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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 • • • 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 • • • • 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 • • • 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 • • • • 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 • • • • 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 • • • 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 • • • 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 • • • • • • • 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 • • 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 • • • 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 • • • 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: • • • • Sugar Coffee / Caffeine Bread (untoasted) Alcohol • • • • Fatty and Fried Foods Carbonated drinks Citrus Fruits for 3-6 months NSAIDS Do’s and Don’ts of Eating After Bariatric Surgery • • • • • • • • • 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 • • • • • 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