The "Rules of WLS"...Dare to compare?
I've noticed that the "rules" of WLS vary widely depending on your doctor. I thought it might be interesting to compare what some of us post-ops are following, as well as informative for those who are still thinking about surgery and wanting to know in detail what eating will be like after surgery. Where I had my surgery at Duke WLS in North Carolina, the post-op diet consits of four stages. Below is the instructions for RNY gastric bypass post-ops from their online patient manual found at http://www.dukewls.org
Since I am ten weeks out I am currently on Stage 3 - soft foods. I won't transition to the final stage until I have my three month follow-up appointment and group session with the nutritionist and psychiatrist in early July. So far I have been able to folllow the instructions pretty well. The first few weeks were a bit difficult trying to get the fluids in, but since then it has been pretty smooth sailing. If you're "rules" differ, I would like to know how and why if you know.
On the day after surgery, if your swallow study is OK, you will begin sips of water (1 oz. each hour while you are awake). Please do not use straws or drink carbonated beverages, as these will cause you to swallow more air/gas, which is poorly tolerated and uncomfortable. You will start with small amounts of water to avoid overfilling your new stomach and possibly tearing your sutures, and to test that it empties well. If you tolerate water, the next day you will be advanced to the Stage 2 diet that consists of 2 oz. (2 medicine cups) of a high protein nutritionally complete fluid each hour while awake (your choice of Boost, Boost Plus, Choice DM, Skim milk or Carnation Instant Breakfast with Low fat milk). In addition to the protein liquid, if tolerated you may have 2 oz (2 medicine cups) of a non-carbonated, non-caffeinated beverage (water, decaf tea, or decaf coffee) every 15 minutes for a total of 8 ounces (8 medicine cups) per hour.
STAGE 2: Modified Full Liquids
When you go home:
Starting on the day you go home from the hospital, you should drink 2 oz. (60 ml) of a high protein liquid every hour, on the hour, while you are awake. This must be a nutritionally complete liquid, which is something that would pass through a standard strainer. In addition, if you are thirsty, you can have another 2 oz. of any non- carbonated, non-caffeinated, liquid every 15 minutes after the hour. This liquid should not be high calorie and can be with or without protein.
Your first priority is to drink enough fluid to prevent dehydration; protein is a secondary priority. You should drink a total of 6-8 cups of fluid each day to avoid getting dehydrated. This will take some effort on your part because you may not feel hungry or thirsty at first. For best tolerance, do not use straws, take small sips, and start with room temperature liquids.
Sample Meal Schedule
8:00 a.m. - 2 oz Boost High Protein 8:15 a.m. - 2 oz water (optional) 8:30 a.m. - 2 oz beverage (optional) 8:45 a.m. - 2 oz water (optional)
You should choose a high protein drink with no more than 30 grams of sugar and at least 10 grams of protein in an 8 oz serving.
PROTEIN:
Protein is essential to aid in healing and healthy weight loss after surgery. It may also help avoid (but not necessarily prevent) hair loss associated with rapid weight loss. Try to consume at least 45-60 grams of protein per day.
STAGE 2: Modified Full Liquids (continued):
Due to the change in size and function of your stomach you will need to take a complete vitamin/mineral supplement every day. For the first three weeks post op your multivitamin will need to be chewable or liquid. We suggest you start with an adult chewable vitamin such as Centrum Chewable (take one daily) or Children’s Flintstones (take two daily). Thereafter you can change to an adult complete multiple vitamin with minerals (ex: Centrum Advanced Formula, One-A-Day Maximum). You can take generic equivalents but be sure to compare the contents to the recommended vitamins to make sure they have adequate nutrients of at least 18 mg of Iron, 15 mg of Zinc, and 400 mcg of Folic Acid.
After the first month you will need to add a calcium supplement as well. Calcium Citrate is the preferred form of calcium since it is better absorbed. You will need to take 1200 mg of Calcium daily. For best absorption take no more than 600 mg of calcium at one time (ex) 600 mg in the a.m. and another 600 mg at bedtime (Citracal, or Bariatric Advantage Chewable Calcium Citrate from www.bariactricadvantage.com are acceptable options).
Follow up:
At your three-week follow up clinic visit you will have a diet advancement class with the program Dietitian. In this class you will learn how to successfully incorporate soft solid foods back into your meal plan.
*Please do not start solid foods until after your three-week clinic visit!
During your 3-week clinic visit, you will have an hour session with the Nutritionist to explain how to add these new foods. Please do not begin STAGE 3 on your own before this visit. You will slowly begin adding soft foods to your meal plan over the next 6 – 8 weeks. After your new pouch tolerates the soft foods you can add easily tolerated solid foods to your meal. Remember your new stomach is still healing so treat it gently.
During this phase, you must still focus on high protein foods and avoid foods that are high in fat, sugar, or fiber. You will probably still need to get some of your protein from supplements until you are able to eat enough solid food to meet your nutritional needs, (see the list of protein supplements on page 2). Getting enough protein in your diet will help you stay healthy and maintain your muscle mass as you lose weight. During meals, eat the high protein foods first; making sure you fit them in. You will be instructed to add only one new food at a time and observe your reaction to it. If you do not tolerate a food well, the problem may be with the food itself, how you prepared it, or the way you consumed it. Please see page 5 for tips on making your diet progression and weight loss successful.
Learn to recognize when you are full. Indications of fullness may be a pressure or fullness in the center of your abdomen just below your rib cage or feelings of nausea, regurgitation or heartburn. Please stop eating when you feel full.
If you have a problem with vomiting, it is most often the result of eating inappropriately and rarely a complication of surgery. Common eating related causes of vomiting are: eating too fast, not chewing food properly, eating too much food at once, eating solid foods too soon after surgery, drinking liquids either with meals or right after meals or eating foods that do not agree with you.
Following are lists of foods allowed and those to be avoided for Stage 3 of your diet progression. The foods on the avoid list are there because most patients don't tolerate them for the first 2-3 months after surgery. Some patients do tolerate these foods, but it is best to start with the foods on the allowed list. Once you have learned how to eat with your new gastric pouch and have healed from surgery, you can start to add other foods one a time over the next few months. If you follow these suggestions you should transition to solid foods and lose weight successfully!
Remember, your gastric bypass surgery is a crutch to help you lose weight, but it is not magic. If you overeat or eat mostly high calorie foods or beverages this will reduce the amount of weight you lose. Try to eat protein-dense foods to get the most nutrition from the smaller amount of foods you will be eating.
Congratulations, you made it to STAGE 4. It is now 10-12 weeks post surgery and you are ready to progress from soft solids to regular consistency foods. Below you will find some tips on how to transition from soft foods to solid foods. Remember you will begin to try solid foods one at a time, to test your tolerance to them. Do not worry if you cannot tolerate or do not want foods you used to eat. Most people experience some problems at first, especially with meats and breads. Most people find it easier to tolerate seafood first, ground or tender cooked pork and beef next then ground or tender cooked poultry. Eventually, you will probably be able to eat most of what you were eating before surgery, only in much smaller amounts. A few patients become vegetarians. Overall you should be making healthy food choices including lean meat or vegetable protein, low fat dairy, incorporating fruit and vegetables as you are able; and avoiding empty calorie or “junk” foods as they are typically high in fat and sugar. Remember you must be very careful with foods or beverages high in sugar as they may cause the Dumping Syndrome.
Long term, patients must choose foods with good nutritional value. Each meal should have at least 3 ounces of protein (such as eggs, cottage cheese, fish, poultry, beans, meat, or tofu). Learn to read food labels and limit fat and sugar intake, choose low fat (5 grams or less per serving), low sugar (5 grams or less per serving) and lean protein foods. The volume you can tolerate will always be limited so choose foods wisely to avoid filling up on foods with little nutritional value.
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I had the DS, and the rules are a bit different (thats the why)..... The first 2 weeks I was on purees, week 3 I was on soft foods, and week 4 I was on solids. There are really very few rules at this point, basically: 1) take all my suppliments (2 multis, 1200 mg of calcium citrate, Extra Vit D, and A) 2) Eat at least 120 grams of protein (although since i started weight lifting I've been trying to get in 150-200 grams) 3) Limit simple carb intake during the weight loss phase. I stayed below 100 grams of carbs during the 1st 6 months and below 150 grams for the first year. 4) Fat is your friend. It sounds "anti-weight loss" but fat actually helps a DSer break plateaus and keep regular Thats basically it in a nut shell. Scott
on 6/7/07 9:31 am - Houston, TX
