Maintaining a healthy diet after surgery
After surgery is when the real work starts. You will need to change your eating habits to avoid pain and vomiting, rupture of staple lines and, of course, to achieve your weight loss goals.
Changing your eating habits can also help prevent stomach obstruction. Swallowing food in pieces that are too big can make it difficult from the foods to pass into the intestine. It is critical that you eat slowly and chew your food very well to lower the risk of anything becoming caught. Your new motto should be: “slow, small, moist and easy”.
Stop eating as soon as you are full
Overeating even one spoonful can cause you to vomit and lead to harmful stretching of your stomach pouch. Pay attention to your body’s signals, not to the food left on your plate. Indications of fullness may not feel the same as before surgery. Here are some not-so-obvious signs that your stomach pouch is nearly full:
- A feeling of pressure or fullness in the centre of your abdomen, just below your rib cage.
- A feeling of nausea, regurgitation or heartburn. You may have a feeling of satiety several minutes after you are actually full. If your pouch is 30 cc, you can put 30 cc in it, and you will not feel full for about 5 minutes. To help you find the right portion size, try the following: Measure 30 cc of water, drink it and wait for a few minutes. If you feel full with this amount and are comfortable, measure this amount of food for each meal. This will prevent stretching of your stomach pouch and the discomfort caused by overeating.
After your surgery, it is easy to accidentally overeat at parties – especially when you are having fun and involved in conversations. It is also easy to nibble beyond fullness. Nibbling is a no-go after surgery, as you may find yourself eating tiny amounts all day long. We suggest making ‘party eating’ one of your meals for the day. Other tips for ‘party eating’ include:
- Never snack directly from a communal bowl, as it makes portions harder to estimate. Instead, place a portion of the food on a small plate, and take only the amount food you are planning to eat. Remember, you cannot eat more than a small child’s portion now.
- Take time to socialise more, have fun and enjoy the people at the party. Learn to focus on other things besides the food. Over time, will hopefully feel a sense of freedom from the drive to eat – use this opportunity to find new focus and enjoyments in life.
General mealtime tips
- Set aside 30 to 45 minutes for each meal. Chew each bite of food many times. If you wear dentures, which don’t chew as well, it may be necessary to stick to ground or soft foods. Learn to eat slowly and deliberately, to allow your body to feel the fullness and digest the food better. When you eat too fast, there is a greater risk of overeating and of not chewing your food well enough, which could cause vomiting.
- Explain to friends and family why you must eat slowly so they don’t urge you to eat faster.
- Take small bites of food. Try using a saucer instead of a plate to help with portion control.
- Use small utensils to help you identify the right portion.
- Pay attention to taste. Learn how to savour your food. You may find that your tastebuds have changed after surgery.
- Eat only at mealtimes as suggested by your health care team. Between-meal snacking or ‘nibbling’ on small amounts of food when not recommended by your health care team can sabotage your weight loss efforts.
- Avoid drinking liquids when eating solid foods. Liquids should be avoided for a period of 30 to 45 minutes before and 30 to 45 minutes after eating solid foods. Combining liquids and solids may cause nausea and may push foods through the stomach pouch faster, potentially causing you to eat more.
- Eat high-quality, fresh and all-natural foods. Fresh foods are higher in nutrients and more flavourful.
What to eat after surgery
Proteins
Protein is essential for your muscles as well as for your heart, brain and other organs. Our bodies require a constant supply of protein to repair and replace tissue that becomes worn out or damaged. Protein also helps fight infection.
Because your new stomach pouch has a very small capacity, it is important to eat high-protein foods with every meal to ensure your body gets enough protein to maintain itself.
Eat at least 60 grams of protein a day
A daily intake of at least 60 grams of protein should be the goal for the first 6 months. If you do not take in enough protein, after three weeks, your body will start to break down its own source of protein: muscle. This will cause you to feel nauseated and weak.
In the early days after your surgery, when you are drinking protein drinks, it is easy to keep track of how much protein you are consuming. Later, however, when you are eating regular food, it can be a bit more difficult. Use nutrition labels as your guide. Be careful with protein shakes, drinks and bars, as they tend to be high in sugar and calories.
In some cases, your dietitian may advise you to consume more protein.
Supplements
After bariatric surgery, the small stomach pouch does not allow you to eat enough to get all the nutrients you need through food alone. Moreover, the malabsorptive element of bariatric surgery decreases the body’s ability to process vitamins and minerals. To ensure you get enough nutrients, you will need to take multivitamin and mineral supplements daily for the rest of your life. Your health care team will tell exactly which supplements you need. Typically, they will prescribe some combination of the following:
Vitamin B12: B12 deficiency can develop quickly, with little warning, and can be very dangerous. Food sources containing B12 include all types of animal products (meat, fish, poultry, dairy, eggs). Take care to have your vitamin levels checked regularly by your health care team.
Calcium: You will need to take a calcium supplement daily. Calcium is necessary for healthy bones, teeth and nerve transmission. With the reduced volume of food you can eat, it will not be possible to get enough calcium through diet alone.
Iron: Many patients, particularly women, will require an iron supplement to maintain adequate iron stores and prevent iron deficiency and anaemia. Iron is available in many different forms. Some forms can cause constipation. Consult your health care team regarding the type of iron supplement that is right for you.
Multivitamin complex: A multivitamin complex may be prescribed according to your needs.
Gallbladder medication: Bariatric surgery patients who still have their gallbladder may need to take specific medications during the period of maximum weight loss to minimise the risk of developing gallstones. Ask your health care team if this treatment is necessary for you.
Liquids
Drink 1.5 to 2 litres of still water per day between meals. (Increase this amount by 20% if you are sweating.) In addition to water, you can drink unsweetened, low-calorie and non-carbonated drinks. Juices are high in calories, provoke dumping syndrome (check in “my condition”/”caues and risk factors”) and provide very little nutritional value. Here are some tips:
- Avoid carbonated beverages: When a cold carbonated beverage is consumed, it warms and releases gases, distending the stomach pouch and causing harmful stretching. This can cause discomfort and vomiting.
- Do not drink 30 to 45 minutes before or after meals to keep the stomach pouch from stretching and to prevent vomiting.
- Sip slowly and carefully.
- Sip liquids regularly all day long to prevent dehydration.
- Eliminate high-calorie drinks such as milkshakes, soda, alcoholic beverages and juices. High- calorie beverages tend to be low in nutritional value and contain simple sugars. They are also quickly absorbed and may cause dumping syndrome.
NOTE: If your urine is dark or your mouth is dry, you are not getting enough liquids.