Post-Bariatric Surgery_ Nutritional Guidelines

By: Pallavi Vathiar. Practicing Clinical Nutritionist, Mumbai.

Email: fihealthie@gmail.com

Nine Areas of Behavior Change Crucial to Success After Surgery (1).

  • Meal Frequency

Many patients in our clinic were in the habit of eating very large quantities in only one or two meals per day. Early postoperative food capacity is usually about one-half cup or less. Patients must learn to eat frequent, small meals consisting of healthful foods.

  • Food Volume and Meal Pacing

The habits of taking small bites and eating slowly and mindfully are crucial for patients to have mastered by the time surgery is performed. If not, vomiting will probably result, having a negative impact on patients’ nutrition and overall health.

  • Adequate Fluid Intake

In the early postoperative period, patients often report a sub-optimal fluid intake, perhaps as a result of the fluid restriction at meals and snacks. Dehydration can be very dangerous to overall health, and it can lead to constipation and poor absorption of medications and nutrients.

  • Consumption of Fruits, Vegetables, and Whole Grains

Patients who are morbidly obese typically do not eat the number of servings of fruits, vegetables, and whole grains recommended for a healthy diet.

  • Adequate Protein Intake

Approximately 60–80 g of daily protein is recommended for nutritional adequacy and for wound healing after surgery. This fact can be complicated by patients’ intolerance of many food sources of protein, especially red meats and poultry. Also, lactose intolerance is a possible post surgical complication, requiring a modification of milk products.

  • Avoidance of Sweets

Average servings of foods and beverages containing large amounts of sugar will cause the dumping syndrome and must be avoided.

  • Vitamin/Mineral Supplements

The gastric bypass creates malabsorption, whereby iron, calcium, and B-vitamin nutrition is in jeopardy. In addition to a nutritious diet, supplements are necessary to work against potential deficiencies.

  • Regular Attendance at Support Group Meetings

Attendance at support group meetings should be mandatory before surgery, and patients should continue regular attendance for several months or longer after surgery.

  • Compliance With Exercise Program

Incorporating activity into the patient’s lifestyle is crucial for good health and maintenance of weight loss.

Post Surgery Diet Plan Suggestions (2)

Bariatric Full Liquid Diet

  • During this period, you need to eat three very small meals a day.
  • Initially 1 to 2 tablespoons of food may be all your body is able to tolerate. Do not take an extra bite.
  • Walking can help food move out of stomach pouch.
  • Overall goal is to get over 50-60gms of protein and carbs at this stage.
  • Constipation is not uncommon on this diet.
  • Keep walking to promote regularity at least 30 minutes/day.

Bariatric Pureed Diet

You will be on a pureed diet days 15 to 30 after your surgery. Pureed foods are a very smooth consistency, such as:

  • Apple sauce
  • Beans
  • Cottage cheese
  • Scrambled egg (light and fluffy)
  • Pureed meats (puree ¼ cup broth with ¼ cup chopped meat)
  • Pureed vegetables (puree ¼ cup vegetable with water or broth)
  • Pureed fruits (puree ¼ cup fruit with 2 to 4 tablespoons of water)

When you start the pureed diet: Eat protein food first (3 ounces (21 gm) per meal); carbohydrates second (15-20 gm/meal)

Bariatric Soft Diet

You will be on a soft diet days 31 to 60 after your surgery. You will start this after your 1 month follow-up visit.

  • Chew foods to a pureed consistency.
  • Slowly add soft foods to your meals and snacks.
  • Drink 6 to 8 glasses of water each day.
  • Stop eating when you are full!
  • Start doing strength-building exercise in your daily routine, such as strength and aerobics for 60 minutes each day.

Bariatric soft diet foods include:

  • Well cooked vegetables (no skin)
  • Canned fruits (in own juice or light syrup) or ripe fruit (no skin)
  • Fish
  • Tender meats/poultry (cook in water, crock pot or slow cooker)
  • Anything allowed on the pureed, full, or clear liquid diets

Bariatric General Diet

You will be on a general bariatric diet for the rest of your life starting day 61 after your surgery.

  • Continue to drink at least six to eight cups of plain water per day.
  • Eat protein food first, then carbohydrates second.
  • Do not eat red meat that is tough or has gristle for 4 months after your surgery.
  • Do not eat white bread for 4 months after your surgery.
  • Eat lean foods, such as baked, broiled, grilled, or steamed foods. Do not eat fried or breaded foods.
  • Keep doing strength and aerobic exercise for 60 minutes or more each day. Add variety and intensity to your routine.

General Takeaway Guidelines (3)

  • Eat balanced meals with small portions.
  • Follow a diet low in calories, fats, and sweets.
  • Keep a daily record of your food portions and of your calorie and protein intake.
  • Eat slowly and chew small bites of food thoroughly.
  • Avoid rice, bread, raw vegetables, and fresh fruits, as well as meats that are not easily chewed, such as pork and steak. Ground meats are usually better tolerated.
  • Do not use straws, drink carbonated beverages, or chew ice. They can introduce air into your pouch and cause discomfort.
  • Avoid sugar, sugar-containing foods and beverages, concentrated sweets, and fruit juices.
  • For the first two months following surgery, your calorie intake should be between 300 and 600 calories a day, with a focus on thin and thicker liquids.
  • Daily caloric intake should not exceed 1,000 calories.

Fluids

  • Drink extra water and low-calorie or calorie-free fluids between meals to avoid dehydration. All liquids should be caffeine-free.
  • Sip about 1 cup of fluid between each small meal, six to eight times a day.
  • Drink at least 2 liters (64 ounces or 8 cups) of fluids a day.
  • Avoid drinking alcoholic beverages. After surgery, alcohol is absorbed into your system much more quickly than before, making it sedative and mood-altering effects more difficult to predict and control.

Reference

  1. https://spectrum.diabetesjournals.org/content/18/2/82
  2. https://uihc.org/health-topics/dietary-guidelines-post-bariatric-surgery
  3. https://www.ucsfhealth.org/education/dietary-guidelines-after-bariatric-surgery

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