Days 1 and 2: Bariatric Clear Liquids

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1 Gastric Bypass Diet Days 1 and 2: Bariatric Clear Liquids Duration: 2 days Food consistency: Bariatric clear liquids, which includes clear, non-carbonated, noncalorie, caffeine-free liquids such as: o Water o Crystal Light o Flavored, sugar free water (Fruit 2 O, Propel) o Sugar-free Kool-Aid o Decaffeinated coffee or tea (iced or hot) o Low fat broth o Diet Jell-O Instructions on First Day: 1. You will sip small amounts of fluid throughout the day. 2. It is important for you to sip these liquids slowly. 3. Do not use a straw as they can make you feel bloated and gassy. 4. As the initial swelling goes down and your pouch heals, fluids will exit the pouch as if it were going through a funnel. Instructions on Second Day: 1. If you tolerate small amounts of liquids for approximately 24 hours, you will advance to larger amounts of the same liquids from Day You will receive a meal tray for breakfast, lunch and dinner. 3. You will also receive these bariatric clear liquids between your meals to help you drink enough fluid to stay hydrated. 4. It is again important to sip these liquids slowly. Tips: The purpose of this phase is to ensure that you tolerate something in your new stomach pouch and slowly transition you to larger amounts of liquids Unflavored water may be difficult to tolerate initially. The reason why is unknown; however, putting a slice of orange or lemon into your water can improve tolerance Beverages that contain a lot of sugar, including natural sugar=calories! A lot of beverages on the market claim to give you energy, provide you with 100% of the RDA for vitamins, minerals, and antioxidants, but will also increase caloric intake

2 Do not drink carbonated beverages even if they are flat. When you swallow flat soda, the trapped air bubbles are released in the pouch and cause additional gas Duration: 7 days Day 3 to 9: Bariatric Full Liquids Food consistency: A full liquid diet consists of foods that pour off a spoon like soup and thin cream of wheat. These liquids not only provide fluid to prevent dehydration, but also supply protein and other nutrients to keep you healthy and with healing. Instructions: 1. All items should be low in fat and sugar to prevent excessive caloric intake and improve tolerance. 2. You should start the protein supplements during this phase. Minimum protein requirements: 60 8 per day. It is important for you to sip these full liquids slowly. 3. It is pertinent that you keep track of your protein intake daily to ensure you are meeting your protein requirements. Protein is essential to help preserve muscle mass, assist in wound healing, keep your energy level up, and keep your body s everyday functions running smoothly. 4. Try adding non-fat dry milk powder to foods to increase the protein content without adding volume (3 Tablespoons of non-fat dry milk powder = 4 grams of protein). You can also add unflavored protein powder to food items; i.e. Unjury (2 per scoop) or Beneprotein (6 grams per scoop). Measuring conversions: 3 tsp=1 TBSP 1 fl oz=30 cc s 2 TBSP=1 oz=28.3 grams 4 oz=1/2 cup 4 TB=2 oz=1/4 cup 8 oz=1 cup 8 TBSP=4 oz=1/2 cup 4 cups=16 oz=1 pint 8 cups=64 oz=2 quarts

3 Bariatric Full Liquids *You should purchase these items before surgery* Suggested Full Liquids Portion Size Protein Content Protein Supplements See protein supplement section See protein supplement section Skim Milk 1 cup 8 grams Blended and Strained low 1 cup 6 12 grams fat cream soups (made with skim milk) Blended and Strained low 1 cup 4 8 grams fat broth soups Thin cream of wheat or rice ½ cup 3 grams (no oatmeal) No sugar added, fat-free ice cream ½ cup 2 grams Full Liquids: Sample Menu Breakfast Morning Snack Food ½ cup thin cream of wheat (with 3 T dry milk powder) ½ cup skim milk Protein Supplement Protein Content 7 grams 4 grams Lunch 1 cup blended and strained low fat cream soup (with 3 T dry milk powder) Afternoon Snack Protein Supplement 16 grams Dinner 1 cup blended and strained low fat cream soup (with 3 T dry milk powder) ½ cup no sugar added, fat-free ice cream Evening Snack Protein Supplement Total protein: 41 grams not including protein supplements 12 grams 2 grams

4 Day 10-30: Bariatric Pureed Foods Duration: 3 weeks Food consistency: smooth-blended foods with a consistency of Stage 2 baby foods. Instructions: Commercial baby foods can be purchased in the grocery store or foods from home can be blended to this consistency using a blender or food processor. If you puree your own foods, the following tips are important to remember: o All ingredients need to be sugar-free and low-fat o Cut all food intended to be blended into small pieces o A small amount of liquid should be added to the food that you are blending. Do not use water as this will dilute the taste and the nutrients. Try adding skim milk, V8*, tomato juice*, broth* or fat-free gravy (* use the low salt variety if you are being treated for high blood pressure) Your portion size should be approximately ¼ to ½ cup per meal at this phase. It will likely be necessary that you eat at least 3 meals daily and drink at least 2 protein supplements daily to meet your nutritional needs (See list of suggested protein supplements in the protein supplement section of the manual). Minimum protein requirement for women: 60 7 per day. Minimum protein requirement for men: 70 8 per day. It is important for you to add up your protein intake every day to make sure you are meeting your protein requirements. Inadequate protein intake can result in hair loss and improper healing. Mild spices, herbs, salt, pepper and small amounts (1 teaspoon) of butter, margarine, or oil are permitted to add flavor to your meals. Do NOT use sugar, honey, molasses, or syrups. Sugar substitutes such as Splenda, Equal, and Sweetn-Low are acceptable to use throughout this process. Aim to drink at least 64 oz of bariatric clear liquids between your meals daily. It is very important to stop drinking liquids 15 minutes before your meal and to wait 1 hour after your meal before drinking fluids again. The purpose of this phase is to slowly add some texture to the diet while not overworking the stomach pouch so it can heal properly. Advancing to foods with more texture before the 3 weeks have passed may result in complications such as vomiting or blockage in the pouch. This could result in readmission to the hospital.

5 Bariatric Pureed Foods Suggested Foods Portion Protein Content Strained baby meat ¼ cup 1 (Stage 2) Low fat, cottage cheese (small ¼ cup 7 grams curd) Low fat, ricotta cheese ¼ cup 7 grams No sugar added, low fat, ¼ cup 2 grams smooth-blended yogurt Smooth-textured whipped ¼ cup 1.5 grams potatoes No sugar added puddings ¼ cup 1 gram made with skim milk Strained baby vegetables ¼ cup 0.5 grams (Stage 1 or 2) Baby applesauce (Stage 1 or 2) ¼ cup Strained baby fruit (Stage 1 or ¼ cup 2) Pureed Vegetables ¼ cup 0-1 grams Pureed Bananas or other fruits ¼ cup without seeds Pureed fish tuna, poultry, veal, 1 oz 7 grams pork, or beef Pureed egg/egg substitutes or poached egg 1 egg or ¼ cup 7 grams

6 Pureed Foods: Sample Menu Day 1 Day 2 Day 3 1 egg pureed 1 oz low fat cheese 8:00 a.m. ½ cup cream of wheat Add 2 tbsp of fat free milk 4 oz fat free milk 2 oz fat free yogurt 1 banana 9:30 a.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid 10:30 a.m. with 8 oz fat free milk with 8 oz fat free milk with 8 oz fat free milk 12:00 p.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid 1:00 p.m. 2 oz. pureed ham ¼ cup mashed potatoes 2 tbsp pureed vegetables ¼ cup pureed tuna salad (made with low-fat mayo) 2 tbsp pureed fruit ¼ cup pureed chicken salad (with low fat mayo) 2 tbsp unsweetened applesauce 2:30 p.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid 3:30 p.m. with 8 oz fat free milk with 8 oz fat free milk with 8 oz fat free milk 5:00 p.m. ½ cup Greek yogurt ¼ cup low fat cottage cheese 1 tbsp pureed peaches ¼ cup fat free refried beans 1 oz low fat cheese 6:00 p.m. 2 oz pureed chicken 2 tbsp pureed carrots ¼ cup mashed potatoes 1 tbsp fat free gravy ½ cup pureed chili 1 oz low fat cheese 2 oz pureed shredded beef 1 tbsp fat free gravy 2 tbsp pureed cauliflower ¼ cup mashed yams 7:30 p.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid 8:30 p.m. 1 wedge low fat Laughing Cow cheese 4 tbsp unsweetened applesauce ½ cup Greek yogurt ½ cup cottage cheese 10:00 p.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid

7 Duration: 4 weeks Food Consistency: Soft solids 1. No large pieces of meat 2. No raw vegetables 3. No skins or seeds of fruit Instructions: Days 31 to 58: Soft Solid Foods You should add only one new food at each meal to test your tolerance of that particular food. Adding too many foods at one time will make it difficult for you to determine which foods you tolerate and which foods you don t tolerate Limit the total amount of food to no more than ¾ cup to 1 cup per meal. The purpose of this phase is to slowly incorporate more texture into your diet before advancing to a full textured diet, thus assessing your tolerance to various foods. Advancing to foods with more texture before this 4 week period may result in complications such as vomiting or blockage in the pouch. This could result in readmission to the hospital. Soft Solid Foods Suggested Soft Foods Portion Protein Content Low-fat cheese 1 ounce 7 grams Finely ground meats 1 ounce 7 grams Flaked fish (haddock, 1 ounce 7 grams tilapia, orange roughy) Eggs 1 egg 7 grams Egg Substitutes ¼ cup 7 grams Canned tuna in water ¼ cup 7 grams Baked Potato (no skin) ¼ cup 1.5 grams Oatmeal ¼ cup 1.5 grams Squash, acorn or butternut ¼ cup 1.5 grams Whole grain pasta ¼ cup 1.5 grams Whole wheat crackers grams Whole wheat toast ½ slice 1.5 grams Low sugar cereal ¼ cup 1 gram Cooked vegetables ¼ cup 0.5 grams Canned fruits in water ¼ cup

8 8:00 a.m. 1 scrambled egg 1 slice toast 2 tsp low-fat margarine Sample Menu for Phase 5 Day 1 Day 2 Day 3 1/3 cup oatmeal 1 slice toast 1 egg or ¼ egg substitute 1 slice low-fat cheesemake into an omelet 9:30 a.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid 10:30 a.m. with 8 oz fat free milk with 8 oz fat free milk with 8 oz fat free milk 12:00 p.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid 1:00 p.m. 1 oz of low-fat cheese melted over ¼ - ½ cup pasta 1 tbsp marinara sauce ¼ cup cooked broccoli 1 slice whole wheat bread (toasted) 1 slice low fat cheese 1 oz chipped low fat deli meat (example-turkey, chicken, ¼ cup chicken salad (with low fat mayo) 1 slice toast ¼ cup unsweetened applesauce ham) 2:30 p.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid 3:30 p.m. ½ cup Greek yogurt 4 All Bran crackers with 1 ½ cup low fat cottage 6:00 p.m. ¼ of a large baked potato (no skin) ¼ cup Chili 1 tbsp light sour cream wedge Laughing Cow cheese ¼ cup chicken and rice casserole ¼ cup soft cooked green beans 1 peach half (canned in water) cheese ¼ cup fat free refried beans 1 oz lean ground beef 1 oz low fat cheese ½ of a 6 soft tortilla 7:30 p.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid 8:30 p.m. 2 oz of tuna ½ cup Greek yogurt 1 hard boiled egg 1 tsp low-fat/fat-free mayo 3 whole wheat crackers 10:00 p.m oz clear liquid 8-12 oz clear liquid 8-12 oz clear liquid

9 Unrestricted Textures If you tolerate soft solids for 4 weeks, you can slowly advance your diet to regular textures. At this time, you should tolerate most foods. It is best to start with the softer raw fruits and vegetables, such as bananas, melons, and tomatoes and work up to the harder, more fibrous raw fruits and vegetables, such as oranges, apples and carrots. At first, you may want to peel off any tough skins. As you proceed with different food textures, you will likely be able to consume unpeeled foods. Toast bread to improve tolerance. Limit your intake to no more than 1 cup per meal. You may not be able to eat this much, so eat until you are satisfied without exceeding a cup. You should add only one new food at each meal to test your tolerance of that particular food. Adding too many foods at one time will make it difficult to determine which foods you tolerate and which foods you don t tolerate As always, choose foods that are low in sugar and fat.

10 Sample Menu Menu Breakfast ½ cup cottage cheese ¼ cup peaches ¼ cup oatmeal Morning snack bariatric clear liquids protein supplement as needed Lunch 1 oz low fat ham 1 oz low fat cheese 1 slice of toast ½ banana ¼ cup yogurt Afternoon Snack bariatric clear liquids protein supplement as needed Dinner 2 oz chicken ¼ cup rice ½ cup salad ½ small apple Evening Snack bariatric clear liquids protein supplement as needed Protein Content 14 grams 1.5 grams 7 grams 7 grams 3 grams 2 grams 14 grams 1.5 grams 0.5 grams