Diet – What to Eat After Gastric Sleeve (Sleeve Gastrectomy) Surgery

PHASE 1: CLEAR LIQUID DIET (Although it is 0-3 days post-surgery, it may vary) Goal: 1.5 - 2 liters of fluid (6-8 / 250ml glass) UNRESTRICTED DIET FORBIDDEN FOODS • Water • Linden, lemon balm, fennel, and rosehip tea • Sugar-free and grain-free fruit compote juice • Freshly squeezed and filtered fruit juices (apple/peach/grape/apricot) • Low-fiber, lean, strained vegetable soups or juices (spinach, carrot, zucchini, potato) • Fat-free soft cheese or quark • Fat-free plain yogurt • Skim and lactose-free milk or soy milk • Probiotic yogurt • All sugary, carbonated, and alcoholic beverages • Ready-made fruit juices with added sugar • Brewed/strong tea and coffee • All caffeinated beverages • Soups prepared with vegetables other than freebies • Ready-made soups • Stock cubes • Cocoa • Full-fat, flavored milk, and Ayran • Solid foods • Tomato paste PHASE 1: CLEAR LIQUID DIET (All liquids should be consumed in sips at intervals of 10-15 minutes, and all liquids should be at room temperature.) MORNING 07:00-07:30 1 cup clear broth soup (without any clear pulp) (50-100ml) BREAK: 09:30 1 tbsp pineapple or apple or cherry juice (pulp-free, without sugar) (50-100ml) LUNCH: 11:30 1 cup clear broth soup (without any clear pulp) (50-100ml) BREAK: 13:30 1 tbsp pineapple or apple or cherry juice (pulp-free, without sugar) (50-100ml) BREAK: 15:30 1 cup clear broth soup (without any clear pulp) (50-100ml) EVENING: 17:30 1 cup clear broth soup (without any clear pulp) (50-100ml) BREAK: 19:30 1 tbsp pineapple or apple or cherry juice (pulp-free, without sugar) (50-100ml BREAK: 21:00 (at least 2 hours before bedtime) 1 cup clear broth soup (without any clear pulp) (50-100ml) ***Additionally, upon request, 2 teacups (100ml each) of Linden/Fennel/Jasmine/Lemon Balm tea can be consumed twice daily.

PHASE 2: DARK LIQUID DIET (11 days, the plan may vary depending on the patient.) Goal: 1.5 - 2 liters of fluid (6-8 / 250ml glass) • 3 main meals and 3 snacks spread throughout the day (every 2-3 hours) • All consumed foods should be at room temperature. • In this phase, protein intake can be gradually increased to 40 grams. • The administered foods may vary depending on the patient's tolerance. UNRESTRICTED DIET FORBIDDEN FOODS • Water • Linden, lemon balm, fennel, and rosehip tea • Sugar-free and grain-free fruit compote juice • Freshly squeezed and filtered fruit juices (apple/peach/grape/apricot) • Low-fiber, lean, strained vegetable soups or juices (spinach, carrot, zucchini, potato) • Fat-free soft cheese or quark • Fat-free plain yogurt • Skim and lactose-free milk or soy milk • Probiotic yogurt • All sugary, carbonated, and alcoholic beverages • Ready-made fruit juices with added sugar • Brewed/strong tea and coffee • All caffeinated beverages • Soups prepared with vegetables other than freebies • Ready-made soups • Stock cubes • Cocoa • Full-fat, chocolate, flavored milk, and Ayran • Solid foods • Tomato paste MORNING: 07:00 1 cup protein drink (50-100ml) BREAK: 10:00 PHASE 2: DARK LIQUID DIET 1 glass freshly squeezed juice (without pulp, except for orange!! - cherry-apple juice) (50-100ml) LUNCH: 12:30 1 tbsp lactose-free milk (50-100ml) BREAK: 14:30 1 cup protein drink (50-100ml) BREAK: 17:00 1 glass freshly squeezed fruit juice (without pulp, except for orange!! - cherry-apple juice) (50-100ml) INTERMISSION: 19:00 1 cup protein drink (50-100ml) *** Between meals, a minimum of 1 - 1.5 liters of water should be consumed daily. No water should be consumed during meals. *** Additionally, upon request, 2 teacups (100ml each) of Linden/Fennel/Jasmine/Lemon Balm tea can be consumed twice daily. 1 liter of water!!! Take probiotics once daily. 1 scoop (5ml) of multivitamin syrup per day. Mix 1 scoop of protein powder with 300ml of lactose-free milk and consume it as 3 meals per day (if the volume is increased to 150ml, 2 meals per day are sufficient).

PHASE 3: SOFT DIET (15 days, it may vary depending on the patient)

• 3 main meals and 3 snacks throughout the day (every 2-3 hours).

• All food consumed should be at room temperature. NOTE: Solid and liquid foods must be consumed separately. Consumption of water and other liquids should be avoided 30 minutes before or after the meal.

UNRESTRICTED DIET

• Water

• Light tea, lime, lemon balm, fennel and rose hip tea

• Sugar-free and grain-free compote juice

• Freshly squeezed and filtered fruit juices (apple/peach/grape/apricot/melon only) Apple/peach/grape/apricot/melon/watermelon/cherry/banana)

• Fat-free natural yoghurt, lactose-free milk and light ayran

• Smoothies prepared with lactose-free milk and fruit (top with free fruit)

• Low-fat cheese, cottage cheese, labneh or quark

• Egg

• Lean red meat/chicken/turkey/fish in mince

• Mixed or strained lean and tomato paste-free soups (rice and vegetable soups with milk/ minced meat/chicken, vermicelli, tarhana soup)

• Vegetable dishes (with spinach, chard, potatoes, aubergines, carrots, courgettes, tomatoes)

• Wholemeal, rye, oat flour

• Thoroughly crushed seeds

FORBIDDEN FOODS • All sugary, carbonated, alcoholic beverages. • Ready-made fruit juices with added sugar • Brewed/strong tea and coffee • All caffeinated drinks • Cocoa • Full fat, chocolate, flavoured milk and ayran • All vegetables that cause flatulence (e.g. cabbage, cauliflower, broccoli, radishes) • Ready-made soups • Broth tablets • Breads other than those specified • Fruit juices other than certain fruits • Fatty and hard meats

MORNING: 07.00 1 SB protein drink (150 ml) BREAK:09.30 PHASE 3: SOFT FOOD 1 portion fruit puree or juice in case of intolerance LUNCH:12:00 1 SB Mixer soup (meat, chicken, fish group and vegetables) (100-150ml INTERRUPTION:14:30 1 SB protein drink (150 ml) BREAK:17.00 1 portion fruit puree EVENING:19.00 2-3 tbsp vegetable puree 2 tablespoons lactose-free yoghurt 1-1.5 litres of water!!! Take probiotics once a day Every day 45-60 hours walking!!! *** At least 1 - 1.5 litres of water should be drunk daily between meals. No water should be drunk with meals. *** In addition, if desired, 1 tea glass (100 ml) of light tea / lime / fennel / jasmine / lemon balm tea can be drunk 2 x daily. Unsweetened vanilla pudding (2 servings): Put 1 glass of lactose-free milk + 1 level tablespoon of starch + 1 teaspoon of flour in a saucepan and stir slowly over low heat. When it boils and starts to thicken, turn it off and mix in 1 teaspoon of Labne cheese.

PHASE 4: CONTINUE DIET Target: 1.5 - 2 litres of fluid (6-8 250 ml cups) and 60-90 grams of protein per day. - 3 main meals and 3 snacks throughout the day (every 2-3 hours). - All food and liquids consumed should be at room temperature. MORNING: 07.00 1 egg (boiled) 1 cheese (30g-low fat) 2-3 olives BREAK:10:00 FORBIDDEN FOODS • All sugary, carbonated, alcoholic beverages. • Ready-made fruit juices with added sugar • Brewed/strong tea and coffee • All caffeinated drinks • Cocoa • Whole milk and its products • All vegetables that cause flatulence (e.g. cabbage, cauliflower, broccoli) • Ready-made soups • Broth tablets • Breads other than those specified • Very fatty and tough meat • Very sugary and starchy desserts PLEASE NOTE PHASE 4: CONTINUE DIET

• Legumes are decided according to the patient's tolerance. However, it is better not to consume them for the first 3 months.

• Olives can be consumed from the 2nd month.

• Tomatoes and lettuce can be consumed gradually in small quantities finely chopped after the 4-5th month.

1 portion of fruit or puree if you cannot tolerate it LUNCH:13:00 2 meatballs fish**/meat/chicken/turkey(60g) (grill cooked) 1-2 tbsp vegetable dish INTERRUPTION:15:30 1 SB Protein Drink (150 ml) EVENING:17.30 2 meatballs fish**/meat/chicken/turkey(60g) (grill cooking) 1-2 tbsp vegetable dish BREAK:20.00 until 2 hours before bedtime at the latest 1 SB protein drink (150 ml) *** At least 1 - 1.5 litres of water should be drunk daily between meals. No water should be drunk with meals. *** Additionally, if desired, 1 tea glass (100 ml) of light tea / lime / fennel / jasmine / lemon balm tea can be drunk 2 x daily.

Breakfast: PHASE 5: CONTINUE DIET - Tea: 1 ML of "Instant Herbal Drink" mixed with 200-250ml of water (preferably hot) and at least 2 of "Aloe Vera" (2 lids full) and - Shake: with 300ml water mixed with 1ML "Protein Drink Mix" and 2 ML of our "Healthy Meal". => We should have our breakfast within 1 hour of waking up. Please send a photo to the group so that I can write down the times and keep track of it. After 3 hours we eat our .... .... Snack e.g: - Skyr yoghurt (available in different flavours: vanilla, fruit or natural) approx. 150gr. If fresh fruit and toppings are added to the yoghurt, it is better to use only 80-100 gr. yoghurt. - Boiled egg with e.g. some vegetables (cucumber) on top - 1 Herbalife chocolate bar - 1/2 Herbalife Express Muesli Bar - Almonds 15 pieces - Walnuts 6-8 pieces - roasted chickpeas 1 small handful roasted chickpeas / Leblebi 1 avuc ici - Light cream cheese with a few cherry tomatoes, season a bit - Skyr spread (available at Penny); can also be used as a dip with vegetables - Exquisa Fitline yoghurt (different varieties) - Protein yoghurt from Ehrmann - Tomato soup - top nutritional values, ready in 2 min (you can also make it a bit thicker and use it as a sauce with lentil noodles, for example) - 1 glass of "Iced Coffee"

After 3 hours we eat our .... .... Main meal eg: - White meat (turkey, fish but please not breaded!!!) - Red meat (1 time a week) - All vegetables - Protein-rich salad - Wholemeal pasta - Lentil noodles - Bulgur rice, quinoa, wholemeal rice, brown rice or basmati rice as a small side dish - Kebab box without bread - Barbunya, Nohut yemegi, Kuru fasülye Again in a 3-hour rhythm we eat the snack: And after 3 hours again our shake (prepared as for breakfast, see above). In between please drink a lot of water (at least 2 L a day), if you support it with sports would be great. SPORT: Tuesday and Thursday evening live training at 22:00, Fridays 6pm (for women only)

FOODS AND LIQUIDS TO AVOID AFTER SURGERY The foods and liquids in the following list contain large amounts of sugar and/or fat. Consuming sugar and fat in excess of the recommended amounts slows weight loss and prevents a balanced diet. It can also cause dumping syndrome. For this reason, it is extremely important to read the label information of packaged foods and make choices based on their fat and sugar content.

• Alcoholic beverages: It is recommended to avoid alcohol during the first year of surgery. If, with the agreement of the doctor and dietician, it is decided to consume alcohol, low-energy carbonated, white or red wines can be consumed. However, they should also be consumed in small quantities and gradually. It would be much better if the contents were diluted by adding ice to the alcoholic drink. Alcohol can be rapidly absorbed after bariatric surgery and pass into the bloodstream, making its effects felt after only a few sips. For this reason, it should be avoided if possible, but consumption should be limited.

• Acidic drinks: They can cause the stomach to grow again and affect stomach health. Carbonated drinks are 25% water and 75% air, and swallowing this much air will cause the stomach to expand.

• Sweets, candies, cakes, biscuits, honey, jam, syrup, chocolate: Sugary foods and drinks should not be eaten for at least 6 months.

• Fried food

• Carbonated drinks (beer, lemonade, carbonated water, etc.)

• Salad dressings, mayonnaise, cream, etc.

• Full-fat dairy products such as coffee creamers

• Processed meat with high fat content: sausage, cold cuts, salami should not be eaten.

• Chicken/turkey with skin and fatty meat: It can be consumed without skin and fat.

• Fast food

• Greasy canned fish

NUTRITION AND EATING TECHNIQUES AFTER BARIATRIC SURGERY Equipment required

• Glasses, spoons for measuring

• Kitchen scales for weighing food

• Small serving plates, bowls and cutlery

• Water bottle to fill with the amount to be consumed during the

day. • 3 main courses + 3 snacks: Meal layout It is recommended to take a small amount of food or liquid at a time as the stomach volume is reduced. The number of meals can be increased or decreased depending on tolerance. • Separation of liquid and solid food: Consumption of water or liquids during meals is not recommended. Consuming solid and liquid foods together may cause nausea and bloating, as well as rapid passage through the digestive system and excessive food intake. Consumption of water/liquid should be avoided 30 minutes before and after main and snack meals. • Eat food slowly and chew well: Each food should be chewed an average of 20-25 times, taking small bites of the food. • Consume liquids in sips throughout the day: Aim for 1.5 - 2 litres of fluid per day. To achieve this goal, fluids should be drunk slowly and between meals and snacks. • Each meal lasts 30-45 minutes: Meals should not be prepared in front of a computer or television. Meal time must be respected.

• Prefer low-fat and sugar-free foods: Foods high in fat and sugar can cause dumping syndrome and slow down weight loss because they contain a lot of energy. Therefore, it should not be consumed. • Cooking techniques: Boiling, steaming, baking and cooking in pots should be preferred to frying and roasting methods. • Prioritise foods with protein sources: Protein-containing foods should be consumed mainly at mealtimes. These are: Cheese, eggs, yoghurt, milk, kefir, buttermilk, chicken, fish, meat. • Integrate movement into life: Care should be taken to remain active throughout life from the time after the operation. This process can be started at the beginning with short and stride-free walks and then with light steps. Using the stairs instead of the lift, walking short distances, swimming and dancing are good alternatives. NOTE: Stop eating and drinking when you feel full and fuller. If your meal is not finished after waiting at least 30-45 minutes, you can continue. Get well soon. If you need nutritional support, you can