I used to participate on a particular WLS support board, and we had an absolute deluge of people posting about “cheating” on their post-operative diets. Some of the netizens would respond “oh, honey, that’s okay… we’re all human.” Discussions about how impossible it is to fight food addictions would ensue. As a nurse, I was horrified that these people did not seem to understand the critical importance of following the post-operative diet instructions from the surgeon.
In case this post runs on too long and you need the TLDR; (too long, didn’t read) version here it is: STICK TO YOUR SURGEONS POST-OP INSTRUCTIONS TO THE LETTER. IT IS NO LESS THAN YOUR LIFE ON THE LINE.
Understand your surgery
Most bariatric surgeries today are performed arthroscopically. That means there are only a few tiny holes that you can see from the outside. You need to understand that the surgery on the inside is HUGE. If you’ve had the vertical sleeve gastrectomy (VSG) there is a suture line running the entire length of your stomach. If you’ve had Roux-en-Y (RNY) also known as the gastric bypass, there are multiple suture lines throughout your digestive tract. There are other surgeries, but those are the main ones, and the principles hold for all of them.
If you had a long cut on your arm, you’d (hopefully) know that you need to keep it clean, keep out dirt and other stuff that can get stuck in the wound, and how important it is to protect the area while it heals. You can’t see the wounds that are on the inside, but they require the same kind of protection and support while healing. But we can’t put bandages on them, or keep from eating. So food is going to be in contact with those healing wounds.
Also, whichever surgery you had, your stomach has a new configuration and doesn’t know how to manage food easily just yet. Your digestive system has to re-learn how to do its job with the new configuration, just like a newborn baby’s. It’s important to start easy and work up to harder to digest foods.
A diet for healing
Any food you eat while the suture lines heal (about 6-8 weeks) will be in contact with a healing wound. Most surgeons give very detailed instructions about what to eat after WLS, and it’s all designed to protect that suture line and ease the newly configured stomach into its new way of working.
Over the years, doctors have learned what foods are best for a healing stomach, and that translates into the post-op diet progression instructions. Typically, that looks like this: Clear liquids, full liquids, pureed foods, soft foods. Each phase typically lasts a week or two. Only after those phases are complete will they have the patient slowly move into a "full" diet beginning with high moisture content foods first. The surgeon will specify what foods belong in each phase, and how long to stay in the phase.
The general idea in the very early weeks is to eat foods that will not stress the healing suture line, and do not have particles that are known to cut into the raw tissue or get embedded into the suture line. If a cut or embedded food particle gets infected, it can become an abscess and develop into a life-threatening leak. Foods that are particularly known to cause issues are those that swell up like rice, have seeds like strawberries, or have rough hard edges or hard to digest fibers like wheat crackers or raw vegetables.
When moving from one stage to the next, it's typically advised to add just one food at a time, in small amounts, and see how it's tolerated. A food that's not tolerated well can be tried later on as well. If an entire stage is not being tolerated, back up to the previous stage for a while, and then try again more slowly. For example, eggs were on my soft foods list, but I couldn’t tolerate them until after I was eating moist proteins. My surgeon said that was common, and many food intolerances early on will clear up later after more variety of foods is well tolerated.
A very real risk
Just as there are people who smoke a pack a day while drinking a pint of whiskey and live to be a hundred, there are people who eat all sorts of things against their doctor's orders and suffer no ill effects. This is not a justification to ignore your surgeon’s instructions, it’s pure luck on their part, or possibly some amazing genetics. You shouldn’t count on either.
The reality is that some people will develop abscesses and leaks because they ate things before they were cleared to by their doctors, and there is no way to predict who will have the complications and who will not. And the consequences can be as severe as death.
I don’t say this to scare you away from WLS. These complications are very rare. But you increase the risk significantly when you ignore your surgeon’s post-op instructions. The doctors are not testing you or trying to make your life hard. They are giving you the best information they have to keep you safe.
It’s incredibly difficult to deal with cravings or “head hunger” as some of us call it, or wanting desperately to chew real food. It’s very hard to be on liquids only for weeks. Acknowledge that it’s hard, and seek support in getting through it, but understand how vital it is to muscle through. Violating these orders is not "cheating" on a diet. It's risking your life.
Trust your surgeon
If you spend any time talking to other WLS patients, you’ll find that every surgeon has a slightly different protocol. Some skip entire phases listed above, or shorten them dramatically. Some seem to be completely radical and start patients back on solid food in just days after surgery. This is not a case of right or wrong. Each surgeon operates based on what they were taught combined with their personal experiences. They may even make modifications for an individual patient based on that patient’s health and history.
If you are trusting this surgeon to operate on you, then you need to have trust in their protocols. The time to make sure you fully understand the protocols, have documentation about the specifics of the protocols, and that you agree to the protocols is BEFORE SURGERY DAY. If you don’t trust everything your surgeon advises, get a new surgeon. If there’s a particular concern about part of a protocol, sort it out before you schedule the surgery.
I personally would never stay with a surgeon, for instance, who doesn’t allow any protein drinks (even clear ones) for 2 full weeks post-op. (Relayed by a patient online, I don’t know if it was truly in the plan.) I know from my training that healing requires lots of protein, and a huge amount of the healing happens in those first 2 weeks. If that were in a surgeon’s protocol, I’d get a referral to another.
WLS is a fantastic tool for many people in retaking control of their health. It’s a huge commitment. Do yourself and your surgeon a favor, and don’t risk all the time, energy, and money you’ve put into it. Follow your instructions. Believe me, it’s over faster than you know, and it sets you up for success in the rest of the process.