Phase II - Puree Diet Phase (from Week 2 to end of Week 3)

If you are tolerating fluids well then you can progress to a puree diet in the second week after your gastric sleeve operation. However, if you had difficulty keeping up with fluids intake you may want to postpone puree diet till the third week.

What are the essentials of a puree diet?

This phase of your recovery diet requires that the foods you eat be pureed and reduced to liquid form. You will therefore need a blender or food processor. Pureed foods are characterised as those that can be easily liquefied in a blender or mashed into a near-liquid pulp with a spoon or other implement and thus can be more easily tolerated by your new, smaller stomach.

Drinking liquids with these pureed foods will cause the food to pass through the stomach more quickly and will speed up its emptying. You should therefore keep the pureed foods and liquids separate and consume them at appropriate times – pureed food at your three meal times and liquids in between meals. A basic puree diet meal plan consists of the following:

• Breakfast – pureed cereal such as Weetabix or porridge with low-fat milk.
• Morning tea or snack – 100 ml of low-fat yoghurt, pureed fruit.
• Lunch – ½ cup pureed chicken, meat, or fish (or ½ cup Optifast) and vegetable soup.
• Afternoon tea or snack – the remainder of your Optifast.
• Dinner – same pureed meats as at lunch, plus pureed vegetables.

Foods suitable for pureeing for this phase of your recovery diet include:

• Starches – cooked cereal, cream of rice, cream of wheat, thinned grits or oatmeal, baked potatoes, baked beans, mashed potatoes, mashed sweet potatoes.
• Fruits – cooked or canned fruit (if canned, make sure they have no added sugar).
• Dairy – skim or fat-free milk, low-fat yoghurt, and low-fat or fat-free cottage cheese.
• Meats – fresh or canned chicken or lean meats, shaved deli meats, almost any type of fish if cooked by baking, broiling, slow cooker, or other methods that add no oils or butter.
• Vegetables – cooked or canned vegetables, preferably low-sodium.

At this point in your recovery, you will still most likely not feel hungry, and you will feel full even after consuming small amounts of food, so the general advice of take it easy and take it slowly still holds. During this period in which you will begin to consume more substantial (but still liquefied) foods, it is important to remember a few general guidelines:

• Keep to a routine of three meals per day, but only three. Avoid between-meal snacking.
• Start with small portions, no more than 1-2 tablespoons of food at a time.
• Continue drinking fluids (1-1.5 litres per day).
• Do NOT drink these liquids with your meals of pureed foods, because it will hamper the digestive process. Don't drink liquids for 30 minutes prior to and after a meal.
• Consume the pureed foods slowly, because eating too much out of habit can result in slowing the healing process. Learn to eat only small amounts at a time; eating with a teaspoon from a small bowl will help you to accomplish this.
• Avoid extremely hot or cold foods.
• The minute you start to feel full, stop eating.

Additional tips for making the puree diet work for you

When eating, you should take small bites. Don't rush things. If you try to eat too quickly or take bites that are too large, you may experience nausea or reflux. Remember to chew even though the pureed foods are already in near-liquid form; this releases enzymes that are important to the digestive process. Do not swallow until the bite you are working on is at least at apple sauce consistency.

During this phase, it is more important to focus on making sure that you are receiving adequate nutrition than it is to focus on "texture" or other qualities of the food. You are eating pureed foods to decrease or eliminate the need for chewing and to ease the digestive process. For this reason, avoid choosing doughy foods (such as breads) or sticky or starchy foods (such as rice or pasta) as candidates for pureeing. All of the foods you eat during this phase should approximate the texture of baby food (although baby food itself is not recommended because it is designed for the nutritional needs of growing babies, not adults) and should be eaten in small bites taken from a spoon.

It is important to maintain your protein levels (50-60 grams per day) during this initial phase of rapid weight loss to prevent muscle tissue loss. You can accomplish this by having a protein shake similar to the ones you had during the "free liquid" phase (or one of the Optifast replacement meals) at least once a day. Naturally, you can also experiment with different sources of protein such as chicken, lean meat, fish, eggs, and dairy and puree them as one or more of your daily meals. You should eat the protein first before the carbohydrates (starchy) foods.

You should also remember to take a multivitamin supplement such as Nutrichew or Centrum twice a day. A liquid vitamin supplement or a chewable vitamin crushed up is the best but can be hard to find.