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Nutrition Guide to Bariatric Surgery print email
The importance of good nutrition following bariatric (weight loss) surgery cannot be overemphasized. This nutrition guideline was designed to help you succeed in your quest to lose weight, keep it off, and stay healthy. As you read through this guide, jot down any questions you have and discuss them with one of our Registered Dietitians. The Kennedy Bariatric Team looks forward to helping you succeed!

Preparing for Surgery

  • It's best to eat sensibly and to reduce portion sizes. You'll be able to incorporate most of your favorite foods into your new way of eating after your surgery, so there's no reason to eat prior as if it's your "last meal."
  • Wean yourself off of caffeine to avoid withdrawal symptoms after surgery. Decrease, and then eliminate coffee, tea, cola, and chocolate.
  • Wean yourself from all carbonated beverages, including diet and regular soda, seltzer water and tonic water. You must avoid carbonated beverages for the rest of your life, as carbonation puts pressure on the new stomach.
  • Make your transition home from the hospital easier by stocking your kitchen with foods you will be able to eat following surgery.
  • Buy or borrow a blender or food processor if you do not already own one.
  • Your initial diet after surgery consists of liquids and smooth puree foods. If you have time, experiment with recipes and begin pureeing food. These foods can be frozen in ice cube trays and stored frozen in zip-lock bags, enabling you to re-heat in a microwave and enjoy.
  • Learn your diet, and write down any questions you have, so they can be discussed during your follow-up appointments.
  • Purchase a notebook to use as a food diary. Keep a 3-day food record prior to each nutrition visit.

Introduction to Diet Progression After Surgery

Important: Do NOT advance your diet before discussing it with your surgeon. Each stage will be explained in detail at your surgeon's office before you advance.

Step 1: Clear Liquids
  • Approximately one day after surgery, you will start on a clear liquid diet. You will stay on clear liquids for about two weeks.
  • These will be non-carbonated, caffeine-free, sugar-free liquids.
  • Sip in small amounts, consuming no more than 1-2 ounces per hour.
Step 2: Smooth Consistency
  • You will progress to a pureed, smooth-consistency diet and stay on this diet for approximately two weeks.
  • Pureed foods that are low in fat and contain no sugar.
  • Eat every 3-4 hours.
  • Sip liquids all day long, and wait 30 minutes after a meal.
  • Enjoy protein powder or shakes.
Step 3: Minimal Texture/Soft Diet
  • You will progress to a soft diet and remain on this soft diet, progressing to minimal texture as tolerated, for about two weeks.
  • Progress to soft, cooked foods
  • Initially a "cottage cheese" consistency, still pureed but not as smooth
  • Next, increase to finely ground meats, soft fruits, cooked vegetables, as tolerated, and unsweetened cereals
  • Finally, advance to diced poultry (without skin), well-cooked pasta
  • Continue to sip fluids all day long, along with vitamin and mineral supplementation.
Step 4: Solids & Maintenance
  • You will progress to a regular diet, as tolerated.
  • Gradually advance to solids, adding whole grains, while limiting fat and sugar.
  • Pay attention to volume.
  • Strive for a high-fiber diet by including non-starchy, high-fiber carbohydrates.

Potential Nutritional Side Effects

Dumping Syndrome (Gastric Bypass Patients)
Dumping syndrome -- also called rapid gastric emptying -- occurs when the undigested contents of your stomach (often liquids or sweets) are transported or "dumped" into your small intestine too rapidly. Symptoms of Dumping Syndrome include: lightheadedness, dizziness, paleness, rapid pulse, palpitations, sweating, abdominal cramps, bloating, nausea, vomiting, and/or diarrhea. Lying down immediately after eating reduces these symptoms. Dumping can be avoided by minimizing the consumption of sweets.

Avoid the following to prevent Dumping Syndrome:
  • Beverages: alcohol, milkshakes, cocoa, sport drinks, sweetened drink mixes, flavored milk, sweetened coffee, sweetened tea, sweetened fruit juice or undiluted fruit juice, carbonated beverages – soda, diet soda, seltzer water, club soda.
  • Breads and cereals: pastries, doughnuts, muffins, sweet rolls, breads with frostings or glazes, sugar-coated cereals.
  • Fruits and vegetables: sweetened fruit juice or fruit drinks, fruits canned in heavy or light syrup, any vegetables with added sugar (example: candied sweet potatoes or glazed carrots).
  • Desserts and sweets: cakes, cookies, pies, pastries, chocolate, gelatin, ice cream, frozen yogurt, Italian water ice, popsicles, some yogurts, candy, marshmallows, sugar, syrup, honey, jelly, jam.
A good rule of thumb is to avoid products that list any of the following in the first three ingredients on a food label: sugar, corn syrup, sucrose, dextrose, glucose, lactose*, maltose, fructose*, corn sweeteners, honey, maple syrup, molasses, sorghum, sorbitol, mannitol.

*Lactose is the natural sugar found in milk, and fructose is the natural sugar in fruit. Both are usually well-tolerated in their natural state after gastric bypass.

Protein Deficiency
Protein is an essential part of every cell and tissue in the body, and the primary nutrient used to build and repair the body. Following weight-loss surgery, adequate protein intake will promote healing, prevent hair loss and maintain immune function. Because Bariatric surgery reduces the stomach's capacity to a very small volume, foods high in protein must be carefully eaten with every meal to ensure the body gets enough to maintain itself. If protein is eaten during the first half of every meal, deficiency can be avoided. See "Protein Power" on page ____ for more information.

Nausea and Vomiting
Nausea and vomiting can be prevented by sipping liquids slowly, eating foods slowly, chewing foods well, and avoiding sweets. Stopping before the feeling of fullness is important as well. Never try to take "just one more bite." Even months after your surgery, nausea and vomiting can result from eating too much or too fast, and/or drinking liquids with meals.

It is important to introduce foods slowly, chew foods well (to a baby food texture), and avoid foods which may block the opening to the intestine (foods with skins/seeds). If vomiting occurs, try to determine what caused it. If it continues for more than 24 hours, contact your surgeon.

Constipation can be a problem following weight-loss surgery. It can be effectively treated by increasing your intake of dietary fiber through food or supplements, drinking adequate fluids and increasing activity. In some instances, medications can be prescribed if needed.

It is very important to drink about 8 to 10 (8-ounce) glasses of fluids each day. Do not drink liquids with meals or 30 minutes prior to and 30 minutes after meals. Since your stomach can only hold a small amount of food/fluid at a time, you should consume about one ounce of water every 10 minutes throughout the day in order to meet your fluid needs. You must learn to sip water all day, so it may be helpful to carry a water bottle. If you would like to add flavor to your water, Crystal Light® or sugar-free Kool-Aid® may be used.

Vitamin and/or Mineral Deficiencies
At your first post-operative visit with your surgeon, you will receive specific guidelines about which and how many vitamins and minerals to take. In order to prevent deficiencies, it is important to take these vitamin and mineral supplements as recommended.

Hair Loss
General anesthesia can result in hair loss for up to three months; this is a temporary situation that should resolve with a healthy diet and adequate protein and vitamin intake. However, a poor diet (protein deficiency, in particular) can result in hair loss after three months.

Loss of Muscle Mass
Exercise can prevent the loss of muscle mass, so it is very important that you exercise daily for at least 20-30 minutes. This will not only preserve muscle mass, but also enhance fat burning and hasten weight loss. Adequate protein intake also helps to maintain muscle tissue.

Red Meat Intolerance
Red meats may not be well-tolerated immediately following surgery. You may want to avoid red meats until your stomach is functioning well, usually after about one month.

Lactose Intolerance
Lactose intolerance is the inability to digest the milk sugar lactose, resulting in diarrhea and cramping. If you are lactose intolerant prior to surgery, you will continue to be lactose intolerant. Other patients also develop lactose intolerance after surgery. To test out your tolerance for dairy products, slowly add small amounts of milk to your diet after surgery. If problems occur, use low-fat milk or lactose-free milk, such as Lactaid® or Dairy Ease®, as well as other lactose-free products. The severity of intolerance varies. Often yogurt and cheese are better tolerated. As time progresses, you can experiment and try milk again.

Vitamin and Mineral Supplementation After Surgery

Since the post-surgical stomach pouch is too small to allow adequate intake of vitamins and minerals, supplementation is crucial. Depending on the type of weight-loss surgery you undergo, there are several vitamins and minerals that you will need take each day for the rest of your life to avoid deficiencies. Your surgeon will advise you on which specific vitamins and minerals you will need. The following are some examples:

Multivitamin with minerals
  • Flintstones™ Complete (chewable)
  • Bugs Bunny™ Complete
  • Generic equivalent or adult multivitamin, ideally liquid or chewable
  • Recommended Intake = 1200 mg.
  • Examples: Viactiv® (chewable, look for sugar-free), Tums® with Calcium (also helps with indigestion), Citracal©, Nature's Basics® Chewable Calcium, Os-Cal
  • Make sure to take your calcium supplement in individual doses throughout the day. Do not take calcium with your iron supplement or within 1-2 hours if taking any medicine, since calcium can interfere with its absorption.
Iron - for menstruating women or people with anemia
  • Recommended Intake = 50-66mg.
  • Ask your doctor which iron supplement is best for you.
Vitamin B-12
  • Supplements may be prescribed by your physician if your blood levels are low.
  • Examples: B12 injection, GNC® Sublingual B-12 (which dissolves under your tongue for better absorption), Twinlab® B-12 Dots®.
  • Make sure to take B-12 supplement before breakfast (does not include injection form).

Foods to Avoid

badfoodsIn the months following your surgery, you may feel good enough to want to try some of your favorite foods.

There are, however, some foods you should not attempt to eat, even in small quantities, for at least a year after your surgery. Avoiding these foods is worth avoiding the pain and discomfort you will feel if you cannot tolerate them:
  • Fast food
  • Candy
  • Cheesesteaks
  • Soda
  • Alcohol

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