Following weight loss surgery, it is very important for you to follow strictly the specific dietary guidelines given to you by your Surgeon. The post surgery diet plan is set to ensure that your body heals properly and obtains adequate nutrition after weight loss surgery.

Dietary Phases are as follow:

Phase 1 (Day 1 to Day 7)- CLEAR LIQUID DIET

• Day 1             Warm water taken in gulps of 20 ml every 15 minutes
• Day 2 to Day 7 Apple juice, cranberry juice, grape juice, flat 7Up, black tea or herbal tea
  water warm, Not Hot.

 Phase 2 – Day 8 to Day 14   – FULL LIQUID DIET

Sip constantly during your waking hours, aim for 200mls of fluids over a one hour period.

Acceptable food and beverages on this phase include:

• Tea, decaffeinated coffee
• Fruit juices (not citrus)
• Jelly
• Sugar-free popsicles/ice lolly
• Yoghurt (plain or flavoured but without fruit pieces)
• Low-fat cream soups, blended vegetable soups, blended chicken soup
• Fresh Laban
• Milk (cow’s milk or soy milk fortified in Calcium or lactose-free milk in case of lactose intolerance)
• Soup (clear, strained or blended without pieces)
• Porridge (cooked in sufficient water/milk)
• Semolina (cooked in sufficient water/milk)
• Protein shakes

Phase 3 – Day 14 to Day 21 – SOFT FOOD

As you transition to soft foods, foods with texture but easy to chew, you are learning to chew your food thoroughly and to eat slowly. Make a habit of eating very slowly and chew your food thoroughly (to a mushy consistency). Try to make each meal last 20 minutes.

Acceptable foods for this period include:

• Low fat cottage cheese or ricotta cheese
• Low-fat yoghurt (if flavoured, choose a reduced sugar one)
• Eggs (scrambled, poached or soft-boiled)
• Tofu
• Cheese
• Baked fish that flakes easily (without fish bones) / canned tuna / canned salmon
• Thinly sliced deli turkey /deli chicken/ham
• Lean ground beef or minced chicken
• Fruits like Banana, Peaches or pears canned in natural juice (not syrup), Ripe avocado
• Apple sauce or other pureed fruit compote
• Soft well-cooked vegetables like carrots, zucchini/courgette, mushroom, broccoli florets, cauliflower, okra, etc (mushy not crunchy), Tomato sauce, Tomato juice or vegetable juices.
• Mashed potatoes, sweet potatoes, Crackers, Toast, Soups
• Smooth nut butter (preferably 100% natural, no sugar added)

Acceptable drinks for this period include:

• Still water (can be flavoured with few lemon/orange drops or mint/basil leaves)
• Non-fizzy, sugar-free flavoured waters
• Unsweetened tea, coffee
• Stop drinking fruit juices at this stage (even fresh or natural ones)
• Protein shakes

Foods to still avoid at this stage:

• Raw fruits and vegetables (except bananas)
• Pasta, noodles, rice and bread
• Nuts, seeds, pop-corn
• Sugar and concentrated sweets

Suggestions for phase 3 diet:

• During this phase, you can start eating 3 small meals a day.
• Do your best to chew your food well and try to make each meal last 20 minutes
• Learn to stop eating when you feel full, which initially may already be after 2 or 3 mouthfuls of food. Indications of fullness include a feeling of pain or pressure in the centre just below your rib cage, nausea, or pain in your shoulder or upper chest. Eat only until you feel satisfied. If you continuously eat until you feel stuffed, you will stretch your stomach pouch.
• Get into the habit of eating first a protein-rich food with each meal.
• Your meals should be about ½ cup in size (4-6 oz).
• Continue to drink plenty of fluids (especially water, no carbonated drinks). However, do not drink liquids for 30 minutes prior to mealtimes (to make sure your stomach is empty), do not drink anything with your meal (to allow room for food), and do not drink anything for 30 minutes after a meal (to prevent “washing” the food through the stomach too quickly).

Phase 4 – Day 22 and beyond – HEALTHY EATING

You will now be able to eat solid foods and can now tolerate a normal, varied and healthy diet. Your stomach pouch will have fully healed.

Suggestions for Phase 4 diet:

• Continue to eat a diet that is rich in Protein.
• Continue the habit of only eating 3 nutrient-dense meals per day. They should include:
  Protein first, then vegetables or fruit, and then only whole grains (if not already full).
• Avoid snacking and grazing throughout the day as it will prevent you from reaching your target weight.
• Develop an exercise programme. Exercise will help you to burn more calories and build lean body mass or muscle. The more muscle you have, the more calories you will burn. You will lose weight faster and keep it off as long as you are exercising.
• Recognise when you are full and learn to stop eating when you are comfortably satisfied, not stuffed. Remember the only reason to eat is because you are hungry (physiologically, not mentally hungry J ). If you are not hungry, do not eat. 

The following problems may be encountered after surgery

Managing Liquids

• Fluids are needed to replace normal water loss and to prevent dehydration. You should aim to drink at least 2 litres of the fluids every day.
• Avoid liquids with meals, saving room for solid foods.
• When drinking liquids, sip them slowly. If liquids are gulped too quickly, abdominal cramping, discomfort, and/or vomiting may occur.
• Avoid carbonated drinks and drinking from a straw. Doing this can help you to avoid excess gas and pressure.

Nausea, vomiting, bloating and/or heartburn

Nausea, vomiting, bloating and/or heartburn can occur from any of the following:

• Eating and drinking too quickly
• Not chewing food well enough
• Drinking cold fluids
• Eating too much
• Eating rich or sweet foods, fried, or high-fat foods
• Eating gas-producing foods or drinking carbonated beverages

Constipation

• Make sure you drink enough liquids
• Progressively increase your fibre intakes by adding vegetables, fruits and later wholegrains into your diet
• Increase your level of activity. Moving and exercising help relieve constipation.

Dumping Syndrome (applicable to Gastric Bypass Surgery)

Dumping syndrome can be a feeling of quick abdominal fullness, weakness or dizziness, warmth, rapid pulse, cold sweats, nausea, cramps, possible vomiting, and possible diarrhoea. This happens whenever foods and drinks that are too high in sugar are consumed. To avoid dumping syndrome, avoid concentrated sweets (ice-cream, milkshakes, juice drinks, sodas, sweets, cakes etc.). You may only be able to tolerate a very small amount of these items at a time if any at all.

Blocking of the Stoma

The new opening created by the surgery is smaller than the original opening that released food from the stomach into the intestine. The new opening may become blocked when food has not been thoroughly chewed, which can result in abdominal pain or vomiting.To prevent blockage from occurring:

• Avoid eating high fibre foods, such as raw fruit and vegetables, for the first 6 weeks after surgery. After the 6 weeks make sure you chew high fibre foods thoroughly.
• Chew all foods to the consistency of mush before swallowing.
• Use chewable or liquid multivitamins.

Overeating

One of the ways that weight loss surgery works are to create a smaller stomach that is unable to hold the large volumes of food it had previously held. Constant overeating can stretch the stomach pouch. Meals should always be and remain small! The more solid the food, the less you will be able to eat so the better.

To prevent stretching the pouch:

• Eat only 3small meals each day to prevent overfilling of your stomach.
• Eat slowly so that the nerve receptors in your stomach area can relay the message to your brain that your stomach is full. It takes approximately 15-20 minutes for the message of fullness to reach the brain. Take time between bites of food and stop eating as soon as fullness is experienced.
• Recognise when you are full, which can feel like pain or pressure in the centre just below the rib cage, nausea, or a pain in your shoulder or upper chest. Stop eating at this stage.
• Constant nibbling, grazing or snacking, or consuming liquid calories (juice, flavoured coffee, ice-cream, soda, milkshake…) may not stretch your stomach pouch, but it will stop your weight loss and prevent you from reaching your target weight.

Undernutrition

Total food consumption is reduced after surgery, and therefore, intakes may be nutritionally inadequate.

To compensate for reduced nutrient intake:

• Consume a varied diet. Include foods such as lean meats, low-fat dairy, fruits and vegetables, and high fibre bread and cereals. Avoid foods such as carbonated drinks, crisps, pastries, sweets and fried foods.
• Take recommended supplements (multivitamin, calcium, iron and Vit.B12) every day.

Food Intolerance

Food intolerance varies widely and one individual may tolerate a food that disagrees with another person. Therefore, it is important to try a variety of foods. Each individual must try new foods carefully to test his or her reactions after surgery.

The following foods may be difficult to eat, especially for the first few months:

• Tough meats – dry, gristly meats may be difficult to digest
• Bread – fresh, doughy bread can form a ball and stick at the opening of the stomach.
• Pasta – pasta may form a paste and be more difficult to pass.

However, if you experience very frequent intolerances or intolerances with multiple foods, re-evaluate your eating behaviour (chewing well, eating slowly, drinks away from meals…).

Your Weight Loss Surgery Team wishes you a safe and healthy weight loss journey!