St. Luke’s –
Roosevelt Hospital Center
Center for Bariatric Surgery
and Metabolic Disease
Your Guidelines for
Food Choices and Nutrition
DIET GUIDELINES FOLLOWING
GASTRIC BYPASS SURGERY
and
GASTRIC
BANDING SURGERY
These guidelines are
to help you choose, prepare and eat foods after gastric bypass and gastric
banding surgery. There will be certain
foods you will need to avoid and your portion sizes will be much smaller than
before because the new pouch will hold only a small amount of food. Although it
will take several weeks, you will be able to eat regular foods again.
The Gastric Bypass procedure creates a very small gastric pouch
with a narrow connection to a bypassed segment of the small intestine. Because
the size of your functioning stomach is much smaller and the opening from the
stomach to the small intestine is narrower than before surgery, you will need
to make changes in the way you eat.
The Gastric Banding procedure places an
adjustable band around the upper part of your stomach, dividing the stomach
into two sections, creating a new small stomach pouch above the band with a
narrow outlet (stoma) into the lower stomach below the band.
AFTER SURGERY
√ Initially,
your stomach will only be able to hold 2-3 ounces of food at a time.
√ Start
slowly and introduce one new food at a time.
√ Eat
slowly. It should take at least 30
minutes to eat a meal.
√ STOP
eating if you feel pain, fullness, discomfort, nausea, or vomiting. Occasional vomiting is common and food
intolerances vary on an individual basis.
If a food is not tolerated, reintroduce it a week later.
√ 
You may experience changes in taste and
appetite. You may not feel hungry or want to eat, but it is important to eat at
regular intervals in order to recover from surgery and stay healthy.
You may experience changes in taste and
appetite. You may not feel hungry or want to eat, but it is important to eat at
regular intervals in order to recover from surgery and stay healthy.
√ Large
pieces of food will not easily pass through the narrow connection. You will
need to choose soft foods and chew foods very well when your diet progresses to
regular texture.
√ Food
will pass through the stomach at a much slower rate than before the
surgery. Consequently, you will feel
full sooner and will stay satisfied longer.
√ Avoid
high fat foods and foods with added sugar. Patients that undergo gastric bypass
surgery may experience an adverse side effect known as Dumping syndrome (pg 14).
Gastric banding patients usually do not experience this syndrome; however these
foods should still be avoided.
√ Drink
at least 6-8 cups (48-64 oz) of fluids daily to prevent dehydration.
√ Do
not drink beverages with your meals.
Gastric
Bypass: You will need to supplement your
diet with a multivitamin, calcium and iron daily for the rest of your life.
Gastric
Band: You will need to supplement your
diet with a multivitamin for the rest of your life.
DIET PROGRESSION FOLLOWING
GASTRIC BYPASS SURGERY
and
GASTRIC BANDING SURGERY
The gastric bypass and lap band surgery diets
are designed to provide adequate fluids and nourishment while promoting weight
loss after surgery. The diet is divided
into three stages:
Stage I:
Clear liquid diet and protein supplement
·
Gastric
Bypass: Begins the day after surgery, and last for at least 1
week. If no problems are experienced with clear liquids, your surgeon will add
a high protein liquid supplement to your diet when you go home from the hospital.
·
Gastric
Banding: Begins the day of surgery, and last for at least 2 weeks.
If no problems are experienced with clear liquids, your surgeon will add a high
protein liquid supplement to your diet when you go home from the hospital.
·
Please
do not advance the diet without speaking to the surgeon, nurse practitioner, or
dietitian.
Stage II:
No Concentrated Sweets, Low-fat Puree diet
·
Gastric
Bypass: Lasts up to approximately 3 week after surgery. During
this stage the surgeon will progress your diet to pureed foods. All
foods are blended to the consistency of applesauce.
·
Gastric
Banding: Lasts up to approximately 2 weeks after surgery. During
this stage the surgeon will progress your diet to pureed foods. All
foods are blended to the consistency of applesauce.
·
Please
do not advance the diet without speaking to the surgeon, nurse practitioner, or
dietitian.
Stage III: No Concentrated Sweets, Low-fat diet
·
Gastric
Bypass and Gastric Banding: Depending on your progress, approximately one
month after surgery, your diet will be advanced to a regular texture no concentrated sweets low-fat diet.
·
Please
do not advance the diet without speaking to the surgeon, nurse practitioner, or
dietitian.
STAGE I
POST - OPERATIVE DIET
GUIDELINES
·
Only clear liquids are allowed
initially. Avoid sweetened beverages unless sweetened with a sugar substitute.
·
Please follow the 4 x 4 rule after your surgery. Start off with 1 ounce of liquid
sipped slowly over 1 hour. As tolerated,
fluids will be increased in 1 ounce increments every 4 hours to a goal
rate of 4ounces / hour while awake.
·
Use the guide on the next page (page
6) to help you keep track of how much you are drinking.
·
The
hospital will send normal sized portions of liquids. It will be up to you to regulate how much you
consume.
·
A minimum of 48-64 oz. (6-8 cups) of
liquids should be consumed daily to replace fluid losses and prevent
dehydration. It should take you 12-16
hours to drink 48-64 oz. of liquid.
·
Liquids should be sipped very slowly
to avoid stretching your pouch. Do not
use a straw. Drinking through a straw can overfill your pouch with liquid and
air. If the pouch gets full very quickly,
you may experience nausea, vomiting and pain.
·
Avoid caffeinated, carbonated, and
alcoholic beverages.
·
STOP DRINKING IF YOU FEEL FULLNESS,
PAIN, OR DISCOMFORT.
·
The Stage I diet is inadequate in all
nutrients, as it does not have enough calories, protein, vitamins, and minerals
for good health. For gastric banding
patients it is necessary to add a daily chewable multivitamin. For gastric bypass patients it is necessary
to add a chewable multivitamin, chewable calcium citrate with vitamin D, and
iron pill. (see Dietary Supplement sheet-pg 11). It is also necessary to supplement your diet
daily with a protein supplement when advised by your surgeon.
4 x 4 RULE
Please follow the 4 x 4 rule after surgery,
which is outlined on the previous page (pg 5).
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Quantity in ounces
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Check: once complete
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Time
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1 oz
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1 oz
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1 oz
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1 oz
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Increase to 2 oz /
hour as tolerated for the next 4 hours.
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2 oz
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2 oz
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2 oz
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2 oz
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Increase to 3 oz /
hour as tolerated for the next 4 hours.
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3 oz
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3 oz
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3 oz
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3 oz
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Increase to 4 oz /
hour as tolerated for the next 4 hours.
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4 oz
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4 oz
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4 oz
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4 oz
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·
You will need to drink 48 – 64 oz of
liquids per day to stay hydrated. Remember you cannot drink
more than 4 ounces over a 1 hour period.
It should take you 12 – 16 hours to drink 48 – 64 oz of liquids.
STAGE I: CLEAR
LIQUIDS
HOSPITAL
STAY
The
hospital will send normal sized portions of these liquids. It will be up to you to regulate how much you
consume. Please follow the 4 x 4 rule (pg 5)
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Breakfast
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Lunch
|
Dinner
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Diet gelatin
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Diet gelatin
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Diet Gelatin
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Water
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Water
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Water
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Decaf tea
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Decaf tea
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Decaf tea
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Lemon
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Lemon
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Lemon
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Broth
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Broth
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Broth
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Sugar Substitute
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Sugar Substitute
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Sugar substitute
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Apple/Cranberry juice
(Dilute 1:1
Juice: Water)
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Apple/Cranberry juice
(Dilute 1:1
Juice: Water)
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Apple/Cranberry juice
(Dilute 1:1
Juice: Water)
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Remember: Stop drinking if you feel fullness, pain, or
discomfort.
WHEN YOU GO HOME
Upon
discharge from the hospital, your goal will be to continue to consume 4 oz’s.
( ½ cup)
liquid per hour while awake with a goal of 48-64 oz’s (6-8 cups) per day. It
should take you 12-16 hours to consume
48-64 oz’s of liquid.
You may select from
the following beverages:
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Crystal Light
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Decaffeinated Tea
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Water, Smart Water
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Diet Snapple
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True Lemon,True Lime, True orange
flavor packets
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Flavored, Calorie Free Water
-Fruit20
-Dasani
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Diet Wyler’s lemonade
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Diet Twister®
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Herbal Tea
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Sugar-free Kool-Aid
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Diet V-8® Splash
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Broth or Consommé
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Sugar-free ice pops
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Diet Tang®
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Miso soup
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Sugar-free gelatin
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Ocean Spray lite juice
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Roses® lime juice diluted with water
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Important Notes:
·
Avoid
juices once
you leave the hospital, they have too many calories. 64oz of juice has 960calories!
·
Taste
changes,
such as heightened sensitivity to artificial sweetener, may occur after
surgery. You may also develop a preference
for hot, cold, or luke warm beverages.
·
Electrolyte enhanced water (Smart
Water) and water infused with fruit (lemon with water) are well tolerated.
Remember do not eat the fruit; it is there to add a touch of flavor.
PROTEIN SHAKES
Protein is the most important nutrient after surgery
for healing. It is very important to
ensure you are getting at least 70 grams a
day from a protein drink to help meet your daily needs. Protein shakes are initiated the day after
you go home from the hospital. As your
diet advances and food is introduced (more protein is coming from food) your
dietitian will evaluate your protein intake and reduce and eventually eliminate
the protein shakes.
There are various brands of protein supplements available. When you visit the Vitamin Shoppe or GNC, the
choice may be mind-boggling. Each brand
has its own flavor, taste, and texture. You may need to experiment with a
variety of them before finding your favorite.
Purchasing sample packets at stores or on the internet is a great way to
see what flavor, texture, and type of protein powder you prefer.
Please refer to “The Protein Powder Packet” section to help guide you. Here you will find useful information
including:
1.
List of protein supplement suggestions
2.
Tips
3.
Blender information
4.
Recipes
5.
And more….
KEEP A FLUID
JOURNAL
Keeping a liquid journal will help you to monitor
your intake and tolerance to liquids. The records will also be helpful for your
dietitian to provide suggestions for better tolerance or fluid balance.
On the following pages you will find a sample menu
and a blank menu. Use the sample menu as a guide, and make sure to fill out the
blank menu on a daily basis after surgery.
You may make copies of the blank template provided or purchase your own
journal.
Please follow the instructions below.
Record the:
1.
Time
2.
Amount of liquid
3.
Type of liquid
**Please remember to
bring these records with you for the dietitian to review.
√ Drink adequate fluids to prevent dehydration. Aim for 48-64 oz (6-8 cups)
of liquids per day.
√ Purchase beverages with less than 5-10 calories per serving.
√ Beverages must be sipped slowly,
not gulped.
Tip: Do not use straws. Try sippy cups or a sports top water bottle to
slow you down. Keep fluids with you all day long.
STAGE 1:
CLEAR LIQUID DIET
SAMPLE MENU
Below you will find a sample menu for stage 1 clear liquid diet.
PROTEIN SHAKE INFORMATION:
Name: _Designer Whey Protein___________
Protein per scoop.____18grams__________
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Time
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Amount of oz
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Type of Liquid
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5-6 am
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---
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---
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6-7 am
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---
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---
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7-8 am
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4 oz
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Water
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8-9 am
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4 oz
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Water
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9-10
am
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4 oz
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Protein
Supplement
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10-11
am
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4 oz
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Water
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11-12
pm
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4 oz
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Crystal
Light
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1-2 pm
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4 oz
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Broth
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2-3 pm
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4 oz
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Diet Snapple
Lemonade
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3-4 pm
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4 oz
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Diet
gelatin
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4-5 pm
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4 oz
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Protein
Supplement
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5-6 pm
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4 oz
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Water
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6-7 pm
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4 oz
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Sugar-free
ice pop
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7-8 pm
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4 oz
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Protein
Supplement
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8-9 pm
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4 oz
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Water
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9-10
pm
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4 oz
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Water
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10-11
pm
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4 oz
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Water
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11-12
pm
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---
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12-1
am
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---
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1-2am
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---
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2-3 am
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---
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3-4 am
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---
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TOTAL: 56oz
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STAGE 1:
CLEAR LIQUID DIET
BLANK MENU
Below you will find a blank menu for the liquid diet. Use the sample menu on the
previous page to use as a guide. Please fill out on a daily basis after
surgery.
PROTEIN SHAKE INFORMATION:
Name: _______________________________
Protein per scoop:
_____________________
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Time
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Amount of oz
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Type of Liquid
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TOTAL:
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DAILY
VITAMIN AND MINERAL GUIDELINES
In addition to eating much less food, you will also absorb vitamins and
minerals differently after surgery. You
will require daily vitamins and minerals for the rest of your life.
Requirements:
·
Gastric Bypass: Multivitamin, Calcium Citrate with vitamin D, and Iron
·
Gastric Banding: Multivitamin
First
Month after surgery (Begin the day of hospital discharge):
Multivitamin
·
Due to the
large size of multivitamins, it is recommended that you chose a chewable or
liquid form.
o Centrum adult chewable: Take 1 a day.
o Centrum silver chewable: Take 1 a day.
o Prenatal chewable: Take 1 a day.
o Centrum
junior or Flintstones complete. Take 2 a day.
o Centrum
Liquid, Vitamin Shoppe Liquid multivitamin
·
Take with
food.
·
Avoid time
release vitamins. Avoid gummy texture chewable vitamins.
·
Weight loss surgery
specific vitamins are available if you are interested; however they are not
covered by insurance. (celebratevitamins.com. bbvitamins.com)
Calcium Citrate with vitamin D
·
Chewable or
liquid form is recommended. The daily requirement for calcium intake is
1200-1500mg. This level is important to
maintain in order to prevent osteoporosis.
·
Calcium citrate is the most appropriate type of calcium for weight loss surgery
patients. Citrate is easily absorbed and
is not required to be taken with food.
o Citracal + Vit D
o Calcium citrate 600mg + D
o UpCal + vitamin D
o Twin Labs Calcium Citrate chewable wafers
o DO
NOT PURCHASE CALCIUM CARBONATE.
·
Our bodies
can only absorb 500-600mg of calcium at one time; therefore calcium
supplementation must be spread out over the day.
o Please read the nutrition label carefully for dosage
recommendations.
·
Do NOT take
calcium with iron (take iron 2-4 hours apart. It will interfere with
absorption).
Iron
·
Iron is
prescribed by your doctor or nurse practitioner.
o Vitron-C, Ferretts, Ferrimin 150, Ferrex 150 Forte,
Niferex 150 Forte,
·
Iron is best
absorbed on an empty stomach. Vitamin C
enhances absorption.
·
It may be
taken with food to reduce stomach distress; however food reduces absorption by
50%. Avoid time release iron pills
·
Do NOT take
with bran, fiber supplement, tea, coffee, dairy products or eggs.
NEVER
FORGET TO TAKE YOUR
DAILY
VITAMINS AND MINERALS AGAIN!
Instructions: Create your own
schedule similar to the sample schedule shown on the left. Use the information on the previous page to
help you plan your daily schedule.
*Please remember to bring these with you to
your appointment for review*
Things to Remember:
- Multivitamin: Chewable or
Liquid form is best in 1st month after surgery.
- Calcium Citrate with Vitamin D: is the only
form of calcium that you should be taking.
- Do
NOT take calcium with iron (Take 2-4 hours apart)
- Do
NOT take more than 500-600mg of calcium at one time.
- Vitamin
and mineral supplements ARE for life!
|
Time
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My
Schedule
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Sample Schedule:
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Time
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My
Schedule
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Breakfast
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Multivitamin: Centrum
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Lunch
|
Calcium Citrate: 600mg
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Afternoon Snack
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Calcium Citrate: 600mg
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Bedtime
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Iron: Ferre
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SHOPPING
LIST FOR WEEK 1 AFTER
GASTRIC
BYPASS SURGERY
Purchase
the following items at least one week prior to surgery
v Multivitamin
o Centrum adult chewable, Centrum silver chewable, or
Prenatal chewable. Adults take 1 a day.
o Centrum junior or Flintstones Complete. Adults take
2 a day.
v Measuring
cup and measuring spoons
v Baby
spoon to help with meal pacing
v
Skim Plus milk, Lactaid, Soy milk to mix with Protein
Supplement
v
Sugar substitute if required.
o
Splenda,
Equal, Sweet n’ Low, Truvia, Sweet Leaf SteviaPlus Fiber.
v
Clear Liquids: Choose from the
following
|
Crystal Light
|
Decaffeinated Tea
|
Water
|
|
Diet Snapple
|
True Lemon
|
Smart Water
|
|
Diet Wyler’s Lemonade
|
True Lime
|
Calorie Free Flavored Water
|
|
Diet Twister®
|
Herbal Tea
|
·
Fruit20
·
Dasani
|
|
Diet V-8® Splash
|
Broth or Consommé
|
Sugar-free Kool-Aid
|
|
Diet Tang®
|
Miso soup
|
Sugar-free ice pops
|
|
Ocean Spray lite juice
|
Roses® lime juice diluted with water
|
Sugar-free gelatin
|
v Protein
Supplement
Designer Whey Protein:
o
One scoop three/day- Mix with 3-4oz of
Skim Plus® Milk/Fat-free Lactaid®, soy milk.
o
If you are lactose intolerant you may
not be able to tolerate certain protein supplements, such as Designer Whey.
Look for soy based and lactose free formulas. For assistance refer to their
website or ask your dietitian.
o
Other protein supplements you may
choose from include (see “Protein Powder
Packet” for a complete list): Isopure, Genisoy Ultra XT, ProBlend,
ProComplex, Proteinex.
v
Breath Freshener – You may experience
bad breath for the first month after surgery; the following products may
help: GNC Breath Relief, Chlorophyll
tablets, Devrom pills.
What is Dumping Syndrome?
Dumping Syndrome can occur after any surgery
that changes the normal way in which food leaves the stomach. It occurs when
food passes too quickly (“dumped”) from the stomach into the small intestine.
In response, water from the surrounding blood
vessels is drawn into the small intestine, usually resulting in a combination
of the following symptoms: abdominal
fullness, nausea, light-headedness, sweating, cramping, rapid heartbeat and
diarrhea. Symptoms can occur 10-20 minutes after eating a meal and/or 1-3 hours
after eating. Dumping syndrome occurs with gastric
bypass surgery, but not with gastric banding surgery.
What causes Dumping Syndrome?
Refined sugars, overeating and drinking
liquids with meals are the usual culprits. Dumping Syndrome symptoms have also
been reported with high fat food consumption.
Dumping syndrome does not occur with gastric
banding, but it is still best to avoid sweets and fried foods in order to
maximize weight loss and the nutritional value of your diet.
How can Dumping Syndrome be avoided?
·
Avoid refined sugars/sugar alcohols
(see list below)
·
Avoid all foods/liquids with added
sugar listed as one of the first three ingredients on the food label.
·
Eat small, frequent meals
·
Eat slowly and rest a little after
eating
·
Do not drink liquids with meals
·
Avoid Caffeine and very hot or very
cold liquids/foods.
Refined Sugars/Sugar alcohols to avoid
Barley Malt
Brown Sugar
Cane Sugar
Confectioners Sugar
Corn Syrup
Corn sweeteners
Dextrose
Fructose
Glucose
Granulated Sugar
Honey
High Fructose Corn
Invert Sugar
Isomalt
Lactose
Lactitol
Levulose
Maltose
Mannitol
Maple Syrup
Molasses
Raw Sugar
Sorghum
Sucrose
Sorbitol
Turbinado
Table sugar
Xylitol
NOTES:
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