Diet and nutrition after Bariatric and Metabolic Surgery
The average post-surgical diet moves slowly through several phases as advised by the surgeon. This slow dietary advancement is necessary to ensure proper healing, prevent micronutrient deficiencies, maximize weight loss, prevent loss of lean body mass and develop lifelong healthy eating habits. Patients are required to follow a special diet with protein and hydration goals as recommended by the medical team. Patients begin with clear liquids and then gradually incorporate full liquid, pureed, soft foods and solid foods into meals. The average post-surgical diet moves through the following several phases under the direction of the surgeon:
Liquid Phase
Patients typically need to maintain a liquid diet for 2 weeks after surgery. The first week, only clear liquids are recommended. Some options include clear/water based/sugar-free/milk-free/caffeine-free protein drinks, water, sugar-free carbonation free drinks, diluted/un-sweetened fruit juice, beef/chicken/vegetable broth, jello, or sugar free ice pops. For the following week, in addition for clear liquids, patients can choose other protein drinks/powders, fat-free, skim, Lactaid or soy milk, plain, low sugar, or no-fruit added, non-greek yogurt, sugar free pudding made with fat-free milk, v8 vegetable juice or tomato juice.
Puree Phase
Once it is shown that liquids are tolerated, patients may be able to handle strained or pureed foods. These meals should be free of any small solids, having the consistency of smooth, thick liquids. To achieve the desired flavor and consistency, foods should be pureed and can be combined with many of the above liquids. Common pureed food choices include:
- Cottage cheese, light or fat-free ricotta cheese
- Low sugar, low fat, non-fruit added Greek yogurt
- Scrambled eggs, mashed/pureed beans/lentils
- Well-cooked/pureed vegetables
- Strained soups, blended till smooth
- Some fruits, such as fruit canned in juice or unsweetened apple sauce
Soft Food Phase
With clearance from their physician, patients may incorporate soft, non-pureed foods into their diet. The typical recommendation is between three and five small meals per day. Food should be soft, kept moist, and cut into small pieces. Several foods may be added during this stage of the post-bariatric diet, such as:
- Flaked fish
- Well-cooked, non-fibrous vegetables
- Eggs
- Beans and Legumes
- Ground chicken and turkey
Solid Food Phase
Patients may begin to incorporate solid foods into their diet about eight weeks after surgery. With each meal totaling about 1 to 1-1/2 c of food, patients may begin with three meals per day. The focus should be on protein first and follow with veggies and a small amount of whole grain carbohydrates. You want to avoid:
- Foods high in saturated fats
- Carbonated beverages
- Slider/snack foods like chips and pretzels
- Fried food
- Food high in sugar
- Tough/stringy/fibrous meats/vegetables
- Dry meat
- Starchy foods
- Popcorn, nuts, seeds
Please note: The dietary recommendations for patients may vary depending on an individual’s needs and health status. Food should be reintroduced slowly with only one food tried at a time to check for tolerance. A physician will provide specific guidance after surgery and guide when to begin each stage.
Key Dietary Guidelines for Recovery
While moving through dietary phases during the recovery period, the slow incorporation of new foods helps ease each transition. Patients should also eat every meal slowly, chew thoroughly, put their fork down between bites, use a small plate and stop eating when they feel comfortably full. Additional guidance will be provided. Some other guidelines include:
Hydration
Patients should pay special attention to their fluid intake, aiming to drink 64 oz of fluid per day. They should take small sips slowly, avoid gulping, and avoid the use of a straw. Adequate hydration is important for bariatric surgery patients in many ways, including easing and preventing the following ailments:
- Nausea
- Potential kidney problems
- Constipation
- Fatigue
Maintaining a Well-Balanced Diet
Patients should strive for delicious, well-balanced meals that contain protein, starch, fruit/vegetable, and healthy fat, each in the right portion sizes. Receiving enough lean protein is a key component. Depending on the patient, it is typically recommended to take in between 60 and 100 grams of protein per day. Focusing on protein-rich foods can help combat weakness and muscle loss. Ideal sources of protein for post-bariatric surgery patients include:
- Fish
- Lean meats, such as turkey or chicken breast
- Low-fat deli meats
- Eggs or egg substitutes
- Soups
Vitamins and Supplements
It is recommended that patients take vitamin and mineral supplements daily for life after bariatric and metabolic surgery. Vitamin and mineral supplements help ensure patients receive the nutrition their bodies need to heal, avoid nutritional deficiencies and thrive in the long term. Vitamin/mineral supplements should be chewable until cleared by the surgeon. Patients will be monitored at follow-up appointments and through routine blood testing. Along with a multivitamin, the recommended supplements may include:
- Vitamin B-12
- Calcium
- Vitamin D
- Iron
- Folic acid
Shakes and Liquid Diet
It may be recommended that patients begin using protein supplements to ensure adequate nutrition intake. This is also helpful for patients having trouble meeting protein recommendations through everyday meals. Flavored and non-flavored protein powders are available and easily incorporate in a blender with the following:
- Yogurt
- Fruit
- Soups
- Sugar-free juices
In many cases, protein supplements are typically recommended over meal replacements for their low carbohydrate and fat content.
