Dietary Guidelines After Weight-Loss Surgery

Day 0 (Day of Surgery)

Post-Op Day One

Once you have had your esophagram and have been cleared to drink liquids, you should aim to drink 24 ounces of clear fluids that day. Try sipping 1 ounce (30 milliliters) every hour. Stop when you feel full.

Clear liquids include:

1. Sugar-free, diet, noncarbonated beverages such as Crystal Light, sugar-free Kool-Aid, sugar-free Tang, Diet Snapple, FUZE, Powerade Zero, Diet V8 Splash, Propel, Fruit₂O, coffee, tea and water
2. Low-sodium broth soups (chicken, vegetable or beef). Tomato soup and other creamy soups are not broth soups. It needs to be a clear liquid and should NOT contain bits and pieces of meat, tofu, noodles or vegetables. Each serving should not contain more than 140 mg of sodium (salt). Bullion cubes are not acceptable as they are too high in sodium. The best places to find low-sodium broth (140 mg or less) is at Trader Joe’s, Sprouts and Whole Foods.
3. Sugar-free Jell-O and sugar-free popsicles
4. Isopure or Syntrax Nectar (clear protein drinks)

Tips to meet your daily fluid needs:

• Carry a large water bottle with you wherever you go.
• Drink the things on the clear-liquid list that you enjoy the most.
• Make a slushy by adding ice to your beverage and blending it.

Post-Op Day Two

You should aim for a goal of 48 ounces of fluid for the day. Your goal is to consume 2 ounces (60 ml) every hour.

Post-Op Day Three and Forward

You should aim for a goal of 64 ounces of fluid each day, taking sips to avoid dehydration. Remember 64 ounces a day is a goal. If you aren’t able to drink this amount just yet, don’t worry; just continue to shoot for that goal each day.

Post-Op Day Five to 13

Continue drinking the liquids on the clear-liquids list, but now you can add liquids that contain protein and vitamins your body needs for healing. Your food will continue to be in the liquid form because your stomach is still swollen and tender on the inside, and your stitches need time to heal.

Acceptable liquids include:

1. One cup (8 ounces) of milk (skim, 1%, Lactaid, almond or soy), 6 ounces of yogurt, nonfat Greek yogurt (no more than 110 calories and 12 grams of sugar per serving) or soy yogurt (for those with lactose intolerance), half a cup of Jell-O pudding, and sugar-free Fudgesicles.
2. Protein shakes:
   a. Muscle Milk (Costco, Target, GNC and major grocery chains)
   b. Pure Protein Shakes (Trader Joe’s)
   c. Premier Protein Shakes (Costco)
   d. EAS 100% Whey Protein Powder (Walmart)
   e. Jay Robb Protein Powder (strawberry, vanilla, chocolate and unflavored – available at Sprouts and Whole Foods)
   f. Jay Robb Egg White Protein Powder
   g. Soy protein powder (for those with lactose intolerance – available at Sprouts and Whole Foods)
   h. Syntrax Nectar or Isopure (GNC and Vitamin Shoppe – for those with lactose intolerance or just wanting different juice like flavors)

Note: Lactose-free products include Jay Robb Protein Powders, soy protein powders, Syntrax Nectar or Isopure.

Post-Op Weeks Three and Four

Pureed and blended foods are added.

In Week Three, you may begin eating "real” foods, just with a different texture. Start focusing on your food intake. Keeping a food journal is a great way to stay on track. From this point forward your daily goals are:

• 1,000-1,200 calories
• 20 grams of fat
• 60-80 grams of protein
• 150-180 grams of carbohydrates
• 25 grams of fiber
• 25 grams or less of sugar (exceptions: fresh fruit and milk – they contain natural sugars)

Remember your stomach is still healing during this phase. In order to allow these areas to heal properly without stress to your stitches and to allow your small stomach pouch to get used to its new role, the food you eat must already be broken down and liquefied (blended or pureed). If you attempt to eat solid food now, your stitches and your procedure will be unsuccessful. Remember this area is still tender and needs time to heal. Please note, everyone heals at a different rate, therefore, you may feel no restriction or a lot of restriction at this point. Regardless, you must follow the progression of the post-surgery diet to assure healthy healing.

Examples of foods that can be blended or pureed:

• Cooked, canned or steamed vegetables
• Tuna, chicken or egg salad (hard-boiled egg, nonfat or light mayo, mustard and relish)
• Low-sodium soup
• Oatmeal
• Small curd nonfat or low-fat cottage cheese
• Homemade smoothies (nonfat or light yogurt, Greek yogurt, soy yogurt, fresh fruit)
• Beans

Note: The above foods need to be pureed during post-op weeks three and four.

Avoid Drinking Liquids with Your Meals
Liquids make the stomach pouch expand and won’t allow enough room for the blended food. If the food passes through the stomach, you will be hungry sooner and more likely to snack. Aim to stop drinking liquids at least 30 minutes before a meal and do not start drinking liquids again until 30 minutes after eating.

Post-Op Week Five and Six

Soft foods are reintroduced.

Slowly introduce new foods into your diet. A soft diet does not mean the foods have to be blended, but they should be foods that are easy to tolerate, such as bland foods. There will be some foods that you may not be able to tolerate at this time and therefore should wait until at least seven weeks post-op before trying them. If intolerance does happen, please do not feel like you can never have this particular food again. You may just need to prepare it differently the next time. There is no need to lock yourself in a box! Just give your body a few more weeks and then try the food again. If the food is still intolerable, it is probably best to avoid that food for the time being.

Appropriate soft foods for the soft diet include:

• Tuna, chicken, or egg salad (hard-boiled egg, nonfat or light mayo, mustard, relish)
• Fresh or frozen fish
• Eggs or Egg Beaters
• Beans
• Cooked, canned or steamed vegetables
• Fruit without skin
• Sugar-free pudding
• Nonfat or light yogurt, Greek yogurt or soy yogurt
• Nonfat or low-fat cottage cheese
• Low-sodium soups
• Baked potato (regular or sweet)
• Low-sugar, high-protein cereal

Note: You do not have to blend or puree these foods, but make sure you chew them thoroughly.

Post-Op Week Seven and Beyond

At this time, there are no texture restrictions. Remember that bariatric surgery restricts solid foods. If you are eating soft and/or mushy foods, you may not feel the restriction. Please follow a well-balanced diet with a focus on lean protein sources. Bariatric surgery is just a tool to help you lose weight, but you will still need to watch your calorie intake (by reading food labels and keeping a food diary) and exercise (at least 30 minutes a day).

Remember to:

1. Chew your foods 20 to 30 times before swallowing.
2. Pay attention to your body’s signals of fullness (often pressure or discomfort).
3. Avoid drinking fluid for 30 minutes before or after a meal.
4. Include protein as part of each meal, and eat your protein foods first. Protein assists with healing, maintaining muscle mass, preventing hair loss, and providing energy. It is digested slowly so it helps you continue to feel full.

Choose from these health protiens:

• Chicken (soft, moist, canned or thinly sliced deli meats; do not eat fried chicken)
• Turkey (soft, moist, canned, ground or thinly sliced deli meats)
• Fish (soft, moist, canned, or fresh fish, or shellfish)
• Lean ground beef (96% to 98% lean)
• Yogurt (nonfat, light, artificially sweetened or plain)
• Cottage cheese (nonfat or light)
• Eggs or egg whites (Egg Beaters)
• 98% fat-free refried beans
• Soy
• Tofu
• Lentil, black bean or split pea soup
• Protein shakes (Pure Protein, Premier, Jay Robb Protein Powder, soy protein powder, EAS 100% Whey, Muscle Milk Light)
• Protein drinks (Isopure, Syntrax Nectar)
• Textured vegetable protein (TVP)
• Milk or nonfat dry milk

Food Intolerances

Food tolerance varies from person to person and from day to day in a given individual. If you experience difficulty with a specific food, that doesn't mean you will never be able to eat it again. You can try to eat it again a few weeks later. Time of day and stress levels can affect how you handle particular foods.

If you are following the recommended eating practices, it could be the texture of the food, preparation of the food or just the food itself that’s causing the problem. If you are experiencing tightness in your chest, nausea or vomiting, it could be you have an intolerance to that particular food at this time, but that does not mean you always will. Here are a few examples of foods that may cause problems:

• Dry or overcooked meats
• Skins of certain fruits and vegetables (potatoes, apples or oranges)
• Doughy or sticky foods (white bread, croissants, donuts, cakes, bagels)
• Rice or pasta
• Stringy or fibrous foods (broccoli, asparagus, celery, pineapple or artichoke – all of these foods are tolerated better if they are cooked thoroughly)