G 1494 Dietary Guidelines Post-Bariatric Surgery

1. Dietary Guidelines for Post-Bariatric Surgery
After surgery, it is important to follow special dietary guidelines to ensure proper healing, to
obtain adequate nutrition, and to avoid complications. Because your stomach is reduced in size,
the amount of food that you eat at one time is very small at first. Your diet will advance, with
additional foods added as you tolerate each diet phase. However, keep in mind that people have
varied tolerances to different foods following this type of procedure.
A registered dietitian can help you identify food intolerances, make appropriate food choices,
and assist you in planning a balanced meal plan.
Timetable and Diet Progressionfor Different Types of Surgery
Vertical banded gastroplasty (VBG)
The day after surgery:
 Drink water, up to 2 fluid ounces (fl oz)/hour
 Add clear liquids, up to 4 fl oz/hour, as tolerated
 Initiate clear liquid protein supplements
Three days after surgery:
 Add full liquids, 46 fl oz/hour
 Drink at least 8 cups (C)/day to help ensure adequate hydration
One week after surgery:
 Add pureed foods, using a blender or food processor to puree
 Eat small meals and focus on high-protein foods
 Continue to monitor fluid intake
Three weeks after surgery:
 Add soft foods, 24 oz of soft-cooked foods every 34 hours
 Continue to focus on high-protein foods, such as:
○Fish
○Seafood
○Low-fat cheese
○Cottage cheese
○Yogurt
○Eggs/egg substitute
Five weeks after surgery:
 Continue with soft foods, focusing on those high in protein
 Add poultry and pasta, as tolerated
Two to three months after surgery:
 Add poultry, low-fat beef, and pork, as tolerated
 Add soft fruits and cooked vegetables

2. Four months after surgery:
 Add the following, as tolerated:
○Salads
○Crunchy fruits and vegetables
○Dried beans
○Peanut butter
○Cereal
○Toast
○Crackers
○Potatoes
 Begin maintenance plan after achieving goal weight, based on a 1200- to 1600-calorie diet,
using the diabetic exchange lists as guidelines
Laparoscopic adjustable gastric band (LAGB)
Day after surgery:
 Drink clear liquids
Three days after surgery:
 Add full liquids, as tolerated
 Drink decaffeinated, noncarbonated clear liquids for hydration
One month after surgery:
 Add pureed foods, using a blender or food processor to puree
 Eat small meals and focus on high-protein foods
 Continue to monitor fluid intake
Two months after surgery:
 Add soft foods, 24 oz of soft-cooked foods every 34 hours
 Continue to focus on high-protein foods, such as:
○Fish
○Seafood
○Low-fat cheese
○Cottage cheese
○Yogurt
○Eggs/egg substitute
 Add soft fruits and cooked vegetables, as tolerated
 Add lean chopped/ground beef, turkey, or chicken, as tolerated
 Limit meats high in saturated fat
 Continue to monitor fluid intake
Three months after surgery:
 Add solid protein foods
 Add crunchy vegetables and fruits, as tolerated
 Avoid stringy foods, such as celery, rhubarb, and asparagus, unless well cooked

3.  Continue to monitor fluid intake
Six months after surgery:
 Add whole-grain complex carbohydrates
 Continue to monitor fluid intake
 Begin maintenance plan after achieving goal weight, based on a 1200- to 1600-calorie diet,
using the diabetic exchange lists as guidelines
Biliopancreatic diversion with duodenal switch (BPD/DS)
Day after surgery:
 Drink clear liquids
 Add low-lactose full liquids once clear liquids are tolerated
Three days after surgery:
 Add pureed foods, using a blender or food processor to puree
 Continue to monitor fluid intake and protein supplementation
One month after surgery:
 Add soft foods with focus on high-protein foods, such as:
○Low-fat soft cheeses
○Eggs/egg substitute
○Fresh seafood
 Add soft fruits and cooked vegetables, as tolerated
 Reintroduce milk gradually
Two months after surgery:
 Add poultry, as tolerated
 Continue to monitor fluid intake
Three months after surgery:
 Add lean red meat and pork
 Add the following foods, as tolerated:
○Salads
○Crunchy fruits and vegetables
○Beans
○Nuts
 Begin maintenance plan after achieving goal weight, based on a 1200- to 1600-calorie diet,
using the diabetic exchange lists as guidelines
Roux-en-Y gastric bypass surgery (RNY)
Day after surgery:
 Drink clear liquids
Three days after surgery:
 Add high-protein pureed foods and supplements

4. Two weeks after surgery:
 Add soft foods with focus on high-protein foods, such as:
○Fish
○Seafood
○Cottage cheese
○Eggs/egg substitute
○Soft cheese
○Yogurt
 Continue with high-protein supplements, as needed
One month after surgery:
 Add poultry and lean meat, as tolerated
Three months after surgery:
 Add soft fruits and cooked vegetables, as tolerated
Four months after surgery:
 Add the following foods, as tolerated:
○Salads
○Crunchy fruits and vegetables
○Beans
Six months after surgery:
 Add seeds and nuts, as tolerated
 Begin maintenance plan after achieving goal weight, based on a 1200- to 1600-calorie diet,
using the diabetic exchange lists as guidelines
Generalguidelines
These suggestions may help:
 Know that clear liquids include:
○Chicken or beef broth
○Sugar-free gelatin
○Artificially sweetened, noncarbonated beverages
 Understand that full liquids include:
○Strained cream soups
○Protein shakes
○Milk
○Yogurt
○Sugar-free pudding
 Take small bites of food, chew thoroughly, and eat slowly, allowing at least 30 minutes to
finish each meal
 Consider using child-sized silverware or chopsticks (for solid foods), which will force you to
eat more slowly
 Do not drink while eating, and avoid drinking liquids during meals, and at least 30 minutes
before and after each meal

5.  Sip on fluids (low-calorie, sugar-free, noncarbonated, and caffeine-free beverages) throughout
the day to prevent dehydration—at least 4864 fl oz total
 Stop eating when you begin to feel full—overeating can lead to vomiting
 Add new foods one at a time to determine how well you tolerate them:
○Wait about 1 week after having a food that you did not tolerate before trying it again
 Avoid concentrated sweets and sugar, which are found in:
○Cakes
○Pies
○Cookies
○Candy
○Jelly
○Syrup
○Regular soda and other sweetened beverages
○Etc
 Avoid high-fat foods, such as:
○Fried foods
○Regular snack chips
○Gravies
○Cream sauces
○Cream soups
○High-fat meats
○Butter
○Margarine
○Oil
○Regular cheese, sour cream, and cream cheese
○Etc
 Remove all visible fat from meat, when you are able to eat meat
 Drink protein supplements daily for up to 6 months after surgery, or as prescribed by your
surgeon or registered dietitian:
○Supplements should provide at least 6080 grams (g) protein/day
 Avoid carbonated beverages for at least the first 6 months following surgery to prevent
abdominal discomfort or distention:
○Limit these beverages to one or two each week, if you do choose to drink them
○Choose sugar-free varieties
○Allow the beverage to sit open for at least 1 hour to decrease the carbonation
 Avoid the following foods, which are high in fiber residue, until indicated in the progression of
your meal plan, because these foods may obstruct the opening of your stomach:
○Coconut
○Orange pulp
○Skins of some fruits and vegetables (eg, apples, pears, and cucumber)
 Take the vitamin and mineral supplements as prescribed by your surgeon or registered dietitian
every day for the rest of your life
 Have your blood levels checked annually
 Limit alcohol intake:
○Know that your tolerance to alcoholic beverages has significantly declined

6. ○Avoid mixed drinks that are high in sugar, such as daiquiris, piña coladas, and those mixed
with regular fruit juices
 Avoid extreme hot or cold food temperatures, which may produce chest pain when ingested
 Participate in a lifestyle modification program to learn how to make healthy food decisions,
adopt positive eating behaviors that support a healthy lifestyle, and incorporate exercise into
your daily routine.
Common nutritional problems and prevention tips
Nausea and vomiting
Causes:
 Overeating
 Eating too quickly
Prevention tips:
 Eat slowly
 Chew your food very well
 Stop eating as soon as you feel full
Chronic malnutrition problems
Cause:
 Nutrients are absorbed differently following surgery
Prevention tips:
 Eat a healthy diet
 Always take your vitamin and mineral supplements
Lactose intolerance
Symptoms after drinking milk:
 Gas
 Bloating
 Cramping
 Diarrhea
Prevention tips:
 Drink smaller amounts of milk at a time
 Use lactose-free or lactose-reduced milk
 Try soy milk
Temporary hair loss
Causes:
 Rapid weight loss
 Lack of protein in the diet

7. Prevention tip:
 Eat the amount of protein recommended by your registered dietitian
Dehydration
Symptoms:
 Dark and strong smelling urine
 Dry mouth
 Headache
 Fatigue
Prevention tip:
 Take frequent sips of liquid throughout the day
Dumping syndrome
Cause:
 Food emptying too quickly from the stomach
Symptoms:
 Diarrhea
 Nausea
 Cold sweats
 Light-headedness
Prevention tips:
 Avoid:
○Consuming sugary foods or beverages
○Drinking fluids too soon after a meal
○Eating high-fat foods
Constipation
Cause:
 Food and fiber intake are reduced following surgery
Prevention tips:
 Eat applesauce, oatmeal, or prunes daily
 Drink plenty of water
 Exercise regularly
 Take a fiber supplement
Protein shakes
Basic Vanilla or Chocolate Shake
(28 g protein)
One scoop vanilla whey protein powder
1 C fat-free milk

8. 1 tablespoon (Tbsp) cocoa powder (for chocolate shake)
Banana-Peanut Butter Shake
(12 g protein)
1 C fat-free milk
1 Tbsp peanut butter
One fourth to one half banana
Creamy Orange Shake
(28 g protein)
One scoop vanilla whey protein powder
One scoop sugar-free orange powder drink mix
1 C fat-free milk
Protein shake tips
Try these ideas when making protein shakes:
 Vanilla, almond, and coconut extracts improve flavor
 Bananas, strawberries, and/or peanut butter provide the most flavor
 Unflavored cocoa powder offers a deeper chocolate flavor without added fat
 Milk cubes (made by freezing milk in ice-cube trays) are great for blending with your shake,
making it icy cold and adding protein without diluting the shake
 Yogurt adds extra creaminess and protein to your shake
 If you are lactose intolerant, use lactose-free milk or soy milk
Adapted with permission from: Clark-Reyes C, Breiter AM. Nutrition education for bariatric
surgery. In: The Florida Medical Nutrition Therapy Manual. Tallahassee, FL: Florida Dietetic
Association; 2005.
References and recommended readings
Bariatric Solutions. Bariatric Surgery Diet Manual. Accessed October 28, 2010.
Clark-Reyes C, Breiter AM. Nutrition education for bariatric surgery. In: The Florida Medical
Nutrition Therapy Manual. Tallahassee, FL: Florida Dietetic Association; 2005.
Temple University Hospital, Temple Bariatric Program. Your diet after surgery. Accessed
October 28, 2010.
Review Date 1/11
G-1494