NUTRITIONAL GUIDELINES AFTER BARIATRIC SURGERY
Introduction
Make permanent changes
Stage 1
Clear liquids: days 1-3
Stage 2
Full liquid diet: days 3-17
Macros
Months 0-3 post-op
Meal plan + vitamins
Full liquid diet: days 3-17
Stage 3
Blended diet: days 17-30
Stage 4
Solid food: days 30-60
Stage 5
Days 60-120
Stage 6
Months 4-12
Macros
Months 4-12
Stage 7
Months 12-24
Macros
Months 12+
Secrets to Success
Nutritional Follow Up
Blood Work Post-Op
Introduction
To make your weight loss surgery a true success and to maintain the weight you are comfortable in for the rest of your life, you will have to change your nutritional lifestyle permanently. The goal of bariatric surgery is to help you develop new eating habits and provide initial hormonal and metabolic boost that promotes faster weight loss.
What is your ideal weight? It is the weight you are comfortable in and the weight you can sustain. There isn`t one formula that can be applied equally to all patients, as our weight depends on many factors, such as age, sex, body shape, muscle weight, bone density, our personal preferences. To learn more, visit Ideal Weight After Bariatric Surgery.
Surgery itself is only a part of treatment. Gastric Sleeve or Gastric Bypass do not constitute a cure for morbid obesity; they are great tools that we need to teach you how to apply. As any chronic disease, obesity cannot be cured, but can be controlled. The most important part of treatment is your adherence to a healthy diet. This is what determines your ability to keep your weight under control – following a diet after the surgery as well as for the rest of your life.
This diet is different from any other diet that you might have followed in the past. It will progress through a series of stages; you will be eating much smaller portions compared to what you are probably used to, and you will have to eat and drink regularly according to the schedule. Nevertheless, you will have to learn to listen to your body as every person recovers slightly differently and new foods are tolerated at everyone`s individual pace. If you overeat it can cause stomachache and/or vomiting. After surgery most of the patients get full by eating very small portions. Eventually you will learn when to stop in order to get full and not overdo it.
A permanent change of eating habits is necessary in order to insure both an adequate nourishment and successful weight loss on the long run. The surgery will help you make the changes. If your body does not get an adequate nutrition, it becomes vulnerable to fatigue, depression, infections and other diseases that can affect your organism, compromise your health, and even put your life in danger.
It is important not to be obsessed with the calorie or nutritional value, since it is not a regular diet. Food tracking apps, such as Baritastic or MyFitnessPal, can become very valuable tools at the beginning of your journey, while you are still learning and developing new eating habits as well as exercise routine.
The key is to get well-nourished through a well-balanced diet. The surgery is going to restrict the amount of food one can eat, but not the choices you make.
Remember that you have access to our bariatric nutritionists, therapist, and your surgeon. You can request a consultation with each of them via email through your patient coordinator as many times as needed. Utilize our Facebook support group to help you stay motivated; don`t hesitate to share your progress with others, celebrate every small victory. And finally, do not compare yourself to other patients and do not expect overnight results. Live your life, keep your mind busy, and trust the process!
DIETARY EVOLUTION
STAGE 1
Clear Liquids: Days 1 to 3 Post-Op
The day after surgery (that is the day of your leak test) is your 1st day on clear liquids. The clear liquid diet is non-carbonated and sugar-free. Your first consumption will be ground ice only.
You will be encouraged to drink at least 32 to 48 oz. of fluids per day in order to avoid dehydration. It might be necessary to drink even more during hot weather. Drinking soon after surgery may be difficult and painful, thus we do not expect you to reach the ultimate goal of 64 oz. per day until later stages. In the first few days, drink very slowly, make tiny sips but frequently, until you determine the amount of fluid that can be tolerated.
Remember your stomach is swollen, it`s capacity is very limited: about 1 to 1.5 ounces. As the swelling slowly subsides within 1-2 months, its capacity will increase to about 3-4 oz.
The amount of clear liquids you are allowed to drink is not limited. Hydration is your goal #1 at this stage (not the protein intake, but hydration) You cannot stretch your stomach by drinking too much liquid. At the beginning it will be easier to tolerate water rather than juices, however everyone is different: you will have to try and find the type of fluid you can tolerate well. If you cannot reach at least 32 oz. of liquids per day, make sure to switch to liquids with electrolytes (sugar-free Gatorade, Pedialyte, Crystal Lite, etc.) in order to ensure better hydration.
Body temperature fluids usually work better, although some prefer ice cold liquids.
If you take medication in a form of pills, they may need to be crushed or changed to a liquid or chewable form. Continue taking antacids twice a day during the first 2 months post-op or even longer if needed. Vitamins can be resumed 1- or 2-weeks post-op in order to allow your stomach time to heal and to be able to tolerate pills with less discomfort. Do not take vitamins on an empty stomach in order to avoid nausea.
Liquids Allowed:
- Water or any non-carbonated beverage, free of sugar and caffeine
- Ground ice
- Jell-O sugar-free
- Protein cocktails with electrolytes and zero carbohydrates
- Gatorade low in sugar
- Chicken broth
- Decaffeinated tea
- Herbal or fruit infusions
- Protein water
- Sugar free popsicles
TIP! Pay attention to the signs of fullness such as coughing, sneezing, yawning, hiccups, or runny nose. Once your new stomach is full, certain nerves will become irritated, causing these symptoms. Do not ignore them, another sip or bite might be too much and cause vomiting. It may take time to learn your new stomach capacity, its likes and dislikes, do not get frustrated.
Interesting facts:
- Sneezing. This is known as the snatiation reflex, which is a combination of the words “sneeze” and “satiation”. A person experiences this reflex when their stomach is full and becomes stretched.
- Runny nose. Gustatory Rhinitis and Vasomotor Rhinitis cause our nose to run during or after eating. Certain foods, stomach fullness and stomach irritation including GERD (acid reflux) cause these conditions.
- Hiccups. Involuntary spasms of the diaphragm (aka hiccups) occur when we eat or drink too much or too fast, the stomach stretches and causes spasms.
STAGE 2
Full Liquid Diet: Days 3 to 17 Post-Op
On average during the first two weeks after weight loss surgery, you will have to drink liquids only. Solid foods could cause pressure on the sutured line of the stomach and stretch the new stomach pouch. This might cause vomiting and pain. Liquid diet will also give enough time for the stomach tissue to heal. This stage could last a little less or a little longer, it is a matter of tolerance, which varies greatly among patients. Please do not test your stomach, do not skip diet stages. Forcing your stomach to accept solid foods too soon could cause not only stomach irritation and pain that usually lasts for days or even weeks, but could lead to serious surgery complications. Some patients are able to move to Stage 3 (blended and pureed foods) at 14 days post-op, others recover slowly and continue Stage 2 (liquids only) up to 21 days post-op or even longer.
To ensure an adequate intake of protein, calcium and other nutrients, the liquid post-op diet has to be based on foods that contain protein. Sugar-free protein shakes are encouraged.
If you are able to drink fluids with little to no restriction, please do not worry. It is a great blessing and you will be able to stay well-hydrated. There is nothing wrong with your stomach, you will get the feeling of restriction as soon as you start solid foods. If you are not able to hydrate yourself sufficiently, consider having an IV therapy at least once or twice a week during this early recovery stage. Any local IV center or a ER will be able to help you with IV hydration.
Liquids and Foods Allowed:
- Liquids included in Stage 1
- Fish broth
- Bone and beef broth (occasionally and measuring their tolerance, because they are more difficult to digest and contain more saturated fats)
- Greek yogurt (with or without flavor but without added sugar or chunks of fruit)
- Low fat milk and/or lactose free milk
- Sugar free pudding
- Vegetable soup, very thin, blended and strained (vegetables easier to digest are: zucchini, squash, carrots, spinach)
- Egg drop soup
- Almond, coconut or soy milk without added sugar
TIP! Protein powder (unflavored) can be added to chicken broth, soups or Jell-O. When making soups, avoid vegetables high in fiber and those that produce gas: cauliflower, broccoli, asparagus, celery, mushrooms.
Greek yogurt (flavored but sugar-free) or protein shakes can be frozen and make a nice dessert option.
Type of exercising: walking
Time: 30 minutes
Calorie expenditure with exercise: 50 – 100 Cal
Recommendations
-
- Use your kitchen scales or cups to weigh and measure food portions. Utilize smaller plates and utensils (children size utensils will become handy).
- Your stomach capacity may vary due to swelling: for bypass patients between 1-2 oz., for gastric sleeve patients between 2-3 oz. As the stomach swelling subsides within 1-2 months post-op, stomach capacity will increase by 1-2 oz. Do not get discouraged if you cannot finish your liquid meal. Do the best you can, you can finish the meal later or have it as a snack.
- Your main goals are hydration and protein intake.
- Strive to consume 48 to 64 oz. of liquids per day (protein shakes and yogurt are not included in your liquid intake).
- Minimum protein goal is 60 to 70 g. per day. Calculate your ideal needs of protein by multiplying your weight in pounds by 0.36. For example, a person who weighs 200 pounds has a need in 72 g. of protein per day, because 200*0.36 = 72.
- Ideal chicken broth recipe. Take 100g (3.5 ounces) of chicken/fish (add a little bit of vegetables for better taste) in its own broth (120 ml or 4 liquid oz.) and blend it. After thorough blending strain it and remove the solids, consume pure liquid. This type of processing will make the nutrients contained in chicken/fish remain in its prepared broth.
- Have a minimum of 5 liquid meals per day (including the protein supplement). Ideally, keep sipping fluids all day long. Make it a habit to carry your water bottle wherever you go. Sip on water between meals. If regular water is not palatable or causes nausea, add pieces of fruit, mint leaves, crushed cucumber, or watermelon to add pleasant flavor. Be careful and strain out all the solid pieces, seeds, or skins.
- Start taking vitamins, preferably chewable and/or liquid, but pills should be well tolerated at 2 week post-op. Do not take vitamins on an empty stomach to avoid nausea. The recommended list of vitamins can be found at VITAMINS.
- Do not skip antacids! Take them twice a day 20 mg each time for a minimum of 2 months. Continue taking antacids if heartburn or acid reflux persists. Antacids will decrease stomach acid production, and thus will keep GERD (acid reflux) and stomach irritation under control.
- Important! Avoid spicy and acidic foods (including tomato sauce/soup, citrus juices, and coffee). Coffee may be resumed at 1.5 – 2 months post-op, only if tolerated well and ideally not on an empty stomach, as coffee irritates the stomach increasing heartburn and acid reflux.
Macros
Calories: around 500-600
Protein: at least 60-70 gr
Fats: 20 gr
Carbs: no more than 30-40 gr a day
Sugar: less than 10 gr per day
Fiber: about 7-10 gr per day. Add fiber gradually, adding fiber too quickly may cause such gastrointestinal symptoms as bloating and gas.
Sodium: about 1000 mg a day
Meal Plan Sample + Vitamins (Full Liquid Diet: Days 3 to 17 Post-Op )
Breakfast
- *Greek Yogurt (2-4 oz.)
- *Protein shake (0.5-1 bottle)
- Calcium citrate w/Vit D3 (1 chewy bite – 500 mg)
- Magnesium Citrate (500 mg)
Snack
- *Protein shake (0.5-1 bottle)
- *Jell-o with protein added, unflavored
- Bariatric Multivitamin (2 chewable tablets)
Lunch
- *Chicken broth 3.5 oz. (100 g of solids blended and strained) or
- *Fish broth, tilapia 3.5 oz. (100 g of solids blended and strained) or
- Squash/yellow zucchini cream soup
- Calcium citrate w/Vit D3 (1 chewy bite – 500 mg)
- B-complex (1 capsule) Probiotic (2 chewable tablets)
Snack
- *Protein shake (0.5-1 bottle)
- *Jell-o with protein added, unflavored
Dinner
- *Chicken broth 3.5 oz. (100 g of solids blended and strained) or
- *Fish broth, tilapia 3.5 oz. (100 g of solids blended and strained) or
- Spinach & zucchini cream soup
- *Greek Yogurt (2-4 oz.)
- Calcium citrate w/Vit D3* (1 chewy bite – 500 mg)
NOTE! An asterisk * implies one option, it doesn`t mean that all of the offered options have to be applied at the same time.
Consider our bariatric-friendly “liquid” recipes:
STAGE 3
Blended or Pureed Diet: Days 17 to 30 Post-Op
This stage may be started at 14 days post-op, it depends on everyone`s tolerance. At this point you can start eating pureed and soft foods that require minimum chewing. Everything you eat must be chewed to the point of becoming a mousse in your mouth. Take bites the size of a dime coin. Put your utensils away between bites, wait up to 1 minute before taking a new bite.
Solid food is not allowed at this stage.
Slowly, day by day start introducing very moist and soft textured foods into your diet. A good option to start with is egg white cooked like scrambled eggs or poached, not boiled, to make it more moist and easier to swallow.
As always, preference is given to foods rich in protein, but low in sugar and fat. In a few more weeks, the capacity of the new gastric pouch will increase.
Stop eating as soon as you feel satisfied, and always eat foods rich in protein first.
Soon after surgery you may start experiencing loud and unusual stomach noises, throat gurgling. It is perfectly normal and very common. Please learn about the cause and possible solutions at Stomach Noises, Gurgling, Growling After Weight Loss Surgery.
Featured recipes to enjoy at this stage:
Foods Allowed:
- Liquids from the stage 1 – 2
- Pureed salmon, tuna, tilapia
- Crab
- Lobster
- Tofu
- Any low fat cheese (cottage cheese, ricotta, panela, mozzarella, feta)
- Vegetable cream soups (very thin, no cream added, skimmed milk is allowed)
- Apple sauce free of sugar added (thinned apple sauce)
- Scrambled eggs (egg white at first, add egg yolk only if tolerated well)
- Bean broth (do not eat solid beans, only blended and strained)
- Lentil broth (do not eat solid lentils, only blended and strained)
- Soft vegetables: steam or boil them until they are very soft and mushy (dark leafy greens, zucchini, pumpkin, squash, sweet potato*, carrots*, beetroot*, yucca*).
*An Asterisk denotes higher glycemic food, eat in moderation.
Type of exercising: walking, elliptical, very light weights
Time: 30 minutes
Calorie expenditure with exercise: 50 – 100 Cal
Recommendations
- Continue drinking liquids slowly as at stage 2. Try to reach a goal of 64 oz. of liquids per day (not including protein shakes, yogurt, and soups).
- Drink protein supplement (also as an appetizer) between meals.
- Keep taking chewable or liquid vitamins.
- Eat slowly, taking very little bites.
- Bread, rice, pasta, fruit and raw vegetables should not be consumed during Stage 3.
- It is important to have a meal schedule to track your protein and carb intake. Keep a diary of what you eat using free bariatric apps.
- If you do not feel hungry, have only a few bites of food in order to keep up with your daily needs in protein and nutrients, and to keep your metabolism at a steady level.
- Do not force yourself to eat a whole dish at one time; your stomach capacity is still considerably restricted; your stomach is still healing.
- Avoid at this stage and in a long-term period the following foods:
-High content carbs food (pasta, rice, bread, cookies, all kinds of potatoes, corn, macaroni with cheese and candies)
-Foods high in saturated fat
-Fried foods
-Sugary drinks like juices and soft drinks
STAGE 4
Solid Food: Days 30 to 60 Post-op
Foods Allowed:
You can start Stage 4 in four weeks after surgery assuming that you can tolerate foods from Stage 3 with no difficulty. If not, stop progressing in your diet and continue Stage 3. As you are progressing to a normal diet, you will have to make your food choices very carefully. At this point it is safe to start experimenting with solid foods that have different textures. Make sure that what you eat is very tender and chew it thoroughly; you should be able to eat regular food now.
It is important to eat slowly and chew every bite at least 20 times, until it feels pureed in your mouth. Stop eating once you feel full, as after 4 weeks post-op your stomach capacity restriction is still significant; remember that your stomach tissue is still in the healing process and can be somewhat inflamed, which causes certain restriction also.
Continue eating small portions and always give priority to foods with high level of protein.
Always drink between meals, do not drink while eating. This rule is especially important for bypass surgery patients, as drinking while eating will promote faster stomach emptying flushing food into the small intestine and you will be able to overeat. And for gastric sleeve patients drinking while eating may fill you up too quickly, and you will not be able to finish your meal and consume enough protein and other nutrients.
Do not forget taking your multivitamins and protein supplements.
Important! If you are experiencing acid reflux (common within the first 2 months post-op), continue avoiding spicy and acidic foods (including tomato soups, ketchup, pineapple juice, citrus juices, and coffee). Coffee may be resumed at 1.5 – 2 months post-op, only if tolerated well and ideally not on an empty stomach, as coffee irritates the stomach increasing heartburn and acid reflux. You may want to choose low-acid coffee brands.
- All foods and liquids from previous stages
- Salmon 3.5 oz. (100 g)
- Tuna 3.5 oz. (100 g)
- Tilapia 3.5 oz. (100 g)
- Crab / Shrimp
- Beans, broad beans, lentils
- Eggs (whole)
- Chickpeas (hummus)
- Turkey breast
- Chicken breast
- Avocado
- Eggplant
- Cooked vegetables (be careful with those that ferment in the stomach and are very fibrous: cauliflower, broccoli, cabbage, asparagus, celery, and mushrooms)
- Garlic
- Onion
- Herbs (dill, cilantro, Rosemary, parsley, etc.)
- Vanilla, almond or hazelnut extracts
- Olive or avocado oil in moderation
- Oatmeal (occasionally)
- Low fat mayonnaise occasionally
Type of exercising: at 6-8 weeks post-op it is safe to start more vigorous exercising such as fast walking, walking up the hill, elliptical, bicycle, water aerobics, Zumba, other cardio exercises, light weights. You may want to avoid jogging or running as extra body weight will hurt your joints.
Time: 30 minutes
Calorie expenditure with exercise: over 100 Cal
STAGE 5
Days 60 to 120 Post-op
At two months after surgery, you must significantly increase your physical activity. At this stage your incisions and stomach are healed sufficiently. Depending on your health status, you will begin an exercise program focused on your cardiac training. In order to maintain an adequate calorie expense, you have to continue exercising in the same rhythm for at least 15 minutes, preferably 30 minutes. The goal is to increase your heart rate and start sweating.
As you increase your physical activity, your nutritional needs grow as well. At this stage you can tolerate a variety of foods, now you can also increase the percentage of calories coming from carbohydrates, not forsaking though an adequate protein consumption of 70 – 100 g per day.
This stage is indispensable for your metabolic balance: gradually your body starts adjusting, and increased physical activity will promote a stable, continuous and healthy weight loss.
In those days when you are not physically active lower your carbohydrate intake.
Featured recipes, enjoy at stage 5 or 6 based on individual tolerance:
Foods Allowed:
- Foods from the previous stages
- Dry cranberries
- Raisins
- Dates
- Strawberries, raspberries, blackberries
- cherries
- papaya
- melon, watermelon
- apple, pear
- peach, plum
- Citrus fruits or acidic fruits start at 3 months postop (orange, pineapple, grapefruit, lemon, kiwi, etc.)
- Tomatoes (remove seeds at the beginning)
- Raw dark green leaves such as kale and spinach (if tolerated well, then you can try lettuce, it is heavier for digestion)
- Peas
- Artichoke
- Green beans
- Jicama
Calorie daily intake: 600 – 750 Cal
Type of exercising: walking, jogging, Zumba, water aerobics, swimming, walking up the stairs, rope jumping, running, riding bicycle; weight lifting can gradually increase. At this stage there is no weight lifting restriction.
Time: 30 – 45 minutes in intervals of 15 minutes
Calories expenditure with exercise:100 – 250 Cal
STAGE 6
4 to 12 Months Post-op
At this point you are entering in a new stage of your long journey to a new healthy life style. Your stomach has healed and you can tolerate almost all types of food. Now you can no longer rely on your stomach to control WHAT you eat. You have to make wise choices. The stomach will control HOW MUCH you eat, but not WHAT you eat.
By this time, you have already lost a significant percentage of the excess weight. The following months are indispensable for a continuous weight loss process, this is why it is so important that you continue changing your lifestyle and work on your mental attitude, your relationship with food.
There is a risk of regaining weight during the very last months of this stage. Weight regain might take place only if you do not follow your diet plan and indications regarding your physical activity. During these 8 months your weight loss process will slow down, but do not get discouraged. You will notice that while you haven`t lost much weight, your sizes went down, you will notice changes in your physical appearance, your neck will become thinner, your cheeks will deflate, your hips will get slimmer and your stomach will become smaller. If you follow your diet program and continue being physically active this stage will not constitute any difficulty for you.
You will notice that your food intake ability has increased comparing to the first stages of your diet. This could make you return to your old nutritional habits that could cause a plateau in your weight loss process or even some regain. Do not get frustrated, you still have time to correct mistakes and reach the goal. Do not expect perfection from yourself at all times. Every once in a while, you will step off track, it is normal. Do not think that you have ruined it all and do not look for comfort in food. Rather get back on track and accept mistakes as a normal part of this journey. It is a lifelong battle, thus never give up and never become too comfortable.
As you get closer to your goal weight, you will have an opportunity to increase the variety of foods, and increase the amount of carbohydrates with complex sugars while always avoiding simple sugars. The consumption of carbohydrates will have to be limited and allowed only on the days of increased physical activity. You still need to continue your daily protein intake of approximately 70 – 100 g and vitamins.
If you have problems with your joints give preference to exercises that make less pressure on them, like swimming or riding bicycle; yoga can help increase your flexibility.
Note that during Stage 6 your diet includes raw fruit, greens and seeds. Make it a habit to incorporate them in your meals daily but limit fruit and nuts intake when you are not physically active, especially fruits that contain lots of carbohydrates. Remember that the priority always belongs to the foods with high content of protein. Adding red meat to your diet is important at this stage, but you have to be very careful as it can cause certain discomfort especially during the first intake. It is recommended to start with ground beef from the sixth month on, since by this time your stomach will be better prepared.
Foods Allowed:
- Foods from the previous stages
- Red meat (starts at 6th month post-op: lean beef (ground, steak)
- Lean pork
- Raw seafood
- Bananas, grapes, mango, guava
- Asparagus, broccoli, lettuce, cabbage, mushrooms
- Peanuts, almonds, pecans, other nuts
- Cereal (limited and occasional)
- Quinoa
- Sunflower seeds, pumpkin seeds, hemp seeds, flaxseed, chia seeds
- Pickles (if tolerated)
- Peppers
- Edamame
- Fennel
- Radish
- Cucumber
- Brussels sprouts
- Celery
- Olives
- Peanut butter powder (PB2)
- *Nuts, seeds and peanut butter powder should be eaten in moderation.
Calorie daily intake: 700 – 900 Cal
Type of exercising: walking, swimming, jogging, Zumba, rope jumping, spinning, running, bicycle riding, etc.
Time: 30 – 60 minutes in intervals of 30 minutes
Calorie expenditure with exercise: 200 – 350 Cal
Macros
General recommendation in order to continue losing weight (depending on your physical activity):
Calories: 800 per day
Protein: at least 70-80 gr of protein per day
Carbs: 80 gr per day (less than 50-60 gr on days when you do not exercise)
Fat: 20-25 gr of healthy fat per day
STAGE 7
12 – 24 Months Post-op
On this long path of dieting after the surgery you have come to a point when there is an ease of consuming foods that seemed to be impossible to eat before, including alcohol and some types of junk food. It is quite common that at this point the patient has returned to old habits that do not contribute to general well being and may cause weight regain.
At this stage you have lost enough weight. On average, bariatric patients tend to lose between 50% – 70% of excess weight by this time. It is rare that a patient loses 100% of their excess weight, this will depend on the individual characteristics of the person.
Do not compare yourself with others, every individual is different and will have different results, remember this is not a competition. The key to continue weight loss process (if it is still required) is in following a healthy, simple and low carbohydrate diet, high in protein and moderate in fat. You’ve already lost enough weight and have been exercising for over a year. The new challenge of this stage is to increase caloric expenditure by increasing the time of your work out and by continuing the diet featured in the previous stages, taking into account that if your calorie expenditure is greater, the calorie intake has to increase accordingly.
Remember that your stomach can and will stretch with time. It will never go back to its original size, but in about 2 years post-op, it will stretch sufficiently to allow for a small child`s size food portion. It can however stretch further if you overeat constantly. In bypass patients, the anastomosis (the connection between the stomach pouch and the small intestine) can also stretch with time. Be careful and to not overeat frequently, as once the anastomosis is stretched, the only way to make it tight again is through another surgery.
Stay away from constant grazing/snacking, avoid slider foods that do not fill you up but add unnecessary calories, such as pretzels, chips, candies, popcorn, etc., and of course always stay away from sodas, Frappuccino’s, and other high calorie drinks. Consume alcohol only on occasion as it also adds a lot of extra calories.
Calorie daily intake: 900 – 1200 Cal
Type of exercising: Running, walking, swimming, jogging, Zumba, rope jumping, spinning, running, bicycle riding, muscle conditioning
Time: 60 minutes in intervals of 30 minutes
Calorie Expenditure with exercise: 300 – 500 Cal
Macros
In order to maintain weight, our general recommendation is:
Calories: 1000-1200 per day
Protein: at least 70-80 gr per day
Carbs: 100-125 gr per day (depends on your physical activity)
Fat: around 35 gr per day.
The formula to calculate your ideal amount of protein per day is to multiply your weight in pounds by 0.36, for example a person who weighs 200 needs 72 gr of protein per day, that is 200*0.36 = 72.
SECRETS TO SUCCESS
HOW YOU SHOULD EAT
WHAT you are eating after the surgery is as important as HOW you are eating. The moment you sit down at the table you need to change your way of thinking: do not get distracted but focus on every bite, even on the way you chew.
Keep working on such useful habits as:
- Develop a new taste palate, learn to enjoy low-processed foods, raw fruit and veggies, explore new flavors and new recipes, consider our suggestions at Pre – & Post-Op Recipes.
- Food texture matters: solid food provides more satisfaction than liquids. Consider why texture is so important especially for gastric bypass patients at The Difference in Restriction Among Bypass Patients.
AVOID
- Sugars and refined flours
- Carbonated drinks
- Alcoholic beverages
- Eating fast
- Talking while eating
- Fluid intake while eating
- Eating while doing other activities
- Skipping meals (your diet program)
- Filling up your plate with food
- Red meat in the first 4–6 months
- Artificial sweeteners
- Sweet snacks
- GRAZING (adding snacks, nibbling, or tasting foods that are usually high in calories and fat can add hundreds of calories a day to your diet.) Eating between meals (unhealthy foods) will slow your weight loss and may lead you to gaining weight again.
NEW HABITS
- Chew 20–30 times per mouthful
- Acquire small plates, forks and spoons, this will limit the portions you can consume including child-sized.
- Eat small portions and weigh them at least until you learn your new stomach capacity.
- Keep a record of every meal you eat in a Bariatric app of your choice; this will help to have an objective control over your nutritional goals and how to accomplish them.
- Look for foods allowed during each STAGE depending on their nutritional value, always seek the sources of significant amounts of protein.
- Rest your body, it needs rest; sleeping from 7 to 8 hours daily helps to increase energy levels and promotes optimal recovery.
- Set a time each week to weigh yourself; do not obsess over the scale. Weighing yourself weekly and taking measurements helps keep track of your surgical outcome, write it in your application.
MAKE PLANS
- Plan your meals and make food choices days in advance. Learn more at Mastering Meal Prepping.
- Your diet plan starts with shopping for groceries, keep the pantry with the necessary food and have an inventory of your purchases. This will help to get a sense of the nutritional choices and avoid unnecessary purchases of food without nutritional value.
- Cook your own food so that you are aware of the portions and quality of food.
PLATEAU
The Plateau is a stage that occurs between the first and the second postoperative months, i.e. 30–60 days (this time frame may vary among patients). It is characterized by the absence of weight loss, commonly lasts between 2–4 weeks. It is common for the patient to feel disappointed, to believe that the purpose of the procedure and nutritional education is lost. “The Plateau” is a part of the weight loss process and patient`s experience. Do not get discouraged, this stage is also characterized by the loss of sizes as you begin to notice changes in your body image.
There will be several plateau stages during your weight loss journey, and they will vary from a few weeks to a few months as you progress further. Your body will be adjusting to the chemical and biological changes that occur during weight loss. If the plateau continues for more than a few weeks, review your nutrition plan and physical activity level.
NUTRITIONAL SUPPLEMENTS
The amount of food you are able to consume will be insufficient to meet the needed nutritional requirements; therefore it must be compensated with nutritional supplements depending on the surgical procedure. The supplementary food needs after the gastric sleeve and the gastric bypass are different. It is recommended that the gastric sleeve patients continue taking their supplements for at least 2 years after the surgery, the supplementation for the gastric bypass patients is for life. Recent studies have shown that the pre- and post-op intake of lactobacilli decreases subsequent gastrointestinal symptoms, ask your doctor about the nutritional requirements and follow the rules according to these guidelines.
RED MEATS
Red meat has to be avoided in the first 4–6 months post-op. Usually patients make attempts to eat red meat prior to this stage. In that case it is common to have abdominal pain, nausea and vomiting. We recommend starting with ground beef, as it is softer, easier to chew and less aggressive to the recently healed stomach.
ALCOHOL
It is important that you avoid alcoholic beverages until your stomach heals completely by the end of the first 6 months post-op. You should avoid all kinds of carbonated drinks including beer. Calorie levels in distilled liqueur like whiskey, vodka and tequila are high; this type of liquor can cause an upset stomach, nausea and vomiting.
The gastric bypass patient is highly susceptible to the effects of alcohol after the surgery; because alcohol directly enters into your intestine, absorption is almost immediate, thus increasing toxicity in your body, not to mention that the side effects appear sooner and are more intense. The patient should be aware that the best decision is to avoid alcoholic beverages of any kind to prevent symptoms that cause discomfort.
DRUGS
- If you are taking medications for pre-op health-related conditions, talk to your doctor. Due to weight loss and a low-calorie and low-carb diet the dosage may need to be decreased, some medications may need to be stopped completely, some may not be absorbed in the same way as preoperatively. NSAIDs should be avoided completely for the rest of your life. To reduce gastritis, acid reflux symptoms and prevent ulcers after surgery, you should start with Omeprazole 20 mg every 12 hours during 2 weeks prior to the surgery and continue for at least 2 months after the surgery.
NUTRITIONAL FOLLOW UP
It is extremely important that you are aware that bariatric surgery is a tool to help you modify your eating habits; if you believe that surgery will work by itself you are making a mistake. Any patient undergoing bariatric surgery requires monitoring by a multidisciplinary team that includes the physical, nutritional and psychological aspect, if you are not willing to work on these 3 areas, you have high chances of failure, this means that you can experience nutritional deficiencies and insufficient weight loss after the surgery.
Remember that you have access to our bariatric nutritionists, therapist, and your surgeon. You can request a consultation with each of them via email through your patient coordinator as many times as needed. Utilize our Facebook support group to help you stay motivated.
Blood Work Post-Op
Please note that a general blood test is recommended within 3, 6, 12 and 24 months after surgery in order to determine whether your body is lacking any vitamins, minerals and other important elements, and if so, make necessary diet adjustments. Feel free to submit your test results by fax at 855-457-1400 or by email to your coordinator or to info@golightbariatrics.com in order to receive an evaluation by your surgeon.
Please request the following type of blood test with your PCP: CBC, Cholesterol (total, HDL, LDL), Fibrinogen, Basal Insulin Level (fasting insulin), Glycosylated Hemoglobin (HbA1), A1C, Glucose, Urea, Creatinine, Vitamin Levels (B1, B12, D, folates), Minerals levels (Calcium, Magnesium, Phosphorus, Iron), total iron binding capacity (TIBC), Ferritin, TSH, Liver Function Test, Albumin, Urinalysis.