The Bariatric Food Pyramid for WLS PatientsOctober 3, 2016
"You mean to tell me that I should stay away from whole grain bread?” A patient asked during one of our visits, “but I thought whole grains were good for you! Oh, I’m so confused, just when you think you’ve got if figured out it switches on you!"
The patient in our clinic was right! Nutrition can be confusing and to put that information into action can be hard. Especially when you are trying to make healthy choices after bariatric surgery. In this article, we are going to focus on the foods and nutrients you should keep a close eye on to make sure you are staying healthy during your weight loss journey. Keep in mind each center will have their own recommendations, so reach out to your team with any questions or concerns you may have.
General healthy advice offered by the traditional food pyramid and the new My Plate guide don’t take into account the special needs of those who have had bariatric surgery.
The Foundation: Fluids
At the base of the Bariatric Food Pyramid, we can find fluids. Dehydration is the leading cause of going back to the hospital after bariatric surgery which means sip, sip, and sip! Most bariatric programs recommend that you drink at least 64 ounces per day which equals eight 8-ounce glasses. Our top pick for your fluid needs is plain ole’ water, but if you need a little variety, choose fluids that are sugar-free, calorie-free, carbonation free and caffeine free. Examples include:
- Zero Calorie Sports Drinks
- Sugar-Free Water Enhancers
- Decaffeinated Teas or Coffees
- Herbal Tea
Level Two: Protein and Vitamins
The second level is shared between protein and vitamins. Changes made to your digestive tract after surgery can make it difficult to eat enough to meet all of your needs; plus you may not be able to absorb everything you are able to eat. To get everything you need to be healthy, the key is to track how much protein you are eating and make sure you are taking your vitamin supplements daily.
When you sit down to a meal or grab a snack, make sure the first thing you eat is protein. Because your pouch is small, eating protein first will help you meet your daily protein goals. Most programs recommend between 60 and 80 grams per day. If you are able to get 60 grams of protein, that will be equal to about 9 ounces of lean protein while eating 80 grams would equal about 11 ounces of lean protein per day. Nutritious high protein foods include:
- Lean meats, poultry, and fish
- Low-fat dairy such as cottage cheese, low sugar yogurt, shredded cheese
Getting protein from whole food sources should be the first choice. If you are unable to meet your protein needs with food alone, protein supplements may be used to fill in the gaps. Refer to your center’s recommendations for the right protein supplement for you.
Taking daily vitamins and minerals will be a part of your routine for life. Having bariatric surgery means you have unique vitamin needs. Even with a balanced diet, it is important to take your vitamins to avoid any deficiencies. The most important supplements to focus on include:
- A Bariatric Specific Multivitamin. A generalized multivitamin may not have everything you need in the amounts that you need them. Watch the portion size too! Sometimes you need to take more than one tablet or serving’s size to get everything that is on the label.
- Calcium and Vitamin D. Calcium and Vitamin D work best together, so try to find a supplement that has both Calcium Citrate and Vitamin D3. The goal is to get at least 1500 milligrams of Calcium per day and 800-2000 international units of Vitamin D. You will have to split the dose of Calcium into 500-600 milligram doses because the body can’t absorb more than that at one time.
- Iron and/or Vitamin B12. You may be recommended to take Iron and/or Vitamin B 12. Some centers recommend these two vitamins and minerals only if blood levels are low, so don’t be alarmed if your provider doesn’t recommend these two right away. Other centers make these two vitamins and minerals a part of a daily regimen. Follow the lead of your care team.
Level Three: Non-Starchy Vegetables
To round out a nice healthy meal it is important to include non-starchy vegetables. Veggies are jam packed with tons of good for you nutrients such as vitamins, minerals, antioxidants and fiber. Once you have eaten your protein, your next stop should be a serving of non-starchy vegetables. A few examples include:
- Leafy greens and lettuces
Your veggies can be cooked, fresh or frozen. No matter what form they are in, your goal is to aim to eat three to five servings of vegetables each day. If you are early in your post-operative period wait to introduce raw vegetables until you are three months post-op. As you try new foods, add one in at a time and be mindful of how you feel two hours after you eat. Some foods may not be well tolerated after surgery so it is important to adjust your foods as needed.
At the Top of the Pyramid: Healthy Fats and Complex Carbohydrates
Healthy fats and complex carbohydrates are foods that should be consumed in moderation in order to avoid weight gain and uncomfortable side effects such as dumping syndrome. Although healthy fats add flavor and nutrition, they can also add unwanted calories. Keep the amount of fat you are eating to about 30% of total calories.
For example, if you are eating 1000 calories per day you would want to limit fat to 35 grams per day; 1200 calories you would want to limit fat to about 40 grams per day; 1500 calories per day about 50 grams per day. Make sure to completely avoid foods high in saturated fats such as fried foods. To make sure you are making the most of your healthy fats choose from the below list and watch portions sizes to make sure you are not overdoing it.
- Nuts and seeds
- Vegetable oils
- Fatty fish such as salmon or albacore tuna
After surgery, it is important to continue to watch those carbohydrates closely. A good rule of thumb to stick to is to keep carbohydrates to under 50 grams per day. Once you get to the weight maintenance phase, you may be able to add more in, but talk to your care team and follow their guidance.
When choosing carbohydrates make sure they are coming from nutritious sources such as fruit, beans or dairy products. It is recommended that carbohydrates coming from any sugar-containing foods and fruit juice be eliminated completely.
Although there is a lot of information out there about what to eat and what not to eat, the Bariatric Food Pyramid provides guidance to meet the specific needs of those who have had bariatric surgery. It can help prioritize what foods and nutrients can build a healthy diet. With a focus on getting plenty of fluids, enough protein, taking vitamins and minerals daily and including non-starchy vegetables to round out a healthy meal, you will be on the right track for continued weight loss and overall health.
- Academy of Nutrition and Dietetics. Bariatric Surgery. Nutrition Care Manual web site. Available at: https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&ncm_toc_id=16927 (login required). Accessed July 20, 2016.
- Academy of Nutrition and Dietetics Evidence Analysis Library. Adult Weight Management Evidenced-Based Nutrition Practice Guideline. Available at http://andeal.org/topic.cfm?menu=5276&cat=4688 (login required). Accessed July 20, 2016.
- Life After Bariatric Surgery, ASMBS, Accessed 2016.
- Brown, Rachel. Fruit and Vegetables after Bariatric Surgery. Obesity Action Coalition. Available athttp://www.obesityaction.org/educational-resources/resource-articles-2/nutrition/fruits-vegetables-after-bariatric-surgery. Accessed 2016.
- Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. Bariatric Nutrition: Suggestions for the Surgical Weight Loss Patient. Journal of American Society for Metabolic and Bariatric Surgery.2008;4 (4S)1-36).
ABOUT THE AUTHORStephanie McGinnis, RDN oversees the functions of the bariatric program at Banner Gateway Medical Center. Her duties include care coordination, program development, and patient & staff education. She leads a multidisciplinary team that promotes the delivery of quality cost-effective care and supervises members of the Bariatric Team with responsibilities including: recruiting & retention, performance management, development & coaching, recognition & disciplinary actions.