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NUTRITION AND DIETARY INFORMATION FOR SLEEVE GASTRECTOMY SURGERY DIETITIAN: ____________________ CONTACT NUMBER: 9272 0408 Suite 1A, Level 2, Mercy Medical Centre, Ellesmere Road, Mount Lawley WA 6050 Telephone: (08) 9272 0400 Fax (08) 9370 9732 Email: [email protected] Website: www.mercybariatrics.com.au DIETARY PROGRESSION POST-SURGERY Following Sleeve Gastrectomy Surgery, it is important to follow a modified diet for the first six weeks. This diet will ensure that your body heals and adapts to the changes in stomach size and digestion. You will start with a liquid diet and progress through a range of textures and thicknesses until you are back to regular foods. LIQUID DIET A liquid diet should be followed for TWO WEEKS following your surgery. There are two components to the liquid diet, the clear fluid phase and the nourishing fluid phase. Avoid ALL solid foods during the liquid diet Increase the quantity of fluid slowly. Start with small sips (max. 50mls) Wait to see if you feel any discomfort If no discomfort, begin slowly sipping again If you feel discomfort or start to feel full, do not drink again until the feeling has passed It can take up to 30 minutes to get through one cup of nourishing fluids Progress through liquid stages gradually, starting with small trials of liquids until you feel comfortable CLEAR FLUIDS A clear fluid diet should be followed for the first 2-3 days post surgery Clear fluids are fluids that easily pass through a straw Examples include juice, milk, clear broths or decaf tea or coffee NOURISHING FLUIDS A nourishing fluid diet should be followed from approximately day 3 post surgery After the clear fluid phase you will begin to increase the thickness of fluids as tolerated The nourishing fluids provide enough protein, energy, vitamins and minerals during required to help you recover post surgery The table below describes what nourishing fluid and how much of the nourishing fluid you will require EACH DAY How much each day What to start with (initial) Protein 2 cups Dairy ½ - 1cup Fruit ½ cup Vegetables ½ cup Optifast or Optislim Low fat ice cream Fruit juices V8 vegetable juice Ensure Nutritional Supplement Low fat milk (can be flavoured with Milo) Sustagen Sanitarium Hospital Formula Up and Go What to Pureed Yoghurt progress to meat/chicken/fish when based soups comfortable Low fat (progression) custard Notes Avoid citrus as they can aggravate reflux Pureed fruits Packaged puree fruit tubs Prepare meat/chicken/fish + vegetable soup prior to surgery. Freeze small portions. Defrost and puree to desired thickness Pureed vegetable soups Pureed vegetables If you have pre-prepared a pureed meat and vegetable soup, this equals a protein and vegetable serve This will total 1L of nourishing fluid. You require a minimum of 1.5-2 L of total fluid each day. You will need to drink 0.5-1 L of other fluids to reach this. OTHER FLUIDS In addition to nourishing fluids, you will 0.5-1L of extra fluid per day To reach the desired 1.5-2L of fluid, sip on the following options between meals. Aim for one litre of: Water – can add lemon or low joule cordial Tea/Coffee/Herbal Tea Bonox Sample Nourishing Fluid Meal Plan – initial Meal Breakfast Lunch Dinner Snacks x 2 Option 1/2 cup low fat milk Optifast shake Optifast shake ½ cup fruit juice ½ cup V8 juice Nutrient Dairy ½ cup Protein 1 cup Protein 1 cup Fruit ½ cup Vegetables ½ cup Sample Nourishing Fluid Meal Plan – progression Meal Breakfast Lunch Dinner Snacks x 2 Option ½ cup yoghurt + 1-2 tbsp pureed fruit 1 cup meat and vegetable soup 1 cup chicken and vegetable soup ¼ cup tinned fruit ½ cup Sustagen Nutrient Dairy ½ cup Fruit ¼ cup Protein ¾ cup Vegetables ¼ cup Protein ¾ cup Vegetables ¼ cup Fruit ¼ cup Protein ½ cup Quantities are a guide only; consult your dietitian if you have any concerns regarding the quantities you can manage Shopping list 1. Multivitamin You will require a multivitamin supplement to help you achieve your recommended dietary intake of nutrients. The multivitamin must contain adequate iron, zinc, magnesium and other minerals to maintain your nutritional status long term. We recommended Elevit – 1 per day in the morning. There are also chewable bariatric specific multivitamins that are available for purchase at Mercy Bariatrics, or online. These require 2 tablets to be taken per day. 2. Benefibre Benefibre can help with both constipation and diarrhoea, which can occur due to the lack of solids or adequate fibre in the diet. You need to drink at least 1.5L of fluid/day for Benefibre to work. Take Benefibre only when required - 2 tsp / day or as tolerated Difficulty Drinking after Surgery In some cases, the swelling associated with having surgery may make it difficult to drink and keep fluids down. The following strategies can help you to maximise your fluid intake. Begin with small amounts of fluids, 40-50ml over 30 minutes, and build up your intake as you feel comfortable. Sit upright when drinking. If you are able to, walk around between drinks, to aid digestion. Water can be difficult for some people immediately after surgery. A small dash of juice or slice of lemon can make water easier to tolerate. Trial different temperatures. You may find cold or hot beverages work better than those at room temperature. Choose very thin fluids to start with as they will be easier to manage. Reduce the thickness of thicker fluids by diluting with milk, water or ice. Aim for a minimum of 1.5L total fluids over the day. This will include fluids such as jelly, soups, juice and other nourishing liquids. If you are struggling to achieve the required fluid quantities, try freezing nourishing liquids into icy-pole form and sucking on these slowly over time. In some circumstances, rehydration solutions, such as Hydralyte, may be beneficial to increase hydration. If you are concerned about your fluid intake, speak to your Bariatric Surgeon or Dietitian regarding further strategies to increase your fluid intake.