Bariatric Surgery & Comprehensive Obesity Management Program

It is helpful to start practicing habits before surgery to make sure you’re confident with the nutrition guidelines. Here are some nutrition basics for when you’re ready to start:

• Eat 3 meals per day (have 1-2 snacks if needed)
  • Eating 3 meals can help stabilize your blood sugar and will allow you to meet your protein goals. Avoid skipping meals or eating too late at night.
• Have protein in every meal
• Eliminate sugary beverages (even 100% fruit juice or unsweetened fruit juice has almost as much sugar as soda)
• Start limiting high carbohydrate (starches)/high sugar/processed/fried foods such as chips, cookies, cakes, candy, ice cream, pizza, French fries, rice, breads, cereals, pasta

Practice eating meals without consuming liquids.

• You can drink right up to your meal, but during and a half hour after, allow your food to digest. You’ll have such a small stomach, that you’ll want to fit the protein in and allow for proper digestion.
• This can be a difficult habit to break so it is best to start this now.

Practice drinking at least 64 oz (2 liters) of fluid each day.

• Be sure all beverages are sugar-free, and contain less than 5 grams of carbohydrates (1 gm of sugar or less)

Reduce/avoid consumption of caffeine and carbonated beverages.

• The acid from caffeine can erode the lining of the stomach, causing ulcers. Caffeine is also a natural diuretic and can cause dehydration after surgery. You can reintroduce caffeine in moderate amounts after 1 month post op.
• Carbonated beverages introduce air into the stomach, causing gas. We do not recommend reintroducing these drinks, indefinitely.

Eat slowly

• Eating slowly can increase your awareness for when you become full and can prevent overeating. You will need to eat slowly after surgery to avoid vomiting. It should take you at least 30 minutes to eat a meal. Stop eating when you feel full. Practice chewing each bite 25+ times; you will need to do this after surgery.

Call the front desk at 443-849-3779 to make an appointment any time!

A diet high in carbohydrates can cause inflammation or enlargement of the liver. Since the liver overlays the stomach, it must be lifted in order for the surgeon to perform surgery on the stomach. The larger the liver, the more difficult it is to maneuver. By following a low carbohydrate/starch free diet, the liver can “shrink” in size, allowing for an easier and safer procedure. Starchy foods (to be removed) include corn, potatoes, peas, cereal, bread, grains (rice, oats, quinoa, etc.), pasta, popcorn, and tortillas. Fruit and dairy are permitted during the 3 week period before surgery.

(Clear liquid diet should be followed 48 hours before surgery.) Any liquid that you can see through is permitted in the clear liquid diet, including water, sugar-free drinks (PowerAde Zero, Propel Zero, Vitamin Water Zero, Crystal Light, etc.), Isopure Zero Carb Protein drink, Designer Whey 2Go Protein Water, Special K Protein Water, herbal tea, broth, sugar-free popsicles (red is acceptable), and sugar-free gelatin (red is acceptable).

Since your stomach will be significantly smaller after surgery, it is important to utilize the small space as best as possible, to consume your daily protein recommendations. Adding fluid to a stomach full of food following surgery, is similar to pouring water into a clogged drain; vomiting may occur. Fluid causes food to expand in the stomach, which can cause discomfort, nausea, and vomiting. Drinking with meals can also cause the food to empty from the stomach faster. The faster the food we consume leaves our stomach, the longer it takes us to feel full, which often leads to overconsumption. It is recommended to drink up to your meal, but to avoid drinking during and 30 minutes after your meal.

After surgery, you should consume at least 64oz. of fluid every day. You will not be able to drink a lot at once with your new stomach. It is best to sip constantly throughout the day at a rate of 4-8oz. per hour. Initially after surgery, you will be given 1 oz medicine cups full of water every 10 mins. It will take about 11 hours to consume 64 oz of fluid 1 oz every 10 mins = 3 oz every 30 minutes = 6 oz every hour. 

Nearly all body processes depend on water for proper functioning. Drinking plenty of fluids can help prevent constipation.

Everyone has a range of 70-100gm of protein per day. You should consume 20-30gm at each meal (as we only absorb up to 30gm of protein at a time – therefore, protein needs to be spaced out during the day). It is very important to meet your daily protein requirements. It is okay to consume slightly more than the daily required amount.

Protein is crucial for the healing process after surgery. The body uses protein to repair and rebuild tissue. Protein is also important to maintain lean muscle mass. Lean muscle mass helps increase metabolism, which helps our bodies utilize calories more efficiently. Meeting your daily protein requirements can also help reduce hair loss after surgery and help with regrowth. High protein foods such as lean meats and fish, eggs, and low-fat dairy products are the best source. Protein powders can be used to supplement your diet and help you reach your daily protein requirements.

Be sure to choose a product with “Whey isolate” or “whey protein isolate” as the first ingredient. Whey isolate is a “complete” form of protein, which means it contains all 9 essential amino acids. These amino acids are considered essential since they cannot be made by the body, therefore; we must obtain them through our diet. Soy protein and pea protein isolate are considered “incomplete” proteins, meaning they are missing one or more essential amino acid. One way to think of this rule is whey protein is derived from milk, which is an animal product. Animal products contain all essential amino acids, while plant sources do not.

• 200 calories/serving
• 15-30gm protein
• < 4gm of saturated fat
• < 5mg of sugar

You can find whey protein isolate powder at GNC, Wal-Mart, Walgreens, CVS pharmacy, and Amazon. It is highly recommended to sample different products, when possible, before committing to one product.

You will need to take a multivitamin for the rest of your life to prevent deficiencies. You will be required to take 2 multivitamins each day, in addition to 1500mg total of calcium citrate and 1000 IU total of vitamin D. Be sure that the multivitamin you select contains thiamin, 400mcg folic acid, and 18mg iron. 

Risk of iron deficiency is most common in pre-menopausal women but others can be at risk as well due to poor intake and impaired absorption. Make sure to get a total of 36mg of iron daily from your multivitamin or a separate iron supplement. 

Vitamin D can be a common deficiency after surgery. Make sure you are getting at least 1000 IU of vitamin D from your calcium supplement. If not, take an additional vitamin D supplement to total 1000 IUs. 

Thiamin (also known as B1) stores in your body deplete in 2-3 weeks. Severe deficiency can cause nausea and vomiting. Check your multivitamin to make sure it has thiamine. 

The best multivitamins available are bariatric multitvitamins as they more closely meet your needs after surgery. 

You will also need to have at least yearly lab checks. Insurance almost never pays for vitamin and mineral supplements but usually does pay for labs.

Hair loss may occur a few months after surgery. It usually improves after a few months. To help reduce hair loss and facilitate regrowth:

• Eat enough protein
• Take your supplements
• Add 2-5mg of biotin or take a specialty hair supplement like Biosil
• Add fish oil supplements

For information regarding special shampoos, please visit nicehair.org.

Food intolerances: 
After surgery, some food can be uncomfortable to eat (particularly those that are dry, sticky, gummy, or stringy). Each individual responds differently to particular foods and most people discover which foods are best tolerated by trial and error. 

Some patients may develop food intolerances after surgery. Although some intolerances are permanent, most resolve with time. If you have a bad reaction, try that food again in a few weeks. Possible intolerances include: 

Meats: 
Try moist cooking methods such as boiling, pressure cooking, or using a slow cooker.

• Red meat
• Pork
• Poultry (if dry)
• Shellfish

Vegetables:

• Raw vegetables
• Cooked vegetables with tough skins
• Stringy vegetables (celery, asparagus)
• Gaseous vegetables (broccoli, cauliflower, cabbage, Brussels sprouts).

Milk/Dairy: 
If you become lactose intolerant, try:

• Lactaid milk
• Dairy Ease
• Calcium-fortified unsweetened soymilk
• Unsweetened almond milk
• Fairlife milk

Fruit:

• Fruit with tough skin
• Hard fruit
• Citrus fruit

Bread (which you should avoid regardless):

• Dense bread
• Bagels
• Pasta
• Biscuits

Other Food:

• Chili or spicy food
• Fried or high fat food
• Sweets or sugary food

Dumping syndrome: 
Dumping syndrome occurs when foods containing sugar or excessive amounts of salt are consumed. Sugary or salty foods draw excess water into the intestines. Symptoms include:

• Nausea
• Cramping
• Diarrhea
• Sweating
• Increased heart rate
• Low blood pressure
• Low blood sugar
• Vomiting

Most patients are instructed to eat 1/4 cup, or 2 ounces, of food at each meal. As time goes on, you can eat more as tolerated (as instructed by your medical team). Most people can eat approximately 1 cup of food after a year or more following surgery.

The guidelines are designed to improve the chance of long-term success in weight loss. You may also experience complications such as vomiting, diarrhea, dehydration, malnutrition or deficiencies after surgery. Furthermore, you will not see the weight loss progress you desire.