There will be a few diet transitions after the Endoscopic Sleeve Gastroplasty (ESG) procedure. You will not be able to resume eating normal food immediately after your procedure. The diet progression will start with clear liquids, then move onto full liquids, followed by soft foods, and eventually back to regular texture foods. The purpose of this 4-week diet progression is to ensure optimal healing and minimize pain or discomfort from the ESG procedure.
DAYS 1-3 post ESG: Clear Liquid Diet
Prior to your ESG procedure, you will be NPO (nothing by mouth), but afterward, you will begin on a Clear Liquid Diet with the goal to drink 48-64 fluid ounces per day. To reach this amount, it’s important that you take small sips. Avoid gulping or drinking too quickly to help prevent discomfort. A good benchmark is to aim for 1-2 ounces of clear liquids every 15 minutes. The Clear Liquid Diet will consist of sugar-free, non-carbonated beverages that contain less than 10 calories per 8-ounce serving. Some examples include water, Hint water, Fruit2O, Mio drops, Crystal Light, True Lemon/True Lime packets, sugar-free Jell-O, sugar-free popsicles, and decaf tea or coffee (no cream or sugar). Clear beverages with electrolytes include Vitamin Water Zero, Propel, Powerade Zero, Gatorade Zero, and broth (vegetable, chicken, beef, or bone – no solids). Some clear protein drinks to choose from include Premier Protein Clear or Protein20. The main goal of these first 3 days is to make sure you are staying hydrated.
Extremely hot or extremely cold liquids may not be tolerated as well as moderate-temperature liquids. You especially want to avoid caffeine and alcohol during this time, as they can lead to stomach irritation and dehydration. Avoid using straws because they can make you drink too quickly and take in too much air which may cause discomfort. Changes in bowel habits are normal during these transitional diets, so it is recommended to take 1 dose of MiraLAX daily for the first 2 weeks.
DAYS 3-14 post ESG: Full Liquid Diet
As you transition to a Full Liquid Diet you will still need to get at least 64 ounces of sugar-free, non-carbonated liquids (spoiler alert: this recommendation will never change). You will still need to pace yourself and aim for 1-2 ounces every 15 minutes. Now is when the focus comes back to protein, with a goal of 60-90 grams of protein per day. While on the Full Liquid Diet, you can still drink everything listed on the Clear Liquid Diet, in addition to a protein shake with specific requirements. You will need to drink 2-3 protein shakes/day to meet your protein goal. When looking for an appropriate protein shake or powder, here are some basic requirements per serving: 20-30 grams of protein, less than 200 calories, less than 10 grams of total carbohydrates, and less than 5 grams of sugar.
Some of the most popular Ready-To-Drink protein shakes are Premier, Fair Life Core Power, Fair Life Nutrition Plan, and Atkins Protein Plus. If you prefer to choose a protein powder instead, that is fine; be sure to take note of the serving size, sometimes the serving size is 1 scoop, but sometimes it is 2 scoops. If choosing a protein powder, mix it only with water or unsweetened almond milk; you are not making smoothies! So don’t get fancy, no fruit, vegetables, nut butter, etc. Protein powder plus liquid, and that’s it.
You will also start taking your vitamins during this time. Since you will not be able to eat as much after the ESG procedure it’s likely you therefore won’t be getting the ideal amount of micronutrients, vitamins, and minerals, from food alone. The goal is to minimize the risk of vitamin and mineral deficiencies by starting to supplement before your levels have a chance to drop low. Maintaining normal vitamin and mineral levels is important for optimal brain function, bone maintenance, energy levels, and more! Recommendations are to start a daily calcium, Vitamin D, Vitamin B12, and an adult chewable multivitamin with Iron.
WEEKS 2-4 post ESG: Soft Diet
Good news, this does not mean baby food or pureed food! The consistency of food during this phase should be soft enough to mash with a fork. You still need to aim for 60-90 grams of protein per day (another spoiler: this recommendation will also never change). During the soft diet phase, you will need to continue with 1 protein shake per day in addition to choosing protein-based soft foods such as eggs, soft-baked white fish, canned chicken/tuna/salmon (mixed with mayonnaise or plain Greek yogurt to have the appropriate texture so that it can be mashed with a fork), deli meats (like chicken, turkey, or ham), and soft vegetable proteins like tofu. You will also be able to incorporate some real cheese, cottage cheese, ricotta cheese, Greek yogurt (plain or light), legumes, lentils, or refried beans. Certain soft-cooked non-starchy vegetables, canned fruit, and unsweetened applesauce can also be consumed during this diet phase – but only after protein goals are met.
Your meal pattern will be 3 meals and 1 snack daily, and you will only spend 15-20 minutes on your meals. Your meals will be small and almost entirely protein, and remember to always eat your protein first. Another reminder during this phase is that you will not be able to eat and drink at the same time, there simply will not be enough room in your new, smaller, stomach. Remember to stop drinking about 15 minutes before you plan to eat and wait 20-30 minutes after eating before you drink again. This is important to minimize discomfort, while still getting appropriate fluid and protein intake.
AFTER 4 WEEKS post ESG: Regular Maintenance Diet
This doesn’t mean going back to what used to be your regular diet. We’re referring to the regular texture and consistency of foods with an emphasis on, you guessed it, high-protein food choices. As you transition to regular consistency foods you will notice you will not be able to eat quite as much as you did when you were eating soft foods. This is normal. This is the purpose. Your focus will continue to be a consistent meal pattern of 3 meals daily with 1 snack if needed. You will most likely need to continue with 1 protein shake/day for the next month or so, just to make sure you are consistently getting the desired 60-90 grams of protein daily.
When creating your meals, the main focus will be choosing a dense, quality protein that requires you to take your time to chew well; this will help keep you feeling fuller, for longer. And as always, eat your protein first. This means, with your smaller stomach, that about 75% of your meal should be protein. If you are still hungry, and still within time limits, you may add a non-starchy vegetable to your meal. Remember to limit your mealtime to whatever you can comfortably eat in 15-20 minutes. Obviously, you will want to avoid foods that are breaded and deep-fried. Eating like this on a consistent basis will allow the ESG surgery to work in your favor to promote maximum weight loss while still nourishing your body with adequate macro and micronutrients.
Even though your diet texture will transition, you will still need to get 60-90 grams (or more) of protein and drink 64 ounces (or more) of sugar-free, non-carbonated liquids daily. If you wish to maximize your weight loss potential, it will be vital to continue with your exercise habits and adjust the intensity and/or duration to meet your goals. The true key to achieving your goals is to prioritize and remain consistent with these dietary and lifestyle modifications.