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Life After Surgery
The following identifies areas that will
be important for patients to follow
after weight loss surgery.
The modifications made to your
gastrointestinal tract will require
permanent changes in your eating habits
that must be adhered to for successful
weight loss. Post-surgery dietary
guidelines will vary by surgeon. You may
hear of other patients who are given
different guidelines following their
weight loss surgery. It is important to
remember that every surgeon does not
perform the exact same weight loss
surgery procedure and that the dietary
guidelines will be different for each
surgeon and each type of procedure. What
is most important is that you adhere
strictly to your surgeon's recommended
guidelines. The following are some of
the generally accepted dietary
guidelines a weight loss surgery patient
may encounter:
When you start eating solid food it is
essential that you chew thoroughly. You
will not be able to eat steaks or other
chunks of meat if they are not ground or
chewed thoroughly.
Don't drink fluids while eating. They
will make you feel full before you have
consumed enough food.
Omit desserts and other items with sugar
listed as one of the first three
ingredients.
Omit carbonated drinks, high-calorie
nutritional supplements, milk shakes,
high-fat foods and foods with high fiber
content.
Avoid alcohol.
Limit snacking between meals.
Going Back to Work
Your ability to resume pre-surgery
levels of activity will vary according
to your physical condition, the nature
of the activity and the type of weight
loss surgery you had. Many patients
return to full pre-surgery levels of
activity within six weeks of their
procedure. Patients who have had a
minimally invasive laparoscopic
procedure may be able to return to these
activities within a few weeks.
Birth Control & Pregnancy
It is strongly advised that women of
childbearing age use the most effective
forms of birth control during the first
16 to 24 months after weight loss
surgery. The added demands pregnancy
places on your body and the potential
for fetal damage make this a most
important requirement.
Long-Term Follow-Up
Although the short-term effects of
weight loss surgery are well understood,
there are still questions to be answered
about the long-term effects on nutrition
and body systems. Nutritional
deficiencies that occur over the course
of many years will need to be studied.
Over time, you will need periodic checks
for anemia (low red blood cell count)
and Vitamin B12, folate and iron levels.
Follow-up tests will initially be
conducted every three to six months or
as needed, and then every one to two
years.
Support Groups
The widespread use of support groups has
provided weight loss surgery patients an
excellent opportunity to discuss their
various personal and professional
issues. Most learn, for example, that
weight loss surgery will not immediately
resolve existing emotional issues or
heal the years of damage that morbid
obesity might have inflicted on their
emotional well-being. Most surgeons have
support groups in place to assist you
with short-term and long-term questions
and needs. Most bariatric surgeons who
frequently perform weight loss surgery
will tell you that ongoing post-surgical
support helps produce the greatest level
of success for their patients.
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GASTRIC BYPASS DIET GUIDELINES
To lose weight, calories consumed must
be less than calories expended. Gastric
Bypass surgery partitions the stomach
producing a small pouch that can hold
only a limited amount of food, about 1-2
ounces at a time. The resulting decrease
in food intake and calories produces
weight loss. Weight loss is also
facilitated by the "malabsorptive"
component of the operation. The
rerouting of the small intestine
prevents some of the digestive juices
from reaching food until it has passed
fairly far down the intestinal tract. As
a result, less absorption of calories
occurs which produces weight loss. Your
doctor may prescribe vitamin / mineral
supplementation because of this.
Gastric Bypass is a major surgery and
requires major lifestyle changes. It
radically alters a person's anatomy,
physiology and eating patterns. The
post-operative period is strictly
structured and advances from low sugar/
sugar free clear liquids to regular food
gradually over the next 5-8 weeks after
surgery. It is imperative to comply with
the diet to prevent complications and
maximize weight loss.
Because intake is so limited after
gastric bypass, it is important to
consume nourishing foods in order to
maintain your nutritional health. FLUIDS
and PROTEIN are most important and
should be your focus. You will have to
consume small amounts of fluid (12
ounces) on a near constant basis
everyday to maintain proper hydration.
These fluids should be calorie free such
as water, Crystal Light, sugar free
Kool-Aid, etc. Once you begin eating
foods, you will NOT drink fluid while
you are eating. Also, don't drink any
fluid until about one hour after
completing a meal.
Protein is important because it is
needed for healing and maintaining
muscle tone. It helps prevent or lessen
hair loss (provided you are taking your
vitamin/mineral supplements as
instructed). Your daily protein need is
approximately 80 grams. You will likely
need to consume a protein supplement to
meet this need. Some examples include:
1. Designer Whey: available at GNC
stores in a clear liquid type beverage
and also a powder for making "shakes".
2. Promod: a protein powder made by Ross
Labs (who make Ensure).
3. Sugar free Carnation Instant
Breakfast: available in your
supermarket.
4. Carb-Solutions: available at your
pharmacy or discount stores (Wal-Mart,
CVS)
• Choose a protein supplement that is
low in sugar! Sugar is not typically
tolerated well after gastric surgery and
also contains "empty calories". Ensure,
Boost, Slim Fast contain sugar and are
not recommended for your consumption.
Progression of Diet after Gastric Bypass
Day of surgery: Nothing by mouth (NPO)
Day after surgery: Ice chips Weeks 1-2:
Low sugar and sugar free Clear liquids
Weeks 34: Low sugar and sugar free Full
liquids Week 5: Puree diet When
tolerated: Soft diet When tolerated:
Regular foods
CLEAR LIQUID DIET
PURPOSE: To provide calories and
electrolytes as a means of preventing
dehydration.
GENERAL DESCRIPTION: This diet is given
in frequent feedings throughout the day.
It includes only liquids which are clear
at room temperature and emphasizes sugar
free and low sugar choices. 1/2 ounce
serving as tolerated every 5-10 minutes
is prescribed. (1/2 ounce = 15 cc = %Z
medicine cup = 1 Tbsp.). If you
experience pain or nausea while sipping
liquids, STOP until the feeling passes.
RECOMMMENDED CLEAR LIQUIDS: Water, Sugar
free drink mixes (Crystal Light,
Kool-Aid, etc), Decaf.,Unsweetened tea,
Coffee, Sugar free Gelatin, Unsweetened
fruit juice, Sugar free Popsicles, Diet
soda and Carbonated beverages are
discouraged.
• Designer Whey Protein Blast (clear
liquid protein supplement)
• Pro-Mod - can add to clear liquids
FULL LIQUID DIET
PURPOSE: To provide protein and minimal
calories with liquid foods.
GENERAL DESCRIPTION: Continue with
frequent feedings (1-2 oz.) as
tolerated. Emphasis is still on sugar
free as well as low fat/fat free
choices. This diet allows the
unsweetened clear liquids plus skim/low
fat milk and milk products. If you are
lactose intolerant, try Lactaid milk or
milk treated with Lactaid drops. Milk is
an important source of protein.
RECOMMENDED FULL LIQUIDS: Skim milk, Low
fat cream soups, Hot cream cereals
(Cream of Wheat), V-8 juice, Sugar free
pudding, Sugar free/fat free smooth
yogurt, Fat free broth, Sugar free
gelatin, Sugar free Popsicles,
unsweetened tea, coffee, unsweetened
fruit juice, sugar free drink mixes.
Crackers may be tolerated if desired
with soup.
TIPS:
• Add powdered skim milk powder to
liguid milk to increase the protein
content. 2-4 Tbsp. per cup of milk (1
Tbsp adds 3 grams protein)
• Soy or Whey protein powders can be
added to milk or soups. Look for powders
that contain 1 gram or less of sugar per
serving.
Yogurt Smoothie High Protein Milkshake
8 ounces vanilla yogurt (low fat/low
sugar) %a cup sugar free ice cream
%z cup skim milk %4 cup skim milk
1 cup frozen fruit (no syrup) 4 Tbsp.
dry milk powder
*Blend on high until smooth *Blend until
smooth
TIPS
• Add powdered skim milk to liquid milk
to increase the protein content: 2-4
Tbsp. per cup of milk (1 Tbsp. adds 3
grams protein)
• Yogurt Smoothie: 8 ounces vanilla
yogurt, %z cup skim milk, 1 cup frozen
fruit (NO syrup) - Blend on high until
smooth.
High Protein Milkshake: % cup sugar free
ice cream, '/4 cup skim milk, 4 Tbsp.
dly milk powder - Blend until smooth.
Puree Diet
General Description: "Solid" foods are
introduced but must be of puree
consistency -smooth and creamy; requires
no chewing. One ounce servings as
tolerated continues. Continue to avoid
high sugar/ high fat foods.
Emphasis should be placed on:
1. Selection of protein rich lean meats,
poultry, fish. Eggs, low fat cottage
cheese and creamy peanut butter also
provide protein.
2. Including at least 8 ounces of skim
milk daily ( provides protein, calcium,
fluid)
3. Maintaining hydration status with
adequate fluid intake. DRINK WATER!
4. Eating very slowly! (30 minutes per
meal)
HINTS:
Baby foods are often used as they are
"ready to eat" and the proper
consistency.
Puree meats, vegetables, and fruits are
allowed. You may eat mashed potatoes in
one ounce servings but try to limit t0
110 more than 4 ounces per day.
Try to eat at least 6 ounces of lean
puree meat per day, in one ounce
portions, in addition to your milk
intake.
Puree fruits ( i.e. applesauce, baby
peaches, baby pears, baby bananas, etc.)
and puree vegetables ( i.e. baby green
beans, squash, carrots, etc.) provide
important vitamins and minerals as well
as healthy carbohydrates.
Ice cube trays are handy for storing
home made puree food portions. Each ice
cube section holds approximately one
ounce.
- Avoid very hot or cold foods unless
well tolerated.
- Sugar free Metamucil or Milk of
Magnesia may be helpful if constipated.
*Avoid drinking liquids with you "solid"
food. There is not enough room in your
stomach for both. Stop drinking about 30
minutes before you eat and wait 30-60
minutes after you've eaten to resume
drinking liquids.
Soft Diet
General Description: Solid foods that
are easy to chew and digest are allowed.
Raw vegetables and fruits (unless ripe
and soft) should be avoided. Meats may
be better tolerated if chopped or
ground. Continue to avoid high sugar and
fatty foods.
Recommended Foods:
Meats: Chicken, Turkey, Fish, Lean Pork.
Lean Beef is allowed but may be harder
to digest - chew very well and eat very
slowly!
Other Protein Foods: Soft cooked eggs,
Low fat cottage cheese, Low fat cheese,
Low fat creamy peanut butter, dried
beans (cooked well), Tofu
Starches: Potatoes (no skin), rice,
noodles, ready-to-eat corn or rice
cereals ( i.e. grits, Corn Flakes, Rice
Krispies, etc.), bread. *Avoid high
fiber/ bran foods and anything with nuts
or seeds
Vegetables: Soft canned vegetables.
Fresh or frozen vegetables are allowed
if cooked well.
Fruits: Soft canned fruits, no sugar
added. Fresh fruits are allowed if soft
- no skins! No citrus fruits or
membranes.
HINTS:
- Begin to develop a more regular meal
schedule instead of grazing all day
long.
- Try 3 meals, 3 snacks. Continue to
drink fluids throughout the day but do
not drink beverages at the same time you
are eating. (discussed earlier stage)
- You may attempt to eat 2 ounce
portions of meat at "meal time" if
tolerated. DO NOT overeat to the point
of discomfort.
- Eat slowly. Allow 30 minutes to eat a
meal.
- ALWAYS EAT YOUR. PROTEIN FOOD FIRST!
Sample Meal: 1-2 ounces Meat/ Protein
food
1-2 Tbsp. "side dish" (vegetable and/or
fruit)
Regular Post Gastric Bypass Diet
General Description: A regular diet now
means that you can eat anything you want
as long as you can tolerate it. You will
likely find that foods you have eaten in
the past are not tolerated well now.
This is because of the small stomach
size and decreased stomach acids for
digestion. Some foods may be better
tolerated with time to come. You are
encouraged to consistently eat low fat
and low sugar foods for healthy weight
control.
REGULAR POST GASTRIC BYPASS DIET: SAMPLE
DAY
7:00 AM 2 ounces beverage (water)
7:30 AM 2 ounces beverage (water)
8:00-8:30 AM Breakfast: 2 eggs; 2 Tbsp.
applesauce
9:00 AM 2 ounces beverage (coffee)
9:30 AM 2 ounces beverage (skim milk
with 1 Tbsp. dry milk powder)
10:00 AM 2 ounces beverage (water)
10:30-11:00 AM Snack: '/4 cup (2 oz.)
low fat cottage cheese
11:30 AM 2 ounces beverage (skim milk
with 1 Tbsp. dry milk powder)
12:00 PM 2 ounces beverage (diet
lemonade)
12:30-1:00 PM Lunch: 2 ounces lean meat;
2 Tbsp. vegetable
1:30 PM 2 ounces beverage (tea)
2:00 PM 2 ounces beverage (tea or water)
2:30 PM 2 ounces beverage (skim milk
with 1 tbsp. dry milk powder)
3:00 PM 2 ounces beverage (water)
3:30-4:00 PM Snack: 2 Tbsp. dry roasted
nuts or seeds
4:30 PM 2 ounces beverage (water)
5:00 PM 2 ounces beverage (skim milk
with 1 Tbsp. dry milk powder)
5:30 PM 2 ounces beverage (water)
6:00-6:30 PM Supper: 2 ounces lean meat;
1 Tbsp vegetable; 1 Tbsp. fruit
7:00 PM 2 ounces beverage (tea)
7:30 PM 2 ounces beverage (skim milk)
8:00 PM 2 ounces beverage (water)
8:30-9:00 PM Snack: '/4 cup (2 oz.) low
fat, sugar free yogurt or pudding
9:30 PM 2 ounces beverage (water)
10:00 PM 2 ounces beverage (skim milk
with 1 Tbsp. dry milk powder)
10:30 PM 2 ounces beverage (water)
11:00 PM 2 ounces beverage (water)
This menu provides approximately 910
calories, 87 grains protein, 44
ouncesfluid per day. This is minimal
fluid - try to drink more water through
the day!
SAMPLE MENUS AFTER GASTRIC BYPASS
Brea&Last Ideas
D 1 poached egg with % slice crumbled
bacon over it; I canned peach half
D I -2 scrambled eggs; 2 Tbsp. oatmeal
with milk.
D 3 Tbsp. ground ham; 2 Tbsp. grits; I
canned pear half
D '/2 slice thin bread with cheese,
toasted
D 3 Tbsp .cottage cheese with 1 Tbsp.
chopped canned peaches
D I egg/cheese/mushroom omelet; 4 grapes
D 3 Tbsp. shredded beef in 1 Tbsp. cream
sauce over %i slice thin toast
D 1 slice cheese with 2 saltine
crackers; 2 Tbsp. applesauce
D 2 Tbsp. smooth peanut butter on 1
cracker with 1 Tbsp. plain yogurt
Lunch and/or Supper Ideas
D 1 % inch square of milk meatloaf; 1
Tbsp. green beans
D 3 Tbsp. baked chicken with broth; I
Tbsp. rice; 1 Tbsp. greens
D 3 Tbsp. flaked fish 3 Tbsp. canned
peas
D I slice cheese melted over 2 Tbsp.
macaroni; 1 small broccoli flower
D 4 Tbsp. beef-rice casserole; 1 Tbsp.
green beans
D I-2 ounce meatball; 1 Tbsp. mild
spaghetti sauce; 2 Tbsp. noodles
D 3 Tbsp. canned salmon; 2 asparagus
tips; 2 Tbsp. applesauce
D I-2 ounces pork roast; 1 Tbsp. mashed
potatoes with %Z tsp. margarine; 3 beet
slices
D 2 ounces stewed chicken; 1 Tbsp.
noodles; 1 Tbsp. soft cooked carrots
D 1-2 ounces roast turkey with broth; 1
Tbsp. mashed sweet potato; I-2 Tbsp.
stewed summer squash
D 1-2 ounce tender roast beef with
broth; I Tbsp. baked potato with Y2 tsp.
margarine; 1 small broccoli flower
D 1-2 ounces ham; 1 Tbsp. greens; 1
Tbsp. mashed sweet potatoes.
D 1-2 ounces beef stew meat; 1 inch
potato cube; 2 carrot pieces
D I ounce mild cheese; 2 Tbsp. baked
beans; 1 Tbsp. tomato sauce
D 1-2 ounces baked veal cutlet; 1 Tbsp.
buttered noodles; 1 small cauliflower
flower
D 3 Tbsp. tuna; 2 Tbsp. noodles; 1 Tbsp.
peas - mix in form of tuna noodle
casserole
Between Meals
D Minimum of 6 cups fluids per day! Take
30 -45 minutes before or after your
meals.
D Include = plain water, skim milk (8-12
ounces/day), orange juice (6-8 ounces)
-diluted if better tolerated, other
unsweetened juice (4 ounces)
D Protein drinks are recommended if you
have trouble eating meats - preferably
low sugar varieties. Example: sugar free
Carnation Instant Breakfast; Designer
Whey beverage or protein powder
(available in GNC stores)
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PROTEIN COUNTER
To ensure that your diet is adequate in
protein, use this list to count the
number of grams that you eat in a day:
I ounce of meat (beef, pork, poultry, or
fish) = 7 grams
1 whole egg = 7 grams
I/4 cup egg beaters = 5 grams
8 ounces of milk (skim or 1%) = 8 grams
I/2 cup beans = 6-8 grams of protein
I/2 cup starchy vegetables (like
potatoes), rice, pasta = 2-3 grams
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Our offices are located in:
Rock Hill, SC (803-324-5858) and Chester, SC
(803-581-0233)
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