Steps of diet progression after Bariatric Surgery
Phase One: The Bariatric Surgery Clear Liquid Diet
Duration: 7 Days Post-Surgery
After surgery, your body needs time to rest and adjust to the changes. There are 4 phases of the post-op diet to help gradually incorporate foods back into your meal plan as your stomach completely heals, which usually takes 4 weeks.
The reason there is a range of phases after surgery is that each person is different and you heal and adapt at different rates. It is very important for you to learn to be mindful and listen to your body; it will tell you when it is ready to go to the next phase.
The first phase of the post-op diet focuses on hydration and strictly consuming clear liquids.
List of Approved Clear Liquids
Phase 1 of the Clear Liquid diet only lasts for 7 days after bariatric surgery. Your goal is to be able to consume 1.5 to 1.8 ltrs of fluids per day to stay hydrated before moving to the next phase. Drink small sips and never use a straw!
Clear liquids are anything that is transparent and sugar-free including;
- Water
- Broth
- Flavored Water
- Sugar-Free Jello
- Popsicles
- Herbal Tea
- Broths
- All clear soups
- Fresh low sugar juices
- Dal pani chana soup
To assist with being able to get the minimum requirement of 1.5 lts of fluids, avoid any extremes like too hot or too cold.
Having warm teas or broths and room temperature water or juices are the best options. The other thing that will assist you is having something warm first thing when you wake up; this helps in relaxing the stomach muscles. After the surgery you will not be able to gulp fluids anymore, so train yourself to sip throughout the day.
What We Recommend
Overall your clear liquids will consist of water, broth, herbal tea, dal pani,clear soups, or popsicles. If you want to add lemon to your tea that would be fine, this will decrease the acidity of the drink; although lemons are
acidic, they have the opposite effect in our bodies and help in creating an alkaline environment.
A lot of people ask about clear liquid protein. You don’t need to take them during this phase but if you want to use it for a variety it’s fine. Remember your goals during this phase are rest for your body so it can heal and to constantly keep fully hydrated.
What to Avoid
You can not have any carbonated beverages, such as soda, and you must also rule out regular and decaf coffee from your diet. After surgery, your stomach is very sensitive and many people have problems with nausea and .
Because coffee is acidic it can exasperate the acid reflux. You want to wait a minimum of 30 days before you attempt to incorporate coffee back into your meal plan. If you are having any type of acid reflux DO NOT have coffee until this goes away.
Moving to the Next Phase
When you are drinking 1.5 -1.8 ltrs of fluid and feel hungry, your body is telling you it is ready for phase 2, which is thick liquids
Phase Two: The Bariatric Surgery Thick Liquid Diet
Duration: 7 to 14 Days Post-Surgery
We are discussing Phase 2 of the post-surgery meal plan; thick liquids. If you are moving on to Phase 2 of the meal plan, this means you are easily taking in 1.8 ltrs of fluids, and you feel hungry or ready for the next phase. It typically lasts for 7 days.
Avoid nuts and seeds for 8 weeks post-op
Approved Thick Liquids
- All foods from the previous stage
- Cream of Wheat
- Oatmeal
- Soup
- Almond milk
- Protein Powders
- Greek Yogurt (remember it needs to have more protein than sugar – Fage/Chobani plain Greek yogurt)
- Almond or Coconut Milk
- Natural Apple Sauce
- Hot cereals like oatmeal/ cream of wheat/Kashi hot cereal
- Sugar-Free Pudding
- Soups (chose higher protein soups like bean soup, can take chunky soups and blend before eating)
- Avoid all carbonated beverages (fills the stomach with gas), sugar (extra calories that fight against weight loss), and coffee (it is acidic and may have problems with acid reflux after surgery. It is also a diuretic, causing you to be dehydrated)
The Goal of Phase Two: Protein Intake
The goal of phase 2 thick liquids is to continue to get 1.8 ltrs of fluids but now you start focusing on getting the appropriate amount of protein as well.
The general range of protein is between 60 to 90 grams per day. If you want to know a more accurate value for you; you would take your ideal body weight and divide that by 2.2.
This the minimum amount of protein to maintain your current muscle mass.
Making sure you get the proper amount of protein is necessary. If you don’t then some of your weight loss could be from muscle instead of fat loss. The more muscle you lose, the harder it will be to reach your goal weight and keep it off. It also increases the amount of saggy skin you may have post-surgery.
For example: If your goal weight is 68 kgs then your recommended protein intake would be 68 grams per day(1 gram per kg body weight)
What We Recommend
During this phase, you can incorporate protein powders to make protein smoothies or pre-made protein drinks. Pureed soups, but be mindful of creamed soups; many people do not do well with milk after surgery and creamed soups are very high in fat. We recommend you stick with bean or chicken-based soups you can blend. I’d recommend using almond or coconut milk instead of regular milk.
Many people become lactose intolerant due to the sugar in the lactose after surgery and can diarrhea and discomfort. We recommend using either almond or coconut milk instead of regular dairy milk.
Phase Three: The Bariatric Surgery Soft Solid Diet
We are discussing Phase 3 – Soft Solids of the post weight loss surgery meal plan. You will start this phase 2 weeks after your surgery, around day 15 to 21. At this stage, you are still drinking 1.5 -1.8 ltrs of fluids to prevent dehydration. Also, continue reaching for your goal of 60 to 90 grams of protein by getting 15 to 20 grams of protein per each meal.
Approved Soft Solids
The soft solid phase is the consistency of mashed potatoes or baby food but you don’t want to eat baby food because your nutrition needs are much different than a child. This is the phase where you start weighing your food. If you have not already bought a pocket digital scale you need to get one.
- Add only ONE food at a time
- Scrambled eggs (soft, boiled, poached)
- Egg salad
- Tuna fish moistened well with mayo
- Chicken salad, salmon, moistened with mayo
- Cottage cheese
- cheese
- Tofu
- Fruit (mashed, can – anything soft)
- Veggies (mashed, can, and slow-cooked to tenderize)
- Refried beans with cheese
- Meats pressure cooked to tenderize
- Bananas
- Sweet potatoes, and potatoes (mashed – only)
- Greek Yogurt
The Goal of Soft Solids
You begin to weigh your food at this stage. The goal is no more than 170 grams of food- 85 grams of protein, 28 grams of healthy fat, and 56 grams to play with adding vegetables, fruits, or carbohydrates. Your goal is to work towards getting 20 grams of protein at each meal
You will begin to have 3 meals per day 110-170 grams and then one protein shakes a day. Your goal is to get in at least 340 grams of food per day. So if you can not get in 85 grams of protein at one time your 3 meals may turn into 6 meals having only 56 grams at a time. Each person is different after surgery.
Avoid Overeating
It is very important that you listen to your body and not overdo it. In time, you will be able to eat 170 grams at one meal. Now that you are eating real food you will stop drinking all fluids 30 minutes before you eat, no fluids while you eat, and then wait 30 minutes after you eat. Why is it important to follow this and not drink with your meals?
You have to remember you have drastically decreased the size of your stomach. If you drink before you eat you will fill your pouch up with fluids and not be able to get the proper nutrition. If you eat during or directly after you will push the food through your pouch faster causing you to be hungry sooner.
What We Recommend
It is very important that you weigh your food. Your goal at each meal will be to eat 170 grams of food. 85 grams will always be protein. When you can eat 85 grams of protein you can add 28 grams of healthy fat like pureed avocado or add coconut oil or some other oil to your foods. Then you have 56 grams you can play with to add some fruit like applesauce or vegetables like purred eggplant or green beans.
During this phase, you will need to eat very slowly and although the food is soft, still practice chewing your food until applesauce consistency before swallowing. Also, take pinky size bites to minimize your chances of regurgitation or to get nauseous. One of the main reasons people have problems with regurgitation or vomiting is because they are either eating too fast, or they have taken too big of a bite.
We recommend getting tiny utensils to assist in only eating a little amount at a time. Also during this phase, it would be beneficial to try one new food at a time. If you seem to be constantly vomiting at this stage, and you have slowed you’re eating down and you are taking the pinky size bites; go back to thick liquids for a day or two and try again.
We are discussing Phase 3 – Soft Solids of the post weight loss surgery meal plan. You will start this phase 2 weeks after your surgery, around day 15 to 21. At this stage, you are still drinking 1.5 -1.8 ltrs of fluids to prevent dehydration. Also, continue reaching for your goal of 60 to 90 grams of protein by getting 15 to 20 grams of protein per each meal.
Phase Four: The Bariatric Surgery Solid Food Diet
Duration: Maintain Phase 4 Nutrition Guidelines Forever
We are discussing Phase 4 – Solid Foods of the post weight loss surgery meal plan which starts at approximately three to four weeks after surgery. It is important to remember not to compare yourself to others as far as what you can eat or the rate at which you are losing weight.
Approved Soft Solids
Every person is different, and your body adapts to the surgery differently meaning you can incorporate different types of foods at different rates. Your primary goal is to get still 60 – 90 grams of protein and to drink a minimum of 1.5-.18 ltrs of fluids. Fluids should come predominantly from water, flavored herbal tea, and vitamin water.
- All foods from previous stages
- Cheese (any cheese other than American or Velveeta)
- Dried beans: kidney, lentil, split pea
- Lean Meats: fish, tuna, chicken, turkey (Make sure all meats are moist)
- Canned fruit in natural juices
- Soft cooked vegetable
- Be careful of fibrous/gassy vegetables (celery, broccoli, cabbage, etc…)
- Avoid the membrane of the fruit (skin on citrus)
- Avoid tough meat
- Fish
- Shrimp
- Eggs
- Chicken
- Tofu
- Meatless products
- Beans
- Cottage cheese
- Low-sugar Greek yogurt
No carbonated beverages post-surgery, especially soda. The carbonation creates gas and can cause significant discomfort. Also, remember not to drink with a straw, you will pull more air into your pouch that can cause pain. You can add coffee back in moderation when you are not experiencing acid reflux, and you don’t have any problems eating food or drinking fluids.
Learn More: Avoiding Dehydration Post-Surgery
Coffee is acidic, so it may exacerbate or create acid reflux and cause discomfort. Coffee is also a diuretic which pulls fluids out of you and can cause you to be dehydrated if you are not drinking enough other fluids.
Learn More: Drinking Coffee After Bariatric Surgery
You are still weighing your food, 3 meals at 170 grams, and one protein shake per day. Your meals consist of 85 grams of protein, 1 ounce of healthy fat, and 56 grams of fruits, vegetables or starch. It may take a few months to be able to eat 170 grams of food at one sitting. We recommend starting at 85-110 grams and slowly increasing to 170 grams.
What We Recommend
Become aware of how many grams you can eat at one time and be sure not to force more than your body is ready to tolerate at this time. Depending on how many grams you can take in at one time your total goal for the day is 340-540 grams of total food 255 grams being protein. So if you can only eat 85 grams at one time, you would eat 4 to 6 times per day having 56 grams of protein and one ounce of something else. You always want to have some form of protein with each meal.
Not only will this assist with increased weight loss, but it also helps with maintaining muscle mass and will help prevent feelings of discomfort, being nauseous or bloated from gas being produced. You really will need to listen to your body and adapt this meal plan to fit where you are at and what foods you are able to tolerate.
Phase Four Tips
This phase is to slowly incorporate real whole food back into your diet. It may take up to 6 months for you to be able to eat most foods. When trying a new food try one new food at a time to see how you do. If a particular food does not agree with you, wait a few weeks and try again. It is very important that you learn to eat very slowly, cutting your food up into pea-size bits and chewing until the food is applesauce consistency before swallowing.
By training yourself to do this you minimize your chances of getting food stuck. This takes practice, so hopefully, you started doing this before surgery. When incorporating lean meats you may want to begin with a soft fish like tilapia and see how you do. When cooking your protein be sure to use cooking methods that will allow the meat to be very moist like using a crockpot or a slow cooker where you cook your protein in a broth or liquid base.
When incorporating vegetables start with cooked vegetables that have mostly insoluble fiber and are non-fibrous gassy vegetables like green beans, squash, eggplant, zucchini, leafy greens, and carrots. Vegetables that are high in sugar or contain more soluble fiber tend to create more gas and can cause discomfort. Gassy and fibrous vegetables like celery, broccoli, cabbage, onions, cauliflower, and peas you may want to wait a while before incorporating. See how you do with several cooked vegetables before moving on to raw veggies.
When incorporating fruit to start, you will want to remove all the skin. You may wish to start with canned fruit in its juice, rinsed and drained, to begin with then gradually change over to whole fruit. In time, you will be able to eat fruit with the skin but that may take a few months.
Remember to continue not to drink 30 minutes before you eat, while you are eating and 30 minutes afterward. After surgery, it is critical that you train yourself to be a mindful eater, having the time to eat without distraction or stressful emotions.