YOUR DIET AFTER WEIGHT-LOSS SURGERY

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1 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 1 YOUR DIET AFTER WEIGHT-LOSS SURGERY

2 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 2

bariatric-diet after weight loss booklet 2017_booklet 3/21/2017 11:16 AM Page 3 Your Diet After Weight-Loss Surgery Now that you have completed your weight-loss surgery, it is important for you to

3 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 3 Your Diet After Weight-Loss Surgery Now that you have completed your weight-loss surgery, it is important for you to follow a healthy diet plan. As a general rule, adequate fluid and protein intake are essential to successful recovery. The information in this packet will serve as general guidelines to help you to determine what foods are best for you at the different stages of your recovery process. Your outpatient registered dietitian will help you customize a successful diet according to your specific tolerances and taste preferences. This nutrition expert will also provide you with other nutritional materials to help you with your diet. In the Hospital The day after surgery, when you have received approval from the surgeon, you will be able to drink 30 ml (one fluid ounce) of clear liquids. Liquids must be sipped over 30 minutes during waking hours. If this is tolerated, then on day two you will be able to drink 30 ml sipped over 15 minutes. You may choose from the following: Water Crystal Light Unsweetened decaffeinated iced tea Decaffeinated tea or coffee (Do not add cream.) Sugar-free ice pops (Popsicle ) Sugar-free, diet gelatin (Jell-O ) (Do not have red gelatin.) Clear broth Before you are discharged, you will advance to a stage 1 diet. (See PAge 3.) When you are ready to leave the hospital, a dietitian will briefly review the dietary guidelines in this packet with you. Once you are discharged from the hospital, your surgeon or dietitian will continue to assist you with your dietary needs. How Weight-Loss Diet Planning Works You will progress through four stages of dietary guidelines throughout your recovery process. If you are having difficulty with your current stage, please contact your surgeon and DO NOT advance to the next stage. ½ 1

4 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 4 The following chart describes each dietary stage you will experience based on the food type and the general period of time you are to follow the prescribed diet. Stage Recommended Diet Description Stage 1 Full Liquid Stage 2 Pureed Diet Stage 3 Soft Texture Stage 4 Healthy Diet You are able to add You are able to add blenderized protein Diet Approximately three Weight for Life Diet Plan smooth, minimal texture foods and protein supplements to your diet. Continue on this diet for approximately the first two weeks (14 days). (See PAge 3.) food sources to your diet in addition to blenderized fruits, vegetables and starches. Continue on this diet for approximately one week (7 days). (See PAge 5.) weeks after your procedure you will regain the ability to eat non-blenderized foods. Continue on this diet for approximately one week (7 days). (See PAge 8.) The general dietary recommendations in this stage will help you maintain a healthy weight for life. (See PAge 10.) Important Tips It is important that you remember the following tips throughout each stage of your dietary process: Do not use straws. Do not chew gum (may cause blockage). Do not drink at least 30 minutes before and after meals. Do not drink caffeine. Do not drink beverages with carbonation. Do not drink alcohol. Do not drink fruit juice. Do not eat citrus foods. Do not eat food high in fat and/or sugar. each meal should last 30 minutes. Always drink and eat slowly. ½ 2

5 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 5 Stage 1: Full Liquid Diet The Full Liquid Diet is generally recommended the second day after your procedure. You will now add a protein supplement to your diet. Use the recommendations below as guidelines for healthy eating during this diet stage. The foods in this section are grouped according to their food type. It is important that you choose foods from all three groups on a daily basis. To help you determine how to plan meals, a sample one-day meal plan is included at the end of this section. Fluids Group Slowly sip sugar-free, non-carbonated, caffeine-free fluids throughout the day. Remember to avoid using a straw. Drink 64 ounces of fluids per day to maintain hydration. (Do not drink within 30 minutes before and after meals.) Options: Water Fruit-flavored water Sugar-free Kool-Aid Crystal Light Unsweetened decaffeinated Iced Tea Decaffeinated tea or coffee (You may add fat-free and sugar-free creamer) Sugar-free ice pops (Popsicle ) Sugar-free gelatin (Jell-O ) Clear broth Strained cream soup (no chunks, 98% fat free and made with 1% or skim milk) Broth with one scoop of protein powder Milk or Lactaid (skim or 1%) Soymilk (plain or unsweetened vanilla) Soft Foods Group Consume ¼ to ½ cup of appropriate soft foods three times per day. Choose from the following: Sugar-free pudding made with 1% or skim milk Light, low-fat smooth (no chunks, plain or vanilla only) yogurt made with artificial sweetener (greek yogurt is an excellent choice.) Cream of Wheat made with water or skim milk Protein Supplements Group Your goal is to consume 60 grams of protein each day. You will need to gradually work up to this goal. Work with your dietitian to determine how you will meet this goal. You will need a protein supplement to reach this goal. Guidelines for Choosing a Protein Supplement Use a protein supplement that is: 3 grams of fat or less 3 grams of sugar or less 150 calories or less At least 15 grams of protein examples of ready-to-drink, commercial, high-protein, supplement drinks: eas AdvanteDge Carb Control Ready-to-Drink gnc Total Lean Lean Shake Isopure Premier Protein 100% whey protein powder (Choose any brand; can be mixed with fat-free milk; typically has 20 grams of protein per scoop.) ½ 3

6 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 6 You may make your own supplements with protein powder. examples of protein powder include Designer Whey, Zero Carb Isopure, gnc 100% Whey Protein, UNJURY and Syntrax Nectar. Sample Meal Plan for Stage 1: Full Liquid Diet Breakfast ¼ cup light yogurt examples of homemade high-protein shakes: Yogurt Shake INgReDIeNTS 4 ounces of allowed smooth yogurt 4 ounces of 1% or skim milk or Lactaid 1 scoop protein powder 1tablespoon Crystal Light Lunch Dinner Fluids Slowly sip Between Meals ¼ cup strained cream soup ¼ cup skim milk allowed fluids throughout the day. Drink 64 ounces per day. Drink high-protein supplement to help reach your goal of 60 grams of protein per day. ½ 44 DIReCTIONS Use a blender to blend all ingredients until smooth. Vanilla Shake INgReDIeNTS 8 ounces of 1% or skim milk or Lactaid 1 scoop protein powder ½ teaspoon vanilla extract DIReCTIONS Use a blender to blend all ingredients until smooth. Stage 2: examples of other high-protein foods: High-Protein Pudding You will need the Jell-O sugar-free instant pudding mix (4 servings). Measure 2 cups of cold skim milk (as indicated in package directions). Add two scoops of protein powder to the two cups of cold milk. Thoroughly mix the protein powder with the milk by shaking or stirring. Put the Jell-O sugar-free instant dry pudding mix into a bowl. Add the protein powder and milk mixture. Cream of Chicken Soup Pour 8 ounces of skim milk into a microwave-safe container. Microwave milk about one minute, then microwave 10 seconds at a time, checking the temperature each time until 130 degees. Do not heat above 130 degrees. (It is a good idea to use a meat thermometer for the first time. This will allow you to know how long your microwave takes.) Stir in one scoop (or one packet) of UNJURY Chicken Soup flavor protein powder or the unflavored style of protein powder.

7 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 7 Pureed Diet The Pureed Diet stage requires you to add pureed foods to your diet. Continue to use a high-protein supplement. Use the recommendations below as guidelines for healthy eating during this diet stage. The foods in this section are grouped according to their food type. Although the foods will be blenderized, do not mix food from different food groups. You may mix foods from the SAME food group. Steps to Preparing Pureed Foods 1. Select food from one of the food groups. 2. Use a blender or food processor to puree foods to an applesauce consistency. 3. Add low-sodium broth, low-fat gravy or low-fat milk for moisture when blenderizing meats. When pureeing foods, add only enough liquid to create an applesauce consistency. This helps maximize your protein intake in a limited amount. You are also able to eat the condiments listed below: Light or fat-free mayonnaise Mustard Fat-free spray butter Spices/herbs To help you determine how to plan meals, a sample one-day meal plan is included at the end of this section. processor. Meats need to be tender (stewed, baked or boiled) before they can be pureed. Cook in crock pot until very tender. Use light mayonnaise when blending tuna or egg. Add low-fat milk to hot cereal or mashed potatoes to increase protein content. Add 1 to 2 tablespoons of protein powder to foods to increase protein. You may add butter buds, butter spray and/or spices to season foods as tolerated. Important Tips to Remember For STAGE 2: Pureed Diet Your goal is to consume at least 60 grams of protein per day; however, you will need to gradually work up to this goal. Work with your dietitian to determine how you will meet this goal. Continue to consume two servings of high-protein supplements daily. eat protein first. Blend all foods to the consistency of applesauce. Add foods slowly and one at a time to test tolerance. Stop eating or drinking when full. Overfilling may stretch the stomach pouch and hinder weight loss. eat slowly. Sip fluid slowly. Do not eat baby food. Be sure to consume food items from each of the following groups daily. Tips for Preparing Pureed Foods Be sure to use a blender or food Fluids Group Slowly sip sugar-free, non-carbonated, caffeine-free fluids throughout the day. ½5

8 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 8 Drink at least 64 ounces of the following fluids throughout the day. (Do not drink within 30 minutes before and after meals.) Options: Water Fruit-flavored water Sugar-free Kool-Aid Crystal Light Unsweetened decaffeinated iced tea Decaffeinated tea or coffee Sugar-free ice pops (Popsicle ) Sugar-free gelatin (Jell-O ) Broth Protein Foods Group eat serving sizes between ¼ to ½ cup of pureed protein foods. Choose from the following: Pureed chicken or turkey with no skin Pureed fish (water-packed tuna) These soft fish should be mashed very fine with a fork: haddock, tilapia, cod and salmon Pureed tofu 2 scrambled egg whites or ¼ cup egg substitute Pureed fat-free refried beans Cream soups made with fat-free or 1% milk 1% cottage cheese Part-skim ricotta cheese Pudding (low fat, sugar free, no sugar added) Milk or Lactaid (skim, fat-free or 1%) Soymilk (plain or vanilla) Blended light low-fat yogurt (no chunks) made with artificial sweetener Fruits, Vegetables and Starches Group eat ¼ cup of pureed fruits, vegetables and starches once daily. Note that these foods are not rich sources of protein. Applesauce (natural, no sugar added) Mashed banana Mashed potato Canned vegetables Pureed peas Pureed carrots Pureed green beans Pureed beets Pureed acorn or butternut squash Pureed sweet potato Cream of Wheat (make with skim or 1% milk) Oatmeal (make with skim or 1% milk) Protein Supplements Group Drink 8 ounces of protein supplements two times per day. Use liquid, high-protein supplement drinks as previously listed in the Protein Supplements Groups of Stage 1: Full Liquids. You may also use alternative high-protein supplements. See list of examples (serving size included). examples of alternative high-protein supplements: High-Protein Oatmeal ½ 6

bariatric-diet after weight loss booklet 2017_booklet 3/21/2017 11:16 AM Page 9 ½ cup oatmeal Make oatmeal as directed but make with low-fat milk instead of water.

9 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 9 ½ cup oatmeal Make oatmeal as directed but make with low-fat milk instead of water. After oatmeal is cooked, stir in one scoop of protein powder (plain or flavored), until well blended. Optional: Add 2 ounces of additional milk, cinnamon and nutmeg. High-Protein Cottage Cheese Add a small amount of cold water to a scoop of protein powder (plain or flavored). Stir to make paste. Add protein-paste to ½ cup low-fat cottage or ricotta cheese. Stir until well blended. High-Protein Hot Chocolate Add a small amount of cold water to a scoop of protein powder, stir to make a paste. Add paste and one packet of sugarfree hot cocoa mixture to bottom of mug. Heat 8ounces of skim milk. Pour hot milk into mug and stir well. Optional: Add cinnamon, nutmeg, any flavor of sugar-free syrup or 1 teaspoon of fat-free whipped topping. Sample Meal Plan for Stage 2: Pureed Diet Breakfast ¼ cup egg Lunch Dinner Fluids Slowly sip Between Meals substitute or 2 egg whites and ¼ to ½ cup light yogurt ¼ to ½ cup pureed chicken ¼ to ½ cup mashed tuna with light mayonnaise and ¼ cup pureed cooked vegetables allowed fluids throughout the day. Drink 64 ounces per day. Drink highprotein supplement to help reach your goal of 60 grams of protein per day. High-Protein Cream Soup Combine one can of 98% fat-free cream condensed soup and 8 ounces of skim milk. Bring to a simmer. Add two scoops of plain protein powder and stir well. Take off heat and carefully strain any chunks of food. Pour 1 cup soup in bowl (makes two servings). Stage 3: Soft ½7

10 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 10 Texture Diet With the appropriate approval you have entered the Soft Texture Diet. At this stage, you will need to add non-blenderized foods to your diet. Use the recommendations below as guidelines for healthy eating during this diet stage. The foods in this group do not need to be blenderized. Be sure to follow these important tips: Continue to aim to consume at least 60 grams of protein per day. Work with your dietitian to determine how you will meet this goal. Wean yourself off protein supplements when you reach your protein goal through meals. eat protein foods first. Avoid mixed dishes, such as casseroles. After protein foods, eat vegetables and fruit. eat only cooked vegetables and skinless fruit. Add foods slowly and one at a time to test tolerance. Stop eating or drinking when full. Overfilling may stretch the stomach and hinder weight loss. Chew thoroughly. Foods to Avoid Soft breads, doughnuts, pastries (These may form a dough ball and block the stomach outlet.) Salads or other raw vegetables Sugar and sweets (table sugar, cakes, cookies, pies, pastries) High-fat meat (bacon, sausage, bologna, pepperoni, salami) Steak, roast beef, pork, lamb, veal, venison High-fat foods (butter, high-fat salad dressing, mayonnaise, sour cream, cream cheese, whole milk, whole-milk cheese, ice cream, cake, cookies, pies) Fibrous vegetables (broccoli, cauliflower, Brussels sprouts, corn, cabbage, salad greens, asparagus) Fresh fruit except bananas Nuts, seeds, coconut, raisins, popcorn, dried fruit Rice and pasta The foods in the following sections are grouped according to their food type. It is important that you choose foods from all three groups on a daily basis. To help you determine how to plan meals, a sample one-day meal plan is included at the end of this section. Fluids Group Slowly sip sugar-free, non-carbonated, caffeine-free fluids throughout the day. Drink at least 64 ounces of the following fluids throughout the day. (Do not drink within 30 minutes before and after meals.) Options: Water Fruit-flavored water Sugar-free Kool-Aid Crystal Light Unsweetened decaffeinated iced tea Decaffeinated tea or coffee Sugar-free ice pops (Popsicle ) Sugar-free gelatin (Jell-O ) Broth Protein Group ½ 8

bariatric-diet after weight loss booklet 2017_booklet 3/21/2017 11:16 AM Page 11 Consume serving sizes between ¼ to ½ cup of protein foods at meals.

11 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 11 Consume serving sizes between ¼ to ½ cup of protein foods at meals. Choose from: Cooked chicken or turkey with no skin; thinly sliced and moist Lean ground beef (at least 90% lean) Fish, water-packed tuna Tofu 2 egg whites Canned beans (kidney, lentils) Reduced-fat cheese Cream soups (98% fat free) made with low-fat milk 1% cottage cheese Part-skim ricotta cheese Smucker s Natural Peanut Butter Reduced Fat Jif Whipped Creamy Peanut Butter Milk or Lactaid (skim, fat-free or 1%) Soy milk (plain or unsweetened vanilla) Blended light low-fat yogurt (no chunks) Hummus (no chunks) Fruit, Vegetables and Starches Group Consume serving sizes between ¼ to ½ cup of the non-protein foods, one to two times per day. Note that these foods are not rich sources of protein. Choose from: Cooked cereal (Cream of Wheat, oatmeal) Ripe bananas Canned fruit (packed in natural juice) Vegetables cooked tender without seeds or skin boiled or well steamed Tomato sauce pureed, no seeds or skins (Do not eat pasta.) Stage 4: Healthy Weight Sample Meal Plan for Stage 3: Soft Texture Diet Breakfast ¼ cup egg Lunch Dinner ¼ cup to ½ Fluids Slowly sip substitute or 2 egg whites ¼ cup to ½ cup chicken cup tuna fish with light mayonnaise and 1 to 2 tablespoons soft cooked vegetables allowed fluids throughout the day. Drink 64 ounces per day. Between Meals Drink high-protein supplement to help reach your goal of 60 grams of protein per day. ½ 9

bariatric-diet after weight loss booklet 2017_booklet 3/21/2017 11:16 AM Page 12 for Life Diet Plan Your dietitian or doctor has determined that you are ready for the Healthy Weight for Life Diet

12 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 12 for Life Diet Plan Your dietitian or doctor has determined that you are ready for the Healthy Weight for Life Diet Plan. At this stage you should have general goals in place that will help you maintain the best nutrition and weight for the rest of your life. Healthy eating for long-term weight control will be reviewed with you by your dietitian when appropriate. Goals As you plan meals, remember to keep the following goals in mind: Keep meals low in fat. Keep meals low in sugar. eat foods adequate in protein. new protein goals are grams per day. Drink 64 ounces of fluids each day to maintain hydration. eat fresh fruits for added fiber. Start with softer fruits like bananas, peaches, pears, etc. You may introduce crunchy, fibrous vegetables and salads four to six months after surgery. While not recommended, whole-grain bread and pasta products may be tolerated four to six months after surgery. Items may be subject to your individual tolerance. Drink adequate amount of fluid. Tips for Healthy Weight for Life Diet Plan Always eat protein foods first. Your Protein Food Sources Include: Choose the leanest and/or lowest fat options. Remember to prepare with no ½ 10

bariatric-diet after weight loss booklet 2017_booklet 3/21/2017 11:16 AM Page 13 added fats.

13 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 13 added fats. Meat Chicken (1 oz) 7 grams Turkey (1 oz) 7 grams Seafood (1 oz) 7 grams Beef (1 oz) 7 grams Pork (1 oz) 7 grams egg (1) 7 grams Venison (1 oz) 7 grams Dairy greek yogurt (6oz) 17 grams Yogurt (8 oz) 8 grams Milk (8 oz) 8 grams Cottage cheese (½ cup) 6 grams Cheese (1 oz) 6 grams Vegetable Sample Meal Plan for Stage 4: Healthy Diet for Life Breakfast Lunch Dinner 3 ounces Fluids Slowly sip Between Meals Drink 6 ounces greek yogurt ½ cup chicken salad and 2 tablespoons cooked carrots cooked salmon and 2 tablespoons cooked green beans allowed fluids throughout the day. Drink 64 ounces per day. high-protein supplement if needed to help reach your goal of 60 grams of protein per day. Black beans (½ cup) 7 grams Chick peas (½ cup) 7 grams Hummus (½ cup) 10 grams Lima beans (½ cup) 7 grams Pinto beans (½ cup) 7 grams Soymilk (8 oz) 6 grams Soy yogurt (8 oz) 8 grams Miso (½ cup) 18 grams Tempeh (½ cup) 17 grams Tofu (½ cup) 22 grams Almonds (1 oz) 6 grams Cashews (1 oz) 5 grams Peanut butter (2 tbsp) 8 grams Pistachios (1 oz) 6 grams Sesame or sunflower seeds (1 oz) 6 grams ½ 11

14 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 14 Bariatric Surgery Vitamin And Mineral Supplements For the first month after bariatric surgery, you need to have chewable or liquid vitamins and minerals. After 1 month, you can switch to pills. Most other medications are designed to dissolve easily, but vitamins and minerals do not. So while you are healing, it is best to take chewable supplements. The types of vitamins and minerals you will need are listed below. Multivitamin with iron Buy only from the following list of Complete with Iron vitamins. Pokemon CompleteÔ with Iron FlintstonesÔ Complete Centrum Ò Children s Complete with iron Centrum Ò Adult Chewable Vitamins or Centrum Liquid CVS Spectravite Ò Chewable or Liquid Walgreen s Complete Multivitamin Ò Multimineral Supplement Liquid Since you will be taking 2 multivitamins a day, you will need at least 60 chewable tablets for the first month. Vitamin B-12 Buy sublingual (melts under your tongue) vitamin B-12. You need 350 to 500 micrograms (mcg) of vitamin B-12 per day oral/sublingual or nasal or 1,000 micrograms per month intramuscularly. Do not buy time release. You can take vitamin B-12 once a day. You do not need to spread out the doses. Vitamin D-3 The amount of vitamin D recommended is 3,000 IU a day. Vitamin D can be found in liquid or in gel caps. You can take vitamin D-3 once a day. You do not need to spread out the doses. Calcium citrate with vitamin D Purchase a calcium supplement that contains vitamin D. The amount of calcium you need: Men and premenopausal women: 1,200 milligrams (mg) a day. Postmenopausal women: 1,500 milligrams a day. Do not take your other vitamins at the same time as your calcium citrate supplements. Calcium and iron (in the multivitamin) compete for absorption. It is best to take your vitamins a couple of hours apart from your calcium. It is also important that you spread out your doses when you take your calcium supplements. For better absorption, the doses should be taken at least 2 hours apart. It is best to take your calcium supplements with meals, ½ 12

15 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page 15 Notes

bariatric-diet after weight loss booklet 2017_booklet 3/21/2017 11:16

16 bariatric-diet after weight loss booklet 2017_booklet 3/21/ :16 AM Page South Manning Boulevard Albany, New York Rev. 3/2017

Bariatric Surgery. Step 2 Diet. General guidelines

Bariatric Surgery. Step 2 Diet. General guidelines Bariatric Surgery Step 2 Diet The Step 2 Diet consists of full liquids and blended or puréed solids. The portions are very small to help prevent vomiting. These small high protein meals will help your