Adopting a new way of eating is an essential part of the success of your weight loss surgery. Follow these guidelines to establish new habits and focus on the particular nutrients you’ll need most after surgery.
Diet Plan Immediately After Surgery
To help your stomach heal after having weight loss surgery, you need to introduce small amounts of food slowly and cautiously. This may take up to six weeks. It’s critical to avoid vomiting, obstruction and stretching of the stomach pouch during this time. In addition, it is important to consume adequate protein to foster healing. Here’s how your diet phases may progress.
Immediately after surgery, you’ll follow a clear liquid diet, which starts with sips of water, and then allows sugar-free beverages, diluted sugar-free juice, diet gelatin, bouillon or clear broth, and a flat, noncarbonated beverage in small amounts. This stage is inadequate in calories and protein. After a few days of clear liquid, it is essential to add a high-protein supplement to maintain your energy levels and support healing.
- Sip fluids slowly. Stop if you feel full. If you drink too much, too quickly, you may vomit.
- Avoid drinking with straws and chewing gum to prevent gas.
- Drink at least six times a day and avoid beverages with alcohol, caffeine, sugar and carbonation.
- At the hospital, try to drink 32 ounces of fluids in a day. Gradually build up to 64 ounces of fluids daily at home.
- Progress to the next stage after talking with your surgeon.
If you don’t have any problems with clear liquids, you’ll start high-protein “semi-liquids.” These are high-protein thin liquids, the consistency of milk and protein drinks. You must stay hydrated and consume enough calories and protein to prevent loss of muscles.
- Sip slowly. Stop when you feel full.
- Eat/drink six times a day. Avoid beverages with alcohol, caffeine, sugar and carbonation.
- If you experience lactose intolerance, substitute lactose-free milk or fortified soy or rice milk.
- Track your protein and fluid intake. You should consume a minimum of 60 grams of protein and 64 ounces of fluid per day.
- If your doctor recommends, start your chewable/liquid/sublingual multivitamin supplements, according to your doctor’s specific recommendations.
Semi-Solid Puree to Soft Foods
Your doctor will advise you when to advance to smooth pureed foods. This diet starts with high-protein foods like cottage cheese, eggs or lean meats (i.e., tuna fish, chicken, or pork) puréed in a blender until they are smooth in texture. After smooth pureed foods, you may slowly progress to soft chopped or ground foods. When you eat soft foods, it is essential to chew your food well and eat very slowly. Consume your protein choices first. When you can consume at least 60 grams of protein daily in your food, you can wean off the protein supplements.
- Avoid drinking 15 minutes prior to a meal and for up to 60 minutes following the meal, as drinks can cause meals to pass too rapidly through the stomach and/or make you too full to eat nutritious foods.
- It is very important to eat your protein first, then your vegetables and finally your carbohydrate, which may be either fruit or starch.
- Eat slowly and stop when you feel full.
- Try one small bite of the new food and chew well. Wait two minutes and if there are no problems, go to step two.
- Try two small bites and chew well. Wait two minutes and if there are no problems, go to step three.
- Try three small bites and chew well. If there are no problems, finish eating.
- If at any time you feel full or nauseated, or you vomit, stop eating and rest. Take only clear liquids at the next meal, and add blended foods and liquids at the following meal. Try one solid food again the next day.
Life-Long Healthy Diet
After progression from thin liquids to soft chunky foods, you can start to add high-fiber and raw produce (vegetables and fruit). Add foods one at a time so you can quickly identify foods your body may not tolerate well. While this diet includes all food groups, it is important to eat meals in a set order. Eat your protein foods first (poultry, fish, eggs, dairy), then your vegetables, and finally, your carbohydrate-containing fruit and whole grains. Each meal or snack should be small. Drink clear liquids between meals. Your goal is to achieve a well-balanced diet of about 600 to 800 calories per day during your weight loss phase.
Follow this advice to manage key nutrients and avoid digestive problems.
- Protein first — Protein is the most important nutrient to assist in weight loss and maintain muscle mass. Eat your protein first. This will help minimize carb intake. Gastric band patients may need an adjustment if hungry two to three hours after eating protein.
- Choose lean, moist proteins — Proteins are associated with fats and have the potential to be high in calories. Be sure to choose lean protein like fish or chicken. You can prepare your protein foods using low-fat cooking methods such as roasting, poaching, grilling, braising and broiling. Be aware that preparation can cause food to become too dry and difficult to swallow or tolerate. The best-tolerated method of reheating protein is steaming because it keeps foods nice and moist.
- Avoid red meat — Many people do not tolerate red meat after surgery. We recommend that you avoid red meat for at least four months after surgery. When you do try it, start with extra-lean ground beef. Pay close attention to how you feel. If you feel nauseated, then don’t eat it for a few weeks and reintroduce it later.
Good Carbs/Bad Carbs
- Focus on “good carbs” — Whole and unprocessed fruit, legumes and whole grains provide fiber and nutrients necessary for good health, satiety and gut function. These foods help you to feel full and normalize your bowels.
- Avoid sugary carbs — “Bad carbs” include sugars and sugary foods. Sugary foods can cause dumping syndrome (diarrhea). To avoid this, limit your consumption of foods that contain more than 5 grams of sugar per serving. Choose foods that are labeled “sugar-free.” Do not eat or drink a food item if one of the first three ingredients on the label is sugar, honey, corn syrup, sucrose, glucose, dextrose, fructose or molasses.
- Skip bread, white rice and popcorn — These items tend to get gummy and expand in your stomach pouch. They can easily cause a blockage or a band to slip.
- Choose fat-free and low-fat foods — Fats have a lot of calories and make weight loss difficult. Stay away from solid fats and fatty meats such as butter, sour cream, cream cheese, full-fat cheeses, full-fat sour cream and yogurt, sausage, ribs and corned beef. These are high in saturated fats and are not good for your heart.
- Choose healthy oils — Cook with liquid oils that are high in monounsaturated fats such as olive oil, canola oil and peanut oil. Avoid deep-fried foods such as chicken, chips, tempura and chimichangas.
- Pick healthy fats — Choose avocado, olives, mayonnaise, nuts and nut butters. Margarine that is free of transfats is better than butter.
- Avoid carbonated (fizzy) beverages — When a cold, carbonated beverage is consumed, it warms and releases gases, distending the stomach pouch and stretching the stomach.
- Do not drink within 15 minutes before or 60 minutes after meals — This prevents pouch stretching and vomiting. It also helps with digestion and satiation.
- Sip slowly and carefully — You will need to consume ½ to 1 cup (4-8 ounces) of fluids every hour. You may use a 2-ounce medicine cup and sip one every 15 minutes.
- Eliminate caffeine — Many beverages contain caffeine, which is an appetite stimulant. That means it makes you feel hungry and can make both initial weight loss and long-term weight control harder. Caffeine also irritates the lining of the pouch and may lead to ulceration as well as dehydration and gastric reflux.
- Sip fluids continually all day long — Avoid drinking from water fountains or with straws. It is more difficult to control the volume of your intake, and can introduce air into your stomach pouch, causing gas.
- Eliminate high-calorie drinks — High-calorie beverages tend to be low in nutritional value and contain simple sugars. They add calories while giving your body little in terms of nutrition. In addition, the simple sugars they contain are quickly absorbed into the bloodstream and lead to a rapid rise in blood sugar levels that increases hunger. Weight loss can be slowed down dramatically and even stopped by use of high-calorie liquids.
- Eliminate energy drinks — They have excessive caffeine, which irritates your new pouch, and may contain sugar making them similar to other high-calorie drinks like soda.
You will need to take a multivitamin with mineral supplement for the rest of your life to prevent diseases associated with chronic vitamin and mineral deficiency. Your surgeon may require you to take additional vitamins or change your vitamin routine based on your lab results. It will be key for you to continue lifelong follow-up appointments with your doctor, to have your lab levels checked to look for any deficiencies.
The vitamin and mineral supplements should be taken in chewable, liquid or powdered form for at least the first three months after surgery to facilitate ease of digestion. Then you may progress to a whole capsule or tablet as tolerated. Gummy vitamins are not recommended.
Your multivitamin should contain 100 percent of the daily value, per serving, for at least two-thirds of the nutrients listed on the label. Your doctor will likely recommend you take two tablets per day to obtain 200 percent.
Your doctor may also recommend a variety of additional supplements that are crucial for your health:
There are essentially five types of protein supplements available: whey, casein, soy, egg (albumin) and a combination. The body uses protein in the form of “protein isolates” best. Choose a supplement that has a protein source as the main ingredient (listed first on the ingredients list). If you are not allergic to dairy, whey protein tends to taste the best and is easily absorbed. It is what many bodybuilders use.
Avoid supplements that list collagen, collagenic protein isolate or hydrolyzed collagen as the protein source. Some of these brand names to avoid are Proteinex®, New-Whey® and Liquacel®. These are not complete protein and will not meet your needs.
You will need to take calcium supplements for the rest of your life to prevent metabolic bone disease and osteoporosis. The supplements should be in chewable, liquid, or powdered form for at least the first three months after surgery. You may progress to a whole capsule or tablet as tolerated thereafter. Avoid combining calcium with iron-containing supplements to aid your body in absorbing these nutrients. And be sure to take your calcium supplement at least two hours before or after your multivitamin.
Vitamin B12 (Cobalamine) Supplements
Vitamin B12 is a water-soluble vitamin whose primary function is the production of red blood cells and maintenance of a healthy central nervous system. Postoperative weight loss surgery patients are at risk of B12 deficiency because of the low-acid environment of the new stomach pouch. Those who avoid animal products are also at risk. If you had Roux-en-Y gastric bypass or vertical sleeve gastrectomy surgery, it is important for you to take your B12 for life. (Patients who have had an adjustable gastric band surgery may also require B12 for life if their doctor recommends it.)
Potential Problems Post-Bariatric Surgery
Weight loss surgery creates dramatic changes in the size and shape of the stomach. It may take some time to get used to these changes. Many problems after surgery result from poor eating habits and may be helped by adjusting your diet. Here are some common problems and suggestions to prevent them. If you have any problems or concerns that persist, please call your surgeon for specific instructions.
Nausea and Vomiting
This is usually a result of not chewing your food thoroughly, eating too quickly or eating too much. It may also occur after eating a food that your body can no longer tolerate. Vomiting can stretch the pouch over time and damage your stitches right after surgery.
Suggestion: Chew foods very thoroughly before swallowing. Eat slowly. Wait several days before trying a new food again. You may need to go back to liquids or pureed foods for a couple of days and return to more solid foods slowly. Avoid sweets. Measure portion sizes. Avoid eating in front of the TV since it can lead to mindless and excessive eating.
Blockages or Obstructions
These usually occur from not chewing your food thoroughly or from introducing semi-solid/solid foods too quickly. The food can get stuck in the new opening between your stomach pouch and intestine and not allow food and fluid to flow through it properly. Contact your physician if you experience ongoing nausea and vomiting, bloating or increased abdominal pain.
Suggestion: Chew all foods very well (approximately 20-30 times a bite). Follow diet guidelines carefully and advance your diet when your healthcare provider tells you it is okay.
This commonly occurs due to a reduced volume of food, especially high-fiber foods such as vegetables, beans/legumes, fruit, whole grains and fluid.
Suggestion: Make sure you eat a high-fiber diet, drink 48 to 64 fluid ounces (6 to 8 cups) of non-caffeinated low-calorie fluids every day; increase physical activity. You may also benefit from taking a daily fiber or probiotic supplement.
This may occur if vomiting or diarrhea are persistent or fluid intake is less than 48 to 64 fluid ounces per day.
Suggestion: Drink 6-8 cups of non-caffeinated low-calorie beverages every day. Sip fluids all day between meals. If you cannot keep liquids down, contact your surgeon’s office or go to the emergency room.
Caused by eating sugar, sweets and high-fat greasy foods, dumping syndrome can be problematic. Diarrhea may also be due to lactose intolerance or drinking with meals.
Suggestion: Try lactose-free dairy products such as Lactaid or fortified soy milk. Avoid sweets and high-sugar foods. Avoid high-fat, fried foods. Lie down immediately after eating if symptoms persist. Separate liquids from meals by 30 minutes.
This can be caused by not chewing foods well, eating too fast, eating large portions, eating hot and spicy foods, or eating foods and fluids that are too hot or too cold. Carbonated beverages and drinking through a straw will cause gas and possibly heartburn. Caffeine also contributes to heartburn.
Suggestion: Avoid hot and spicy foods for at least three months after your surgery and introduce them slowly as tolerated. Chew all foods thoroughly. Eat slower. Decrease your portion size at each meal. Limit greasy foods and avoid very hot or very cold foods and beverages. Avoid caffeine.
It is easy to rebound, especially after 18 months, if you return to the following old patterns: grazing and snacking, drinking high-calorie beverages, choosing high-sugar and high-fat foods, and failing to exercise daily.
Suggestion: Do not consume caloric beverages such as regular sodas, juices and alcohol. Avoid high-fat/high-sugar foods. Try sugar substitutes such as Splenda. Do not snack between meals. Exercise at least 30 minutes per day.
Sometimes water is difficult to drink, and it may even cause nausea or swallowing discomfort.
Suggestion: Choose calorie-free flavored beverages, flavor water with natural lemon or lime, or sip warm or tepid fluids.
Doctors at Palo Alto Medical Foundation
Prithvi Legha, M.D.
Bariatric (Weight Loss) Surgery
John J. Feng, M.D., FACS
Bariatric (Weight Loss) Surgery
Beemen N. Khalil, M.D., M.S., FACS
Bariatric (Weight Loss) Surgery