Gastric Sleeve Diet - Week 3 and 4

Image of consultant bariatric surgeon, Mr Rishi Singhal

Medically reviewed by Prof Rishi Singhal MBBS, MRCS, FRCS, MD  
By Heather Fry BSC (Hons)

What to eat on weeks 3 and 4 of the gastric sleeve diet

In weeks 3 and 4, avoid stretching the stomach with hard foods. Transition from liquids to pureed foods in Week 3 and soft foods in Week 4. Portion control, slow eating, and separating food and drink are essential. Have balanced meals, and avoid carbonated beverages, alcohol, certain medications, and milkshakes.

Phase 2: Weeks 3 and 4

The stomach tissues are still healing 2 weeks after your gastric sleeve operation. It remains important not to stretch the sleeve with foods that are hard or indigestible. You should begin to make the transition from liquids to puréed foods at the start of week 3. At the start of week 4 start to transition to soft foods. Do not eat larger quantities than recommended even if you feel that you could.

What is a puree?

A pureed food has the same consistency as a thick liquid: it will plop off a spoon rather than pour. It should have no lumps in.

What is a soft food?

A soft food will be easily mashed with a fork. You should not need a knife to cut up soft foods

How much should I eat each day?

Start by eating up to 6 small pureed ‘meals’ per day and then towards the end of this phase try to establish a 3 meal a day pattern of eating soft foods. Your portion size should be about 3-6 tablespoons per meal – don’t ever have any more than this. Serve your meals on a 7-inch side plate or small bowl.

Will I be able to eat normally?

Just like it might have been initially after surgery, you will need to be very cautious about introducing foods. You must take your time and eat slowly. Start to follow the 20,20,20,20 technique:

1. Take a 20-pence-sized bite of food.
2. Chew for 20 seconds. Even though there might not be much to chew in this phase, it is important you still wait this length of time before moving to the next step.
3. Once swallowed, wait at least 20 seconds before you prepare your next bite.
4. Repeat the above steps over a period of 20 minutes. Stop before this if you feel you have had enough.
This technique means small amounts of food will be slowly sent down to your stomach and will avoid causing any pain or regurgitation. You will need to continue with this technique in your weight loss journey.

Can I drink with food?

It is very important to keep eating and drinking separately. Drinking with or too close after a meal can cause discomfort and flush your food through quicker, but it also has the potential to cause your stomach to stretch. You can drink up to starting a meal if you feel this is comfortable, but most people who have had a gastric sleeve wait 30 minutes before eating. You must then wait at least 30 minutes after eating before having a drink.

Continue to aim for 2L of fluid per day and focus on calorie-free fluids:
• Water
• Tea (including fruit and herbal)
• Coffee
• No added sugar squash
• No added sugar-flavoured water

There are some drinks you might enjoy but limit to 1 or 2 per day as they can be high in 
salt or sugar but low in protein:
• Bovril/Marmite/Oxo
• Light hot chocolate (e.g., Cadbury Highlights, Options)
• Light malted drinks (e.g., Horlicks, Ovaltine)
• 100ml fruit smoothie or fresh fruit juice (diluted 50:50 with water)

What foods should I eat?

During this phase we need to start building on the variety in your diet from each food group: protein, vegetables/salad/fruit and carbohydrate. By the end of week 4 you should be able to have “balanced” meals. You still need to aim for 70-80g of protein per day.

Foods suitable from the protein group are:
• Soft/runny scrambled egg
• Pureed chicken/quorn/tofu/minced meat/soft fish. Use gravy or a tomato-based sauce to make a smooth consistency
• Smooth yogurts
• Cottage cheese
• Low-fat soft cheese
• Beans/pulses/lentils
Foods suitable from the vegetable/salad/fruit group are:
• Overcooked vegetables such as broccoli, carrots, cauliflower
• Avocado
• Baked beans
• Soft fruits such as bananas, berries, melons

Foods suitable from the carbohydrate group are:
• Ready Brek, porridge oats, Weetabix
• Semolina
• Overcooked pasta/noodles/tinned pasta (e.g., spaghetti hoops)
• Centre of a jacket potato, mashed potato (white or sweet potato)

Do I need to avoid anything?

There are a few things you need to avoid during this phase to prevent any pain or problems:

• Sugary drinks such as flavoured water, squash, and still-ready mixed fruit drinks (e.g., Ribena, Oasis). Sugar-free or no added sugar options are fine.
• Full sugar varieties of hot chocolate or malted drinks.
• Any carbonated drinks. These can cause extreme pain from the gas. It is advised to generally avoid them long-term.
• Alcohol. Your tolerance of alcohol following weight loss surgery is greatly reduced and can cause dehydration so best to avoid it in this phase.
• Milkshakes that aren’t a meal replacement shake e.g., Frijj, Galaxy, Mars, Shaken Udder, Yazoo. They tend to be very high in sugar.
• Tablets. Some medications may need to be crushed or taken in liquid form for the first 6 weeks after your surgery. It is best to check with your doctor before crushing your pills, as many medications are slow-release and cannot be crushed. Also, please check with your doctor before restarting medication for diabetes, as your requirements are likely to be much less than they were before your surgery.
• Medications that are irritating to the stomach, especially non-steroidal anti-inflammatory medicines such as aspirin, ibuprofen, diclofenac, sulindac, celecoxib, diflunisal and naproxen. If you are unsure, ask the Healthier Weight medical team for advice.

Sample menu

A typical day in week 3 might look like this:

Time Liquid Protein content (g)

8.00am

15g Ready Brek/fine porridge oats with 75ml cow’s milk and 2 heaped tbsp of skimmed milk powder (26g).
13

9.00-10.00am

Water/tea/squash/coffee

10.30am

5 level tbsp of high protein yogurt with 1 tbsp pureed fruit (sieved to remove any seeds)
8

11.30-12.30pm

Water/tea/squash/coffee

1.00pm

3tbsp pureed cottage cheese with 1tbsp pureed vegetables and 1 tbsp mashed jacket potato
16

1.30-2.30pm

200ml water/tea/squash/coffee

3.00pm

200ml (1/2 can) lentil/pea and ham soup blended with 1tbsp of skimmed milk powder
10

4.00-5.00pm

Water/tea/squash/coffee

5.30pm

3tbsp pureed chicken/mince/fish in sauce with 1tbsp skimmed milk powder. Served with 1tbsp pureed vegetables and 1 tbsp pureed baked beans
19

6.30-7.30pm

Water/tea/squash/coffee

8.00pm

130g/ 1/3 can of semolina pudding with 50ml milk, 1tbsp skimmed milk powder topped with 1tbsp pureed fruit
11

8.30-9.30pm

Water/tea/squash/coffee

Sample menu

A typical day at the end of week 4 might look like this:

Time Liquid Protein content (g)

8.00am

2 scrambled eggs made with a splash of milk and 1/2 tbsp of skimmed milk powder. Serve with ¼ avocado.
20

9.00-10.00am

Water/tea/squash/coffee

10.30am

200ml cow’s milk with 1 heaped tbsp of skimmed milk powder (13g). Warm up and add coffee if preferred.
11

11.30-12.30pm

Water/tea/squash/coffee

1.00pm

3tbsp mince, 1tbsp overcooked vegetables, 1 tbsp overcooked pasta mixed in a tomato-based sauce with 1tbsp low-fat soft cheese stirred through.
19

1.30-2.30pm

200ml water/tea/squash/coffee

3.00pm

½ high protein yogurt with ½ small banana
8

4.00-5.00pm

Water/tea/squash/coffee

5.30pm

3tbsp soft fish in sauce with 1tbsp skimmed milk powder added. Served with 1tbsp soft vegetables and 1 tbsp lentils
20

6.30-9.30pm

Water/tea/squash/coffee

Ready to take the next step?

Image of consultant bariatric surgeon, Mr Rishi Singhal

All content on this page is reviewed by a multi-disciplinary team lead by Prof Rishi Singhal.

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