16142--Nutrition Guidelines for Bariatric Surgery

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Nutrition Guidelines for Gastric Bypass & Sleeve Gastrectomy Surgery

1. Diet Progression

First 1-2 meals: Sugar-free Clear Liquids
Week 1: Protein Shakes + Sugar-free Liquids

Week 2: Blended/Pureed Food
Week 3: Blended/Pureed Food
Week 4: Soft foods
Week 5: Regular foods

2. Protein

Consume at least 60g (women) – 70g (men) of protein each day.
High protein foods: lean meat, fish, poultry, low-fat dairy, beans, eggs, and nuts.
Protein drinks are essential in the first 3-5 weeks after surgery. Request Handout.

3. Sugar and Fat

All foods must have less than 5 grams Total Fat and less than 10 grams Sugar per serving. Foods high in fat and sugar can cause dumping syndrome. Read all food labels!

4. Eating

Consume 3 meals and 1-2 snacks each day, even if you don’t feel hungry.
Take small bites, eat slowly and chew each bite well – take 20-30 minutes to eat each meal.
Eat until you are comfortably full, save leftovers for later. Do not weigh or measure food.

5. Drinking

Sip on 48-64 ounces of sugar-free, calorie-free fluids each day (water is best).
Do not drink during or 30 minutes after a meal.
Avoid carbonated beverages, straws, and caffeine for at least 6 weeks after surgery.
Avoid alcohol for a minimum of 1 year after surgery.

6. Supplements

Multivitamin with Iron 2 times a day
Calcium with Vitamin D 2 times a day
Vitamin B12 1 time a day
Thiamin (vitamin B1) 1 time a day for the first month after surgery
You will have to take vitamins and minerals for the rest of your life!

7. Exercise

Start low and slow, working towards 30 minutes of planned movement 5 days a week.
Find forms of exercise you enjoy, plan them into your week, have a back-up in case of bad weather.
Exercise is important for health and weight management.

8. Scheduling

You must plan when you will eat, drink and exercise!

9. Support

Research shows that people who join a supportive community do better. Join our support group!

Additional Information:

Protein

Protein will be an essential part of your diet before and after surgery.
Protein helps with wound healing, muscle and skin re-growth, cell repair, and preventing hair loss.
Every meal and snack should have a source of protein.
Always eat protein first to avoid filling up on other foods.

Drinking

Do not drink during or 30 minutes after meals.

Drinking with a meal may overfill the stomach pouch and cause vomiting.
It can also cause food to exit the stomach too quickly and leave you feeling hungry between meals.
Drinking during and after meals can cause dumping syndrome.

Sip slowly and consistently between meals.

Vitamins and Minerals

You will not be able to meet your daily requirements for vitamins and minerals with food.
Purchase supplements before your surgery.
Avoid Men’s formula vitamins and “Silver” vitamins.

Avoid taking your multivitamin or iron at the same time as calcium because they compete for absorption.
Avoid gummy multivitamins

Dumping Syndrome & Intolerance

After surgery, some patients experience “dumping syndrome” when eating sweets, high fat foods and/or drinking fluids with meals.
Dumping syndrome occurs when food exits the stomach pouch rapidly and “dumps” into the intestine. This causes the intestine to immediately pull water from the rest of the body to dilute the food. The food then moves rapidly through the intestines and out of body.
Symptoms of this intolerance are urgent diarrhea, nausea, lightheadedness, flushing, sweating, bloating, gas and stomach cramps.

Food Labels

Read the “Nutrition Facts” panel on all foods to check the fat and sugar content.
Packages labeled “Low Fat” or “Low Sugar” may not meet the guidelines.
Read the ingredient list

Sources of sugar include: sugar, sucrose, malt syrup, maple syrup, honey, molasses, corn syrup, corn sweetener, glucose, maltose, dextrose, sorghum, cane sugar, brown sugar, fruit juice concentrate, agave

Aim for 60g (women) and 70g (men) of protein every day.
Foods	Serving Size	Protein (g)	Options for Use
Meat & Seafood
Lean Meat (beef/pork/chicken)	1 oz. (cooked)	6-8	Chop and add to salads, vegetables, soups, omelets, scrambled eggs, quiche, casseroles, sandwiches or quesadillas.
Fish/shellfish	1 oz. (cooked)	6-8
Lunch Meat	1 oz. (2 slices)	4
Eggs
Egg	1	6-8	Add hard boiled eggs to fresh salads or make egg salad.
Egg Whites	1	3-4	Add hard boiled eggs to fresh salads or make egg salad.
Egg Beaters	¼ c.	6
Dairy
Skim or 1% Milk	1 c.	8	Use milk instead of water when making protein drinks, smoothies, grits, oatmeal, cream of wheat, canned soups or hot chocolate.
Fairlife Milk, skim or 1% (high protein ultra-filtered)	1 c.	13
Kefir, 0-1% fat	1 c.	11	Enjoy alone or add to cereal, fruits, gelatins and smoothies.
Greek Yogurt (0-2% fat)	¾ c.	15-18
Plain Yogurt	¾ c.	7
Cheese, 2% reduced fat	1 oz.	7	Sprinkle on salads or eat with fruit/whole grain crackers.
Cottage cheese, low fat	½ c.	13	Eat with fruits and vegetables or add it to meals such as casseroles and lasagna.
Ricotta Cheese	½ c.	14
Instant Pudding, low fat, low sugar	½ c.	4
Non-Fat Dairy Milk Powder	1 tbsp.	2	Add to milk, oatmeal, grits, casseroles, muffins, sauces, cream-based soups, & mashed potatoes.
Beans & Nuts
Refried beans, fat-free	¼ c.	3
Beans, Black-Eyed Peas, Chickpeas (Garbanzo Beans), Lentils, Lima Beans	¼ c.	3-4	Use as a salad topping, in soups, stews, casseroles. Pureed beans can be added to thicken sauces. Chickpeas can be roasted for a crunchy snack.
Almonds, Cashews, Peanuts, Pistachios, Walnuts, Pumpkin seeds, Sunflower Seeds, etc.	¼ c.	6-8	Sprinkle on fruit, cereal, Greek yogurt, and salads. Blend with vegetables and herbs to make a sauce for noodles or other vegetables.
Nut or Seed Butters (peanut, cashew, almond, etc.)	2 tbsp.	4-8	Use as a spread for sandwiches, crackers, oatmeal, pancakes and fruit. Use as dip for carrots and celery. Add to Greek yogurt, and smoothies.
Hummus	¼ c.	4	Use as a dip for raw vegetables. Spread on a sandwich or wrap as a condiment.
Meat Substitutes
Tofu	3oz	11	Add to salads, vegetables, soups, omelets, quiche, sandwiches, or baked potatoes.
Veggie Sausage Patty or Links	1 patty	9-12
Quorn, Boca, Morningstar, Gardein, Sweet Earth frozen meatless vegetable products	1 c.	12-15
Other
Quinoa	1/3 c.	6	Use in place of rice in a meal.
High protein “grain” or “pasta” (eg Banza, Barilla Protein Plus)	2oz	11-13	Use in place of traditional pasta or rice.

Diet Progression

The weight loss surgery diet is divided into 5 stages. The diet progression is outlined below.

Sugar-free Clear Liquids (1-2 meals)

For one to two meals after surgery you will be given sugar-free clear liquids such as water, broth, or Jell-O to see how you tolerate eating.
Sip slowly and pay attention to your feelings of fullness.

Sugar-free Liquids + Protein Shakes (for 1 week after surgery)

After 1-2 meals, we will add a premade protein shake to your diet in the hospital.
Continue only sugar-free liquids and liquid protein shakes for at least one week after surgery at home.
This liquid diet will help minimize nausea, vomiting, and discomfort as well as provide the hydration and protein you need.

Blended/Pureed Food (for weeks 2 & 3 after surgery)

One week after surgery, you may try blended or pureed foods at your comfort level.
It is very important to follow this diet until your first follow up visit. Eating solid foods too soon will put pressure on your incisions and staples and may cause breakage or leaking.
All foods you eat must be the consistency of thin, smooth applesauce or baby food.
Put cooked foods in a blender or food processor, then add liquid such as skim milk, broth, fat free gravy or low fat creamy soup and blend until smooth.
Use the recipe booklet you are given at your work-up visit for meal ideas.

Food	Choose	Avoid
Protein	Lean fish, tuna, poultry, beef or pork Low-fat cottage cheese Low-fat or non-fat cheese Eggs, egg whites, or egg substitute Cooked beans or Tofu Reduced fat peanut butter Protein powders/premade protein supplements	Fried or breaded meats Meat with lots of visible fat Regular cheese
Milk Products	Fat-free (skim) or 1% milk or Nonfat dry milk powder Greek or Regular low fat yogurt (check added sugar, keep below 10 grams) Low-fat cheese	Whole, 2% milk, or chocolate milk
Fruit & Vegetables	Applesauce, banana, mashed potato and other fruit & vegetables without seeds or skins	Raw fruit and vegetables
Starches	Oatmeal, grits, & cream of wheat	Bread, rolls, cold cereals, pasta, rice
Other	Sugar free gelatin, sugar free fat free pudding, sugar free popsicles	Chewing gum Sweets and desserts

Sample Menu: Approximately 76 grams protein

Meal	Food	Protein
Breakfast	½ cup high protein cream of wheat/oatmeal/grits	12g
Snack	Ensure Max Protein supplement	30g
Lunch	½ cup high protein Jell-O	13g
Snack	½ cup plain nonfat Greek yogurt (with option to added sugar substitute)	15g
Dinner	½ cup fat free refried beans	6g

Soft Food (1 week, beginning at week 4 after surgery)

After your follow up visit, with your doctor’s approval, you may advance to soft foods.
The general rule is “Can I mash this food with a fork?”
Consume 3 meals and 1-2 snacks each day
You will need to eat and drink slowly. Take small bites and chew very well.
You are “re-educating” your stomach. If you eat too fast, too much, or don’t chew enough, you will feel uncomfortable and could vomit.

Food	Choose	Avoid
Protein	Lean, moist, skinless meats (fish, tuna, poultry, pork) Lean shredded or ground meats Low-fat cottage cheese Low-fat or non-fat cheese Tofu Eggs, egg whites or egg substitute Reduced fat peanut butter	Crunchy peanut butter Fried meats Dry, tough, or chewy meat Fast food meat Meat with skin or visible fat
Milk Products	Fat-free (skim) or 1% milk Greek or Regular low fat yogurt (check added sugar, keep below 10 grams) Low-fat cheese	Chocolate milk Whole or 2% milk Ice cream
Fruit and Vegetables	Any vegetables that have been cooked until soft Canned vegetables Unsweetened canned fruits Fresh soft fruit	All others – including raw vegetables (such as salads) and raw crunchy fruits (especially those with tough skins/seeds)
Starches	Oatmeal, grits, and cream of wheat	Soft bread/rolls/bagels Crunchy and sweet cereals
Other	Sugar free gelatin, sugar free fat free pudding, sugar free popsicles	Chewing gum Sweets and desserts

Sample Menu: Provides 61 grams protein

Meal	Food	Protein
Breakfast	1 egg with 1 slice of low-fat cheese	11 g
Snack	½ cup chicken salad	15 g
Lunch	1 veggie burger	16 g
Dinner	½ cup chili with ¼ cup low-fat cheese	16 g
Snack	½ cup low-fat cottage cheese with fruit	13 g

Solid Food (starting week 5 after surgery)

5 weeks after your surgery, you may begin to try solid foods, one item at a time.
Eat solid proteins before other foods.
Most people experience some food intolerance, especially with meat and bread.
Do not skip meals - you will not get enough protein.

Food	Choose	Avoid
Protein	Lean, moist, skinless meats (fish, poultry, pork) Lean shredded or ground meats Low-fat cottage cheese Low-fat or non-fat cheese Eggs, egg whites or egg substitute Tofu or Vegetarian meat substitutes Reduced fat peanut butter	Fast food meat Meat with skin or visible fat Fried meats Dry, tough, or chewy meat
Milk Products	Fat-free (skim) or 1% milk Greek or Regular low fat yogurt (check added sugar, keep below 10 grams) Low-fat cheese	Whole or 2% milk and chocolate milk Ice cream
Fruits	Fresh Canned in its own juice Frozen without added sugar	Fruit with added sugar or syrup Canned in heavy syrup
Vegetables	Fresh Canned without added salt Frozen without added sauce	Fried or breaded Vegetables with high fat sauces
Bread	Whole wheat Low-fat whole grain crackers Baked tortillas Thins (bread and bagels)	Sweet breads Danish, doughnuts, pastries White bread Soft rolls
Cereals	Oatmeal, grits, & cream of wheat Whole grain, high protein cold cereals	Sweet cereals Hot and cold cereal with added sugar/chocolate
Potatoes, Rice and Pasta	Boiled, mashed, or baked potatoes Whole wheat pasta Brown rice	Instant noodles & instant potatoes Fried potatoes, French fries White pasta and rice
Other	Sugar free gelatin or popsicles Sugar free fat free pudding	Fried, salty snack foods Cakes, cookies, brownies

Sample Menu: Provides 65 grams protein

Meal	Food	Protein
Breakfast	1 scrambled egg 1 veggie sausage patty	18 g
Lunch	Roll-up: 4 thin slices lean deli meat + 1 slice low-fat cheese with ¼ c. fruit	13 g
Dinner	3 ounce chicken breast ¼ cup cooked vegetables sautéed in 1 Tbsp olive oil	24 g
Snack	6 oz. Greek yogurt (check added sugar, keep below 10 grams)	10 g

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last update:

November 2023