Junior Member
Registered: 06-05-07
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I am 2 years post-op. I am also a nurse at the Weight Management Center at Methodist. I just wanted everyone to know that not everyone has problems with nausea and vomiting. If you measure your food, eat slowly, and stop eating when you feel the first twinges of fullness, even if you have only had a few bites, you will not get sick. I can honestly say that I have never thrown up once. I have eaten something greasy and felt a little nauseous, but I quickly learned that fried foods and greasy things are not something I tolerate well. I am posting our nutrition guidelines. I'm sure everyone's guidelines differ to some degree, but they are probably pretty close. I hope this helps you all.
Weight Management Center
Nutrition Guidelines with Roux-en-Y Gastric Bypass
The Roux-en-Y gastric bypass is a serious, life-changing procedure. It is not a “quick fix” for weight loss. It requires self-discipline in regard to food selections. Making a consistent effort to follow the nutrition guidelines is essential for maintaining goal weight.
Eating behaviors must change permanently. The diet after surgery starts with clear liquids and progresses gradually to solid foods. The diet progression promotes gastrointestinal tolerance, initial healing after surgery, and reduction of potential complications associated with surgery.
A. The Roux-en-Y reduces calorie intake in the following ways:
1. The new stomach pouch is about the size of an adult’s thumb or the amount of 2 tablespoons.
2. The opening from the stomach to the intestine (called a stoma) is less than 1 inch; this slows the rate at which food empties from the stomach pouch into the intestine
3. Normal digestion and absorption of nutrients are reduced due to the surgery.
B. General guidelines for continued weight loss and long-term weight maintenance:
1. Take daily vitamin / mineral supplements as prescribed by your physician.
a. Vitamins and minerals affected most are iron, calcium, vitamin D, vitamin B12, and folic acid [Table 1].
b. In addition to poor digestion /absorption of nutrients, reduced calorie intake may lead to vitamin, mineral, and/or protein deficiencies and poor nutrition. Possible side effects are hair thinning, hair loss, bone loss, low body iron stores, tiredness, and muscle loss.
c. Daily vitamin /mineral supplementation is required for life.
2. Drink recommended fluid amount for good hydration—[see Table 2]
a. It may be difficult to drink enough fluids after surgery due to small stomach size and reconstructed gut.
1) Recommendation- at least eight 8-ounce servings (64 ounces) fluid per day.
2) Water is preferred. In addition, sugar-free fluids are recommended to avoid gastrointestinal upset, e.g., dumping syndrome, and to reduce caloric intake.
3) Avoid fluids with caffeine, carbonation, and alcohol that can trigger unpleasant side effects, e.g., nausea, vomiting, belching. [Section C].
b. Drinking enough fluids may be difficult because fluids and foods cannot be consumed at the same time.
1) Wait at least 30-60 minutes before and after meals to drink fluids.
2) Drinking fluids right after meals may expand the stomach pouch or force foods through the gut at a faster rate causing uncomfortable side effects.
3) Drink 1 cup of fluid over 1 hour.
c. Sip fluids rather than gulping due to the small size of the stomach pouch.
1) Drinking too fast may cause uncomfortable side effects [Section C].
2) Drinking water and sugar-free fluids on a constant basis (between meals) is important for good hydration
3) Keep beverage container or sports bottle “on hand” during the day.
3. Choose low-fat, high protein foods—[see Table 3].
a. Low fat, high protein foods are important to increase nutrition with extreme limited calorie intake.
b. Eat the protein or meat first at every meal.
c. Talk to your dietitian before using any protein supplements, e.g., protein drinks, powders, or protein bars.
4. Changing food textures and portions will help ease digestion.
a. The timeline of diet progression depends on patient tolerance to foods [Table 4].
1) Clear liquid is the first stage. The diet progresses slowly to a low-fat, regular diet.
2) Use measuring spoons or cups for exact measurement of food or fluids. Do not eat more than recommended.
5. Space meals throughout the day.
a. Consume small meals while drinking fluids between meals.
b. Take small bites and chew foods thoroughly (about 30 chews for each bite).
c. Meals should last up to 30 minutes.
6. Include daily physical activity with physician approval.
a. Exercise burns calories and helps preserve muscle during weight loss.
b. Start slow and increase amount of exercise time- try activities such as walking or swimming.
c. Regular exercise is a key component in maintaining goal weight.
7. Continue follow-up visits with physician and dietitian for on-going medical management.
C. Potential post-surgery problems with suggested solutions:
1. Dumping syndrome— consuming foods or fluids (1) high in sugar or high in fat, (2) at the same time, or (3) in larger amounts may trigger “dumping” or faster emptying of food or fluid from the stomach pouch directly into the gut, causing symptoms such as abdominal cramps, diarrhea, lightheadedness, sweating, and heart palpitations.
Suggestions:
a. Avoid foods and liquids with high sugar content.
b. Allow at least 30-60 minutes between taking fluids and solids.
c. Eat and drink slowly.
d. Eat smaller portions.
e. Chew food thoroughly (chew food about 30 times for each bite).
2. Dehydration
Suggestions:
a. Goal: at least eight 8-ounce glasses of fluid every day.
b. Do not gulp fluids; sip fluids.
c. Carry a water bottle or drink container to have fluids on-hand throughout the day.
d. See recommendations for fluids [Table 2].
3. Vitamin/ mineral and protein deficiencies
Suggestions:
a. Eat recommended amount of protein – [see Table 3].
b. Take vitamin /mineral supplement every day for life.
c. Vitamin/mineral supplement, iron, vitamin B12, folic acid, calcium, vitamin D—[see Table 1].
d. Deficiencies may cause hair thinning, hair loss, muscle loss, bone loss, low body iron stores, and tiredness.
4. Nausea and vomiting
Suggestions:
a. Eat and drink slowly.
b. Eat small portions and stop eating when you feel full.
c. Chew food thoroughly.
d. Do not lie down immediately after meals.
e. Follow diet progression as instructed by your physician or dietitian.
f. Drink enough fluid to make up for fluid losses.
g. Contact your physician if nausea and vomiting continues for more than 1-2 consecutive days.
5. Diarrhea
Suggestions:
a. Avoid fluids with sugar.
b. Avoid very hot or very cold temperatures in foods and liquids.
c. If lactose intolerant, (1) limit milk and milk products, (2) use lactose-free milk, or (3) use supplement that eases digestion naturally, e.g. Lactaid®.
d. Drink enough fluids to make up for fluid losses.
6. Constipation
Suggestions
a. Increase fluid intake as recommended to eight 8-ounces glasses (64 ounces) per day.
b. Include fiber foods in diet.
c. Choose prune juice as a natural laxative (limit to ½ cup per day).
d. Include daily physical activity.
e. Use over-the-counter laxative if directed by your physician.
7. Belching
Suggestions:
a. Eat and drink slowly.
b. Avoid carbonated beverages.
c. Avoid caffeine.
d. Do not use drinking straw with fluids.
8. Indigestion
Suggestions:
a. Reduce portions as recommended.
b. Eat meals slowly; meals should last up to 30 minutes.
c. Do not lie down immediately after meals.
Table 1. Vitamin and mineral supplementation
Supplement Recommended Dosage / Types Food Sources
Vitamin / mineral supplement
(MVI) • 2 children’s chewable multivitamin
(For 3 months after surgery)
• May change to 1 adult vitamin/ mineral with iron supplement daily In addition to taking your supplements, eat a variety of foods as listed below.
Iron
• Ferrous gluconate
• 40-65 milligrams (mg) elemental iron by mouth—
e.g., Fergon® high potency iron supplement- 1 tab every day
• May take with 500 mg vitamin C for better absorption
• Do not take within 2 hours of tea, coffee, calcium supplement, or antacids • Ground beef, lean
• Pork chop, loin
• Egg
• Turkey, white or dark meat
• Enriched cream of wheat, farina
• Dried beans
• Cooked spinach
• Tofu
Folic acid
• 1 milligram (mg) by mouth • Egg
• Cooked lentils
• Fortified breakfast cereal
• White rice, cooked
• Tomato juice (low sodium)
OR:
Prescription chewable prenatal vitamin (1 tab per day) may be substituted for the MVI, iron, and folic acid supplements above.
Vitamin B-12
• 1,000 mcg—monthly shot
OR
• 500 micrograms (mcg)—daily supplement (sublingual) absorbed by placing under tongue • Beef
• Tuna
• Milk
• Fortified breakfast cereal
• Cheese
Calcium
• Calcium citrate with vitamin D—
1200-1500 milligrams (mg) by
mouth, e.g.,
Ultradense Citracal®–
630 mg tab with 400 IU vitamin D
twice daily
• Take calcium in smaller doses (approximately 500 milligrams at a time for better absorption) • Milk, skim or 1%
• Powered non-fat milk
• Plain low-fat yogurt
• Cottage cheese
• Cheese
• Tofu
• Beans, lentils, black beans, pinto
• Whole-wheat bread
• Calcium-fortified orange juice (no pulp)
Choosing a vitamin /mineral supplement:
• Look for the initials USP (testing organization U.S. Pharmacopoeia) or words such as “release assured” or “proven release”, meaning supplements are easily dissolved in short period of time.
• Avoid herbals or dietary supplements that may cause adverse health effects and interfere with medications.
• Due to poor absorption with the altered intestine, you will need a much greater amount recommended for the general population.
• Do not self-prescribe. Talk to your physician or dietitian before taking any supplement or vitamin.
Table 2. Fluid
Fluid Recommendations Sources
At least eight 8–ounce glasses per day. (Total 64 ounces per day)
* Milk is a good source of protein and calcium. Drinking two 8-ounce glasses per day can help meet protein intake. • Broth or bouillon
• Water
• Decaffeinated coffee
• Decaffeinated tea
• Crystal Light® or Diet Snapple®
• Diet lemonade or sugar-free fruit flavored drinks
• 100% fruit juice (limit 1 cup per day, may dilute with water)
• Sugar-free fruit ice or sugar-free popsicles (no fruit pieces)
• Sugar-free gelatin
• Milk (skim to 1%)*
• Low-fat buttermilk
• Low-fat soy milk
• Low-fat cream-style soups (strained, no pieces remaining)
• Protein drinks (Slim Fast low carb®, diet instant breakfast made with milk or water; low-fat, low carb protein shakes made with protein powder)
Table 3. Protein
Food Amount Grams of protein
Lean meat (beef, poultry, fish, pork) 1 ounce (by weight) 7
Low-fat cheese 1 ounce (by weight) 7
Tofu (1 ounce) 1 ounce 3-4
Egg
• 1 egg (soft boiled, poached, or scrambled)
• 2 egg whites or
• 1/8 cup egg substitute
1 ounce (by weight)
7
Milk (skim, ½% or 1%) or soy milk ½ cup 4
Nonfat dry milk (dry) 2 tablespoons 4
Low-fat cottage cheese ¼ cup 6
Yogurt (light or plain) ¼ cup 2-3
Beans (kidney, pinto, lentils) ¼ cup 3.5
Vegetables ¼ cup 1
Grains (cereal, pasta, rice) ¼ cup 1.5
Recommendation for protein intake:
• Dietary protein goal – At least 70 grams or more per day
• Aim for 6 ounces of meat (eggs, fish, cheese, poultry, or beef) per day
• Ground lean beef or shaved deli meats may be better tolerated than fibrous, red meats.
• If lactose intolerant, try soy-based milk substitute or lactose-free milk.
• Add non-fat dry milk or protein powder to cereals, beverages, or soups to increase total protein intake if needed.
• Eat the protein or meat first at every meal.
Diet Progression
Diet progression begins with clear liquids and gradually advances to a regular, low-fat diet. Do not eat more food than recommended. Consult your physician or dietitian if you have questions regarding your diet progression.
Table 4. Diet progression
Duration Stage of diet Volume / Frequency Description of foods
Day 1 Clear liquids
• Stage 1
• The initial diet following surgery
• 1-2 ounce (2-4 tablespoons) fluid every hour
• Liquids including water, broth, sugar-free beverages, and sugar-free gelatin
• See Table 5
Days 2-3
Full liquids
• Stage 2
• Used as transition from clear liquids to semi-solid food.
• 2 ounces (4 tablespoons) fluid or food every hour • Fluids allowed on clear liquids with addition of select milk products; refined, low-fiber cooked cereals; strained low-fat soups
• See Table 6
Days 4-24
(3 weeks) Pureed
• Stage 3
• Blenderized
• 2-3 ounces food per meal
• 4-5 meals per day
• Drink fluids (Up to 1 cup over 1 hour between meals; wait at least 30 minutes before and after meal to drink fluids) • Blended foods with baby food or mushy consistency
• Foods with a smooth paste appearance (no pieces).
• See Table 7
Days 25-52
(4 weeks)
Soft
• Stage 4
• Reduced fiber • 4 ounces food per meal
• 3 meals per day (+1 high protein snack (2-4 ounces)
• Drink fluids (Goal – 64 ounces per day between meals)
• Whole, soft textured foods that are easily chewed. Cut into small pieces before eating.
• See Table 8
Lifetime Regular
• Stage 5
• Low-fat, low sugar • 4-8 ounces food per meal
• 3 meals per day (+1 high protein snack (2-4 ounces)
• Drink fluids (64 ounces per day between meals) • Whole, low-fat foods that can be easily chewed. Cut into small pieces before eating.
• See Table 9
Measurements
3 teaspoons = 1 tablespoon 3 ounces = ⅓ cup
2 tablespoons = 1 ounce 4 ounces = ½ cup
1 ounce = ⅛ cup 6 ounces = ¾ cup
2 ounces = ¼ cup 8 ounces = 1 cup
Table 5. Clear Liquid Diet Guidelines
Stage 1
This is the first stage that you will be on after surgery.
Recommended amount of liquid: 1-2 ounces (2-4 tablespoons) every hour during waking hours (or volume as directed by your physician)
You will be expected to self-monitor the volume and frequency of liquid consumed.
Fluids Allowed
• Water
• Broth (bouillon)
• Non-carbonated, caffeine-free beverages
• Sugar-free lemonade or fruit flavored drinks, e.g., Crystal Light®
• Sugar-free gelatin
• Sugar-free fruit ice / sugar-free popsicles (no fruit pieces)
Table 6. Full Liquid Diet Guidelines
Stage 2
After you can tolerate clear liquids, you may begin a full liquid diet.
Amount of food or fluid recommended: 2 ounces fluid or food every hour during waking hours.
NOTE: This diet includes all foods and fluids below in addition to fluids allowed on Stage 1.
Food and Fluids Allowed
• Low-fiber, refined, cooked cereals, e.g., cream of wheat, cream of rice, malt-o-meal, thinned grits.
• Cream-style soups (made with water or skim milk)
• Blended, strained soups
• Vegetable juices, e.g., V-8®, tomato juice, carrot juice.
• Sugar-free or diet puddings or sugar-free custards
• Plain or light yogurt (no fruit pieces or seeds)
• Skim or 1% milk
• Low-fat soy milk
• Low-fat buttermilk
• No sugar added protein drinks, e.g., no sugar added Carnation Instant breakfast®, Slim Fast Low Carb® meal replacement
• Protein powders mixed with skim milk or water, e.g., 100% whey protein powder, whey protein isolate, soy protein powder
Table 7. Pureed Diet Guidelines
Stage 3
Pureed foods appear to have a smooth paste or thick liquid consistency.
Amount of food recommended: Approximately 2-3 ounces food per meal; 4-5 meals per day
To prepare: Place food and small amount of liquid in blender; blend to smooth paste consistency (no pieces). You may freeze extra puree in small containers.
You may drink up to 1 cup fluid over 1 hour time periods between meals. Wait at least 30 minutes before and after meals to drink fluids.
NOTE: This diet includes all foods and fluids in Stage 1 and Stage 2.
Food Group Foods Allowed
Meats and meat alternatives
• Pureed meats, e.g., poultry, pork, veal, lamb.
• Blended fish
• Blended or mashed low-fat cottage cheese
• Blended low-fat tofu
• Soft poached or scrambled eggs, mashed with fork*
Milk products
• Skim or 1% milk
• Low-fat soy milk
• Low-fat buttermilk
• Sugar-free, low-fat yogurt without fruit pieces, nuts or seeds
• Sugar-free or diet pudding or sugar-free custard
Fruits • Unsweetened, pureed fruits without skins or seeds, e.g., peaches, pears; applesauce, well-mashed ripe bananas.
• 100% fruit juice- diluted limit to 1 cup per day, may dilute with water
Vegetables • Pureed, cooked vegetables (or well mashed with fork)– no skins or seeds e.g., cooked carrots, squash, green beans
• Vegetable juice, e.g., V-8®, tomato juice, or carrot juice
• Whipped potatoes (no skin)
Cereals • Refined, low-fiber cooked cereals, e.g., cream of wheat, cream of rice, thinned grits
Soups • Broth, bouillon
• Blended, strained soups (no visible chunks)
• Low-fat cream soup that has been blenderized
Combination foods • Blended, low-fat casseroles
Other • Sugar substitutes, e.g., Nutrasweet®, Splenda®, Sweet-N-Low®
• Sugar-free or diet jelly (no fruit pieces)
Pureed Diet sample menu
Time Amount (by volume) Sample Food
7:30 a.m. – 8:00 a.m. 3 ounces food 3 ounces cooked cereal (cream of wheat) made with small amount of milk or water (add protein powder) OR
2 mashed, scrambled eggs blended with 2 ounces whipped potato
8:30 a.m. – 9:30 a.m. Up to 1 cup fluid Up to 1 cup water or sugar-free fluid
10:00 a.m.- 10:30 a.m. 2 ounces food 2 ounces applesauce or well-mashed banana
11:00 a.m. – 12:00 p.m. Up to 1 cup fluid Up to 1 cup water, sugar-free fluid, skim milk, or protein drink
12:30 p.m. – 1:00 p.m. 3 ounces of food 2 ounce (2 tablespoons) pureed fish or pureed chicken (may use 2 tbsp olive or canola oil)
1 ounces (2 tablespoons) pureed carrots or other vegetable of choice
1:30 p.m. – 2:30 p.m. Up to 1 cup fluid 1 cup water or sugar-free fluid
2:30 p.m. – 3:30 p.m. Protein drink Commercial ready-made protein drink or protein powder mixed with water or milk—may add ½ small banana for flavoring
3:30 p.m. – 4:30 p.m. Up to 1 cup fluid Up to 1 cup water or sugar-free fluid
5:00 p.m. – 5:30 p.m. 3 ounces food 2 ounces blended cottage cheese
1 ounces pureed peaches
6:00 p.m.— 7:00 p.m. Up to 1 cup fluid Up to 1 cup skim or soy milk
7:30 p.m. – 8:00 p.m. 3 ounces food 3 ounces sugar-free light vanilla yogurt or sugar-free pudding
8:30 p.m.— 9:30 p.m. Up to 1 cup fluid Up to 1 cup water or sugar-free fluid
Table 8. Soft Diet Guidelines
Stage 4
Soft foods are whole, tender foods that are easily chewed. On this stage, foods must be cut into small pieces and chewed thoroughly.
Amount of food recommended: Approximately 4 ounces food per meal; 3 meals per day (plus 1 high protein snack if needed (¼ -½ cup).
Your fluid goal is 64 ounces of fluid per day between meals.
NOTE: This diet includes all foods and fluids included from Stage 1 through Stage 3
Food Group Foods Allowed Foods not Allowed
Meat and meat alternatives
Recommend at least 4-6 ounces (½ to ¾ cup) of meat per day
• Tender cuts of lean meats, (e.g. beef, pork, poultry), fish, shellfish
• Tuna salad, chicken salad, egg salad (no celery, onion, pickles/relish)
• Eggs (poached, soft-boiled, scrambled; egg whites; egg substitutes)- limit 3 whole eggs per week due to higher cholesterol content
• Low-fat cottage cheese
• Low-fat cheese, e.g., mozzarella, ricotta, Alpine Lace®, Laughing Cow® [no more than 5 grams fat per ounce]
• Smooth, reduced-fat peanut butter (limit 1 oz per day)
• Tofu (low fat) • Fatty meats, organ meats, sausage, hot dogs, fried meats/fish, gristly meats, fibrous red meat (may obstruct stomach opening)
• Fried eggs or hard-boiled egg (egg may be rubbery and become stuck in stoma opening)
• High-fat natural or processed cheeses, e.g., American, Colby, cheddar, Swiss, Monterey Jack, cheese spreads
• Chunky peanut butter
• Nuts and seeds
Milk products
May drink up to 16-24 ounces of skim or 1% milk per day as tolerated • Light yogurt (non-fat or low-fat), soy yogurt
• Sugar-free or diet pudding or custard
• Skim milk to 1% milk, evaporated skim milk, powdered skim milk, soy milk, low-fat buttermilk • Yogurt made with whole milk
• Ice cream
• Whole milk custards
• Whole milk, 2% milk, regular or low-fat chocolate milk, eggnog
Fruits • 100% fruit juice (limit 1 cup per day, dilute with water)
• Canned or cooked fruits (water packed or in own juices) – no skins or seeds
• Unsweetened applesauce
• Citrus fruits, e.g., oranges, grapefruits without membranes
• Bananas
• Melon • Fresh fruits except those allowed
• Dried fruit
• Fried fruits
• Fruits in heavy syrup
Vegetables
• Well-cooked vegetables (no seeds)
• Vegetable juices (low sodium) • Fresh vegetables (due to high fiber content) or partially-cooked steamed vegetables
• Fibrous vegetables, e.g., corn, Brussel sprouts, cabbage, celery, green beans, peas, fried vegetables
Soft diet (cont.)
Food Group Foods Allowed Foods not Allowed
Cereals, Grains, Pasta, Bread, Beans • Well-mashed beans (e.g. refried beans, black beans, chick peas)- limit ¼ cup per day
• Well-toasted breads (without seeds or nuts), low-fat crackers
• Baked or boiled potatoes (no skin)
• Pasta, white rice (not sticky)
• Corn tortillas
• Unsweetened hot cooked cereal
• Dry cereals (e.g. Rice Krispies®, Corn Flakes®, Cheerios®, Special K®) • Whole, cooked beans (lima beans)
• White or brown breads (not toasted)
• High-fat crackers or high-fiber crackers, e.g., Triscuits®
• Doughnuts, croissants, muffins, biscuits, sweet rolls
• Fried potatoes, corn chips, hash browns, French fries
• Wild rice
• Flour tortillas
• Popcorn
• Flavored cereals (honey or sugar coated), granola-type cereals with dried fruits, nuts, bran, or coconut
Fats and Oils
Limit 3 servings per day.
• Unsaturated vegetable oils, e.g. sunflower, soybean, corn, olive, canola, safflower, sesame seed (sparingly in cooking) (1 tsp)
• Light tub margarines (1 Tbsp)
• Fat-free or low-fat vinaigrette dressings (1 Tbsp)
• Fat-free mayonnaise (1 Tbsp)
• Fat-free cream cheese (1 Tbsp)
• Fat-free sour cream (1 Tbsp) • Lard, stick butter or stick margarine
• Coconut oil, palm or kernel oil
• Gravies, cream sauces, hollandaise sauces, au gratin
• Regular, creamy dressings (i.e. Caesar, blue cheese, ranch, thousand island)
Soups • Fat free or low-fat soups made with allowed ingredients
• Broths (low sodium)
• Low fat, cream-style soups • Cream-style soups with whole milk or cream (bisques, chowders)
Beverages • Water
• Decaffeinated coffee and tea
• Non-carbonated diet or sugar free beverage (caffeine free)
• Beverages made with skim /low-fat milk
• Flavored or carbonated water (e.g. club soda, Perrier®)
• Caffeinated coffee or tea
• Carbonated beverages (regular or diet soda)
• Beverages made with whole milk, cream, half & half, or ice cream
• Alcohol (beer, wine, liquor)
Desserts • Sugar-free gelatin
• Sugar-free or diet, low-fat pudding or custards • Sweets and desserts (pies, cookies, pastries, chocolates, candy, ice cream, etc.)
• NOTE: Sugar-free products containing sugar alcohols, or polyols (i.e. sorbitol, mannitol, isomalt, xylitol) may have “laxative effect”
Other • Diet jelly; diet syrup
• Diet instant breakfast; whey or soy protein powder, low carb protein drinks- Slim Fast Low Carb®
• Sugar substitutes, e.g., Sweet-n-Low®, NutraSweet®, or Splenda® • Regular jelly, jam, preserves, honey
• Higher sugar nutrition supplements or meal replacements, e.g., Slim Fast®, Boost®, Ensure®, Glucerna®
Soft diet sample menu
Time Amount (by volume) Sample menu
7:30 a.m.- 8:00 a.m.
Breakfast
2 scrambled eggs
½ piece of wheat toast
1 tablespoon trans-fat free margarine or diet jelly
OR
½ small banana
8:30 a.m.- 9:30 a.m.
1 cup fluid
1 cup water or other beverage of choice (sugar-free, caffeine-free)
9:30– 10:30 a.m.
Protein drink (1cup)
1 cup low-fat milk or water mixed with
Diet instant breakfast or Protein powder
11:00 a.m.– 11:30 a.m.
Lunch
2 ounces flaked, broiled fish
OR
2 ounces ground turkey (may use 1 tsp. olive or canola oil)
---------
1 ounce sweet potato (no skin)
1 ounce soft-cooked chopped spinach or carrots
12:00 p.m.—1:00 p.m.
1 cup fluid
1 cup low-fat milk
1:30 p.m.—2:00 p.m. Protein drink
1 cup protein drink of choice
2:30 p.m.—3:30 p.m.
1 cup fluid
1 cup water or sugar-free fluid
3:30 p.m.- 4:30 p.m. Protein snack 2-4 ounces light yogurt OR 2-3 ounces low-fat cheese
5:00 p.m.—5:30 p.m.
1 cup fluid
1 cup low-fat or water
6:00 p.m.- 7:00 p.m.
Dinner
2 ounces broiled chicken breast (may use 1 tsp. olive or canola oil)
1/2 small orange
1-2 ounce broccoli florets
7:00 p.m.—8:00 p.m.
1 cup fluid
1 cup sugar-free fluid
Table 9. Regular (low-fat) Diet Guidelines
Stage 5
After following the soft diet, you may progress to a regular-textured, low fat diet. Foods selected must be lean or low in fat. You should take small bites and chew everything thoroughly.
Recommended amount of food: Approximately 4-8 ounces per meal; 3 meals per day (plus 1 high protein snack if needed. (¼-½ cup).
*If unable to eat 4 ounces of food at one time, reduce portions / follow portion recommended from previous stage. Always stop eating when you are full. The amount of food tolerated at one time will depend of the type of food consumed.
Your fluid goal is at least 64 ounces of fluids between meals.
NOTE: This stage includes all foods and fluids from Stage 1 through Stage 4
Food group Foods allowed in addition to soft diet
Meat and meat alternatives
• Shellfish- up to 4 ounces per week due to higher cholesterol content
• All lean meats as tolerated
Fruits and vegetables
• Fresh fruits and vegetables (Try one food at a time for tolerance)
• All cooked vegetables
Cereals, Grains, Pasta, Bread, Beans • Bran or whole grain cereals
• Whole grain rice and pasta
• Whole, cooked legumes, beans, and peas
• Dry and crunchy snacks (e.g. pretzels or baked chips) in moderation
NOTE: Avoid olestra (fat substitute) containing products (e.g. fat-free potato chips) that have gastrointestinal side effects (e.g. abdominal cramping or diarrhea) and may inhibit body’s absorption of some fat-soluble vitamins and nutrients.
Regular diet sample menu
Time Amount (by volume) Sample menu
7:30 a.m.- 8:00 a.m. Breakfast 3-4 ounces of plain, cooked oatmeal or dry whole-grain cereal made with water or skim milk- may add protein powder
2-3 ounces berries or small banana
8:30 a.m. – 9:30 a.m. 1 cup fluid
1 cup water or sugar-free fluid
9:30 a.m.- 10:30 a.m. 1 cup fluid
1 cup fluid or low-fat milk
11:00 a.m.- 12:00 p.m. Lunch 2 ounces grilled chicken tenders (may use 1 tsp. olive or canola oil)
2-4 ounce cooked spinach OR 1 cup small salad with 1-2 chopped cherry tomatoes (1 Tbsp. low-fat vinaigrette dressing)
½ small orange (if tolerated)
12:30 p.m.- 1:30 p.m. 1 cup fluid 1 cup sugar-free fluid or protein drink
1:30 p.m. – 2:30 p.m. Protein drink (1 cup) 1 cup milk or water made with 1 scoop protein powder (per package directions) or low carb protein drink
May blend with ¼ cup fruit of choice
2:30 p.m. – 3:30 p.m. 1 cup fluid
1 cup sugar-free fluid or low-fat milk
4:00 p.m. – 4:30 p.m. Protein snack 2-4 ounces light yogurt or tuna salad
5:00 p.m. – 6:00 p.m. 1 cup fluid 1 cup water or sugar-free beverage
6:30 p.m. – 7:00 p.m.
Dinner 2 ounces broiled shrimp or chicken (may use 1 tsp. olive or canola oil)
1-2 ounce cooked legumes
1-2 ounce cooked vegetable
1 ounce low-fat cheese
1 Tbsp. avocado
7:30 p.m. – 8:30 p.m.
1 cup fluid 1 cup decaf hot tea or decaf hot or iced coffee (as tolerated)
D. To-do list before surgery:
Grocery list:
1. Sugar-free fluids (e.g., Crystal Light®)
2. Low-sodium broth or bouillon cubes
3. Sugar-free gelatin
4. Skim milk or soy milk
5. Protein powder or protein drinks
6. Refined, cooked cereals (e.g., cream of wheat)
7. Multivitamin/ mineral supplements (e.g., chewable multivitamin/mineral supplement, iron, folic acid, (or prescription prenatal vitamin), calcium, sublingual vitamin B12)
8. Household measuring spoons and measuring cups
E. Heart healthy cooking tips
1. Remove skin from chicken
2. Trim all visible fat from meats
3. Bake, broil, grill, poach instead of frying, sautéing, basting
4. Avoid foods prepared in the following ways: au gratin, escalloped, cheese sauce, creamed, parmesan, hashed, “in own gravies”, marinated in oil, pot pie
F. Tips to follow your meal plan when dining out
1. Ask for “heart healthy” entrees or request low-fat food preparation.
2. Limit portions by ordering senior entrées or selecting à-la-carte items, side dishes, or appetizers as your meal.
3. Share a meal (use a bread plate to portion your food).
4. Eat before going to restaurant or parties. Only sip on fluids instead of ordering a meal or sampling foods.
5. Limit breads, chips, and dips before the meal.
6. Limit dining out to two times per week.
G. Physical Activity
1. Talk to your doctor before starting exercise program.
2. Physical activity is a key component after surgery and promotes general feeling of wellness.
3. Routine exercise, in addition to a low-fat diet, helps with weight loss and maintaining goal weight.
4. Goal: 30 minutes of exercise (i.e. walking, swimming) on 5 or more days of the week.
5. Use a pedometer to count the number of total steps during the day (2,000 steps equals 1 mile)
H. Follow-up nutrition counseling
1. May complete 5-day food record (3 weekdays and 2 weekend day).
2. Call The Methodist Hospital Weight Management Center (713-441-5955) to schedule a follow-up nutrition counseling visit.
References:
1. Mayo Clinic- Nutrition Guidelines for Weight- Reduction Surgeries Rochester, MN 2001
2. Wadden, TA, Stunkard A. Handbook of Obesity Treatment. New York, NY. 2002.
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