Dietary Guidelines After Bariatric Surgery

Protein

Preserve muscle tissue by eating foods rich in protein. High-protein foods include eggs, meats, fish, seafood, tuna, poultry, soy milk, tofu, cottage cheese, yogurt and other milk products. Your goal should be a minimum of 65 to 75 grams of protein a day. Don't worry if you can't reach this goal in the first few months after surgery.

Supplements

You must take the following supplements on a daily basis to prevent nutrient deficiencies. Please remember that all pills must be crushed or cut into six to eight small pieces. You are not able to absorb whole pills as well as before surgery, and it can be difficult for the pills to pass through your new anatomy.

Multivitamins

Take a high-potency daily chewable multivitamin and mineral supplement that contains a minimum of 18 mg of iron, 400 mcg of folic acid, selenium, copper and zinc. Brands that contain this formula include Trader Joe’s and Centrum Adult chewable multivitamins. Take two tablets daily for at least three months after your surgery, and then one tablet daily for life.

Calcium Supplement

Take 1,200 to 2,000 mg of calcium daily to prevent calcium deficiency and bone disease. To enhance absorption, take the calcium in two to three divided doses throughout the day - for example, a 500 to 600 mg supplement taken three times a day. Calcium citrate is the preferred form of calcium.

Vitamin D Supplement

Take a total of 800 to 1,000 International Units (IUs) of vitamin D each day. This total amount should be taken in divided doses of 400 to 500 IUs twice a day. Vitamin D should be taken with your calcium supplement. If you prefer, you can take a combination calcium-vitamin D supplement to avoid taking multiple pills, so long as it contains the proper dosages.

Vitamin B₁₂ Supplement

Take 500 mcg of vitamin B daily. It can be taken as a tablet, or in sublingual forms placed under the tongue.

Other Supplements

Some patients need additional folic acid or iron supplements, particularly women who are still menstruating. Your dietitian will discuss this with you.

Diet Progression After Bariatric Surgery

Immediately following surgery, you will begin with a clear liquid diet. You may gradually start adding thicker liquids to your diet after you are discharged from the hospital.

Two weeks following surgery, you may progress to blended and puréed foods. You may use high-protein (more than 20 grams protein), low-calorie (less than 200 calories) liquid supplement drinks or powders to meet your protein requirements during this period.

It is important to know that following surgery, your stomach size is very small - less than 1/4 cup, or about the size of an egg. The opening that allows food to pass out of your stomach is also very narrow. For this reason, it is important to take only two to three sips or bites at a time of any new food and then wait 10 minutes before taking more. This will help you learn your limits and tolerance. Liquids will empty faster from your stomach than soft solids.

If you overeat or eat too quickly, you may experience nausea or pain. You should avoid rich, creamy liquids such as gravies, sauces and ice creams.

Diet in the Hospital

You will receive clear liquids such as juices, Jell-O and broth as your first meal following surgery. Juice and Jell-O are high in sugar content, but your portions will be very small at this stage. Gradually increase the amount you drink at each meal as you can tolerate it.

Diet for the First Two Weeks Post-Surgery

You will begin adding thicker liquids that are high in protein and low in fat and sugar. (For examples, see the list below.) You may use high-protein, low-calorie liquid supplement drinks or powders to meet your protein requirements during this period.

The goal is to consume small portions that will empty easily from your pouch. Begin with 1 tablespoon portion sizes and increase to 2 tablespoons as tolerated. Begin drinking 1/4 cup of liquid at a time and increase to a 1/2 cup as tolerated. Your daily caloric intake should not exceed 400 calories.

It is also very important to stay well hydrated. Drink 1 to 1.5 liters of water or other non-caloric liquids per day.

Recommended thicker liquids:

• Nonfat or 1% milk, if you can tolerate milk
• Lactose-free or soy-based low-calorie drinks
• Sugar-free pudding
• Sugar-free, nonfat yogurt
• Low-fat cottage cheese
• Blended broth-based soup or other low-fat soups
• Refined hot cereals that are low in fiber, such as cream of rice or cream of wheat. Make them with extra liquid to create a soup-like consistency. Do not eat oatmeal.
• Optional high-protein, low-calorie liquid supplement drinks (drinks containing less than 200 calories and more than 20 grams of protein in an 8- to 11-ounce serving).

To increase your protein intake, add 2 tablespoons non-fat dry milk powder, egg substitute or powered egg, or other protein powder to each 1/2 cup of nonfat or low-fat milk. You can also add these to soups, hot cereal and other thick liquids.

Remember to drink 1 cup of water or other non-caloric fluids between meals. Take a multivitamin supplement every day.

Diet for Weeks Two to Four Post-Surgery

Begin adding very small portions of puréed and soft foods as tolerated. Take very small bites and chew everything very well. Do not take more than two bites every 20 minutes when adding a new food.

Recommended puréed and soft foods:

• Applesauce
• Yogurt
• Cottage cheese
• Well-cooked, puréed vegetables
• Hot cereals
• Mashed potatoes
• Noodles
• Scrambled egg whites or egg substitute
• Canned fruits
• Canned tuna fish
• Lean fish
• Tofu
• Lean ground meats or poultry

Avoid all bread and meats that are not easily chewed.

Recommended Meal Plan For Weeks Two to Eight Until Two Months Post-Surgery

At this time, your caloric intake will probably be no more than 500 calories a day, divided into six to eight small meals. Recommended portion sizes are 1/4 cup for solids and 1/2 cup for liquids.

Sample Menu

This sample menu includes different foods that are safe for you to eat. You may adjust the menu to fit your tastes and tolerance.

Breakfast
1/4 cup hot cereal made with non-fat milk

Mid-Morning
1/2 cup nonfat milk*

Late Morning
Two scrambled egg whites

Lunch
1/2 cup low-fat chicken noodle soup

Mid-Afternoon
1/4 cup low-fat cottage cheese

Late Afternoon
1/4 cup sugar-free, nonfat yogurt

Dinner
2 ounces lean ground meat
1/4 cup puréed or well-cooked vegetables

Bedtime Snack
1/4 cup non-fat milk

* Add 1 tablespoon non-fat dry milk powder to each 1/4 cup nonfat milk for additional protein.

Remember to drink 1 cup of water or other non-caloric fluids between meals. It is important to take a multivitamin and mineral supplement every day, plus additional iron if required, and calcium and vitamin D supplements two to three times per day.

Recommended Meal Plan for Two to Six Months Post-Surgery

Consume 900 to 1,000 calories and at least 65 to 75 grams of protein a day. For balanced nutrient intake, your daily servings should include:

• 3 servings milk and dairy products (nonfat and low-fat)
• 3 servings meat or meat alternative (lean and low-fat)
• 3 servings starch (limit bread and rice)
• 1 serving fruit (avoid dried fruits and fruits with skin)
• 2 servings vegetable (well-cooked only)

Recommended portion sizes are 1/4 cup for solids and 1/2 cup for liquids.

Discontinue taking high-protein liquid supplement drinks or powders if possible. We recommend meeting your protein needs with food.

Sample Menu

This sample menu includes different foods that are safe for you to eat. You may adjust the menu to fit your tastes and tolerance.

Breakfast
1 egg or 1/4 cup egg substitute
1/2 cup hot cereal

Mid-Morning
1/2 cup nonfat milk

Late Morning
1/2 cup chopped melon

Lunch
1/2 cup low-fat chicken noodle soup
Two Saltine crackers

Mid-Afternoon
1/4 cup low-fat cottage cheese
1/4 cup canned fruit packed in water or juice

Late Afternoon
1/2 cup sugar-free, nonfat yogurt

Dinner
2 ounces lean meat or fish
1/4 cup mashed potatoes
1/4 cup pureed or well-cooked vegetables

Bedtime Snack
1/2 cup nonfat milk

The sample menu offers eight small meals per day. You may wish to eat more or less often, but be sure to eat at least six times each day.

Remember to drink 1 cup of water or other non-caloric fluid between meals. It is important to take a multivitamin and mineral supplement daily, plus additional iron if required. In addition, you must take calcium and vitamin D supplements two to three times per day.

Recommended Meal Plan for Six Months Post-Surgery and Beyond

• Continue consuming 900 to 1,000 calories per day
• Decrease to three meals and only one to two snacks per day
• Discontinue taking high-protein liquid supplement drinks
• Increase the variety of low-fat, low-sugar and low-calorie foods, as tolerated
• Avoid raw vegetables, fresh fruits with skins, dried fruits, breads, popcorn, nuts and red meats only if poorly tolerated

Long-term Dietary Guidelines

Over time, you will be able to increase the variety and consistency of foods in your diet. Some foods may continue to be poorly tolerated, including red meats, chicken, breads, and high-fiber fruits and vegetables. Focus on low-fat, low-sugar and low-calorie foods and continue to count your calories every day. Try to meet your serving goals for all food groups based on the 900 to 1,000 calories diet plan described above.

To stay well hydrated, drink at least 2 liters of water or non-caloric fluids daily, unless this is contraindicated due to a medical condition.