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Nutritional Guidelines After Roux-en-Y Gastric Bypass Surgery

The purpose of your diet after gastric bypass surgery is designed to restrict caloric intake to produce desired weight loss, to help develop appropriate eating habits and to prevent disruption or obstruction of your pouch.

In addition, it is strongly recommended to pursue weight loss in preparation for surgery. Even a small amount of weight loss may contribute to a decreased surgical risk during bariatric treatment.

Main Focus:
 1. Drink enough fluids to keep your body hydrated
 2. Eat adequate protein
 3. Take required vitamin and mineral supplements to meet Recommended Daily Allowances.

Diet Principles: 
1. Drink 6-8 cups of fluid each day

  •  Sip one cup of liquid over an hour
  •  Stop drinking within 30-60 minutes of a meal
  •  Sip allowed beverages slowly
  •  Do not use a straw

2. All foods, beverages and snacks that are high in calories are omitted.

3. When your doctor gives you permission, vitamin/mineral and calcium supplements are required daily. Additionally, vitamin B12, iron and zinc also may be recommended.

4. Eat very slowly. Foods need to be thoroughly chewed to prevent blockage.

5. Stop eating as soon as you are full. Indications of fullness are: a) a feeling of pressure in the center just below your rib cage, b) a feeling of nausea, c) a pain in your shoulder area or upper chest. Contact your doctor if the above symptoms persist or worsen.

6. Include protein first at each meal to help maximize protein intake. As your pouch expands, you may only need to eat 3 meals and 1-2 high-protein snacks each day.

7. The diet will be advanced gradually, depending on tolerance:

 Phase I: Clear liquid diet (in hospital only)
 Phase II: Full liquid diet (1-2 weeks)
 Phase III: Puree diet (2 weeks)
 Phase IV: Soft diet (2 weeks)
 Phase V: Regular diet (after 1-2 months)

Foods That May be Difficult to Tolerate After Surgery

Meats and Meat Substitutes
  • Steak
  • Hamburger
  • Pork Chops
  • Fried or fatty meat, poultry or fish
Starches
  • Bran, bran cereals
  • Granola
  • Popcorn
  • Whole-grain or white bread (non-toasted)
  • Whole-grain cereals
  • Soups with vegetable or noodles
Vegetables
  • Fibrous vegetables (dried beans, peas, celery, corn, cabbage)
  • Raw vegetables
  • Mushrooms
Fruits
  • Dried fruits
  • Coconut
  • Orange and grapefruit membranes
  • Skins (peel all fruit)
Miscellaneous
  • Carbonated beverages
  • Highly seasoned and spiced food
  • Nuts
  • Pickles
  • Seeds
*Sweets
  • Candy
  • Desserts
  • Jam/jelly
  • Sweetened fruit juice
  • Sweetened beverages
  • Other sweets

 * Sweets should NOT be part of your diet if you want to reach your weight-loss goal followed by weight maintenance.

Phase I: Clear Liquid Diet
1. After surgery, you will not eat any food or drink any liquids until approval by the surgeon.

2. Once approved, you will receive water, clear broth, unsweetened apple juice or decaffeinated* tea (no red fluids)**. You will only be able to drink 30mL (1 oz) every hour. If you tolerate 1 oz of liquid each hour, on day 2 you may advance to 60mL (2 oz) of liquid every hour.

3. Remember to drink liquids SLOWLY. Do not use a straw***.

4. There may be large quantities of liquids brought to you on your tray. You do not have to finish everything. When you feel full, stop!

5. It is not unusual to experience nausea and/or vomiting during the first few days following surgery. Make sure that you drink slowly. If nausea or vomiting persists, contact your nurse.

*Caffeine should be avoided after surgery because it is a diuretic. This will cause you to lose fluids and make it more difficult for you to keep yourself hydrated.

**If “red foods” are consumed after surgery and you vomit, it may be mistaken for blood. “Red foods” include foods on the clear liquid diet such as sugar-free gelatin, sugar-free popsicles or any “red” sugar-free beverages.

***If you drink from a straw after surgery you will cause air to enter into your new pouch. This will create a full feeling and you will have less room for liquids needed to keep hydrated as well as nutritious foods when you advance to those stages.

Phase II: Full Liquid Diet
1. On discharge from the hospital you will start the full liquid diet.

2. You will stay on the full liquid diet for 1-2 weeks unless directed otherwise by your surgeon and dietitian.

3. To prevent nausea and vomiting, drink liquids slowly. Sip ¼ cup (2 oz) of liquid over 30 minutes. You do not have to finish everything. When you feel full, stop!

4. Drink at least 6-8 cups of water or low-calorie drinks between high-protein beverages. Remember to avoid carbonation, caffeine and citrus.

5. Take your prescribed multi-vitamin/mineral supplements and calcium as instructed.

6. Make sure you keep track of the kind and amount of high-protein beverages you drink. Remember, you need a minimum of 60 grams of protein each day.

The following are examples of protein sources that should be included on the Full Liquid Diet:
1 cup Fat free or 1% milk = 8 g protein
1 cup Soy milk or lactose-free milk (Lactaid or Dairy Ease) = 8 g protein
No-sugar-added breakfast drink made with fat-free or 1% milk (Carnation Instant Breakfast) = 12 g protein
Strained cream soup made with milk (no tomato, mushroom or corn pieces) = 8 g protein
Commercial supplements as suggested by your surgeon or dietician

To help boost protein intake, add non-fat powdered milk to the above list of liquids.
(1 Tbsp = 3 grams of protein, 25 calories)

Phase III: Puree Diet
1. After 1-2 weeks on the Full Liquid diet, you will be able to SLOWLY add foods of a thicker consistency. All foods for the next 2 weeks will be blended to a baby-food consistency.

2. You can continue to include foods on the full liquid diet throughout this stage.

3. It is very important to chew foods thoroughly to avoid blockage or nausea. Try 1-2 Tbsp of food at a time to see if tolerated. Each meal should consist of only 2-4 Tbsp (1/8 – ¼ cup of food).

4. Remember to always include protein first at each meal. You need a minimum of 60 grams of protein each day.

5. Keep yourself hydrated! Drink 6-8 cups of water and low-calorie beverages between meals. Fat free or 1% milk can be included as part of your total fluid intake.

6. Continue to keep track of the kind and amount of protein you eat every day. 

The following are examples of foods from each food group that should be included on the Puree (Blended) Diet. The meat and the milk group include food choices that are “complete” proteins. “Complete” proteins contain all the essential amino acids your body needs. Food choices from the starch, fruit, and vegetable groups are not “complete” proteins and should only be used with foods from the milk and meat group.

Meat Group (7 grams protein per serving)
2 Tbsp (1 ounce) cooked pureed lean meats (chicken, fish, turkey are best tolerated)
¼ cup (2 ounce) baby food meats
¼ cup fat free or 1% pureed cottage cheese
¼ cup low-fat pureed ricotta cheese

Milk Group (8 grams protein per serving)
1 cup fat-free or 1% milk
¾ cup no-sugar-added/low-fat “light” yogurt (no fruit pieces)
1 cup sugar free pudding made with fat free or 1% milk
1 packet of no-sugar-added instant breakfast made with fat-free or 1% milk (12 grams of protein)
1 cup strained cream soup made with milk (no tomato, mushroom or corn pieces)

Starch Group (3 grams protein per serving)
½ cup cream of wheat/rice/baby oatmeal
½ cup mashed potatoes, sweet potatoes, winter squash
1 cup broth-based soup

Fruit Group (0 grams protein per serving)
½ cup pureed peaches, apricots, pears, melon, banana (no skins or seeds)
½ cup unsweetened applesauce
½ cup baby food fruits
½ cup diluted unsweetened fruit juice (limit to 1 serving a day)

Vegetable Group (2 grams protein per serving)
½ cup pureed carrots, green beans (no skins or seeds)
½ cup baby food vegetables

Important Tips:
1. You may need to add fat-free milk, clear broths or fat-free gravies to the above foods and use a blender to make the foods a baby-food consistency.

2. Add non-fat powdered milk or acceptable protein powders to your foods to boost protein amount.

3. Try one new food at a time. If you feel nauseated or experience gas or bloating after eating, then you are not ready for this food. Wait a few days before trying this food again.

4. Portions may need to be adjusted depending on your individual tolerance. Listen to your body. Stop when you feel full.

Phase IV: Soft Diet
1. After 2 weeks on the Puree Diet, you will no longer have to blend your foods. You can slowly add foods that are soft in consistency. Soft foods can be cut easily with a fork.

2. You will remain on the Soft Diet for 2 weeks. Remember to try one new food at a time.

3. For better portion control, use smaller plates and baby spoons and forks. Stop eating when you feel full. 

4. Keep yourself hydrated! Drink 6-8 cups of water and low-calorie beverages between your meals. Don’t drink with your meals. Don’t drink 30 minutes before and 30 minutes after meals.

5. Continue to take your supplements as prescribed.

6. Continue to keep track of the kind and amount of protein you eat every day. Remember, your goal is a minimum of 60 grams of protein each day.

The following are examples of foods from each food group that can be included on the Soft Diet.

Meat Group (7 grams protein per serving)
2 Tbsp (1 ounce) cooked lean meats: skinless chicken, fish, turkey, ground beef (moist meats are usually tolerated best, beef is usually least tolerated)
2 Tbsp (1 ounce) water-packed tuna or chicken
¼ cup egg substitute or 1 egg scrambled
¼ cup fat free or 1% cottage cheese
1 oz (1 slice) low-fat mild cheese
1 tbsp CREAMY peanut butter

Milk Group (8 grams protein per serving)
1 cup fat-free or 1% milk
¾ cup no-sugar-added/low-fat “lite” yogurt (no fruit pieces)
1 cup sugar-free pudding made with fat free or 1% milk
1 packet of no-sugar-added instant breakfast made with fat free or 1% milk (12 grams protein)
1 cup cream soup made with milk (no tomato, mushroom or corn pieces)

Starch Group (3 grams protein per serving)
1 slice of bread (toasted)
4-6 crackers
½ cup cooked cream of wheat/rice/oatmeal
½ cup mashed potatoes, sweet potatoes, winter squash
1 cup broth-based soup

Fruit Group (0 grams protein per serving)
½ cup canned peaches or pears (in own juices or water packed)
½ soft banana
½ cup unsweetened, diluted fruit juice (limit to ½ cup a day)

Vegetable Group (2 grams protein per serving)
½ cup soft, cooked carrots or green beans (no skins or seeds)

Important Tips:
1. All foods should be cooked without added fats. Bake, grill, broil or poach meats. You may season meats with herbs and spices instead of fats.

2. Moist meats are tolerated better at this phase. Add chicken or beef broths, fat free gravies and low-fat cream soups to moisten meats. Finely dice meats and chew well.

3. Add 1-2 Tbsp of a new food at a time; if you feel nauseated or bloating after eating then you are not ready for this food. Wait a few days before trying this food again. Everyone progresses differently. Listen to your body.

Phase V: Regular Diet
1. After 2 weeks on the Soft Diet, you may begin the Regular Diet if ready. You may be ready for this phase at 1 month after surgery or possibly not until 2 months after surgery. Everybody progresses differently.

2. This is the last stage of the diet progression. Continue to add new foods in slowly. Raw fruits and vegetables can be added in as tolerated. You may want to avoid the skin and membranes on fruit.

3. Follow a low-fat diet and avoid simple sugars for life. Your protein goal remains at a minimum of 60 grams each day. For successful weight loss, caloric intake may range between 800-1200 calories each day. Ask your registered dietitian how many calories are appropriate for you.

4. Continue to eat 5-6 small meals each day. As your pouch expands, 3 small meals and 1-2 high protein snacks may be more appropriate.

5. Continue to take your prescribed supplements for life.

6. Keep yourself hydrated! Always drink 6-8 cups of water and low-calorie beverages daily.

7. Continue to track your daily intake and activities. Include calories, protein, fluids, supplements and exercise.

The following are examples of foods from each food group that are included on a Regular Diet:

Meat Group (7 grams protein per serving)
¼ cup egg substitute, 2 egg whites or 1 egg
¼ cup fat-free or 1% cottage cheese
1 ounce cooked lean meats (chicken, turkey, pork, fish, beef)
1 Tbsp peanut butter
1 ounce lean luncheon meats
1 ounce low-fat cheese
½ cup cooked beans, peas or lentils

Milk Group (8 grams protein per serving)
1 cup fat-free or 1% milk
¾ cup no-sugar-added/low-fat “lite” yogurt
1 cup sugar-free pudding made with fat free or 1% milk
1 cup cream soup made with milk

Starch Group (3 grams protein per serving)
1 slice of bread (may be tolerated better toasted)
4-6 crackers
½ cup cooked cream of wheat/rice/oatmeal
¾ cup unsweetened dry cereal
½ cup potatoes, winter squash, corn or peas
1/3 cup rice, pasta
1 cup broth-based soup

Fruit Group (0 grams protein per serving)
½ cup canned “lite” fruit 
½ banana or small fresh fruit (avoid skins and membranes)
½ cup unsweetened, diluted fruit juice (limit to ½ cup a day)

Vegetable Group (2 grams protein per serving)
½ cup cooked non-starch vegetables
1 cup raw non-starchy vegetables

Fat Group
1 tsp margarine or oil
2 tsp diet margarine
1 tsp mayonnaise
1 tbsp low-fat mayonnaise or salad dressing

Next: Life After Roux-en-Y Gastric Bypass Surgery > >

This information has been provided courtesy of the Cleveland Clinic Bariatric and Metabolic Institute. Please visit the Cleveland Clinic Bariatric and Metabolic Institute.