Gastric Sleeve rules: using the sleeve for weight loss success
Bariatric surgery is the best tool available for people with obesity that want a better lifestyle, increase years to their lives and look forward to being their very best selves.
Sadly, since surgery does pretty much all the work during the first months and weight loss is easily achieved regardless of any changes being made, patients may not find necessary to put the effort into acquiring new dietary or exercise habits. For these reasons, some patients may choose or prefer calorie dense foods and justify these choices due to the fact that the scale is still going down. As the pouch reaches its final size by nine months after surgery and eating starts feeling more comfortable, food intake capacity increases. A previous experience of eating calorie dense foods, not taking supplements, not establishing mealtimes, grazing or not exercising can cause suboptimal weight loss, early plateaus and even weight regain.
At a year from surgery (such as a gastric sleeve in Mexico), weight loss success will depend on the changes made during this time. The principle for long-term weight control as a weight loss patient is being able to:
• identify satiety
• keep abnormal hunger at bay
• maintain the pouch’s small size
• meet nutritional needs from quality food and supplements
“The definition of insanity is doing the same thing over and over again, but expecting different results”.
Gastric Sleeve rules
Meal times and meal size
Eat small but frequent meals (4-6 meals). Calculate frequency depending on protein intake at each meal.
A normal day has only three hours between breakfast and lunch, and then six to seven hours between lunch and dinner; satiety cannot be maintained over the full seven hours, no matter how solid the food was eaten or small is the pouch. This leads to either snacking or overeating at a later meal. Grazing can accumulate calories pretty fast not to mention that most snacks are “fillers of the pouch” and void of nutrients. And, overeating on a daily basis, even if it is only one teaspoon at each meal, will end up stretching the pouch.
Plan on 4 to 6 meals in a day to be able to meet your nutritional needs, including protein intake. While the pouch is still small (which is how you want to keep it) if you skip a meal you won’t be able to compensate at a later meal for the nutrition or protein you didn´t get. Not getting enough nutrition leads to cell dysfunction, including fat burning.
Eat until “comfortably satisfied”. Eating to the point of feeling full may cause discomfort, even pain, and could lead to P-Bing and stretching of the pouch. The difference between feeling satisfied and feeling full may be one teaspoon difference! vomiting, pain or P’Bing are obvious signs of overeating.
Some patients find it easier or convenient to shift their diets to mostly liquids, convenient snacks (i.e. cookies) or soft solids. This is called the “soft calorie syndrome”. Liquids, refined carbs, and soft solids empty at a faster rate from the pouch without having the chance to put pressure on the stomach walls and stimulate satiety and hunger hormones, thus becoming hungry too soon before the next meal and giving in to snacking between meals.
Plan on eating a “complete meal” even if it is very small. A complete meal includes lean protein sources and fresh or frozen produce (P&P diet: protein and produce). Alternate between vegetables and fruits at each meal for optimal nutrition. In addition, add one healthy oil or fat serving.
In the mature pouch at one plus years’ post-op, the more solid of food that a patient eats, the longer is the satiety period after the meal. You should start scheduling and planning for your meals at early stages to establish a long-term healthy dietary pattern.
Always eat your protein first
Protein intake is necessary to prevent hair loss and muscle break down among many other functions, including blood, tissue, hormone and enzyme synthesis.
Your personal protein intake goal was written down at the post-op diet calendar on surgery day. If you don’t have this information, feel free to request it by emailing [email protected] For most women, it is 60 to 80 grams per day and for most men, it is 80 to 100 grams per day.
You need to count your protein intake, per meal, on a daily basis. This will let you make decisions on the composition of your next meal and frequency of meals.
Muscle break down happens on a daily basis and depends on daily protein intake.
Vegetables and fruits are necessary, include them only after meeting your protein intake.
Other carbs and refined carbs such as bread, pastries, pasta, rice, etc. are considered “fillers” of the pouch and lack nutrients. Eating these before eating protein will take the pouch’s space and will limit meeting the recommended intake. And, carbs empty faster from the pouch -when compared to protein and produce combined-, making you feel hungrier sooner.
Protein prolongs satiety, helping reduce cravings.
Follow the P&P diet
Plan your meals by following the “P&P diet” which stands for protein and produce; i.e. protein + veggies, protein + fruit. Include other carbs like whole grains only after exercising and only after eating P&P.
If you commit to mindful eating, it will become easier to follow your dietary guidelines, you’ll enjoy your food a lot more and you will naturally eat less.
Use small plates and cutlery when eating. A 7” plate and using baby spoons and forks is ideal. When eating from food that doesn’t require cutlery, most people tend to overeat and eat faster. Needless to say, food that you eat while standing up such as hot dogs, hamburgers, burritos, etc. are not optimal choices.
Take your time at each meal, at least 20 minutes. Take a few one-minute breaks from eating during meals. Put your fork down between bites. Cut your food one bite at a time. This will help trigger satiety hormones and avoid P’Bing from overeating.
Eat without distractions. There is substantial research that when not paying attention to what and how much you eat can result in overeating, and even nutritional foods (organic or not) can cause weight regain if you eat too much.
Eat slowly and chew your foods until having a pureed consistency on your mouth. About 40 chews a bite. Chewing more will help you eat less. If you find this difficult to do, feed yourself with your non-dominant hand -this will force you to pay attention to what you are doing and will slow you down.
Enjoy your food. Focusing on the experience of eating and the taste of food will help you appreciate your food and eat slowly. You may want to close your eyes with each bite to enhance the experience or try to taste and identify all the different ingredients in your meal.
Ask yourself if you are eating to deal with feelings other than hunger, such as boredom, being tired, having anxiety or just from stress. If it is the case, prepare yourself with strategies to replace this behavior. Some actions you may find helpful are: call a friend, take a warm bath or shower, listen to music or download some music to keep you busy, avoid watching TV -especially cooking shows! go for a walk, keep your hands busy in gardening, read, or get into knitting.
Pay attention to your body’s physiological needs. Primal instincts win over will power anytime! so you need to become aware of hunger, thirst, lack of satiety or sleep, and learn how to avoid them.
Initially, when the pouch volume is small, the solute load is also small, and you may not see the point of hydration between meals and before a meal. However, as you pouch volume increases the solute load increases as well, and it becomes a significant issue to avoiding liquids 5 minutes before eating, during and for at least 30 minutes after a meal.
It is important that you be fully hydrated before coming to the next meal because the solute load of the meal will create thirst after completing it.
Have small frequent sips between meals to meet your daily hydration goals. Or, try a fluid load before each meal to help prevent post-meal thirst. If you cannot tell the difference between hunger and thirst, you may have a fluid load as well. Or, whenever you feel the sensation of hunger and didn’t hydrate between meals or if you are tempted to snack.
Fluid loading is the rapid drinking of a non-calorie liquid on an empty stomach to achieve a maximal fluid intake. Fluid loading also provides satiety which lasts for fifteen to twenty-five minutes.
A large ingestion of a large number of calories hidden in high-calorie liquids bypasses the gastric pouch restriction and leads to weight stalling or weight regain. Do not drink your calories (i.e. soda, alcohol, milk, energy drinks, sports drinks, juices -even if organic-).
Avoid alcohol, it dehydrates and has many non-nutritional calories.
Sip on liquids slowly.
Eat foods as tolerated, some foods like red meat or fibrous veggies might be hard to tolerate but this doesn’t mean you can never have them again. If something is not tolerated, reintroduce this particular food at a later time or learn how to prepare it to add moisture for a lighter texture. Gravies, sauces, yogurt, broth and avocado are good aids to this purpose.
Nutrition in quantity and quality is important for good health and for maximal and long-term weight loss success.
Follow the P&P diet
Do not eat 8 meals from fear of not getting enough nutrition, this is sometimes encouraged by well-meaning friends or relatives. During this time of pouch adaptation and until it matures (1-year post-op), there are two major nutritional needs: protein, vitamins, minerals and phytochemicals. These can be easily obtained from following the P&P diet, choosing high-quality foods and routinely taking high-quality bariatric supplements.
Bariatric mandatory supplements include multivitamins, probiotics, calcium with vitamin D3, probiotics, Omega-3 and Vitamin B12. These are available at a discounted rate here: For Life! monthly kit
Include protein shakes to help meet protein requirements or as meal replacements.
Don’t forget to separate the multivitamin from the calcium at least 2 hours apart as the iron from the multivitamin competes in absorption at the gut with calcium.
Choose organic, free-range, grass fed & grass finished, or game lean protein sources.
Fresh and frozen fruits and vegetables have the same nutritional value, choose organic. Learn more on organic foods at www.ewg.org
Add plenty of herbs and spices to your food. Include as many as possible! Turmeric enhances liver function, oregano is anti-bacterial and antioxidant, coriander aids in blood sugar control and has cholesterol reducing properties, rosemary reduces the cancer promoting agents from meats.
Quality foods and quality supplements should be used to reduce toxic load, the opposite increases the slowing down the body´s capacity to function normally resulting in stalled fat burning, low libido, and low energy levels.
Be aware that using artificial sweeteners increase hunger and reduce satiety. You should avoid soft drinks and soda as well. If you experience very strong hunger cravings during the first weeks or months post-op these can be ceased with stopping the use of artificial sweeteners. Beware of commercial proteins and vitamins that emphasize taste and have a variety of flavor choices.
To a long, healthy, productive, and happy life.
Lucia Chavez, NC
Chief Nutritionist | Obesity Control Center