Nutrition manual Bariatric Surgery Center - Salem Health
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Bariatric Surgery Center Nutrition manual
2
Salem Health Bariatric Surgery Center
Nutrition manual
Bring this manual to each appointment. You will write
and add material to it each visit.
This manual belongs to:
Salem Health Bariatric Surgery Center
875 Oak St. SE, Building C
Suite 5040
Salem, OR 97301
Phone: 503-814-5286
Fax: 503-814-5469
Email: bariatric.surgery@salemhealth.org
salemhealth.org/bariatric
The best way to contact a dietitian is by
sending a message through MyChart or by
calling the clinic. Learn more about MyChart
at salemhealth.org/mychart.
3
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Additional Resources Food Lists Special Concerns Post-Surgery Plan Pre-Surgery Plan Healthy Habits
Table of Contents
Healthy Habits: Getting ready for bariatric surgery and creating healthful habits.. . . . . . . . . . . . 6
Eating for the health of it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Food labels 101 — How to read one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Food groups and portion sizes.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
My meal plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Getting started with meal planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Start now. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Pre-Surgery Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Pre-surgery liquid meal plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Pre-surgery liquid diet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Post-Surgery Plan.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Weeks 1–2: Liquid diet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Weeks 2–4: Very soft foods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Weeks 4–6: Soft foods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Week 6 and beyond: Regular texture foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Special concerns and what to do.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Food lists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Foods high in vitamin B1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Vitamin B12 foods list. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Calcium content of foods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Iron-rich nutrition therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
High-iron foods list. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Zinc foods list. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Protein content of foods.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Additional resources for success.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
5
Getting ready for weight loss surgery
Eating for the health of it Where to eat
Eat at a dining table. Limiting where we eat (not in
Healthy Habits
Living healthy before any surgery a car, at a desk, in front of a TV, in bed, standing
helps healing and recovery after in the kitchen, walking in a shopping mall, etc.),
surgery. Following the guidelines usually limits how often and how much we eat. If
we eat while watching TV, in bed or standing in the
below before your weight loss
kitchen, then we’re cued to eat in those places.
surgery will provide a glimpse of
your life after you fully recover Create awareness
Pre-Surgery Plan
• Eating slowly and limiting where we eat make
from surgery. Remember, weight
us more conscious of our eating. Another way
loss surgery is only one of the to make us more aware of eating is to not do
many tools you will use to eat something else while we’re eating (e.g. watching
healthy and live actively for the television or reading). The best technique is to
eat with others and enjoy their company. If you’re
rest of your life.
Post-Surgery Plan
eating alone at home, play some relaxing music
(and light a candle or two). You’re worth it!
How to practice mindful eating
• Set a meal timer for 20 to 30 minutes for meals
Eat slowly and 10 to 15 minutes for snacks.
Eating slowly prevents nausea and vomiting after
surgery. It’s also an excellent strategy in learning Meal planning
to taste the food we eat so we're naturally satisfied • Set time aside to prep meals and snacks.
Special Concerns
with a smaller amount (people who eat quickly tend • Enjoy breakfast within one hour or waking.
to overeat).
• The sooner we eat after waking, the sooner our
• Use a knife, fork and spoon to eat and put bodies ability to burn calories “wakes up.”
utensils down between bites. If eating a sandwich
or other “finger food” such as a fresh apple, Plan several meals at a time, then make a
return the food to your plate between bites. shopping list. That way, whether it’s breakfast at
home or packing a lunch and snacks for work — the
• To chew well, which also helps to eat more slowly,
Food Lists
food you need will be on hand when you need it.
say your ABCs (silently) for each bite of food.
• Allow 20 to 30 minutes for a meal and 10 to 15 Avoid keeping food in your home that will tempt
minutes for a snack. you to over indulge. If other family members want
candy or chips, for example, then they need to buy it
• A good habit to start now is to stop eating before
and eat it elsewhere. You’re not depriving them, but
you are full. After surgery, it will be important
Additional Resources
rather modeling a healthy lifestyle that will help them,
not to stretch your pouch (new, smaller stomach)
too. If you struggle with this, at first, keep a single
by eating too much. We can eat enough without
portion of the food and add a protein source with it.
being full.
For example, a two-inch, single cut slice of cheesecake
from the bakery with a ¼ cup of almonds.
6
Eat before grocery shopping. An empty stomach Be prepared with alternatives for those times when
causes impulse buying and eating at the store. Only you’re not hungry for food and list them here:
Healthy Habits
buy foods on your meal plan. Eating healthy is not
1.___________________________________________
about will power. It’s about planning and creating
the environment (at home, work, etc.) that supports 2.___________________________________________
our goals. If we don’t buy it now, then we can’t eat it
3.___________________________________________
later!
When preparing meals at home, don’t eat while If you're hungry, you can always have a free food
cooking. This encourages mindless eating and (see page 13) or a vegetable serving along with a
grazing behaviors. When the meal is ready, keep the protein source.
prepared food on the counter, stove or in the oven —
• Try rating your hunger on a scale from 1 to 10.
rather than in serving bowls on the table.
1 is starving and 10 is so full you feel sick. Then
Consider using a smaller (salad) plate, bowl and eat when it’s about 3 or 4; stop eating when it’s
cup. Eat from your plate only (e.g. don’t finish other about 7 or 8 so you don’t overeat.
people’s uneaten food, not even one bite). We can • Keep a journal or log meals on an app — such as
throw it in — or we can throw it out. We eat with our Baritastic or MyFitnessPal — and include meal
eyes first. Try a toddler plate or indulge in buying times.
smaller dishes. Use baby or toddler utensils for all
• If there’s a pattern to your hunger (e.g. same time
meals and snacks to decrease your portions without
for 2 to 3 days in a row), talk to your dietitian
feeling deprived.
about revising your meal plan. Honor your
Store most foods in the kitchen cupboard or hunger so you’re in control of it, rather than
refrigerator. The only food on the counter that letting it control you
should be “calling you” is fruit or vegetables (e.g. and your food
get rid of candy dishes, snacks in the TV room or choices.
bedrooms).
What if I’m hungry?
If you’ve just eaten, wait 20 minutes to see if you’re
really hungry. It takes that long for the brain to get
the full message from the stomach.
If you’re hungry, ask yourself, “What am I hungry
for?” If you eat when you’re not hungry, you’ll still
be hungry when you’re done eating. It’s important
to get in touch with what’s eating you and nourish
that. Maybe what you really need is a nap, a drink
of water (sometimes we’re just thirsty), or talk
with a friend or rock out to your favorite music.
7
Food labels 101 — How to read one
Nutrition Facts
Healthy Habits
1 Serving size: How much is considered a single
serving of the food item. Remember, if you eat more 8 servings per container
2
than one portion, you will be consuming more 1 Serving size 2/3 cup (55g)
3
calories, fat, protein, carbs, etc.
1
230
4 Amount per serving
2 Total fat: Look for foods low in trans and Calories
saturated
3 fats. Try consuming low-fat foods: 5–6 % Daily Value*
1
grams of total fats per serving. Avoid deep fried or Total Fat 8g 10%
4
heavily
2 breaded foods. 2 Saturated Fat 1g
Trans Fat 0g
5%
3 Total carbohydrates: Foods high in fiber Cholesterol 0mg 0%
can Sodium 160mg 7%
4 be beneficial to a healthy diet and can help
Total Carbohydrate 37g 13%
lower blood cholesterol and glucose levels. A
carbohydrate’s job is to give us energy and is 3 Dietary Fiber 4g
Total Sugars 12g
14%
important for brain and body function. Includes 10g Added Sugars 20%
• If you have diabetes and are counting carbs, only 4 Protein 3g
look at the “total carbs”. One carb serving is 11 to Vitamin D 2mcg 10%
20 grams per meal. Have at least one carb serving Calcium 260mg 20%
and up to 3 for women and 4 for men. Iron 8mg 45%
Potassium 240mg 6%
• If you like to enjoy a snack, 2 hours after a meal it
* The % Daily Value (DV) tells you how much a nutrient in
1 is okay to have a 0 to 1 carb serving at that time. a serving of food contributes to a daily diet. 2,000 calories
a day is used for general nutrition advice.
2 This practice helps maintain healthy blood sugar
levels.
3
4 Protein: Add a serving of protein at each meal
and snack. Lean proteins are the best choices. See
the food list in the back of this manual for ideas.
8
Food groups and portion sizes
Use an 8-inch plate
Healthy Habits
Your plate should be less than 8 inches across.
Asparagus Corn
Broccoli Corn tortilla
Brussels sprouts Fruit
CARBOHYDRATES
Cabbage (coleslaw) Berries
Cauliflower Whole grains
Cucumbers Winter squash
NON-STARCHY VEGETABLES
Dark leafy greens Bean, lentils and peas
Eggplant Milk and yogurt
Mushrooms Chicken
Okra Eggs and cheese
Pea pods Fish: salmon, tuna, etc.
Peppers Lean beef
PROTEIN
Radishes Nuts
Salad greens Nut butter
Tomatoes Shrimp
Zucchini Tofu
9
Foods groups
Carbohydrate foods
Servings per meal: Breakfast 2 to 4 servings Lunch 2 to 4 servings
Healthy Habits
Dinner 2 to 4 servings Snacks 0 to 1 serving
Starch/grain group
Each serving = 11 to 20 grams of carbohydrates, 80 to 100 calories t = also 5
grams of fat
Bagel, mini 1 ounce Pasta, cooked 1/3 cup
Bread 1 ounce slice Peas, cooked 1/2 cup
Cereal, cooked 1/2 cup Popcorn, light t or plain 3 cups
Cereal, dry, 6 grams of about 3/4 cup (check Potato, cooked 2 ounces
sugar or less label) Potatoes, mashed 1/2 cup
Corn, cooked ½ cup or 6” ear Potatoes, hash browns t 1/2 cup
Crackers t 3 grams or 5 medium Pretzels 3/4 ounce
more fiber
Quinoa 1/3 cup
Dried beans, cooked 1/2 cup
Rice, cooked 1/3 cup
English muffin 1/2 whole
Squash, winter, cooked 1 cup
Graham crackers 1 1/2 whole
Tortilla, corn 1
Hamburger or hot dog bun 1/2 each
Tortilla, 6 inches, flour t 1
Lima beans, cooked 2/3 cup
Waffle, frozen t 1
Muffin, small t 1 ounce
Yam or sweet potato 2 ounces or 1/2 cup
Pancake, 6” 1
Sweets and combination foods
Each serving = 11 to 20 grams of carbohydrates, 100+ calories
t = also 5 grams of fat = also contains 6 to 8 grams of protein
Cake, no icing, 2 inches square 1 piece Pizza, thin crust t 1 (4 inches) slice
Casserole t ½ cup Soup (100 calories per 8 ounces
8 ounces), broth-based t
Chili t ½ cup
Spaghetti or pasta sauce ½ cup
Cookie, 3 inches across t 1
Granola bar t 1 (check label)
10Fruit group
Healthy Habits
Each serving = 11to 20 grams of carbohydrates, 60 to 80 calories
Choose unsweetened fresh or frozen fruit. If you use canned fruit, choose
fruit canned in juice or extra-light syrup: ½ cup = one serving *Goal: Eat 2
fruit servings/day* Serving size for fruit juice is 1/3 to 1/2 cup.
Apple 1 small or 4 ounces Orange 1 medium
Banana ½ large or 4 ounces Peach 1 medium
Black or blueberries ¾ cup Pear 1 medium
Cantaloupe ¼ small or 1 cup Pineapple, fresh ¾ cup
Cherries 12 Plums, fresh 2 small
Grapefruit ½ medium Prunes, dried 3 medium
Grapes 15 small Raisins 2 tablespoons
Kiwi 1 large Raspberries 1 cup
Mango ½ medium Strawberries, whole 1 cup
Nectarine 1 medium Watermelon 1 cup
Vegetables
These vegetables are non-starchy and low in carbohydrates (2 to 5 grams per
serving) and calories (20 to 30 calories per serving) and may be eaten freely.
*Goal: Eat 3 or more servings daily* (1/2 cup vegetables or 1 cup salad)
(Corn and peas are in the starch/bread/carbohydrate group).
Examples of 3 ounce portions:
Artichoke Celery Peppers
Asparagus Cucumbers Radishes
Beets Green beans Salad greens
Broccoli Greens (kale, turnip greens, etc.) Spinach
Brussels sprouts Jicama Tomatoes; 4 ounces tomato or
vegetable juice
Cabbage Lettuce (dark green is best)
Turnips
Carrots (baby carrots = 1 gram Mushrooms
carbohydrate each) Zucchini or summer squash
Onions
Cauliflower
Pea pods or snow peas
11Protein foods
Healthy Habits
Meat
Each one ounce = 7 grams of protein, 3 to 10 grams of fat, 30 to 100 calories.
Eat about two, 3 ounce servings daily.
• These foods have no carbohydrate (or almost none), but usually have fat.
• Meat should be baked, broiled, or grilled; no breaded and/or fried
• Remove skin from poultry.
t = higher-fat choices (limit these)
*Goal: Eat a serving of protein at EACH meal and snack*
Examples of 3 ounce portions:
• Meat about the size of a deck of cards • 1 medium unbreaded fish fillet (about the size
• Chicken: ½ of whole breast or 1 leg + 1 thigh of a checkbook)
(no skin) • 1 soy burger
• 1 small pork chop or tenderloin
Each food below is equal to approximately one ounce of meat or protein:
1 ounce low-fat cheese (6 grams of fat or less) 1/4 cup egg substitute or 2 egg whites
1/4 cup low-fat cottage cheese ½ cup cooked beans (red, refried, etc.) also
3 tablespoons of fat-free cream cheese carbohydrates
1/4 cup water-packed tuna or salmon 1 tablespoon peanut butter t (3.5 grams of
protein)
1 ounce (1/4 cup) nuts (160-200 calories) t
2/3 cup edamame
Below are also carbohydrates 3 to 4 ounces tofu
1/2 cup quinoa 1 ounce (1/4 cup) soy nuts
1 whole egg
Dairy group
Each serving = 11 to 20 grams of carbohydrates, 80 to 120 calories
t = also 5 grams of fat = also contains 5 to 15 grams of protein
*Goal: Eat 2 servings/day*
Milk: skim/1%/Kefir or soy 8 ounces Frozen yogurt t ½ cup
Lactose free: skim/1% 8 ounces Yogurt, plain nonfat 8 ounces
Ice cream, no sugar added ½ cup Yogurt, light (100 to 120
Ice cream, reduced fat t ½ cup calories/6 ounces; 130 to 160 calories/8 ounces
with no more than 12 to 14 grams of sugar for either
12Healthy Habits
Fat foods
1 serving = 5 grams fat; each food listed is one serving.
♥ = mono and polyunsaturated fats (healthy) n = Saturated fats (limit)
*Goal: Eat no more than one serving/meal, especially if you do not
have a gallbladder.*
Avocado ♥ 2 tablespoons Oil (corn, soy, sunflower) ♥ 1 teaspoon
Butter n 1 teaspoon Oil (canola, olive) ♥ 1 teaspoon
Cream cheese n 1 tablespoon Nuts ♥ ¼ cup
Cream cheese, light/whipped n 2 tablespoons Peanut butter, nut butter ♥ 1 tablespoon
Gravy n 2 tablespoons Salad dressing, regular 1 tablespoon
Margarine, regular 1 teaspoon Salad dressing, light 2 tablespoons
Margarine, light tub 1 tablespoon Sour cream, regular/IMO n 2 tablespoons
Mayo, regular 1 teaspoon Sour cream, light n 3 tablespoons
Mayo, light 1 tablespoon Sunflower seeds ♥ 1 tablespoon
Olives 8 black or 10 green
Free foods
These foods have 4 grams or less of carbohydrates and 20 calories or less
Unlimited free Limited free (1 serving per meal)
• Decaffeinated coffee and decaffeinated tea • Ketchup (1 tablespoon)
• Diet gelatin • Low sugar jam/jelly (2 teaspoons)
• Mustard, herbs and seasonings • Sugar-free syrup (2 tablespoons)
• Butter-flavored sprays, sprinkles • Whipped topping, light (2 tablespoons)
• Crystal Light and similar: no more than • Creamer, plain (1 tablespoon)
8 ounces, 3 times a day
13My meal plan
Healthy Habits
Include daily: from carbohydrate foods; 2 fruit servings and 2 dairy/calcium rich servings; 3 or more
vegetable servings; and a serving of meat/protein at each meal/snack.
Timing: Meals 4 to 5 hours apart, lasting 20 to 30 minutes. Snacks: 2 hours after meals, lasting 10 to 15 minutes.
Food group Example Now pracice your own plan
1 slice whole wheat
2 to 4 servings carbohydrate toast (one carbohydrate
0 to 2 ounces protein serving)
First meal
0 to 1 serving vegetable 1 whole egg
0 to 1 serving fat 8 ounces skim milk (one
carbohydrate serving)
Nonfat, no sugar added
1 serving carbohydrate
First snack Greek yogurt (6 ounces)
1 serving veg/protein (one carbohydrate serving)
• 1 to 2 cups spinach salad
• (with tomato, egg white,
low-fat cheese)
2 to 4 servings carbohydrate • 2 tablespoons low-fat
dressing on side (dip fork
Second 2 to 3 ounces protein
into dressing, then salad)
meal 1 to 2 servings vegetable
• 1/2 cup peas (one
0 to 1 serving fat
carbohydrate serving)
• whole grain dinner
roll (one carbohydrate
serving)
• Fresh apple (one
Second 1 serving carbohydrate
carbohydrate serving)
snack 1 serving vegetable/protein
• Mozzarella string cheese
• 2/3 cup pasta with ½
cup red pasta sauce
2 to 4 servings carbohydrate
• (3 carbohydrate servings)
2 to 3 ounces protein
Third meal • 2 small meatballs
1 to 2 servings vegetable
• ½ cup green beans
0 to 1 serving fat
with 1 teaspoon olive oil
• green salad with lemon
3/4 cup blueberries (fresh
or frozen, 1 carbohydrate
Third snack 1 serving carbohydrate serving)
(before • Or cucumber/tomato for
sleep) 1 serving vegetable/protein
veggie
• ¼ cup cottage cheese
14Grocery game plan
Healthy Habits
• Include meal times.
• Meals should be no more than 5 hours apart.
• Snacks are 2 hours after meals. Do your best to avoid grazing (eating between meals and snacks).
Create a grocery game plan weekly calendar
Sun Mon Tue Wed Thu Fri Sat
Breakfast
Lunch
Dinner
Snacks
Notes:
15Getting started with meal planning
1) Bean and cheese burrito: 1 small whole wheat 8) 1 egg poached or fried in nonstick skillet over
flour or corn tortilla, ¼ cup (vegetarian or fat- toast with butter or margarine; piece of fruit, ½
Healthy Habits
free best) refried beans, ½ ounce (2 tablespoons cup unsweetened applesauce or fruit cocktail. (280
shredded) cheese, salsa as desired. Cover with calories)
moist napkin and microwave for 1 minute. (180 to
200 calories) 9) 1/3 to 1/2 cup couscous (ideally whole wheat)
cooked (takes 3 minutes after adding boiled chicken
2) Pasta with meat sauce: 1 ounce dry pasta (1/2 broth or water) with ¼ cup peas (cooked in broth
cup cooked) with 1/4 cup jarred tomato sauce or 1 or water). Add 2 to 3 ounces of cooked shrimp or
to 2 teaspoons olive oil, 2 ounces cooked shrimp or scallops (or leftover chicken, pork or beef), garlic
leftover beef, poultry or fish, 1 tablespoon parmesan and or onion powder and/or chives or low-fat salad
cheese. (180 to 260 calories) dressing. (200 to 275 calories)
3) Salad: 1 cup lettuce or mixed greens with 2 to 3 10) Bagels and Lox: Add 2 ounces of smoked salmon
slices (2 to 3 ounces) lean meat, poultry or fish with to ½ toasted bagel with lite cream cheese. Add
lite dressing. (200 to 250 calories) cucumber, lemon, dill or capers if desired; add small
side salad with low-fat dressing. (300 to 350 calories)
4) Soup or chili: 1 cup of bean or lentil soup or 1
cup chili (from grocery or small Wendy's) and ½ to 1 11) ¾ cup frozen succotash cooked in microwave
serving of whole wheat crackers (250 to 300 calories) with 2 to 3 ounces of chopped ham, turkey or
chicken; 1 teaspoon of low-fat margarine. (200 to
5) Sandwich: PB & J on whole wheat crackers 250 calories)
or toasted thin whole wheat bread (using 2
tablespoons peanut butter and 1 tablespoon sugar- 12) One “Boca Burger” on two slices of thin toast
free jelly) with ½ cup or small piece of fruit (360-380 and 1 slice of melted, low-fat cheese,
calories) or 2 to 3 ounces lean luncheon meat on 2 ketchup, mustard, if
slices of thin whole wheat bread with 1 tablespoon desired. (220 to 240
Lite Miracle Whip OR lite mayo and 1 small piece of calories)
fruit. (300 to 320 calories)
6) Frozen pizza: Small, single, low calorie servings
(e.g. Lean Cuisine, DiGiorno, South Beach or Amy's
brands) and ensure adequate protein earlier in
the day or consider adding 1 to 2 ounces of cooked
shrimp, poultry or meat to pizza or meal. (350 to 400
calories)
7) ½ to 3/4 cup canned or frozen cooked corn mixed
with 1/3 avocado and 2 to 3 ounces of cooked shrimp
and lite salad dressing. (250-300 calories)
16Getting started: Healthy grocery list items
Dairy Meat/Protein
Healthy Habits
Milk: skim, 1% Chicken breast, no skin
Lactose-free, skim, 1% Chicken tenderloin, no skin, no breading
Soy milk, 100 calories/8 ounces White turkey meat, no skin
Yogurt, light (Swiss 120 calories or less/6 ounces; White fish
Greek 100 calories or less/5.3 ounces; “smooth” Tuna or salmon packed in water
yogurt only for full liquid diet)
Lean deli meat (ham, chicken, turkey)
Dry milk powder
Cottage cheese, low-fat or reduced-fat
Hot cocoa, no sugar added
Ricotta cheese (nice spread for toast)
Lifeway Kefir
Cheese: mozzarella, string, reduced fat (6 grams fat
or less/ounce)
Fruit/Vegetable
Egg substitute/eggs
Fresh vegetables in season
Peanut butter (Regular, not low-fat, not low-sugar)
Ready-to-eat salad mixes
Light tofu
100% V8 or tomato juice (not vegetable/fruit
Soy cheese
blends)
Fresh fruits in season Other
Canned, in extra light syrup or juice, including
Soups, 100 calories or less/8 ounces
individual packs of peaches, applesauce, pears, etc.
Broth or bouillon
Frozen fruits and vegetables
Crystal Light
Unsweetened applesauce
Kool Aid, sugar-free
Grains Gelatin, sugar-free
Breakfast cereal (6 grams sugar or less/ Decaf coffee, tea
serving) Frozen dinners (Healthy Choice, Lean Cuisine, etc.)
Sandwich bread (whole grain Salad dressing, reduced-fat
preferred)
Mayonnaise, reduced-fat
Crackers (3 grams or more fiber)
Sour cream, reduced-fat or fat-free
Bread sticks
Margarine, light, (e.g. Smart Balance Light, I Can’t
Pretzels Believe It’s Not Butter Light)
English Muffins, whole grain Cooking spray, e.g. Pam (be careful how much!)
Pasta, whole wheat preferable Monk fruit (natural zero calorie)
Truvia/stevia or Splenda (artificial)
17Start now
My responsibilities to help me 6. Additional supplements may be recommended
reach my surgery goal based off your lab values.
Healthy Habits
• You will need lifelong bariatric supplements
1. Nutrition goals to practice now:
after surgery. This is for safety and health
• Include 2 servings of fruit and calcium rich foods
maintenance.
and 3 or more servings of vegetables per day.
• If you have problems obtaining supplements,
Have a serving of protein at each meal/snack.
please inform your dietitian so we can help you.
Fluid goals are 48 to 100 ounces per day.
• Do your best to take the recommended
• Enjoy meals every 5 hours, allowing 20 to 30
supplements daily. Now is the time to treat
minutes per each meal. Have breakfast within an
nutrients deficiencies. After surgery, it can be
hour of waking.
difficult to normalize nutrient levels due to
• Two hours after meals, enjoy a snack (if
malabsorption.
physically hungry or next meal is greater than 5
hours later); allow 10 to 15 minutes for snacks. 7. Cost of supplements needed daily is about $30 per
month. Protein supplements for the first 3 months
2. Please bring your binder, nutrition manual and after surgery is $70 to $80 per month in addition to
food journal to every appointment! the supplement cost.
3. Weigh and measure your foods. Use a food scale 8. Weigh yourself once per week. Your goal weight
and measuring cups/spoons. for surgery is: _________________________
4. No alcohol, caffeine, carbonation, tobacco, or 9. Personal letter (a letter you write to yourself
marijuana, in any form. Please inform our bariatric about your goals and vision one year after surgery).
team if you are struggling with this, so we can help. Due prior to surgery: ________________________
5. Start taking a multivitamin/mineral supplement • Submit through MyChart OR bring to pre-op
daily with a meal. It should contain at least 18 mg appointment OR via mail.
of iron. • This letter will be returned to you at your one year
• Check with your dietitian before taking “Silver”, post-op appointment. Patients enjoy seeing how
“Men’s” or other varieties — these do not far they’ve come within a year after surgery!
contain iron.
10. Recommend purchasing: baby spoon/toddler
• No gummy vitamins because these typically do silverware; kid size or smaller dessert bowls, 8
not contain iron either. ounce cups, and an eight-inch diameter or smaller
plate. Using a kitchen timer creates mindful cues for
meal timing.
11. Women will need two forms of birth control up
to 18 months after surgery.
18Congratulations!
You have a surgery date!
Pre-surgery liquid meal plan
Pre-Surgery Plan
and pre-operative class
information
19Pre-surgery liquid meal plan
When you’re about two weeks Water and sugar-free beverages
(no caffeine or carbonation)
away from surgery, the next step
Your daily goal is to drink at least 48 to 64 ounces of
to prepare is to stop eating solid liquid every day to avoid dehydration. It’s possible
foods. All the energy and protein to drink too much liquid; no more than 128 ounces
you eat will come only from liquids. per day is advised for most people.
Starting this diet now will give you time to get Examples of approved liquids
Pre-Surgery Plan
used to it and experience how to make it work (you can “see through” them)
(e.g., you should still eat with your family) on a
day-to-day basis. Sugar free clear liquids (no protein and few
calories)
Protein beverages (primary source • Water
of protein)
• Water infused with lime,
You will consume three liquid meals (breakfast,
cucumber, etc.
lunch and dinner) and three liquid snacks
(midmorning, midafternoon and evening). • Crystal Light®, sugar-free
Kool-Aid® (makes great
• You’ll follow this pattern (three meals and three popsicles, too)
snacks) on your liquid diet after surgery, too — to
• Sugar-free popsicles
ensure you get enough daily protein and liquids.
• Sugar-free lemonade
• Your daily goal is 60 to 80 grams of protein spread
throughout the day over these three liquid meals • Sugar-free, decaf iced tea (sweeten with sugar
and snacks. substitute such as stevia)
• Sugar free gelatin
• Decaffeinated tea or coffee
• V8 low sodium tomato juice
• Broth
• Gatorade Zero
• Propel Zero
Sweet beverages, including full-
strength juices, can cause Dumping
Syndrome (see page 42 on this).
Carbonated beverages, even sugar-
free ones, can irritate the stomach.
Not recommended!
20Gum
If you chew gum, find an alternative now (such as sugar-free mints). Sugarless gum causes more air to be
swallowed and creates gas in the intestine. This could be very uncomfortable after surgery. Also, post-
surgery, gum that’s accidentally swallowed could cause a blockage.
Examples of approved full liquids Protein
These contain calories, energy and protein. Typically, you can't "see through" these (grams)*
Pre-Surgery Plan
8 ounces skim/soy/1% milk 8
Lactose-free, non-fat, 1% milk 8
Smooth non-fat, no-sugar yogurt (e.g. Yoplait blue label, plain nonfat Greek yogurt) 5 to 18
Smooth soups, 8 ounces (box brands: Pacific, Imagine) 5
Egg substitute, ¼ cup (liquid only, not cooked) 6
8 ounces protein supplement (Ex: Unjury, Premier brands. See list provided at pre-op class for
more ideas) 20
6 ounces, no-sugar-added hot cocoa (make with 6 ounces skim/1%/lactose-free or soy milk for
6 to 9 more grams of protein) 2
Sugar-free pudding (made with skim milk) 4
Sugar-free Fudgsicle (one) 2
Lifeway Kefir 11
* Information on label
Smoothies (homemade or store-bought) have too many calories and can produce
gas pain/discomfort from blenders; not recommended now or after surgery.
21Recommended recipes for the liquid nutrition plan
Skinny nog (try any time of the year)
Healthy Habits
1 quart, skim or soy milk ½ tablespoon, almond extract
1 cup, egg substitute* ½ tablespoon, orange extract
Pour all ingredients together and mix with a fork (avoid using blenders; they may cause
gas). Serve in large glass and sprinkle with grated nutmeg. Makes 5 (8 ounce) servings,
each providing 11 grams of protein.
Pre-Surgery Plan
*Do not use raw eggs. Egg substitutes are pasteurized and OK to use in recipes for
uncooked foods (like this nog) and cooked foods.
Spiced cider
8 ounces skim milk 1 ounce, sugar-free, chai-flavored syrup
2 tablespoons egg substitute One package, sugar-free spiced cider
Post-Surgery Plan
Gently heat (don’t boil) skim milk, egg substitute and sugar-free flavored syrup on stove.
Add the sugar-free spiced cider and mix until blended. 11 grams of protein per serving.
Soup
Use skim/1% milk, soy or lactose-free skim/1% milk when making soups for added protein.
Special Concerns
Other smooth, ready-to-heat soups (that don’t need added water or milk) — such as squash
— are also allowed.
• Soups that aren’t smooth are not recommended now or after surgery.
• For your safety, do not blend any soups (e.g. beef barley) to make it smooth.
Soups can be high in calories — and all your liquids need to be low (about 100 calories/8
ounces) or no calorie (e.g. water or Crystal Light).
Food Lists
Additional Resources
22Pre-surgery liquid diet
Protein Fluid
Sample menu: Pre-surgery liquid diet
(grams) (ounces)
Decaffeinated coffee with skim/1%/lactose-free or soy milk and 0 8
Breakfast sugar substitute
6 ounces smooth Swiss style yogurt 5
Snack Protein supplement with 8 ounces skim/1%/lactose-free or soy milk 28 8
8 ounces soup 2 8
Lunch
8 ounces infused water 0 8
Pre-Surgery Plan
Snack Protein supplement with 8 ounces skim/1%/lactose free or soy milk 28 8
8 ounces soup 2 8
Dinner
6 ounces water 6
6 ounces no-sugar-added hot cocoa (make with 6 ounces skim/1%/
Snack 8 6
lactose-free or soy milk)
TOTAL 73 grams 60
ounces
Protein is better absorbed if taken throughout the A low blood glucose level is less than 70 mg/dL.
day (20 to 30 grams is better absorbed than 45 to 60 Always contact your health provider if your blood
grams at one time). Try adding small amounts of sugar runs low for safety reasons.
unflavored protein powder to sugar-free gelatin or
sugar-free pudding.
Other pre-surgery responsibilities
1. Complete a daily Post Surgery Food and
You’ll know you’re drinking enough liquid if your
Activity Journal (download at salemhealth.org/
urine is straw colored. If it’s the color of apple
bariatric — Click FAQ/Ask a Question — then click
juice, you need more liquid (even if you’re drinking
Questionnaires and Forms on the left.)
64 ounces). In hot weather or after high intensity
• Make sure you are getting 60 to 80 grams of
exercise, you may need to drink more than your
protein and 48 to 64 ounces of liquid.
usual amount. Limit total fluid intake (includes
both clear and full liquids) to no more than 128 • No more than 100 ounces of liquid daily.
ounces (1 gallon) per day. • Record your protein intake in the “Pro g” column.
If you have diabetes, check your blood glucose in
2. Order your bariatric vitamins at least one
the morning (before eating) and at bedtime, at least
week before surgery (order at Procarenow.com —
two hours before or after your last liquid meal for
or call 877-822-5808).
accurate testing. Contact the doctor who prescribed
your medications to see if they need to make Please start taking your bariatric vitamins
possible adjustments while in the liquid meal plan. ONLY when instructed by your dietitian. Taking
bariatric supplements prior to surgery is dangerous
and can harm your body.
23Additional Resources Food Lists Special Concerns Post-Surgery Plan Pre-Surgery Plan Healthy Habits
24
and guidelines
Post bariatric surgery
Post-Surgery Plans
meal plans, diet advancementWeeks 1–2: Liquid diet
What will I eat when I get home?
• Your post-surgery liquid diet is the same as your
pre-surgery liquid diet. Remember, your daily
goal is 48 to 64 ounces of sugar-free, no caffeine,
non-carbonated liquids.
• The first week after surgery, liquids are more
important than protein. If you can’t tolerate
your protein supplement or can only drink a
small amount — drink as much as you can of
other allowed liquids you can tolerate. To prevent Supplements
nausea, sip beverages slowly. Most people do
All supplements and medications must be
best not using a straw (if it helps you drink more
crushed, chewable or liquid for one month after
liquid, then drink slowly; if you get gas, then stop
surgery. No gummy or children’s vitamins. When
using one).
Post-Surgery Plan
advised by your dietitian, you will start taking
• To be sure you are getting enough fluid and one, bariatric chewable multivitamin daily.
protein, make an appointment with yourself to
It’s dangerous and unhealthy to not take and/
drink your meals and snacks at scheduled times
or inconsistently take your supplements DAILY
(7:30 a.m. for breakfast; 10 a.m. for morning
after surgery. You’re at higher risk for nutrient
snacks, etc.). Your hunger mechanism may take a
deficiencies after bariatric surgery. Please
while to wake up — so you can’t rely on when you
communicate with us if you are struggling to
feel hungry to eat.
purchase or maintain consistency with your
• See the Pre-surgery liquid diet section for more supplements. We are here to support you and keep
information about your full liquid diet. Many you safe!
liquid supplements or meal replacements (such
as Slim-Fast®) contain too much sugar and are
not for you. IF IN DOUBT, DO WITHOUT
and then call the Bariatric Surgery Center
(503-814-5286) or send message through
MyChart to your dietitian.
• Don’t chew gum — even sugarless
gum. Air is swallowed when chewing
gum and this will cause more gas
in your intestine, which can be very
uncomfortable.
• Avoid using blenders; these also add
air and cause gas.
25Sample menu with supplements: Post-surgery liquid diet
Healthy Habits
Drink liquids first and add protein supplement as tolerated. You may not be able to drink 48 to 64 ounces of
liquid and 60 grams of protein daily the first few days you’re home; do the best you can.
Protein Fluid
Post-surgery Liquids
(grams) (ounces)
8 ounces water 8
5.3 ounces smooth Greek yogurt 12
Pre-Surgery Plan
Breakfast
One chewable bariatric multivitamin (starting
one week after surgery)
8 ounces skim/1%/soy/lactose-free milk
Snack 28 8
1 scoop protein powder
8 ounces broth 8
Lunch
Sugar-free pudding 4
8 ounces skim/1%/soy/lactose-free milk
Post-Surgery Plan
Snack 28 8
1 scoop protein powder
8 ounces infused water 8
Dinner
4 ounces soup 4
6 ounces no-sugar-added hot cocoa (make with
Snack 8 6
6 ounces skim/1%/lactose-free or soy milk)
TOTAL 80 grams 50
ounces
Special Concerns
If you have diabetes, check your blood glucose Other responsibilities:
regularly as directed by your primary care provider. Weeks 1 and 2
If your blood glucose is low (≤ 70 mg/dL) and
you’re still taking diabetes medication, contact the 1. Complete a Post-Surgery Food and Activity
doctor who prescribed your diabetes medication to Journal daily (download at salemhealth.org/
see if it can be adjusted. bariatric — Click FAQ/Ask a Question — then click
Questionnaires and Forms on the left) to ensure
Food Lists
you’re getting at least 60 grams of protein and 48
to 64 ounces of liquid. No more than 100 ounces
of liquid daily.
2. Walk 20 to 30 minutes/day (five-minute session,
in the house, is OK).
Additional Resources
26Weeks 2–4: Very soft foods
After being on liquids for two weeks after surgery, You may no longer drink fluids with your meals.
starting _________________, you are ready for Very Taking fluids and food together will cause weight
Soft Foods if you are drinking 48 to 64 ounces of gain and stretch your pouch. This could hurt and/or
liquid daily and getting 60 to 80 grams of protein make you vomit. You may drink until the time of your
daily. Your new stomach, often called a pouch, first meal or snack. Then, you may resume drinking
is still tender, somewhat swollen and healing. allowed/recommended beverages 30 minutes after
Therefore, any food you eat must be easy to digest. you finish eating. If a straw helps you drink more
If you try to eat solid food, you could cause a liquid, drink slowly. If using a straw gives you gas,
blockage (causing vomiting) or worse. stop using a straw.
Over the next two weeks, you will add Very Soft Visualize your new stomach (remember the football
Foods to your diet. Your dietitian will provide you and the egg?). Your new stomach is small: it can hold
with a list of options (see green separate list). You 1 to 2 ounces if you’ve had a gastric bypass, and 2 to
may season these allowed foods with cinnamon, 3 ounces for a sleeve gastrectomy (compared to 40 to
garlic powder, onion powder, tabasco (if tolerated), 60 ounces before surgery).
Post-Surgery Plan
or ground pepper. You may add one new food per
day and continue to drink full and clear liquids.
However, you’ll now get protein and energy from
Very Soft Foods as well.
27Respect your new stomach by: ▸ High fructose corn syrup
▸ Sucrose
1. Taking small, thumbnail-sized bites of food.
▸ Glucose
2. Chewing well. Get in the habit of chewing each
▸ Sorbitol, mannitol or xylitol
bite until your food becomes the consistency of
applesauce before swallowing. Don’t eat foods with added sugar such as:
3. Eating slowly. Try setting a timer for 20 to 30 ▸ Ice cream
minutes for a meal and 10 to 15 minutes for a
▸ Sherbet, sorbet
snack. Eat at a table or place where you cannot
accidently overeat due to distractions. ▸ Frozen yogurt
▸ Frozen ice, frozen fruit bars
4. Stop eating before you’re full. You will be
satisfied before you feel full. See thre Healthy ▸ Sweetened juice drink, fruit punch
Habits section of this manual (pages 6, 7) for ▸ Chocolate milk
more tips on how to eat.
Post-Surgery Plan
▸ Regular gelatin
Use a salad plate or small bowl, rather than a dinner
Remember to drink 48 to 64 ounces of sugar-free, no
plate and regular size bowl, for your meals and an
caffeine, and non-carbonated liquid and to eat 60
iced tea spoon or infant spoon.
to 80 grams of protein DAILY. Drink no more than
Do not eat any sweet foods or drink any sweet 128 ounces of total fluids, daily. Try adding small
beverages, including full strength fruit juices. amounts of unflavored protein powder to sugar-free
gelatin or sugar-free pudding.
• An 8 ounce glass of 100% fruit juice has more
calories (and sugar) than a 12 ounce regular cola. Here’s a sample menu, including a bariatric
• Sugar, even naturally occurring sugar in 100% multivitamin, for your Very Soft Food diet. It’s
fruit juice, can cause Dumping Syndrome (see always OK to eat less than the amount shown.
page 42 for more information). Weigh and measure your food to make sure you
don’t eat more than amount shown on your Very
• Read food labels to be sure there is no added
Soft Foods list.
sugar. Check the ingredient label for these words
that mean sugar:
▸ Sugar
▸ Brown sugar
▸ Honey
▸ Molasses
▸ Agave
▸ Maple syrup
▸ Corn syrup
28Very soft foods Protein (g)
2 scrambled egg whites 7
¼ cup egg substitute (no raw eggs, Add one new food per day.
7
please)
Do not use Brown Sugar Splenda or Domino Light.
¼ cup cottage cheese, low-fat 7
Both have sugar.
¼ c. cooked hot cereal (oatmeal,
cream of wheat, etc.) made with 4
nonfat/1%/soy milk Protein is necessary for proper healing of your
incision and your new stomach. Protein is also
¼ c. tofu 3
needed to prevent loss of muscle. You must continue
¼ c. plain, fresh mashed sweet
potato made with nonfat/1%/soy
to get 60–80 grams of protein and 48–64 ounces of
2
milks fluids daily.
¼ c. plain, fresh mashed white
potato made with nonfat/1%/soy
2
milks (no: skin, butter, sour cream,
Post-Surgery Plan
bacon)
¼ c. no sugar added applesauce 0
¼ to 1/3 banana 0
High protein liquids Protein (g)
6 ounces nonfat, no sugar added,
12
smooth Greek yogurt
6 ounces nonfat, no sugar added,
5
smooth Swiss yogurt
½ cup tomato soup made with skim
5
milk
1 cup kefir (Lifeway brand) 11
1 cup nonfat/1%/soy milk 4
½ cup sugar-free pudding made
4
with skim milk
1 tablespoon nonfat dry milk 3
29Protein Fluid
Very Soft Foods
(grams) (ounces)
Healthy Habits
7:30 a.m. 8 ounces decaf coffee 8
1/4 cup old fashioned oatmeal made with 4 ounces of nonfat/1%/ 6 to 9
8 a.m. soy milk
One bariatric calcium citrate chewable 500 mg
9 a.m. 8 ounces of tomato juice 8
Pre-Surgery Plan
10 a.m. Protein supplement in 8 ounces nonfat/1% or soy milk 26 to 29 8
2 tablespoons (1 ounce) low-fat cottage cheese 3
Noon
One bariatric chewable multivitamin
1 p.m. 8 ounces of water 8
2 p.m. 6 ounces of no-sugar-added hot cocoa made with nonfat/1%/soy milk 8 to 11 6
Post-Surgery Plan
3:30 p.m. 8 ounces of protein supplement 20 8
2 scrambled egg whites or 1/4 cup of egg substitute 7
5 p.m.
One bariatric calcium citrate chewable 500 mg
7 p.m. 8 ounces nonfat/1%/soy milk 6 to 9 8
76 to 88 54
TOTAL grams ounces
Special Concerns
If you have diabetes, check your blood glucose 2. All supplements and medications must be
regularly as directed by your primary care provider. crushed, chewable or liquid for one month after
If your blood glucose is low (≤70 mg/dL) and you are surgery. No gummy vitamins.
still taking diabetes medication, contact the doctor • One bariatric chewable multivitamin daily.
who prescribed your diabetes medication to see if it
• You need 1200 mg calcium citrate and 800 IU
can be adjusted.
vitamin D daily in addition to what’s in your
Food Lists
multivitamin and foods you eat and drink.
Other responsibilities
1. Complete a Food and Activity Journal daily This is usually one 500 mg bariatric calcium citrate
(download at salemhealth.org/bariatric. Click FAQ/ chewable/lozenge, TWICE a day. Most chewables
Ask a Question — then click Questionnaires and from the store are not calcium citrate. No gummy
Forms on the left.) — OR bring your own food record calcium. (Do not take both doses of calcium citrate
Additional Resources
in a phone app or personal notebook — to ensure together. It will not absorb properly).
you are getting at least 60 grams of protein and 48
Check the back of your supplement bottle(s),
to 64 ounces of liquids. No more than 128 ounces of
under supplement facts. Be sure to review the
total liquids daily.
serving sizes for your specific supplements for
accurate dosages.
30Weeks 4–6: Soft foods
You may eat soft, easy to chew foods such as feel satisfied before you are full. Even one more
white chicken and cooked (canned in light syrup teaspoon of food can make you nauseous. You
or its own juice) fruits and vegetables starting will feel full shortly after feeling satisfied (“full”
_____________________. may feel like pressure under your left rib cage or
even in your throat). It’s also OK not to “clean your
• Always measure your serving of food onto your
(smaller) plate.”
small plate or into your small bowl. It’s okay to
eat less if you are satisfied. As you are able, you may eat up to 1 ½ to 2
• Continue to drink liquids (48 to 64 ounces per measured ounces of food at a time. You can start
day) separately from your meals. No more than by adding one new food per day, e.g. 1/2 ounces
128 ounces of liquid daily. (1 tablespoon) of cooked vegetable. The next
day add 1/2 ounce (1 tablespoon) of fruit. Always
• You may drink up to the time you eat and you
eat your protein food first to make sure you get
may resume drinking allowed/recommended
enough protein per day. Start thinking of protein +
beverages 30 minutes after you finish eating.
vegetable as your model for meal planning.
• If a straw helps you drink more liquid, drink
Post-Surgery Plan
slowly. If using a straw gives you gas, stop using Cook once, eat twice. Make enough at one time
a straw. for a few meals. If you are not going to freeze the
food right away, put it in the refrigerator right
• Do not drink any beverages with your meals.
away. DO NOT LET ANY COOKED FOOD “COOL” TO
• See the Healthy Habits section for more info on ROOM TEMPERATURE BEFORE REFRIGERATING/
how to eat. FREEZING.
Take small, thumbnail-sized bites of food and Do not reheat cooked meats, especially chicken. They
chew well. Chew each bite 30 times (say your dry out in the refrigerator and with microwaving,
ABCs for each bite) so your food has become difficult to digest. You may eat
the consistency of applesauce cooked meat, fish or chicken cold
before swallowing. This at another meal.
will help you to eat
slowly and to stop
eating when you
are satisfied. You’ll
31Here’s a sample menu for your Soft Foods diet with your vitamin, mineral and protein supplements:
Protein Fluid
Soft Foods
(grams) (ounces)
1 ounce mozzarella cheese (Ex.: string cheese, 6 grams fat/ounce
7
7:30 a.m. or less)
Calcium citrate with vitamin D
8:30 a.m. 8 ounces of water 8
9:30 a.m. Protein supplement with 8 ounces nonfat/1%/soy milk 26 to 29 8
10:30 a.m. 12 ounces of water 12
1 ounce (2 tablespoons) tuna mixed with 1 tablespoon cottage cheese 7
1 to 2 tablespoons (1/2 to 1 ounce) canned peaches (light syrup/no 2
Noon
sugar added)
One bariatric chewable multivitamin
Post-Surgery Plan
1 p.m. 8 ounces unsweetened decaf iced tea 8
Mid- 2 tablespoons ricotta cheese on 2-4 whole grain crackers OR ¼
5
afternoon banana
1 ounce chicken tenderloin, no skin 7
5:30 p.m. 2 tablespoons of cooked carrots
Calcium citrate with vitamin D
6:30 p.m. 8 ounces nonfat/1%/soy milk 6 to 9 8
8 p.m. 8 ounces Lifeway Kefir 11 8
71 to 77 52
TOTAL grams ounces
32If you have diabetes, check your blood glucose 3. Supplements: You may now swallow your
regularly as directed by your primary care provider. medications and supplements. Although you no
If your blood glucose is low (≤70 mg/dL) and you’re longer need to take them in crushed, chewable or
still taking diabetes medication, contact the doctor liquid form, you may continue to do so if you prefer.
who prescribed your diabetes medication to see if it No gummy vitamins or gummy calcium.
can be adjusted. • One bariatric multivitamin daily.
• You need 1200 mg calcium citrate and 800 IU
Other responsibilities
vitamin D daily in addition to what’s in your
1. Complete a Food and Activity Journal daily
multivitamin and foods you eat and drink.
(download at salemhealth.org/bariatric — Click
See the “supplement facts” label on your
FAQ/Ask a Question — then click Questionnaires
supplement packaging for proper dosages.
and Forms on the left) — OR bring your own food
This is usually 2 tablets of calcium citrate twice a
record in a phone app or personal notebook — to
day or one calcium citrate chewable/lozenge two
ensure sure you are getting at least 60 grams of
times per day. Most chewables in the store are not
protein and 48 to 64 ounces of liquid. No more
calcium citrate. No gummy calcium.
Post-Surgery Plan
than 128 ounces of liquid daily.
4. Do your lab tests the week before your next
2. Physical activity 5 to 6 days per week, 20 to 30
appointment (6 weeks post-op appointment).
minutes daily. (For example: it’s OK to break this
up into 10 to 15 minutes, twice a day.) 5. Never smoke, vape, drink wine, beer, or mixed
drinks. Avoid exposure to heavy smokers.
33Week 6 and beyond: Regular texture foods
Starting __________________ you may add high This diet is very similar to “My Meal Plan” before
fiber foods such as fresh fruits and raw vegetables your surgery (check the sample menu you wrote at
and high fiber (whole grain) breads and cereals to that time). The difference is the amount of food you
your diet. eat at one time now will be less than before your
• Review the Grocery List for suggestions of what to surgery and your beverages are between meals only.
buy at the supermarket. You may season food with herbs, spices, garlic
• You may drink up to the time you eat and resume powder, onion powder, tabasco (if tolerated),
drinking allowed/recommended ground pepper, salt, Mrs. Dash, lemon or
beverages 30 minutes after you lime juice.
finish eating.
Allow 20 to 30 minutes for a
• If a straw helps you drink meal, 10 to 15 minutes for a
more liquid, drink slowly. snack so there is “downtime”
If using a straw gives you for your metabolism to
gas, stop using a straw. digest, absorb, and process
Post-Surgery Plan
• Continue logging meals/ nutrients.
snacks in a food record.
Keep your nutrition guidelines
Note which foods are well
card provided in your wallet for
tolerated or made you feel ill.
easy reference when shopping.
Try no more than one new food per day; Using the Food groups section (starting
add another food to another meal the next day and on page 10) as your guide, here are some
so on. additional tips for foods you may now choose:
• Eat slowly (20 to 30 minutes for a meal, 10 to 15
minutes for a snack) and eat at the table only. Eat
Lean meat/protein
at specified times (grazing and missing meals (Less than 6 grams fat per ounce)
will affect your long-term health and weight loss). • Eat these first at each meal or snack.
Record meal and snack times in your food record.
• The fewer legs the better! Fish is leaner than
• Take small, thumbnail-sized bites of food and chicken, which is leaner than beef, pork, or lamb.
chew well. Your food should have the consistency Lean cuts of beef include round, flat iron, flank,
of applesauce before swallowing. This will help sirloin, and tenderloin.
you to eat slowly and to stop eating when you are
• Lean pork or lamb includes tenderloin, loin chops
satisfied.
and leg.
• Stop eating before you are full. The size of the
• The leanest poultry is white meat from the breast
opening of your stomach is about the same as a
with no skin.
straw.
• Your mouth now has to do what your stomach did
before surgery: grind food. Before swallowing,
your food should feel like applesauce.
34• Ground poultry can have as much or more fat
Do not eat:
as ground beef because it may include dark meat
and skin. • Breaded and/or fried meat, fish or poultry
• Choose ground breast of turkey or ground chicken • Hard to chew meats such as jerky;
breast, not just ground turkey or ground chicken. • Sausage of any kind
Ask your dietitian for tips for healthy cooking for
• Bacon or turkey bacon
ways to cook lean protein.
• Cold cuts such as bologna and salami (turkey and
Frozen meals/dinners ham are OK)
Choose ones that have 6 grams fat or less and 300 • Hot dogs, including chicken or turkey dogs
calories or less for the whole meal. Ones that are • Ribs of any kind
mostly protein and low-calorie vegetables are best.
• Ribeye, strip or T-bone steaks
• Dark meat from poultry
• Meat or fish in oil, cream or butter sauce
Post-Surgery Plan
• Regular cheese (more than 6 grams fat per
ounce).
Vegetables
(1 serving = ¼ to ½ cup cooked or ½ cup of
vegetable juice)
• Eat 3 or more servings/day (e.g. use raw
vegetables to dip in salsa).
• Use no more than one serving of fat (see page 13)
At this point you will only be able to eat about 1/3
for green salads (e.g. one tablespoon regular
of the frozen meal. Also, look in the freezer section
salad dressing or 2 tablespoons of light dressing).
for Morningstar brand soy substitutes for chicken,
ground meat and sausage links. • If you dip your empty fork into your dressing first,
it will last to the last bite (with some left over!).
If chicken or turkey is too dry, moisten with a small
amount of broth. Do not reheat cooked meats, Do not eat breaded or deep fried vegetables.
especially chicken. They dry out in the refrigerator
and reheating, even in a microwave, makes it Carbohydrates
difficult to digest. You may eat cooked meat, fish or
chicken cold (e.g. on a green salad) at another meal. Fruit
1 serving is about ¼ to ½ cup of canned fruit (in
1 serving of protein = 1 ounce; your goal
juice or light syrup) or half a piece of fresh fruit.
eventually is to eat 8 to 10 servings per day.
• Eat no more than two servings per day.
35• Limit fruit juices to one 4-ounce serving per day
Do not eat:
diluted with 4 ounces of water; this will count as
one of your fruit servings. • Fried foods
• Tater tots
Do not eat:
• Pastries such as doughnuts or Danish
• Fruit canned in heavy syrup
• Most store-bought muffins chips, cake, cookies,
• Juice drinks (less than 100% juice)
ice cream or pie.
• More than 8 ounces per day of half strength,
diluted 100% fruit juice
Fats
Dairy • No more than one serving of fat per meal; no
more than 3 servings of fat per day.
1 serving is equal to 1 cup nonfat or 1% milk, 1 cup
nonfat lactose-free milk or 1 cup soy milk; 5.3 to • Do not “double up” on fats (e.g. using no dressing
6 ounces of yogurt (about 100 calories or less for on salad at lunch doesn’t mean you can have two
either Swiss or Greek). servings of fat at dinner).
Post-Surgery Plan
• A 4-ounce carton of yogurt should • Low fat options are less than 5g of
have no more than 70 calories. total fat per serving.
• Eat no more than 2 servings
per day.
General food tips
Use this “honeymoon” the
Do not eat: first year after surgery to
develop eating habits and
• Whole milk
physical activity that will
• 2% milk
promote health and maximize
• Other yogurts (e.g. more than your weight loss.
100 calories per carton)
Your goal is 60 to 80 grams of protein
daily and 48 to 64 ounces of liquid daily.
Grains/Starchy vegetables
1 serving equals ¼ to ½ cup mashed (white or • No more than 128 ounces of liquid daily.
sweet) potato; one two-ounce baked potato (with • The best way to know you are getting enough
skin), ¼ to ½ cup of hot cereal; 1 slice of whole liquid is if your urine is straw-colored. If it’s the
wheat toast (bread usually not tolerated). color of apple juice, you need more liquid (even if
• You may eat up to 2 to 3 servings per day (one you’re drinking 64 ounces).
per meal) after you’ve eaten enough protein, • Measure/weigh your food. Eat on smaller dishes
vegetables and fruit. with baby or toddler sized utensils.
• It may be a few more months before you can eat • Record your intakes.
foods from this group regularly.
36While each person will tolerate different foods
differently, here are some foods that are typically not
well tolerated initially:
▸ Celery and other stringy foods
▸ Membranes of oranges and grapefruit
▸ Bread (toast OK)
▸ Soft, doughy foods such as white rice, white
bread, and white pasta are usually not
tolerated, even long after surgery. Try brown Soft, doughy foods such as white rice, white bread
rice and other whole grains such as bulgur, and white pasta are usually not tolerated, even
whole grain bread and whole wheat pasta. long after surgery. Try brown rice and other whole
▸ Skins and seeds of some fruits and vegetables grains such as bulgur, whole grain bread and
(small seeds as in strawberries are usually OK). whole wheat pasta.
Post-Surgery Plan
Here is a sample menu for your regular texture diet including Bariatric supplements:
Protein Fluid
Regular Texture Diet Menu
(grams) (ounces)
1/2 cup old fashioned oats made with 8 ounces of nonfat/1%/soy milk 8
1 tablespoon of raisins
Calcium citrate with vitamin D 500 mg
12 ounces of water 12
Protein supplement with 8 ounces nonfat/1%/soy milk 26 to 29 8
1 to 2 ounces of grilled chicken on green salad with 1 to 2 teaspoons of low-fat 7 to 14
vinaigrette dressing
One bariatric multivitamin
16 ounces of infused water 16
1/2 cup of Greek yogurt
6
1/4 cup of melon
8 ounces nonfat/soy/1% milk with no-sugar-added cocoa 8 8
1 to 2 ounces of baked sole or other whitefish 7 to 14
¼ to ½ cup of carrots
Calcium citrate with vitamin D
8 ounces of Lifeway Kefir 11 8
72 to 79 53
TOTAL grams ounces
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