Gastric Bypass or Sleeve Diet*

Immediately after surgery

A patient can start taking low sugar clear liquids 4 hours after surgery. Initially this should be water and ice chips, but any liquid that is not opaque (i.e. can be seen through) and low sugar is allowed. This includes diet iced tea, low calorie sport drinks (e.g. Propel Water), light soups (e.g. broth), sugar free Popsicles, sugar free Jell-O, etc. There is no limit on the volume of clear liquid that is allowed. However, all liquid should be taken slowly. Extremely hot or cold liquid may be less well tolerated than that of medium temperature. Avoid gulping, as this increases the amount of swallowed air (and subsequent belching) which can be uncomfortable.

Post-op Days 1-7

Follow the general guidelines given above. As the first week post-op progresses larger volumes can be consumed. Liquids that are hot or cold may be better tolerated. Read labels and avoid liquids with too many calories.

Post-op Weeks 2-4(Post-op Days 8-28)

If there are no prior problems, the patient may progress to the soft low sugar, low fat diet for weeks 2-4. This does not mean pureed food – a better limit on the consistency of the food is that it should be easily mashed up with a regular fork. Foods that do not pass this test (e.g. chicken or bread) need to be avoided. These meals should also be low in sugar (less than 4-5 grams per meal) and low in fat (less than 6 grams). It is essential to read labels, not only for overall carbohydrate and fat content, but also for specific ingredients. When sugar or high fructose corn syrup is one of the first ingredients, that food product should be avoided. Similarly, saturated and trans-fats should not be consumed. Protein on the other hand should be emphasized with a target of 12-20 grams per meal. Soft foods rich in protein include baked fish, tuna, lean ground beef, and legumes (e.g. beans, lentils).

After Post-op Week 4 (>28 days Post-op)

After the fourth week post-op the patient should start the solid low sugar, low fat diet. This includes all solid foods as long as they are low sugar and low fat (see above). The objective is 3 meals a day with approximately 4-5 grams of carbohydrate, 6 grams of fat and 12-20 grams of protein for each meal. Food should be chewed well, but not to the level of puree. It is also essential for the patient to eat slowly as this will help prevent vomiting if there is restriction.

How to Eat after a Gastric Bypass

Remember that the gastric bypass creates a small pouch – about the size of a large egg – at the top (inlet) of the stomach. This pouch is separated from most of the rest of the stomach, and is connected to the small intestine (the roux limb). Food will pass from the small pouch into the roux limb and flow 30 to 60 inches down the intestine to where the biliary limb (from the bypassed stomach and duodenum) reconnects. Beyond this point there is a common channel of small intestine of 10-12 feet before it empties into the large intestine. The operation works because: 1) by filling the small pouch with very little food, the patient will feel full and be able to control hunger, 2) any processed or high density sugars, and some fats, will lead to the dumping syndrome, and 3) the bypassed stomach and duodenum produce less hunger hormone than before, which decreases the drive to eat. The dumping syndrome consists of the unpleasant symptoms of flushing, cramping and diarrhea. If the offending substances (all of which are high calorie) are not ingested, it will cease. The dumping syndrome provides powerful incentive not to ingest them again.

Several important points must be kept in mind. The patient cannot put too much food into the pouch too fast, which will result in discomfort or vomiting. This unpleasant problem can almost be eliminated if the patient eats slowly and pays attention to what he/she is feeling while eating.

Liquids pass through the new system without restriction and can lead to the uptake of too many calories. Juices, milk, ice cream, latte, Gatorade, sodas, soups etc. should be avoided. Even such “healthy” choices as protein shakes and fortified vitamin drinks should be avoided as they have too many calories. Liquids should be no calorie or low calorie such as: water, iced tea (artificial sweetener), coffee (artificial sweetener), skim or 1% milk, crystal lite, low calorie sport waters (e.g. Propel), and diet sodas (after 30 days). Look at labels. All liquid should be less than 5-10 calories per serving. Protein supplementation should be in powder form (whey protein) and put on solid food.

Although it is less important than with the adjustable gastric band, the order in which a patient eats and drinks is important. If a patient fills the pouch with solid food and feels full – but then drinks a large quantity of water – the water would act to flush the food out of the pouch. This may eliminate some of the full feeling that comes with filling the pouch. The patient may experience more difficulty suppressing hunger in-between meals. So, it is preferable that the patient have liquids first during a meal. He/she can have as much no or low calories liquid as desired to reduce any feeling of thirst. The patient will only need to wait 1 minute or so for the liquids to clear the pouch and then he/she can proceed to fill the pouch with solid food. This strategy works the best to create the necessary intra-meal satiety to help the patient control his/her hunger between meals.

If these guidelines are followed, the best effect will be achieved with a gastric bypass, and the patient will get the most weight loss from the surgery.*

Gastric Sleeve Surgery and the Importance of Vitamins

Watch the video below to learn more about the importance of vitamins after surgery.

Buy Post-Op Vitamins

You can buy vitamins in Dr. Marvin’s eStore through Bariatric Advantage by clicking the button below.