Pre-Op Very Low Energy Diet (VLED)

Following a strict pre-operative diet is very essential for patients undergoing weight-loss surgery in order to decrease the size of the liver and facilitate minimally invasive (laparoscopic) surgery safely, which is associated with less post-operative pain and faster recovery.

If you are diabetic, your diabetic medication will need to be adjusted by your diabetes nurse educator, GP or endocrinologist.

What is the pre-op diet stage?

• You will begin the pre-op diet stage about 2-4 weeks before surgery. Your bariatric

surgery healthcare team will tell you when you need to start this diet.

• This stage involves following a Very Low Energy Diet (VLED). VLED may also be called

a VLCD (very low-calorie diet).

• The most common VLED product recommended is Formulite and Optifast other products can be considered so discuss with our dietitian.

Your bariatric surgery healthcare team may recommend an alternative product. This will be based on any pre-existing medical conditions you may have.

• Strictly follow the instructions for taking your VLED . If you do not follow the pre-op diet

stage correctly, the size of your liver may not reduce, and your surgery could be cancelled.

How do they work?

• VLED meal replacement products are very low in carbohydrates, which will cause your

body to go into mild ketosis.

• During ketosis, the body switches from using carbohydrates as the main source of

energy, to using your body fat.

• Ketosis will assist to reduce the size of your liver. This will allow your surgeon to better

access your stomach.

• This means it is extremely important to follow the plan. Do not include any extra

carbohydrates (e.g. breads, grains, cereals, fruit, dairy foods like milk or yoghurt or

sugars) which can stop the ketosis process.

• A VLED meal replacement plan will assist with reducing your body weight and improving

your nutrition before surgery.

Common challenges.

During the first 3 days of this diet, you may experience some of the following symptoms:

• Fatigue

• Hunger

• Nausea

• Poor concentration

• Dizziness / light-headedness

• Headaches

• Diarrhoea

Ensure you continue to follow the VLED plan and drink plenty of fluids during this time.

After 3-4 days your body should adapt, and you should feel much better

Post-operative diet.

You will also need to follow a specific diet plan after bariatric surgery.

Immediately after the surgery, a special diet will allow your stomach to heal. Initially, the stomach does not contract very well, so you will consume liquids/purees only for the first 3 weeks. This means no solid food at all during the first 3 weeks post-op diet.

Three weeks after weight loss surgery.

You can start to eat soft and moist foods. We can help you make a bariatric diet food list for guidance, or just use the resource book given to you. You will be able to manage most food textures by 6 weeks after surgery. Some foods, such as chicken breast or well-done steak, often take longer to manage. Occasionally there may be a food that just never sits well in the stomach after surgery.

Keep in mind.

You will need to learn to eat slowly, chew food well, and get used to not finishing meals.

The following points are important to keep in mind:

Everyone progresses at different rates with what foods they can manage after surgery, the amount of food they can eat comfortably, and their rate of weight loss.

It can take some people weeks to get used to eating smaller amounts of food and not finishing meals. You will adjust though; it just takes some time and patience.

Here are a few things that you can try when eating out:

Only order small meals, entrees rather than main courses; share food with others at your table; ask to take leftovers home when eating out at restaurants and cafes.

After a gastric bypass.

After a gastric bypass, (and sometimes gastric sleeve), patients can encounter something known as Dumping Syndrome when eating foods high in simple carbohydrates such as sugar. For this reason, the bariatric diet does not include these foods.

Helpful Tips.

If you are getting uncomfortable when eating – for example, regurgitating, vomiting, or having a buildup of saliva after eating – this means you are usually eating too much or too fast. If you believe it is for none of these reasons, please contact the clinic so we can help you resolve any underlying issue that might be causing you problems.

-Try using smaller cutlery such as teaspoons rather than the usual knife and fork to help you to eat more slowly.

-When preparing specific bariatric diet recipes, don’t hesitate to halve the quantities to create a smaller meal.

-Serve your food on smaller plates and in smaller bowls to help to adjust to smaller portions.

-Do not drink anything too close to eating. Wait about 30 minutes after eating to start drinking again. It is important to remember that both food and drinks fill the space in your stomach and because you have had this stomach size reduced this it can be difficult to drink and eat at the same time.

-Avoid getting over-hungry as you are more likely to eat too quickly, leading to some discomfort.

Be in touch with your clinic if you need any further advise.

Weight loss surgery can lead to reduced amounts of vitamins and minerals because people eat less and may absorb less in the intestines. Weight loss surgeries have different effects on vitamins and minerals based on how much change in absorption they cause. Deficiencies in vitamins, minerals, and protein can negatively affect health causing:

• fatigue (feeling tired)
• anemia (low levels of red blood cells that carry oxygen through your body)
• bone and muscle loss
• impaired night vision
• low immunity (your body’s ability to stay healthy)
• loss of nerve function (can affect your senses such as touch, taste, and smell)
• mental function deficits (changes how clearly you think)

Fortunately, nutrient deficiencies following surgery can be easily avoided with a good diet and the use of supplements including vitamins, minerals, and sometimes protein supplements. Before and after surgery, patients are advised of the appropriate diet and vitamin supplement needed. Most weight loss surgery programs also require patients to have their vitamins and minerals checked on a regular basis after surgery. Nutrient deficiencies and any associated health problems are preventable with monitoring and patients following diet and supplement (vitamin and mineral) recommendations. Health problems due to deficiencies usually occur in patients who do not regularly follow-up to monitor healthy vitamin and mineral levels. Be sure you stay in touch with your weight loss surgery team for best results!

Surgery to treat type 2 diabetes!

Nearly all individuals who have surgery to treat diabetes (also called metabolic/bariatric surgery) show improvement in their diabetes, sometimes as quickly as a few days after surgery. They experience lower blood sugar levels, need less diabetes medications, and see an improvement in diabetes-related health problems. Overall, 78 percent of patients experience remission thus eliminating the need for diabetes medications.

Diabetes surgery performed today has been highly refined over the course of the past 70 years and is among the best studied therapies in modern medicine. These operations result in less food intake and decreased calories absorbed. Most importantly, however, these operations result in changes to the metabolism that affect intestinal hormones that regulate blood sugar control, often before the patient loses any weight. In addition, these procedures reduce hunger, increase the sense of fullness after meals, and assist the body’s ability to achieve a healthy weight. Diabetes surgery has been proven to be the most effective therapy for diabetes but also greatly improves obesity and other associated conditions.

This is otherwise known as “diabesity”.

An international coalition of  45 medical organisations recently agreed that surgery is now a standard treatment in patients with morbid obesity who are living with Type II diabetes.

This surgical pathway represents the biggest step forward in the treatment of diabetes in nearly 100 years.  Find answers to the most asked questions on bariatric surgery for diabetes.