Bariatric Nutrition Guidelines

• Practice sipping fluids slowly throughout the day.
• Practice eating slowly and chewing food completely before swallowing.
• Meals should take 20 - 30 minutes to consume.
• Put down your eating utensil between bites.
• Consider using a baby-sized utensil.
• Discuss diet changes with the people that live with you. It is helpful if they try not to bring unhealthy foods into the home and focus on improving their own eating habits.
• Begin keeping a food diary by either writing intake down or with an app/online website.

Caffeine

• Do not have any caffeine for the 3 days before your surgery.
• Do not have any caffeine for 6 weeks after surgery.
• Limit decaffeinated and regular products to 2 (8 oz.) cups daily long term.

Carbonated Beverages 
Do not drink carbonated beverages for 6 months after surgery. This can cause excess gas, bloating or irritation.

Alcoholic Beverages 
Do not drink alcoholic beverages for 6 months after surgery. Alcohol provides “empty calories” and should be consumed with caution.

Ice Chips and Clear Liquids

Clear Liquids - Use for hydration

• Beef, chicken or vegetable bouillon or canned broth
• Decaffeinated coffee or tea
• Crystal Light®
• Sugar-free gelatin
• 100% juice – apple, grape or white grape, diluted 50/50 with water
• Sugar-free Kool-aid® or lemonade
• Sugar-free popsicles
• Isopure® protein water (buy at health food store)

Below are foods that you are allowed to have in the first 2 weeks after your bariatric surgery. If at any time you experience nausea and/or vomiting, try switching back to clear liquids to allow your system to rest. Please do not eat anything that is not on these lists!

Fulls - East ¼ to ½ cup meals 6 times a day for 14 days:

• Cottage cheese – small curd, low-fat
• Skim or 1% milk
• Sugar-free pudding
• Sugar-free fudgsicles
• Yogurt (no-sugar added, fat free)
• Low-fat cream soups - strained (Cream of Mushroom, Chicken, Celery, Tomato, Potato)
• Cooked cereals including oatmeal (no added sugar), cream of wheat, cream of rice and grits
• Peanut butter (for recipes ONLY)
• Hot cocoa mix (no sugar added)
• Nonfat dry milk powder
• Evaporated skim milk
• Liquid egg whites, pasteurized (do not cook)

Vitamins & Minerals: One Week After Surgery 
Take one adult chewable multivitamin with iron OR take two children’s chewable multivitamins with iron per day with food. Check that the product contains carbonyl iron, or ferrous gluconate.

Keep Hydrated 
The goal for fluid intake is 64 ounces (8 cups) per day.

• You are not expected to reach this goal until after you are home from the hospital.
• Do not use a straw when you drink fluids.
• Stop drinking fluids 30 minutes before a meal and not for 30 minutes after a meal.
• All juices on your tray must be diluted 50:50 with water to prevent dumping syndrome.
• You will be given standard portions of liquids on your hospital trays.
• Do not try to consume all of it. This is the time for you to begin to pay attention to your body’s feeling of fullness. Try only what sounds good to you.
• Maximum amount for each meal is ¼ cup in the hospital.

Get Adequate Protein 
Your protein intake goal is 65 - 75 grams per day or 11 - 13 grams per meal.

• It is very important that you reach and maintain this level of protein intake long term to help prevent malnutrition and prevent muscle wasting.
• You are not expected to reach this goal until after you go home from the hospital.

Protein Supplements:

• Plan to put protein powder in most foods and beverages to help you reach your goal.
• The supplement that you buy should be a whey, or soy protein ISOLATE.
• An acceptable protein powder should contain between 15 - 20 grams of protein per scoop and little or no fat or sugar.
• We recommend unflavored and flavored protein powders.

Where you can buy protein supplements: 
Unjury® protein powder, and Syntrax® Nectar® protein powder sold by Mount Carmel Bariatric Program. You may also obtain protein powder from any drugstore, health food store or grocery store. Proteins cannot be over-blended or heated past 140°F. They can clump and become "gritty" in texture.

Limit Fat 
Eating high fat foods can cause diarrhea because your body does not absorb fat as well after surgery. High fat foods usually contain a lot of calories which is not beneficial for weight loss.

Sample Menu: 
Sample Menu: The following is a sample menu to follow for the first 2 weeks after your bariatric surgery. You may consume ANY of the foods/supplements/liquids on the full liquid list. Please note that this is an example, do not limit yourself to these foods only. The times listed are examples also.

8:00 a.m. ¼ - ½ cup fulls recipe (see below) 
11:00 a.m. ¼ - ½ cup strained cream soup with protein powder 
1:00 p.m. ¼ - ½ cup sugar free pudding with protein powder 
4:00 p.m. ¼ - ½ cup no sugar added yogurt with protein powder 
7:00 p.m. ¼ - ½ cup cooked cereal with protein powder 
10:00 p.m. ¼ - ½ cup fulls recipe

Be On the Look Out For: 
The symptoms of lactose intolerance are: gas, bloating, and diarrhea. If you are lactose intolerant, try using lactose free milk or chewable lactase enzyme tablets before meals containing milk or dairy products. You may try low sugar/low fat soy milk.

Dumping syndrome is caused by eating or drinking concentrated sources of sugar. Sugar cannot be broken down in your new small stomach and can cause large amounts of fluid to enter your intestine. This can result in facial flushing, increased heart rate, nausea, vomiting, and/or diarrhea. Not everyone gets dumping syndrome but we strongly recommend you avoid high sugar, empty calorie foods to promote weight loss.

You can begin pureed foods at week 3

• Continue with low sugar, low fat foods only.
• Use broth, milk or juice to help with consistency when blending. You are trying to blend to a smooth mashed potato consistency.
• Add new foods one at a time so if you have any intolerance, you will know what caused it.
• You may use stage 1 or stage 2 baby foods. Avoid stage 3 baby food or any foods with chunks or pieces.
• You may season foods to taste. Avoid large amounts of salt.
• Continue to eat slowly. You should be taking 20 – 30 minutes to consume a ¼ - ½ cup meal.
• Continue to consume 6 small meals per day. Each meal should be no more than ½ cup.
• Continue to include 8 cups of fluid each day. Remember to stop drinking fluids 30 minutes before a meal and not resume until 30 minutes after a meal.
• Avoid skins of raw fruits and vegetables when blending.
• You may eat meats which have been very finely chopped, fish that has been flaked apart before eating and scrambled eggs, (substitute or whites only) without passing through the blender.

Sample menu for Pureed stage:

8:00 a.m. – 2 scrambled egg whites (7g protein) 
11:00 a.m. – ? cup tuna with 1 TBSP light mayo (13g protein) 
1:00 p.m. – ? cup refried beans with 1 oz. shredded 2% cheese (11g protein) 
4:00 p.m – 1 oz. chopped chicken with fat free gravy, 2 - 3 TBSP pureed vegetable (8g protein) 
7:00 p.m – ½ cup skim milk with 1 scoop UNJURY® (25g protein) 
10:00 p.m – ½ cup Greek yogurt (11g protein) 
Total = 75g protein

You can begin soft foods at week 5.

• Continue low sugar, low fat food choices only. Use low fat cooking methods such as grilling, baking, steaming or microwaving.
• Continue to introduce new foods one at a time.
• Whole grain breads and crackers may be introduced now. Toast bread for the first few times, eat only ¼ of a slice until you are sure you can tolerate it. After that, the portion is ½ slice of bread or 2 - 3 crackers. Make sure you chew well.
• Choose canned fruits only, juice or water packed, none in heavy syrup.
• Choose soft cooked vegetables.
• Choose tender meats, cut into small pieces. Keep meats moist with fat free gravy or broth.
• Avoid any food that is difficult to chew well. Examples: steak, asparagus, nuts, seeds.

Vitamins & Minerals: Six Weeks After Surgery 
Take one multivitamin with iron per day. Check that the product contains carbonyl iron.

• Take Calcium Citrate with vitamin D daily (1200 - 1500 mg). Do not take at the same time as iron because iron interferes with calcium absorption. Do not take any other medications within 1 - 2 hours. Do not take more than 600 mg dose at one time.
• Take one Vitamin B12 1000 - 1200 μg (micrograms) sublingual tablet weekly, or 300 - 500 μg daily.
• Take other supplements as directed/recommended by your physician.
• Take one Multivitamin with Iron per day. Check that the iron source is carbonyl iron.
• Take one Vitamin B12 1000 - 1200 μg (micrograms) μg sublingual tablet weekly or 300 - 500 μg (micrograms) daily.
• Take 1200 - 1500 milligrams (mg) of Calcium Citrate with Vitamin D added, daily. Do not take at the same time as iron because iron interferes with calcium absorption. Do not take any other medications within 1 - 2 hrs. Take no more than one dose at a time.
• As directed by your surgeon for those with a history of anemia or menstruating women, take Iron – 50 - 66 milligrams (mg) (carbonyl iron) daily. Do not take Calcium at same time. Do not take on an empty stomach. If you are taking an iron supplement, take a multivitamin without iron.

Here are some general guidelines to follow when choosing the right foods:

• You may introduce fresh fruit and vegetables at this stage.
• Continue to eat 6 small meals per day, working slowly up to 1 - 1 ½ cups 4 times daily by the end of the first year.
• Continue to drink at least 8 cups of fluid per day.
• Take fluids with you when you are away from home.
• Remember to drink only between meals, not with meals.
• Take vitamins and minerals as recommended by the dietitian and your surgeon.
• Eat balanced meals as much as possible. Remember to start with high protein foods, add whole grains, fruits, vegetables and skim / 1% milk.
• Write down what you eat and drink every day or use an online calorie counting website/app to keep track of your daily intake.

Tips for Weight Loss

• Pay attention to your body’s feeling of fullness.
• Eat your meals at a table without TV or other distractions.
• Avoid snack items (crackers, chips, etc.) and snacking between your 6 meals.
• Develop a physical activity plan with your doctor’s approval and STICK TO IT! Make small goals with a long term goal of 250 or more minutes per week.

Get Adequate Protein 
Protein is important in helping to prevent hair loss and maintain muscle mass during weight loss. However, you can consume adequate amounts of protein and still have some hair loss. Iron and zinc intake, as well as some medications and the stress of surgery can all cause hair loss. This hair loss does not occur until 2 to 4 months after surgery. You can help prevent hair loss by eating adequate protein and taking vitamin/mineral supplements as recommended by your dietitian and surgeon.

Some examples of foods high in protein include:

• 1 oz or ¼ cup tender cooked meat (chicken, turkey, fish, pork, beef, veal) – 7 grams
• ½ cup low fat cottage cheese – 15 grams
• 1 slice or ounce low fat cheese – 7 grams
• 1 egg – 7 grams
• ½ cup skim or 1% milk – 4 grams
• ½ cup yogurt – 4 grams
• ½ cup beans – any type – 5 - 7 grams
• ½ cup low fat chili – 10 grams
• ½ cup bean soup – 3 - 5 grams
• 1 tablespoon peanut butter – 4 grams
• 2 tablespoons nuts – 2.5 grams
• ¼ cup tofu – 5 grams
• 1 cup soy milk – 7 grams
• 1 vegetable burger – 10 - 13 grams

NOTE: You may not tolerate all meats well after surgery. Remember to keep them moist with fat free gravy or broth. Substitute other high protein foods if you have difficulty.

Limit Fat 
You will need to limit your fat and calorie intake to help promote weight loss. The goal is to eat no more than 35 grams of fat per day. Read food labels to monitor your fat and calorie intake. You will need to minimize portions or consume low fat or fat free versions of many foods.

NOTE: Do not eat low fat or baked chips, fat free or sugar free desserts, except in very limited quantities. These products are not calorie free and usually have little nutritional value.