Purpose behind the Post-Op Diet Stages

[KevinS62 73]

I'd like to know the reasons/purposes of the post-op diet and the different stages. I am following my instructions exactly. I think. I hope I'm doing it right.

Now, likely all y'all know that a clear liquid diet sucks. The guide I was given says I have to be on the clear liquid stage for week 1 and I have 2 days left. But I have heard others only having Clear Liquids for 1-3 days. I'm doing well and I'd like to try a few things that are on my list for week 2 if it isn't going to hurt me. Which leads me to the question. What is the purpose of the clear liquid diet? Am I on a clear liquid diet to allow my new sleeve stomach to heal or is it so I won't have issues with reflux, heartburn, nausea or gas? If I knew, maybe I'd try a little of the food from the next stage. Or at the very least, not worry as much when I try to decide if my Soup is as clear as it's supposed to be.

In two days I graduate to a week 2 full liquid diet. The guide doesn't use the word puree', just full liquid. Is this the same thing or no? According to the guide I can add cream Soups (strained). premade Protein Shakes, sugar free pudding, V8 Tomato juice, low fat yogurt and Fat free milk. This is much better than week 1, but by the end of week 2, I know I'm going to start looking ahead to week 3 and want to try something from it.

Week 3 is really not much different. Just adding bananas and oatmeal. But I can add unsweetened fruit to my smoothies. And, then I see this. NO GRITS & NO POTATOES. Really? Don't just say I can't have it without telling me why. What harm is going to come from potatoes, other than carbs/calories?

In week 4, I am finally allowed to have cottage cheese. Not that cottage cheese is something I have to have, but I would love some right now with my clear liquids. I can also finally have well cooked Beans and veggies, as well as 2% milk. Then I see, NO RICE & NO GREEN PEAS. Why? Again, I assume its starches and carbs from the rice, but tell me why...

Week 5 I can finally have a scrambled egg.. Finally I can have an egg? In week 6 I can finally baked fish. Why not week 5? And then they say, NO HONEY & NO DRIED FRUIT. Why?

Again, this is mostly my curiosity. But it frustrates me that they did not give me much (any) background information. I will continue following the guidance they gave me, I mean I'm dropping weight daily so it's working. But when I go to my follow-up appointment next Tuesday, I'm going to bring up some of these specific questions.

I know this was a long post, but if any of you can shed some light on any of the questions I have, please feel free.

Edited July 19, 2022 by KevinS62

[liveaboard15 1,293]

The whole reason is to let your new stomach heal. You just had major surgery and your stomach was basically cut up and stapled. It needs time to heal from all the cuts and inflammation. Eating solids right away after surgery stresses your stomach out and you can potentially cause a perforation. But every surgeon is different in regards to pre op and post op diet... For me it was 2 weeks of liquids only after surgery which i did to the letter. after that i moved onto small foods on week 3 which was scrambled eggs and canned tuna. and i ate very small amounts at a time. Some cant handle soft foods yet so soon. I am currently 3 months post op and i can eat anything i want without issue. Let that stomach heal properly and you shall be rewarded lol

[Sleeve_Me_Alone 656]

The primary functions are 1) to allow time for your surgical wounds to heal (this was MAJOR surgery, you don't want to push it) 2) to slowly integrate foods to prevent sickness/overeating 3) to allow time for you to learn your new body and adjust to your new eating habits. That being said. every surgeon has their own pre- and post- op diet requirements and there is no use comparing one to another. The ASMBS does not have hard and fast recommendations on the food plans, so surgeons are left to devise their own and they can vary wildly. Mine were both extremely restrictive, with the pre-op lasting 2 weeks and post-op being 8 weeks.

Regarding the WHY of what you can/can't eat and when, reach out to your nutritionist and see if they can provide some insight on what they recommend what they do. We could all speculate, but ultimately, that guidance is coming from your team an thus the justification should as well.

[Nepenthe44 188]

Asking the specific why questions is bound to leave you extremely frustrated, because the truth is that these plans, even more than most of medical practice, aren't well-studied and are pretty arbitrary. A lot of guidelines seem to be trying to outwit the assumed devious and/or stupid fatties, the sort of person who if given permission to drink coffee will drink a venti Carmel Salted Caramel mocha. So they tell everyone not to drink coffee.

I was previously seeking surgery from a program that disallowed steaming your vegetables in the pre-op diet---raw broccoli only!--presumably because then you might get the idea that you could have cooked vegetables in any form and cooked vegetables will probably be fried in oil or slathered with cheese sauce. Ergo, no steamed veggies for you, dumb fat person who thinks that cheese sauce doesn't contain any calories.

There's no way to tell which guidelines are based in actually demonstrated science, which are at based on a plausible mechanism, and which are just the random things that seemed to work for that particular surgeon or nutritionists' past patients. You can ask, I suppose, but I'd guess that they're not going to appreciate it, because most people in the medical field do like to think that they're doing evidence based practices, even when they're just... not.

And there's also no guarantee that the explanation is going to be the truth. The signpost I use to see whether a source is BSing is whether they claim that you need to drink only Water because caffeinated beverages are dehydrating. 1) It's not even plausible, since caffeine is a very weak diuretic so the net Fluid balance would be positive unless you're taking caffeine pills with just a sip of water. 2) It's actually been studied frequently since it's such a ubiquitous myth that's so easy to test, and found to be false, even with doses of caffeine much higher than typical consumption.

The reason you need to drink only water is so that you don't have permission to consume liquid calories and you can't be trusted not to consume liquid calories if you're allowed no-calorie liquids other than water... that's it.

Just jump through the hoops they want you to. Some of them are genuinely there to limit reflux or to keep you from ripping your internal stitches open and some of them are there because you can't be trusted and there's no telling which ones are which. It's just food.

Signed, a medical researcher for whom giving up the tea habit will be the hardest part of the process.

[Arabesque 7,335]

As everyone has said it is to support the healing of your tummy & not to stress & strain it. Remember all those sutures & staples holding your tummy together. Think how you would protect a large wound & sutures on your arm or leg & how long that would take to heal.

Purées are thicker which is why they are the stage after liquids. They should still be runny but not watery like the liquid stage. With soft foods think slow cooked, fall of the bone tender, minced meats, braised, etc. Foods that needs some chewing but not a lot. Think how much work your tummy has to do to digest thicker & then more solid denser foods.

Plans differ but they also have a lot of similarities too. Some surgeons, like mine, tailor the pre & post diets to their patient. Some have specific requirements based upon their experiences. The best advice is always to follow the one you were given. But of course you can ask your surgeon & dietician why your plan is as it is & you may be able to negotiate slight adjustments based upon your recovery & needs.

Yes, some plans recommend avoiding certain foods & liquids to not aggravate your healing. After surgery, we tend to produce extra stomach acid, hence why many are prescribed PPIs for a period after surgery. Carbonated drinks, caffeine, etc. can stir up the acid in your tummy causing discomfort & reflux symptoms.

We’re told to avoid foods like rice, Pasta & bread because they tend to swell in your tummy, filling you quickly. Remember your focus is on getting in your Protein & that can be challenging enough in the post surgical stages. These foods also have little nutritional value. Consuming nutritionally dense food is important while you can eat so little to ensure you’re getting in the Vitamins, minerals, etc. your body needs. While losing many of us are advised to follow the rule to eat your protein first, then vegetables as you can, then high fibre carbs only if you are able. If you can only eat 1/4 - 1/3 cup of purée & soft food to begin like I was, why eat food that fills you without giving you the nutrients your body needs. It also gets you starting to think about your food choices & the quality of the food you are eating. I still follow a lot of this: protein first, nutritionally dense foods, etc.

Foods like peas & potatoes are considered higher in sugar & in starch (which converts more quickly to sugar). They’re not included in Keto diets. Not saying you’re on a keto diet but you’ll notice influences from lots of different diets & eating styles on your food recommendations while losing.

The reason why we’re advised to avoid dried fruit is you tend to eat more dried fruit than you would eat them as fresh. We can easily eat several pieces of dried fruits but remember 2 dried apricots is 1 apricot, a prune is a plum. Their sweetness is concentrated too in their dried form so you are continuing to feed your desire for sugar. Same with juice. Honey is just another firm of sugar. This is an opportunity to break some of your food dependencies & cravings. For many of us lots of foods become super sweet & quite awful to eat too during these first months when our tastebuds become extra sensitive.

Many are able to go back to eating small amounts of restricted foods while losing or in maintenance. Personally I still don’t eat potatoes, rice, bread or pasta. I find them too heavy & I feel blah on the odd occasion I’ve tried them since I lost my weight. But that’s me.

The first months are the most challenging because the food you likely depended upon to comfort, soothe & make you happy has been taken away from you. So you think about & crave them more. But food doesn’t actually comfort you or make you happy you just think they do. Realising & understanding this is part of the head work we all have to do.

This whole process is about breaking poor eating habits, poor food choices & establishing new habits, introducing new foods, etc. & discovering what works best for you. The most restrictive aspects of the diet are only for a short period of time & are to benefit your immediate health & recovery. The long term changes you will choose to make are to enable you to maintain a lower weight & live a happier, more active & healthier life long term.

Sorry for the 10 000 word response.

[KevinS62 73]

17 hours ago, liveaboard15 said:

The whole reason is to let your new stomach heal. You just had major surgery and your stomach was basically cut up and stapled. It needs time to heal from all the cuts and inflammation. Eating solids right away after surgery stresses your stomach out and you can potentially cause a perforation. But every surgeon is different in regards to pre op and post op diet... For me it was 2 weeks of liquids only after surgery which i did to the letter. after that i moved onto small foods on week 3 which was scrambled eggs and canned tuna. and i ate very small amounts at a time. Some cant handle soft foods yet so soon. I am currently 3 months post op and i can eat anything i want without issue. Let that stomach heal properly and you shall be rewarded lol

Thanks for this. As I said, I am following my guide to the letter, but a little frustrated that things weren't explained better. And of course, I am anxiously looking towards when I can have small bites of soft food.

[KevinS62 73]

13 hours ago, Nepenthe44 said:

Asking the specific why questions is bound to leave you extremely frustrated, because the truth is that these plans, even more than most of medical practice, aren't well-studied and are pretty arbitrary. A lot of guidelines seem to be trying to outwit the assumed devious and/or stupid fatties, the sort of person who if given permission to drink coffee will drink a venti Carmel Salted Caramel mocha. So they tell everyone not to drink coffee.

Thanks for your response. I didn't quote your full response, but everything you said makes total sense to me. It's how I think, but could not put into words.

As I sit here sipping my black coffee (that does not count towards my daily 64 oz of liquid) one thing I remember from the meeting with the doctor's suggested dietician. She dealt in absolutes. I NEVER deal in absolutes. When she said "Never again" on things such as potatoes and rice, I wanted hold up my hand and say, Easy there." She was just going by the script and probably never really questioned anything.

Edited July 20, 2022 by KevinS62

[KevinS62 73]

7 hours ago, Arabesque said:

The first months are the most challenging because the food you likely depended upon to comfort, soothe & make you happy has been taken away from you. So you think about & crave them more. But food doesn’t actually comfort you or make you happy you just think they do. Realising & understanding this is part of the head work we all have to do.

Thanks for your informative response. It helps a lot and I wish that that my post-op diet could have been explained better. As I said in a previous response, I think the dietician follows the script and did not vary from it. When I asked questions, her answers were vague. Like she didn't know the answer or she didn't want to give me the full answer.

[KevinS62 73]

All - Thanks for the great responses. It gives me faith in this forum that I can ask a question and get real answers, without worrying about the negative crap and the shaming you might get in a Facebook group or other forums I have been in.

Today is my last day of my "Week 1 Clear Liquid" stage so I wait till tomorrow to choose a few items from my "Week 2 Full Liquid" stage. I'm still a week away from oatmeal and bananas. The clear liquid week, as sucky as it has been, did allow me to lose 10 lbs so far. So I'll call it a win.

Edited July 20, 2022 by KevinS62

[TayTay5889 2]

Hi Kevin! Dietitian here. You're correct in that much of this isn't researched and is anecdotal. Clear liquid stage is to help your stomach heal and prevent nausea/heartburn, everything you listed. If you feel like you're tolerating that stage fine, you can move on to the next. Just take baby steps.. start slowly sipping on a Protein Shake, if you do great try to add something else. If you start to feel queasy, take a step back for a day. It is all subjective and listening to your body. Some of the other things you asked about... corn/grits can be difficult to digest. I'd recommend trying that down the line, maybe 3+ months post-op. Small amount of potatoes is ok. The main concern is that it's just crucial to get your protein- so eat the potatoes last. As you know, you'll fill up on much less food way quicker, so you don't want to fill up on potatoes. Same thing with rice and peas. Rice can also expand in your pouch and make you feel uncomfortably full, so very small bites & chew very well. In our practice you can have scrambled eggs in the pureed stage. Dried fruit isn't advised bc it's a large amount of concentrated sugar- even if sugar isn't added to it. Honey digests the same as white sugar- so you want to avoid, or minimize, it to prevent dumping syndrome. For fish... if you're tolerating other "soft" foods fine, I don't see why you couldn't introduce it sooner. As long as it's tender & flaky. I hope some of this helps!

[KevinS62 73]

3 hours ago, TayTay5889 said:

Hi Kevin! Dietitian here. You're correct in that much of this isn't researched and is anecdotal. Clear liquid stage is to help your stomach heal and prevent nausea/heartburn, everything you listed. If you feel like you're tolerating that stage fine, you can move on to the next. Just take baby steps.. start slowly sipping on a Protein Shake, if you do great try to add something else. If you start to feel queasy, take a step back for a day. It is all subjective and listening to your body. Some of the other things you asked about... corn/grits can be difficult to digest. I'd recommend trying that down the line, maybe 3+ months post-op. Small amount of potatoes is ok. The main concern is that it's just crucial to get your protein- so eat the potatoes last. As you know, you'll fill up on much less food way quicker, so you don't want to fill up on potatoes. Same thing with rice and peas. Rice can also expand in your pouch and make you feel uncomfortably full, so very small bites & chew very well. In our practice you can have scrambled eggs in the pureed stage. Dried fruit isn't advised bc it's a large amount of concentrated sugar- even if sugar isn't added to it. Honey digests the same as white sugar- so you want to avoid, or minimize, it to prevent dumping syndrome. For fish... if you're tolerating other "soft" foods fine, I don't see why you couldn't introduce it sooner. As long as it's tender & flaky. I hope some of this helps!

Just when I said this forum was a great place to get answers, I get another great response. This helps a lot. TayTay - Thanks so much for your views! I wish my dietician/surgeon (surgical office/team) would have taken the time to explain some of these things better. As I said, just saying NO POTATOES does not help someone trying to make the right choices to make the surgery and recovery go well.

I just started the "Full Liquid" stage yesterday, but have been slow introducing new stuff in my diet. They said I could have cream Soups, so I did have Campbell's Cream of Broccoli for lunch, after running it thru the blender. OMG it tasted so good after having nothing but broth for so long. I also had 12 oz of V8 juice which was also great.

Unfortunately, my plan does not include anything called pureed Stage, It just slowly progresses for 7 weeks and drops you off with an 8 Weeks and beyond (my new normal) diet. I will ask about pureed foods on Tuesday when I go in for my follow up.

Thanks again TayTay!

[Nepenthe44 188]

On 7/20/2022 at 7:23 AM, KevinS62 said:

She dealt in absolutes. I NEVER deal in absolutes.

The only absolute in biology is that there are no absolutes, there's always an exception or a complication. (That's why I love it!)