Download post bariatric surgery dietary guidelines

POST BARIATRIC SURGERY DIETARY GUIDELINES*
Stage 1
Days 1-3**
Clear Liquid (see through liquids) and Protein Supplements
• Example: broth, sugar-free gelatin, Crystal Light, protein shakes
Stage 2
Weeks 1-2
(Days 4-14)
Full Liquid and Protein Supplements
• Example: Protein shakes, non-fat milk or unsweetened soy milk
(consistency should be able to go through a straw but do not use
straw to eat/drink, NO chunks), non-fat plain or light
yogurt/Greek yogurt
Stage 3
Weeks 3 to 4
Blended/Pureed
• Consistency of applesauce or pudding with 2 protein
supplements per day
• Examples: Cream of Wheat, cottage cheese, unsweetened
applesauce, low-fat refried beans, tofu, mashed potatoes, pureed
chicken or turkey
• Daily Meal Planning: two meals and two protein supplements
Stage 4
Weeks 5 to 6
Soft
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•
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Soft, moist (almost dripping) and shredded or minced with two
protein supplements
Example: soft fish, ground chicken or turkey, canned fruits (no
sugar added) or fruit cup, cooked vegetables
Daily Meal Planning: 2 meals plus 2 protein supplements and 1
snack if needed
Stage 5
Weeks 7 to 12
Early Transition to Solid Food
• Slow transition from soft to solid foods with 2 protein
supplements
• Daily Meal Planning: 2-3 meals and 2 protein supplements plus 1
snack if needed
Stage 6
Months 3 to 6
Later Transition to Solid Food
• Slow increase in amount of food at one sitting with 1 protein
supplement per day
• Daily Meal Planning : 2-3 meals and 1 protein supplement plus 1
snack if needed
Lifetime
Months 7 +
(may start later
based on
tolerances)
Healthy Meal Plan
• Balanced meals with or without protein supplements
• Daily Meal Planning: 3 meals and 1 protein supplement if using
plus 1 snack if needed
*Stage progression may be changed by your bariatric team.
**Day 1 = 1st day you wake up at home
POST OPERATIVE DIETARY GUIDELINES:
STAGE 1 – CLEAR LIQUIDS
Days 1 – 3 (begin after hospital stay)
POST OPERATIVE
BARIATRIC
DIETARYGUIDELINES
GUIDELINES
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This liquid diet allows the gastrointestinal system time to adapt to the new stomach pouch.
HYDRATION and PROTEIN are the main concerns.
Choose foods and beverages from the lists below. Avoid drinking too much fluid at one time, since it may
overwhelm the pouch and cause pain. Your goal is to consume at least 4 -6 oz per hour.
Do not drink through a straw, it can cause gas and discomfort
PROTEIN: Strive for 60 – 75 g of protein per day. Protein supplements can be purchased online or at a nutrition
store. See protein supplements list for examples.
CLEAR LIQUID PROTEIN SUPPLEMENTS PREFERRED
Isopure – Perfect Zero Carb
20 oz bottle – 40 g protein
Syntrax Nectar Whey (mixed with water)
1 scoop – 23 g protein
FOOD & BEVERAGES ALLOWED –
WATER / FLUID GOAL- WORK TOWARDS 32 - 64 OZ PER DAY
BEVERAGES
Water, Crystal Light, Ice Chips, Diet Snapple
(diluted*), sugar free beverages
SOUP
Low Sodium Broth, bouillion
FRUITS
\
Juice – apple, cranberry, grape (diluted with 1
part juice and 3 parts water). Only ½ cup
juice daily
OTHER
Sugar-free popsicles, sugar-free gelatin
Kaiser Permanente does not endorse the products mentioned. Any trade names listed are for easy identification only.
POST OPERATIVE DIETARY
GUIDELINES:
STAGE 2 – FULL LIQUID
Days 4 - 14
GUIDELINES
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This is a transition to a more calorically dense, higher protein meal plan.
Choose foods and beverages from the lists below.
GOALS:
o FLUID : Try for 32 - 64 oz of fluid per day
o PROTEIN: Your goal is 60g - 75g of protein per day. See protein supplement list for examples.
SUGGESTED FULL LIQUIDS:
BEVERAGES
Light or Non-Fat unflavored soy, almond or
fat-free Lactaid Milk
SOUP
Strained, low fat cream soups, butternut
squash soup
DAIRY
Kefir
CARBOHYDRATES
Strained, cooked cereals (Oatmeal or Cream
of Wheat), lower-carbohydrate yogurt (15-18
g total carbohydrate / 80- 100 calories),
Greek yogurt. It should be liquid enough to
fit through a straw.
POST
OPERATIVE
DIETARY
POST
OPERATIVE
DIETARY
GUIDELINES:
GUIDELINES:
STAGE
& PUREED
STAGE 31 –– BLENDED
CLEAR LIQUIDS
Days 15 – 28
D
0 3
GUIDELINES
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During this stage you will transition into a blended consistency diet.
Food consistency should be of applesauce or pudding (similar to baby food consistency).
Choose foods/beverages from the list below.
GOALS:
o FLUID : Try for 32 - 64 oz of fluid per day
o PROTEIN: Your goal is 60g - 75g of protein per day. See protein supplement list for examples.
SUGGESTED BLENDED FOODS:
BEVERAGES
Water, crystal light, light or non fat
unflavored milk alternative (soy, almond,
Lactaid), any sugar-free, non-carbonated
beverage
CEREALS AND STARCHES
Cream of wheat or oatmeal thinned with
nonfat milk alternative
Mashed potatoes thinned with light milk
alternative, well-cooked whipped yams
without skin
SOUP
Blended split pea, black bean, butternut
squash soup
MEAT / MEAT ALTERNATIVES
low fat refried beans, pureed chicken or
turkey. No red meat
DAIRY
Low -fat cottage or ricotta cheese
FRUITS
Applesauce (unsweetened or no sugar
added), blended fruits
VEGETABLES
Blended vegetables
OTHER
Sugar-free popsicle, sugar-free pudding
MISCELLANEOUS
Mild Seasonings or herbs
POST OPERATIVE DIETARY
GUIDELINES:
STAGE 4 – SOFT FOODS
Days 29 – 42
GUIDELINES
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The purpose of this stage is to improve your nutrition status post-surgery while gradually advancing your food
texture.
Try one new food at a time to assess tolerance. If a food is not tolerated, reintroduce it in 1-2 weeks.
Do not eat and drink fluids at the same time. Stop drinking 30 minutes before each meal and do not drink for
30 - 45 minutes after each meal.
Eat slowly! Take 30 minutes to eat each meal, chewing each bite thoroughly.
REMEMBER YOUR PRIORITY:
o FLUID : Try for 64 oz of fluid per day
 Water or sugar free beverage
 Clear broth
o PROTEIN: Your goal is 70g – 100g of protein per day. You will still need to use protein supplements
daily. Protein goals may be adjusted periodically.
o FOOD TEXTURE: Soft, visibly moist (almost dripping) and shredded or minced
o BALANCED MEALS: Eat protein first, then vegetables and fruit.
POST OPERATIVE DIETARY
GUIDELINES:
STAGE 4 – SOFT FOOD
Days 29 – 42
SUGGESTED STAGE 4 FOODS
PROTEIN
During the Stage 4 meal plan, you will continue to use a
protein supplement to meet your protein needs. See
protein supplement list for examples.
BEVERAGES
Water, crystal light, light or non fat unflavored milk
alternative (soy, almond, Lactaid), any sugar-free, noncarbonated beverage
CEREALS AND STARCHES
Cream of wheat or oatmeal, Baked potatoes or well-cooked
yams without skin
SOUP
All types, except those with peas, long grain or wild rice or
chunks of meat
MEAT / MEAT ALTERNATIVES
Steamed or poached fish, moist tuna, ground or shredded
chicken or turkey, soft vegetable burgers, low fat beans –
all shredded and moistened with broth
EGGS
Scrambled egg whites or egg substitute, soft-cooked or
poached (not fried)
DAIRY
Lower-carbohydrate yogurt (15-18 g total carbohydrate /
80- 100 calories), Greek yogurt, low-fat cottage or ricotta
cheese, low-fat or nonfat cheese string cheese, non-fat feta
cheese
FRUITS
Applesauce (unsweetened or no sugar added), ripe banana,
soft, canned fruit in juice (pour juice out) or fruit cup
VEGETABLES
All soft, well-cooked vegetables (except fibrous ones such
as celery, asparagus, corn)
OTHER
Sugar-free popsicle, sugar-free pudding
MISCELLANEOUS
Mild Seasonings or herbs
POST OPERATIVE DIETARY GUIDELINES:
STAGE 5 – EARLY TRANSITION TO SOLID FOODS
Days 43 - 84
GUIDELINES
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Gradually advance to more solid foods.
Include all foods from Stage 1, 2, 3, and 4.
Do not eat and drink fluids at the same time. Stop drinking 30 minutes before each meal and do not drink for
30 minutes after each meal.
REMEMBER YOUR PRIORITY:
o FLUID : Try for 64 oz of fluid per day
 Water or sugar free beverage
 Clear broth, Herbal tea
o PROTEIN: Your goal is 70g – 100g of protein per day. You will still need to use protein supplements
daily. Protein goals may be adjusted periodically.
o FOOD TEXTURE: Soft, visibly moist and you may want to still have shredded
o BALANCED MEALS: Eat protein first, then vegetables and fruit, last is your whole grains
SUGGESTED NEW STAGE 5 FOODS
PROTEIN
Protein drink from suggested protein list,
skinless poultry, fish, tofu, edamame, low-fat
cheeses, low-fat cottage cheese, low-fat, noadded sugar yogurt (Greek best); light soy
milk; peanut butter (natural)
EGGS
Soft cooked, hard boiled eggs; scrambled egg
substitute or egg whites
FRUITS
All soft fruits without hard peels. No citrus
fruits.
VEGETABLES
Eventually all vegetables, including salad
with low-fat oil based dressing. Start with
softer and gradually move to crunchier
vegetables.
MISC
Lemon or lime juice in moderation for
flavoring
POST OPERATIVE DIETARY
GUIDELINES:
STAGE 6 – LATER TRANSITION TO SOLID FOOD
Months 3 - 6
GUIDELINES
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Gradually advance to more solid foods.
Include all foods from Stage 1, 2, 3, and 4.
Do not eat and drink fluids at the same time. Stop drinking 30 minutes before each meal and do not drink for
30 minutes after each meal.
REMEMBER YOUR PRIORITY:
o FLUID : Try for 64 oz of fluid per day
 Water, sugar free beverage (sparingly) NO Sodas
 Clear broth, Herbal tea
o PROTEIN: Your goal is 70g – 100g of protein per day. You will still need to use protein supplements
daily. Protein goals may be adjusted periodically.
o FOOD TEXTURE: Advancing into more solid foods.
o BALANCED MEALS: Eat protein first, then vegetables and fruit, last is your whole grains
SUGGESTED NEW STAGE 6 FOODS
PROTEIN
Protein drink from suggested protein list; nonfat or 1% milk; light soy milk
EGGS
Any style eggs, egg substitute, or egg whites.
Not fried
FRUITS
All fruits without peels
VEGETABLES
All vegetables, including salad with low-fat
dressing
STARCH
Well-toasted bread, baked potato without skin,
brown rice, quinoa, couscous
MISC
Lemon or lime juice in moderation
POST OPERATIVE DIETARY GUIDELINES:
LIFETIME
Months 7+
GUIDELINES
EATING
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Slowly increase the amount of food at one sitting to 1-1½ cup at a time.
Eat 2-3 small meals per day. Stop eating at the first sensation of abdominal pressure or
fullness
Eat very slowly. Take 30 minutes to eat each meal.
Chew well. Take very small bites and chew your food to applesauce consistency.
Select a balanced diet, choosing foods from all groups such as the My Healthy Plate model.
Avoid sugar, sweets and desserts. Also avoid high fat foods such as creamy soups, gravy,
butter, etc.
Avoid foods which often cause stomach upset.
PROTEIN
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Protein supplements, in the form of liquid, between meals might be required to meet your
daily protein requirements
Be sure to meet your daily protein recommendation of 70g – 100 g per day by eating at least
one food high in protein during each meal. Use protein drinks as needed to reach your goal.
FLUID
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Drink only calorie-free beverages (except nonfat milk and protein drinks).
Consume at least 6-8 cups of fluid per day. DO NOT drink with meals. Drink either 30
minutes before or beginning 30 minutes after your meals.
Avoid alcohol and carbonated drinks.
OTHER
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DO NOT TEST your pouch’s limits. This can lead to mechanical problems and sabotage
your weight loss goals.
Take a multivitamin and additional supplements as advised based on lab values.
Maintain consistency with your exercise plan. Exercise at least 30 – 60 minutes daily. This
can be in 15 – 20 minute periods.
PRIORITIES AFTER BARIATRIC SURGERY
Hydration
Water, sugar free beverages
Clear broth: chicken, beef, vegetable
Adequate Protein
The goal is 70 – 100 grams daily.
Whey or Soy protein (isolate)
Powder or prepared, like New Directions or Optifast HP
(less than 4 grams fat, less than 6 grams of sugar and at least 15 grams protein/serving)
Balanced Meals (once transitioned from liquid diet)
Eat Protein 1st, Vegetables 2nd, Fruits 3rd, and Starches/Carbs/ Whole Grains 4th as able.
Avoid:
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Sugar
Coffee / Caffeine
Bread (untoasted)
Alcohol
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Fatty and Fried Foods
Carbonated drinks
Citrus Fruits for 3-6 months
NSAIDS
Do’s and Don’ts of Eating After Bariatric Surgery
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Do drink at least 64 fluid ounces per day to prevent dehydration and constipation.
Do stop drinking liquids 30-45 minutes before meals and resume 30-45 minutes after meals
Do eat and chew slowly – it should take approximately 30 minutes for each meal
Don’t snack or graze between meals
Don’t drink empty liquid calories, like juices or sports drinks
Do remember the stomach can only hold a few tablespoons after surgery and eventually it
can hold about ½ to 1 cup
Do stop eating when comfortably satisfied – if ignored, vomiting will follow.
Do follow the diet guidelines as prescribed by your bariatric team to avoid complications,
like nausea, vomiting, or leaks
Do take your vitamin and mineral supplements daily as prescribed by your bariatric team
Kaiser Permanente does not endorse the products mentioned. Any trade names listed are for easy identification
only.
Making Your Plate
A balanced meal 6 – 9 months after bariatric surgery
Use 5 inch Plate
For lifetime
No fluids with meal
Eat Protein 1st
Eat Starch 4th
Eat Vegetables 2nd
Use Infant Utensils
First 2-3 months
Eat Fruit 3rd
Vitamins/Minerals
(as directed by your
bariatric team)
POST OPERATIVE DIETARY
GUIDELINES:
PROTEIN SUPPLEMENT LIST
Your daily protein needs are from 70 to 100 grams each day.
It is necessary to eat this quantity to avoid protein deficiency.
The following protein supplements have been reviewed to be of high quality:
CLEAR LIQUIDS
Supplement
Name
Grams of
Protein
Where to purchase
Isopure RTD
Zero-Carb
40 g
Available at some Kaiser Permanente Healthy Living
Stores, GNC, Vitamin Shoppe
Nectar
23 g
Select Vitamin Shoppe, Amazon or GNC
Supplement
Name
Grams of
Protein
Where to purchase
New Directions
24g –
Available at select Kaiser Permanente Healthy Living
Stores* and participating Kaiser Permanente locations
(this has thin
consistency)
PROTEIN POWDERS
27 g
* For first time order, may need prescription from
member of the Bariatric team
Premier Protein 30g
Costco
Unjury
20g –
www.unjury.com
21 g
1-800-517-5111
25 g
GNC or Target
Optimum
Nutrition 100%
Gold Standard
Whey
Kaiser Permanente does not endorse the products mentioned. Any trade names listed are for easy identification only.
POST OPERATIVE DIETARY
GUIDELINES:
POST OPERATIVE
DIETARY
PROTEIN
SUPPLEMENT LIST
GUIDELINES:
PROTEIN SUPPLEMENT LIST
PROTEIN POWDERS
Supplement
Name
Grams of
Protein
Where to purchase
EAS 100%
Whey Protein
Powder
23 g
Target, Grocery Stores,
Costco, Vitamin Shoppe
Pure Protein
23g or
35g
Trader Joe’s or Target
26g
Walmart
(Thinner
consistency)
Body Fortress
If Not Using a Recommended Protein Source,
Follow the Guidelines Below:
LOOK FOR A PROTEIN SUPPLEMENT THAT CONTAINS
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Less than 6 grams of sugar
Less than 4 grams of fat
At least 15 grams of protein per serving
Protein source as the main ingredient (whey protein isolate, soy protein isolate, milk, soy, egg)
AVOID supplements which list collagen, collagenic protein isolate or hydrolyzed collagen as the protein
source in the ingredient list (eg- Profect, Proteinex)
Kaiser Permanente does not endorse the products mentioned. Any trade names listed are for easy identification only.
POST OPERATIVE DIETARY
GUIDELINES:
FOODS TO EAT AFTER SURGERY
Use the Following List to Help you Shop after Surgery
PROTEIN
Beans (navy, pinto, black, etc)
Beef (very lean, ground)
Chicken (moist, no skin)
Cheese (reduced fat)
Cottage Cheese (reduced fat)
Crab / imitation crab
Egg / egg whites
Egg substitute
Ham
Lamb
Lobster
Pork (lean)
Fish (cod, tuna,
trout, salmon, etc)
Scallops/shrimp
Tofu / soy beans/ edamame
Soy milk / Lactaid milk
Turkey (no skin)
Veal
Veggie burger (soy based)
Yogurt (15 – 18 g total
carbohydrates)
VEGETABLES
Artichoke
Asparagus (well-cooked)
Beets
Broccoli
Brussels sprouts
Cabbage
Carrots
Cauliflower
Chard
Collard Greens
Cucumber
Eggplant
Green snap peas
Jicama
Kale
Leeks
Mushrooms
Onions
Radish
Peppers
Salad/spinach greens
Seaweed
Tomato
Water Chestnuts
Yellow Squash
Zucchini
Grapes
Guava
Kiwi
Lemon
Nectarines
Papaya
Peach
Honeydew melon
Pears (remove skin)
Pineapple
Plums
Raspberries
Strawberries
Tangerines
Watermelon
FRUIT
Apple (without peel)
Applesauce (unsweetened)
Apricots
Banana
Blueberries
Cantaloupe
Cherries
Grapefruit
POST OPERATIVE DIETARY
GUIDELINES:
FOODS TO EAT AFTER SURGERY
Use the Following List to Help you Shop after Surgery (continued)
FAT – SMALL AMOUNTS
Avocado
Olive Oil
Canola Oil
Vegetable Spray – can be olive or canola oil
Margarine
(trans-fat free)
MISCELLANEOUS
Cinnamon
Garlic/garlic powder
Herbs / seasonings
Mrs. Dash
Mustard
Pepper
Pickles / Relish
Vinegar
21 Seasoning Salute
POST OPERATIVE DIETARY
GUIDELINES:
FOODS TO AVOID AFTER SURGERY
Avoid excessive amounts of the following list of foods following your surgery.
These foods may cause unwanted weight gain, dumping syndrome, or block the
anastomosis between the stomach and small intestine
STARCHES
Bagels
Biscuits
Bread sticks
Bread (untoasted)
Croissants
Doughnuts
French Toast
Grits
Muffins
Pancakes
Pasta
Pastry
Pita Bread
Granola
Rice cakes
Rolls
Stuffing
Waffles
AVOID THE FOLLOWING LIST OF FOODS ENTIRELY FOLLOWING YOUR SURGERY.
MAY BLOCK THE ANASTOMOSIS
Coconut
Dried fruit
Nuts/seeds
Potato skins
Corn
Gum
Popcorn
Celery, raw (cooked in
soup if OK)
MAY CAUSE DUMPING SYNDROME
Ice Cream
Juice Smoothies
Cookies
Candy / candy bars
Cake
Coffee drinks
Excess Fruit Juice
HIGH FAT FOODS (MAY CAUSE WEIGHT GAIN)
Bacon
Fried Food
Fast Food
Hamburger
French fries
Hash browns
Fried egg rolls
Mayonnaise
MISCELLANEOUS FOODS
Alcohol
Caffeinated beverages
Skins/seed of fruit
and vegetables
Hot Dog skins
Soda Pop
Frozen Yogurt
Milkshake
Onion Rings
Pizza
Potato chips
Sausage
Carbonated beverages
Spicy foods