Diet ADvAncement After BAriAtric Surgery StageS of Diet Stage 1: Clear liquiDS: Follow for 2 nights while in hospital Stage 2: full liquiDS: Follow for 2 weeks, starting day of hospital discharge Stage 3: PureeD fooDS: Follow for 1 week, after 2 weeks of full liquids Stage 4: Soft fooDS: Follow for 1 week, after 1 week of pureed foods Stage 5: aDvanCeD Diet: Follow indefinitely, after 1 week of soft foods Stage 1: Clear liquiD Diet You will most likely be instructed to advance to Stage 2: Full liquids upon hospital discharge. If your surgeon discharges you home on a clear liquid diet, you can try additional clear liquids like light apple juice and no-sugar-added popsicles. All liquids should be non-carbonated, since carbonated drinks can put pressure on your small stomach pouch. Avoid chewing gum- even sugar-free- because accidentally swallowing it could cause a blockage. Sip liquids slowly. Aim to drink 64 – 80 oz per day. Clear liquiDS ShoPPing liSt • Unsweetened light juices: light apple juice, light white grape juice, or Light Cranberry Juice Cocktail, Must be <10 grams of sugar per serving • Sugar-free Jell-O • No added sugar popsicles without fruit pieces: Dole, Welch's, or Tropicana No Sugar Added Fruit Juice Bars • Fat-free chicken or beef broth, like College Inn Fat-free Broth • Decaffeinated tea, or herb tea • Non-carbonated no-cal flavored drink like Crystal Light or Fruit-2-O • Non-carbonated bottled water • Isopure Protein Zero Carb • Premier Protein Clear protein drink • Proti liquid protein concentrate (Sold at FCB Norwalk and Shelton locations) Stage 2: full liquiD Diet Upon discharge from the hospital you will start the Stage 2 Full Liquid Diet unless otherwise directed by your surgeon. You will stay on the full liquid diet for 2 weeks from the date of hospital discharge. To prevent nausea and vomiting, DRINK LIQUIDS SLOWLY. At each meal, sip liquid protein source. You do not have to finish everything. Stop drinking your protein when you feel full. Aim for 60-80 grams of protein daily. Aim for at least 64 – 80 ounces of water or a calorie free drink between high protein beverages. Remember to avoid carbonation, sugar, carbonated drinks, caffeine, citrus, and chewing gum. Protein-riCh full liquiDS inCluDe: Pre-mixe D B ranD Protein CalorieS Sugar net CarBS Serving Pure Protein Can 35g 170 1g 3g 11oz Premier Protein 30g 160 1g 2g 11oz Muscle Milk 25g 160 0g 3g 11oz Atkins 15g 160 1g 1g 11oz Protein PowDer BranD Protein CalorieS Sugar net CarBS Serving Vega Sport Performance 30g 150 1g 2g 1 scoop Bariatric Advantage 27g 150 1g 5g 2 scoop Isoure Whey Unflavored 25g 100 0g 0g 1 scoop Pure Protein Powder 23g 130 3g 4g 1 scoop Garden of Life Organic 21g 120 2g 4g 2 scoop Designer Whey 20g 110 2g 3g 1 scoop Whey To Go 20g 90 1g 2g 1 scoop Proti Shakes 17g 1 1g 4g 1.2oz Garden of Life Plant Based 15g 90 0g 3g 1 scoop Protein water Protein CalorieS Sugar net CarBS Serving Isopure 20g 100 5g 5g 16 fl oz Isopure 20g 100 5g 5g 16 fl oz Premier 20g 90 0g 1g 16.9 fl oz Proti 15 15g 76 2g 2g 1 packet what Size iS my StomaCh now? gaStriC ByPaSS anD Sleeve gaStreCtomy Your new stomach holds only 1.5- 2 oz (3-4 measuring tablespoonfuls), so when planning your prepare a maximum of: 2 to 3 tablespoonfuls of protein-rich food, plus 1/2- 1 tablespoonful of vegetable laP BanD Your new stomach holds only 3oz-4oz (6-8 measuring tablespoonfuls), so when planning your prepare a maximum of : 3 to 4 tablespoonfuls of protein –rich food 1 to 2 tablespoonfuls of fruits & vegetables Initially you may manage only a few teaspoonfuls per meal. Stop eating when you begin to feel full, even if there is food left on your plate. meaSurement ComPariSon liSt aBout the Size of ½ oz = 1tbsp = 1/16 cup = a poker chip 1oz = 2tbsp = 1/8 cup = a golf ball 2oz = 4tbsp = 1/4 cup = 4 dice 3oz = 6tbsp = 3/8 cup = a deck of cards 4oz = 8tbsp = 1/2 cup = a tennis ball Stage 3: PureeD Diet You will start your pureed diet after two weeks of full liquid diet. You will stay on pureed diet for one week. Now that your diet has progressed to pureed, you can start eating three meals a day- with a spoon! Eating chunks of food could block the exit from your stomach. Start with small portions of pureed foods, and stop before you feel full. Remember to eat slowly - each meal should take 15- 30 minutes. Because protein is so important to help you maintain muscle while you are losing weight, eat your protein-rich foods first at meals. Then move on to vegetables. It is still important to drink enough fluids- aim for at least 64 - 80 oz per day. Drink fluids between meals, so you don’t overfill your stomach: wait 30 - 45 minutes after meals before drinking, and stop drinking 30 minutes before a meal. To puree foods, use a blender or food processor to a smooth consistency. If necessary, add water, broth, tomato juice, milk or low fat mayo to make a smooth puree. To save time, you can use stage 1 strained baby food like strained chicken and no-added sugar strained fruit. Toddler foods are not suitable because they are lumpy. Most patients still have at least one protein shake during the pureed stage, to ensure that enough protein in being consumed daily. PureeD fooD guiDe ProteinS: yeS - Pureed skinless chicken and turkey, pureed fish (like water-packed tuna), pureed scrambled eggs, pureed tofu, low fat ricotta cheese, light greek yogurt, stage 1 baby food strained chicken or turkey no - Pureed beef, pork, lamb, pate, liverwurst, hot dogs, fried fish, canned fish in oil, fried eggs, boiled eggs, sliced cheese, cream cheese, yogurt with fruit chunks, yogurt with added sugars, ice cream vegetaBleS: yeS - Pureed cooked vegetables (Carrots, spinach, tomatoes, squash, beets, very small amounts of sweet potato) no - Raw vegetables, gassy vegetables (broccoli, cauliflower, onions, cabbage), fries, chips, gravy, mashed potatoes SamPle menu Stage 3: PureeD fooDS BreakfaSt: 1 large egg, pureed with 1 ounce part skim mozzarella cheese (15 g protein). Wait 30 minute after breakfast to begin sipping water. Sip water slowly. Stop 30 minutes before lunch lunCh: Premier protein shake (30 grams protein) Wait 30 minute s after lunch to being sipping water. Sip water slowly. Stop 30 minutes before dinner Dinner: 2 ounces pureed turkey with 1-2 ounces pureed squash (15 g protein) Wait 30 mins after dinner to begin sipping water aim to Drink 64 – 80 oz liquids daily (calorie-free, non-carbonated beverages) aim to eat 60g – 80g protein daily (your dietitian will instruct you on your specific protein needs) requireD vitamin anD mineral SuPPlementS after weight loSS Surgery Once you feel comfortable with your pureed foods, you should start your daily vitamins and fiber supplement. See vitamin section of this packet for specifics. You will not be able to meet certain vitamin and mineral needs without supplementation. Vitamin and mineral deficiencies have been observed in patients after weight loss surgery. Iron, Folate, vitamin B12, calcium and zinc are common deficiencies after gastric bypass and gastric sleeve surgery. If you are having gastric banding surgery you will not need to take all the above supplements. Gastric banding does not cause malabsorption of nutrients from your foods. A daily chew- able multi-vitamin and calcium supplement is usually sufficient. We strongly advise Bariatric Fusion vitamins, sold at FCB locations in Shelton or Norwalk. These vitamins have been found to sufficiently cover bariatric patients. These should be taken as instructed on packaging. We also advise starting a fiber supplement at this time. Please note that we will send you for lab work to have your vitamin levels checked 6 weeks post-operatively, and one year post-operatively. Should any of your vitamin levels appear low on your blood work, we will advise extra supplementation.