NUTRITION AFTER BARIATRIC SURGERY

·       High-calorie foods and beverages should not be consumed.

·       For this reason, all food and beverages eaten must be registered.

·       All portions should be measured.

·       Supplements such as Ensure, Boots, etc. should be avoided for a long time.

·       It should only be used by adding low-calorie cereal to milk without oil.

·       In addition to skimmed milk, only low-calorie beverages should be consumed.

·       Excessive physical activity should be avoided.

PROTEIN – MUST BE A NECESSARY PART OF DIET!

WHAT IS PROTEIN?

Protein is responsible for the care and continuation of all tissues and structures that use nutrients. It contains protein in muscle, bone, organs, hair and skin. In order to stay healthy, an adult woman should take 50-60 g of protein per day, and an adult male should take 60-70 grams of protein per day. After surgery, a minimum of 60 g of protein should be taken per day.

The best sources of protein are: lean meat, chicken (poultry), fish, milk, dairy products, low-fat peanut butter, dried beans and eggs. Low-fat everyday products that can be used: lean bird meat, white or red poultry meat (except skin), eggs and egg substitutes.

Frying should be avoided when preparing meals.  This means extra fat and can cause discomfort. Baking, grilling, scalding should be preferred instead of frying. In addition, low-fat or lean products should be preferred as much as possible.

PROTEIN SUPPLEMENT

PRACTICAL METHOD: Protein supplement should be less than 200 kcal, carbohydrate should be less than 20 gr, protein should be at least 15-20 gr.

These products should be used instead of meals.

 *NOTE: Your dietitian determines the product that is suitable for you for protein supplementation. Ask a dietitian or surgeon before using any product.

WHAT IS CAFFEINE?

Caffeine is a stimulant and naturally found in more than 60 herbs; Including cocoa, tea and coffee. Caffeine is also added to soft drinks, over-the-counter medications, and dietary supplements including protein powders and beverages.

Caffeine momentarily speeds up the heart, increases energy and is often used to combat fatigue. Caffeine acts as a diuretic, which means dehydration. As a result, caffeine can leave you dehydrated if used as a main source of fluid intake.

The recommended daily amount of caffeine is 300 mg or less than 90-150 g cup of coffee.

However, it is best to avoid caffeine after the operation. For every 240g of caffeinated beverage, you must add 240g of decaffeinated beverage. If you continue to take caffeine after surgery, it will be very difficult to reach the target amount of fluid. If you continue to have a very high caffeine intake in your diet, you should gradually reduce your caffeine intake until surgery. It will help to avoid headaches in quitting caffeine.

SOME GENERAL CAFFEINE CONTAINING FOODS AND BEVERAGES

VITAMIN AND MINERAL SUPPLEMENTS REQUIRED AFTER BARIATRIC SURGERY

After gastric bypass or sleeve gastrectomy surgery, the patient needs to take supplements to meet certain vitamin and mineral needs.

Deficiencies were observed in patients when no supplement was taken after surgery. The most affected nutrients were iron, vitamin B₁₂, Ca and vitamin D.

All required supplements are listed below. It is available without a prescription at local pharmacies. If you have any difficulties finding or tolerating supplements, consult your dietitian or surgeon for advice.

If the required daily dose of vitamin D₃ has not been taken (50,000 Iu).

WHAT IS MANDATORY SUPPLEMENT AND WHY SHOULD WE TAKE IT? 

MULTIVITAMIN:

· Choose the powder version, not the gummy version

Getting enough multivitamins helps you meet your micronutrient needs.

VITAMIN B₁₂:

It can be taken daily as 1000 mcg sublingually or in pill form.

It can be taken as a monthly injection with a prescription from your surgeon.

Vitamin B₁₂ aids in blood cells, nerve function, digestion and absorption of nutrients, and protein synthesis. As a result of the deficiency of the vitamin, it causes types of anemia.

IRON:

·        Take iron as a supplement of 18 mg daily as a multivitamin.

·        Iron can be found in any of the following forms: ferrous fumarate, ferrous sulfate, or ferrous gluconate

·        Iron is very important for the red blood cells that supply the whole body with oxygen.

·        Each iron supplement should meet all of your daily iron needs.

INTERACTIONS: You should take calcium 1-2 hours before or after taking iron. Do not consume milk, eggs, cheese, whole grain bread and breakfast cereals with iron.

·        Iron can cause diarrhea or constipation.

CALCIUM CITRATE WITH VITAMIN D:

·        1000-1500 mg should be taken daily. The best absorption dose of calcium is 500-600 mg at a time.

·        Calcium citrate form is better absorbed than other forms because it does not require stomach acid to be absorbed.

·        Ca and vitamin D supplementation is important for bone strengthening, helps the heart pump and repairs soft tissue.

INTERACTIONS: Caffeinated products, spinach and whole grain products may reduce absorption.

·        Calcium reduces iron absorption when iron is taken at least 1-2 hours before or after taking calcium.

VITAMIN D₃:

·        If the weekly maximum dose of vitamin D₃ is not taken, take the tablet form of 2000 IU daily (50,000 IU).

·        Vitamin D helps the absorption of calcium and phosphorus, which are necessary for the proper growth of the body and the development of bones and teeth.

WHAT IS THE OPTIMAL SUPLEMENT AND WHY SHOULD IT BE TAKEN?

STOOL SOFTENER

·        If needed, it can be taken daily or on the 3rd day to manage constipation.

BIOTIN

·        It is taken before and after the operation to prevent/reduce weight and hair loss.

You don't have to take chewable supplements. Some patients may tolerate this better as they progress with the diet.

With a regular diet, the capsule can be better tolerated.

PHASE 1

Clear Liquid Diet (For hospitalized patients only)

1. After the operation, no food or liquid should be consumed until the surgeon and nutritionist approve.

2. Liquids to take, when appropriate: unsweetened apple or grape juice, unsweetened gelatin (non-red)* or decaffeinated** tea. Drink 30 ml of liquid per hour. If you can tolerate 30 ml of fluid per hour, you can increase your fluid intake to 60 ml per hour. If you have nausea, the amount of fluid taken per hour is reduced to 30 ml.

3. When you go home, you can take as much fluid as tolerated. You do not have to continue to drink 2 measures (60 ml) of liquid per hour. Stop when you listen to your body and feel full.

4. Drinks should be drunk slowly. *Pipette should not be used.

5. There may be liquids offered to you in large quantities. You don't have to finish everything. Stop when you feel full!

6. It is normal to experience nausea and vomiting for the first few days after surgery. Drink fluids slowly. If you experience nausea or vomiting, talk to your nurse.

**Caffeine should be avoided after surgery, because caffeine is a diuretic. This causes fluid loss and upsets your fluid balance.

*** If you use a straw after the operation, you will cause air to escape into your stomach. This will make you feel full, your stomach will have less room for liquids, and your fluid balance will be less than it should be.

PHASE 2

FULL LIQUID DIET (2 WEEKS)

1. On discharge from the hospital, a full liquid diet is started.

2. It is applied for 2 weeks unless otherwise stated by the dietitian.

3. Drink fluids slowly to prevent nausea and vomiting. You can drink ¼ cup (60 ml) per meal or more protein source liquid if you can tolerate it within 30 minutes. You don't have to finish them all. Stop when you feel full!

4. Drink at least 6-8 glasses of water or low calorie and high protein drinks at the same time. Avoid carbohydrates, caffeine, and citrus fruits.

5. Take the prescribed Multivitamin/mineral supplements and calcium as instructed.

6. Keep track of the type and amount of protein in your high protein drinks. You should get a minimum of 60 grams of protein per day.

Examples of the protein content of foods on the Whole Liquid Diet:

-        1 cup skim or 1% fat milk = 8 g protein

-        1 cup Soy milk or low-fat lactose-free milk = 8 g protein

-        1 cup of low-fat creamy strained soup (excluding tomato, mushroom or corn kernels) = 8 g protein

-        Supplements recommended by the Surgeon and Dietitian

PHASE 2 FULL LIQUID DIET SAMPLE DAILY MENU

 Below is a sample daily menu you can make when you start a full liquid diet. This menu includes 60 g of protein and 6-8 cups of liquid. Portions may vary for each individual. Your meals should not be less than 30 minutes.