Page 1 of 12 Diet Guidelines after Duodenal Switch Surgery Drs. Leslie and Ikramuddin The purpose of your surgery is to reduce the amount – After about four weeks, you may eat between of food you can eat and to absorb fewer calories. 1/2 and 3/4 cup of food per meal. To keep the After surgery, your diet will consist of small, high- weight off, you will need to eat small amounts protein meals. It is important for you to eat slowly of food for the rest of your life. and chew well. – The long-term goal is a serving of 1 cup of food at meals. You will eat less food and absorb fewer nutrients. For this reason, you will need to take vitamin and • Stop eating as soon as you feel satisfied. mineral supplements daily. • Eat slowly. Each meal should last 20 to 30 Guidelines for eating minutes. Eating too fast can cause you to eat too much before you feel full. It can also cause • Do not snack all day or graze. Eating throughout nausea (sick feeling in your stomach), vomiting the day may keep you from losing weight. It may (throwing up), pain or pressure in the shoulder or even cause weight gain because you are eating too upper chest. many calories. • Sit down to eat your meals. Try setting your • Keep track of the number of times you eat spoon or fork down between each bite, then wait during the day. Since your meals are small in at least one minute before taking the next bite. size, you may need to eat five meals a day to get enough protein. As your stomach stretches and • Chew all foods into a paste the thickness of you can take in more food at a time, you may applesauce. The opening that leads from your need to eat less often. stomach to your bowel (intestine) is very small. Foods that are not chewed well may block this • Eat small amounts. opening. They can cause discomfort. You may feel – At first, your stomach can hold only up to sick to your stomach or vomit. To prevent this, 1/2 cup of food. If you try to eat more than this, cut your food into small pieces. Then, chew your you may get sick. Your stomach will slowly food well. It may take more time to chew beef, stretch over time. raw fruits and raw vegetables. If you are deaf or hard of hearing, please let us know. We provide many free services including sign language interpreters, oral interpreters, TTYs, telephone amplifiers, note takers and written materials. Page 2 of 12 • Eat at least 80 to 100 grams of protein each day. Guidelines for liquids Since you are eating less food, you will need to work harder to get enough protein. Try to include • Do not drink liquids with meals. Stop drinking a good source of protein with each meal (such as 30 minutes before your meals. Then wait 30 eggs, lean meats, poultry, fish, beans and low- minutes after eating to drink liquids again. fat or fat-free dairy products). Protein helps you This will: maintain muscle while you quickly lose weight. – Prevent the stomach from over-filling • Avoid sugar and fat. Do not fill your small – Keep food from flushing out too quickly stomach with junk foods that lack vitamins and – Keep you feeling full longer. other important nutrients. You should eat lean proteins, low-fat milk products, fruits, vegetables • Sip all liquids slowly. Drinking too quickly may and whole grains. cause nausea or vomiting. • Do not chew gum. Gum chewing may cause gas. • Drink plenty of calorie-free liquids between If you swallow the gum, it may cause a blockage. meals. Plain water is best. Drink at least 6 to 8 cups (48 to 64 ounces) of fluid a day. • Avoid high-calorie liquids. These add extra calories without making you feel full. For example, do not drink: – Regular soda pop – Coffee drinks (mocha, latte, cappuccino or other specialty drinks) – Kool-Aid – Smoothies – Sugar-sweetened drinks – More than 1/2 cup (4 ounces) diluted fruit juice in a day • Do not drink any alcohol. • Avoid carbonated (fizzy) drinks. These can cause gas and bloating. • Avoid caffeine. Caffeine may irritate your stomach and prevent your body from absorbing iron. Page 3 of 12 Exercise guidelines Stage 1: Clear liquids Get regular exercise to help you lose weight. It uses Drink only clear liquids for the first 1 to 2 days after energy and burns calories. If exercise is not in your surgery (while you are in the hospital). routine, begin slowly. As you lose weight, moving will get easier. Goal: Your diet • Slowly sip 6 to 8 cups (48 to 64 ounces) of liquid during the day. Drinking too fast can cause There are five stages to your diet plan. If you have nausea, vomiting, pain or pressure. problems—like throwing up or feeling sick to your stomach—you may need to go back one stage. Tips: For example, if you are having problems with soft • Drink 2 ounces of liquid every 30 minutes. Try foods, go back to a pureed diet. Then, slowly move to increase this over the next 48 hours until you to the next stage in your diet. reach 6 to 8 cups (48 to 64 ounces) of liquid a day. • Avoid straws. Straws bring air into the stomach, First day after Stage 1 Clear liquids causing gas, bloating, pain or pressure in the surgery shoulder or upper chest. Stage 2 Day 2 to 13 Low-fat full liquids Suggested liquids: – Water Stage 3 Day 14 to 27 Pureed foods – Decaf, sugar-free iced tea – Sugar-free popsicles Stage 4 Day 28 Begin soft foods – Clear broth Begin regular – Cranberry juice or 100% apple or grape juice (add Stage 5 8 to 12 weeks foods extra water to dilute it; limit yourself to 1/2 cup, or 4 ounces, per day) – Decaf coffee or tea with no sugar or honey (artificial sweeteners are okay) – Sugar-free, enhanced or infused water – Herbal tea – Low calorie sports drink (less than 20 calories in 8 ounces) – Sugar-free gelatin Page 4 of 12 Stage 2: Full liquids (days 2 to 13) Foods allowed: Full liquids are a little thicker than clear liquids. You – Skim milk, 1% milk, plain soymilk or Lactaid milk will be drinking low-fat full liquids when you leave – Protein drink (as described) the hospital. Stay on this diet until two weeks (13 – Low-calorie or “light” smooth yogurt (no fruit days) after surgery. chunks) Goals: – Fat-free plain yogurt • Have no more than 1/2 cup food per meal. – Fat-free Greek yogurt – Sugar-free pudding • Add more liquid choices. – Low-fat cream soup, strained • Keep drinking 6 to 8 cups (48 to 64 ounces) of fluid each day. – Cream of Wheat, Cream of Rice and Malt-O-Meal Any clear liquids allowed in your stage 1 diet. If • Use a protein drink that has (8 ounce serving): you drink juice, have no more than 4 ounces per – No more than 200 calories day (diluted, pulp-free, not sweetened). – 15 to 30 grams of protein – Less than 20 grams of carbohydrate Sample Menu for Full-Liquid Diet – Less than 5 grams of fat Breakfast – Less than 10 grams of sugar • 1/4 cup Cream of Wheat • Start taking vitamin and mineral supplements. • 1/4 cup sugar-free custard Tips: Snack • To make sure you drink enough fluids, you may • 1/2 cup sugar-free pudding want to space them throughout the day. Try drinking about: Lunch 20 ounces before lunch • 1/2 cup strained cream soup 20 ounces before dinner 20 ounces before bed. Snack • Eat three meals daily at about the same times each • 1/2 cup protein drink (see page 4) day. Do not skip meals. Dinner • Your body may find it easier to handle liquids at room temperature than ice-cold liquids. • 1/2 cup low-calorie yogurt (no fruit chunks) • Freeze liquids in plastic bottles to carry with you. Page 5 of 12 Stage 3: Pureed foods (days 14 to 27) Proteins: You will start a pureed diet 14 days after surgery. You – Skim or 1% milk will stay on this diet for about 2 weeks. – Protein drink (see page 4) Goals: – Low-calorie yogurt (no chunks of fruit) • Add more food choices. Foods are blended – Low-fat cottage or ricotta cheese, mashed with (pureed) so they are the same thickness as a fork applesauce. This will reduce the risk of nausea and – Mashed eggs (poached, soft boiled or scrambled) vomiting. or mashed egg substitute • Meals should be about 1/2 to 3/4 cup of food. – Mashed tofu • Keep drinking enough liquids. Remember to stop – Pureed lean beef, lean pork, chicken, turkey or liquids 30 minutes before your meals. Wait 30 fish (or use baby food meats) minutes after eating to start liquids again. – Mashed beans (such as black beans, pinto beans or fat-free refried beans) Tips: – Pureed chili • Add new foods slowly. Try one new food at a time. Grains and starches: • At first, you may only be able to handle 1 to 2 – Hot cereals (Cream of Wheat, Cream of Rice, tablespoons at a time. You may want to use a Malt-O-Meal, oatmeal, grits) small saucer and a baby spoon. Slowly increase your food until you are eating 1/2 to 3/4 cup of food – Mashed potatoes, sweet potatoes or winter squash at each meal. Fruits and vegetables: • Eat the protein part of your meal first.