Bariatric Specialists of North Carolina Weight Loss ... · Weight loss surgery is an excellent tool to help you limit the amount of food you eat and help you lose weight. For most

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Bariatric Specialists of North Carolina Weight Loss Surgery Nutrition Guidelines

Overview

Weight loss surgery is an excellent tool to help you limit the amount of food you eat and help you lose weight. For most people, weight loss surgery requires a significant change in diet and lifestyle to safely and healthfully reach your goal weight. After bariatric surgery, you will likely lose weight rapidly. Good nutrition is essential to maintain lean body mass (muscle), hydration, skin elasticity, and to minimize hair loss.

The primary nutrition goals before and after surgery are:

Learn proper eating habits that will promote weight loss while maintaining health at a reduced weight.

Consume adequate amounts of protein to minimize loss of lean body mass and facilitate healing.

Drink adequate amounts of fluid to maintain hydration.

Consume adequate nutrients for optimal health through healthy food choices and vitamin and mineral supplementation.

For most individuals, bariatric surgery meal planning requires a significant change in how and what you eat and drink. We recommend that you begin adapting your current diet pattern and health behaviors now to prepare for this change.

How Your Diet Will Advance After bariatric surgery, protein and fluid intake are essential to successful recovery. Most patients will go home from the hospital on a liquid diet. The liquid diet is prescribed to provide a concentrated source of nutrition that will empty from the stomach easily and allow for healing. The liquid diet will consist of fluids to provide protein and fluids to provide hydration.

Weeks 1 & 2: Liquids only Week 3: Liquids and semi-solids (puréed) Week 4-Month 3: Soft foods

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The Liquid Diet Weeks 1 & 2 Key Concepts:

Clear liquid: any liquid that will allow light to pass through. Clear liquids are to be consumed days 1 & 2 after surgery.

Full liquid: any liquid or food that is liquid at room temperature. Full liquids include low fat milk, protein shakes, and strained low fat soup. You can consume full liquids starting day 3 after surgery.

No carbonated, sugar-containing or caffeinated fluids are allowed. Choose a variety of different non-carbonated, sugar-free, caffeine free fluids to stay hydrated and provide a source of protein.

Drink fluids in no more than 2 ounce (¼ cup) portions every 15 minutes. When drinking fluids, sip on the 2 ounce portion over 10-15 minutes. Try to drink about 2 ounces (¼ cup) of a protein fortified fluid each hour. During the rest of the hour, sip on 2 ounces of non-protein fortified fluid every 15 minutes to stay hydrated. You should be drinking about 8 ounces (1 cup) total each hour.

Sip on fluids slowly and do not gulp. Do not use straws, sippy cups, or water bottles with straw contraptions. Do not chew on chewing gum.

The daily fluid goal is at least 64 ounces (oz.) to stay hydrated.

Try to keep a constant trickle of fluid throughout your system all day to prevent dehydration.

The daily protein goal is 60-80 grams (g). For duodenal switch (DS) patients, the daily protein goal is 80-100 grams (g) of protein.

Protein-fortified clear and full liquids provide a concentrated source of nutrition that will empty from the stomach easily and allow for healing. Start consuming full liquids day 3 after surgery.

You may be sensitive to very hot and very cold fluids initially. Start drinking fluids at room temperature and then gradually make them colder and/or warmer as tolerated. This is usually a temporary side effect and will resolve for most patients in several days to weeks.

Liquids should be able to pass through a fine mesh strainer with no solids, chunks, or seeds

NO SOLID FOODS WEEKS 1 & 2 IMPORTANT! In the hospital, you may receive items on your meal tray that are semi-solid, like cream of wheat or yogurt. These items are NOT recommended until three weeks after surgery. If you receive these items on your meal tray please avoid them and focus on drinking the protein fortified nutrition supplements and hydration fluid provided.



Dehydration Dehydration is the primary complication of weight loss surgery!

Symptoms of dehydration include:

Fatigue

Nausea

Dry mouth

Dark or concentrated urine

Low urine output

If you are having difficulty drinking the recommended amount of fluid each day and are suffering from any of the above symptoms, we recommend that you call the clinic to discuss your fluid intake.

Lactose Intolerance Lactose intolerance is your body’s inability to digest the naturally occurring sugar, also known as lactose,

which is found in milk and dairy products.

Symptoms of lactose intolerance include:

Cramping

Gas

Bloating

Loose stools

Nausea

If you do not tolerate lactose after your surgery, look for a soy-based protein drink. You can also try drinking

soy milk, almond milk, or Lactaid®.

Choosing a Protein Supplement You will need to have two types of fluid to drink after surgery:

(1) fluids for hydration (2) fluids for protein

Choose a liquid protein supplement with 20 g or less of total carbohydrate, 10 g or less of sugar, 10 g or less of total fat, and at least 15 g of protein per 8-12 ounce serving. Start full liquid protein drinks day 3 after surgery. Hydration fluids help prevent dehydration. Examples can be found on the next page. Protein fluids provide a source of protein and nutrition. Examples can be found on the next page. **Some people experience taste changes after surgery. For this reason, we recommend trying a variety of recommended fluids and sampling them before surgery.**



Weeks One & Two Liquid Diet

CLEAR LIQUIDS DAYS 1 & 2; START FULL LIQUIDS DAY 3

Liquids Weeks One & Two

Hydration Protein

Sugar-free gelatin

Sugar-free popsicles

Chicken, beef, or vegetable broth

Water

Diet, clear, sugar-free fruit juice (apple, grape,

cranberry)

Decaf coffee or tea Splenda, Equal, Truvia, and Stevia are allowed Crystal Light, sugar-free Kool-Aid

Vitamin Water Zero

Fruit2O®

MiO

Dasani DROPS®

Dasani flavored water

Hint water® (Whole Foods & Fresh Market)

Skinny water® (Harris Teeter, Target)

Propel

Syntrax Nectar protein powder Healthwise high protein fruit drink

Healthwise sugar-free protein gelatin Healthwise bouillon

Isopure® liquid protein New Whey 42 liquid protein

Premier Protein Clear

Premier protein shake

Muscle Milk protein shake ChocoRite protein shake

Syntrax Matrix 2.0 or 5.0 protein shake Met Rx meal replacement shake

Healthwise high protein hot chocolate Bariatric Advantage meal replacement shake

Met Rx Protein Plus RTD 51 shake Pure Protein RTD shake Oh Yeah protein shake

Chike meal replacement protein shake Unjury protein shake

Skim or 1% milk, soy milk, almond milk, Lactaid® milk

Protein fortified, strained, low fat soups (Try stirring protein powder into soup to increase protein content)

NO Bubbles, NO Sugar, NO Caffeine

Full Liquid Protein (Day 3 after surgery)

Clear Liquid Protein (Days 1 & 2 post-op)

(Start immediately post-op)

Other Full Liquids (Start Post-op Day 3)



Sample Clear and Full Liquid Fluid Schedule:

Drink fluids in no more than 2 ounce (¼ cup) portions every 15 minutes. When drinking fluids, sip on the 2 ounce portion over 10-15 minutes. Try to drink about 2 ounces (¼ cup) of a protein fortified fluid each hour. During the rest of the hour, sip on 2 ounces of non-protein fortified fluid every 15 minutes to stay hydrated. You should be drinking about 8 ounces (1 cup) per hour.

Use the above schedule to make sure you get enough fluid and protein each day, alternating between fluids for protein and hydration throughout the day. Try to sip on each 2 oz. (¼ cup) of fluid over 15 minutes. Try not to drink to quickly or gulp fluids.

*Drinking too quickly or drinking too much at one time may cause pain or discomfort.*

Following this sample

schedule, it will take

most people about

12-14 hours each day

to reach their fluid

and protein goals.

TIP: Drink fluids from a smaller cup, like a 2-3 oz. disposable bathroom cup or take fluids by

the spoonful to help control the amount of fluid you drink. ALWAYS measure out your

fluids, 2 oz. (¼ cup) at a time. DO NOT sip from large cups on the liquid diet.

1-2 oz.

protein

drink

1-2 oz.

fluid for hydration

1-2 oz.

fluid for hydration

1-2 oz.

fluid for hydration



Liquid Diet with Semi-Solids Week 3 Key Concepts:

All liquids from week 1 & 2 are allowed with the addition of some semi-solid foods.

Semi-solid foods are those that would normally be eaten with a spoon and are applesauce consistency. Avoid any skins, seeds, or chunks.

Semi-solids allow the diet to progress slowly but continue to limit stress on the gut as it heals. They provide a concentrated source of nutrition that will empty from the stomach and allow for healing.

Try to eat semi-solid food about every three to four hours for 4-6 small semi-solid meals daily. Take 20-30 minutes to complete each meal.

Eat no more than ⅓ cup of semi-solid foods at a time.

Try only one new food at a time.

Do not drink fluids while eating semi-solids. Stop drinking fluids 30 minutes before a semi-solid meal. Do not start drinking fluids until 30 minutes after finishing a semi-solid meal.

Try to keep a constant trickle of fluid through your system all day between trials of semi-solids.

Continue to use all the fluids on the liquid hydration list to prevent dehydration.

Do not drink any carbonated, caffeinated, or sugar-containing fluids.

Drink fluids in 2 ounce (¼ cup) portions and sip on this fluid portion over 10-15 minutes.

Sip slowly and do not gulp. Do not use straws, sippy cups, or water bottles with straw contraptions. Do not chew on chewing gum.

The daily fluid goal is at least 64 ounces (oz.) to stay hydrated.

The daily protein goal is 60-80 grams (g) of protein. For duodenal switch (DS) patients, the daily

protein goal is 80-100 grams (g) of protein.



Week 3 Semi-Solids & Protein Shakes

Protein goal: 60-80 grams per day (80-100 grams per day for duodenal switch patients)

Semi-Solids to Try Semi-Solids to Avoid

Protein fortified, strained soups: broth and low-fat soups

(Try stirring protein powder into soup to increase protein

content)

Any unstrained soup with meat, veggie, rice or noodles

Full fat soups

Light or low fat yogurt Full fat yogurt or yogurt with fruit or seeds

Low fat (1%) cottage cheese or ricotta cheese Full fat dairy and cheese

Oatmeal, grits

Protein fortified, cooked, and mashed or pureed non-gas

forming vegetables

(ex. add unflavored protein powder to blended carrots,

squash, green beans)

Any mashed fruits and veggies with seeds or fibrous skins

Mashed beans (ex. black, pinto, or navy beans)

Low fat refried beans

Regular, full fat refried beans

Protein fortified, sugar-free, and low fat or fat free

pudding (add protein powder to pudding)

Full fat, sugar-containing puddings

Hummus Hummus containing pine nuts or other solids

Semi-solids allow the diet to progress slowly while limiting stress on the gut as it heals.

All liquids from weeks 1 & 2 are allowed with the addition of semi-solid (pureed) foods.

Semi-solid foods are those that would normally be eaten with a spoon and are applesauce consistency.

Eat a semi-solid food approximately every three to four hours for 4-6 small semi-solid meals per day.

Eat no more than ⅓ cup of semi-solid foods at a time.

Try only one new food at a time.

Take thumbnail-sized bites. Chew thoroughly.

Take 20-30 minutes to finish your semi-solid meals.

Do not drink fluids 30 minutes before and 30 minutes after eating a snack or meal.

Please DO NOT try soft foods until you have received instruction on the soft food diet

phase from the dietitian!



Soft Foods To be consumed after bariatric surgery from week 4 until 3 months after surgery, or when normal textures of food are cleared by your surgeon. Protein goal: 60-80 grams of protein per day; for duodenal switch patients, 80-100 grams per day

Four weeks after surgery, you will receive instruction from the dietitian at your soft foods diet class. You will learn how to safely and healthfully reintroduce soft foods, plan meals, and make nutritious food choices to aid with continued weight loss and healing.

Due to the change in size and function of your stomach after surgery, there are foods and fluids that should be limited or avoided for the first three months after surgery.

At your three month follow up in clinic, you will be given clearance by your surgeon to reintroduce regular consistency foods.

Foods to avoid on the soft diet:

Carbonated drinks

Sugar sweetened, caffeinated beverages

Simple, refined carbohydrates (ex. chips, crackers, rice, pasta, and noodles)

Tough, dry meats (ex. steak, pork chops)

Rubbery meats (ex. ham, hotdogs)

Skins, membranes, and seeds of fruits and vegetables

Fresh, doughy bread (ex. yeast rolls, biscuits) Fried or high fat foods

Whole milk and full fat products

Please DO NOT START to eat soft foods until you have received instruction on the soft foods diet from the dietitian!

All patients should avoid alcoholic beverages for one year after surgery.



Meal Planning:

The Plate Method

Dumping Syndrome



Only a side effect after the Roux-en-Y gastric bypass

Dumping syndrome refers to a group of symptoms that are caused by a change in size and function of the bypassed stomach. Most Roux-en-Y gastric bypass patients will experience dumping syndrome to a minor degree after surgery. The severity of dumping syndrome can depend on the volume, consistency, and sugar or fat content of food eaten. There are two phases to dumping syndrome, early dumping and late dumping. Some patients experience only one phase of dumping, while others experience both phases. Symptoms of early dumping may begin as early as 45 minutes after a meal. Symptoms of late dumping may occur up to 2-3 hours after eating.

Signs and Symptoms:

Bariatric Vitamin and Mineral Fact Sheet

Early Dumping:

Abdominal Cramping

Diarrhea

Fatigue

Sweating

Rapid heart rate

Decreased blood pressure

Flushing

Dizziness

Shortness of breath

Late Dumping:

Shakiness

Cold sweats

Fatigue

Decreased blood pressure

Head ache



A chewable or liquid B-Complex is the only vitamin recommended for the first month

after surgery.

The American Society of Metabolic and Bariatric Surgery (ASMBS) recommends that all weight loss surgery patients take a bariatric formulated multivitamin daily.

All supplements and medications must be chewable or liquid until 30 days post-op. B-Complex

A B-complex vitamin is the only vitamin recommended for the first month after surgery, but is optional thereafter.

If not purchased through the Envision Nutricenter, please ensure your B-complex contains at least 12 mg of thiamin (vitamin B1).

Multivitamin: Begin 4 weeks after surgery when you start soft foods.

We recommend a bariatric formulated multivitamin that contains iron. The multivitamin should be taken without food for increased absorption.

Elemental Iron

Iron should be taken without food for increased absorption.

Additional iron is recommended for menstruating women and patients who have a history of iron deficiency anemia. Consult your registered dietitian or bariatric surgeon for more information.

Calcium: Begin 4 weeks after surgery when you start soft foods.

Take calcium supplement doses at least 2 hours before or 2 hours after the multivitamin and iron. Calcium supplements should be spaced throughout the day for increased absorption.

Please speak with your surgeon about returning to other pre-operative supplements following surgery. If you have questions or concerns about your vitamin and mineral supplementation, please speak with one

of our registered dietitians or your bariatric surgeon.





Bariatric Surgery Meal Planning Goals Things to Do Before Surgery: _____ Begin preparation for pre- and post-op liquid diets.

_____ Begin setting up a weight loss surgery meal plan NOW. Limit or avoid high sugar and high

fat foods and plan to eat a meal every 3-4 hours for a total of 4-6 small meals each day. Eat protein at each meal and make sure to eat breakfast within 1 hour of waking up.

_____ Begin or continue an exercise program. Work up to a goal of 30-60 minutes of

INTENTIONAL physical activity 4-5 times each week. Include a form of strength training 3 times per week. Strive for 10,000 steps per day!

_____ Purchase a chewable or liquid B-complex that has at least 12 mg thiamin (Vitamin B1).

_____ Begin or continue taking a daily general multivitamin until day of surgery.

_____ Practice not drinking with meals and try to establish a habit of sipping on fluids between

meals.

_____ Try to increase fluid intake between meals and consume at least 64 oz. hydrating fluid per day. Begin eliminating carbonated, caffeinated, and sugar-containing beverages.

_____ Attend weight loss surgery support groups, both before and after surgery. _____ Practice mindful eating. Try to eliminate distractions during meals, including TV and cell phones. _____ Begin decreasing high fat, fried, and sugary foods. No more than 10 grams of total fat or 10 grams of sugar per serving. _____ Try to slow down your eating speed. Take 20-30 minutes to finish a meal.

_____ Practice chewing foods to an applesauce-like consistency. _____ Maintain your weight or initiate weight loss depending on your surgeon’s instructions. _____ Begin or continue reading and self-education prior to surgery.

Password for website nutrition materials: protein60

_____ Begin or continue food journaling to increase mindfulness to food/fluid choices and diet pattern.



Sample Menu:

Breakfast

2 egg omelette with vegetables (ex. mushrooms, peppers, spinach) 1 oz. low fat cheese

A.M. Snack

⅓ cup hummus with sliced cucumbers, carrots, peppers

Lunch

Taco salad: 1-2 oz. grilled chicken ¼ cup black beans Over: spinach, pico de gallo, peppers, onions Topped with 1 oz. guacamole, cilantro and salsa

P.M. Snack

2 low fat cheese sticks

Dinner

Shrimp lettuce wraps: 3-4 oz. grilled shrimp Shredded carrots, cucumbers, scallions ¼ cup brown rice Wrapped in lettuce leaves Topped with low sugar, low fat Asian dressing

P.M. Snack

½ cup Greek yogurt, topped with sliced almonds & berries

Protein Sources

Beans & Nuts:

Beans (ex. black, pinto, white, navy, garbanzo,

black-eye, kidney)

Fat free refried beans

Lentils

Peanut butter or other nut butters (ex. almond,

sunflower seed)

Nuts (ex. almonds, walnuts, pistachios, peanuts)

Seeds (ex. sunflower seeds, pumpkin seeds)

Steamed soy beans (edamame)

Dairy:

Low fat cottage cheese

Light or low fat yogurt

Light or low fat Greek yogurt

Light or low fat cheese

Skim or low fat milk

Unsweetened almond milk, soy milk, Lactaid®

Meat and Seafood:

Eggs or egg whites

Fish, shellfish, seafood

Chicken

Turkey

Lean beef or pork (ex. loin, round)

85-95% lean ground meats (ex. turkey, beef)

Meat Alternatives:

Veggie burger

Soy burger patty

Black bean burger

Tofu

Tempeh

Protein shakes

Protein bars

Try to consume at least 15

grams of protein at each meal!


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Bariatric Specialists of North Carolina Weight Loss ... · Weight loss surgery is an excellent tool to help you limit the amount of food you eat and help you lose weight. For most