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Bariatric Surgery

Dietary Guidelines after Bariatric Surgery

The purpose of the following guidelines is to reduce the symptoms associated with gastric bypass surgery, promote long-term satisfaction, and to achieve and maintain a desirable weight. The diet following surgery is divided into three phases.

 

Phase 1: First 2 weeks* after surgery - Liquids

(*Time frame varies according to physician)

 

Acceptable beverages include:
  • "Sport drinks" (Gatorade, Powerade) slightly diluted with water
  • Sports drinks with less sugar such as PowerAde Zero, G-2, or Propel
  • Water
  • Flavored waters that are sugar-free and non-carbonated
  • Crystal Light® (generic brands are fine)      
  • Broth, bouillon, consommé (chicken, beef, or vegetable)
  • Sugar-free popsicles
  • Sugar-free gelatin
  • Tea:  unsweetened or artificially sweetened; iced or hot; black, green, or herbal (decaffeinated is best, but caffeinated is fine if less than 2 cups a day)
  • Coffee (decaffeinated is best, but caffeinated is fine if less than 2 cups a day)
  • Sugar-free, fat-free hot cocoa (made with 1% or skim milk)
  • Skim, 1%, Ultraskim, or Superskim milk*
  • Fat-free or low-fat soy milk, Lactaid®, or Dairy Smart®
  • Almond milk (not a significant source of protein)
  • No Sugar Added Carnation® Instant Breakfast
  • Any other protein supplement as long as the first ingredient states "whey protein isolate" or "soy protein isolate" (example: Bariatric Advantage® or Unjury®)
  • Tomato soup or any other low-sodium, low-fat condensed soup in which you add 1% or skim milk
*Use caution as some people become lactose intolerant after surgery.  If you experience intolerance to dairy, try soy milk, Lactaid®, or Dairy Smart®.
Avoid:
  • Fruit juices: both 100% fruit juice and those with added sugar
  • Regular and diet soda
  • Carbonated beverages
  • Alcoholic beverages
 
Suggestions for Phase I Diet:
  • Increase liquids as tolerated to at least 2 liters a day (64 oz., or eight 8 oz. cups). Drink enough fluid to keep your urine a clear, pale yellow color.  If your urine becomes cloudy, dark or foul-smelling, drink more!
  • Sip slowly throughout the day. Drink 8 oz. of fluid over a period of 1 hour. Do not gulp liquids or drink too quickly. Gulping or drinking too fast can cause abdominal pain and/or nausea.
  • Protein goal is 60 to 80 grams/day; this may not be possible at first, but patients should work towards this amount of protein.
  • It is very important to avoid any liquids with a high amount of sugar at this time (more than 15 g. in an 8 oz. serving). Sugary liquids may cause dumping syndrome, which is something you do not want to experience. Plus they are an added source of unwanted calories.
  • Avoid drinking from a straw. When you drink from a straw you swallow more air, which may make you belch more often. Carbonated beverages are to be avoided for the same reason; they will cause excess gas.
  • Pre-freeze or refrigerate plastic bottles of water, Crystal Light®, tea, etc. and carry the bottle around with you so that you can take small, frequent sips of fluid throughout the day and avoid becoming dehydrated.
  • During this phase of the diet, begin taking a chewable multivitamin/mineral supplement twice a day. Other vitamin and mineral supplements (calcium, vitamin D, vitamin B12, and iron) may be started as well. (See the vitamin section of this handout for examples).
 
 
 
Phase I Sample Menus
Note:  Times of day are irrelevant!  The point is to sip constantly during your waking hours.First 2 weeks after surgery -- generally sip on 8oz. fluid over a one-hour period of time.


 


8am:  8oz. water
9am:  8oz. decaf coffee w/ Splenda®
10am:  8oz. skim milk + one serving of approved protein supplement (Bariatric Advantage® for example)
11am:  8oz. Crystal Light®
12pm:  8oz. chicken broth
1pm:  ½ cup sugar-free gelatin
2pm:  8oz. water
3pm:  8oz. water
4pm:  8oz. skim milk + one serving of approved protein supplement (Bariatric Advantage® for example)
5pm:  8oz. vegetable broth
6pm:  sugar-free popsicle
7pm:  8oz. herbal tea


 
24oz. water + 8oz. Crystal Light + 16oz. broth + 16oz. decaf coffee/tea + 4oz. gelatin + 1 popsicle + 16oz. skim milk = at least 84oz. fluid and ~ 66g of protein
Note: if abdominal cramping, bloating, nausea and/or gas is experienced with cow’s milk, try soy milk or Lactaid®.


8am:  8oz. water
9am:  8oz. Orange sugar free, noncarbonated beverage
10am: 8oz. skim milk + one serving of approved protein supplement (Bariatric Advantage® for example)
11am:  8oz. sugar-free hot cocoa made with 1% or skim milk
12pm:  8oz. beef broth
1pm:  8oz. decaf iced tea w/ lemon
2pm:  8 oz. skim milk + one serving of approved protein supplement (Bariatric Advantage® for example)
3pm:  sugar free popsicle
4pm:  ½ cup sugar-free gelatin
5pm:  8oz. water
6pm:  8oz. chicken broth
7pm:  8oz. water


32oz. water+ 16oz. milk + 16oz. broth + 16oz. ice tea/hot cocoa + 4oz. gelatin + 1 popsicle.  = at least 84oz. fluid and ~ 72g of protein
 
 
 
 
 
Phase II:  Week 3-6 weeks after surgery - Soft  Foods
Protein (include one of the following protein foods at each meal)
  • Fat-free or low-fat cottage cheese and ricotta cheese
  • Sliced/shredded fat-free or low-fat cheese
  • Fat-free or low-fat artificially sweetened yogurt. Look for versions with less than 15 grams of sugar per serving.
  • Low-fat or fat-free Greek yogurt
  • Sugar-free, fat-free pudding
  • Eggs, egg whites, Eggbeaters® (poached, scrambled, soft-boiled)
  • Sugar-free egg custard
  • Low-fat tofu
  • Fat-free refried beans
  • Canned baby meats/pureed meats
  • Canned/vacuum packed tuna, salmon, chicken (in water only)
  • Baked fish that flakes easily with a fork (cod, salmon, tilapia, crab meat, etc.)
  • Thinly-sliced lean deli turkey breast, roast beef, or ham (not chipped ham)
  • Lean ground beef, pork, buffalo (bison), or turkey (93% lean or better)
Only include the following foods in your meal plan if you are consuming 60 to 80 grams of protein a day:
Fruits
  • Unsweetened applesauce
  • Diced peaches or pears (canned in own juice)
  • Banana (soft)
Vegetables
  • Soft-cooked vegetables such as carrots, green beans, broccoli, cauliflower (mushy, not crunchy)
Starch/Other
  • Mashed potatoes, sweet potatoes, or winter squash
  • High fiber, whole grain dry cereal soaked in 1% or skim milk
  • Cooked cereals (baby oatmeal, cream of wheat/rice, farina, grits) made with 1% or skim milk
*May add nonfat dry milk powder or protein powder to foods and beverages to increase protein content.
  
 
Allowed Condiments
  • Sugar (no more than one teaspoon per meal)
  • Artificial sweetener (Splenda®, Equal®, etc.)
  • Non-dairy, fat-free, or powdered creamer
  • Light margarine (free of trans-fats)
  • Ketchup
  • Light or fat-free mayonnaise
  • Sugar-free jam, jelly, or preserves
  • Reduced-fat and fat-free salad dressings
  • Hot sauce
  • Mustard
 
Use Sparingly
  • Butter and regular margarine
  • Natural Peanut butter
 
Avoid--these foods usually are not tolerated well this soon after surgery.
  • Raw fruits (except bananas), dried fruits, and raw vegetables
  • Corn, peas, and popcorn
  • Pasta, noodles, rice, bread
  • Nuts and coconut
  • Alcohol
  • Carbonated beverages
  • Greasy or fried foods
Suggestions for Phase II diet:
  • During this phase, begin the practice of eating only 3 small meals a day.  Do not snack or “graze” throughout the day. Grazing and snacking lead to poor weight loss after surgery. Grazing is also associated with significant weight regain after surgery.
  • Make it a habit to eat very slowly (putting your fork down between each bite) and chew your food very thoroughly (to a mushy consistency). Try to make each meal last 20 minutes. Take small bites.
  • Learn to stop eating when you feel full, which initially may be after only 2 or 3 bites of food.  Indications of fullness include a feeling of pain or pressure in the center just below your rib cage, nausea, or pain in your shoulder or upper chest. Eat only until you feel satisfied.
  • Your meals will be about 3-4 oz. (½ cup) in total size. Use small plates and cups, instead of large plates and bowls, for your meals.
  • At this time, get into the habit of eating at least 2 oz. (or ¼ - ½ cup) of a protein rich food at each meal. In addition, eat the high protein portion of your meals first. If you are unsure which foods are high in protein, see the protein section of this handout. Aim for at least 60-80 grams of protein every day.
  • Usually it is not hard to consume enough protein from food alone as long as you concentrate on eating high protein foods at each meal. Protein supplements (powders, shakes, bars, etc.) in most cases are not necessary. However, if you are truly concerned that you are not getting enough protein, or if you are experiencing a lot of nausea and vomiting and cannot consume high protein foods at meals on a consistent basis, then speak to your dietitian about protein supplement options and how often they should be taken.
  • Continue to drink 64 ounces of liquid each day. However, do not drink anything with your meal (to allow room for food) and do not drink anything for 30 minutes after a meal (to prevent “washing” the food through the stomach too quickly). This will make a profound impact on your feeling of satiety (satisfaction and fullness) after eating.
 
 
 
 
 
 

 

Phase 2: Weeks 3 to 6 after surgery - Soft Foods

Phase II:  Week 3-6 weeks after surgery - Soft  Foods

Protein (include one of the following protein foods at each meal)

  • Fat-free or low-fat cottage cheese and ricotta cheese
  • Sliced/shredded fat-free or low-fat cheese
  • Fat-free or low-fat artificially sweetened yogurt. Look for versions with less than 15 grams of sugar per serving.
  • Low-fat or fat-free Greek yogurt
  • Sugar-free, fat-free pudding
  • Eggs, egg whites, Eggbeaters® (poached, scrambled, soft-boiled)
  • Sugar-free egg custard
  • Low-fat tofu
  • Fat-free refried beans
  • Canned baby meats/pureed meats
  • Canned/vacuum packed tuna, salmon, chicken (in water only)
  • Baked fish that flakes easily with a fork (cod, salmon, tilapia, crab meat, etc.)
  • Thinly-sliced lean deli turkey breast, roast beef, or ham (not chipped ham)
  • Lean ground beef, pork, buffalo (bison), or turkey (93% lean or better)

Only include the following foods in your meal plan if you are consuming 60 to 80 grams of protein a day:

Fruits

  • Unsweetened applesauce
  • Diced peaches or pears (canned in own juice)
  • Banana (soft)

Vegetables

  • Soft-cooked vegetables such as carrots, green beans, broccoli, cauliflower (mushy, not crunchy)

Starch/Other

  • Mashed potatoes, sweet potatoes, or winter squash
  • High fiber, whole grain dry cereal soaked in 1% or skim milk
  • Cooked cereals (baby oatmeal, cream of wheat/rice, farina, grits) made with 1% or skim milk

*May add nonfat dry milk powder or protein powder to foods and beverages to increase protein content.

  

 

Allowed Condiments

  • Sugar (no more than one teaspoon per meal)
  • Artificial sweetener (Splenda®, Equal®, etc.)
  • Non-dairy, fat-free, or powdered creamer
  • Light margarine (free of trans-fats)
  • Ketchup
  • Light or fat-free mayonnaise
  • Sugar-free jam, jelly, or preserves
  • Reduced-fat and fat-free salad dressings
  • Hot sauce
  • Mustard

 

Use Sparingly

  • Butter and regular margarine
  • Natural Peanut butter

 

Avoid--these foods usually are not tolerated well this soon after surgery.

  • Raw fruits (except bananas), dried fruits, and raw vegetables
  • Corn, peas, and popcorn
  • Pasta, noodles, rice, bread
  • Nuts and coconut
  • Alcohol
  • Carbonated beverages
  • Greasy or fried foods
    Suggestions for Phase II diet:
    • During this phase, begin the practice of eating only 3 small meals a day.  Do not snack or “graze” throughout the day. Grazing and snacking lead to poor weight loss after surgery. Grazing is also associated with significant weight regain after surgery.
    • Make it a habit to eat very slowly (putting your fork down between each bite) and chew your food very thoroughly (to a mushy consistency). Try to make each meal last 20 minutes. Take small bites.
    • Learn to stop eating when you feel full, which initially may be after only 2 or 3 bites of food.  Indications of fullness include a feeling of pain or pressure in the center just below your rib cage, nausea, or pain in your shoulder or upper chest. Eat only until you feel satisfied.
    • Your meals will be about 3-4 oz. (½ cup) in total size. Use small plates and cups, instead of large plates and bowls, for your meals.
    • At this time, get into the habit of eating at least 2 oz. (or ¼ - ½ cup) of a protein rich food at each meal. In addition, eat the high protein portion of your meals first. If you are unsure which foods are high in protein, see the protein section of this handout. Aim for at least 60-80 grams of protein every day.
    • Usually it is not hard to consume enough protein from food alone as long as you concentrate on eating high protein foods at each meal. Protein supplements (powders, shakes, bars, etc.) in most cases are not necessary. However, if you are truly concerned that you are not getting enough protein, or if you are experiencing a lot of nausea and vomiting and cannot consume high protein foods at meals on a consistent basis, then speak to your dietitian about protein supplement options and how often they should be taken.
    • Continue to drink 64 ounces of liquid each day. However, do not drink anything with your meal (to allow room for food) and do not drink anything for 30 minutes after a meal (to prevent “washing” the food through the stomach too quickly). This will make a profound impact on your feeling of satiety (satisfaction and fullness) after eating.
     
     
     
     
     
     
    Phase II Sample Menus
    Week 3
     

    Breakfast
    ½ cup fat-free cottage cheese
     
    Mid-morning
    8 oz. skim or 1% milk
    Sip 16 oz. of water or non-caloric beverage throughout the morning
     
    Lunch
    3oz. lentil soup or chili (slightly mashed)
     
     
    Mid-afternoon
    Sip 16 oz. of water or non-caloric beverage throughout the afternoon
     
    Dinner
    ¼ cup scrambled egg (needs to be 'runny')
    ¼ cup Greek yogurt
     
    Evening
    8 oz. skim or 1% milk
    Sip 16 oz. of water or non-caloric beverage throughout the evening

     
    The above sample menu provides about 70g. protein and 64oz. (2 liters) of fluid.
    Week 4

     
    Breakfast
    ¼ c. low-fat cottage cheese
    ¼ c. diced peaches
     
    Mid-morning
    8oz. skim milk
    16oz. water or non-caloric beverage throughout morning
     
    Lunch
    ½ c. canned tuna mixed w/ 2 T. extra-firm low-fat tofu, 1 T. fat-free sour cream, seasonings to taste
    Mid-afternoon
    8oz. skim milk
    16oz. water or non-caloric beverage throughout afternoon
     
    Dinner
    1-2 thin slices each lean deli turkey breast & 1 slice reduced-fat Swiss cheese, rolled (with 1 T. light mayonnaise if necessary)
     
    Evening
    16oz. water or non-caloric beverage throughout evening
    8oz. herbal tea

     
    The above sample menu provides 510 calories, about 60g protein, and 72oz. of fluid.
    Week 5

     
    Breakfast
    ¼ c. scrambled Eggbeaters® (moist)
    2 oz. reduced-fat shredded cheddar
    ¼ c. diced pears
     
    Mid-morning
    8oz. herbal tea
    16oz. water or non-caloric beverage throughout morning
     
    Lunch
    ¼ c. canned chicken
    (made with 2 tablespoon plain fat-free yogurt)
     
    Mid-afternoon
    8oz. vegetable juice
    16oz. water or non-caloric beverage throughout afternoon
     
    Dinner
    2oz. baked salmon
    ¼ c. green beans w/ 1 t. light margarine
     
    Evening
    8oz. skim milk
    16oz. water or non-caloric beverage throughout evening

     
    The above sample menu provides about 61g. protein, 72oz. of fluid.
     
    Week 6
     

    Breakfast
    1 scrambled egg (moist)
    ½ slice whole wheat toast
    1 t. light margarine
     
    Mid-morning
    1 Carnation® Instant Breakfast® No Sugar Added
    16oz. water or non-caloric beverage throughout morning
     
    Lunch
    2 thin slices lean deli ham
    2 thin slices reduced-fat cheese
    1 T. mustard
     
    Mid-afternoon
    16oz. water or non-caloric beverage throughout afternoon
     
    Dinner
    ½ c. chili w/ beans
    2-3 whole grain crackers
     
    Evening
    8oz. skim milk
    16oz. water or non-caloric beverage throughout evening

     
    The above sample menu provides about 65g. protein, 64oz. of fluid.
     

Phase 3: Weeks 7 and Beyond

Time to experiment!

Six weeks following surgery, you can begin to re-introduce a variety of foods back into your diet. We recommend that you begin with softer foods before moving to solid foods (example: try cooked vegetables before eating raw vegetables and canned fruits before eating raw fruits). But at this point in time, you can begin trying more solid pieces of meat, and raw fruits and vegetables again.

Small meals, slowly, of healthy foods.

It is important to eat at least 4 to 6 ounces of meat (protein) everyday. Be sure that the meat you are eating is moist and tender and avoid any tough, fatty or gristly meats. Your total protein goal will be at least 60 grams everyday.  See the protein section to learn more about high protein foods.   

Suggestions for Phase III Diet:

  • Continue to eat the high protein foods first when you sit down to eat a meal. The amount of food that you are able to eat after surgery is so small that you must focus on getting enough protein in your diet before anything else.
  • Continue your exercise routine. This is a critical component to your success after surgery. Exercise will help you burn more calories and build lean body mass or muscle. The more muscle you have, the more calories you will burn. You will lose weight faster and keep it off as long as you are exercising.
  • Recognize when you are full (pain or pressure in the center just below your rib cage, nausea, or pain in your shoulder or upper chest). Learn to stop eating when you are full, not when you are stuffed. If you eat until you are stuffed, you will stretch your stomach pouch.
  • Continue the habit of only eating 3 small meals per day and avoid snacking and grazing! Snacking and grazing throughout the day will prevent you from reaching your weight loss goals.
  • Remember that the only reason to eat is because you need the nutrients to keep you healthy!

Phase III Sample Menus

 

Week 7

 


Breakfast

2 slices turkey sausage

¼-½ c. oatmeal

 

Mid-morning

8 oz skim milk

16 oz. water or non-caloric beverage throughout the morning

 

Lunch

½ c. hummus

¼ c. fresh dipping veggies (cherry tomatoes, celery, red peppers, cucumber, carrots, etc)

 

Mid-afternoon

8oz. herbal tea

16oz. water or non-caloric beverage

 

Dinner

3 oz. shredded pot roast with low fat gravy

¼ c. cooked carrots

 

Evening

8 oz. skim milk

16 oz. water or non-caloric beverage throughout the evening


 

This sample menu provides about 67g protein and 72oz. of fluid.

Week 8


 

Breakfast

½ c. fat-free, artificially sweetened yogurt (any flavor)

¼ c. mixed fresh berries

 

Mid-morning

8 oz. skim milk

16 oz. water or non-caloric beverage

 

Lunch

¼-½ c. salad greens

2 oz. chicken strips

2 Tbsp. Italian dressing

 

Mid-afternoon

16 oz. non-caloric beverage or water throughout the afternoon

 

Dinner

2oz. tender pork loin

¼ baked sweet potato w/ 1 T. light margarine

 

Evening

8oz. soy milk

16oz. water or non-caloric beverage



The above sample menu provides 800 calories, about 70g protein, 72oz. of fluid.

  

 

 


TROUBLESHOOTING

Changing your eating habits will be important if the operation is to be a success. Although your smaller upper stomach and smaller opening that releases the food and liquid into the intestine will help, several of the following problems may be encountered once eating is resumed after surgery.

Managing Liquids

  • Fluids are needed to replace normal water loss and to prevent dehydration. We recommend that you try to drink 2 liters (64 oz.) of liquid (mostly water and non-caffeinated beverages) every day.
  • Avoid liquids with meals, saving room for solid foods, and preventing the “washing” of food from the stomach. Stop drinking fluids at least 30 minutes before a meal, and wait at least 30 minutes after the meal, to allow for digestion of food. This will make a profound impact on your feeling of satiety (satisfaction or fullness) after eating.
  • When drinking liquids, sip them slowly. If liquids are gulped too quickly, abdominal cramping, discomfort, and/or vomiting may occur.
  • Avoid carbonated beverages and drinking from a straw for approximately 6 weeks after surgery. Doing this can help you to avoid excess gas and pressure.

Nausea, Vomiting, Bloating and/or Heartburn

Nausea, vomiting, bloating and/or heartburn can occur from any of the following:


  • Eating and drinking too quickly
  • Not chewing food well enough
  • Drinking cold fluids
  • Eating too much (quantity)
  • Eating rich or sweet foods, fried, or high-fat foods
  • Eating gas-producing foods or drinking carbonated beverages

Dumping Syndrome

Dumping syndrome can be a feeling of abdominal fullness, weakness, warmth, rapid pulse, cold sweats, nausea, possible vomiting, and possible diarrhea. This happens whenever foods and beverages that are high in sugar or grease are consumed and 'dumped' into the bowel quickly. To avoid dumping syndrome, avoid concentrated sweets (ice cream, milkshakes, candy, pies, cookies, cake, sugar, syrup, honey, jelly, pastries, regular soda, fruit juices, barbecue sauces, etc). You may only be able to tolerate a teaspoonful of these items at a time, if any at all. This may also occur after eating greasy foods such as fried chicken or french fries.

 

Blockage of the Stoma

The new opening created by the surgery is smaller than the original opening that released food from the stomach into the intestine. This new opening may become blocked when food has not been thoroughly chewed, which can result in abdominal pain or vomiting.

If you become unable to tolerate water within the first month after surgery, call us immediately. The sooner we learn of this problem, the more likely we will be able to treat it without surgery.

           

To prevent blockage from occurring:

  • Avoid eating high fiber foods, such as raw fruits and vegetables, and starchy foods for the first 6 weeks after surgery. After 6 weeks time, be sure to chew high fiber foods very thoroughly.
  • Chew all foods to the consistency of mush before swallowing.
  • Be careful when chewing gum; if accidentally swallowed it can cause a blockage.
  • Use chewable or liquid multivitamins.

Overeating

The purpose of bariatric surgery is to create a smaller stomach so that it is unable to hold the large volumes of food it had held previously. Constant overeating can stretch your stomach pouch. Remember that your pouch is only 1 ounce (the size of your thumb). Meals should be about 3-4 ounces (1/2 cup). The more solid the food, the less you will be able to eat. You may be able to eat 4 ounces of applesauce, but only 2 ounces of beef. Even though the amount is smaller, choose the beef because you need the protein.

To prevent stretching the pouch:

  • Eat only three small meals each day, and measure your food before you eat to prevent overfilling the stomach.
  • Eat slowly so that the nerve receptors in your stomach area can relay the message to your brain that your stomach is full. It takes approximately 15-20 minutes for the message of fullness to reach the brain. Take time between bites of food and stop eating as soon as fullness is experienced.
  • Recognize when you are full, which can feel like pain or pressure in the center just below your rib cage, nausea, or a pain in your shoulder or upper chest.  The next step is to stop eating when you feel full.
  • Constant nibbling/grazing/snacking may not stretch your stomach pouch, but it is a common bad food behavior among people who do not meet their weight loss goals and/or regain significant amounts of weight after surgery.

Undernutrition

Total food consumption is reduced after surgery, and therefore, intake may be nutritionally inadequate. 

To compensate for reduced nutrient intake:

  • Consume nutrient-dense foods daily, including a variety of lean meats, low-fat dairy, fruits and vegetables, and high fiber breads and cereals.  Look for breads that have at least 3g of fiber per slice, and cereals that have at least 5g.of fiber per cup. Avoid empty calorie foods, including soda pop, Kool-Aid, chips, pretzels, popcorn, candy, pastries, sweets, and rice cakes. Avoid foods that are breaded and fried.
  • Consume adequate high biological value protein foods each day. See the section on protein for examples of such foods.
  • Take the recommended vitamins (multivitamins, calcium, vitamin D, iron, and vitamin B12 supplements) every day. THIS IS IMPORTANT!  Refer to the vitamin section of this handout.

Food Intolerance

Food intolerance varies widely and one individual may tolerate a food that disagrees with another person.  Therefore, it is important to try a variety of foods.  Each individual must try new foods carefully to test his or her reactions after surgery.

The following foods may be difficult to eat, especially for the first few months:

  • Tough meats – dry, gristly meats may be difficult to digest. Meats (chicken, steak, burger, ham) should be moist and cut into very small pieces about the size of a pencil eraser. Go slowly.
  • Bread – fresh, doughy bread can form a ball and “gum up” the opening from the stomach
  • Pasta – pasta may form a paste and be more difficult to pass
  • Seeds and skins of fruits and vegetables, dried fruit, fibrous vegetables like corn, asparagus, and celery
  • Nuts and peanut butter

Do not be discouraged if a certain food does not agree with you once. Wait a few weeks and try it again. Your stomach just might not have been ready for the food yet.

Vitamin/Mineral Supplementation

 

It is important that you take vitamin supplements everyday for the rest of your life after having bariatric surgery. If you do not take your vitamin and mineral supplements after surgery you will become malnourished! This is because not only are you unable to consume enough food (quantity) to meet your vitamin/mineral requirements, but also because you will have a decreased ability to digest and absorb certain nutrients (after having gastric bypass surgery). We recommend that you take a multivitamin, calcium, iron, B12 and Vitamin D supplements. 

Begin taking all required vitamins and minerals the day you wake up in your own bed following surgery. Example: Surgery on Monday; discharge on Wednesday; wake up at home on Thursday morning. Start taking supplements on Thursday morning.

To make sure you are taking everything you need, in the correct dose, and in the correct form, we recommend bariatric-specific supplements.

Multivitamins

Start taking one chewable multivitamin/mineral supplement twice a day (bypass) or once a day (band) while on liquids. When you progress to soft foods, take them with meals. We recommend one of the following:

  • Bariatric Advantage® Chewable Multi Formula
    • Available in the office or online at www.bariatricadvantage.com
  • Celebrate Vitamins® chewable (available at www.celebratevitamins.com)
  • OpurityTM chewable (available at www.opurity.com)
  • Centrum® Chewable

 

About three months after surgery (or when you are able to take pills and can tolerate solid foods), you can switch to a non-chewable if desired. However, we recommend a bariatric-specific chewable multivitamin long-term over any other product. If you choose to take an over-the-counter vitamin, we recommend any of the following, to be taken twice a day with food (generic, store-brand equivalents are fine):


  • Celebrate Vitamins® multivitamin capsule (available at www.celebratevitamins.com)
  • One-A-Day® Men’s/Women’s Formula
  • Centrum Performance® 
  • Centrum Silver®  based on your age


Take one multivitamin, twice a day (for example 1 at breakfast, 1 at lunch), rather than both at the same time to maximize your absorption of each vitamin.

 

Calcium

There is typically only a small amount of calcium in multivitamins. Therefore, we recommend taking an additional 1000mg-1500mg of calcium everyday when you progress to soft foods. At this stage after your surgery, you will need to take a chewable form because most chewable supplements are too large and difficult to swallow. There are different forms of calcium such as calcium carbonate and calcium citrate. Calcium citrate is the most efficiently absorbed form of calcium following gastric bypass.  However, citrate is difficult to find in a chewable form, so we recommend a bariatric-specific calcium which provides citrate in a chewable form.

  • Bariatric Advantage® Calcium Citrate Chewy Bites (2 chews 2 times per day)
  • Bariatric Advantage® Calcium Citrate Lozenges (one lozenge 2 times per day)
  • Celebrate Vitamins® Chewable Calcium Citrate (one chewable 2 times per day)
  • OpurityTM Calcium Citrate (2 chewables 2 times per day)

 

 

Taking a liquid vs. chewable form of calcium citrate is acceptable

  • Wellesse Calcium and Vitamin D3 liquid
    • Available at:


      • Kroger
      • Rite Aid
      • Walgreens
      • Walmart
      • Order Directly at 800-232-4005




Switch to a non-chewable form of calcium citrate when able to tolerate a solid pill, if desired. Take one dose (500mg-600mg) twice a day with meals for a total of 1000-1200mg of additional calcium per day. Be sure to check the dose on each individual brand to be certain you are getting the correct amount.

  • Citracal-any version

 

Again, take your calcium supplements twice a day in 2 smaller doses rather than taking one large dose all at once because you will absorb the smaller doses better. Also, calcium is best absorbed with taken with food. 

 

It is important to not take the calcium and iron supplements at the same time, as they interfere with the absorption of each other. Take your calcium and iron supplements at least 2 hours apart from one another.

 

Iron

We recommend that you take an iron supplement daily when you progress to soft foods, in addition to the iron in your multivitamin. Iron does come in a chewable form, but the pill should be small enough that you can swallow it without difficulty.

Nausea and constipation are common side effects of iron supplementation. For this reason, we recommend you take one of the most absorbable forms of iron: ferrous fumarate, ferrous sulfate, or ferrous gluconate. All three forms of iron can both be found in over-the-counter. Listed below are some specific products we recommend. Take your iron supplement once a day with food.


  • Bariatric Advantage® Chewable Iron
  • Celebrate Vitamins® Chewable Iron
  • GNC Iron 18
  • Ferro-Sequels® (contains a stool softener as well)
  • Fergon

 

However, if there is still a problem with nausea and/or constipation, try taking your iron every other day instead of daily. Again, avoid taking the calcium and iron supplements at the same time, as they interfere with the absorption of each other. Take your iron and calcium at least 2 hours apart from one another.  Your iron supplement is also best absorbed when taken with food. Iron supplements may also be better absorbed when taken with something acidic.  This can be any food high in Vitamin C such as fruits or vegetables.

  • Men need 18-30mg of elemental iron/day
  • Pre-menopausal women need 50-65mg elemental iron/day
  • Post-menopausal women need 18-30mg elemental iron/day

 

Vitamin B12

Vitamin B12 is digested and absorbed differently than most vitamins. After gastric bypass surgery, you will no longer be able to digest and absorb sufficient amounts of B12 to maintain health. You must take your B12 in a form that directly enters the bloodstream, not through the digestive tract. There are three ways to do this. 

  • A monthly vitamin B12 injection can be obtained at your primary care physician’s office after gastric bypass surgery. West Penn doctors or physician assistants can write a prescription so you can give yourself the monthly B12 injection.
  • A weekly nasal spray (Nascobal®) is an option for your B12 needs. West Penn doctors or physician assistants can write a prescription for you.
  • Another option is to take sublingual B12 lozenges or drops that dissolve under your tongue. A 1000 mcg supplement may be taken daily. If you purchase the 5000 mcg strength, 1 per week should be sufficient. Specific products to ask about include
    • Bariatric Advantage® Sublingual B12 with Folate
    • Any over-the-counter sublingual B12

Vitamin D

In addition to the amount of Vitamin D found in your multivitamin and calcium supplement, begin taking 2000 IU of a supplemental Vitamin D (cholecalciferol D3) a day. The pill is usually small enough to swallow without difficulty, but will vary among different brands. You may begin the Vitamin D when able to tolerate the size pill you purchase. We recommend the following:

  • Bariatric Advantage® Dry Vitamin D3 (take 2 doses per week)
  • Bariatric Advantage® Gel Vitamin D3 (take 1 dose every week)
  • Any over-the-counter Vitamin D3 2000 IU (take daily) 

 

 

Sample Daily Vitamin/Mineral Schedule #1 (bypass)

(Note: This is an example based on using a bariatric-specific multivitamin)

Breakfast:       

1 chewable multivitamin/mineral supplement

1 chewable calcium

Sublingual B12 lozenge or drops

Vitamin D (Note: if Bariatric Advantage® Vitamin D, take one time per week, not daily)

Lunch:

Iron (18-30 mg elemental iron if a man or post-menopausal woman; 50-65 mg elemental iron if a pre-menopausal woman)

Dinner:

1 chewable multivitamin/mineral supplement

1 chewable calcium

 

*Remember to separate Iron and calcium by 2 hours to optimize effectiveness

 

 

Sample Daily Vitamin/Mineral Schedule #2 (bypass)

(Note: This is an example based on using an over-the-counter multivitamin)

Breakfast:       

1 chewable multivitamin/mineral supplement

Sublingual B12 lozenge or drops

Vitamin D (Note: if Bariatric Advantage® Vitamin D, take one time per week, not daily!)

Lunch:

Iron (18-30 mg elemental iron if a pre-menopausal woman, not necessary as a man or post-menopausal woman)

Mid-Afternoon:

1 chewable calcium

Dinner:

1 chewable multivitamin/mineral supplement

 

Bedtime:

1 chewable calcium

 

*Remember to separate Iron and calcium by 2 hours to optimize effectiveness

 

 

Sample Daily Vitamin/Mineral Schedule (band)

Breakfast:       

1 chewable multivitamin/mineral supplement

Vitamin D (Note: if Bariatric Advantage® Vitamin D, take one time per week, not daily!)

Lunch:

1 chewable calcium

Dinner:

1 chewable calcium 


 

Adequate protein intake is of critical importance after bariatric surgery.  At each of your 3 small meals per day there should be at least 2oz of a high protein food, and that high protein food should be eaten first. Your total protein intake each day should be at least 60 grams. There are two different kinds of protein: complete and incomplete.

Complete protein is also known as high biological value protein. This means that it contains all of the essential amino acids. Complete protein is found in most foods that come from animals. In general: 1oz. meat, fish, poultry, or cheese=7 grams; 1 egg=6 grams; ½ c. cottage cheese=14 grams; 1 c. milk=8 grams; 1 c. yogurt=6-8 grams of protein.

Lean sources of complete protein that should be a part of your diet everyday include:

  • White meat chicken and turkey (not fried)
  • Fish and shellfish (not fried)
  • Eggs, egg whites, and egg substitutes
  • Lean cuts of beef (round, sirloin, flank, tenderloin, rib/chuck/rump roast, ground round)
  • Lean cuts of pork (fresh ham, Canadian bacon, center loin chop, tenderloin)
  • Buffalo (bison)
  • Ham
  • Veal or lamb chops and roasts
  • Lean deli meats (turkey, ham (not chipped), roast beef)
  • Venison, pheasant
  • Reduced-fat or fat-free cheeses  
  • Low-fat or fat-free cottage cheese, ricotta cheese, and yogurt
  • Low-fat or fat-free Greek yogurt
  • Skim or 1% milk, soy milk, lactose-free milk


 

High-fat, high-calorie sources of complete protein, which should be consumed less often include:

  • Bacon and sausage
  • Spareribs
  • Kielbasa
  • High-fat cuts of beef (ribeye, prime rib, t-bone)
  • Any fried meat, chicken, fish
  • Regular cheese (American, Cheddar, Swiss, etc.)
  • Bologna, salami, pepperoni
  • Hot dogs

 

Incomplete protein does not contain all of the essential amino acids and is found in plant foods. This includes beans, lentils, vegetables, starches (cereals, pasta, bread, grains, etc.), nuts, and peanut butter. These foods definitely count toward your total protein intake everyday, but a greater emphasis should be placed on complete, high biological value sources of protein. In general:  ½ c. beans or lentils=10 grams; ½ c. cooked or 1 c. raw vegetables=2 grams; 1 slice bread or ½ c. potatoes=3 grams; ½-1c.; cereal=3-6 grams of protein.

 

Soy is the one exception! Even though soy is plant based, is does contain all of the essential amino acids and is considered a complete protein! Go ahead and include tofu, tempeh, soymilk, soynuts, soybeans, soy cheese, and other soy foods in your diet on a regular basis. In general, 1 c. soy milk=8 grams and 4oz. or ½ c. tofu=7 grams of protein. For more information on soy foods, go to www.soyfoods.com to download a Soyfoods Guide for free!

 

Keep in mind that protein supplements should only supplement your food intake. In other words, focus on food sources of protein first, and then add a supplement only in emergency situations. Always be mindful of the first ingredient in your protein supplement. If it does not state, “whey protein isolate” or “soy protein isolate,” do not use it. Also keep in mind that protein bars may be more filling and satisfying than a protein shake, because liquids go down quickly and easily. The same first ingredient rule applies to bars as it does to shakes.

 

Suggestions for Phase I Diet:

  • Increase liquids as tolerated to at least 2 liters a day (64 oz., or eight 8 oz. cups). Drink enough fluid to keep your urine a clear, pale yellow color.  If your urine becomes cloudy, dark or foul-smelling, drink more!
  • Sip slowly throughout the day. Drink 8 oz. of fluid over a period of 1 hour. Do not gulp liquids or drink too quickly. Gulping or drinking too fast can cause abdominal pain and/or nausea.
  • Protein goal is 60 to 80 grams/day; this may not be possible at first, but patients should work towards this amount of protein.
  • It is very important to avoid any liquids with a high amount of sugar at this time (more than 15 g. in an 8 oz. serving). Sugary liquids may cause dumping syndrome, which is something you do not want to experience. Plus they are an added source of unwanted calories.
  • Avoid drinking from a straw. When you drink from a straw you swallow more air, which may make you belch more often. Carbonated beverages are to be avoided for the same reason; they will cause excess gas.
  • Pre-freeze or refrigerate plastic bottles of water, Crystal Light®, tea, etc. and carry the bottle around with you so that you can take small, frequent sips of fluid throughout the day and avoid becoming dehydrated.
  • During this phase of the diet, begin taking a chewable multivitamin/mineral supplement twice a day. Other vitamin and mineral supplements (calcium, vitamin D, vitamin B12, and iron) may be started as well. (See the vitamin section of this handout for examples).

 

 

Phase I Sample Menus

Note:  Times of day are irrelevant!  The point is to sip constantly during your waking hours. First 2 weeks after surgery -- generally sip on 8oz. fluid over a one-hour period of time.


 


8am:  8oz. water

9am:  8oz. decaf coffee w/ Splenda®

10am:  8oz. skim milk + one serving of approved protein supplement (Bariatric Advantage® for example)

11am:  8oz. Crystal Light®

12pm:  8oz. chicken broth

1pm:  ½ cup sugar-free gelatin

2pm:  8oz. water

3pm:  8oz. water

4pm:  8oz. skim milk + one serving of approved protein supplement (Bariatric Advantage® for example)

5pm:  8oz. vegetable broth

6pm:  sugar-free popsicle

7pm:  8oz. herbal tea


 

24oz. water + 8oz. Crystal Light + 16oz. broth + 16oz. decaf coffee/tea + 4oz. gelatin + 1 popsicle + 16oz. skim milk = at least 84oz. fluid and ~ 66g of protein

Note: if abdominal cramping, bloating, nausea and/or gas is experienced with cow’s milk, try soy milk or Lactaid®.


8am:  8oz. water

9am:  8oz. Orange sugar free, noncarbonated beverage

10am: 8oz. skim milk + one serving of approved protein supplement (Bariatric Advantage® for example)

11am:  8oz. sugar-free hot cocoa made with 1% or skim milk

12pm:  8oz. beef broth

1pm:  8oz. decaf iced tea w/ lemon

2pm:  8 oz. skim milk + one serving of approved protein supplement (Bariatric Advantage® for example)

3pm:  sugar free popsicle

4pm:  ½ cup sugar-free gelatin

5pm:  8oz. water

6pm:  8oz. chicken broth

7pm:  8oz. water


32oz. water+ 16oz. milk + 16oz. broth + 16oz. ice tea/hot cocoa + 4oz. gelatin + 1 popsicle.  = at least 84oz. fluid and ~ 72g of protein

 

 

 

 

 

 

Acceptable beverages include:

  • "Sport drinks" (Gatorade, Powerade) slightly diluted with water
  • Sports drinks with less sugar such as PowerAde Zero, G-2, or Propel
  • Water
  • Flavored waters that are sugar-free and non-carbonated
  • Crystal Light® (generic brands are fine)      
  • Broth, bouillon, consommé (chicken, beef, or vegetable)
  • Sugar-free popsicles
  • Sugar-free gelatin
  • Tea:  unsweetened or artificially sweetened; iced or hot; black, green, or herbal (decaffeinated is best, but caffeinated is fine if less than 2 cups a day)
  • Coffee (decaffeinated is best, but caffeinated is fine if less than 2 cups a day)
  • Sugar-free, fat-free hot cocoa (made with 1% or skim milk)
  • Skim, 1%, Ultraskim, or Superskim milk*
  • Fat-free or low-fat soy milk, Lactaid®, or Dairy Smart®
  • Almond milk (not a significant source of protein)
  • No Sugar Added Carnation® Instant Breakfast
  • Any other protein supplement as long as the first ingredient states "whey protein isolate" or "soy protein isolate" (example: Bariatric Advantage® or Unjury®)
  • Tomato soup or any other low-sodium, low-fat condensed soup in which you add 1% or skim milk

*Use caution as some people become lactose intolerant after surgery.  If you experience intolerance to dairy, try soy milk, Lactaid®, or Dairy Smart®.

Avoid:

  • Fruit juices: both 100% fruit juice and those with added sugar
  • Regular and diet soda
  • Carbonated beverages
  • Alcoholic beverages

 

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