Dietary Guidelines

Phase I: First 2 weeks after surgery

Sugar Free, Non-carbonated Liquids Only

Acceptable beverages include:

• Water
• Flavored waters that are sugar-free and non-carbonated
• Crystal Light® (generic brands are fine)        
• Broth, bouillon, consommé (chicken, beef, or vegetable)
• Sugar-free popsicles
• Sugar-free gelatin     
• Tea:  unsweetened or artificially sweetened; ice or hot; black, green, or herbal (decaffeinated is best)
• Coffee (decaffeinated is best)
• Sugar-free hot cocoa
• Sugar-free hard candy

During week 2 after surgery you may try milk products.  Use caution as some people experience lactose intolerance after surgery.  Acceptable beverages include:

• Skim, 1%, Ultraskim, or Superskim milk
• Fat-free or low-fat soy milk, Lactaid®, or Dairy Smart

If lactose intolerance is a problem, try the soy milk, Lactaid®, or Dairy Smart. 

Avoid:

• Fruit juices
• Sports drinks
• Diet soda (or anything else carbonated)

Suggestions for Phase I diet:

• Increase liquids as tolerated to at least 2 quarts a day (64 oz., or 8-8 oz. cups).  Drink enough fluid to keep your urine a clear, pale yellow color.  If your urine becomes cloudy, dark or foul-smelling, drink more!

• Sip slowly throughout the day.  Drink 8 oz. of fluid over a period of 1 hour.  Do not gulp liquids or drink too quickly.  Gulping or drinking too fast can cause abdominal pain and/or nausea.

• It is very important to avoid any liquids with a high amount of sugar at this time (more than 20-25 g. in an 8 oz. serving).  Sugary liquids will cause dumping syndrome, which is something you do not want to experience during your first few weeks after surgery.  It is a very bad feeling.

• Avoid drinking from a straw.  When you drink from a straw you swallow more air, which may make you belch more often.  Carbonated beverages are to be avoided for the same reason, they will cause excess gas.

• Pre-freeze or refrigerate plastic bottles of water, Crystal Light®, tea, etc. and carry the bottle around with you so that you can take small, frequent sips of fluid throughout the day and avoid becoming dehydrated.

• During this phase of the diet, begin taking a chewable multivitamin/mineral supplement twice a day (Flintstone’s® Complete and Centrum® Chewable are excellent examples).

Phase I Sample Menus

Note:  Times of day are irrelevant!  The point is to sip constantly during your waking hours.

Week 1-generally sip on 8oz. fluid over a one hour period of time.

8am:  8oz. water & multivitamin

9am:  8oz. decaf coffee w/ Splenda®

10am:  8oz. water

11am:  8oz. Crystal Light®

12pm:  8oz. chicken broth

1pm:  ½ cup sugar-free gelatin

2pm:  8oz. water

3pm:  8oz. water

4pm:  8oz. Crystal Light®

5pm:  8oz. vegetable broth

6pm:  sugar-free popsicle

7pm:  8oz. herbal tea & multivitamin

32oz. water + 16oz. Crystal Light + 16oz. broth + 16oz. decaf coffee/tea + 4oz. gelatin + 1 popsicle = at least 84oz. fluid!

Week 2-may add low-fat or fat-free milk if desired.  Doing this will give you more variety in your liquids and also a source of high-quality protein.  If abdominal cramping, bloating, nausea and/or gas is experienced with cow’s milk, try soy milk or Lactaid®.

8am:  8oz. water & multivitamin

9am:  8oz. skim milk

10am:  8oz. water

11am:  8oz. sugar-free hot cocoa

12pm:  8oz. beef broth

1pm:  8oz. decaf ice tea w/ lemon

2pm:  sugar-free popsicle

3pm:  8oz. water

4pm:  ½ cup sugar-free gelatin

5pm:  8oz. skim milk

6pm:  8oz. chicken broth

7pm:  8oz. water & multivitamin

32oz. water + 16oz. milk + 16oz. broth + 16oz. ice tea/hot cocoa + 4oz. gelatin + 1 popsicle = at least 84oz. fluid!

Phase II: Soft Foods Only for 4 weeks

Acceptable foods/beverages include all liquids listed above plus:

Protein (include one of the following foods at each meal)

• Fat-free or low-fat cottage cheese and ricotta cheese
• Fat-free or low-fat, artificially sweetened yogurt-try one of the following flavors:

• Vanilla
• Key Lime pie
• Lemon chiffon
• Orange cream

• Sugar-free, fat-free pudding
• Eggs, egg whites, Eggbeaters® (poached, scrambled, soft-boiled)
• Sugar-free egg custard
• Tofu
• Canned baby meats/pureed meats
• Sliced/shredded fat-free or low-fat cheese
• Canned/vacuum packed tuna, salmon, chicken
• Baked fish that flakes easily with a fork (cod, salmon, tilapia, crab meat, etc.)
• Thinly-sliced lean deli turkey breast or ham
• Lean ground beef, pork, or turkey

Fruits

• Banana
• Unsweetened applesauce
• Diced peaches or pears (canned in own juice or light syrup)

Vegetables

• Soft-cooked vegetables, like carrots, green beans, broccoli, cauliflower (mushy, not crunchy)
• Tomato juice, vegetable juice

Starch/Other

• Soup, like tomato, cream of broccoli, and eventually chili (avoid corn, peas, noodles, rice, and pasta)
• Mashed potatoes, sweet potatoes, or winter squash
• Saltines, soda crackers
• Toast

*May add nonfat dry milk powder or protein powder to foods and beverages to increase protein content!

Allowed Condiments

• Artificial sweetener (Splenda®, Equal®, etc.)
• Non-dairy, fat-free, or powdered creamer
• Light margarine (free of trans-fats)
• Ketchup
• Mustard
• Light or fat-free mayonnaise
• Sugar-free jam, jelly, or preserves
• Reduced-fat and fat-free salad dressings

Use Sparingly

• Butter and regular margarine
• Cream
• Regular mayonnaise
• Cream cheese
• Peanut butter

Avoid-these foods usually are not tolerated well this soon after surgery.

• Berry-flavored yogurts with seeds (strawberry, blackberry, mixed berry, etc.)
• Raw fruits and vegetables (except bananas)
• Corn and peas
• Pasta, noodles, rice, bread

Suggestions for Phase II diet:

• During this phase, begin the practice of eating only 3 small meals a day.  Do not snack or “graze” throughout the day.  Grazing and snacking lead to poor weight loss after surgery.  Grazing is also associated with significant weight regain after surgery.

• Make it a habit to eat very slowly (putting your fork down between each bite) and chew your food very thoroughly (to a mushy consistency).  Try to make each meal last 20 minutes.

• Learn to stop eating when you feel full, which initially may be after only 2 or 3 bites of food.  Indications of fullness include a feeling of pain or pressure in the center just below your rib cage, nausea, or pain in your shoulder or upper chest.  DO NOT EAT UNTIL YOU FEEL STUFFED!  Eat only until you feel satisfied.  If you continuously eat until you feel stuffed, you will stretch your stomach pouch and defeat the purpose of the surgery.

• Your meals will be about 4 oz. (½ cup) in total size.  Use small plates and cups, instead of large plates and bowls, for your meals.

• At this time, get into the habit of eating at least 2oz. (or ¼ - ½ cup) of a protein rich food at each meal.  In addition, eat the high protein portion of your meals first.  If you are unsure which foods are high in protein, see the protein section of this handout.  Aim for at least 60grams of protein everyday.

• Usually it is not hard to consume enough protein from food alone as long as you concentrate on eating high protein foods at each meal.  Protein supplements (powders, shakes, bars, etc.) in most cases are not necessary.  However, if you are truly concerned that you are not getting enough protein, or if you are experiencing a lot of nausea and vomiting and cannot consume high protein foods at meals on a consistent basis, then speak to your dietitian about protein supplement options and how often they should be taken.

• Continue to drink 2 quarts of liquid each day (8-8 oz. cups).  However, do not drink liquids for 30 minutes prior to mealtime (to make sure your stomach is empty), do not drink anything with your meal (to allow room for food), and do not drink anything for 30 minutes after a meal (to prevent “washing” the food through the stomach too quickly).  This will make a profound impact on your feeling of satiety (satisfaction and fullness) after eating.

• During this phase, begin taking the rest of your vitamin supplements (calcium, iron, and B12).  Refer to the vitamin section of this booklet.

Phase II Sample Menus

Week 3

Breakfast

½ c. fat-free artificially-sweetened vanilla yogurt

Mid-morning

8 oz. skim or 1% milk

Sip 16 oz. of water or non-caloric beverage throughout the morning

Lunch

¼ c. low-fat cottage cheese

¼ c. unsweetened applesauce

Mid-afternoon

Sip 16 oz. of water or non-caloric beverage throughout the afternoon

Dinner

1/2-1 c. tomato soup (made w/ skim milk)

2-3 saltine crackers

Evening

8 oz. skim or 1% milk

Sip 16 oz. of water or non-caloric beverage throughout the evening

Using skim milk, the above sample menu provides 420 calories, 33.5g. of protein, and 64oz. (2 quarts) of fluid.

Week 4

Breakfast

¼ c. low-fat cottage cheese

¼ c. diced peaches

Mid-morning

8oz. skim milk

16oz. water or non-caloric beverage throughout morning

Lunch

½ c. canned tuna mixed w/ 2 T. extra-firm tofu, 1 T. fat-free sour cream, seasonings to taste

Mid-afternoon

8oz. skim milk

16oz. water or non-caloric beverage throughout afternoon

Dinner

1-2 thin slices each lean deli turkey breast & reduced-fat Swiss cheese, rolled with 1 T. light mayonnaise

Evening

16oz. water or non-caloric beverage throughout evening

8oz. herbal tea

The above sample menu provides 510 calories, 54.5g. of protein, and 72oz. of fluid.

Week 5

Breakfast

¼ c. scrambled Eggbeaters®

w/ 2T. reduced-fat shredded cheddar

¼ c. diced pears

Mid-morning

8oz. herbal tea

16oz. water or non-caloric beverage throughout morning

Lunch

¼ c. canned chicken

1 T. light mayonnaise

Mid-afternoon

8oz. vegetable juice

16oz. water or non-caloric beverage throughout afternoon

Dinner

2oz. baked salmon

¼ c. green beans w/ 1 t. light margarine

Evening

8oz. skim milk

16oz. water or non-caloric beverage throughout evening

The above sample menu provides 452.5 calories, 41.5g. of protein, 72oz. of fluid.

Week 6

Breakfast

1 scrambled egg

½ slice whole wheat toast

1 t. light margarine

Mid-morning

1 Carnation® Instant Breakfast® for the Carb Conscious

16oz. water or non-caloric beverage throughout morning

Lunch

2 thin slices lean deli ham

2 thin slices reduced-fat cheese

1 T. mustard

Mid-afternoon

16oz. water or non-caloric beverage throughout afternoon

Dinner

½ c. chili w/ beans

2-3 saltine crackers

Evening

8oz. skim milk

16oz. water or non-caloric beverage throughout evening

The above sample menu provides 675 calories, 54g. of protein, 64oz. of fluid.

Phase III:  6 weeks and beyond

Time to experiment!

Six weeks following surgery, you can begin to re-introduce a variety food back into your diet.  We recommend that you begin with softer foods before moving to solid foods (example: try cooked vegetables before eating raw vegetables and canned fruits before eating raw fruits).  But at this point in time, you can begin trying more solid pieces of meat, and raw fruits and vegetables again.

It is important to eat at least 4 to 6 ounces of meat everyday. Be sure that the meat you are eating is moist and tender and avoid any tough, fatty or gristly meats. Your total protein goal will be at least 60grams everyday.  See the protein section to learn more about high protein foods.   

Suggestions for Phase III diet:

• Continue to eat the high protein foods first when you sit down to eat a meal.  The amount of food that you are able to eat after surgery is so small that you must focus on getting enough protein in your diet before anything else.

• Splurge a little on your grocery budget.  Since you are only eating a small amount of food, pay the extra money for the 98% lean ground beef.

• Develop an exercise routine.  This is a critical component to your success after surgery.  Exercise will help you burn more calories and build lean body mass or muscle.  The more muscle you have, the more calories you will burn.  You will lose weight faster and keep it off as long as you are exercising.

• Recognize when you are full (pain or pressure in the center just below your rib cage, nausea, or pain in your shoulder or upper chest).  Learn to stop eating when you are full, not when you are stuffed.  If you eat until you are stuffed, you will stretch your stomach pouch.

• Continue the habit of only eating 3 small meals per day and avoid snacking and grazing!  Snacking and grazing throughout the day will prevent you from reaching your weight loss goals.

• Remember that the only reason to eat is because you are hungry.  If you are not hungry, do not eat.

Phase III Sample Menus

Week 7

Breakfast

2 slices turkey sausage ¼-½ c. oatmeal

Mid-morning

8 oz. GNC ProPerformance® 100% Whey Protein supplement (made w/ skim milk)

16 oz. water or non-caloric beverage throughout the morning

Lunch

¼ c. hummus

½ c. fresh dipping veggies (cherry tomatoes, celery, red peppers, etc.)

Mid-afternoon

8oz. herbal tea

16oz. water or non-caloric beverage

Dinner

2 oz. shredded pot roast with gravy

¼-½ c. cooked carrots

Evening

8 oz. skim or 1% milk

16 oz. water or non-caloric beverage throughout the evening

This sample menu provides 687.5 calories, 69g. of protein, 72oz. of fluid.

Week 8

Breakfast

½ c. fat-free, artificially sweetened yogurt (any flavor)

¼ c. mixed fresh berries

Mid-morning

16oz. Revival Soy Protein Shake made w/ soy milk

16oz. water or non-caloric beverage

Lunch

¼-½ c. salad greens

2oz. chicken strips

2 Tbsp. fat-free Ranch dressing

Mid-afternoon

16 oz. non-caloric beverage or water throughout the afternoon

Dinner

2oz. tender pork loin

¼ baked sweet potato w/

1 T. light margarine

Evening

8oz. soy milk

16oz. water or non-caloric beverage

This sample menu provides 800 calories, 81g. of protein, 72oz. of fluid.

TROUBLESHOOTING

Changing your eating habits will be important if the operation is to be a success.  Although your smaller upper stomach and smaller opening that releases the food and liquid into the intestine will help, several of the following problems may be encountered once eating is resumed after surgery.

Managing Liquids

• Fluids are needed to replace normal water loss and to prevent dehydration.  We recommend that you try to drink 2 quarts (or 64 oz.) of liquid (mostly water and non-caffeinated beverages) every day.

• Avoid liquids with meals, saving room for solid foods, and preventing the “washing” of food from the stomach.  Stop drinking fluids at least 30 minutes before a meal, and wait at least 30 minutes after the meal, to allow for digestion of food.  This will make a profound impact on your feeling of satiety (satisfaction or fullness) after eating.

• When drinking liquids, sip them slowly.  If liquids are gulped too quickly, abdominal cramping, discomfort, and/or vomiting may occur.

• Avoid carbonated beverages and drinking from a straw for approximately 6 weeks after surgery.  Doing this can help you to avoid excess gas and pressure.

Nausea, Vomiting, Bloating and/or Heartburn

Nausea, vomiting, bloating and/or heartburn can occur from any of the following:

• eating and drinking too quickly
• not chewing food well enough
• drinking cold fluids
• eating too much (quantity)
• eating rich or sweet foods, fried, or high-fat foods
• eating gas-producing foods or drinking carbonated beverages

Dumping Syndrome

Dumping syndrome can be a feeling of abdominal fullness, weakness, warmth, rapid pulse, cold sweats, nausea, possible vomiting, and possible diarrhea.  This happens whenever foods and beverages that are too high in sugar are consumed.  To avoid dumping syndrome, avoid concentrated sweets (ice cream, milkshakes, candy, pies, cookies, cake, sugar, syrup, honey, jelly, pastries, regular soda, fruit juices, barbecue sauces, etc).  You may only be able to tolerate a teaspoonful of these items at a time, if any at all.

Blockage of the Stoma

The new opening created by the surgery is smaller than the original opening that released food from the stomach into the intestine.  This new opening may become blocked when food has not been thoroughly chewed, which can result in abdominal pain or vomiting.

If you become unable to tolerate water within the first month after surgery, call us immediately.  The sooner we learn of this problem, the more likely we will be able to treat it without surgery.

To prevent blockage from occurring:

• Avoid eating high fiber foods, such as raw fruits and vegetables, for the first 6 weeks after surgery.  After 6 weeks time, be sure to chew high fiber foods very thoroughly.
• Chew all foods to the consistency of mush before swallowing.
• Be careful when chewing gum; if accidentally swallowed it can cause a blockage.
• Use chewable or liquid multivitamins.

Overeating

The purpose of gastric bypass surgery is to create a smaller stomach so that it is unable to hold the large volumes of food it had held previously.  Constant overeating can stretch your stomach pouch.  Remember that your pouch is only 1 ounce (the size of your thumb).  Meals should be about 4 ounces.  The more solid the food, the less you will be able to eat.  You may be able to eat 4 ounces of applesauce, but only 2 ounces of beef.  Even though the amount is smaller, choose the beef because you need the protein.

To prevent stretching the pouch:

• Eat only three small meals each day, and measure your food before you eat to prevent overfilling the stomach.

• Eat slowly so that the nerve receptors in your stomach area can relay the message to your brain that your stomach is full.  It takes approximately 15-20 minutes for the message of fullness to reach the brain.  Take time between bites of food and stop eating as soon as fullness is experienced.

• Recognize when you are full, which can feel like pain or pressure in the center just below your rib cage, nausea, or a pain in your shoulder or upper chest.  The next step is to stop eating when you feel full.

• Constant nibbling/grazing/snacking may not stretch your stomach pouch, but it is a common food behavior among people who do not meet their weight loss goals and/or regain significant amounts of weight after surgery.

Undernutrition

Total food consumption is reduced after surgery, and therefore, intake may be nutritionally inadequate. 

To compensate for reduced nutrient intake:

• Consume nutrient-dense foods daily, including a variety of :  lean meats, low-fat dairy, fruits and vegetables, and high fiber breads and cereals.  Look for breads that have at least 2g. of fiber per slice, and cereals that have at least 6g. of fiber per cup.  Avoid empty calorie foods, including soda pop, Kool-Aid, chips, pretzels, popcorn, candy, pastries, sweets, and fried foods.
• Consume adequate high biological value protein foods each day.  See the section on protein for examples of such foods.
• Take the recommended vitamins (multivitamin, calcium, iron, and B12 supplements) every day.  THIS IS IMPERATIVE!  Refer to the vitamin section of this handout.

Food Intolerance

Food intolerance varies widely and one individual may tolerate a food that disagrees with another person.  Therefore, it is important to try a variety of foods.  Each individual must try new foods carefully to test his or her reactions after surgery.

The following foods may be difficult to eat, especially for the first few months:

• tough meats – dry, gristly meats may be difficult to digest
• bread – fresh, doughy bread can form a ball and “gum up” the opening from the stomach
• pasta – pasta may form a paste and be more difficult to pass

Do not be discouraged if a certain food does not agree with you once.  Wait a few weeks