It is important to follow the gastric bypass diet guidelines after surgery. The diet has been designed to be gentle on your “new” stomach, to ensure proper healing of the staple line, and to help you to avoid overeating. A normal stomach can hold approximately 6 cups of fluid at a time. After surgery your stomach pouch will only be able to handle about ½ cup!! You will likely need to alter your eating habits quite a bit.
This book will outline a basic overview of the diet that you will need to follow after surgery. Later a nutritionist will go over the details with you in a one-on-one interview.
Because you will have a certain degree of malabsorption after surgery and because you will not be able to eat very much food it is critical that you take a multivitamin/mineral supplement EVERY DAY FOR THE REST OF YOUR LIFE. If you are not already taking a multivitamin/mineral, START TODAY! You will not be able to eat enough to meet your daily requirement of vitamins and mineral. You may also need to take additional calcium, especially if you don’t drink milk. Calcium citrate (500mg twice per day) is recommended to meet calcium needs.
PROTEIN will be an essential part of your diet after surgery. Protein helps with wound healing, muscle and skin re-growth, and repair, as well as preventing hair loss. You will need to include an adequate amount of protein in your diet after surgery. We recommend a daily protein goal of 60-70 grams per day. Every meal and snack should have a good source of protein in it. Sometimes 1-2 weeks after surgery it is helpful to consume a protein supplement (as long as it is low in added fats and sugars) such as No Added Sugar Carnation Instant Breakfast, 100% Whey, or Unjury.
Your food choices will also need to be LOW-FAT. Fat may be difficult to digest or tolerate after gastric by pass surgery, especially fried foods or fast foods and snack foods. Small amounts of fats are fine such as those found in lean meats and fish or low fat dairy products. Trying to eat a sensible low-fat diet will help to sustain weight loss after surgery.
In order to meet your protein needs without adding fats choose the following foods:
High Protein Foods (that are low in fat):
Fish. For example: flounder, sole, tuna (canned in water), crab, and salmon.
Lean cuts of beef. Look for the words “loin”, “round” or “select”.
Lean cuts of pork. Look for pork loin or leg.
Skinless chicken or turkey, preferably white meat.
All meats should be prepared by baking, broiling or grilling.
Dry Beans and Legume.
Eggs and egg whites.
Nonfat or Low fat milk and milk products.
After gastric bypass surgery you will also need to follow a diet that is LOW IN ADDED SUGARS. After gastric bypass surgery, most patients experience a phenomenon known as “dumping syndrome” after eating concentrated sweets, fatty foods and/or drinking fluids with meals. This occurs when food exits the pouch rapidly and “dumps” into the intestine. The intestine is not used to concentrated foods (sweet or fatty foods), so it immediately pulls water out of the rest of the body to dilute the food. It then rapidly flows down the remainder of the small intestine; it enters the large intestine (still flowing rapidly) and exits via the rectum. Some patients have shared stories about their dumping syndrome, describing the sudden onset of diarrhea and have reported having accidents in public places. Dumping syndrome can cause not only urgent diarrhea, but often patients will also feel nausea, lightheadedness, flushing, and stomach cramps.
To prevent dumping syndrome you will need to avoid eating sugar and foods containing real sugar. You will need to start reading food labels. Avoid products which list any type of sugar as one of the first three ingredients: including sugar, maple syrup, honey, molasses, corn syrup, corn sweeteners, glucose, lactose, maltose, dextrose, sorghum, sorbitol or mannitol.
NutraSweet, Splenda, Sweet and Low and other artificial sweeteners are acceptable substitutes for real sugar. They will not cause dumping and will help with weight loss and maintenance since they contain very few calories.
The gastric bypass diet is divided into four phases, based on how long ago your surgery was. The diet progressions are outlined below:
Phase 1 – Clear Liquids (1 meal)
For one meal after surgery while you are in the hospital you will be given clear liquids to see how you tolerate eating. You will be started on sips of clear liquids such as water, broth, unsweetened juices, diet Jell-O and diet drinks (such as crystal light, minute maid light and flavored water). Sip slowly – about 2-3 ounces at a time and pay attention to your feelings of fullness. If you tolerate the Phase 1 liquids – your next meal will be Phase 2.
Phase 2 – “Blenderized”/ Puree diet 
Foods to Choose on a Phase 2 “Blenderized”/ Puree Diet After Gastric Bypass
Food | Choose | Avoid |
Meat, protein and protein substitutes | Pureed fish, tuna, poultry, or pork; low fat cottage cheese, low-fat or non-fat cheese, baby-food meats (all types); mashed or pureed tofu, pureed egg or egg substitute; blended low fat casseroles with soft vegetables; | Crunchy peanut butter, all others |
Milk and Milk Products | Fat-free (skim) or 1% milk; sugar free or low fat yogurt (approximately 80 calories per serving) | Chocolate milk, sweetened condensed milk, 2% or whole milk, ice cream |
Fruits and Vegetables | Applesauce, pureed banana, mashed potato or other fruit/ vegetables without seeds or hulls that have been pureed | All others |
Bread and Cereals | Hot cereals cooked in milk (oatmeal, grits, cream of wheat) | Bread and crunchy cereals |
Other | Sugar free gelatin or popsicles, sugar free fat free pudding/custard | Chewing gum, sweets |
If you are having trouble tolerating pureed foods try slowing the speed of your eating or decreasing portion size slightly.
To blenderize foods: first put foods in a blender, then add liquid such as skim milk, broth, fat free gravy or diet juice then blend until smooth.
Sample Phase 2 menu
Breakfast: | 1 cup “Carb Conscious” Carnation Instant Breakfast with skim milk & 1/3 cup powdered nonfat milk |
Snack #1: | ½ cup cottage cheese |
Lunch: | ½ cup fat-free refried beans 1 ounce melted fat-free / reduced fat cheese |
Snack #2: | Blended sugar-free yogurt |
Supper: (Blended) | ¼ cup meat ½ cup low-fat cream soup 2-4 Tbsp skim milk powder |
Provides approximately 60 g protein and 750 calorie
Phase 3 – Semi-solid/ soft diet
About 2-4 weeks after surgery, with your doctor’s approval, you may advance to Phase 3, semi-solid or soft foods portion of the diet. The general rule is “Can I mash this food with a fork?” to determine if it will be soft enough. Phase 3 diet should include about 4 meals per day. Each meal should not exceed 4-6 ounces. You will need to eat and drink slowly. Take small bites and chew very well.
Foods to Choose on a Phase 3 Semi-solid/ soft Diet after Gastric Bypass
Food | Choose | Avoid |
Meat, protein and protein substitutes | Lean soft and moist meats including fish, tuna, poultry, or pork; low fat cottage cheese, low-fat or non-fat cheese; soft tofu, eggs or egg substitute; soft low fat casseroles with soft vegetables; | Crunchy peanut butter, any meat that is dry, tough or chewy. Red meat may not be tolerated in this phase. Fried eggs. |
Milk and Milk Products | Fat-free (skim) or 1% milk; sugar free or low fat yogurt (approximately 80 calories per serving) | Chocolate milk, sweetened condensed milk, 2% or whole milk, ice cream |
Fruits and Vegetables | Any fruit/ vegetables without seeds or hulls that have been cooked soft. Soft unsweetened canned fruits or vegetables. Fresh soft fruit. | All others – including raw vegetables (such as salads) and raw crunchy fruits (especially those with tough skins/ seedy) |
Bread and Cereals | Hot cereals cooked in milk (oatmeal, grits, cream of wheat), cold cereal (high protein) soaked in milk, toasted bread or plain soda crackers | Soft “gummy” bread and crunchy cereals or sweet cereals |
Other | Sugar free gelatin or popsicles, sugar free fat free pudding/custard | Chewing gum, sweets |
Keep in mind that you are “re-educating” your stomach. If you eat too fast, too much, or don’t chew enough, you will feel uncomfortable.
Sample Phase 3 menu
Breakfast: | 1 egg with 1 slice reduced fat/fat free cheese |
Lunch: | 3 oz lean, soft meat (turkey, low-fat ham) ¼ cup canned fruit |
Supper: | ½ cup tuna salad (made with yogurt and light mayo) ¼ cup cooked vegetables |
Snacks: | Sugar-free low-fat yogurt Low-fat cottage cheese with fruit |
Provides approximately 50 g protein and 700 calories
Phase 4 – Solid food
About 4-6 weeks after your surgery, you may begin to try solid foods, one item at a time to test your tolerance to them. Do not worry if you cannot handle foods that you used to eat. Most people experience some problems at first with food tolerances, especially with meats and breads. Gastric bypass patients tend to complain that breads “form a ball” or feel “gummy” and do not go through your pouch easily. Once you are eating solid foods you can reduce the number of meals that you eat to 3 meals per day. Be as regular as possible with meals and meal times. You will always need to try to get about 60 grams of protein in per day and if you skip meals you not will get in enough protein. Start practicing now with eating 3 meals per day.
Foods to Choose on a Phase 4 Solid Diet after Gastric Bypass
Food | Choose | Foods that may be difficult to tolerate | Foods to limit/ avoid for best weight loss |
Meat, protein and protein substitutes | Lean meats egg or egg substitute and tofu; regular low fat casseroles or crock pot meals | Tough meat or meat with gristle. Some patients do not tolerate red meat. | Fried or breaded meat products. Fried eggs |
Milk and Milk Products | Fat-free (skim) or 1% milk; sugar free or low fat yogurt (approximately 80 calories per serving) | Chocolate milk, sweetened condensed milk, 2% or whole milk, ice cream | Chocolate milk, sweetened condensed milk, 2% or whole milk, ice cream |
Fruits | Fresh, canned, frozen or cooked fruit. | Be cautious with apples, grapes, or other fruits with tough peels or skins. Dried fruits. | Fruits that have added sugars or sauces |
Vegetables | Fresh, canned, frozen or cooked vegetables. | Vegetables with very tough skins or a lot of seeds | Fried or breaded vegetable products. |
Bread | Dry, coarse, or well-toasted bread; crispy low fat crackers or baked tortillas | Soft breads that become gummy, breads with a lot of nuts and seeds or dried fruit | Sweet breads, Danishes, doughnuts or pastries |
Cereals | All cooked and dried cereals without added sugar | Cereals containing fruits or nuts | Cereal with added sugar over 10-15 grams per serving |
Potatoes, rice, pasta | Boiled, mashed or baked potatoes; well cooked whole wheat pasta or rice | Potato skins, rice and noodles | Instant noodle dishes |
Other | Sugar free gelatin or popsicles, sugar free fat free pudding/custard | Chewing gum, sweets; popcorn, nuts, chili, or extremely spicy foods | Fried, salty snack foods; creamed soups unless low fat versions |
It is also important to drink FLUIDS. Gastric bypass patients need to drink AT LEAST 4 cups of LOW calorie liquids between meals, especially for the first month, to prevent dehydration. Ideally, you want to try to drink 6-8 cups of fluids per day. You will need to separate your liquid intake from your meal times by at least 30 minutes. Think of it is a 30/30 rule: do not drink fluids 30 minutes before a meal, during a meal, or 30 minutes after a meal. Drinking too close to a meal may overfill the stomach pouch and cause vomiting or the food can be washed through the intestines too quickly and may cause dumping or may leave you feeling hungry quickly.
You will not be able to tolerate carbonated beverages (diet soda) until you are in Phase 4 of the diet. Some ideas for low calorie beverages include:
WATER Minute Maid Light Skim milk Diluted Juice (no more than 4oz juice per day) Flavored Water (Fruit2O, Propel, Sparkling) Crystal Light Diet Nestea
| Diet Snapple Diet V8 Splash Decaf Tea Decaf Coffee Sugar-free Kool-Aid Sugar-free Tang Sugar-free, fat-free hot chocolate Sugar-free, fat-free cappuccino
|
You will need to GO SLOW!!! It is important to chew your foods well and eat very slowly and pay attention to how you are feeling. Stop eating as soon as you feel full. You will also need to sip your liquids slowly between your meals.
While surgery will trigger significant weight loss, you must also do your part to maintain the weight loss by making lifelong changes in your eating habits. It is counterproductive to eat high calorie and high-fat foods after surgery. You need to be committed to making healthy choices and eat high protein and low-fat nutritional foods that will provide you with essential vitamins, minerals and nutrients to keep you well nourished and feeling healthy.
Exercise is also important. Regular exercise during the first year after surgery will result in more weight loss (twenty pounds or more) from surgery than if you do not exercise.
A typical day’s diet should include foods from each of the following food groups:
PROTEIN: 6 servings/day
1 C skim milk 1 oz. Low-fat cheese
1/3 C dry beans 1 C sugar-free yogurt
1/4 C egg substitute 1 oz. lean meat and fish
1 packet Diet instant Breakfast
½ C certain breakfast cereals: Product 19, Total, and Special K
FRUIT: 2 servings/day
½ C unsweetened fruit juice
½ banana
1/3 C canned fruit IN ITS OWN JUICE (not in sugar)
VEGETABLE: 2 servings/day
½ C vegetable juice 1/3 C cooked vegetable
BREAD/STARCH: 2-3 servings/day
½ C cooked cereal 1 C soup
1 C cereal
½ slice bread/toast (when appropriate)
1/3 C corn, potatoes, peas, lima beans (when appropriate)
FATS: 2 servings/day
1 tsp margarine 1 tsp olive/canola oil
1 tsp mayonnaise 1 T sour cream
1 T salad dressing (or choose the reduced-fat and fat free versions of these products)
Note: Failure to follow these dietary instructions on any given day is not a cause for panic.
Tsp = teaspoon T = Tablespoon C = Cup oz. = ounces
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