YOUR DIET AFTER WEIGHT-LOSS SURGERY

YOUR DIET AFTER WEIGHT-LOSS SURGERY

Your Diet After Weight-Loss Surgery Now that you have completed your weight-loss surgery, it is important for you to follow a healthy diet plan. As a general rule, adequate fluid and protein intake are essential to successful recovery. The information in this packet will serve as general guidelines to help you to determine what foods are best for you at the different stages of your recovery process. Your outpatient registered dietitian will help you customize a successful diet according to your specific tolerances and taste preferences. This nutrition expert will also provide you with other nutritional materials to help you with your diet. In the Hospital After surgery, when you have received approval from the surgeon, you will be able to drink 30 ml (one fluid ounce) of clear liquids. Liquids must be sipped over 30 minutes during waking hours. You may choose from the following: Water Fruit-flavored water Sugar-free Kool-Aid Crystal Light Unsweetened decaffeinated Iced Tea Decaffeinated tea or coffee (Do not add cream) Sugar-free ice pops (Popsicle ) Sugar-free, diet gelatin (Jell-O ) (Do not have red gelatin) Clear broth When you are ready to leave the hospital, a dietitian will briefly review the dietary guidelines in this packet with you. Once you are discharged from the hospital, your surgeon or dietitian will continue to assist you with your dietary needs. How Weight-Loss Diet Planning Works You will progress through four stages of dietary guidelines throughout your recovery process. If you are having difficulty with your current stage, please contact your surgeon and DO NOT advance to a higher stage. 1

The following chart describes each dietary stage you will experience based on the food type and the general period of time you are to follow the prescribed diet. Stage Recommended Diet Description Stage 1 Full Liquid Diet You are able to add smooth, minimal texture foods and protein supplements to your diet. Continue on this diet for approximately first two weeks (14 days). (See PAge 3) Stage 2 Pureed Diet You are able to add blenderized protein food sources to your diet in addition to blenderized fruits, vegetables and starches. Continue on this diet for approximately one week (7 days). (See PAge 5) Stage 3 Soft Mechanical Diet Approximately three weeks after your procedure you will regain the ability to eat non-blenderized foods. Continue on this diet for approximately one week (7 days). (See PAge 8) Stage 4 Healthy Weight for Life Diet Plan The general dietary recommendations in this stage will help you maintain a healthy weight for life. (See PAge 10) Important Tips It is important that you remember the following tips throughout each stage of your dietary process: Do Not use straws. Do Not drink at least one-half hour before and after meals. Do Not drink caffeine. Do Not drink beverages with carbonation. Do Not consume citrus foods. Do Not drink alcohol. Do Not eat food high in fat and/or sugar. each meal should last 30 minutes. Always drink and eat slowly. 2

Stage 1: Full Liquid Diet The Full Liquid Diet is generally recommended the second day after your procedure. You will now add soft foods and protein supplements to your diet. Use the recommendations below as guidelines for healthy eating during this diet stage. The foods in this section are grouped according to their food type. It is important that you choose foods from all three groups on a daily basis. To help you determine how to plan meals, a sample one-day meal plan is included at the end of this section. Fluids Group Slowly sip sugar-free, non-carbonated, caffeine-free fluids throughout the day. Remember to avoid using a straw. Drink six to eight, 8-ounce servings of fluids per day to maintain hydration. (Do not drink within one-half hour before and after meals.) Options: Water Fruit-flavored water Sugar-free Kool-Aid Crystal Light Unsweetened decaffeinated Iced Tea Decaffeinated tea or coffee (You may add fat-free and sugar-free creamer) Sugar-free ice pops (Popsicle ) Sugar-free gelatin (Jell-O ) Clear broth Strained cream soup (no chunks, 98% FAT-FRee and made with 1% or skim milk) Broth with one scoop of protein powder Milk or Lactaid (skim or 1%) Soymilk (plain or unsweetened vanilla) Soft Foods Group Consume serving sizes of appropriate ¼ to ½ cup of soft foods three times per day. Choose from the following: Sugar-free pudding made with 1% or skim milk Light, low-fat smooth (no chunks, plain or vanilla only) yogurt made with artificial sweetener (greek yogurt is an excellent choice.) Protein Supplements Group Drink 8 ounces of protein supplements three times per day. Spread the 8 ounces over a one-hour period. (Your goal is to consume 60 grams of protein each day. You will need to gradually work up to this goal. Work with your dietitian to determine how you will meet this goal.) Choose from the following: Ready-to-Drink Commercial High- Protein Supplement Drinks: eas Advantage Carb Control Ready-to-Drink gnc Total Lean Lean Shake Isopure Protica Protein Beverage Profect or Proasis varieties 100% whey protein powder (choose any brand; can be mixed with fat-free milk) 3

Make your own supplements with protein powder. examples of protein powder: Sample Meal Plan for Stage 1: Full Liquid Diet Designer Whey, Zero Carb Isopure, gnc 100% Whey Protein, UNJURY and Syntrax Nectar. (each scoop of protein powder typically supplies about 20 grams of protein. It should have 3 grams or less of sugar and fat. Refer to the Nutrition Facts label for complete information and a list of ingredients.) examples of homemade high-protein shakes: Breakfast Lunch Dinner Fluids ¼ to ½ cup light yogurt ¼ to ½ cup strained cream soup ¼ to ½ cup skim milk Slowly sip allowed fluids throughout the day. Drink 6 to 8 servings per day (Serving size = 8 ounces). 44 Yogurt Shake INgReDIeNTS 4 ounces of allowed smooth yogurt 4 ounces of 1% or skim milk or Lactaid 1 scoop protein powder 1tablespoon Crystal Light Directions: Use a blender to blend all ingredients for about 10 minutes or until smooth. Vanilla Shake INgReDIeNTS 8 ounces of 1% or skim milk or Lactaid 1 scoop protein powder ½ teaspoon vanilla extract Directions: Use a blender to blend all ingredients for about 10 minutes or until smooth. Snack High-Protein Pudding Drink high-protein supplement in between meals to help reach your goal of 60 grams of protein per day. You will need the Jell-O Sugar-Free Instant Pudding mix (4 servings). Measure 2 cups of cold skim milk (as indicated in package directions). Add two scoops of protein powder to the two cups of cold milk. Thoroughly mix the protein powder with the milk by shaking or stirring. Put the Jell-O Sugar-Free Instant dry pudding mix into a bowl. Add the protien powder and milk mixture. Cream of Chicken Soup Pour 8 ounces of skim milk into a microwave-safe container. Microwave milk about one minute, then microwave 10 seconds at a time, checking the temperature each time until 130 F. Do not heat above 130 F. (It is a good idea to use a meat thermometer for the first time. This will allow you to know how long your microwave takes.) Stir in one scoop (or one packet) of UNJURY Chicken Soup flavor protein powder or the unflavored style of protein powder.

Stage 2: Pureed Diet The Pureed Diet stage requires you to add pureed foods and alternative highprotein supplements to your diet. Use the recommendations below as guidelines for healthy eating during this diet stage. The foods in this section are grouped according to their food type. Although the foods will be blenderized, do not mix food from different food groups. You may mix foods from the SAME food group. Steps to Preparing Pureed Foods 1. Select food from one of the food groups. 2. Blenderize the food item to a babyfood type consistency. Consume no more than the serving size provided for the food group that you have chosen. 3. Be sure to consume food items from each group daily. You are also able to eat the condiments listed below: Low-fat or fat-free mayonnaise Mustard Fat-free spray butter Spices/herbs To help you determine how to plan meals, a sample one-day meal plan is included at the end of this section. Tips for Preparing Pureed Foods Be sure to use a blender or food processor. Meats need to be tender (stewed, baked or boiled) before they can be pureed. Cook in crock pot until very tender. Add low-sodium broth, low-fat gravy or low-fat milk to add moisture to the meats when blending. When pureeing foods, add only enough liquid to obtain applesauce consistency to maximize your protein intake in a limited volume. Use light mayonnaise when blending tuna or egg. Add low-fat milk to hot cereal or mashed potatoes to increase protein content. Add 1 to 2 tablespoons of protein powder to foods to increase protein. You may add butter buds, butter spray and/or spices to season foods as tolerated. Important Tips to Remember For STAGE 2: Pureed Food Dieters Your goal is to consume at least 60 grams of protein per day; however, you will need to gradually work up to this goal. Work with your dietitian to determine how you will meet this goal. Continue to consume two servings of high-protein supplements daily. eat protein first. Blend all foods to the consistency of applesauce. Add foods slowly and one at a time to test tolerance. Do not chew gum (It may cause blockage). 5

Stop eating or drinking when full. Overfilling may stretch the stomach pouch and hinder weight loss. eat slowly. Sip fluid slowly. Do not eat baby food. Fluids Group Slowly sip sugar-free, non-carbonated, caffeine-free fluids throughout the day. Drink at least six to eight, 8 ounce servings of the following fluids throughout the day. (Do not drink within one-half hour before and after meals.) Options: Water Fruit-flavored water Sugar-free Kool-Aid Crystal Light Unsweetened decaffeinated Iced Tea Decaffeinated tea or coffee Sugar-free ice pops (Popsicle ) Sugar-free gelatin (Jell-O ) Broth Protein Foods Group eat serving sizes between ¼ to ½ cup of pureed protein foods, four to five times per day. Choose from the following: Pureed chicken or turkey with no skin Pureed fish (water-packed tuna) These soft fish should be mashed very fine with a fork: haddock, tilapia, cod and salmon Pureed tofu 2 scrambled egg whites or ¼ cup egg substitute Pureed fat-free refined beans Cream soups made with fat-free or 1% milk 1% fat cottage cheese Part-skim ricotta cheese No-sugar-added, low-fat, sugar-free pudding Milk or Lactaid (skim, fat-free or 1%) Soymilk (plain or vanilla) Blended light low-fat yogurt (no chunks) made with artificial sweetener Protein Supplements Group Drink 8 ounces of protein supplements two times per day. Use liquid high-protein supplement drinks as previously listed in the Protein Supplements Groups of Stage 1: Full Liquids. You may also use alternative high-protein supplements. See list of exmaples (serving size indicated). examples of alternative high-protein supplements: 1. High-protein oatmeal: ½ cup oatmeal Make oatmeal as directed but make with low-fat milk instead of water. After oatmeal is cooked, stir in one scoop of protein powder (plain or flavored), until well-blended. Optional: Add 2 ounces of additional milk, cinnamon and nutmeg. 2. High-protein cottage cheese: Add a small amount of cold water to a scoop of protein powder (plain or flavored). Stir to make paste. Add protein-paste to ½ cup low-fat cottage or ricotta cheese. Stir until blended well. 6

3. High-protein hot chocolate: Add a small amount of cold water to a scoop of protein powder, stir to make a paste. Add paste and one packet of sugarfree hot cocoa mixture to bottom of mug. Heat 8ounces. of skim milk. Pour hot milk into mug and stir well. Optional: Add cinnamon, nutmeg, any flavor of sugar-free syrup or 1 teaspoon of light cool whip. 4. High-protein cream soup: Combine one can of 98% fat-free cream condensed soup and 8 ounces of skim milk. Bring to a simmer. Add two scoops of plain protein powder and stir well. Take off heat and carefully strain any chunks of food. Pour 1 cup soup in bowl (makes two servings). Sample Meal Plan for Stage 2: Pureed Diet Breakfast ¼ cup egg substitute or 2 egg whites and ¼ to ½ cup light yogurt Lunch Dinner Fluids Snack ¼ to ½ cup pureed chicken ¼ to ½ cup mashed tuna with light mayo and ¼ cup pureed cooked vegetables Slowly sip allowed fluids throughout the day. Drink 6 to 8 servings per day (Serving size = 8 ounces). Drink high-protein supplement in between meals to help reach your goal of 60 grams of protein per day. Fruits, Vegetables and Starches Group eat ¼ cup of pureed fruits, vegetables and starches one to two times daily. Note that these foods are not rich sources of protein. Natural no-sugar-added applesauce Mashed banana Mashed potato Canned vegetables Pureed peas Pureed carrots Pureed green beans Pureed beets Pureed acorn or butternut squash Pureed sweet potato Cream of Wheat (make with skim or 1% milk) Oatmeal (make with skim or 1% milk) 7

8 Stage 3: Soft Mechanical Diet With the appropriate approval you have entered the Soft Mechanical Diet. At this stage, you will need to add non-blenderized foods to your diet. Use the recommendations below as guidelines for healthy eating during this diet stage. The foods in this group do not need to be blenderized. Be sure to follow these important tips: Continue to aim to consume at least 60 grams of protein per day (example: 6 ounces lean meat and 16 ounces of low-fat dairy per day). Work with your dietitian to determine how you will meet this goal. Wean yourself off protein supplements when you reach your protein goal through meals. eat protein foods first. After protein foods, eat vegetables and fruit. eat only cooked vegetables and skinless fruit. Add foods slowly and one at a time to test tolerance. Stop eating or drinking when full. Overfilling may stretch the stomach and hinder weight loss. Chew thoroughly. Foods to Avoid Soft breads, doughnuts, pastries (These may form a dough ball and block the stomach outlet) Salads or other raw vegetables Sugar and sweets (table sugar, cakes, cookies, pies, pastries) High-fat meat (bacon, sausage, bologna, pepperoni and salami) Steak, roast beef, pork, lamb, veal, venison High-fat foods (butter, high-fat salad dressing, mayonnaise, sour cream, cream cheese, whole milk, whole-milk cheese, ice cream, cake, cookies, pies) Fibrous vegetables (broccoli, cauliflower, brussels sprouts, corn, cabbage, salad greens, asparagus) Fresh fruit except bananas Nuts, seeds, coconut, raisins, popcorn, dried fruit RICe AND PASTA The foods in the following sections are grouped according to their food type. It is important that you choose foods from all three groups on a daily basis. To help you determine how to plan meals, a sample one-day meal plan is included at the end of this section. Fluids Group Slowly sip sugar-free, non-carbonated, caffeine-free fluids throughout the day. Drink at least six to eight, 8-ounce servings of the following fluids throughout the day. (Do not drink within one-half hour before and after meals.) Options: Water Fruit-flavored water Sugar-free Kool-Aid Crystal Light Unsweetened decaffeinated Iced Tea Decaffeinated tea or coffee Sugar-free ice pops (Popsicle ) Sugar-free gelatin (Jell-O ) Broth

Protein Group Consume serving sizes between ¼ to ½ cup of protein foods at meals and snacks (a total of five to six servings per day). Choose from: Cooked chicken or turkey with no skin; thinly sliced and moist Lean ground beef (at least 90% lean) Fish, water-packed tuna Tofu 2 egg whites Canned beans (kidney, lentils) Reduced-fat cheese Cream soups made with low-fat milk or with label 98% fat-free 1% cottage cheese Part-skim ricotta cheese Smucker s Natural Peanut Butter Reduced Fat Jif Whipped Creamy Peanut Butter Milk or Lactaid (skim, fat-free or 1%) Soy milk (plain or unsweetened vanilla) Blended light low-fat yogurt (no chunks) Hummus (no chunks) Fruit, Vegetables and Starches Group Consume serving sizes between ¼ to ½ cup of the non-protein foods, one to two times per day. Note that these foods are not rich sources of protein. Choose from: Cooked cereal (cream of wheat, oatmeal) Cold unsweetened cereal soaked in milk Ripe bananas Canned fruit (packed in natural juice) Vegetables cooked tender without seeds or skin boiled or well steamed Tomato sauce pureed, no seeds or skins (DO NOT eat pasta) Sample Meal Plan for Stage 3: Soft Mechanical Diet Breakfast Lunch Dinner ¼ cup egg substitute or 2 egg whites ¼ cup to ½ cup chicken ¼ cup to ½ cup tuna fish with light mayo and 1-2 tbsp. soft cooked vegetables Fluids Slowly sip allowed fluids throughout the day. Drink 6 to 8 servings per day (Serving size = 8 ounces). Snack Drink high-protein supplement in between meals to help reach your goal of 60 grams of protein per day. 9

Stage 4: Healthy Weight for Life Diet Plan Your dietitian has determined that you are ready for the Healthy Weight for Life Diet Plan. At this stage you should have general goals in place that will help you maintain the best nutrition and weight for the rest of your life. Healthy eating for long-term weight control will be reviewed with you by your dietitian when appropriate. Goals As you plan meals, remember to keep the following goals in mind: Keep meals low in fat. Keep meals low in sugar. eat foods adequate in protein. Drink adequate fluid amounts. Regularly consume high-protein food sources. (See list below.) You may introduce crunchy, fiberous vegetables and salads four to six months after surgery. You may begin to introduce wholegrain bread and pasta products four to six months after surgery. Items may be subject to your individual tolerance. When you reach your goal of 60 grams of protein per day through meals, you may wean yourself off protein supplements. Protein Food Sources Include: Choose the leanest and/or lowest fat options. Remember to prepare with no added fats. Meat (All listed contain 7 grams of protein per ounce.) Tips for Healthy Weight for Life Diet Plan eat fresh fruits for added fiber. Start with softer fruits like bananas, peaches, pears, etc. Fill at least half of your plate with vegetables. Drink six to eight, 8 ounce servings of fluids each day to maintain hydration. Chicken Turkey Seafood Beef Pork egg (1) Dairy Yogurt (8 oz) Milk (8 oz) Cottage cheese (½ cup) Cheese (1 oz) 8 grams 8 grams 6 grams 6 grams 10

Vegetable Artichoke (½ medium) 5 grams Baked beans (½ cup) 7 grams Black beans (½ cup) 7 grams Chick peas (½ cup) 7 grams Hummus (½ cup) 6 grams Lima beans (½ cup) 7 grams Pinto beans (½ cup) 7 grams Soy milk (8 oz) 6 grams Soy yogurt (8 oz) 8 grams Miso (½ cup) 16 grams Tempeh (½ cup) 16 grams Tofu (½ cup) 20 grams Almonds (1 oz) 6 grams Cashews (1 oz) 4 grams Peanut butter (2 tbsp) 8 grams Pistachios (1 oz) 6 grams Sesame or sunflower seeds (1 oz) 6 grams To schedule an appointment with the St. Peter s Hospital outpatient registered dietitian, please call (518) 464-9999. For recipes, visit www.bariatriceating.com. Soup with Chopped Chicken and Vegetables Ingredients: ¼ cup cold water 1 scoop/packet Chicken Soup flavor UNJURY 1 / 3 cup frozen diced carrots or other vegetables as tolerated (optional) 1 tablespoon diced onion ¼ cup cooked chopped chicken may use fat-free canned chicken breast in water ¼ teaspoon basil or thyme A dash of nutmeg ½ cup water Salt and pepper to taste Instructions: Part 1 Cold Mixture: Place ¼ cup cold water and UNJURY Chicken Soup flavor in a small shaker with tight-fitting lid. Cover and shake to blend; set aside. Part 2 Hot Mixture: Put vegetables, chopped chicken, basil or thyme, nutmeg, and ½ cup water in a microwave-safe container. Cover and cook on HIgH power for 2½ to 3 minutes, until hot, and vegetables are cooked to desired tenderness. Part 3 Combine: gradually stir 2 tablespoons (liquid portion) of the hot mixture into UNJURY cold mixture. Continue to stir in another 2 to 3 tablespoons of hot mixture. When finished, then add remainder of chicken and vegetables. Adjust seasonings with salt and pepper; serve warm. (Finished soup may be pureed until smooth.) 11

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