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Nutrition Class #3

•Eating after Surgery

•Protein First, Forever

•Vitamins and Water

•Special Considerations

Protein

• The importance of Protein:

– Important nutrient pre- surgery to ensure proper nutrition and get you from one

meal to the next

– Needed for building lean muscle tissue

– Needed for healthy blood, skin, hair, nails

– Essential for growth and maintenance of cells and chemical processes for

body functioning

– The most important nutrient after surgery

– Must be the main focus of your meals: eat all protein first

– Eating lean protein will help you feel fuller longer

– Drink your protein supplement beginning the day after surgery

– Lean protein is found in lean meat, poultry without the skin, fish, egg whites or

egg substitute, low-fat/non-fat dairy, low-fat soy based products and beans

(kidney, garbanzo, lentil, black, etc.)( refer to Lean Sources )

– Remember that about 1 ounce of meat or its equivalent equals 7 grams

of protein

• Protein Supplementation:

– At least 120 calories,15 grams of protein and less than 3 grams of fat and

less than 10 grams of carbohydrate

– In the beginning while on liquids, the protein supplement will be your main

source of protein

– As your diet progresses to solid food, lean protein sources + some protein

supplement will be your main source of protein (see sample meal plans)

– Initially, work toward an intake of 40 grams Protein

– By 1 month after surgery, your goal is to obtain 60 grams of protein daily.

– By 2mos after surgery ,your goal is a minimum of 72 grams of protein and your

maximum goal is 80 grams

– Mix protein powders with water to keep calories lower. Right after surgery skim

milk is acceptable to add calories and protein.

– Some products such as Proteinex can be added to a calorie free drink or full

liquid items like oatmeal, cream of wheat and applesauce

Purpose of the Bariatric Diet

• This diet specifies what type and how much food you can eat at each

meal. Closely following your bariatric diet can help you lose weight

safely.

• To allow the staple line in your stomach to heal without being stretched

by the food you eat

• To get you accustomed to eating the smaller amounts of food that can

be digested comfortably and safely in your smaller stomach

• To help you lose weight and avoid gaining excess weight

• To avoid side effects and complications

Diet Details • Diet recommendations after weight loss surgery vary depending on the

type of surgery, where the surgery is performed and your individual

situation.

• There are five phases to help you ease back into eating solid foods.

How quickly you move from one step to the next depends on how fast

your body heals and adjusts to the change in eating patterns. You can

usually start eating regular foods with a firmer texture about three

months after surgery.

• After surgery, you must pay extra attention to signs that you feel

hungry or full. You may develop some food intolerances or

aversions.

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Post-Bariatric Surgery

Meal Progression

________________: Phase 1 Clear Liquid Diet + Protein supplement. This is for breakfast, lunch and dinner. No soda, no creamer, no sugar. Drink 2 to 3 oz at a time, SLOWLY!

Allowed foods:

Broth

Unsweetened juice

Sugar free gelatin

Caffeine free coffee or tea (sugar substitutes may be used)

Skim milk (mix with protein supplement)

Crystal Light

Sugar free popsicles

** Avoid fruit nectars, juices with pulp and sports drinks

________________: Phase 2 Full Liquid Diet + Protein supplement. All food chosen should be non fat, sugar free, and non carbonated. Your protein consumption should be close to 60 grams per day. Drink/eat meals slowly over 20 minutes. Use a kitchen timer.

Allowed foods:

All foods on clear liquid diet

Strained/pureed/low fat soups (no pieces or chunks) soups should

be broth based or a low fat cream soup

Sugar-free and low fat or fat free yogurt, unsweetened applesauce

and fat free or low fat whipped cottage cheese.

Scrambled EggBeaters are permitted and may also be added to

boiling broth for a higher protein soup

For at least the first 4 weeks after surgery, it is very important to

drink at least 1 high protein supplement over the course of the

day until you are getting in enough protein

**Avoid milkshakes, 2% or whole milk, cream, half and half, alcohol

______________: Phase 3 Pureed Foods (Daily protein goal = 60 grams)

After liquids are well tolerated, it is time to progress to your more solid meals. Pureed: Most foods(low in sugar and fat) can be eaten as long as they are put into a blender and the final consistency is puree, similar to prepared baby food. Be sure there are no pieces of food in the mixture.

To puree your foods, choose solid foods that will blend well, such as:

Lean ground meats

Beans

Fish

Egg whites

Yogurt

Soft fruits and vegetables

Cottage cheese

Blend the solid food with a liquid, such as:

Water

Fat- free milk

Juice with no added sugar

Broth

Fat-free gravy

Keep in mind that your digestive system might still be sensitive to spicy foods or dairy products. If you’d like to eat these foods during this phase, add them into your diet slowly and in small amounts.

* Refer to Food Choices and Sample Menu Handouts

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______________: Phase 4 Soft, solid foods (Daily protein goal =60-80

grams)

With your surgeon’s OK, after a few weeks of pureed foods, you can add

soft, solid foods to your diet. If you can mash your food with a fork, it’s

soft enough to include in this phase of your diet. These soft food may

have small, soft chunks, so be sure to chew very well before

swallowing.

Foods Allowed:

Ground or finely diced meats

Canned or soft, fresh fruit

Cooked vegetables

You usually eat soft foods for eight weeks before eating foods of

regular consistency with a firmer texture, as recommended by your

dietician or surgeon.

_________________: Phase 5 Solid foods ( Daily protein goal = 80

grams)

After approximately 2 months (8 weeks) on the soft phase, you can

gradually return to eating firmer foods. You may find that you still have

difficulty eating spicier foods or foods with crunchy textures. Start slowly

with regular foods to see what foods you can tolerate. If you have

difficulty with any stage, your stomach may not be ready to progress and

you can always go back to the previous stage.

** Foods to avoid:

Nuts and seeds,

Popcorn

Dried fruits

Sodas and carbonated beverages

Granola

Stringy or fibrous vegetables, such as, celery, broccoli, corn or

cabbage

Tough meats or meats with gristle

Breads

These foods are discouraged because they typically aren’t well tolerated

in the weeks after surgery and may cause gastrointestinal upset. Over

time, you may be able to try some of these foods again, with the

guidance of your surgeon.

Returning to Normal Living

Three to four months after weight loss surgery, you may be able to start

returning to a normal healthy diet, depending on your individual situation and

any foods you may not be able to tolerate. It’s possible that foods that initially

irritated your stomach after surgery may become more tolerable as your

stomach continues to heal.

Throughout all phases of the Bariatric Diet

• Keep meals small. During your diet progression, your should eat several

small meals a day and sip liquids slowly throughout the day (not with meals).

You may first start with six small meals a day, then move to four meals and two

to three snacks per day and finally, when following a regular diet, decrease to

three meals and two to three snacks per day. Each meal should include

approximately a half cup to 1 cup of food. Make sure you eat only the

recommended amounts and STOP eating BEFORE you feel full.

• Take recommended vitamin and mineral supplements. After surgery, your

stomach is much smaller and your body won’t be able to absorb enough

nutrients from your food. You’ll need to take a multivitamin supplement every

day for the rest of your life. Start your multivitamin and calcium supplements

within the first week after surgery.

Multivitamin with iron(Flinestones Complete) – 2 tablets daily taken

separately at least 3 hours from each other

Calcium Citrate with Vitamin D- 1500mg calcium citrate with vitamin D

daily. Take 500mg separately 3x day

For the first month after surgery, use only liquid or chewable forms of

calcium citrate with vitamin D supplements

Vitamin B12 it recommended at 3 months post surgery sublingual for

gastric bypass patients. Check with your surgeon on exact dosage.

• Drink liquids between meals, NEVER with meals. Drinking liquids with

your meals can cause pain, nausea and vomiting as well as dumping

syndrome. Also, drinking too much liquid at or around mealtime can leave

you feeling overly full and prevent you from eating enough nutrient rich

foods. Expect to drink at least 6 to 8 cups of fluids a day to prevent

dehydration. Always wait at least 30 min before a meal and 30 min after a

meal to drink fluids. Drinking with meals will flush foods out of your

stomach too soon.

Throughout all phases continued

• Eat and drink slowly. Eating or drinking too quickly may cause dumping

syndrome – when foods and liquids enter your small intestine rapidly and in

larger amounts than normal, causing nausea, vomiting, dizziness, sweating

and eventually diarrhea. To prevent dumping syndrome, choose foods and

liquids that are low in fat and sugar, eat and drink slowly and wait 30 to 45

minutes before or after each meal to drink liquids. Take at least 30 minutes

to eat your meals and 30 to 60 minutes to drink 1 cup of liquid. Avoid foods

high in fat and sugar, such as non diet soda, candy, candy bars and ice

cream.

• Chew food thoroughly. The new opening that leads from your stomach

into your intestine is very small and larger pieces of food can block the

opening. Blockages prevent food from leaving your stomach and can cause

vomiting, nausea and abdominal pain. Take small bites of food and chew to

a pureed consistency before swallowing. If you can’t chew the food

thoroughly, don’t swallow it.

• Try new foods one at a time. After surgery, certain foods may cause

nausea, pain or vomiting or may block the opening of the stomach. The

ability to tolerate different foods varies from person to person. Try one new

food at a time and chew thoroughly before swallowing. If a food causes

discomfort, don’t eat it. As time passes, you may be able to eat this food, so

you may try it again in the future. Foods and liquids that commonly cause

discomfort include, meat, bread, pasta, rice, raw vegetables, milk and

carbonated beverages. Food textures not tolerated well include dry, sticky or

stringy foods.

• Focus on high protein foods. Immediately after your surgery, eating

high protein foods can help heal your wounds, re grow muscle and skin, and

prevent hair loss. High protein, low fat choices remain a good long-term diet

option after your surgery, as well. Try adding lean cuts of beef, chicken,

pork, fish or beans to your diet. Low fat cheese, cottage cheese and yogurts

also are good protein sources.

• Avoid foods that are high in fat and sugar. After your surgery, it may

be difficult for your digestive system to tolerate foods that are high in fat or

added sugars. Avoid foods that are fried and look for sugar free options of

soft drinks and dairy products.

Results

Bariatric surgery can result in long term weight loss. The amount of weight

you lose depends on the changes you make in your lifestyle habits. It may

be possible to lose half, or even more, of your excess weight within two

years.

Following your bariatric diet phases can help you recover from surgery and

return to enjoying many of the healthy foods you enjoyed before surgery. If

you find unhealthy eating habits creeping into your life, you may regain any

weight that you have lost.

Risks

• Dumping Syndrome. This complication occurs most often after eating

foods high in sugar or fat. These foods travel quickly through your stomach

pouch and ‘dump’ into your intestine. Dumping syndrome can cause

nausea, vomiting, dizziness, sweating and eventually diarrhea.

• Dehydration. Because you’re not supposed to drink fluids with your

meals, some people may become dehydrated. You can prevent dehydration

by sipping 64 ounces of water or other low calorie, decaffeinated beverage

throughout the day.

• Nausea and vomiting. If you eat too much, eat too fast or don’t chew

your food adequately, you may become nauseated or vomit after meals.

• Blocked opening of your stomach pouch. It’s possible for food to

become lodged at the opening of your stomach pouch, even if you carefully

follow the diet. Signs and symptoms of a blocked stomach opening include

ongoing nausea, vomiting and abdominal pain. Call your doctor if you

experience these symptoms for more than two days.

• Weight gain or failure to lose weight. It is possible to gain weight or fail

to lose weight after weight loss surgery. There are many reasons why

people may gain weight after weight loss surgery. If you experience any

weight re-gain, see your surgeon and/or dietitian as soon as possible.

Pre Op Liquid Diet

Low Fat, Low Carb, High Protein

• When: Start this diet two weeks before your surgery date.

• Why: To shrink your liver for a safer surgery and to mobilize fat stores for

optimal weight loss after surgery.

• Protein goal: 80 grams per day

• Fluid goal: 64 ounces per day (8 cups)

• Permitted Beverages:

– Water, ice

– Nonfat skim milk, soy milk, lactaid

– High protein supplements

– Sugar free beverages

– Decaf coffee or tea

– Broth (chicken, beef, shrimp or vegetable)

– Sugar free gelatin

– Sugar free popsicles

– Sugar free water ices

• Permitted Extras:

– Low fat or non fat yogurt

– Cottage cheese

– Fresh fruit

– Vegetable soup

• Breakfast

– 8 oz protein supplement

– Decaf coffee with skim milk

and artificial sweetener

• AM Snack

– Sugar-free gelatin

– 1 small piece of fruit

• Lunch

– 1 cup vegetable soup

– ½ cup cottage cheese

– 1 cup sugar free or diet juice

• PM Snack


• Dinner

– 1 cup beef broth


• Bedtime Snack

– Sugar-free popsicle

– 6 oz Greek low fat yogurt

Sample Pre Op Liquid Diet Menu

Bariatric Meal Progression

Calorie, Carbohydrate, Fat and Protein Recommendations

Time Diet Calories Fat Carbs Protein

Day 2 to Day

6

Clear

Liquids

Min 20g

Day 7 to Day

20

Full

Liquids

200-400 Less

than 8g

Min 40g

Day 21 to

Day 35

Pureed 300-400 Less

than 11g

Min 60g

Day 36 to

Day 49

Soft 400 Less

than 11g

Min 72g

2 to 4

Months

Regular 500 15g 50g Min 72g

5 Months Regular 600 16g 60g Min 72g





Lifelong Regular 1000-

1200

33g 120g 105g

Individual calorie, fat and protein needs may vary. Please schedule

a post-op visit with your registered dietitian to determine individual

needs.

Full Liquid Sample Menu Days 7-20

Breakfast 8am Breakfast 8am Breakfast 8am

¼ cup unsweetened

cooked or cold cereal

with ¼ cup skim milk

¼ cup unsweetened

applesauce and

¼ cup non-fat cottage

cheese

¼ cup unsweetened

cooked or cold cereal

with ¼ cup skim milk

Snack 10am Snack 10am Snack 10am

Protein supplement Protein supplement Protein supplement

Lunch 12pm Lunch 12pm Lunch 12pm

1 Tbsp Polaner All Fruit®

¼ cup non-fat cottage

cheese

½ cup non-fat and low

sugar yogurt

½ cup pureed low-fat

soup

Snack 2pm Snack 2pm Snack 2pm

¼ cup non-fat and low

sugar yogurt

¼ cup non-fat ricotta

cheese with cinnamon

and/or nutmeg

¼ cup pureed skinless

fresh fruit

Dinner 6pm Dinner 6pm Dinner 6pm

¼ cup Eggbeaters®, 1/8

cup unsweetened

applesauce

½ cup low-fat cream

soup

½ cup non-fat low sugar

yogurt

Daily Totals:

Calories – 353

Fat – 3.5 grams

Protein – 38 grams

Daily Totals:

Calories – 383

Fat – 5 grams

Protein – 37.5 grams

Daily Totals:

Calories – 373

Fat – 4 grams

Protein – 35.5 grams

Pureed Sample Menu Days 21-35


½ cup Cheerios with ½

cup skim milk

½ cup Eggbeaters®

1 oz fat free cheddar

½ cup unsweetened

oatmeal with ¼ cup skim

milk


Protein supplement Protein supplement


½ cup fat free/low fat

cottage cheese

4 oz pureed Progresso®

Light Soup

½ cup nonfat Greek

yogurt and ¼ small

banana mashed


Protein supplement ½ Protein supplement


3 oz pureed chicken, 1 oz

pureed carrots, 1 oz

mashed potatoes

3 oz pureed turkey, 1 oz

green beans, 1 oz

mashed potatoes

3 oz pureed fish, 1 oz

pureed zucchini, 1 oz

mashed acorn squash

Daily Totals:

Calories – 410

Fat – 11 grams


Daily Totals:

Calories – 380

Fat – 8 grams


Daily Totals:

Calories – 420

Fat – 4.5grams


Pureed Food Choices

Food Group Food Choice

Bread, cereal,

pasta, starchy

vegetables and

rice

Unsweetened cold cereals soaked in milk to soften,

Unsweetened hot cereals- oatmeal, cream of wheat, farina,

grits

Mashed potatoes, mashed sweet potatoes

Fruit Mashed bananas, unsweetened applesauce, pureed canned

fruit packed in water or natural juices, pureed skinless soft

fresh fruit

(Avoid fruits in syrup or added sugar!)

Vegetable Pureed carrots, green beans, beets, acorn squash, zucchini,

broccoli, cauliflower, tomatoes, tomato sauce, 2 oz low

sodium vegetable juice

Meat, Poultry,

Fish, Beans

and Eggs

Pureed skinless chicken, turkey and fish, soft scrambled egg

whites, Eggbeaters®, finely mashed beans- kidney, chick

peas, cannelloni

Milk, Cheese

and Yogurt

Fat free, 1% milk, Lactaid®, or low fat soy milk, Fat free or low

fat sugar free yogurt- no pieces of fruit, Greek style fat free

sugar free yogurt, whipped or small curd fat free/low fat

cottage cheese, fat free/low fat ricotta cheese

Fats and Oils Pam® coating spray, 1 teaspoon olive/canola oil or low fat

mayonnaise, fat free ot low fat salad dressing

Miscellaneous Sugar free popsicles, smooth consistency baby foods are

acceptable – choose high protein and low sugar varieties

(meats)

Liquids Non carbonated, Sugar Free, Fat Free beverages only- Water,

Crystal Light®, regular and decaf coffee/tea, fat free milk

Soft Sample Menu

Days 36-49


4 hard boiled egg whites 1 Morning Star Farms®

sausage patty and ½ cup

Greek yogurt

½ cup unsweetened

oatmeal with 1/8 cup

mixed berries


Protein supplement


½ cup minestrone soup

and 2 oz canned chicken

½ cup Health Valley®

turkey and bean chili

3 oz turkey breast and 1/8

cup sweet potato


Protein supplement


3 oz broiled tilapia, 1/8

cup soft vegetable, 1/8

cup soft boiled potatoes

3 oz fat free ricotta

cheese, 2 oz tomato

sauce, 1 oz Polly-O® fat

free mozzarella cheese

½ cup Eggbeaters®, 1 oz

fat free cheddar, 1/8 cup

diced well cooked

vegetables (peppers,

onions, mushrooms)

Daily Totals:

Calories – 425

Fat – 8 grams


Daily Totals:

Calories – 485

Fat – 11.5 grams


Daily Totals:

Calories – 430

Fat – 6.5 grams


Soft Food Choices


Bread, cereal,

pasta, starchy

vegetables and

rice

Unsweetened cold cereals soaked in milk to soften,

Unsweetened hot cereals- oatmeal, cream of wheat, farina,

grits

TOASTED only 100% whole wheat or rye bread, reduced

calorie, soft cooked potatoes, sweet potatoes or yams

Fruit Soft banana, unsweetened applesauce, pureed canned fruit

packed in water or natural juices, skinless soft fresh fruit

Vegetable Soft cooked carrots, green beans, beets, acorn squash,

zucchini (no seeds), tomato sauce, 2 oz low sodium vegetable

juice

NO CORN, ASPARAGUS, CELERY

Meat, Poultry,

Fish, Beans

and Eggs

Canned chicken breast, turkey breast, tuna packed in water,

soft cooked fish, crab, lobster, shrimp, scallops, ground

chicken or turkey breast, scrambled egg whites, Eggbeaters®,

mashed beans,- kidney, chick peas, cannellini beans, low fat

tofu

Milk, Cheese

and Yogurt

Fat free, 1% milk, Lactaid®, or low fat soy milk, Fat free or low

fat sugar free yogurt- no pieces of fruit, Greek style fat free

sugar free yogurt, whipped or small curd fat free/low fat

cottage cheese, fat free/low fat ricotta cheese

Fats and Oils Pam® coating spray, 1 teaspoon olive/canola oil or low fat

mayonnaise, fat free or low fat salad dressing

Miscellaneous Sugar free popsicles, smooth consistency baby foods are

acceptable – choose high protein and low sugar varieties

(meats)

Liquids Non carbonated, Sugar Free, Fat Free beverages only- Water,

Crystal Light®, regular and decaf coffee/tea, fat free milk

Regular Diet Sample Menu for 800-1000 calories/day


½ cup Eggbeaters®, 1 slice

fat free cheese, 1 slice light

whole wheat toast with

ICBINB spray

¾ cup Kashi Go Lean

Crunch® with ¼ cup skim or

1% milk

½ cup fat free cottage cheese

with ¼ cup fruit


1 Light Cheese Stick with ¼

cup fruit

6 Almonds ½ cup fat free and low sugar

yogurt


1 slice light whole wheat toast,

4 oz canned chicken breast, 1

tbsp light mayo, ¼ cup fruit

Crab melt: 4 oz imitation crab,

1 slice fat free cheese, 1 tbsp

light mayo

1 lettuce leaf, 2 hard boiled

egg whites, 1 tbsp light or fat

free dressing, 1/3 cup tuna in

water


2 wedges Laughing Cow Light

Cheese®, 8 reduced fat

Wheat Thins®

2 oz low sodium ham made

into rolls with 8 reduced fat

Wheat Thins®

1 light cheese stick


4 oz fish (halibut, flounder,

shrimp, etc), ¼ cup cooked

veggies, 1/8 cup banana

5 oz chicken breast or turkey

breast, ¼ cup cooked

veggies, ¼ cup fruit

4 oz extra lean pork

tenderloin, ½ cup brown rice,

1/8 cup cooked veggies

Snack 8:30pm Snack 8:30pm Snack 8:30pm

½ tbsp peanut butter and ½

cup fruit

Light cheese stick 1 tbsp peanut butter and 1

small skinless apple

Daily Totals:

Calories – 905

Fat – 17 grams


Daily Totals:

Calories – 823

Fat – 18 grams


Daily Totals:

Calories – 828

Fat – 20.5 grams


Regular Diet Sample Menu for 1000-1200 calories/day


½ cup Eggbeaters®, small

whole wheat tortilla baked in

toaster, 1/8 cup salsa

1 egg & 3 egg whites, 2 oz

canadian bacon, ½ toasted

whole wheat english muffin

Protein shake and light

cheese stick


1 slice light whole wheat toast

and 1 slice fat free cheese

½ cup fat free and low sugar

yogurt, ¼ cup Kashi® Go

Lean Crunch cereal

3 hard boiled egg whites and

8 reduced fat Wheat Thins®


4 oz canned chicken breast, 1

tbsp light mayo, 4 pieces of

melba toast, ¼ cup skinless

apple

Tuna melt: 4 oz tuna in water,

1 slice low fat cheese, 1 slice

whole wheat toast

5 oz ground turkey breast or

veggie ground round with ¼

cup beans and 1/8 cup

banana


½ cup fat free ricotta cheese

with cinnamon

1 oz 50% reduced fat cheese

and 8 reduced fat Wheat

Thins®

½ cup fruit and ¼ cup low fat

(1%) cottage cheese


4 oz 95% lean ground beef

hamburger patty with 1 slice

fat free cheese, ½ toatsed

english muffin and ¼ cup

cooked green beans

4 oz ground turkey breast

fajita or taco seasoning, 1

taco shell, ¼ cup 2% milk

shredded cheddar cheese,

chopped lettuce and tomato

5 oz cooked shrimp with garlic

and 1 tsp olive oil, ¼ cup

cooked brown rice, 1/8 cup

steamed spinach

Snack 8:30pm Snack 8:30pm Snack 8:30pm

2 tbsp reduced fat peanut

butter

4 oz sugar free, fat free

pudding

¼ cup chopped walnuts-

CAUTION and chew well!

Daily Totals:

Calories – 1042

Fat – 25 grams

Protein –102 grams

Daily Totals:

Calories – 1144

Fat – 31 grams


Daily Totals:

Calories – 1207

Fat – 36 grams

Protein – 122grams

Regular Diet Food Choices


Bread, cereal,

pasta, starchy

vegetables and

rice

Limit to 1 seving/meal or snack (15 grams of carbohydrates)

100% light whole wheat or light whole grain breads, pastas, cereals.

Keep sugar less than 6g/serving for food and cereal. Unsweetened cold

cereals- Cheerios®, Crispix®, Rice Krispies®, etc. Brown rice (well

cooked). All bread should be toasted. No soft bread until 18 months after

surgery.

Fruit Avoid the stringy membrane of oranges and grapefruits. Avoid other

stringy fruits. Otherwise all fruits are acceptable, no skins or seeds

(unless you chew well). Avoid fruit juices with a limit of 2 oz 100%

juice/day

Vegetable All vegetables are acceptable. If having difficulty with any vegetables,

cook them well to help with digestion. Avoid skins or seeds. Be careful of

gas producing vegetables such as broccoli and cauliflower.

Meat, Poultry,

Fish, Beans and

Eggs

Make sure all meats are moist. Extra lean white meat chicken breast or

turkey breast (no skins), egg beaters or egg whites. Cooked fish, crab,

lobster, shrimp, scallops, ground chicken or turkey breast. For the first 2

months avoid nuts, skins and seeds. When you try them, start with a

small amount and chew well. Beef, pork, or lamb 1-2x/month. Choose

leaner cuts (round, sirloin, flank and pork tenderloin) with no visible fat

and cook off the bone.

Milk, Cheese and

Yogurt

Skim, 1% or Skim Plus milk, low fat or fat free and low sugar or sugar

free yogurt with less than 110cal/serving. Choose low fat cheeses with

less than or equal to 3g fat/serving. i.e. Laughing Cow Light® or reduced

fat Cabot® cheese

Fats and Oils Nuts, peanut butter and olive oil are to be used sparingly. i.e. 1 tsp daily

of oil or peanut butter OR 6 almonds, 4-5 walnut halves or 10 peanuts

Miscellaneous Alcohol should be limited to 1x/month if okay with surgeon or eliminated

as it has a high caloric content and is quickly digested. Keep empty

calories to about 25 per day. These are foods that have NO nutritional

value and take the place of healthy more filling foods.

Liquids Water, water, water. Get in at least 64-96 oz per day. Keep to no more

than 8-16 oz of caffeinated beverages/day, non caloric sweeteners, fat

free or low fat milk only and no creamer unless fat free. No carbonation,

sugar free beverages only. Keep drinks to no more than 5 calories per 8

oz serving.

Bariatric

Problem Foods and Beverages

• Sugar: Sugar can cause ‘Dumping Syndrome’ which results in

dizziness, shaking, rapid heart rate, nausea, stomach cramping and

diarrhea. Dumping syndrome occurs when the undigested stomach

contents are released or ‘dumped’ into the small intestine too quickly.

Most people experience symptoms several hours after eating problem

foods and may also experience symptoms of low blood pressure

(feeling faint) and low blood sugar. Avoid products that list any of the

following in the first 5 ingredients: sugar, sucrose, honey, corn syrup,

corn sweetener, glucose, maltose, and dextrose. Sorbitol is a sugar

alcohol. It is sugar free but may cause diarrhea. Avoid excess. Read

labels carefully to avoid all sweeteners except Splenda®, Equal ®,

Stevia ® and Sweet’N Low ®.

• Fat: Fat may be difficult to digest after surgery. Eating too much fat will

delay gastric emptying and may cause heartburn, nausea, diarrhea, or

stomach discomfort. Excess fat above recommendations will also slow

weight loss.

• Alcohol: Consumption should be discussed with your physician. Intake

should be limtied!

– Some alcoholic beverages contain carbonation which causes gas, bloating

and discomfort. All carbonated beverages are prohibited.

– Alcohol provides empty calories which are limited to 25 per day.

– Alcohol will affect you differently after surgery causing intoxication much

quicker. Your risk for alcohol dependence increases post surgery. Seek

assistance if you are consuming alcohol on a consistent basis.

• Empty calories: Any food with no or little nutritional value must be

limited to 25 calories per day. These foods will quickly increase your

calorie intake and slow or STOP weight loss. Some examples include-

pretzels, sugar free/fat free pudding, sugar free ice pops, fat/free sugar

free ice cream, etc.

Constipation- A Common Complaint

• Constipation after bariatric surgery is a common complaint. It may be

caused by decreased food and water intake, and in some people,

supplemental iron, narcotic pain killers, tranquilizers and antidepressants.

• You should not expect your bowel pattern after surgery to be exactly the

same as it was before surgery. Many patients experience less frequent

bowel movements.

• If infrequency and discomfort are present, we recommend the following:

– Drink plenty of fluids: a minimum of 64 ounces per day. In hot

weather or times of increased physical activity/sweating, fluid needs

increase.

– Consider increasing your fiber intake. Unprocessed bran can be

added to meat mixtures such as turkey meatloaf. It can be sprinkled

over food, too. Dried beans and peas are high fiber foods that can be

used as a portion of a meal (if problems with gas occur try adding a

drop of Beano® to your first bite of food.) Include a small portion of

vegetables with meals. Fiber supplements such as Benefiber® or

Citrucel® powder can be added to foods or liquids. These powders

can best be used by mixing with water.

– Increase physical activity once cleared by your physician to do so.

– Check your calcium supplement. Calcium citrate is recommended.

Calcium carbonate is not well absorbed and often contributes to

constipation. Choosing a calcium/magnesium combination with a ratio

of 2:1 works well and promotes softer more frequent bowel

movements.

– If you take iron supplements, choose ferrous fumerate or ferrous

gluconate since they are less constipating and better absorbed.

– Try avoiding ‘binding’ foods such as applesauce, banana, rice,

cheeses, peanut butter and potatoes.

– You may need a stool softener. Ask your physician for

recommendations to meet your specific needs.

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