The inHealth bariatric program offers a multidisciplinary approach to obesity treatment. Bariatric Surgery was developed to help you lose weight and requires a major change in your eating and exercise habits to achieve and maintain your desired weight loss. This guide and working closely with your health coach will help create a lifestyle that allows you to thrive. By using your surgically reduced stomach pouch effectively, you will have a positive impact on your overall health.
Nutrition at a glance
Food serves as an important vehicle for transporting nutrients into the body. Food is broken down into specific nutrients that the body requires. These nutrients are called carbohydrates, fats, proteins, vitamins, and minerals. These nutrients provide energy (fuel) for your body. Since the size of your stomach is now greatly reduced, eating nutrient dense food and eating with the purpose to provide your body with the nutrients it needs is key.
Protein and water will be the most important things you consume after your surgery. Protein is necessary to help heal and preserve muscle tissue while you're losing weight.
Post-Bariatric Nutrition Plan
After bariatric surgery, the pouch won't be able to hold as much food or liquid. Initially, it can only hold about ¼ cup of food or 2 ounces at a time (about the size of an egg). To allow the new pouch to heal completely, introduce liquid and solid foods slowly. This slow introduction is done in different stages. The first stage starts soon after surgery. The stages of the diet are as follows:
Stage 1: Clear Liquids
Stage 2: Full Liquids
Stage 3: Mechanical Soft/Pureed
Stage 4: Solid Foods
There are two things that will change in each stage:
1. Amount: The portions that are recommended are maximums — eat less if needed. It is important to eat only to the point of feeling satisfied.
2. Texture: The stages start off with very liquid-type foods and will progress toward normal solid foods.
Surgery Post-Op Nutrition Guide
Phase 1 – Clear Liquid Diet – 5 to 7 Days
Phase 1 utilizes only clear liquids to allow for proper healing and recovery. This phase lasts a minimum of two days after your operation. At first, take in very small sips at a time, about one teaspoon every 60 seconds. Then gradually increase your intake of liquids to six to eight ounces every hour. Drink very slowly and refrain from gulping.
Goal of Phase 1:
Hydration: minimum of 48 ounces of fluids, optimal goal 64 ounces.
Things to Note:
Sugary drinks, caffeinated drinks or carbonated beverages are not recommended.
Patients must get enough liquids to prevent dehydration. It's important to both calculate and record your intake daily.
If urine is dark in color or your mouth is dry, you are not consuming enough liquids.
Water
Ice chips
Herbal teas
Diluted (60/40) juices (apple, white grape, cranberry)
Broth (Chicken or Beef)
Unsweetened coconut water
Recommended Clear Liquids
Goal of Phase 2:
Stay hydrated. Aim for 64 ounces of fluid.
Protein: Aim for 60 – 90 grams.
Aim for up to 500 calories.
Phase 2 – Full Liquids Diet – 5 to 14 Days
Things to Note:
This diet allows a broad range of liquids and protein supplements.
A good rule of thumb for what is allowed on this diet is anything that has the consistency of what can easily be strained through a straw. Remember, however; at this stage, you should not be sipping anything through a straw!!!
Start taking your supplements days into phase two or as per doctor's recommendation.
All foods from the previous stage
Greek Yogurt, ricotta cheese
Protein Shakes and smoothies
Natural Apple Sauce
Soups (choose higher protein soups like bean soup, and blend chunky soups before eating). Avoid soups made with cream.
Vegetable juice, no pulp
Recommended Clear Liquids
Pudding
Please Avoid:
All carbonated beverages: They fill the stomach with gas.
Sugar: Extra calories can prevent weight loss.
Coffee: it is acidic and may create problems with acid reflux after surgery. It is also a diuretic, causing you to be dehydrated.
Sample Menu: Full Liquids
Breakfast:
7 a.m. - 4 Tbsp. (2 oz.) light yogurt
8-8:30 a.m. - protein drink made with 8 oz. skim milk or unsweetened milk alternative
10 a.m. - 8 oz. water
Lunch:
Noon. - 2-4 Tbsp. (1-2 oz.) strained fat-free soup, 2-4 Tbsp. (1-2 oz.) unsweetened applesauce
1 p.m. - Protein drink made with 8 oz. skim milk or milk alternative
3 p.m. - 4 oz. water
4 p.m. - 4 oz. beef broth with unflavored protein powder
Dinner:
5 p.m. - 2-4 Tbsp. (1-2 oz.) soup, 2-4 Tbsp. (1-2 oz.) light Greek yogurt
6 p.m. - Protein drink made with 8 oz. skim milk or milk alternative
8 p.m. - 8 oz. herbal tea
Dehydration Risk
After bariatric surgery you are at risk for dehydration because you cannot consume large quantities of fluid quickly. Instead you will have to sip on fluids during the day. This may be a challenge for some and a new habit to create. Your fluid goal is 6-8 cups per day or 48-64 oz. You can achieve this goal by sipping on 1 oz. of fluid every 15 minutes or 4 oz. every hour.
Symptoms of dehydration include increased thirst, dry mouth, dizziness, confusion, headache, decreased urine output, or dark urine.
Importance of Protein Supplements
Because of the limited volume capacity of the stomach, it will be nearly impossible to meet your protein needs from food sources for up to a year after surgery. Patients will need to consume protein drinks to get the appropriate amount of protein per day.
Once off the liquid diet, it is best to consume your protein drinks between meals, rather than as a meal.
Supplement RX:
Patients are required vitamin and mineral supplements for the rest of their life. Taking vitamin and mineral supplements is vital to maintain nutritional health and prevent deficiencies.
Take multivitamins with minerals daily. (Bariatric specific vitamins)
The vitamins and minerals listed below are required after surgery:
1-2/day
Multivitamin
Dose dependent on brand purchased—take at 1st meal of the day
2-3x/day (take one 500 mg tablet, 2-3x/day on an empty stomach, in between meals
Calcium Citrate
1200-1500 mg/day (total provided by food intake and in supplemental form in divided doses)
1/day (Take with 2nd meal of the day. DO NOT TAKE IRON AND CALCIUM AT THE SAME TIME – wait at least one hour.)
Iron
Men: 30-45 mg/day
Women: 45-60 mg/day
Women: 45-60 mg/day
3,000 mcg/week sublingual (under the tongue) OR 500 mcg nasally once per week
B12
Take anytime during the day.
A good protein shake should include:
Calories ranging from 120-160 calories/serving
20 or more grams of protein per serving
3 grams of fat or less/serving
3 grams of sugar or less/serving
Some options: Bariatric Advantage/Bariatric Fusion Meal Replacements, Truvani, Garden of Life
30
3
3
90
carbs, g
proteins, g
fats, g
calories
Exercise Guidelines
For the first 30 days, you should not engage in strenuous activities including weightlifting, running, or ab-crunches. It is advised that you start by walking for 20 minutes for the first fourteen days after surgery. After 15 days, you can work up to 30-40 minutes of exercise per day.
Swimming - Wait at least 15 days before using the tub or the pool. Wounds can easily be infected if the wound has not fully healed. Overall, swimming is an excellent exercise that can include resistance training.
Weightlifting - Wait at least 30 days after surgery to include lite resistance training. Use weights you can manage, and still incorporate cardiovascular exercise.
Swimming - Wait at least 15 days before using the tub or the pool. Wounds can easily be infected if the wound has not fully healed. Overall, swimming is an excellent exercise that can include resistance training.
Weightlifting - Wait at least 30 days after surgery to include lite resistance training. Use weights you can manage, and still incorporate cardiovascular exercise.
Always get approval from your doctor before starting any kind of exercise.
Complications
Even though change to the size of the stomach is a useful tool, it can cause serious problems if you don't follow healthy eating habits and meal planning. Complications can happen at any time after surgery. Following the diet guidelines for portion size, specific foods and supplements will help prevent complications. Common complications and ways to prevent them are listed below.
Complication
Possible Causes
Ways to Prevent Complication
Dehydration
Not drinking enough fluid
Vomiting
Drink at least 6-8 cups of fluid daily. (48-64 oz.) Always sip, never gulp fluids.
See below.
Complication: Dehydration
Nausea, vomiting or heartburn
Eating too much food
Eating too fast, or not chewing thoroughly
Follow portion guidelines.
Eat slowly and chew food well. Avoid eating when rushed or under stress.
Complication:
Nausea, vomiting or heartburn
Nausea, vomiting or heartburn
Blockage
Meals should last 20-30 minutes. If you vomit more than 1-2 times/day, or after every meal, call your doctor immediately.
Constipation
Not enough fiber
Add in more fruits, vegetables and whole grains. (Limit whole grain bread, bran and raw fruits and vegetables immediately after surgery- you will need to add these foods in slowly so your pouch can adjust).
Complication:
Constipation
Constipation
Dehydration
Do not take any fiber supplements or laxatives without first getting approval from your doctor.
Diarrhea
Lactose intolerance
Try a lactose-free or dairy alternative milk.
Complication: Diarrhea
Dumping syndrome
Consume smaller portions and avoid simple sugars, sweets. Drink liquids away from meals (at least 30 minutes).
Blockage of stomach opening
Not chewing food well
Chew food 15-30 times before swallowing. Call your doctor if nausea, vomiting or pain persists.
Complication: Blockage of stomach opening
Stretching of stomach pouch
Eating past the point of fullness
Avoid overeating. Eat mindfully. Initially only 2-3 tablespoons of food per meal.
Complication: Stretching of stomach pouch
Once you have successfully tolerated a clear liquid and full diet you will progress to a pureed diet. See Bariatric Guide: Phase 3 & 4. Maintaining a low fat, low/moderate carbohydrate, low processed diet is essential to overall health and wellness. Each phase brings you one step closer to a healthier more active life. Your health coach will guide you through the next two phases.
We are here for you every step of the way. You got this!
© inHealth Medical Services, Inc. 2020