6. What Have I Gotten Myself Into?

The first “diet class” I attended as a requirement of having bariatric surgery left me feeling overwhelmed. But I was armed with information. Lots and lots of information. And I had a plan to prepare for the surgery and afterward.

Nutrition

The first thing to note is that there isn’t just one set of rules to follow when you have bariatric surgery. Each surgeon has different program requirements. My surgeon has a nutrition on staff who has developed a nutrition, exercise, and vitamin regimen to meet your pre- and post-operative health requirements. Your Mileage May Vary.

Also note: I am not including the requirements for diabetics because I do not feel qualified to address those specific concerns. If you are diabetic, there are additional considerations to take into account.

Two weeks before surgery: liquid diet

In the two weeks leading up to surgery, you are required to follow a liquid diet. This allows your liver to shrink so the surgeon can have easy access to your stomach.

Essentially, your main source of nutrition during this period is protein drinks (four per day, at least 64 ounces). In addition, you can have unlimited clear liquids, including Crystal Light, black coffee or tea, water, sugar free jello, 99% fat free broth, and any other calorie free liquid. No carbonated drinks or sugar is allowed.

After surgery

According to my doctor, you will not be released from the hospital unless you can tolerate 2 ounces of water without nausea, vomiting, or cramping.

Days 1-2 post-op: clear liquids

The goals here are:

  • Stay hydrated (48-64 ounces of liquid).
  • Aim for 60 grams of protein per day.

At this point, it’s important to sip a small amount of liquid every 15 minutes. In addition, protein is critical for maintaining muscle mass and keeping your skin, nails, and hair healthy.

No: caffeine, carbonated drinks, high-sugar liquids, straws, or gum.

Days 3-5: clear liquids + 2 protein shakes

Goals:

  • 48-64 ounces of liquids per day
  • At least 60 grams of protein each day
  • Two protein shakes per day

Days 6-13: full liquids

Goals:

  • 48-64 ounces of liquids per day
  • At least 60 grams of protein each day
  • Additional liquids

During this week, the idea is to add in more liquids that you can tolerate, including low-fat or nonfat dairy, protein shakes, low-fat or fat-free soy/almond milk, and low-fat or fat-free soups.

Days 14-21: puree

Goals:

  • 48-64 ounces of liquids per day
  • At least 60 grams of protein each day
  • Bariatric multivitamins, iron, calcium citrate, Vitamin D, etc.
  • Pureed foods (consistency of baby food)
  • 3 small meals a day, every 4-5 hours
  • High-protein snacks if needed

During this week, meals should be 1/4 cup to 3/4 cup at most. In addition, you’ll be starting to consume foods and drinks that you should be choosing for the rest of your life. First, proteins, then vegetables, then fruits, then grains/starches (if you have room). At least half of each meal should be a high-protein food.

Drinks should not be consumed within 30 minutes of your meal (before, during, or after). Liquids will fill up your stomach, but for a short period of time, and you want the food you eat to be absorbed properly instead of being full from drinking.

It is important to learn to eat slowly and to stop eating when you feel full.

Days 22-29: soft

Continue with the same goals as above, but introduce soft foods, such as fish, ground meat, eggs, and beans. Foods to be avoided include rice, breads and cereals high in fiber, raw/fresh vegetables, fresh fruits with skins, fried foods, tough or dry meat, nuts, and seeds.

Day 30+: healthy solid food

Here is where you graduate to solid foods, but remembering the principles learned above. Starchy foods should be limited. Protein is king (2-4 ounces per meal), and vegetables are critical for getting the nutrients you need.

Vitamins

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Taking bariatric vitamins for life are critical to avoid malnourishment. Bariatric surgery changes the amount of vitamins and minerals you can absorb from food, and over-the-counter multivitamins do not contain enough of the right vitamins that bariatric patients require. While your nutritionist will counsel you on the vitamins to take, here are some takeaways:

  • Bariatric multivitamin with 36-60 mg iron
  • 500 mg calcium citrate with vitamin D3
  • Biotin 5,000-10,000 mcg for hair health

Exercise

A lifelong habit of physical activity is critical to maintain a healthy weight–and more importantly–feel fit. Goals include:

  • 30 minutes per day, five or more days per week of moderate-intensity exercise
  • Strength training at least twice per week

Aerobic exercise improves heart health. Three to five days per week, for at least 20 minutes each day. This includes brisk walking, biking, jogging, elliptical, and swimming.

Resistance exercise increases muscle mass and metabolism, and decreases fat mass. Three days per week. On different days, focus on different muscle groups: abdomen, legs, and arms.

Stretching increases flexibility and avoids or lessens injuries. Stretch for a brief period before exercise, and then for an extended period after exercise. Be sure to stretch your calves, hamstrings, shoulders, and triceps.


I hope this is helpful to give you a general idea of what to expect. In future posts, I will share some of the steps I am taking to get ready for surgery and afterward.

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