866-STCLARE • saintclares.org
POST BARIATRIC SURGERY
DIET PROGRESSION
866-STCLARE • saintclares.org
Tips to Remember
• Focus on protein-rich foods fi rst at each meal! Your goal is 60-90 grams of protein each day
• Multivitamin/mineral supplements and any other supplements prescribed by your physician every day, for life
• Drink fl uids! A minimum of 64 oz. (eight, 8-oz glasses) daily as your goal
• Consume protein supplements as directed • Drink only in between meals — 30 minutes
before and 30 minutes after eating • Drink slowly. Do not gulp. Take small sips. • Eat slowly. Chew foods thoroughly and take
20-30 minutes to complete a meal • Stop eating when you are satisfi ed full • EXERCISE! A minimum of 30 minutes, most
days of the week
• You must have blood work done as ordered by your surgeon
• Learn to make healthier substitutions for previous unhealthy food choices or cooking practices. For example, substitute brown rice when making rice and beans or stuffed cabbage. Avoid the skin on poultry and substitute chicken broth for fats like salt pork when making collard greens or other recipes.
REMINDER: Please remember to call your
dietitian for a follow up appointment four to six weeks after your surgery by calling 1-888-808-1234.Bariatric Progression Diet
A clear liquid diet is a diet consisting of food or beverages made from liquids that you can see through. These foods/beverages should have no added sugar or be sugar-free.
Suggested Amount
2-4 oz. of fl uid per hour as tolerated. *16 oz. should consist of your clear liquid protein supplement.
Goal: Initial intake should reach 32 oz. of fl uid a day and gradually work up to goal of 64 oz. (8 cups) each day.
Food Choices
• Clear fruit juices without added sugar and diluted 3/4 with water (No Sugar Added Apple and grape juice are suggested)
• Water/ice chips • Sugar-free gelatin • Sugar-free popsicles
• Fat-free broth (chicken, beef or vegetable)
• Unsweetened decaffeinated tea/iced tea • Non-carbonated fl avored waters (Propel
Fitness water, Fruit-2-O, G2, Crystal Light, Sugar Free Kool Aid)
• *Clear protein supplement (Isopure, Prostat SF, Unjury chicken broth, Profect 42)
STAGE I: Clear Liquid Diet
Please refer to the list of foods that are appropriate in each stage of your diet that are located on the following pages.
STAGE I: Clear Liquid Diet
... Page 3
Days 1 to 4 following your surgery. (Adding water based, thin protein supplements on Day 2)
STAGE II: Full Liquid Diet
... Page 4
Day 5 through Day 14 following your surgery.
STAGE III: Blended/Pureed Diet
... Page 4
Week Three
STAGE IV: Soft Diet
... Page 5
Weeks Four through Eight.
STAGE V: Regular Diet
... Page 6
From Eight Weeks and thereafter.
Reminder For All Diabetic Patients:
Following gastric bypass surgery, your oral diabetes medication and/
or insulin will most likely be discontinued or signifi cantly decreased. Please follow your discharge instructions regarding these medications and follow up with your primary care physician within one week after surgery.
A full liquid diet includes clear liquids plus milk based liquids and some other foods which are listed below. Remember that everything needs to be thin enough to pass through a funnel.
Begin taking your prescribed multi-vitamin and supplements as directed.
Suggested Amount
3-4 oz. at one time, over 20-30 minutes, three meals daily with a protein supplement between meals. Eat and drink slowly! Remember that your stomach and intestines are still healing.
Food Choices
• Skim milk/Skim Plus milk
• Lactaid fat-free milk/light Soy milk
• Low fat strained cream soups (made with Skim Plus milk)
• Fat-free, sugar-free puddings (made with Skim Plus milk)
• Non-fat, no sugar-added light yogurt,
blended without fruit (Dannon Light & Fit) • Very Thin hot cereal - 2 to 3 ounces - (Plain
oatmeal, Farina, Cream of Wheat or Grits) • Protein supplement mixed with Skim Plus
milk (Designer Whey, Aria, Spirutein)
You Must
• Continue to drink a minimum of 64 oz. fl uids per day
• Drink your protein supplement, twice a day, between meals
Note: If you are unable to tolerate most dairy
products post-surgery due to lactose intolerance, you may substitute any foods containing skim milk with Lactaid fat-free milk or Light Soy milk. Fat-free light yogurts may still be tolerated with lactose intolerance.Pureed / blended, smooth consistency foods. Broths and low fat gravies can be used to keep foods thin and moist.
STAGE II: Full-Liquid Diet
STAGE III: Blended/Pureed Diet
Suggested Amount
3-4 oz. low fat/low sugar choices, 3 meals per day.
Food Choices
• Pureed lean meats • Pureed beans (legumes) • Pureed fi sh
• Egg whites
• Plain or sugar free, fl avored yogurt without pieces of fruit
• Whipped cottage cheese
Pureed foods can be thinned with water, skim milk, fat free broth or fat free gravy.
STAGE IV: Soft Diet
Suggested Amount
3-4 oz. low fat/low-sugar choices, 3 meals per day.
You should eat three high-protein meals per day. Remember to always eat your protein fi rst, and to chew all foods well so that food is almost liquid before you swallow. Eat slowly! Drink fl uids in between your meals – stop drinking 30 minutes before meals and do not resume drinking for 30 minutes after your meal. All foods should be a soft consistency, soft cooked or canned. Add one new food at a time to ensure that it is tolerated well. Meats should be of soft texture and chopped to the size of an M&M, or ground, without any visible hardened areas. All meats should be very moist - boiled, baked, stewed or grilled (be sure to chew thoroughly!). Choose lean, moist chicken, turkey, fi sh and vegetarian sources of protein (beans, light tofu- and other soy products) more often than red meat, as it may not be tolerated in the fi rst few months after your surgery.
Avoid all nuts and seeds, since they are very high in fat. All vegetables should be a soft consistency. Avoid all raw vegetables initially. Avoid any canned fruit in heavy syrup. Stick to canned fruits in light syrup or “in its own juice,” or soft-cooked fruits. Consume fruits in small amounts as they have high sugar content.
Food Choices
• Nonfat or low fat (1%) cottage cheese • Soft-cooked eggs, egg salad with low fat
mayonnaise or any egg substitute (Egg Beaters). Frittata – bake egg mixture in a muffi n tin for a portion controlled, convenient breakfast
• Low fat mild cheeses (Fat-free or reduced-fat mozzarella, Alpine Lace, Jarlsberg Light or low fat 2% string cheese)
• Canned tuna packed in water, made with low-fat mayonnaise, 1 tsp. lemon, salsa, mustard or 1 T. guacamole for variety
• Rolled up deli turkey, chicken breast or ham with 1 slice of low fat cheese or cheese stick • Turkey chili or turkey meatloaf
• Light tofu, or any low fat soy product (with less than 3 grams of fat per serving)
• Soft-cooked fi sh (Sole, Tilapia, Halibut, Red Snapper). Be sure to avoid bones!
• Cooked soup beans (Lentils, Kidney beans) • Soft-cooked tender vegetables
• Cooked cereals (Plain Oatmeal, Farina, Cream of Wheat, Grits)
• Natural applesauce
• Soft-cooked or canned fruits in light syrup or “in natural juice”
• Boiled, stewed or soft-baked chicken/poultry (very moist)
Tip: Moisten chicken, turkey and soft meats
with broth (chicken, beef or vegetable) or low-fat gravy. Chew thoroughly! Continue to drink a minimum of 64 oz. fl uids per day!Although you may have no appetite, it is very important to establish new eating habits.
Suggested Amount
4-6 oz. Low fat/ low-sugar choices.
Eat three meals daily with protein supplements between meals.
Continue to add one new food at a time as you continue to progress back to a regular diet. Your goals at this time are weight loss and healing. Always pay attention to what you are eating (especially with protein), the amount of food you are eating, the duration of your meals (20-30 minutes) and the consistency of the foods. Always remember to chew your food thoroughly before swallowing.
Protein-rich foods always need to be eaten fi rst and do not eat solids and liquids together. Stop consuming liquids 30 minutes before your meals, do not drink with your meals and wait 30 minutes after all of your meals to resume drinking.
The following list will act as a guide to help you add variety to your diet, with protein as your top priority.
Food Choices
1. Protein Is Essential
Protein plays a critical role in wound healing post-surgery, helps the body to repair muscle and tissue and helps to maintain lean muscle mass with weight loss. In addition, some high protein foods (meats, beans) also provide iron, for prevention of anemia. Protein is extremely important after surgery.
Protein-rich foods:
• 1 oz. meat (beef, pork, lamb), poultry (chicken, turkey), fi sh,
wild game (venison, goat, bison, buffalo, rabbit, pheasant, quail) (7-8 grams of protein) • 1 egg (8 g. of protein)
• 1/4 cup of egg substitute (6 g. of protein) • 1 cup of Skim milk (8 g. of protein) • 1 cup of Skim Plus milk (11 g. of protein) • 1 cup of Soy milk (8 g. of protein)
• 1 cup of Fat-free Lactaid milk (8 g. of protein) • 1/2 cup Nonfat/lowfat Cottage cheese (11-14
g. of protein)
• 1 cup Nonfat light yogurt (8-13 g of protein) • 1/4 cup Part Skim Ricotta cheese (9 g. of
protein)
• 1 slice fat-free cheese (5 g. of protein) • 1 oz. fat-free cheese (10 g. of protein) • 1 cup canned beans (12-14 g. of protein) • 1 oz. light tofu or lowfat soy product: (5 g. of
protein)
• 1 scoop protein supplement with 8 oz. skim milk (26 g. of protein)
Protein supplements may be needed until you can take in the required amount of protein from the foods that you consume. Your goal amount is a minimum of 60-90 grams per day (or as directed by your surgeon).
STAGE IV: Regular Diet continued
2. Fruits and Vegetables
Fruits and vegetables provide vitamins and minerals, as well as fi ber and antioxidants. Choose two servings of fruit per day. Raw fruits with skin must be chewed thoroughly and should be cut into small pieces.
• Choose soft cooked fruits or canned fruits in light syrup or “in natural juice.” Avoid heavy syrup
• Eat a variety of colors to obtain the different vitamins contained in each
• Avoid high carbohydrate/starchy vegetables (corn, potatoes, winter squash and pumpkin) • Limit your intake of sweet potatoes (plain) to
one time per week
• Avoid the fi brous parts of fruits and
vegetables (bottoms of asparagus, broccoli stalks, snap pea pod membranes, celery and orange membranes)
3. Whole Grains
Whole grains provide fi ber and extra vitamins and minerals. You should only add whole grains to your meals after you have chosen suffi cient protein!
Examples of Whole Grains:
Note: These are low in protein and high in carbohydrates and should be limited to avoid excess calories and inadequate protein intake
• Toasted whole-wheat bread
• High Fiber cereals (Kashi, Fiber-1, Bran Flakes, All Bran, Cheerios, oatmeal) • Barley
• Bulgur • Quinoa
Note: Whole-wheat pasta and brown rice are also included, but may not be tolerated right away. They are not recommended for the fi rst three months.
4. Fats
These foods are low in vitamins and minerals and are high in calories, so a limited intake is recommended. However, some fat is needed by the body for vitamin metabolism, increased energy and essential fatty acid intake. Monounsaturated and polyunsaturated fats are a healthier alternative to saturated fats, and they do a great job at making foods more moist and palatable.
Suggested foods:
Limit to three servings per day.
• 1 tsp. canola, olive or peanut oils
• 2 tsp. light margarine or light butter (Smart Balance, I Can’t Believe It’s Not Butter Light) • 1 tbsp. low fat mayonnaise or Low-fat
salad dressing • 1 tbsp. low fat gravy • 1/8 avocado
Fats and Sugars to Avoid: • Fried foods
• Fast foods
• High-fat dairy products (Whole milk, cream, full-fat cheeses, creamy sauces)
• Pastries, donuts or other high-fat desserts • Chocolate
• High-fat meats (bacon, sausage, salami, pepperoni, chitterlings, etc.)
• Added fats (Regular butter/margarine, regular mayonnaise, regular salad dressings, salt pork).
• Snack foods (potato chips, cheese curls, crackers, etc.)
• Candies, cakes, cookies • Jams or jellies
• Honey, molasses, maple syrup • Sweetened cereals or beverages • Regular ice cream or sherbet/sorbet • Corn syrup
The following foods may not be tolerated: • Untoasted/fresh breads
• Tough meats • Spicy foods
• Fried or greasy foods • Pasta or rice
• Shredded coconut, popcorn & nuts
• Lactose (from dairy products). You may try Fat-free Lactaid or Light Soy milk instead
Vitamins and Mineral Supplements
Specifi c Vitamin and Mineral
Recommendations:
1. Adult multivitamin (chewable or liquid forms) – One to Two per day as directed.
Examples: Centrum Adult chewable or liquid, CVS Spectravite chewable, Walgreen’s Adult chewable, Opurity (opurity.com), Kirkland Adult Chewable (Costco), Berkley & Jensen Adult chewable (BJ’s), Spring Valley Adult chewable (Walmart)
2. Calcium Citrate – (chewable or liquid forms) – 1500 mg. a day in divided doses. (500-600 mg. three times a day) Examples: Calcet (achievepharma.com), Twinlab Chewable Calcium Citrate (Vitamin Shoppe), Opurity Calcium Citrate Plus (opurity.com), UpCal D Calium Citrate Powder (amazon.com), Wellesse liquid (Walgreens.com)
3. Vitamin B12 (sublingual) - 1000mcg per day 4. B-Complex Vitamin – One a day
5. Vitamin D – 2000 IU a day (including the amounts found in your multivitamins and calcium citrate)
Tips for taking vitamin and mineral
supplements:
• Do not take calcium and iron supplements at the same time, since the calcium will interfere with iron absorption. Separate them by two hours. Consuming dairy products with the iron supplement will also interfere with its absorption
• Calcium supplements are better absorbed if taken at several intervals throughout the day • Vitamin C will increase the absorption of iron.
Vitamin C-rich foods include citrus fruits, strawberries, red pepper, and broccoli, to name a few
• If any supplements cause nausea or cramping (especially iron), do not take it on an empty stomach, or try taking it at night before bed. • Coffee, tea, and cola sodas (decaffeinated
or caffeinated) can interfere with iron absorption
• Liquid or chewable vitamins are recommended
You are required to take vitamin and mineral supplements for the rest of your life, as they are essential to provide necessary nutrients and to prevent any defi ciencies. They are not just a supplement but a requirement. You are now at greater risk for decreased absorption of vitamins and minerals because you are eating signifi cantly less food in a day. Also, depending on the type of surgery that you have had, it may cause decreased areas of absorption in the stomach and intestine, where vitamins and minerals are usually absorbed, putting you at greater risk for defi ciencies.
Menstruating females and people with low levels of iron prior to surgery are at risk for iron defi ciency anemia, therefore iron supplementation may also be required. In addition to a supplement, high food sources of iron include red meat, fi sh, poultry, tofu and beans.
Fluids
Fluid intake is very important after surgery, since it prevents dehydration and also helps to minimize constipation. Fluid intake should be at least 32 oz. (1 qt.) to start, building up to 64 oz. (1/2 gallon) and increasing from there. Sip all fl uids slowly!
Fluid Tips:
• Your daily fl uid intake goal is 64 oz. a day • Do not drink fl uids with meals
• Consume fl uids 30 minutes before and 30 minutes after meals
• Do not gulp fl uids. Always sip fl uids very slowly
• Avoid using straws
• Avoid all carbonated and sweetened beverages
• Fluids should be low or non-caloric.
Examples: water, unsweetened decaffeinated tea, fl avored non-caloric waters (Propel Fitness water, Fruit-2-O, Crystal Light, G2), non-calorie juices (Diet Snapple), fat-free broth, Skim Plus milk, low-sodium V-8 or tomato juice
• Avoid alcohol
Call your physician if you experience any of the following:
(May be a sign of dehydration)
• Low urine output or dark-colored urine • Lethargy or lightheadedness/dizziness • Constipation
• Dry mouth or skin
Side Effects That May Occur
Dumping Syndrome
Occurs when carbohydrates are released rapidly into the intestines instead of gradually. Symptoms may include nausea, diarrhea, increased warmth, abdominal cramping, increased heart rate and cold sweats. Avoid all high sugar foods. See the list of high fat/sugar foods to avoid in this handout.
Nausea and Vomiting
Nausea and vomiting can be prevented if recommended dietary guidelines are followed after your surgery. Add one new food at a time to reduce intolerances. Make sure to eat slowly, keep fl uids separate from solids, pay attention to portion control and feelings of fullness and adhere to the recommended consistencies. Call your surgeon if symptoms persist.
Constipation
Reasons for constipation may include inadequate fl uid intake, decreased food intake, decreased activity, medications and inadequate fi ber intake. To improve symptoms, replenish with fl uids fi rst and foremost, followed by adequate food intake, increased activity and increased fi ber intake. Consult your surgeon if no improvement is seen.
Diarrhea
Possible causes of diarrhea include a high intake of refi ned/simple carbohydrates or sugar, excessive fat intake and increased stress levels. Identify the causes and make appropriate changes to prevent it from happening again. Remember that your new stomach can not handle the same foods or the same quantities as it did pre-operatively, so be very careful with your food choices. Dehydration can occur with prolonged diarrhea, therefore, consume adequate fl uids and notify your surgeon immediately if no improvement is seen.
Lifestyle Changes
You have just experienced a life altering event: Bariatric Surgery. After the fi rst few months following your surgery, as you get used to your new stomach and new eating habits, you will begin to develop permanent lifestyle changes with regard to your food intake. You’ll change what you eat, when you eat and how you eat, all changes for the long haul.
In order for your weight loss to be an ongoing success, you will have to work at it for the rest of your life. Surgery alone will not ensure ongoing success. You may still have food cravings and feel the need to overeat and/or make poor food choices. Just remember that you will gain weight or experience slow weight loss if you consume excess calories, high calorie snacks, eating while full or skipping meals.
Don’t expect the surgery to be the fi nal solution to your struggle with obesity. It is merely a tool to get you on your way to a healthy body weight once and for all. Ultimately, life long, lifestyle changes must still take place in order for you to lead a healthy life at a healthy weight.
Physical Activity
A lack of exercise can help to slow your weight loss, as well as increase your risk for blood clots and postpone healing. Taking the stairs instead of the elevator, parking farther away from a store, using a stationary bicycle and walking daily can make a world of difference. You should plan on starting a supervised exercise program as soon as you receive medical clearance from your surgeon.
Benefi ts of exercise:
• Promotes stress relief
• Helps with weight loss through calorie burning
• Helps with muscle toning
Don’t forget to include exercise as a part of your new and improved lifestyle! Your goal is 30 minutes of exercise most days of the week!
Goals to Reach
Before Bariatric Surgery
• Start keeping daily food records • Start taking a daily multivitamin
and mineral supplement
• Start to wean off of sweets, desserts, regular sodas and all sweetened beverages
• Start eating protein-rich foods at each meal and snack
• Eat more fruits, vegetables and whole grains • Learn to sip liquids very slowly.
Practice sipping, not gulping
• Eat meals very slowly, lasting 20-30 minutes • Gradually decrease your intake of fried foods
and high-fat fast foods
• Start to wean off of caffeinated and carbonated beverages and limit alcoholic beverages
Tips to Remember
• Focus on protein-rich foods fi rst at each meal! Your goal is 60-90 grams of protein each day
• Multivitamin/mineral supplements and any other supplements prescribed by your physician every day, for life
• Drink fl uids! A minimum of 64 oz. (eight, 8-oz glasses) daily as your goal
• Consume protein supplements as directed • Drink only in between meals — 30 minutes
before and 30 minutes after eating • Drink slowly. Do not gulp. Take small sips. • Eat slowly. Chew foods thoroughly and take
20-30 minutes to complete a meal • Stop eating when you are satisfi ed full • EXERCISE! A minimum of 30 minutes, most
days of the week
• You must have blood work done as ordered by your surgeon
• Learn to make healthier substitutions for previous unhealthy food choices or cooking practices. For example, substitute brown rice when making rice and beans or stuffed cabbage. Avoid the skin on poultry and substitute chicken broth for fats like salt pork when making collard greens or other recipes.
REMINDER: Please remember to call your
dietitian for a follow up appointment four to six weeks after your surgery by calling 1-888-808-1234.866-STCLARE • saintclares.org
