FAQ's

Dieting Techniques

Post-Operative Diet – General Information

FOOD AMOUNT & SELECTION
Now that you have had a procedure to decrease the size of your stomach, what you eat is more important than ever. Because you will be eating less, it is important to choose your foods carefully so that you will obtain all the vitamins, minerals, and protein you need. Meals should be well-balanced. Be sure to have measuring utensils on hand in your kitchen so that you are eating no more than what is recommended. If you’d like, take home a few of the small 1 oz. plastic cups from the hospital that patients use to help you at home, too.

FOOD TEXTURE
All the foods you eat must be of the proper consistency to avoid damage to the sutures and to avoid clogging up the small opening in between your stomach and your intestines. Initially your diet will consist of liquids only. After about two weeks you should be able to tolerate a small amount of solid foods. These solids will be soft, pureed and/or blenderized. It is very important that you make sure everything is chewed to the consistency of baby food, if it requires chewing. Any foods that cannot be chewed this finely, such as celery, lettuce, etc., should be avoided. Meals should be eaten very slowly, allowing 5 minutes between bites. You will not be drinking liquids with your meals. You must be sure to STOP EATING as soon as you feel full (no longer hungry).

VITAMINS & MINERALS
It is difficult to get all of the essential vitamins and minerals your body needs from the small volume which you will be allowed to eat, so IT IS IMPORTANT TO TAKE A VITAMIN AND MINERAL SUPPLEMENT DAILY. Ask your surgeon if it should be in liquid form, which is available at your local pharmacy. It is recommended to take a chewable, powdered or liquid mulitivitamin after surgery. Make sure your MVI has 100% of the DV (daily value) for zinc and biotin.

Multivitamin Suggestions:
• “Building Blocks”
• “Bariatric Advantage”
• “One-A-Day Energy”

Additional vitamin and mineral supplements are also recommended, such as iron, zinc, calcium (especially important for women in preventing osteoporosis), and vitamin B12.

Iron:
Bypass patients take 65 mg of ferrous fumarate (which is the least constipating form of iron) per day. Banding/sleeve patients can take 18 mg ferrous fumarate or if your multivitamin contains 18 mg of iron, you do not need additional. Taking Colace or a fiber supplement with plenty of water may also help to prevent constipation. Try to get iron with vitamin C to increase absorption. (The Department of Surgery has a chewable iron supplement with vitamin C available.) (continued)

Calcium:
Take 1200 to 1500 mg per day. Gastric bypass and gastric sleeve patients must take calcium in the form of calcium citrate. (Look for calcium supplements that also contain Vitamin D. Do not take your calcium supplement when you take your iron supplement because calcium decreases the absorption of iron.)
• “Building Blocks”
• “Bariatric Advantage Chewable Calcium Citrate”
• “Citrucal”

Folic Acid:
You do not need to take a separate folic acid supplement as long as it is included in your multivitamin.

Zinc:
Make sure the multivitamin you are taking contains zinc. This will help to prevent hair loss that can sometimes occur with significant weight loss.

Vitamin B12:
If your doctor says you need to, take at least 350 micrograms (mg) per day, or 500 micrograms (mg) per week, or by injection. Vitamin B12 is also available in tablets that melt under your tongue (sub-lingual).

BYPASS PATIENTS ONLY

Vitamin A:
Take a total of 10,000 IU’s per day. This amount includes what is in your multivitamin.

PROTEIN
It is important to consume at least 60-80 grams of protein in your diet per day. Protein aides in healing, provides energy, prevents hair loss, and fights infection. This is where your protein shakes come in handy. Your protein shake must initially contain at least 40-50 grams of protein. Other foods high in protein that will be allowed at various stages of the diet include:



LIFESTYLE CHANGES
You need to make long-term lifestyle changes in order to help you maintain your new weight and a healthy body. Don’t forget, it is very possible to regain a significant amount of weight if you continue the lifestyle you had before your procedure! A registered dietitian (“RD”) can help you make positive dietary changes such as decreasing saturated fat and salt and increasing fiber. Seeing an RD post-op as an outpatient is recommended. You should also be increasing your activity level with your doctor’s permission, and finding an exercise that you can do for the rest of your life. A certified personal trainer or exercise physiologist can help you.

A gastric procedure for weight loss is only the short-term cure for morbid obesity.
What YOU do in months and years to come will ensure its long-term success!

Post-Operative Diet – Specific Guidelines

THE DAY AFTER SURGERY:
WATER ONLY
• Once you have passed your swallow evaluation (usually the morning after surgery) you will be allowed to take ice chips, sips of water, and then start on clear liquids.

STAGE 1:
LIQUIDS (WEEKS 1 AND 2 POST–OP)
CLEAR LIQUID DIET ~ ONLY WHILE YOU ARE IN THE HOSPITAL

• chicken or beef broth
• Crystal Lite
• sugar-free Italian ices (frozen fruit ice) or sugar-free popsicles
• sugar-free jello

Consume 3 ounces for breakfast, 3 ounces for lunch, and 3 ounces for dinner (total of 9 ounces per day).
FULL LIQUID DIET ~ ONCE YOU ARE DISCHARGED FROM THE HOSPITAL
• high protein, low sugar protein shake (such as Perfect Low Carb Isopure)

• skim or 1% low-fat milk, or sugar-free yogurt (blended, and without chunks of fruit – it can be fruit flavored such as Dannon Lite Raspberry)

• farina thinned with skim or 1% low-fat milk (not oatmeal)

• strained cream soup

HOW TO MAKE PROTEIN SHAKE:
Mix 9-10 ounces of skim or 1% milk with 2 scoops of powder. This one shake will last you the whole day.
If you chose anything listed above besides the protein shake, it is recommended that you add one scoop of unflavored whey protein powder to provide additional protein. Your unflavored whey protein powder should have approximately 15 grams of protein per scoop.

• It is important to consume at least 60-80 grams of protein per day.

• For bypass/sleeve patients, consume no more than 3 ounces (90 cc) of shake for breakfast, 3 ounces for lunch, and 3 ounces for dinner.

• For banding patients, start off consuming three 3-ounce meals, and if needed you can increase to 6-8 ounces per meal. Only increase if you start to feel hungry!

• Do not drink liquids with your meals. No liquids should be consumed 30 minutes before a meal and 30 minutes after a meal.

• Consume at least 64 ounces of non-carbonated, sugar free liquid per day (water, Crystal Light, Diet Snapple, Fruit2O, Dasani flavored water, Propel)

• Avoid Gatorade-type beverages, hard candy, and chewing gum.

• “Skim Plus” is a creamy tasting milk with no fat! If you are used to 2% or whole milk, this brand may make switching to skim milk easier. “Lactaid” can help with lactose intolerance.

• Don’t forget your vitamin and mineral supplement!

Why Sugar-free? ~ The “Dumping Syndrome”

This only occurs in patients who have had gastric bypass/sleeve, not gastric banding. Even if you are not diabetic, you should avoid sugary foods and drinks. This is to avoid the “dumping syndrome”, which is a condition in which a person may experience symptoms of dizziness, weakness, sweating, rapid heartbeat, dropped blood pressure and/or diarrhea shortly after eating. Later on the person’s blood sugar might drop.

It happens when a large amount of a sugary food or liquid gets “dumped” quickly into the small intestines. Why would that happen? Well, before your procedure, your stomach was large enough to hold food for a while, allowing it to enter the intestines slowly – a little at a time. Now it is too small to hold much of anything, and the intestines are not designed to receive concentrated sugary foods all at once like this. So when it does, it tries to dilute the food by bringing water into the intestines from surrounding tissues and blood vessels. This causes a fluid shift in the body that can result in the unpleasant symptoms described above. This means that although eventually you are allowed to have fruit juice, you should go easy on it.



STAGE 2:
MOSTLY LIQUID, SOME PURE_D AND/OR BLENDERIZED SOLID FOOD (WEEKS 3 AND 4 POST-OP)

• When first starting solid foods, you may have one soft meal per day. The other two meals must remain liquid.

• For bypass/sleeve patients, only 3 oz. of soft high protein food per day is allowed at this stage. Each liquid meal should still be 3 oz. (90 cc) as in Stage 1.

• For banding patients, only 4-6 ounces of soft high protein food per day is allowed at this stage. You can increase your other 2 liquid meals (protein shake) to 6-8 ounces per meal.

• Be sure to include HIGH PROTEIN foods and liquids in your diet. Continue to use the protein shakes.

• Chew your food well if chewing is required.

• Gradually your intake will increase, but this is based on individual tolerance.

• If your surgeon allows solid (non-pureed) food, any high-carbohydrate foods you eat should be WHOLE-GRAIN. Avoid processed carbohydrate foods such as white bread, white rice, white pasta, etc.

• Don’t forget your vitamin and mineral supplements!


ONE SOLID MEAL:

• Begin with pureed foods. Please use the attached list as a guide to make sure you get the required 15-20 grams of protein per meal. Herbs, seasonings, and broth may be added to pureed foods for flavor.

• NO red meat, leafy vegetables, celery, nuts

• NO high-calorie milkshakes, ice cream, cakes or cookies.

TWO LIQUID MEALS:

• Bypass/Sleeve patients: 3 ounces of protein shake
• Banding patients: 6-8 ounces of protein shake

PLEASE NOTE:
Tolerance to solid foods varies from person to person. If you find you cannot tolerate certain foods, AVOID THEM. If you cannot tolerate solid food altogether, go back to the all-liquid diet, supplement with “Pedialyte”, and call your physician. Low-sugar, high protein shakes (8 oz.) may also be substituted for a complete meal if you are having problems with solid food.

STAGE 3:
PURE_D AND/OR BLENDERIZED SOLID FOOD
(FROM 1 - 3_ MONTHS POST-OP)

• Foods should be soft (pure_d) or blenderized.

• Eat meals very slowly.

• If foods require chewing, chew your food very well.

• Between meals sip on non-carbonated, sugar-free liquids.

• Include HIGH PROTEIN foods in your diet (low fat dairy products, lean meat and chicken, fish, eggs, tofu, and legumes such as kidney beans or lentils).

• If you become constipated, you may take Milk Of Magnesia.

• If your surgeon allows solid (non-pureed) food, any high-carbohydrate foods you eat should be WHOLE-GRAIN. Avoid processed carbohydrate foods such as white bread, white rice, white pasta, etc.

• Don’t forget your vitamin and mineral supplement!

• Always consume protein containing foods first, vegetables or fruit second, and carbohydrates last.

• Bypass/Sleeve patients, you might not be able to tolerate the additional fruit at this stage. Make sure you get your protein in first, then consume the soft fruit or soft cooked vegetables.

• Banding patients can add a _ cup of starch (mashed potatoes, whole wheat pasta or Barilla Plus pasta) to the meal pattern listed below. In addition, if you are hungry in between meals, you can add 4 ounces of protein shake as a snack.

• The minimum amount of protein per meal is 3 ounces. You will gradually work up to 4 ounces. Do not go below 3 ounces of protein per meal. It can take you as long as you need to consume those 3 ounces.



EXAMPLE of a “PUREED” OR BLENDERIZED DIET

Breakfast:

• cup (4 ounces) of soft protein foods
(See accepted food list above.)
• cup (2 ounces) of soft or blenderized fruit

Lunch:

• cup (4 ounces) soft protein food
(See accepted food list above.)
• cup (2 ounces) soft cooked or blenderized vegetables, or blenderized fruit

Dinner:

• cup (4 ounces) soft protein food
(See accepted food list above.)
• cup (2 ounces) soft cooked or blenderized vegetables, or blenderized fruit


FOODS APPROPRIATE FOR A PURE_D/BLENDERIZED DIET
(STAGE 2 AND STAGE 3)


Higher protein options:
• Cottage cheese – 1% or 2% fat

• Ricotta cheese – Lite or part skim

• Eggs – scrambled, poached, or soft boiled. Mix with water or milk to make sure they are light and fluffy.

• Egg whites

• Egg beaters

• Low fat cheese (soft)

• Tuna salad – made with lite mayonnaise and no vegetables. Use chunk lite tuna not solid white albacore.

• Egg salad – made with lite mayonnaise and no vegetables

• Poached chicken – cooked in chicken stock, marinara sauce, or in a crock pot. The meat should not be grilled or baked at this stage as it is too dry and tough that way. “Perdue Fit-n-Easy” thin sliced cutlet works well for most patients.

• Poached chicken salad – made with lite mayonnaise and no vegetables

• Hummus – any flavor except ones with chunks of vegetables (i.e. eggplant)

• Tofu

• Beans – Chickpeas, lentils, kidney beans, cannellini beans, black beans – mashed

• Soft cooked white fish -flounder, sole, tilapia. Avoid dry, thick fish like salmon, swordfish, or tuna steak.

• Pureed or blenderized meats blended with broth or milk

• Cold cuts: turkey, ham, low fat cheese


Lower Protein options:
If you chose anything listed below, add an unflavored whey protein powder. Examples include GNC brand unflavored whey protein and Beneprotein. You want to check the label for the amount of protein per scoop to make sure you get at least 15-20 grams of protein per meal.

• Oatmeal – made with skim or 1% milk

• Yogurt – any Lite and Blenderized brand (i.e. Dannon Lite, Yoplait Lite)

• Farina, Cream of wheat, or grits – made with skim or 1% milk

• Mashed potatoes thinned with broth or milk

• Sweet potatoes thinned with broth or milk

• Cream or puree soups – low fat

• Unsweetened applesauce

• Sugar free pudding

• Pureed or very soft cooked vegetables

• Jarred or blenderized fruits


EXERCISE
As soon as your doctor has given you permission, you must start a regular exercise program. This is essential to maintaining - among many other things - a healthy weight, a healthy heart, and a healthy mind.

Choose exercise that you enjoy. At first, exercise in which you don’t have to hold up your own weight makes it easier, such as swimming, or riding a stationary bike. As you grow stronger and your weight comes down, you can add walking, hiking, skiing, dancing, or playing tennis to name just a few fun activities.

Start out very slowly. Do only a few minutes each day at first, and over the next several months gradually work your way up to 10 minutes, then 15 minutes, then 20 minutes and so on. Only do what you can tolerate. Work both your muscles (weight training), and your heart (cardiovascular exercise). Your intensity and duration will increase slowly over time. Remember, a certified personal trainer can help you in creating a safe and effective exercise program that you will enjoy for years to come.


STAGE 4:
REGULAR DIET ~ WITH SMALL PORTIONS
(3-4 MONTHS POST-OP)

• At this stage, it is recommended to set up an individual nutrition appointment to develop a personalized plan for you to follow. This appointment should be made approximately 3 to 3_ months post-op.

• You should be able to tolerate any food consistency at this stage. However, your portion sizes should be much smaller now than they were before you had your procedure.

• It is extremely important to chew your foods very well and eat slowly. If a food feels like it “got stuck”, it usually means you didn’t chew that food enough or the food was too dry or tough.

• Continue taking a daily multivitamin.

• Your doctor may recommend that you continue to avoid chewing gum. If swallowed, it might obstruct the opening between your stomach and your intestines.

• Be sure to stop eating when you are full. Think of this often during your meal. Ask yourself if you need to continue eating, or if you should save the rest for later.

• Eat small meals and healthy snacks. Do not let yourself get to the point of “starving”, which is when a person naturally loses control over food choices and portion sizes.

• Choose foods low in saturated fat and sodium for a healthy diet. Consume lots of whole grains, fruits and vegetables (foods usually high in fiber).

• Avoid processed carbohydrate foods such as white bread, white rice, white pasta, etc.

• Drink plenty of water. Two liters a day is recommended.

• Be sure you are exercising regularly!