Bariatric Nutrition Guidelines

• Practice sipping fluids slowly throughout the day.
• Practice eating slowly and chewing food completely before swallowing.
• Meals should take 20 - 30 minutes to consume.
• Put down your eating utensil between bites.
• Consider using a baby-sized utensil.
• Discuss diet changes with the people that live with you. It is helpful if they try not to bring unhealthy foods into the home and focus on improving their own eating habits.
• Begin keeping a food diary by either writing intake down or with an app/online website.

Caffeine

• Do not have any caffeine for the 3 days before your surgery.
• Do not have any caffeine for 6 weeks after surgery.
• Limit decaffeinated and regular products to 2 (8 oz.) cups daily long term.

Carbonated Beverages 
Do not drink carbonated beverages for 6 months after surgery. This can cause excess gas, bloating or irritation.

Alcoholic Beverages 
Do not drink alcoholic beverages for 6 months after surgery. Alcohol provides “empty calories” and should be consumed with caution.

Ice Chips and Clear Liquids

Clear Liquids - Use for hydration

• Beef, chicken or vegetable bouillon or canned broth
• Decaffeinated coffee or tea (no creamer or milk added)
• Crystal Light®
• Gatorade Zero/Powerade Zero/Propel Zero
• Sugar-free gelatin
• Sugar-free/caffeine-free flavored water
• Sugar-free Kool-aid®
• Sugar-free lemonade
• Sugar-free popsicles
• Protein water
• Water

Below are foods that you are allowed to have in the first 2 weeks after your bariatric surgery. If at any time you experience nausea and/or vomiting, try switching back to clear liquids to allow your system to rest. Please do not eat anything that is not on these lists!

Fulls - Eat ¼ to ½ cup meals 6 times a day for 14 days:

• Cottage cheese – small curd, low-fat
• Skim or 1% milk
• Sugar-free pudding
• Sugar-free fudgsicles
• Yogurt (no-sugar added, fat free)
• Low-fat cream soups - strained (Cream of Mushroom, Chicken, Celery, Tomato, Potato)
• Cooked cereals including oatmeal (no added sugar), cream of wheat, cream of rice and grits
• Peanut butter (for recipes ONLY)
• Hot cocoa mix (no sugar added)
• Nonfat dry milk powder
• Evaporated skim milk
• Liquid egg whites, pasteurized (do not cook)

Vitamins & Minerals: One Week After Surgery 
Take a CHEWABLE bariatric surgery specific multivitamin per day with food. Common brands include: Bariatric Fusion, Celebrate, Bariatric Advantage, ProCare Health, and BariatricPal.

Keep Hydrated 
The goal for fluid intake is 64 ounces (8 cups) per day.

• You are not expected to reach this goal until after you are home from the hospital.
• Do not use a straw when you drink fluids.
• Do not take clear liquids with meals. Take 20 to 30 minutes to eat your meal. Wait 20 to 30 minutes after finishing your meal before drinking again.
• Drink slowly, taking small sips at a time.

Get Adequate Protein 
Your protein intake goal is 65 - 75 grams per day or 11 - 13 grams per meal.

• It is very important that you reach and maintain this level of protein intake long term to help prevent malnutrition and prevent muscle wasting.
• You are not expected to reach this goal until after you go home from the hospital.

Protein Supplements:

• Plan to put protein powder in most foods and beverages to help you reach your goal.
• The supplement that you buy should be a whey, or soy protein ISOLATE.
• An acceptable protein powder should contain between 15 - 20 grams of protein per scoop and little or no fat or sugar.
• We recommend unflavored and flavored protein powders.

Where you can buy protein supplements: 
You may also obtain protein powder from any drugstore, health food store or grocery store. Proteins cannot be over-blended or heated past 140°F. They can clump and become "gritty" in texture.

Limit Fat 
Eating high fat foods can cause diarrhea because your body does not absorb fat as well after surgery. High fat foods usually contain a lot of calories which is not beneficial for weight loss.

Sample Menu: 
Sample Menu: The following is a sample menu to follow for the first 2 weeks after your bariatric surgery. You may consume ANY of the foods/supplements/liquids on the full liquid list. Please note that this is an example, do not limit yourself to these foods only. The times listed are examples also.

8:00 a.m. ¼ - ½ cup fulls recipe (see below) 
11:00 a.m. ¼ - ½ cup strained cream soup with protein powder 
1:00 p.m. ¼ - ½ cup sugar free pudding with protein powder 
4:00 p.m. ¼ - ½ cup no sugar added yogurt with protein powder 
7:00 p.m. ¼ - ½ cup cooked cereal with protein powder 
10:00 p.m. ¼ - ½ cup fulls recipe

Be On the Look Out For: 
The symptoms of lactose intolerance are: gas, bloating, and diarrhea. If you are lactose intolerant, try using lactose free milk or chewable lactase enzyme tablets before meals containing milk or dairy products. You may try low sugar/low fat soy milk.

Dumping syndrome is caused by eating or drinking concentrated sources of sugar. Sugar cannot be broken down in your new small stomach and can cause large amounts of fluid to enter your intestine. This can result in facial flushing, increased heart rate, nausea, vomiting, and/or diarrhea. Not everyone gets dumping syndrome but we strongly recommend you avoid high sugar, empty calorie foods to promote weight loss.

You can begin pureed foods at week 3

• Continue with low sugar, low fat foods only.
• Use broth, milk or juice to help with consistency when blending. You are trying to blend to a smooth mashed potato consistency.
• Add new foods one at a time so if you have any intolerance, you will know what caused it.
• You may use stage 1 or stage 2 baby foods. Avoid stage 3 baby food or any foods with chunks or pieces.
• You may season foods to taste. Avoid large amounts of salt.
• Continue to eat slowly. You should be taking 20 – 30 minutes to consume a ¼ - ½ cup meal.
• Continue to consume 6 small meals per day. Each meal should be no more than ½ cup.
• Continue to include 64oz of clear liquids each day. Remember to avoid drinking while eating and do not resume drinking until 20 to 30 minutes after a meal.
• Avoid skins of raw fruits and vegetables when blending.
• You may eat meats which have been finely chopped, fish that has been flaked apart before eating, and scrambled egg whites without passing through a blender. Meats should be moist and tender; consider adding broth, low-fat gravy, or a low-fat and sugar-free sauce.

Sample menu for Pureed stage:

8:00 a.m. – 2 scrambled egg whites (7g protein) 
11:00 a.m. – ⅓ cup tuna with 1 TBSP light mayo (13g protein) 
1:00 p.m. – ⅓ cup refried beans with 1 oz. shredded 2% cheese (11g protein) 
4:00 p.m – 1 oz. chopped chicken with fat free gravy, 2 - 3 TBSP pureed vegetable (8g protein) 
7:00 p.m – ½ cup skim milk with 1 scoop UNJURY® (25g protein) 
10:00 p.m – ½ cup Greek yogurt (11g protein) 
Total = 75g protein

You can begin soft foods at week 5.

• Foods should have a soft consistency (easily cut with a fork).
• Continue low sugar, low fat food choices only. Use low fat cooking methods such as grilling, baking, steaming or microwaving.
• Continue to introduce new foods one at a time.
• Whole grain breads and crackers may be introduced now. Toast bread for the first few times, eat only ¼ of a slice until you are sure you can tolerate it. After that, the portion is ½ slice of bread or 2 - 3 crackers. Make sure you chew well.
• Choose canned fruits only, juice or water packed, none in heavy syrup.
• Choose soft cooked vegetables.
• Choose tender meats, cut into small pieces. Keep meats moist with fat free gravy or broth.
• Avoid any food that is difficult to chew well. Examples: steak, asparagus, nuts, seeds.

Here are some general guidelines to follow when choosing the right foods:

• You may introduce fresh fruit and vegetables at this stage.
• Continue to eat 6 small meals per day, slowly working up to 1-1½ cups daily by the end of the first year after surgery.
• Continue to drink at least 8 cups of fluid per day.
• Take fluids with you when you are away from home.
• Remember to drink only between meals, not with meals.
• Take vitamins and minerals as recommended by the dietitian and your surgeon.
• Eat balanced meals as much as possible. Remember to start with high protein foods, add whole grains, fruits, vegetables and skim / 1% milk.
• Write down what you eat and drink every day or use an online calorie counting website/app to keep track of your daily intake.

Tips for Weight Loss

• Pay attention to your body’s feeling of fullness.
• Eat your meals at a table without TV or other distractions.
• Avoid grazing between meals. Stick to scheduled meals and healthy snacks.
• Develop a physical activity plan with your doctor’s approval and stick to it! Make small, short term goals and slowly work up to more. Consider activities that you enjoy most to help keep you consistent in participating in physical activity.

Get Adequate Protein 
Protein is important in helping to prevent hair loss and maintain muscle mass during weight loss. However, you can consume adequate amounts of protein and still have some hair loss. Vitamin and mineral deficiencies, some medications, and the stress of surgery can all contribute to hair loss. Hair loss usually occurs at 2-4 months after surgery. The amount and duration depends on the person. Over time, hair loss does improve. You can help prevent hair loss by eating adequate protein and taking vitamin/mineral supplements as recommended by your dietitian and surgeon.

Some examples of foods high in protein include:

• 1 oz or ¼ cup tender cooked meat (chicken, turkey, fish, pork, beef, veal) – 7 grams
• ½ cup low fat cottage cheese – 15 grams
• 1 slice or ounce low fat cheese – 7 grams
• 1 egg – 7 grams
• ½ cup skim or 1% milk – 4 grams
• ½ cup yogurt – 4 grams
• ½ cup beans – any type – 5 - 7 grams
• ½ cup low fat chili – 10 grams
• ½ cup bean soup – 3 - 5 grams
• 1 tablespoon peanut butter – 4 grams
• 2 tablespoons nuts – 2.5 grams
• ¼ cup tofu – 5 grams
• 1 cup soy milk – 7 grams
• 1 vegetable burger – 10 - 13 grams

NOTE: You may not tolerate all meats well after surgery. Remember to keep them moist with fat free gravy or broth. Substitute other high protein foods if you have difficulty.

Limit Fat 
You will need to limit your fat and calorie intake to help promote weight loss. The goal is to eat no more than 35 grams of fat per day. Read food labels to monitor your fat and calorie intake. You will need to minimize portions or consume low fat or fat free versions of many foods.

NOTE: Do not eat low fat or baked chips, fat free or sugar free desserts, except in very limited quantities. These products are not calorie free and usually have little nutritional value.

Vitamins and Minerals: Six Weeks After Surgery

• Continue to take bariatric surgery specific multivitamin per day. Common brands include: Bariatric Fusion, Celebrate, Bariatric Advantage, ProCare Health, and BariatricPal. After 6 weeks post-surgery, the chewable vitamin form can be switched to a capsule form or soft chew form if desired.
• Initiate 1200-1500 milligrams (mg) of calcium citrate daily. Do not take at the same time with iron because iron interferes with calcium absorption. Do not take any other medications within 1-2 hours. Do not take more than 600 milligram (mg) dose at one time.