Dietary Guidelines After Bariatric Surgery

If you are considering bariatric surgery, you already know that you will need to change your eating pattern to avoid unpleasant side effects and promote weight loss after surgery.

The type of dietary changes that you will need to make will depend on the type of procedure you have. As a general rule, purely restrictive procedures such as LAP BAND, which work by reducing stomach capacity, require less stringent dietary measures than do combination procedures, such as a Roux-en-Y, which both decrease stomach capacity and nutrient absorption.

Whichever surgical procedure you have, you will be given a diet progression pattern, similar to the one outlined below, to ensure healing and promote weight loss while maintaining your health.

Step 1:  Clear Liquids

Immediately following surgery, you will be prescribed a clear liquid diet (water, clear juice, gelatin, broth) served at room temperature. LAP-BAND patients usually consume clear liquids for a day or two post surgery. The more aggressive the procedure, the longer you will stay on this diet. Gastric bypass patients may not eat for a day or two after surgery before progressing to clear liquids for a few days.

Step 2: Thick Liquids and Pureed Foods

Once you can tolerate clear liquids, you will be given a full liquid diet which includes clear liquids, as well as creamed soups, liquid protein formulas, yogurt (except for berry yogurts because of the seeds they contain), and even pureed foods. People who have had a LAP-BAND procedure generally follow this diet for two weeks. People who have had gastric bypass surgery generally follow this diet for 3-4 weeks to give their stomach and intestines time to heal.

Step 3:  Soft Foods

The next step is to add soft foods like eggs, cottage cheese, sliced cheese, canned fruits, well cooked pastas, baked potatoes without the skin, rice, and crackers to the diet. LAP-BAND surgery patients usually progress to this stage of the diet by the third week. Gastric bypass patients typically consume soft foods for eight weeks before progressing to the next diet stage.

Step 4: Ground Meats and Fresh Fruit

Between the fourth and sixth week after LAP-BAND surgery, you can add meats that have been ground after cooking to your diet, and if your doctor approves, some fresh fruit. Other foods may be added gradually thereafter. Generally, gastric bypass patients do not progress to this diet stage until three months post surgery.

Step 5: Experimenting with Food Tolerances

Individual tolerance for foods like milk, bread, fibrous vegetables such as celery and corn, fried foods, spicy dishes, seeds, skins, and membranes of fruits and vegetables varies from person to person. You will need to figure out if you can tolerate these food items through trial and error. If you are not able to tolerate a nutritious food like milk the first time you consume it, you may want to try again a few weeks later. On the other hand, if you have trouble digesting fried foods, you may want to avoid them altogether since the fat and calories they add to your diet often outweigh their nutritional benefits.

Beverage Tips

• Drink at least 6 to 8 cups of liquid between meals each day, more if advised to do so by your doctor.
• Sip Fluids Slowly- use a shot glass to slow yourself down initially
• Do not drink during meals. Fluid can make you full before you have had enough nutrients or wash food through the stomach too quickly.
• Drink beverages at least 30 minutes before, or no sooner than 60 minutes after a meal.
• Except for milk, and a small serving of juice, drink calorie-free beverages. High calorie beverages can slow your weight loss results.
• Avoid carbonated beverages. They can cause discomfort and, over the long term, may stretch your stomach.

General Tips: Eat Slowly, Chew Well, Stop When Full

Eat Slowly

Eating too quickly can cause a variety of difficulties. It can cause you to feel full before you have eaten enough food or cause you pain, nausea, and even vomiting if you have overfilled your stomach.

• Allow 30-45 minutes to eat each meal
• People who have had a gastric bypass procedure may need to eat tiny meals, such as an ounce or two of high protein food, throughout the day.
• Pace yourself
• - Take tiny bites to slow your eating pace
• - Put your eating utensil down between bites
• - Use a baby spoon or chop sticks to slow yourself down
• - Chew foods at least 30 times (count them) before swallowing
• - Learn to pay attention to and appreciate the taste and texture of the food
• Explain the need for you to eat slowly to friends and family so they will support your new eating style.

Chew Well

As note above, chewing thoroughly can help you slow your eating pace. It also helps you to get the food into small enough pieces to fit through the smaller stomach opening. As a general rule, chew each bite 30 times or until it develops a mushy consistency.

Stop Eating As Soon As You Feel Full

Overeating can cause you to vomit. If you repeatedly overeat, you will stretch your new stomach, undermining the effectiveness of your surgery. Eating slowly helps you sense fullness before you overstuff yourself.

Fullness may feel different post-surgery. Here is what to watch for:

• Nausea
• A feeling of pressure in the middle of your abdomen, just below your rib cage
• Pain in your shoulder or upper chest region

Coping with Vomiting

Vomiting can indicate you have overfilled your stomach, gotten food stuck in the stomach opening, or that the food does not agree with you. It can also be triggered by lying down shortly after eating or by drinking a beverage too soon after a meal.

• If you vomit more than once during the day, stop eating solid foods and follow a clear liquid diet.
• If vomiting persists for 24 hours, call your surgeon.

Special Considerations for Gastric Bypass Patients

Gastric bypass surgery is a more aggressive procedure than LAP-BAND surgery; thus, it requires patients make additional dietary changes. After surgery, you may be able to eat only an ounce or less of food at a time.

It typically takes 3 months before a gastric bypass patient can eat 3 small meals and 2-3 healthy snacks each day.  Each meal or snack needs to contain a good source of lean protein so your body can repair and maintain its muscle, skin, and organ tissues.

You will need to avoid sugar and control your intake of white flour products to prevent dumping syndrome (nausea, vomiting, diarrhea, dizziness, and sweating caused by foods entering the small intestine too quickly and in larger quantities than normal). Remember, slow is the way to go. Take 30 minutes to eat your meals and 30-60 minutes to drink a cup of liquid.

You must be sure to take all prescribed nutritional supplements. After surgery, your body will have difficulty absorbing adequate amounts of key nutrients such as vitamins D and B₁₂ and minerals like calcium because of changes to your stomach and intestinal anatomy. Some gastric bypass patients have trouble getting enough protein, especially in the first few months after surgery. Carefully follow your doctor’s instructions regarding vitamin, mineral, and protein supplementation.

The good news is that you will achieve significant weight loss and health improvements if you make the effort to control what you eat and how you eat it.