NUTRITIONAL STEPS AFTER BARIATRIC SURGERY

Although it varies from patient to patient after the surgery, they start eating at normal standards approximately 2 months later. This transition is achieved in stages. Differences can be observed in the foods consumed, as well as in the transition period of the post-operative stages. Transition between stages should be made under the control of a doctor and dietician.

1. Phase: Clear Liquid Diet (2-3 days)
2. Phase: Liquid Diet (week 1-2)
3. Phase: Puree Diet (Week 3-4)
4. Phase: Soft-Strict Diet (Week 5-8)
5. Stage: Standard Diet (week 9 and beyond)

1. PHASE: CLEAR LIQUID DIET

The first stage of postoperative nutrition is a clear liquid diet. It provides the body with fluid, electrolytes and a limited amount of energy. It also initiates intestinal activity after surgery. It is recommended to use a clear liquid diet for 1 and 2 days (while hospitalized). By gradually increasing the stomach volume, fluid consumption of approximately 2 liters (8-10 glasses) should be reached, half of which should be water. Start consuming sip by sip and increase as tolerated, provided that it is not more than half a cup per serving. Liquids should not be too hot or cold and should be suitable for body temperature. Avoid using straws at this stage, swallowing air may upset the stomach.

Recommended clear liquids:

✅Water

✅Light tea

✅Grain-free and sugar-free compote juice

✅Freshly squeezed and diluted fruit juice (except citrus juices), 100% diluted fruit juice

📌 30 ml (3 tablespoons) of the recommended liquids should be consumed in 15 minutes.

2. PHASE: LIQUID DIET

Depending on the checks to be made after the surgery, a liquid diet is applied for approximately 2 weeks. The liquid diet has a higher fiber content than the clear diet and meets the patient's energy and nutritional needs more. The most important goals of the nutritional therapy applied at this stage are to provide appropriate hydration (fluid support) and protein .

Goals of the phase:

• The primary goal is to reach 2000 ml (8-10 glasses) of liquid consumption per day. It should be consumed in small amounts and by sipping. Half of the liquid requirement should be met from water.
• 60-80 grams of protein should be consumed per day.
• Consumed liquids should not be too hot or cold.
• Food should be consumed at intervals of 2-3 hours, 3 main and 3 snacks. Each meal should contain approximately 120-250 ml (1 glass) of liquid and approximately 1-1.5 hours should be spent for each meal.

Recommended Liquids and Semi-Liquids;

✅ Protein powders (meal powders containing protein, vitamins and minerals)

✅Fat-free and lactose-free milk, Kefir, Soy/almond/rice milk, Probiotic milk and yoghurt

✅ Fat-free and grain-free soup, lean meat and chicken broth

✅Water, Light tea, linden, sage

3. PHASE: MASHED DIET

Puree diet lasts about 2 weeks. At this stage, it is aimed to start meeting the nutritional and energy requirements of the patient through nutrition, but since sufficient consumption cannot be achieved, especially in the first days, it should be supported with nutritional supplements.

✅ Protein powders (meal powders containing protein, vitamins and minerals)

✅Fat-free and lactose-free milk, Kefir, Soy/almond/rice milk, Probiotic milk and yoghurt

✅ Fat-free and grain-free soup, lean meat and chicken broth

✅Water, Light tea, linden, sage

✅Low-fat cottage cheese, Eggs, egg white and egg substitute (Egg white should be consumed first for 1-2 days, then boiled eggs should be added to breakfast. Consuming one egg every day should be practiced throughout life)

✅Mashed vegetables that are well cooked and do not cause gas and bloating (such as zucchini, broccoli, spinach, green beans, eggplant, carrots), Mashed potatoes

✅Water, Light tea, linden, sage

✅Oatmeal, Whole wheat and rye flours, Low-fat red meat, poultry and fish puree or minced meat

4. PHASE: SOFT-SOLID DIET

The soft diet phase varies between individuals and lasts approximately 3-4 weeks.

Recommended soft foods:

✅ Protein supplements ( meal powders containing protein, vitamins and minerals)

✅ All nutrients in the puree diet phase

✅ Rice, pasta, non-fibrous and soft fruits

5. PHASE: STANDARD DIET

At this stage, foods of normal consistency should be consumed and nutritional diversity should be provided according to tolerance. However, what is meant by normal foods should not be old eating habits. It should not be forgotten that one of the most important points in achieving successful results in bariatric surgery is making changes in lifestyle and not regaining the weight lost.

Nutrient Deficiency :

Some foods are restricted in the 2-month post-operative period. Therefore, protein, vitamin-mineral and energy deficiencies may occur. Vegetables, fruits and whole grain products with high nutritional content should be consumed. Eggs with high biological protein value, skim or low-fat milk and meat should be preferred. Foods such as chocolate, sugary foods, and carbonated drinks should not be consumed, as they are empty energy sources and may cause weight gain. Protein, Vitamin and Mineral deficiency should be supported with nutritional supplements.

Meal Powders with High Protein Content; It can provide nutritional support after bariatric surgery as a supplement with rich nutritional content such as protein, vitamins, minerals and dietary fiber.

Source:

1. BARIATRIC SURGERY GUIDE, Turkish Endocrinology and Metabolism Association 2019
2. OBESITY SURGERY AND AFTER, Dietician Ayşenur KADEMLİGİL Prof. Dr. Volkan GENÇ, ANKARA UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF GENERAL SURGERY