consume food every 3 hours at the latest. Exposure to long fasts can cause serious problems.

LIQUID PERIOD NUTRITION PROGRAM

Breakfast (07:00-08:00)

• A glass of water (with a gastro protective drug) A bowl of vegetable broth soup (potato, carrot…)
• OR 1 cup of low-fat yogurt or lactose-free milk (+additional protein)

Snack (09:30-10:30)

• 96ml of compote
• OR 96ml of fresh fruit juice (except citrus fruit) (+additional protein)

Lunch (12:00-13:00)

• A bowl of vegetable chicken soup (mushroom, pea, corn…)  

Snack (15:30-16:30)

• 1 cup lactose-free buttermilk (lactose-free milk, lactose-free kefir, soy milk) 

Dinner (18:00-19:00) 

• A glass of water (with a stomach protector) 1 cup of lactose-free yogurt
• OR A bowl of vegetable soup (start with zucchini)

Snack (20:00-20:30)

• 1 cup of lactose-free milk
• OR Soy milk

The list above is an example of the nutrition program. You can change the times of your meals and the places of the recommended foods. However, if you try to consume the same meal at an exact time every day, you will gain regular eating habits.

The measurements in the nutrition program are sample measurements, you do not have to consume as much as the written amounts; you can eat until you feel full. 

POSTOPERATIVE PERIOD 15. - 30. DAY

Puree Period

 PERIOD You are now in a new period that you will apply for 2 weeks between the 15th and 30th days after the surgery. During this period, you should consume your meals with the help of a blender until they reach a puree consistency or by crushing them with a fork.

From the first day you enter this period, you should be trying a new food every day. You should consume meals according to your body's tolerance, and in case of any discomfort, you should remove that food from your diet for a while. You should chew your food well. After trying all the dishes in order, you can increase the amount over time. The nutrients in the liquid period are free for consumption, in addition;

Free Foods

• Eggs (soft in the first week, omelet the next week)
• Cheese (curd or cottage cheese the first week, all varieties the next week)
• Vegetables (boiled and blenderized)
• Fruits (without peel and blenderized)
• Vegetable dishes with minced meat and chicken (well-cooked and blenderized)
• Boneless fish meat (boiled, steamed, oven)
• Canned tuna
• Freshly squeezed fruit juices (it is our priority to consume the fruit)
• Activia (probiotic yogurt)
• Tea (except green tea, e.g. linden, chamomile, sage)
• Coffee (decaffeinated)
• Fruit yoghurts (with purified fruits)

Things To Pay Attention!

• You should not be consuming a very hard-boiled egg (it is enough to boil for 7-8 minutes).
• Instead of salty and fatty cheeses, you should prefer curd or cottage cheese.
• You should definitely not consume raw vegetables. Consume all vegetables by peeling their skins. Your preferences should be seasonal vegetables. It will be more comfortable to consume easy to digest vegetables with soft consistency. You can have zucchini, carrots, and potatoes.
• Every meal should have a source of protein. You can mix your vegetables with minced meat-chicken or milk-yogurt. Instead of frying, cook it as boiled, steamed or juicy food.
• Acidic-carbonated drinks, nuts, popcorn and ready-to-eat foods should not be consumed. • When you heat the cooked meat dishes and consume them again, the dried meat may cause discomfort to your stomach. Cook for one meal if possible.
• If you are going to consume ready-made food, you should read the labels. Foods containing more than 10 grams of sugar per 100 grams per serving, fruit juices should not be preferred.
• Doughy dishes, bread, pasta, and rice are not suitable for you even if they are pureed. • You can consume tea and decaffeinated coffee, but since they are diuretic drinks, they cause excess water removal from the body, so choose water.
• Recommended fruits are seasonal fruits. You can increase your protein by making puree with milk and yogurt.
• There is a rule that no liquid should be consumed 30 minutes before and 30 minutes after the meal. You should start the rule we call SOLID-LIQUID SEPARATION during this period and pay attention throughout your life. Details are available at the end of the book.
• Instead of the fruit juices that are free for your diet, preferring fruits will prevent you from consuming high sugar content in one go and you will get fiber.
• Liquids consumed at the same time with meals can cause DUMPING SYNDROME. Details are available at the end of the book.
• If you have trouble drinking water, you can sweeten your water with flavorings such as cinnamon sticks, mint or slices of orange. Even if you can drink more, drink one glass of water at a time at most.
• For constipation that may occur during and after this period; You can consume prunes and apricots in the form of marmalade by using your blender, you can boil them and consume them as compotes, you can drink apricot teas. You can eat one probiotic yogurt every day. You can include kefir for the night meal. When you increase the amount of water you drink and your walks, the problem will disappear.
• You may see an increase in weight when you are weighed outside of your regular checkups. This is normal. It will give you the most accurate result to be weighed at the same scale all the time, after going to the toilet on an empty stomach in the morning and having been moving for about 10 minutes.
• When you have problems with swallowing and digestion during this period, applying a liquid diet will not help you lose weight, contrary to popular belief; It can make you sluggish by decreasing your energy levels.

Puree PERIOD NUTRITION PROGRAM

Breakfast (07:00-08:00)

• 1 glass of water (with a gastro protective) 1/2 egg or 1/2 slice of cheese 1 cup of light tea (30 minutes after breakfast)

Snack (09:30-10:30)

• 1 cup of milk or butter milk

Lunch (12:00-13:00)

• A bowl of vegetable chicken soup (mushroom, pea, corn…)  

Snack (15:30-16:30)

• 1 medium fruit puree 

Dinner (18:00-19:00) 

• Pureed-blender of soups in liquid period 

Snack (20:00-20:30)

• 1 small bottle of Activia 

The list above is an example nutrition program. You can change the times of your meals and the place of the recommended foods. However, if you try to consume at the same time every day, you will gain regular eating habits.

The above measurements are sample measurements; you do not have to consume as much as the written amounts; You can eat until you feel full. Your purees should be blenderized or mashed well with a fork until they reach the consistency of a pudding.

During this period, you should chew your food very well and eat slowly. Eating fast or not chewing well can cause stomach discomfort. If your gas problem persists, you can prefer lactose-free options. If you do not have a gas problem, you can consume milk and dairy products.

SOLID PERIOD NUTRITION PROGRAM 

During this period that you start to eat normally, you can eat foods (free for liquid and puree period) in solid form, without making them puree. Dishes such as: meatballs, grilled chicken, fish in the oven, vegetable dishes with olive oil. Proteins should be your top priority for the first 2 years in order to protect your existing muscles, accelerate fat burning, and tighten the flexible skin caused by excess weight in your nutrition plan as proteins participate in the structure of the body.

You should get at least 60 grams of protein daily. Since it is not possible to complete this measure with your newly shrunk stomach, your first choice at every meal should always be foods that are a source of protein. By calculating the amount of protein you get from foods according to the amounts of the above, you can complete the missing amount from supplemental proteins if necessary. Detailed protein calculation is at the end of the book.

You may experience the following as a result of a protein deficiency in your nutrition plan:

MUSCLE LOSS: The body uses muscle tissue as an energy source instead of adipose tissue. Thus, you start to lose muscle.

HAIR LOSS: Foods that are protein sources are rich in omega, oils and vitamins. Inadequate protein intake; can cause conditions such as hair loss and nail breakage.

FATIGUE: Tiredness can be seen due to reduced muscle tissue and slowing metabolic rate.

FEELING OF LATE SATIETY: When the proteins that are emptied from the stomach later compared to other food groups that are taken insufficiently, can cause a feeling of hunger again shortly after eating.

EDEMA: Since water and muscle loss will occur, the body tends to have water retention. Thus, lead to edema accumulation.

DISTURBANCE IN WEIGHT BALANCE: When your protein intake is insufficient, muscle and water loss occurs instead of fat tissue.

HORMONE AND ENZYME SYSTEM DISORDERS: When the proteins, which are our basic building blocks, are insufficient, enzymatic events slow down or disrupt. Our digestive, absorption, excretory and nervous systems do not perform adequately. Mood swings, constipation or diarrhea, bowel sounds are examples.

IF YOU DO NOT WANT THE WEIGHT THAT YOU LOST COME BACK; You should maintain regular communication with your team. Because the nutrition plan you know might may not be the best one for you. Your surgery should be a milestone for you, and after that, you should gain a healthy and regular eating habits with the help of our team.

You can contact our team to get information about the suitability of the different protein sources you have discovered and the amounts you should take.

Breakfast (07:00-08:00)

• 1 egg + 1 slice of light cheese or cheese omelet/scrambled eggs with minced meat/veggie omelet 96 ml of tea (30 minutes after breakfast) 96 ml of water (30 minutes after breakfast) 

Snack (09:30-10:30)

• 96 ml of milk 

Lunch (12:00-13:00)

• 60 grams meat – chicken – fish boiled seasonal vegetables

Snack (15:30-16:30)

• 1 small bottle of Activia  

Dinner (18:00-19:00) 

• 5 tablespoons of meaty vegetable dish + 2 tablespoons of yoghurt

Snack (20:00-20:30)

• 1 glass of kefir 1 portion of fruit (you can consume with its peel)

Flour, noodle and spicy soups are not recommended during this period. Raw vegeta- bles, nuts (walnut-nut-pistachio), legumes (lentils, chickpeas, beans) and spices are free the following month.

POST OPERATIVE PERIOD BETWEEN 2nd and 6th MONTH  

The first month is the period of determination of habits in terms of nutrition. After the operation, you may not want to consume certain foods that you enjoyed before. This is completely normal. Your nutrition list is valid up to 6 months. After this period, you are considered to be back to normal in terms of your nutrition intake. In addition to the free to consume foods for the first month, you can consume the following foods.

FREE TO CONSUME:

• Legumes: 1 handful = 10-15 grams of protein
• Raw vegetables
• Nuts
• Spices
• Bulgur
• Recipes made from protein flours such as chickpea flour and almond flour
• Raw vegetables do not have protein, thus there should be a portion of protein upon your consumption. You can add cheese, tuna, chickpeas or dried beans to your salads.
• You can eat legumes as a protein source. 5-6 tablespoons of legumes contain 6 grams of protein. Dry beans; It is a good plant-based protein choice along with animal based protein sources. Since these can cause bloating problems, you can start with small portions and increase the amount over time.
• You can now eat bulgur and pasta while not exceeding 3 tablespoons per week.
• Nuts that are suitable in the solid period, even if they contain protein, are high in calories because they are in the fatty food group. It should not be consumed more than a handful a day. Your preference should be the plain ones. Nuts with salt, sugar and chocolate sauce cause you to take in extra calories.
• After the 3rd month, if your protein intake meets your daily needs, you can remove the protein supplement from your nutrition plan, if necessary, under the control of our dietitian.
• You should stay away from carbonated and alcoholic beverages along with foods with high sugar content.
• You should not consume bread, rice, flour, breakfast cereals, pasta and bulgur more than recommended.
• After this period, the feeling of hunger will increase compared to the first periods. This is completely normal.
• Even if you are not hungry, you should eat at least 3 meals a day. Go out for shopping with a full stomach and not buy more than you need. These will give you good nutrition habits.
• There may be periods when you may experience weight loss stagnation. You should know that these periods are temporary and you should continue to eat healthy.

NUTRITION INTAKE AFTER 6TH MONTH   

During this period when most of the restricted foods are no longer restricted in your nutrition plan, the risk of regaining weight increases. You should continue to follow with your nutrition plan as provided to you. After the operation, your stomach will not increase in volume, but increasing the portions may enlarge your stomach, as bread and its derivatives are no longer restricted in your nutrition plan.

FREE TO CONSUME:

• Bread
• Pasta
• Bulgur
• Noodles
• Hard meats such as steak
• Your daily protein intake can be between 80-100 grams depending on tolerance. For example, it should be 80 grams for women and 100 grams for men.
• Your daily water consumption should be above 2-2.5 liters. NOTHING EXCEPT WATER SUBSTITUTES WATER; Do not choose packaged beverages with high sugar content.
• For our patients who experience sagginess, plastic surgery is not recommended for the first year, before the weight loss is stabilized. • You should not go back to your old-unhealthy-irregular eating habits as you will not have any problems consuming food because you have switched to a more health and regular diet.
• You should not disregard your protein intake for the first year. You should make sure that you get enough protein after the protein supplement is removed from your diet.
• You may be close to your ideal weight, but you should still pay attention to what you eat to ensure to not to gain weight you have lost after the operation.
• Remember that this surgery is not an operation that guarantees a lifelong weight loss as well as weight re-gain. The path we took together is now for you to walk alone. By the end of the 2nd year, you will reach your ideal weight and it is up to you to ensure its continuity. You may experience periodic weight gains. To eliminate this, create a food consumption log and write down what you ate for a week. If you have any mistakes that you are aware of, try to correct them. If you think you are moving in the right direction; Contact our team before your weight gain progresses.

POSTOPERATIVE NUTRITION PROGRAM AFTER THE 6th MONTH

 Breakfast (07:00-08:00)

• 1 egg 1 slice of cheese 2 walnuts
• Or 10 hazelnuts-pistachios-almonds Seasonal vegetables

Snack (09:30-10:30)

• 96ml of milk 1 portion of fruits

Lunch (12:00-13:00)

• 100 gram meat – chicken – fish
• OR 5-6 tablespoon of legumes Salad 1 glass of water with yogurt (30 minutes after breakfast) 1 glass of water (30 minutes after breakfast)

Snack (15:30-16:30)

• 1 handful of nuts 1 portion of fruits

Dinner (18:00-19:00) 

• 100 gram meat – chicken – fish
• OR 5-6 tablespoons of meat and vegetables 1 bowl of yogurt (30 minutes after dinner)

Snack (20:00-20:30)

• 1 bowl of yogurt 1 portion of fruits

A SAMPLE NUTRITION PROGRAM FOR THE FIRST 2 YEARS

 Breakfast (07:00-08:00)

• 1 egg
• 2 slices of cheese
• 2 walnuts = 10 hazelnuts-pistachios-almonds or 4-5 olives
• Seasonal vegetables or seasonal fruits 1 slice of whole wheat bread (25 g)

Snack (09:30-10:30)

• 1 glass of milk 

Lunch (12:00-13:00)

• 100 gram meat – chicken – fish
• OR 5-6 tablespoon of legumes Salad 1 glass of water with yogurt (30 minutes after lunch)

Snack (15:30-16:30)

• 1 bowl of yogurt
• 1 serving of fruit
• 1 handful of nuts

Dinner (18:00-19:00) 

• 1 bowl of soup
• 100 gram meat – chicken – fish
• OR 5-6 tablespoons of legumes
• 5-6 tablespoons of meat and vegetables
• 1 slice of whole wheat bread (25 grams)
• 1 bowl of light yogurt (30 minutes after the meal) 

Snack (20:00-20:30)

• 1 glass of kefir or 1 glass of milk or 1 bowl of yogurt + 1 portion of fruits