Bariatric Surgery

Dietary Guidelines After Bariatric Surgery

Your diet after gastric bypass surgery should begin with very small portions and eating small frequent meals. The volume of your smaller stomach pouch is less than a quarter of a cup -- equivalent to 60 cc or 2 ounces. Over time your stomach volume will increase to one-half to three-quarters of a cup. The opening from the stomach into the small intestine is very small. Liquids will empty faster from your stomach than soft solids.

These diet guidelines are designed to limit calories while providing a balanced meal plan to help prevent nutrient deficiencies and preserve muscle tissue.

General Guidelines

• Eat slowly and chew foods thoroughly.
• Avoid rice, bread, raw vegetables and meats that are not easily chewed such as chicken, pork and steak. Ground meats are usually better tolerated.
• Avoid use of straws, carbonated beverages and chewing ice because it introduces too much air into your pouch that will cause discomfort.
• Eat balanced meals with small portions.
• Concentrate on following a diet low in calories, fats and sweets.
• Keep a daily record of your food portions and calorie intake.
• Follow-up with a dietitian after discharge.

Fluids

• Drink extra water and low- and calorie-free fluids between meals to avoid dehydration.
• Sip approximately 1 cup of fluid between each small meal, 6 to 8 times a day.
• Drinking at least two liters (64 ounces or 8 cups) of fluid a day is recommended.

Protein

Preserve muscle tissue by eating foods rich in protein. High protein foods are meats, fish, tuna, poultry, cottage cheese, eggs, tofu, yogurt and milk products.

Vitamins and Minerals

• A daily multivitamin with minerals supplement is recommended because decreased food intake, changes in food selections and a decrease in total stomach acid can lead to inadequate intake.
• A liquid form of multivitamin or chewable vitamins may be better tolerated in the first 8 weeks after surgery.
• Additional folic acid and iron may be needed. Taking a prenatal multivitamin instead of a standard multivitamin helps to meet these needs.
• Vitamin B-12 supplementation may be needed in the future. Your primary care provider should monitor blood levels of vitamin B-12.
• Calcium deficiency can occur. A supplementation of 1000 milligrams of calcium is suggested. Take 500 milligrams of calcium two times a day to enhance absorption. TUMS may be used as a calcium supplement.

Diet Progression

In the Hospital

You will receive clear liquids such as diluted juices, jell-o and broth as your first meal following surgery. These foods are high in sugar content but your portions are very small and this is allowable at this early stage. Gradually increase the amount you drink at each meal as tolerated.

After Discharge and for the Next Two Weeks

Begin adding thicker liquids that are low in fat and sugar. The goal is to eat small portions that will empty easily from your pouch. Begin with portion sizes of only 1 tablespoon with increase to 2 tablespoons as tolerated. Begin drinking ¼ cup of liquids at a time with increase to a ½ cup as tolerated.

Recommended foods include:

• Nonfat or 1 percent milk
• Lactose -free or soy-based low-calorie drinks if you do not tolerate milk
• To increase protein add 2 tablespoons nonfat dry milk powder or egg substitute to each half cup of nonfat or low-fat milk
• Diet pudding
• Sugar-free or nonfat yogurt
• Low-fat cottage cheese
• Blended broth based or low-fat soups
• Hot cereals (refined cereals low in fiber such as cream of rice or cream of wheat -- not oatmeal -- made with increased liquid to a soup-like consistency
• Optional for the first two weeks only are high-protein supplement diet drinks with no sugar added (less than 200 calories and more than 20 grams of protein in an 8 to 11 ounce serving)

Remember to drink 1 cup of water or other non-caloric fluids between meals. Take a multivitamin supplement everyday.

After Your First Outpatient Follow-Up Visit

For the next two to four weeks, begin adding small portions of pureed and soft foods as tolerated including applesauce, canned fruits, well cooked pureed vegetables, hot cereals, mashed potatoes, noodles, scrambled egg whites or egg substitute, canned tuna fish, lean fish, ground meats or poultry.

Recommended Meal Plans

Weeks Two to Eight

This meal plan is recommended for weeks 2 through 8, and can be followed for up to two months. At this time intake usually is no greater than 500 calories and is taken in six to eight small meals a day. Recommended portion sizes are a ¼ cup for solids and a ½ cup for liquids.

• Breakfast -- ¼ cup hot cereal made with nonfat milk

• Mid-Morning -- ½ cup nonfat milk

• Late Morning -- ½ cup tomato juice

• Lunch -- ½ cup low fat chicken noodle soup

• Mid-Afternoon -- ¼ cup low fat cottage cheese

• Late Afternoon -- ¼ cup juice packed canned fruit

• Dinner -- 2 ounces ground meat and ¼ cup pureed or well cooked vegetables

• Bedtime Snack -- ½ cup nonfat milk

Remember to drink 1 cup of water or other non-caloric fluids between meals. Take a multivitamin supplement everyday.

Two to Six Months After Surgery

This meal plan is recommended for two to six months after surgery. At this time intake usually is 900 to 1000 calories and at least 65 to 75 grams of protein a day.

Your daily servings for balanced nutrient intake should include:

• 3 milk or dairy servings (nonfat and low-fat varieties)
• 3 meat or meat alternate servings (lean and low-fat varieties)
• 3 starch servings (avoid bread and rice)
• 1 fruit serving (avoid dried fruits and fruits with skin)
• 2 vegetable servings (well cooked only)

Recommended portion sizes are ¼ cup for solids and ½ cup for liquid. Discontinue taking high protein diet supplement drinks.

• Breakfast -- 1 egg or ¼ cup egg substitute and ½ cup hot cereal

• Mid-Morning -- ½ cup nonfat milk

• Late Morning -- ½ cup tomato juice

• Lunch -- ½ cup low fat chicken noodle soup and 2 saltine crackers

• Mid-Afternoon -- ¼ cup low fat cottage cheese and ¼ cup water or juice packed canned fruit

• Late Afternoon -- ½ cup sugar free nonfat yogurt

• Dinner -- 2 ounces lean meat or fish, ¼ cup mashed potatoes and ¼ cup pureed or well cooked vegetables

• Bedtime Snack -- ½ cup nonfat milk

The sample menu offers eight small meals a day. You may wish to eat more or less often than shown on the sample menu. Be sure to eat at least six times each day.

Remember to drink 1 cup of water or other non-caloric fluids between meals. Take a multivitamin supplement everyday.

After Six Months

Continue the goal of 900 to 1000 calories a day with a decrease to three meals and only one to two snacks each day. Discontinue taking high protein drinks. Increase variety of low-fat, low-sugar and low-calorie foods as tolerated. Avoid raw vegetables, fruits with skins, dried fruits, breads, rice, popcorn, nuts and red meats only if poorly tolerated.

Long-Term

Over time, you will be able to increase the variety and consistency of foods in your diet. Some foods may continue to be poorly tolerated including red meats, breads, rice, high-fiber fruits and vegetables. Focus on low fat, low sugar and low calories foods and continue to count your calories every day.

For more information or to request an appointment with a registered dietitian, please contact the UCSF Nutrition Counseling Center at (415) 353-1461.

• Bariatric Surgery Overview
• Life After Bariatric Surgery
• Bariatric Surgery Procedures

Reviewed by health care specialists at UCSF Medical Center.
Last updated February 14, 2008

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.