Gastric Bypass

Life-long

Nutrition Manual

Dr David Provost

2501 Scripture St., Suite 303

Denton, TX 76201

940-323-3450, FAX 940-323-3451

Good Nutrition After Gastric Bypass Surgery

Gastric Bypassis a surgical procedure that decreases the size of your stomach, reducing hunger and limiting dietary intake to promote weight loss. The initial eating plan after this procedure is very limited in choices and amounts as we are trying to heal your stomach after surgery. Over time, your diet will be advanced as tolerated to include softer items and then eventually more solid items, which are eaten in a more “normal” pattern. Your surgery is a tool that is there to help you, but it can’t make choices for you—it can only make it more difficult for you to eat the way you did before surgery. Nutrition is extremely important for the long-term maintenance of weight loss resulting from this surgery.

A Tool to Make the Job Easier: Like any type of tool, the Gastric Bypass has instructions that tell you how to make it work the way it’s supposed to. Not following the instructions can mean that the tool won’t work the best that it could.

How to Use the Bypass: The Gastric Bypass works in two ways: 1) by allowing you to eat less and still feel full 2) by making your body digest and absorb food less effectively. However, to get the maximum benefit from this surgery, it is important to eat solid foods. If you choose foods that easily run through your stomach pouch, it will slow or inhibit your weight loss. Why? Liquids, salty crunchy foods and softer foods will not stay in your new stomach pouch and you will become hungry again shortly after eating. You will also be able to eat a lot of them because they slide through the pouch! These foods can also cause Dumping Syndrome. The longer this cycle continues, the less weight you will lose. In fact, this pattern of eating commonly can result in weight re- gain.

Where Nutrition Fits: Because you will not be able to eat as much as before, good nutrition is even more important! Making your food choices count is key. Choose foods rich in nutrients but low in calories. Choose solid foods like meats, vegetables, fruits, and whole grains that will stay in the pouch over liquid and soft foods that will easily slide through and not help you stay full. Establishing healthy eating habits is very important for lifelong success.

Why should you follow these instructions? The purpose of this food plan is to limit calories while providing you with adequate nutrition to preserve muscle mass and prevent nutritional deficiencies. The diet is intended to prevent complications from your surgery and to promote food tolerance, long-term weight maintenance, and optimal health. If you do not follow this food plan carefully, your new stomach pouch may stretch and you may experience: pain, discomfort, nausea, vomiting, or dumping syndrome.

Dumping syndrome occurs when food empties quickly from your stomach into your intestine. Drinking with meals, extreme temperatures, fried foods, all sugars, and refined carbohydrates (such as pasta and potatoes) can trigger dumping syndrome. Symptoms include: nausea, vomiting, diarrhea, abdominal cramping and bloating, feeling dizzy, sweating, or feeling like you might faint. If you follow your dietary guidelines, this won’t happen!

Exercise! Getting regular exercise is a vital part of sustained weight loss. A goal could be to work up to 30-35 minutes of activity each day. Exercise is very important during the first 3-6 months after surgery. It will help you lose weight faster. The added weight loss achieved with an hour of exercise during the first months following surgery may require 5 hours of exercise a year or two later. Remember this when you don't feel like exercising. You want to make the most of this special post-operative time.

Gastric Bypass Nutrition Flowchart for Clinic Visits

NewPatient Visit: Evaluation and education day. We will review the material contained in this manual. Insurance may require 3-6 months of medically supervised weight loss before approving your surgery. In addition, we may require special lab work or testing prior to your surgery.

~2 weeks before surgery: At this time you will begin your pre-op very low-calorie, low-carbohydrate liquid or solid food diet. You will also learn about the diet you will follow after your gastric bypass.

~2 days to 1 week before surgery: Pre-Op testing day. Clinic and hospital visits for your pre-op physical, pre-admission to the hospital, and pre-surgical paperwork at the hospital.

Night before and morning of surgery:Nothing by mouth after midnight

After surgery: Once Dr Provost feels it is medically appropriate for you to begin consuming liquids by mouth, you will start with a clear liquid diet, which includes water, sugar –free juices, and broth.

Afternoon of post-op day 2: Phase 1: Full Liquid Diet that includes water, juice, milk, and liquid nutrition supplements. Stay on this plan from the day of hospital discharge until your 2 week Post-Op Visit

Post Op Visit: ~2 weeks after surgery: Post-op check. Begin Phase 2 Diet: Full Liquid/Soft Diet, start after your clinic appointment

Dietician visit via phone or office ~4.5--6 weeks after surgery: Begin Phase 3: Solid Foods.. This will be your lifelong eating pattern, thus it is a way of life, not a true ‘phase’

1st and 2nd Year Post-Op – Appointment every 3 months, blood tests every 6 months

3rd Year Post-Op – Appointment every six months, blood test every 12 months

Lifelong Follow-up – Appointment with blood tests once a year

Dietary Timetable

Stage of Diet / What To Eat / Amount to Eat
Pre-Op Diet
(2 weeks before Surgery) / Very low-calorie, low carbohydrate liquid or solid food diet / 3 oz protein 3 x per day, 1-2 cups vegetable 3x per day or 3 cups protein drink per day
Night Before/ Morning of Surgery / Nothing after midnight / Nothing after midnight
Surgery! / Surgery! Then small amount of clear liquids / Surgery! Then small amount of clear liquids
Phase I
1-2 Weeks After Surgery / Full Liquids (3 cups protein drink + 3 cups water/non-calorie liquids). Drink more water as needed. / 1 oz (2 tablespoons) every 15 minutes all day long, while awake
Phase II
2-5 Weeks After Surgery / Full Liquids/Soft Foods (2 cups protein drink + 1 cup pureed soft foods) = 3 cups totalper day / Start with 4 meals
Meal; size ¼ cup
Continue protein drinks, zero calorie fluids, etc.
Phase III
5+ Weeks After Surgery and beyond / Solid Foods. The beginning of the rest of your life! / Start with 4-5 smaller meals
Goal is 3 meals per day
Meal size: ½ cup
Life-Long / Multivitamin with iron, Calcium citrate with Vitamin D (1000-1200 mg daily) divide into ½ dose twice daily / 2-3 children’s chewable multivitamin and 1000-1500 mg Calcium citrate
Take vitamins and calcium separately. Only 500-600 milligrams of calcium at a time.

The Bariatric “Solid Food Pre-Op” Diet

Follow for 2 weeks prior to surgery to shrink your liver

A very low calorie, very low carbohydrate diet.

Protein Foods / Vegetables /

Extras

Three, 3-ounce portions per day
90% lean
or
less than 3 grams of fat per ounce / 1-2 cups, 3 portions per day / You may have up to three items off this list per day
Fish
Chicken (white meat, skinless)
Turkey (white meat, skinless)
Beef (sirloin, top round)
Pork (tenderloin)
2 Eggs or egg sub
Veal (chop, leg, cutlet)
Shellfish: crab, shrimp, lobster
Tofu (low-fat)
Luncheon Meat
Cheese, low-fat
Ham, low-fat
Canadian Bacon
Beef Jerky
Meats should be baked, broiled, grilled, boiled, or steamed.
3 ounces is about the size of a deck of playing cards. / Asparagus
Alfalfa Sprouts
Artichokes
Beets
Bean Sprouts
Bell peppers
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Carrots
Celery
Cucumbers
Eggplant
Garlic
Green beans
Greens: spinach, turnip
Lettuce:
Mushrooms
Onions
Peppers: all types
Parsley
Radishes
Snow peas
Squash: summer, zucchini
Tomatoes
Turnips
Vegetable Juice
Water Chestnuts / Light mayonnaise (1 Tbsp)
Regular salad dressing (1 Tbsp)
Reduced-fat salad dressing (2 Tbsp)
Olive or canola oil (1 tsp)
Regular margarine (1 tsp)
Reduced calorie margarine (1 Tbsp)
Non-fat milk (½ cup)
0-2% cottage cheese (½ cup)
Fat-free, sugar-free yogurt (½ cup)
In addition:
  • Take a multi-vitamin with iron
  • 1000-1200 mg calcium citrate with vitamin D each day. ***Separate into (2) 500-600 mg doses. Allow at least 2 hrs between calcium supplement and multivitamin.
  • Make sure you are getting 800 mg of vitamin D in each day (via vitamin, calcium supplement, etc).
Tbsp: tablespoon
tsp: teaspoon
Free Foods: consume as desired:
Non-caloric beverages:Condiments:Other:
WaterLemon or lime juiceSugar-free Popsicles
CoffeeVinegarSugar-free gelatin
TeaCooking oil spray (PAM)Light Soy Sauce
Crystal LightHerbs/Spices
Sugar-Free Kool-Aid or like beveragesMustard
Broth, fat-free (low salt varieties are available)

If you have hypertension, avoid these sodium rich foods.

Phase 1 Gastric Bypass Diet: “FULL LIQUIDS””

Generally followed from post op day 2 until 2 weeks after surgery.

Stay on this diet until you come into the clinic for your 2 week post-op checkup.

Be sure to measure your liquids carefully and keep a log of your fluid intake to help ensure that you are drinking enough

Consume 1 ounce every 15 minutes (while you are awake!) Drink slowly. Do not force

Nutrition Beverages: “Protein Drinks”
1 ounce/ 2 tbsp at a time, 15 minutes apart /
Calorie-free Beverages
1 ounce at a time, 15 minutes apart
Try to consume 3 cups (24 oz) each day: / Consume at least 3 cups (24 oz) per day:
Water
Tea
Coffee
Crystal Lite
Sugar-free Kool-Aid or like mixes
Fruit2O
AquaCal
Sugar-free Popsicles
Sugar-free Gelatin
Broth, fat-free (chicken, beef, veg)

No Carbonated Beverages

Beverages must be non-caloric
“Sugar-free”
Juice: You may substitute up to 1 cup of no sugar added fruit juice each day for non-caloric beverage. This is allowed during this stage only. In later stages we suggest avoiding all juices.
  • Bariatric Advantage Meal Replacer
  • Carnation Instant Breakfast, Sugar-free (skim milk)
  • Slim Fast High Protein Low Carb
  • EAS Myoplex Low Carb Lite
  • Muscle Milk Lite
  • Carb Solutions
  • Atkins Shake
  • Pure Protein
/
Lactose-free choices
  • Boost Glucose Control*
  • Glucerna Shake*
  • Isopure*
  • Nectar*
  • Choice DM*
  • Glytrol*
  • Resource
  • Diabetic*

***If you choose to use Isopure Zero Carb talk to your dietitian.

Sample Full Liquid Menu

7:00 a.m. 1 oz Carnation Instant Breakfast / 5:00 p.m. 1 oz unsweetened juice
7:15 a.m. 1 oz unsweetened juice / 5:30 p.m. 1 oz Carnation Instant Breakfast
7:30 a.m. 1 oz Carnation Instant Breakfast / 5:45 p.m. 1 oz water
7:45 a.m. 1 oz water / 6:15 p.m. 1 oz Carnation Instant Breakfast

*Continue consuming allowed foods/beverages every 15 minutes.

Acceptable Protein Drinks:

Dr Provost’s Recommended Protein Drink: Bariatric Advantage is available for purchase in the clinic. Bariatric Advantage is a high quality supplement designed for the post-surgical nutritional needs of a bariatric patient.

If you are either unable or unwilling to purchase protein drink from the clinic, the above are acceptable alternatives.

Protein Drink Nutrient Specs: A good protein drink should have the following nutrients per serving:

~20 g protein per scoop/serving

  • ~5 g or less of carbohydrate/sugars per scoop/serving
  • ~5 g or less of fat per scoop/serving

Additional Instructions:

Lactose intolerant:

Choose lactose-free supplements or lactose-free/lactose-reduced milk. Chewable lactase enzymes are also available over the counter which can be consumed with dairy products to improve tolerance

Gum:

Avoid chewing gum (or be very careful with it). Swallowed gum can block the opening to your stomach.

Do not force liquids/ food:

Do not force yourself to consume liquids/ food if you are not hungry or are uncomfortable. Continuing to eat/ drink when you are full can cause nausea and vomiting and can possibly stretch your pouch.

Unable to eat/ drink:

Call Dr Provost if you are not able to eat due to nausea or vomiting, or if you have severe diarrhea. Call immediately if you cannot hold down liquids.

Take your supplements every day:

  1. 1 dose of a good quality chewable or liquid multivitamin/mineral with iron each day
  2. 1000-1200 mg of chewable or liquid calcium citrate with vitamin D each day each day in divided doses of 500-600 mg at a time. Separate calcium supplement from multivitamin by 2 hours before or after.

Fluids:

Caffeine is a diuretic (increases urine production.) If you are having a hard time getting enough fluids in, drink decaffeinated beverages. You do not need to avoid caffeine for life.

Beverages that are very hot or very cold may stimulate dumping. Avoid extreme temperatures if you suspect this is happening to you.

Avoid alcohol. It adds calories and may impair your judgment leading to poor food choices. It is also a diuretic.

Advancing your diet:

Do not advance your diet until you are seen in the clinic and either Dr Provost or his dietitian tells you to do so.

Phase 2 Gastric Bypass Diet: “SOFTS”

Begin after your 2 week post-operative visit and follow until you are advanced to solid foods by Dr Provost or the dietician.

You remain on full liquids and softs for a few more weeks in order to continue healing from the surgery. Your intestines are not ready yet for the consistency of solid food.

Nutrition Beverage
2 ounces at a time /
Calorie-free Beverages
2 ounces at a time
Consume 2 cups (16oz) each day: / Consume at least 3 cups (24 oz) per day:
Water
Tea
Coffee
Crystal Lite
Sugar-free Kool-Aid or like mixes
Fruit2O
AquaCal
Sugar-free Popsicles
Sugar-free Gelatin
Broth, fat-free (chicken, beef, veg)

No Carbonated Beverages

Beverages must be non-caloric

“Sugar-free”

Avoid alcohol. It adds calories and may impair your judgment leading to poor food choices. It is also a diuretic.
  • Bariatric Advantage Meal Replacer
  • Carnation Instant Breakfast, Sugar-free (skim milk)
  • Pro Complex (mixed w/ a zero-cal beverage)
  • Slim Fast High Protein Low Carb
  • EAS Myoplex Low Carb Lite
  • Muscle Milk Lite
  • Carb Solutions
  • Atkins Shake
/
Lactose-free choices
  • Boost Glucose Control*
  • Glucerna Shake*
  • Isopure*
  • Nectar*
  • Choice DM*
  • Glytrol*

***If you choose to use Isopure Zero Carb talk to your dietitian.

This is a Pureed food NOT

Limit 2 oz (1/4 cup) at a time a Goal /

Additional Instructions

Consume 4-5 “meals” each day:
¼ cup Cooked cereal
¼ cup Sugar-free, fat-free yogurt
¼ cup Scrambled Eggs
¼ cup Pureed MOIST Meats: turkey, fish, chicken, tofu, shellfish, etc
¼ cup Pureed vegetables
¼ cup Pureed fruit, unsweetened / Do not drink 15 minutes before and at least 60 minutes after eating pureed food
Remember to take your multivitamin and calcium citrate supplement each day.
Meal 1 / Meal 2 / Meal 3 / Meal 4
Pro 1/8 cup
Veg 1/8 cup / ¼ cup
total / Pro 1/8 cup
Fruit 1/8 cup / ¼ cup
total / Pro 1/8 cup
Fruit 1/8 cup / ¼ cup
total / Pro 1/8 cup
Fruit 1/8 cup / ¼ cup
total
Meal 1 / Meal 2 / Meal 3 / Meal 4
Pro 1/8 cup
Veg 1 Tbsp
Fruit 1 Tbsp / ¼ cup
total / Pro 1/8 cup
Veg 1 Tbsp
Fruit 1 Tbsp / ¼ cup
total / Pro 1/8 cup
Veg 1 Tbsp
Fruit 1 Tbsp / ¼ cup
total / Pro 1/8 cup
Veg 1 Tbsp
Fruit 1 Tbsp / ¼ cup
total

Phase 1 and 2 Shopping List

Use while you are on liquid and/or soft foods.

Acceptable Protein Drinks:

Lactose Free Beverages
Bariatric Advantage
Carnation Instant Breakfast, Sugar-free
Pro Complex (mixed w/ a zero-cal bev)
Slim Fast High Protein Low Carb
Lean Body, Carb Watcher’s, powder
EAS Myoplex Low Carb Lite
Muscle Milk Lite
Carb Solutions
Atkins Shake
Pure Protein / Boost Glucose Control*
Glucerna Shake*
Isopure*
Nectar*

Fluids:

Crystal Light or Sugar-free Kool Aid

Fruit2O

Tea/coffee

Sugar-free gelatin

Sugar-free Popsicles

Broths, Bullion, or Base, fat-free (Chicken, Beef, Vegetable)

Phase 2 Soft Foods

Chunk Lite Tuna in water

Canned chicken breasts in water

White Fish Fillets: such as White sea bass, Halibut, Tilapia, Catfish, Cod

Eggs OR Egg Beaters (flavor of your choice)

Pureed fruits

Pureed vegetables

Pantry Necessities:

Zero-calorie sweeteners: Splenda, Equal, NutraSweet, or Sweet N Low, Stevia

Herbs and spices, your choice

Cooking Oil spray, example: PAM

Supplements:

1. Complete multivitamin-mineral with iron, chewable or liquid for the first 3 months:

EXAMPLE: Bariatric Advantage, Centrum Complete, Flintstones

  1. Calcium Citrate with Vitamin D, chewable or liquid for the first 3 months:

EXAMPLE: Bariatric Advantage, Blue Bonnet Liquid Calcium, Citracal Creamy Bites, other chewable or liquid calcium citrate with vitamin D