Need info about the Verticle Sleeve

I am Leader of a weight loss support group in my area called * Little by Little*...Most of our members have had the RNY...We have a new member that recently had the verticle sleeve...I would like information about the sleeve, such as how is it different than the RNY, can you eat the same foods, can you eat more than someone who had the RNY, how does your food digest compared to someone with the RNY, how long are you on soft foods/liquids after surgery, when can you start eating solid foods such as chicken, and etc...Do you dump? Any information would be so greatly appreciated...This way I can do what I can to encourage those who have had the sleeve...Its hard to give ideas, suggestions, when I don't know anything about the sleeve...Thanks for any help you are able to give me...Tammy

I don't know all the answers, and some answers may vary depending on what your surgeon/RD says, but here is what I understand:

--it is different from the RNY in that approx. 85% of the stomach is removed permanently (not sealed off into a blind second stomach) and there is no re-routing of the intestines. The pyloric valve remains intact.

--immediately post-op the diets may vary a little bit, but probably not much. After the healing process, from what I know, sleeve patients tend to have fewer problems with digesting things like steak, bread, and sweets that apparently cause issues for some people with RNY.

--how long you are on soft foods/liquids varies a lot depending on your surgeon. I think it is probably pretty close to what RNY patients do.

--for most sleeve patients, food is digested after surgery the same way it was before, just in much smaller quantities. Since there is no intestinal skipping/re-routing, there is no malabsorption. Some sleeve patients may have issues with digestion just because the stomach is so small, food will not be exposed to the stomach juices for as long, and that is where digestion starts. So there are some people who struggle with certain types of food.

--most sleeve patients don't dump but a small percentage do. We also get the slimies/foamies from eating too fast or too much food or sometimes from the wrong type of food. I don't know if RNY patients get that. It's when you basically start spitting up large quantities of saliva. It's gross! I got this the other day for the first time (not after eating -- pretty sure it was caused by my mineral supplement).

 

Thank you for taking the time to give me your thoughts on this...I sure do appreciate it...As for the slim/foamies, Ive gone through that many times, and Ive had RNY...I am usually sick for hours when this happens.

I had vsg, my wife had RNY two weeks later. There wasn't even a separate vsg chapter in the notebooks we were given by the surgeon, I have just followed the RNY plan. There's been little difference between what or how much we eat, and even that I would say is more specific-body related rather than surgical-procedure related.

You would have thought that there would have been a seperate notebook about the sleeve...Is it because your surgeon thinks the two surgery types are similar and you can eat basically the same foods, and etc?

Thanks for your help!!!

Here is a pdf that should be a great resource ...

http://muhealth.org/documents/bariatric/Bariatric Booklet VSG.pdf

Here is my nutritionist provided post op meal plan ... this should also prove helpful ...

I was given a huge book that entailed my plan and it is very specific and very drawn out and definitely errs on the side of being cautious the whole way.  I am also a perfectionist which is why I lost 95 pounds in a little over 5 months and was basically at goal.

First the Tips for Post-Op Patients ... G D E s (Gotta Do Ems) - adapted from EAT IT UP by Connie Stapleton, PhD

- Make consistently healthy food choices (protein first)

- Maintain portion control

- Chew your food thoroughly (at least 20 times a bite)

- Take your time when eating (at least 20 minutes per meal)

- Drink plenty of water throughout the day, but not with meals

- Eat Breakfast

- Plan your meals and follow your plan 

- Exercise on a regular basis

- Keep food and exercise journals (myfitnesspal.com)

- Get good rest

- Utilize healthy support system (support group meetings and online support, individual counseling if needed

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Phase 1 - Post Operative Thin Liquid Diet

- Days 1 - 10 after surgery

- Calories 600 - 800

- Protein 75 - 90 grams

- Fluid: Aim for at least 64 oz. (8 cups).  Continue to stay hydrated with plenty of fluids.  No straws, no carbonation.

- No Chewing Gum at all this phase.

- After surgey, during the Phase 1 post op liquid diet, you have the option of continuing the Optifast 800s Ready to Drink shakes OR purchasing alternative protein supplements of your choice.

- No protein bars, including the Optifast 800 bars, are permitted until Phase 4, the soft diet.

Examples of acceptable sugar free, low calorie fluids:

   = Water or flavored water

   = Crystal Light or equivalent sugar free drink mixes

   = Sugar free popsicles

   = Sugar free gelatin

   = Broth - strained broth based soups acceptable (beef, chicken, vegetable)

   = Coffee/Tea (decaf, no cream)

   = Protein Supplement (Optifast or supplement of choice)

   = Skim or 1% milk, soy milk, almond milk (unsweetened)

Examples of fluids not allowed during Phase 1 post op diet

   = Milkshakes and smoothies

   = Yogurt, pudding, applesauce

   = Fruit Juice

   = Carbonated Beverages

   = Cream Based Soups

PROTEIN SUPPLEMENT GUIDELINES

   = Whey Protein Isolate (not blends or concentrates as they are not as quickly used and therefore some of the protein passes right through.

   = Approx. 24 grams of protein per serving.  

   = Less than 5 grams of sugar per 8 oz serving

   = Less than 5 grams of fat per 8 oz serving

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Phase 2 - Post Op Full Liquid Diet

Days 11-14 after surgery

Calories: 600 to 800

Protein: 75-90 grams of Protein

Fluid: Aim for at least 64 oz. (8 cups).  Continue to stay hydrated with plenty of fluids.  No Straws, No Carbonation.

Continue taking your chewable multivitamins and calcium daily.

Continue to consume the thin liquids from Phase 1.  Gradually work in small amounts of full liquids through the day.

Most of your calories and protein will still come from your protein supplements and/or low fat milk.

Examples of full liquids:

   = Strained, fat free cream soups without chunks.  Look for 98% fat free varieties that are made with 1% or less milk fat.

   = Sugar free pudding made with 1% or skim milk (or unsweetened almond milk, soy milk)

   = Light Low fat blended yogurt without chunks made with artificial sweetener

   = Unsweetened Applesauce

   & Portion Size: approximately 1/4 to 1/2 cup ... SMALL BITES

Keep track of your protein, calorie, and fluid intake.

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Phase 3 - Post Op Pureed Diet

Weeks 3-4 after surgery

Calories: 800 to 1000 (SIDE NOTE >>> I DID NOT INCREASE CALORIES AND KEPT BETWEEN 600 and 800)

Protein: 75 - 90 grams of protein

Fluid: 64 oz.    No Straws, No Carbonation

During this phase you may start having slightly textured foods.  Your food must be soft enough and moist enough that it can be very easily mashed up with a fork.  This will help you transition to more solid foods later.  Even though these foods are pureed or mashed, chew very well before swallowing.

- Continue taking your multivitamins and calcium dailies.

- Continue to STAY HYDRATED

- DO NOT drink any fluids 30 minutes before your meal, during your meal, or 30 minutes after your meal.

- Protein is important to help you maintain muscle while you are loosing weight so always consume your protein foods first, then move on to fruits and vegetables, and then whole grains.

- Portion size per meal ... 1/4 to 1/2 cup.  It should take you 20-30 minutes to consume this amount of food.

- You may need to have 5 or 6 small meals daily.  Do not Graze.

- Keep track of your protein, calories, and fluid intake.

- Continue to use your protein supplements (shakes) between meals to help meet your protein and calorie needs.

- Boost the protein content of lower protein foods by adding unflavored whey protein isolate powderor dried milk powder.

- Add foods one at a time to test tolerance.

- If you feel full, nauseated, or pressure in the upper stomach, then STOP!!!  Do not eat or drink anything for 2 hours.  Let the food pass.

FOODS in the pureed phase may include:

   = Scrambled Eggs, egg whites, or egg substitute (good source of protein)

   = Low fat cottage or ricotta cheese  (good source of protein)

   = Sugar free / low fat pudding

   = Fruits such as no sugar added applesauce, mashed bananas, or small homemade fruit smoothies made with a yogurt base.

   = Cream of Wheat/Rice. grits, oatmeal (thin and soupy consistency)  (SIDE NOTE ........... I didn't do this until maintenance phase)

   = Mashed sweet or white potatoes

   = Pureed acorn or butternut squash

   = Canned vegetables - coo****il very soft and mash with a fork.  Examples include puree peas, carrots, green beans, beets

   = Pureed chicken or turkey (no skin) or mashed canned chicken (white meat)  (good source of protein)

   = Soft fish - haddock, tilapia, cod, salmon, and water packed tuna can be mashed with a fork.  (good source of protein)

   = Fat free refried beans  (good source of protein)

   = Cream Soups (98% fat free)

   = Blended light, low fat yogurt or Greek yogurt (higher protein content)

   = Condiments:  low fat or fat free mayo, mustard, fat free spray butter, spices and herbs, hot sauce, and vinegar.

SAMPLE PUREED MEAL PLAN

Breakfast:  1/4 cup egg substitute or 2 egg whites and 1/4 cup light yogurt

Snack:  Protein supplement (shake)

Lunch:  1/4 to 1/2 cup pureed chicken

Snack:  Protein supplement (shake)

Dinner: 1/4 to 1/2 cup mashed tuna fish with light mayo and 1/4 cup puree cooked vegetables

Snack:  Protein supplement (shake)

 

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Phase 4 - Post Op Soft Diet

Weeks 5-8 after surgery

Calories: 800 to 1000 (SIDE NOTE >>> I DID NOT INCREASE CALORIES AND KEPT BETWEEN 600 and 800)

Protein: 75 - 90 grams of protein

Fluid: 64 oz.    No Straws, No Carbonation

Portion size: 1/2 to 3/4 cup.

- Choose soft foods that are low in fat and sugar but high in protein.

- Chew well !!!  Your food should be liquid in your mouth before swallowing.  If you have dentures, be sure to cut your food into small pieces.

- Slow Down !  Take 20 to 30 minutes to consume meals.

- Wean off protein shakes when you reach your calorie and protein goals through meals.  One shake a day for the rest of your life is fine.  (I PERSONALLY AT ONE YEAR POST OP STILL DO A SHAKE FOR BREAKFAST EVERY DAY)

- Eat protein foods first then move on to vegetables, fruits, and whole grains.

- Eat only cooked vegetables and avoid high fiber vegetables.

- Add foods slowly and one at a time to test tolerance.

- Stop eating or drinking when full.  Overeating may stretch the stomach pouch and hinder weight loss.

- You may need to have 5 to 6 small meals daily.  DO NOT GRAZE.

- If you do not follow these precautions, you may experience vomitting, stomach irritation, and swelling.  You could also have a stoma obstruction.

- If solid foods cause nausea and vomitting, go back to the clear and full liquid diet.

FOODS IN THE PHASE 4 SOFT DIET:

   = Fruits:  Soft fruits such as a ripe banana or soft melon or canned fruit packed in natural juices, not syrup

   = Vegetables:  Soft cooked vegetables without seeds or skins.  Tomato sauce puree with no seeds.

   = Potatoes:  Sweet potatoes, baked potatoes

   = Cereals:  Cooked oatmeal, grits, Cream of Wheat or Rice, Unsweetened dry cereal without nuts with added milk for soaking.

   = Bread and Crackers:  Dry or toasted bread.  Melba toast, whole wheat crackers.

   = Protein:  Baked or broiled flakey white fish, eggs, low fat soups, chicken or turkey without skin, tender roast beef, pork tenderloin, lean ground beef (at least 90% lean), water packed tuna, tofu, canned beans

   = Dairy:  Low fat cottage cheese, part skim ricotta cheese, low fat cheeses, sugar free low fat puddings or yogirt, Greek yogurt (higher protein content), 1% or skim milk

CAUTION FOODS INCLUDE:

   = Soft breads, doughnuts, pastries.  These may form a dough ball and block the stomach outlet.

   = Salads or other raw vegetables

   = Sugar and sweets such as table sugar, cakes, cookies, pies, pastries, and granola

   = High fat meat (bacon, sausage, salami, bologna, hot dogs)

   = Tough or gristly meat such as steak, roast beef, pork, lamb, veal, and venison

   = High fat foods such as butters, regular salad dressings, full fat mayo, sour cream, and cream cheese, whole milk, whole milk cheese, full fat ice creams

  = Fibrous vegetables such as broccoli, cauliflower, Brussels sprouts, corn, cabbage, salad greens, asparagus, and celery.  Some of these may be tolerated well if cooked very well.

   = Fresh fruit except bananas and soft melon

   = Rice and pasta.  These may also form a dough ball and block the stomach outlet.

   = Nuts, seeds, coconut, raisins, popcorn, dried fruit.

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PHASE 5 Post Op Regular Diet

Weeks 9 - a lifetime!  Once you are about 9 weeks out from surgery, you may start introducing fully solid foods into your diet.

For the rest of your life you should enjoy a low calorie, heart healthy diet that emphasizes lean protein, vegetables, fruits, and whole grains.

Portion size: 3/4 to 1 cup

Keep track of your protein, calorie, and fluid intake.  You need approximately 800 to 1000 calories and 75 to 90 grams of protein per day.  Your individual protein and calorie needs will be set by your dietician but these general guidelines usually apply.  The patients who keep track of their calorie and protein intake have better weight loss success after weight loss surgery.

- Continue to stay hydrated with plenty of fluids.  Drink at least 8 cups of fluid each day.  Remember to sip, not gulp.  Limit your caffeine intake and avoid carbonation.

- Set your meal and times and only eat at the designated times.  No grazing.  You can sneak in a lot of calories by nibbling between meals or sipping on fluids with calories, including alcohol.

- Get your protein in first.  Prioritize how you fill your stomach.  When you feel full ... STOP !!!

- Separate your food and drink.  Drinking with meals will wash food out of your stomach and make you hungry faster.  Liquids may also fill you up and leave no room for nutritional food.

- Enjoy and savor your food.  Eat slowly.  Try putting your fork down between bites.  Do no****ch television or play on the computer while eating.  (I AM SO GUILTY OF THAT >>> LOL)

- Exercise is critical when trying to lose weight.  Patients who exercise lose more weight than those who don't.

- Attend support group.

PROTEIN POINTERS

- Protein is required to build, repair, and preserve tissue to keep you healthy as you lose weight.

- Protein helps maintain fluid balance between blood and body tissues.

- If you do not get enough protein, you may develop flaky skin, hair loss, and or color change, swelling in your legs or abdomen.  You will also likely begin to feel weak, especially if you aren't taking in much of anything else.

- Cut chicken, beef, and pork into small, thin bites to increase tolerance.

- Double check your chewing (20-30 chews per bite) and check the clock.  Is it taking you 20-30 minutes to consume your meal?

- Protein foods help you feel fuller for longer so it's important to eat them at every meal, most meals of the week.

- Soft proteins like eggs, dairy, fish, and lean deli meats may be easier to digest, especially at first.

- Use low fat condiments to moisten foods when eating such as mustard, low fat mayo, ketchup, bbq sauce, tomato sauce, broth, low fat gravies.

- If you feel that your protein food was too dry and feels stuck in your throat, you may sip on appropriate fluids to help ease it down or wait 5 - 10 minutes until the feeling goes away.  But, make sure you avoid doing this repeatedly by eating slowly, taking small bites, and preparing your foods appropriately.

EASY PROTEIN IDEAS:

- Healthy Request bean soups

- Fat free refried beans and salsa

- Steamed white fish with lemon juice / olive oil

- Well blended crab salad on a whole wheat cracker

- Egg drop soup

- Frozen mini shrimp with ****tail sauce

- 2 slices of deli turkey rolled up with low fat cheese and Dijon mustard (I DID THIS A LOT WITHOUT MUSTARD ... USED WALDEN FARMS BACON RANCH 0 CALORIE DRESSING INSTEAD)

- 1/4 cup low fat cottage cheese with cinnamon and Splenda (or Stevia)

- Peanut Butter on reduced fat Triscuits

- Turkey meatballs with marinara sauce (CURRENT FAVORITE)

- Boca Burger with reduced fat melted cheese

- Leftover meat wrapped in a spinach leaf

- 1/4 cup low fat ricotta cheese or Greek Yogurt ... add Splenda, cinnamon, or soft fruit

- 1 oz. soy protein chips

   

 

Wow thanks for all the wonderful and helpful hints and suggestions...I sure do appreciate the time you put into this...Thank you very much.

Tammy,

In case this has not been mentioned in a previous response, the portion of the stomach that is removed is where most of the ghrelin is produced.  So, most of us lose our hunger.  That and a smaller stomach help us to maintain eating much less.  

While not everyone loses their hunger and over time the body can compensate with more ghrelin, my hunger has not returned yet.  And I am almost 3 years post-op.  

Before surgery, I used to get 'absolutely starving' where I would just eat almost anything I could get my hands on at times.  That has changed,.  I do feel some hunger, but nothing like before surgery.  And when you are not hungry and still eat, you realize that it is more of a habit or head hunger.  Big difference.  

Thank you so much for your reply and information...I appreciate it !!!

Hi Tammy, and welcome to the club here. Thank you for taking the time to get to know the sleeve better to help your group-ies. I've learned much from my doc's group over the ten years been going (between my wife's WLS and my own).

Overall the sleeve is similar in results and characteristics to the RNY but does have its' differences which are worth noting. Diets are similar, though the sleeve has fewer restrictions as concerns about things getting stuck in the stoma (the small orifice at the bottom of the RNY pouch that restricts throughput) is not a concern. Dietary progression to soft and harder foods is generally somewhat quicker though many programs use the same plan for both out of convenience.My doc's program, based upon long term DS/sleeve experience, allows most soft proteins (seafood, beans, cheeses, etc.) along with liquids and purees from the outset depending upon individual tolerances progressing to most everything else after the first month. It is probably best to ascertain what an individual patient's program calls for. There does seem to be some general liberaliztion of sleeve programs from the RNY standards as more surgeons get comfortable with the sleeve's characteristics.

Overall eating style over the intermediate to long term is generally similar - eat your protein first, minimize liquids with meals and avoid them for a half hour (give or take) after a meal, avoid drinking calories (protein shakes being a general exception though some programs encourage moving to real food protein sources as soon as reasonably possible,) avoid grazing - in general, avoid eating around your pouch or sleeve.

Related is that supplementation regimens are similar between the two, but with the RNY putting additional emphasis on minerals owing to its malabsorptive properties (you may, for instance, typically see 2000 mg or more calcium recommended for RNY patients vs.1000-1500 mg for sleevers with a similar divergence for iron and other minerals,) while sleeve patients typically have B12 added to their mix.