Rafał Mulek

Preoperative period:

Diet and work with a dietitian
Each patient who decides for surgical treatment of obesity has repeatedly tried to lose weight using a variety of diets. Of course, most of them end in a failure, otherwise the patient would not seek new solutions. So when he hears that before resuming surgery to resume working with a dietitian, he often reacts with surprise and objection. However, this is not pointless, as dietary treatment before surgery is a re-entry into the proper "diet path". Thanks to this, before the operation, the patient has the chance to reduce his body weight, so that he will enter gently in the postoperative treatment stage – without the element of surprise. This period of treatment is for the patient the same thing as for the athlete building the form before the competition. It should also be borne in mind that the smaller the weight of the patient on the day of operation, the easier the surgery will be for the surgeon. After all, this is the patient who should be extremely interested in reducing the risk of the surgical procedure.

A healthy diet is primarily a varied and balanced diet containing both proteins, fats and carbohydrates. In other words, it cannot be a diet based on one type of product, like a pasta or a famous pork neck. 

A healthy diet also means a regular intake of foods. By keeping constant intervals between meals (on average 2-3 hours), there is no overwhelming feeling of hunger that we satisfy eating much more than we actually need. Eating regularly, we take less food each time than when we eat twice a day, with the first meal usually symbolic, and the real feast is at the end of the day, after a late return home. By eating smaller portions of food regularly, we also prevent stretching of the stomach, and this is very significant. The stomach sends a nervous pulse informing on its satiety only when it is full. The bill is simple - a big stomach needs more food to feed the satiety message. As a consolation I shall add that after the surgical treatment, by reducing the volume of the stomach, it is much easier for the patient to follow the "reasonable" volume of food intake since the size of the "new" stomach is on average several times lower than the original.

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 Postoperative period:

The period immediately after the operation is the time of the explorer. The patient must re-learn their digestive tract and learn how to eat and drink to feel comfortable. In the first days after surgery the stomach tissue is swollen and the stomach volume is smaller than it will be in 3-4 days. In the first postoperative period, the patient can only take water. At one time, the patient should take a sip or a maximum of 2 sips of water, then wait a few minutes to ensure that the volume of fluid taken is not too high. If too much water was drunk, at best, you may experience epigastric discomfort; the feeling of fullness in the esophagus and even pain may also occur. Only slow but systematic water intake guarantees a feeling of comfort while satisfying your thirst.
 

Usually from the second postoperative day, the patient may take a liquid diet. The principle of taking a liquid diet is exactly the same as for taking water. After a teaspoon or two teaspoons of soup, there should be a few minutes of pause, during which the patient can see if his stomach is already full, or can take another teaspoon of soup. Bear in mind that a liquid diet means food that freely pours from the cup or plate after tilting, and does not require engagement of teeth. Liquid diet should be kept for 6 weeks after surgery.

• For the first 2 weeks diet should be based on broth and clear soup, in the following weeks may be gradually condensed, which means that the soup can be in the form of creams

• Starting no sooner than the fourth-fifth week the patient can mash his food

•  After 6 weeks, the patient may attempt to return to the normal consistency of the food, such as before the operation.
   

In the first days after surgery, the food should be first and foremost very carefully chosen and prepared so that the patient does not feel discomfort in eating due to the intake of too much food. On consecutive days, when the patient is able to predict how much food can be taken at once, food can be taken at regular intervals. You should strive to take five meals a day at intervals of 2-3 hours.
It is very important that when applying both liquid and solid diet do not forget about constant intake of water between meals. 

Once you start using a regular diet:
 

• Start eating meat in pieces, cut the meat into small pieces and carefully chew them; start with veal or chicken because it is easier to chew;

•  Try to eat vegetables with more fiber content, but you still have to be careful with asparagus, leaf spinach, cauliflower, broccoli stems, green beans, leek and cabbage;

• Stop eating immediately when you start to feel satiated, even if it means leaving food on the plate;

• Try to eat fruit cut into small pieces;

• Avoid foods containing thick fibers (fibrous meat, especially beef, fruit peels, vegetable peels) and other fibrous products such as: sauerkraut, citrus, lettuce and leafy vegetables, coarse grains or wholemeal cereal products - may get stuck in the stomach even after careful chewing and also because the fibers contained in them can swell.

 

If you experience vomiting, indigestion or nausea, ask yourself:
 

• Did I eat too fast?

• Did I chew enough food?

• Did I eat too much or were not the bites / contents of teaspoon too big?

• Did I drink after the meal?

• Did I start drinking too early after eating?

• Didn't I lay down too early after eating?
   

 

What do you do when you feel the food is stuck in the esophagus / stomach?

Immediately stop eating and try to drink something (small sips). If the next few hours appear as if the fluids do not go down, contact a doctor.
 

 You should consult your doctor when the following symptoms appear:
 

• Multiple, frequent vomiting after meals

• Repeated black, loose or of unpleasant smell stool

• Sudden abdominal pain with accompanying vomiting

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Recommendations for food selection

 Vegetables

•  Asparagus, leek - very difficult to chew, it is good to cut them into pieces

• Beans - Bean Beans - do not forget to chew them well

• Broccoli, cauliflower - stalks are difficult to chew well, better cut them

• Cabbage, lettuce - chew carefully, eat small bites

• Spinach - contains long fibers. Do not forget to chew it well. Eat small bites.

• Mushrooms - easy to swallow them whole, stems are difficult to chew; chew a piece by piece
   

 Fruits
   

• Bananas - large pieces easy to swallow, chew well, eat small bites

• Cherries - they have stones, make sure you do not swallow the stone

• Nuts - be careful not to swallow them whole, chew carefully

 

Meat and cold meats

• Meat - watch out for raw meat – it is hard to chew, and small pieces are easy to swallow; careful with beef

• Raw ham - can be difficult to chew and generally swallowed in large pieces; this can be avoided by careful chewing

 

Seafood

• Fish - well cooked (grilled, baked) fish meat is generally soft and easy to chew. Do not swallow large pieces.

• Oysters, shrimps, squid, lobster - eat small bites, chew them thoroughly, because their meat can be quite hard
   

Bread

• Wholemeal bread - it should be chewed well, paying particular attention to the skin

• White bread - generally soft, but do not forget of proper chewing