Dietary Guidelines Bariatric Surgery

* Consume only the foods allowed on the soft diet (approximately 3-4 weeks) until otherwise informed by your RHN/RD/MD

* Eat slowly and chew thoroughly- at least 25 times!

* Avoid concentrated sugars, especially those in liquid form. They are filled with non-nutrient calories and slow down weight loss

* Limit fried foods; they are a concentrated source of calories

* Remember the stomach can only hold 4-6 oz after surgery. You will probably feel satisfied after 2-3 tablespoons of food. Do Not Overeat! Over time your stomach will stretch. It takes 6-9 months (possibly longer) for your new stomach size to stabilize and allow you to determine your normal meal amount

* Stop eating when you feel comfortably satisfied- if ignored, vomiting will follow and you can stretch the size of the stomach. If you are unable to keep anything down and are having extreme difficulty staying hydrated, sip on zero sugar Gatorade which also has electrolytes necessary for normal cell function. Once you feel better, return to non-calorie beverages such as water, herbal tea, and diet drinks.

* Drink at least 6 – 8 cups (8oz) of fluid per day to prevent dehydration. (Monitor for the following signs: headache, dizziness, nausea, lethargy, a white-ish coating on the tongue and dark urine.)

* Stop drinking liquids 15 minutes before meals and resume 30 – 45 minutes after meals

* Eat 3 small nutrient dense meals + 1 high protein snack a day

* Meals should include: protein first, then fruits and vegetables, and then whole grains

* Set up a schedule for supplements (vitamins, minerals and protein shakes; refer to pre-op supplement information) and medications; 

* Introduce new foods one at a time in order to rule out an intolerance. If a food is not tolerated, reintroduce it in 1 to 2 weeks

* If you cannot tolerate dairy, substitute Lactaid for milk. You may need to take lactase pills with dairy to help digest the lactose. You can also try almond milk with no sugar added.  You can also choose to eliminate dairy from your diet.

*Exercise! This is the key to long term weight loss and maintenance. Walking should be the main exercise for the first 6 weeks. Between 6-8 weeks, more strenuous exercises can be added.

Your diet progression during and after your hospital stay:

Bariatric Surgery Clears – In the hospital you will receive clear liquids. It is begun after the results of your “swallow test” are back.

• • You will be drinking/eating water, tea, broth, sugar-free jello, and apple juice post swallow test.
• • Try to sip fluids at the rate of 1/2 to 1 oz per 20 minutes (=1 1/2 to 3 oz per hour).
• • Sipping fluids out of bottles or straws may cause gas. Gas is already a problem after surgery so you will not want to make it worse.
• *If you experience diarrhea or vomiting, Gatorade can be used during that time to help re-hydrate.
• You can add watered down protein shakes during this stage.  See below for suggested protein shake options.

Bariatric Surgery Home Pureed – You will progress to a diet composed of pureed foods low in fat. You will add protein shakes (not watered down).

• • You can have foods like pureed poultry and meat, mashed potatoes, avocado, and unsweetened applesauce.
• • You will only be able to eat a few tablespoons of food at one time.
• • It is up to you to control how much you eat.
• Add your protein shakes (not watered down) during this stage

Bariatric Surgery Home Soft Diet – You will follow this diet until approximately 3-4 weeks before you to move onto the solid food diet.

• • Blenderized meat and poultry, soft poached eggs
• • Cottage cheese, sugar free puddings
• • Unsweetened applesauce, pureed canned peaches (not in syrup), mashed ripe bananas
• • Blended soft cooked vegetables, or overcooked and mashed with a fork
• • Oatmeal, grits, farina
• Protein Shakes

Bariatric Surgery Home Solids – If you can tolerate the items in the soft diet after 3-4 weeks, you will gradually advance to solids. This is a modified diet, which emphasizes lean protein, fruits/vegetables, and whole grains and de-emphasizes sugar.

• •This diet is very individualized. It is normal to experience food intolerances. Try to re-introduce that food a week later while focusing on eating slowly, chewing thoroughly, and not overeating.

•You will eventually be able to tolerate a variety of foods from each of the food groups.

Food Suggestions for Home Soft Diet (first 3-4 weeks):

• Whole Grain Toast
• Whole Grain Cereal
• Whole Grain Pasta and Rice 1-2 serving/day – 1 serving = 1/4 cup
• Hot cereal (with milk) – unsweetened oatmeal, cream of wheat, and grits.
• Fruit 1-2 serving/day – 1 serving = 1/4 cup
• Protein Shakes 

Unsweetened applesauce, pureed canned/jarred peaches and pears in their own juice (not syrup), any fruit pureed without the skin, mashed ripe banana.

Vegetable 1-2 serving/day – 1 serving = 1/4 cup

Any vegetable (except corn) cooked soft and blended or mashed with the back of a fork. Make sure broccoli and cauliflower are cooked very well.

• Meat
• Poultry
• Fish
• Nuts (well chewed or nut butters)
• Beans and Eggs 2-3 serving/day – 1 serving = 1/4 cup

Chopped up soft poached eggs or scrambled egg. Egg salad with low fat mayo. Blenderized meat and poultry and flaked fish (fillet) cooked very soft and moist (mix with lemon, light dressing, a pinch of oil).  Blenderized tuna salad without vegetables. Very soft/moist meatloaf (after one week), fish, and silken tofu.

Milk, Cheese, and Yogurt 3-4 serving/day – 1 serving = 1/4 cup

Regular cow’s milk,  cottage cheese or ricotta cheese, almond milk, sugar free custards and puddings, high quality greek yogurt, sugar free frozen yogurt, and sugar free fat free ice cream. 

Fats and Oils are limited to 2 servings per day.

Miscellaneous 2-3 servings/day – 1 serving = 1/4 cup

Canned soups, homemade soups (vegetable, meat, poultry contents should be overcooked or blended, but limit creamed soups) – Healthy choice, Progresso Lite, and Healthy Request, egg drop soup and miso soup all are acceptable.  Sugar free jello, sugar free popsicles (Dole, Starburst), Pedialyte popsicles, sugar free/fat free ice cream.  Artificial sweeteners which are acceptable: Nutrasweet/Equal, SweetnLow/Saccharine and Splenda / sucralose. The best sweetener is Stevia.

Liquids (sip throughout the day but not during meals. Try to drink at least 6 to 8 – 8oz cups of fluid per day)

Flat diet soda, milk or almond milk, Crystal Light, decaf coffee and tea, all broths, any sugar free beverages, sugar free Kool-Aid and sugar free Tang, and water!

*Can I use baby food? For people who do not want to do any preparing, canned and jarred baby foods are acceptable. Choose the ones low in sugar and higher in protein (meat and chicken).

*Most foods can be eaten (low in sugar) as long as they are put into a blender and the final consistency is puree.

Sample Menus (Home diet first 3-4 weeks):

*It is up to you to what time of the day you choose to eat your meals, supplements, and snack.

Concentrated Sweets:

Most of the foods and beverages that contain concentrated sweets are filled with “empty” calories in the form of sugar. These products provide mainly calories with limited nutritional value, which means they often do not contain a good amount of vitamins, minerals, protein and fiber. These nutrients are essential after weight loss surgery to help you recover and receive the nutrition that you need.

After surgery, every bite counts. Filling up on these “concentrated sweets” can prevent weight loss and can replace healthier foods in your diet with high calorie, high sugary foods. Take a look at the concentrated foods / beverages below and make a mental note of a healthier option for you.

Note: Artificial sweeteners such as Nutrasweet/Equal ®, saccharine/Sweet & Low ®, and sucralose/Splenda ® are OK to use as well as Stevia.

THESE CONCENTRATED SWEETS ARE “NO-NO’S”:

• Sugared Ice cream
• Sherbet / Sorbet
• Regular soft drinks
• Sugared Chocolate milk
• Sugared Lemonade
• Sugared Pudding
• Sugared Kool Aid
• Sweetened, fruited or frozen yogurt
• Sugared ice tea
• Dried fruits
• Sugared Snapple or fruit drinks
• Canned or frozen fruits in syrup
• Table sugar
• Sugared Fruit juice
• Honey
• Sugar coated cereal
• Candy
• Doughnut
• Regular Jell-O
• Sugared Popsicles
• Sugared gum
• Cakes
• Molasses
• Pies
• Syrups
• Cookies
• Jellies Jams

 

Diet Progression Bariatric Patients:

 

These are general guidelines regarding when to introduce various foods. Everyone is different and may not progress at the same rate.

• Day 1 Post-op: Nothing by Mouth.

• 2-3 Days Post-op: Progress from Bariatric Surgery Clears (clear liquids, no concentrated Sweets) to Bariatric Surgery Puree (No concentrated sweets, puree). Try to consume 3-4 oz of fluid for every hour you are awake (not during meal time).

• 3 Days to 3 Weeks Post-op: Home Puree and Soft Diet (high protein foods). Try to consume 4-6 oz of fluids every hour. You should be consuming approximately 550-700 calories and approximately 40 to 50 grams of protein.

• 3-6 Weeks Post-op: All foods previously tolerated, tofu, fish and seafood, thinly sliced deli turkey or ham and other luncheon meats, slices of cheese, unsweetened canned or cooked fruit, sweet potatoes, squash, unsweetened cereal with milk or almond milk, boiled chicken in broth (cut up in small pieces), crisp toast and crackers, beans and peas, and lean, moist ground turkey and moist ground beef.

• 6-8 Weeks Post-op: Diced Poultry, vegetable burgers, soft cooked vegetables, soft fruits (watermelon, honeydew, peaches, plums), well cooked whole grain pasta / this is quite high in carbohydrates so please eat very limited amount.

• 3 Months Post-op: whole grain rice, un-toasted bread, lean and moist meat and poultry.

• 4 Months Post-op: Veal, crunchy fruits and vegetables including salads.

• 6 Months Post-op: Beef and Pork (choose poultry and fish more often in view of lower fat content).

The diet should always be high in protein and low in refined carbohydrates (white flour). Preferably, choose protein first, then fruits and vegetables, and then whole grains.

SUPPLEMENT RX:

*You will require vitamin and mineral supplements in order to prevent deficiencies.  Remember, you are eating much less food and it will be harder to get the proper nutrition each day. Begin with vitamins 7 days post surgery.

The first week after surgery:

• Bariatric Expert MultiVitamins: 

• Bariatric Vitamin D3: 

Bariatric Biotin

Bariatric Fiber:

Protein shakes:

• These must be high protein (15-20 grams/serving) AND low sugar (less than 4 grams/serving). You must read product labels to determine the nutritional value.
• Suggested protein shakes : Shakes and Powders mixed with milk or almond milk or water
• Bariatric Food Expert Plant Protein Shakes.
• Directions for powders: Add protein powder by the scoop/tablespoon to 8 oz milk, almond milk or water
• You may choose to drink your shake in 2- 4 oz servings.

After surgery you will need between 50-70 grams of protein a day. In order to meet your protein needs, protein shakes such as the ones listed above, will supplement your meal plans. Once you are able to get enough protein from your food, you will not need to continue using protein shakes on a daily basis.

Supplements after 3 Weeks:

* Labs and other supplements may be prescribed as needed. Labs should be checked  3 to 6 months post surgery with your family/personal physician.

 

If you would like to go even further with your post op guidelines, you can view the following program that includes post op plans, 14 day menu, food logs, recipes, shopping lists, and exercise guidelines:

The Perfect Bariatric Prep and Perform Program