Weight Loss Surgery Care Guide
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Weight Loss Surgery
Care Guide
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Table of Contents
Resources 3
Contact Information 3
Appointment Tracking 5
What to Expect on Surgery Day 7
Choosing Bariatric Surgery 10
Building Lifestyle Change 15
Nutrition 18
Meal Plan Progression 20
Liver Shrinking Diet 21
Enhanced Recovery After Surgery (ERAS) 22
Day of Surgery 22
After Surgery 23
Eating Progression 24
Stage 1 25
Stage 2 meal plan 27
Stage 3 meal plan 29
Stage 4 meal plan 31
Stage 5 meal plan 33
Stage 6 meal plan 35
Post-op week 6 and Beyond - Continued Guidance 37
Vitamins and Minerals 39
Protein Supplements 43
Portion Size Guidelines 46
Bariatric Meal Planning 47
Reading the Nutrition Facts Label 48
Identifying Hidden Sugars 49
Label Lingo 50
Food Quality 51
Mindful Eating 53
Hunger Fullness Scale 54
Making Smart Choices When Dining Out 55
Keeping a Food Journal 57
Optimizing Meal Duration 59
Keeping Liquids Separated from Meals 60
Nutrition Goal Worksheet 61
Setting Good Goals 63
Guidance Beyond Nutrition 66
Weight Loss Expectations 68
Medications 69
Physical Activity 71
Sleep 73
Common Concerns After Surgery 74
Dehydration 75
Dumping Syndrome 76
Constipation 77
Addressing Unhealthy Behaviors 79
Building Wellness through Self Awareness 80
Strategies for Lifelong Success 81
Learning More 82
2020 Bariatric Support Group Meetings 83
Updated November 11, 2020
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Resources
Contact Information
For medical medical concerns, contact:
Saint Joseph Weight Loss Center at Downtown Surgery Specialists
1960 Ogden Street, Suite 550
Denver, CO 80218
Phone 303-318-3240
Fax 303-812-6859
SaintJosephDenverWeightLoss.org
Office hours: 8:00 A.M. to 4:30 P.M.
If you have a question or concern outside of normal office hours that cannot wait until the office reopens,
call and follow the instructions to have an on-call surgeon return your call. For emergencies call 911 or go
to the Saint Joseph Hospital Emergency Room
Surgeons
Dr. Amir Heydari Dr. John Raheb
Dr. Emily Speer Dr. Jason Johnson
Nurse Coordinator
Lisa Swendener, Bariatric Program Coordinator 303-318-3240
Lisa.Swendener@sclhealth.org
Dietitians 303-812-6869
Kaylan Crowther, Registered Dietitian Nutritionist Kaylan.Crowther@sclhealth.org
Kelly Elliot, Registered Dietitian Nutritionist Kelly.Elliot@sclhealth.org
Support Group
Call 303-318-3240 for dates
Second Tuesday of every month 6:00-7:30 p.m. at Midtown Medical Office, Suite 595
Third Tuesday of every month 4:30-6:00 p.m. at Good Samaritan Medical Center, Conference room A
Billing and Financial Information:
Carmen Hochhausen, Billing and Financial Counselor 303-812-6863
Carmen.Hochhausen@sclhealth.org
Saint Joseph Hospital Financial Counseling 303-812-2655 or
303-812-3478
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Congratulations! This is the next step on your journey towards better health! This care guide was designed by your weight loss surgery team. Your surgeon, nurses, dietitians, and coordinators are here to assist in your success. They will help you prepare mentally and physically for weight loss surgery. Weight loss surgery is a powerful tool that has helped hundreds of thousands of people lose weight, but it is just that: a tool that you will need to learn to properly yield for lasting results. As you begin your journey, start making a list of questions you have about lifestyle, eating, and activity changes that happen after surgery. Begin to identify your support network for making these changes. Who are your allies in health? Find friends, family, or co-workers who support you in making the decisions necessary for your health. Explore what led up to being overweight and the habits that cause you to overeat. When you begin to unravel this history, it can help you to move forward. We are so excited to be a part of this life-changing opportunity! Just remember, learning to make healthy habits are the key to permanent success. Sincerely, Your Weight Loss Surgery Team at Saint Joseph Weight Loss Center at Downtown Surgery Specialists 4
Appointment Tracking
Visit Type Date
Initial Visit
Behavioral Health Assessment
Pre-operative Nutrition class - Units 1&2
Pre-operative Nutrition class - Units 3&4
Surgeon Consultation
Primary Care Preoperative exam
Surgery Preparation Class
Surgery Date
Post-operative 1-2 Week Follow-up
Post-operative 6 Week Follow-up (Dietitian)
Post-operative 4 Month Follow-up
Post-operative 6 Month Follow-up
Post-operative 9 Month Follow-up
Post-operative 1 Year Follow-up
After 1 year, plan to visit annually after surgery
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What to Expect on Surgery Day
What should I bring on my surgery day?
● Insurance card
● Photo identification
● A form of payment for your post-operative prescriptions
● Wear something loose-fitting and comfortable
● Glasses
● Hearing aids
● Dentures
● Toiletries
● Bi-Pap machine
● Leave any valuables at home
○ Do not wear or bring jewelry or piercings
○ Please remove nail polish or any artificial nails
How do I check-in on my surgery day?
There is free valet parking available at the main entrance of Saint Joseph Hospital – 1375 E 19th Avenue
Denver, CO 80218. Please check-in on the second floor at your scheduled time, typically two hours prior
to surgery.
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Who will I see before my surgery? A team of nurses and doctors will help in your care at the hospital prior to your surgery. You will meet your anesthesiologist to discuss any concerns you have. It is a good idea to prepare a written list of questions, because it is easy to forget if you feel nervous. Your surgeon will also meet with you before surgery. How long does surgery take? Surgery varies for each patient, procedure, and surgeon. Once you have left the preoperative area, your family can expect to wait about two to four hours before being able to visit with you again. How long will I be in the hospital? Although the length of time varies for each patient and procedure, after laparoscopic surgery, most patients stay only one night. If you need more care, this would lengthen your stay. Should I bring my home medications? No. Unless you have been specifically instructed otherwise, you can leave your home medicines at home. 8
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Choosing Bariatric Surgery Bariatric Surgery Bariatric Surgery encompasses a few different surgical procedures. The three surgeries that are performed at Saint Joseph are Gastric Bypass (Roux-en-Y), Laparoscopic Sleeve Gastrectomy, and Laparoscopic Adjustable Gastric band (Lap Band). Your coverage may allow all of these options, however. Roux‐en‐Y Gastric Bypass Surgery (RYGB) The most commonly performed procedure in the United States, Gastric Bypass has existed in various forms for more than 30 years and has the strongest evidence for long term results. In this open or laparoscopic procedure, a two-tablespoon sized pouch is created from the stomach by dividing the stomach with surgical staples. Part of the small intestine, the jejunum, is attached to the small pouch with a half-inch-sized surgical connection called an anastomosis. This section of the intestine is called the roux limb. The remaining portion of the stomach is bypassed by food and the remaining part of the intestine are linked back to the roux limb, forming a ‘Y’. The small pouch does stretch over time. Most of the weight loss is obtained in the first two years. 10
How Food is Digested After Surgery After surgery, food travels from the mouth, down the throat and into the small pouch that was created, through the anastomosis, into the upper small intestine. Prior to surgery, the stomach worked to grind up foods. The newly created stomach pouch cannot work in this same way, and so thorough chewing is crucial to avoid pain or malabsorption. At the junction of the Y, digestive enzymes from the remainder of the stomach, pancreas, and liver empty into the roux limb. This helps with absorption and prevents symptoms like diarrhea, gas, and discomfort. How Gastric Bypass Surgery Helps You Lose Weight This surgery is both malabsorptive and restrictive. When food stretches the stomach pouch walls, messages of fullness or satiety are sent to the brain. After surgery, a much smaller amount of food is needed to stretch the pouch walls to send the signal of fullness to the brain. After a while, your brain signals to your body to eat smaller amounts of food to feel satisfied. If you eat a larger amount of food, you will feel stuffed, nauseous; you may vomit and even feel pain. This sudden limitation of how much volume you can eat will allow you to learn to make better choices and choose more nourishing, higher quality foods rather than foods that simply fill you up. Our team of dietitians will help you to learn these skills. Gastric bypass also affects hormones produced by the stomach and intestine. One hormone affected is ghrelin, sometimes called the hunger hormone. Ghrelin sends messages of hunger to the brain, increases absorption of calories, and promotes fat storage. The amount of ghrelin produced is greatly reduced after surgery causing a decrease in appetite. Another effect of surgery is a condition called dumping. Before surgery, high-fat and high-sugar processed foods are diluted and begin to be digested in the stomach. The stomach controls the release of this partially digested food into the intestine so not too much is emptied into the intestine at once. After surgery, the valve in the stomach that controls this release is bypassed. This means high-fat or high-sugar foods enter the intestine undiluted at a much faster rate. When this happens, water permeates the intestinal walls to try to dilute these foods. This can cause diarrhea, weakness, sweating, shakiness, sleepiness, and/or a racing heart. This discomfort serves as a strong reinforcement to avoid highly processed foods. Results of Roux‐en‐Y Gastric Bypass Surgery Although weight loss is the most notable change after surgery, improved health is the truest measure of success. As weight is lost, improvements in diabetes, hypertension, hyperlipidemia, gastric reflux, arthritis, and sleep apnea occur. The surgery serves as a powerful tool to promote change in eating and exercise regimens. Many patients can discontinue or decrease the medications they need for these conditions, sometimes even before discharge. 11
Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Laparoscopic sleeve gastrectomy as a weight loss surgery is newer than the Roux-en-Y Gastric Bypass. Over the past ten years, it has proven to be an effective bariatric procedure. In this procedure, surgical staplers are used to cut and seal off a large section of the stomach to create a smaller, tubular stomach. The remaining tube is less flexible and cannot hold as much food as the pre-surgical stomach. Unlike the gastric bypass surgery, the intestines are not altered. How Food is Digested After Surgery After LSG surgery, food travels from the mouth, down the throat and through the smaller, tubular stomach. The smaller curvature of the stomach is less stretchy than the removed part of the stomach and holds less food. The food travels out the bottom of the stomach and continues through to the small intestines as it did before the surgery. 12
How Laparoscopic Sleeve Gastrectomy Helps You Lose Weight This surgery is purely restrictive. In LSG, about 75% of the stomach is removed, causing restriction. This causes earlier satiety when eating. After a while, your brain signals to your body to eat smaller amounts of food to feel satisfied. If you eat more food than your stomach can hold, you will feel overly full, ill, and discomfort. This limitation of volume will allow you to learn to choose healthier foods, instead of less nourishing foods that simply fill you up. Dietitians are available to help you to learn what sorts of foods to eat. Sleeve gastrectomy also reduces the production of the intestinal hormone Ghrelin. Ghrelin is sometimes known as the hunger hormone, and this decreases appetite. Results of LSG Surgery The tubular stomach created in LSG cannot hold a large volume, and so food is released more quickly into the intestine. Improvements in health related to diabetes, sleep apnea, hypertension, and arthritis are found with weight loss after LSG. Acid reflux may worsen after LSG due to the decreased volume the stomach can hold. 13
Gastric Banding (Lap Band) Laparoscopic Adjustable Gastric Banding (LAGB) or the Lap Band procedure is also newer than the roux-en-Y gastric bypass, but also has proven to be an effective bariatric procedure. In this procedure, a hollow band is placed around the stomach around its upper end, creating a smaller stomach pouch. The band is attached to a tube that is connected to a port, which allows access to the band. The band can be filled with saline to tighten the tube around the stomach. This makes the stomach pouch smaller. No parts of the intestine are altered in this procedure. How Food is Digested After Surgery After LAGB, food travels from the mouth, down the throat and to the small section of the restricted stomach. The food is then slowly released through the remainder of the stomach and out the bottom of the stomach and continues through to the small intestine as it did before the surgery. How Gastric Banding Helps You Lose Weight In LAGB, the band causes restriction as its means of causing weight loss. This causes earlier satisfaction when eating. With time, your body receives messages from your brain to eat smaller portions to feel full. If you eat too much food, you will feel too full, unwell, and uncomfortable. The abrupt decrease in volume you can comfortably eat will encourage you to opt for higher quality foods in smaller volumes. The dietitian can help you identify these quality foods. Results of Gastric Banding The small banded section of the stomach can only hold a very small volume, and food is released very slowly into the remainder of the stomach. After surgery, there are improvements in diabetes, sleep apnea, hypertension, hyperlipidemia, and GERD. 14
Building Lifestyle Change
Obesity is a chronic disease that requires ongoing effort and permanent lifestyle changes. Weight loss
surgery is not a cure nor is it to be considered a “one and done” approach to treating obesity. It is a tool to
help you achieve a healthier weight and lifestyle.
In order to have a successful long‐term outcome, it is necessary to make a number of permanent lifestyle
changes. You will need to change your eating habits, behaviors, mindset, stress management strategies,
and physical activity. While the nutrition plan is one of the most important parts of this journey, it is
not the only component to success. Establishing healthy self‐care habits is the key. Weight loss and
optimal health is more than diet and exercise; it is an accumulation of habits that are integrated into your
daily life.
Recovering
Regardless of which procedure you are having, it is recommended that you take two to four weeks off
work for recovery. This allows adequate time to physically recover, adjust to new eating patterns, build up
your exercise routine, and adjust to a pattern of selfcare. Take the time to heal and recover without the
stress of work. The office can help you complete FMLA forms, time-off request forms, time-off letters, and
return-to-work requests. Please provide the documents in a timely manner, as it can take some time to
process these forms.
Create a Support Network
● The length of stay after surgery varies for each patient and procedure, but most patients only stay
one night after laparoscopic surgery.
● In the unlikely case your surgery is converted to an open Roux‐en‐Y (RYGB), you should expect
to stay three to four nights in the hospital.
● You will need someone to drive you home on the day of discharge.
● You should plan to have someone help for one to two weeks after surgery with:
○ Care of your home
○ Care of your children and/or pets
○ Grocery shopping
○ Meal preparation
○ Transportation
● If you cannot identify someone who can help you, ask to speak with the social worker from your
primary care clinic. They may be able to recommend resources.
15Changing the Way You Eat Before Surgery
● Start making small lifestyle changes now in preparation for the surgery. The sooner you start, the
more prepared you will feel for the surgery, recovery, and for the rest of your life.
● Before surgery, you will need to eat a specific way to shrink your liver. This makes the surgery
safer and lowers the chance of needing to convert to an open operation. It also gets you to
identify some of the challenges you may need to overcome to be successful after surgery.
● Remove food that will be inappropriate after surgery from your home and go shopping prior to
your surgery for the foods you will need after surgery.
● Practice new eating behaviors before your surgery. Eating slowly and chewing your food well,
reducing portion sizes, and stopping when you first feel full are the only ways you will be able to
eat without causing problems following surgery.
● Start a food journal. This will be expected following surgery, so start this habit before surgery. See
your binder for guidelines on choosing a good food journal.
● Purchase a set of measuring cups and measuring spoons, a food scale, smaller plates and
utensils to assist in tracking food portions.
● You will begin with drinking sugar-free clear liquids in the hospital, full liquids once you are home,
soft/puree diet at about 2‐3 weeks post op. You may want a blender or food processor to help you
prepare foods to the proper consistency.
● Certain things will change once you have surgery; such as separating fluids from meals (avoid
drinking 15 minutes before and 60 minutes after meals), but the fundamentals are the same:
healthy habits create a healthy body and life.
Disordered Eating
Many patients with morbid obesity may have one or more eating disorders, which, if not addressed
appropriately can complicate their postoperative safety and success. It is important to consider if you use
food as a way of dealing with stress, anxiety, depression, boredom, or as a coping mechanism. It is then
very important that you identify and use healthier ways of coping, such as exercise, meditation, and/or
support groups.
During the pre-op behavioral assessment, eating disorders or eating behaviors may be revealed and may
require further intervention and treatment prior to surgery.
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Nutrition 18
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Meal Plan Progression
What you are able to eat after surgery will change through different stages. These stages are designed to
provide enough for your body to properly heal and lose weight at the same time. After weight loss
surgery, you must carefully follow the recommendations outlined below in order to maximize your weight
loss success, prevent complications, and prevent weight gain. You may hear of guidelines given to
other patients that are different from yours. It is important to remember that each surgery is
slightly different and individualized to each patient. What is most important is that you adhere
strictly to your surgeon's recommended guidelines. You will need to temporarily supplement your
intake with protein supplements in order to achieve optimal nutrition. Post-operative meal plans are
separated into stages. It is imperative that you follow the progression and adhere to the prescribed
regimen to maximize healing and minimize the risk for complications. Here is a brief overview of the
stages:
For Roux-en-Y Gastric Bypass and Sleeve Gastrectomy
When Stage Description
10 days before surgery Start__/__/__ Liver Shrinking Diet Pre-surgery plan to reduce size of
Until day before surgery End__/__/__ See page 21 liver
ERAS Night before surgery and day of
Day before Surgery On__/__/__
see page 22 surgery preparation
My Surgery Date ___/___/___ See page 22
Post-op days 1 and 2 to
Start__/__/__ Stage 1
one week, depending on Sugar-free clear liquids
End__/__/__ see page 25
surgeon
Post-op day 3 or Post-op
day 7(depending on Start__/__/__ Stage 2
Full liquids; begin supplementation
surgeon) through Post-op End__/__/__ see page 27
day 14
Start__/__/__ Stage 3
Post-op week 3 Pureed meal plan
End__/__/__ see page 29
Start__/__/__ Stage 4
Post-op week 4 Soft and moist meal plan
End__/__/__ see page 31
Start__/__/__ Stage 5 Soft and moist with cooked
Post-op week 5
End__/__/__ see page 33 vegetables and/or fruit
Post-op week 6 Stage 6 Healthy solid food meal plan
Start__/__/__
and beyond see page 35 with supplementation
20Liver Shrinking Diet
(Pre-Surgery Diet)
When
10 days before surgery Start __/__/_
Until day before surgery Until the day before surgery
Before surgery, a liquid meal plan is needed for 10 days to help shrink the liver. This helps the surgeon
move the liver out of the way during the surgery, which can reduce your time under anesthesia and
reduce the risk of complications.
Meal Menu Notes
One high protein drink*
* See page 43
200 calories or less;
Breakfast for list of protein
15 grams protein or more
drinks
5 grams sugar or less
AND
One small piece of
fresh fruit
One high protein drink*
(tennis ball sized) * See page 43
200 calories or less;
Lunch OR for list of protein
15 grams protein or more
2 cups of raw or cooked drinks
5 grams sugar or less
non-starchy vegetables
(no potato, no corn,
no peas, no beans)
6 oz yogurt
(less than 100 calories)
Afternoon snack OR This snack is
(Optional) ½ cup cottage cheese optional
OR
2 ounces lean protein (see Dinner for examples)
AND
4 ounces protein
2-4 cups of raw or cooked
Lean turkey, chicken breast,
Dinner non-starchy vegetables
pork, roast beef, fish - baked,
(no potato, no corn,
grilled, or broiled
no peas, no beans)
Evening snack 1-2 cups of raw or cooked non-starchy vegetables This snack is
(Optional) (no potato, no corn, no peas, no beans) optional
*See page 43 for a list of protein drinks
Liquids Drink at least 64 ounces (8 cups) of sugar-free liquids throughout the day to prevent dehydration.
See page 25 for more examples of these liquids. You will not be receiving any caffeinated beverages in
the hospital. You may want to wean from caffeine before surgery. If you choose to add coffee after
surgery, do not use sugar or creamer. Consider adding a few drops of vanilla extract or cinnamon to your
coffee for flavor.
Avoid processed foods such as gravy, BBQ sauce, cheese, salad dressing, mayonnaise, ketchup,
teriyaki, and peanut butter. Avoid fried or breaded foods.
21Enhanced Recovery After Surgery (ERAS)
(Pre-op clear liquids)
When
On __/__/_
1 day before surgery
(the day before surgery)
This clear liquid meal plan is designed to help your body be ready for surgery and recover quickly
afterwards.
The night before surgery, drink 12 ounces of filtered apple juice or Gatorade® G2, unless you are
diabetic.
● This is part of your ERAS or Enhanced Recovery After Surgery program
● Your pre-operative nurse may ask you if you have completed this program
● If you are diabetic, drink Gatorade® G2 or water and follow any special insulin dosing instructions
given to you
Day of Surgery
(Surgery prep)
When
Day of surgery On __/__/_
The day of surgery, drink 12 ounces of filtered apple juice or Gatorade® G2, unless you are diabetic..
● You need to finish drinking it four hours prior to surgery
● This is part of your ERAS or Enhanced Recovery After Surgery program
● Your pre-operative nurse may ask you if you have completed this program
● No other food or drink is allowed
● Do not use mints, cough drops, or chew gum
● No tobacco-neither cigarettes or chewing tobacco
● If you are diabetic, drink Gatorade® G2 or water and follow any special insulin dosing instructions
given to you
4-6 hours after surgery, drink clear liquids, sip 1 ounce every 15 minutes. Your team may line up
1-ounce medicine cups to help you.
22After Surgery Here are brief descriptions of the eating progression after surgery. You will need to make changes to your eating patterns. The size of your stomach pouch is small. You may find that only two to three teaspoons of food will fill you up. You may also find that you are able to eat more of one type of food than another. Over time, the swelling will resolve. By nine to twelve months after surgery, it may enlarge to eight ounces or one cup. Long term, the size of your pouch is likely to be eight to twelve ounces or 1 to 1 ½ cups. This will limit the amount of food you can eat at one time. One of the changes patients often comment about is the concept of “wasting food”. After surgery your eyes and head still work the same way they did before. However, because of the new stomach pouch, you will be satisfied with much less. It is critical that you listen to your body’s signals of fullness It is common to see some variation from program to program related to nutrition. Most programs agree that the primary source of nutrition should be protein. Protein drinks can be helpful to fulfill your protein requirements. There are many to choose from. Look for protein drinks that are low calorie and low sugar and taste good. The Registered Dietitians can assist you in finding an appropriate supplement. Avoid foods that contain sugar. Not only will they slow down your weight loss, but they can make you sick. Sugar may cause “dumping syndrome” in patients who have had the gastric bypass procedure. Dumping, in short, is caused by sugars going directly from your stomach pouch into the small intestine. Symptoms vary among patients but may include heart palpitations, nausea, abdominal pain, shakiness, sweating, sleepiness, and/or diarrhea. Dumping lasts about 30 minutes to an hour. See page 76 for more information. To maintain a healthy weight and to prevent weight gain, you must develop and keep healthy eating habits using real food. You will need to be aware of the volume of food you can tolerate at one time and make healthy food choices to ensure maximum nutrition in minimum volume. A remarkable effect of bariatric surgery is the progressive change in attitude towards eating. Exercise must be part of your daily routine. 23
Eating Progression After Gastric Bypass and Vertical Sleeve Gastrectomy Post-op days 1 and 2 to week 1: Stage 1: Post-op sugar-free clear liquid or bariatric clear liquids This consists of foods that are liquid, as well as low sugar or sugar free. This meal plan is low in calories and protein, but is designed to provide hydration and electrolytes. Post-op day 3 to 7 through post-op day 14: Stage 2: Bariatric full Liquid or post-op full liquid This meal plan consists of liquid and semi-liquid foods. The foods allowed are low sugar, and primarily milk based. Protein and micronutrient supplementation begins at this time. Post-op week 3: Stage 3: Pureed This meal plan consists of foods that are naturally smooth in consistency (foods should be the texture of white glue or smoother when it is swallowed) or pureed, or stage 1 or 2 baby foods. Pureed food has no lumps and feels very soft and smooth in the mouth. No solid pieces or parts should be in the food. Low sugar food selection and protein supplementation continue to be important. Post-op week 4: Stage 4: Soft, moist This meal plan consists of foods that can be easily chewed to a smooth texture, but thicker than Stage 3. Meats are ground or minced into pieces no larger than a quarter inch. All pieces are moist, stick together slightly, but can be easily mashed apart with a fork. It includes deli meat and tender flaky fish. Low sugar food selection and protein supplementation continue to be important. Post-op week 5: Stage 5: Soft, moist with cooked vegetables and fruit This meal plan consists of foods that are the same texture as Stage 4, but now includes small amounts of soft, cooked vegetables and some fresh fruit without peels. Protein remains the priority. Post-op week 6: Stage 6: Bariatric Regular meal plan This meal plan consists of whole tender-cooked foods in the beginning and gradually includes all foods.. Tender raw vegetables that are not fibrous are added. Portion control, chewing foods well, low sugar food selection and protein play an important role in continued successful weight loss. 24
Stage 1
(Post-op sugar-free clear liquids or Bariatric Clear Liquids)
When
Post-op days 1 and 2 to one week, Start__/__/__
depending on surgeon End__/__/__
This clear liquid meal plan is designed to help your body stay hydrated. It does not meet all of your needs
for nutrition, and is designed to be temporary only.
Goals for this stage
Throughout the day, you may drink any of the following liquids at any time. Drink at least 64 ounces (8
cups) to prevent dehydration.
Try sipping 1 ounce of liquid every 10-15 minutes. Red versions are okay.
Choose from these liquids
● Water
● Decaffeinated tea without sugar or cream
● Decaffeinated herbal teas
○ Peppermint, Celestial Seasonings™ teas
● Decaffeinated coffee without sugar or cream
● Broth or stock (any flavor)
● Bone broth
● Sugar-free, calorie-free flavored drinks such as:
○ Crystal Light®
○ MIO™ (Caffeine-Free varieties only)
○ Sugar-free Kool-Aid™
○ Vitamin Water™ Zero
○ Propel™ Zero
● Sugar-free popsicles
● Sugar-free Jello™ gelatin
● Isopure™ Zero Carb (this is a clear liquid protein drink, maximum one per day)
● Premier Protein™ Clear Protein Drink (this is a clear liquid protein drink)
● Sugar substitutes/artificial sweeteners are okay at this time
○ Splenda™
○ Equal™
○ Sweet n Low™
○ Stevia™- some stevia sweeteners contain sugar alcohols, which can cause gas, bloating
or dumping syndrome. Choose these in moderation. Avoid liquid Stevia.
● No alcohol - Avoid alcohol until six months post-op
● No carbonated drinks - Avoid carbonation until 3-6 months post-op, you may resume calorie-free
carbonated beverages in small amounts, only if it does not cause pain. It can be uncomfortable
for many individuals.
● No caffeinated drinks - Avoid caffeinated drinks until you are successfully drinking 64 ounces of
non-caffeinated beverages daily on a regular basis.
25Stage 1
(Post-op sugar-free clear liquids or Bariatric Clear Liquids)
Sample Menu
Day 1
Meal Serving Size Food
Breakfast 1 cup Decaf herbal tea- peppermint flavor
¼ cup Sugar-free gelatin
Snack 1 popsicle 1 sugar-free popsicle
1 cup Isopure Zero Carb
Lunch
1 cup Chicken broth
1 cup Decaf herbal tea – hibiscus flavor
Snack
1 popsicle 1 sugar-free popsicle
1 cup Decaf herbal tea – orange and spice flavor
Dinner
1 cup Beef Broth
Snack ½ cup Sugar-free Kool-aid™
Day 2
Meal Serving Size Food
Breakfast 1 cup Decaf coffee
1/2 cup Vegetable broth
Snack 1 cup Premier Protein™ Clear Protein Drink
1 cup Crystal Light®
Lunch
1/4 cup Sugar-free gelatin
Snack 1 cup Vitamin Water™ Zero
1 cup Beef broth
Dinner
1 cup 1 sugar-free popsicle
Snack 1 cup Decaf herbal tea –lemon flavor
26Stage 2 meal plan
(Bariatric full liquid or post-op full liquid)
When
Post-op day 3 or Post-op day 7(depending on Start__/__/__
surgeon) through Post-op day 14 End__/__/__
This meal plan consists of liquid and semi-liquid foods. The foods allowed are low sugar and primarily
milk based. Vitamin, and mineral supplementation begins at the end of this stage with bariatric vitamins
and minerals. This meal plan may meet all of your nutritional needs.
Goals that remain the same from the last stage
● Drink up to 64 ounces (8 glasses) of fluid per day. You may have any of the liquids from page 25
AND you may add 24-32 ounces of protein-rich liquids in this stage as meals
New goals for this stage
● Eat 3 small meals a day. Allow 20-30 minutes per meal. Drink 1 or 2 8-ounce servings of protein
shake to ensure you are meeting your protein goal.
● Remain upright for 15 minutes before and 60 minutes after eating
● Portion size is 1-2 ounces (2 tablespoons to ¼ cup) of plain yogurt OR up to 8 ounces (1 cup)
protein shake. Start at just 2 tablespoons of yogurt, and only increase to ¼ cup, if comfortably
tolerated. See page 46 for help with portion sizes. You may allow up to an hour to drink 8 ounces
of protein shake.
● Aim for a minimum of 30-45 grams of protein per day.
Examples of foods to add in this stage:
Food Serving Size Protein (grams)
Milk -You may add 25-30g protein powder to each 8 ounces (1 cup)
15-25g
serving. Whey, whey isolate, or soy protein powders (allow one hour to drink)
Light yogurt, plain
2 Tablespoons – ¼ cup 2-5g
[12g sugar or less per 6 ounce container]
Greek yogurt, plain
2 Tablespoons – ¼ cup 2-5g
[12g sugar or less per 6 ounce container]
Any protein drink from page 43 8 ounces (1 cup)
5-10g
(allow one hour to drink)
Begin vitamin and mineral supplementation two weeks after surgery. See page 39.
For the first month, you can use chewable vitamins, but after the first month, most patients tolerate
traditional capsules with ease.
1. Chewable multivitamin with minerals: 2 per day
2. Chewable Calcium Citrate with Vitamin D: 1,500-2,000mg per day (take 500mg 3-4 times daily).
Certain multivitamins will have sufficient Vitamin D and B-12 already in them, but if they do not have this
level, you may need to add separate supplements.
3. Vitamin D: 75mcg or 3,000 I.U. per day (including what is in the calcium supplement)
4. Vitamin B-12: 750-1,000 mcg per day
27Stage 2
(Bariatric full liquid or post-op full liquid)
Sample Menu
Day 1 - 3 meal, 3 snack option
Meal Serving Size Food Protein (grams)
Breakfast 4 ounces Muscle Milk Shake 8g
Snack 4 ounces Premier Protein Shake 8g
Lunch 4 ounces Slim Fast Low Carb Shake 8g
Snack 1/4 cup Plain Greek yogurt 2g
Dinner 4 ounces Orgain protein shake 8g
Snack 2 Tablespoons Plain yogurt 2g
Total Protein 36g
Day 2 - 3 meal, 1 snack option
Meal Serving Size Food Protein (grams)
Breakfast 2 Tablespoons Plain yogurt 2g
Lunch 8 ounces (drink Slim Fast Low Carb Shake 16g
over 1 hour)
Dinner 8 ounces (drink Premier Protein Shake 16g
over 1 hour)
Snack 2 Tablespoons Plain Greek Yogurt 2g
Total Protein 36g
28Stage 3 meal plan
(Pureed meal plan)
When
Post-op week 3 Start__/__/__
End__/__/__
This meal plan consists of pureed foods. This meal plan may meet all of your nutritional needs. Food
should be slightly thicker than Stage 2. Pureed food has no lumps and feels very soft and smooth in the
mouth. Foods should be processed in a food processor or blender to a very smooth consistency or
texture. No solid pieces or parts should be in the food.
Goals that remain the same from the last stage
● Drink up to 64 ounces (8 glasses) of fluid per day. You may have any of the liquids from page 25.
○ Your urine should be pale, straw-colored or even colorless, except immediately after
taking your multivitamins, which may turn your urine bright yellow.
● Eat 3 small meals a day. Allow 20-30 minutes per meal. Add a snack only if you are unable to
otherwise meet your protein goals.
● Remain upright for 15 minutes before and 60 minutes after eating
New goals for this stage
● Use measuring cups or a food scale. See page 46 about portion sizes
○ Each meal should be about 1/4 cup of food
○ Start with just 2 tablespoons, and only increase if comfortably tolerated
● Slow, mindful eating is essential (page 53)
● Do not drink with meals. Wait 15 minutes before and 60 minutes after eating to resume drinking
liquids.
● Aim for a minimum of 45 grams of protein per day
○ Eat about 15 grams per meal
○ Eat protein first
○ 1 cup (8 ounces) of protein shake as one of your meals to reach this goal
■ You may take up to an hour to drink it
● Full liquids can be switched to soft, moist, or pureed protein sources, as tolerated.
● Continue vitamin and mineral supplementation (page 39)
Examples of foods to add in this stage:
Food Serving size Protein (grams)
Eggs, scrambled or soft boiled, light mayonnaise may be 2 Tablespoons – ¼ cup 4-8g
added to moisten.
Baby food or pureed meats 2 Tablespoons – ¼ cup 7-14g
Pureed poultry 2 Tablespoons – ¼ cup 7-14g
Soft, moist fish 2 Tablespoons – ¼ cup 7-14g
Light yogurt, plain [12g sugar or less per 6 ounce] 2 Tablespoons – ¼ cup 2-5g
Greek yogurt, plain [12g sugar or less per 6 ounce] 2 Tablespoons – ¼ cup 2-5g
Any protein drink on page 43 4 ounces (1/2 cup) 5-10g
29Stage 3
(Pureed meal plan)
Sample Menu
Day 1
Meal Serving Size Food Protein (grams)
Breakfast 1 egg One egg, scrambled 8g
Lunch 8 ounces Slim Fast Low Carb Shake 16g
Snack ¼ cup Plain Greek yogurt 7g
Dinner ¼ cup Poached tilapia 14g
Total Protein 45g
Day 2
Meal Serving Size Food Protein (grams)
Breakfast 8 ounces Premier Protein Shake 22g
Snack ¼ cup Turkey and Gravy baby food 5g
Lunch ¼ cup Pureed ground turkey 15g
Dinner ¼ cup Plain Greek yogurt 7g
Total Protein 49g
30Stage 4 meal plan
(Soft, moist meal plan)
When
Post-op week 4 Start__/__/__
End__/__/__
This meal plan consists of soft, moist foods. Meats are ground or minced into pieces no larger than a
quarter inch; all pieces are moist, and stick together slightly. This meal plan meets all of your nutritional
needs.
Goals that remain the same from the last stage
● Drink up to 64 ounces (8 glasses) of fluid per day. You may have any of the liquids from page 25.
○ Your urine should be pale, straw-colored or even colorless, except immediately after
taking your multivitamins, which may turn your urine bright yellow.
● Eat 3 small meals a day. Allow 20-30 minutes per meal.
○ Add a snack only if you are unable to otherwise meet your protein goal.
○ Use measuring cups or a food scale. See page 46 about portion sizes
○ Each meal should be about 1/4 cup of food
○ Start with just 2 tablespoons, and only increase if comfortably tolerated
● Aim for a minimum of 45 grams of protein per day
○ Eat about 15 grams per meal
○ Eat protein first
○ ½-1 cup (4-8 ounces) of protein shake as one of your meals to reach this goal
● Slow, mindful eating is essential (page 53)
● Remain upright for 15 minutes before and 60 minutes after eating
● Do not drink with meals. Wait 15 minutes before and 60 minutes after eating to resume drinking
liquids.
● Full liquids can be switched to soft, moist, or pureed protein sources, as tolerated.
● Continue vitamin and mineral supplementation (page 39)
New goals for this stage
● Increase thickness of foods. Allow for more texture.
● Control portion sizes
○ Set your fork down in between bites
○ Use a small plate or a saucer and small utensils such as a baby spoon or fork
○ Take dime-sized bites and chew food well – to a mushy consistency
Examples of foods to add in this stage:
Food Serving size Protein (grams)
Eggs, scrambled or soft boiled 2 Tablespoons – ¼ cup 4-8g
Finely chopped ground meats 2 Tablespoons – ¼ cup 7-14g
Ground or pureed poultry 2 Tablespoons – ¼ cup 7-14g
Soft, moist fish 2 Tablespoons – ¼ cup 7-14g
Cooked bean, mashed 2 Tablespoons – ¼ cup 5-10g
Cottage cheese 2 Tablespoons – ¼ cup 3-8g
31Stage 4
(Soft, moist meal plan)
Sample Menu
Day 1
Protein
Meal Food Serving Size Recipe
(Grams)
Protein shake 8-11 ounces Premier protein
Breakfast 20-30
(drink in 1 hour)
Chicken & 2.5 ounces 2 ounces of rotisserie chicken
Cheese (1/2 of a leg, no skin) +
Lunch 16
1 Tablespoon cheese +
pinch of dry sage
Chicken salad 1/4 cup total ¼ cup rotisserie chicken breast +
Dinner 1 Tablespoon mayonnaise + 16
small splash of white vinegar
Total Protein 52-62
Day 2
Protein
Meal Food Serving Size Recipe
(Grams)
Protein shake 8-11 ounces Premier protein
Breakfast 20-30
(drink 1 hour)
Tuna Salad ¼ cup total 2 ounces canned tuna (half of a can) +
pinch of thyme +
Lunch 14
pinch dry mustard powder +
1Tablespoon Vinegar
Fiesta salad ¼ cup total 3 Tablespoons chopped chicken +
Dinner 18
1 Tablespoon black beans (pureed)
Total Protein 52-62
32Stage 5 meal plan
(Soft, moist with cooked vegetables)
When
Post-op week 5 Start__/__/__
End__/__/__
Advance meal plan as tolerated. Once protein is well tolerated, add well-cooked, soft vegetables and soft
and/or peeled fruit. Add fruits and vegetables in a texture that is tolerated. Always eat protein first.
Goals that remain the same from the last stage
● Drink up to 64 ounces (8 glasses) of fluid per day. You may have any of the liquids from page 25.
● Eat 3 small meals a day. Allow 20-30 minutes per meal.
○ Use measuring cups or a food scale. See page 46 about portion sizes
○ Each meal should be about 1/4 cup of food or 12 ounces protein shake
○ Add a snack only if you are unable to otherwise meet your protein goal.
● Aim for a minimum of 45 grams of protein per day
○ Eat about 15 grams per meal
○ Eat protein first
● Remain upright for 15 minutes before and 60 minutes after eating
● Do not drink with meals. Wait 15 minutes before and 60 minutes after eating to resume drinking
liquids.
● Slow, mindful eating is essential (page 53)
● Continue vitamin and mineral supplementation (page 39)
New goals for this stage
● After eating protein, if you still have room, add very tender, cooked vegetables.
○ Choose non-fibrous, non-starchy vegetables
○ Chopped, cooked leaves of any type (cooked, chopped spinach in soups or sauces)
○ Cooked carrots, parsnips, rutabaga, tomatoes, zucchini, or mushrooms tend to go better
than broccoli, cauliflower, asparagus, celery, cabbage, or artichoke
○ Avoid hard, tough peels
● After eating vegetables, if you still have room, add fruits
○ Avoid fruits that are very hard or fibrous and peels, like those on grapes
○ Cooked fruits tend to go better (applesauce, canned fruits in juice)
● Use condiments such as mustard, light mayonnaise, plain Greek yogurt, broth to moisten food
Examples of foods to add in this stage:
Food Serving size Protein (grams)
Tender cooked carrots (able to mash easily with a fork) 1-2 Tablespoons 0
Tender cooked parsnips (able to mash easily with a fork) 1-2 Tablespoons 0
Canned, diced tomatoes 1-2 Tablespoons 0
Very ripe pear, diced to ¼ inch pieces 1-2 Tablespoons 0
Applesauce 1-2 Tablespoons 0
Very ripe banana, 2-inch section, mashed 1-2 Tablespoons 0
33Stage 5
(Soft, moist with cooked vegetables)
Sample Menu
Day 1
Meal Food Serving Size Recipe Protein
(Grams)
Chocolate 11 ounces 11 ounces Premier Protein Shake
Breakfast Peanut butter (drink in 1 (chocolate flavor) + 32
Shake hour) 1 Tablespoon PB2
3 Tablespoons canned tuna +
1 Tablespoon mayonnaise +
5 Tablespoons Lemon pepper Mrs. Dash +
Lunch Spicy Tuna salad 12
total 1 teaspoon hot sauce +
1 Tablespoon tender cooked mashed
carrots
1 ounce chicken breast +
Chicken Cordon
Dinner ¼ cup total 1 slice Swiss cheese + 13
bleu
½ ounce Canadian Bacon
Total Protein 57
34Stage 6 meal plan
(Bariatric regular meal plan)
When
Post-op week 6 Start__/__/__
And beyond
Advance meal plan as tolerated. Once well-cooked, soft vegetables and soft and/or peeled fruit are
tolerated, add small amounts of raw vegetables. Always eat protein first.
Goals that remain the same from the last stage
● Drink up to 64 ounces (8 glasses) of fluid per day. You may have any of the liquids from page 25.
● Eat 3 small meals a day. Allow 20-30 minutes per meal. Add a snack only if you are unable to
otherwise meet your protein goal.
○ Use measuring cups or a food scale. See page 46 about portion sizes
○ Each meal should be about 1/4 cup of food
● Remain upright for 15 minutes before and 60 minutes after eating
● Do not drink with meals. Wait 15 minutes before and 60 minutes after eating to resume drinking
liquids.
● Slow, mindful eating is essential (page 53)
● Continue vitamin and mineral supplementation (page 39)
New goals for this stage
● Aim for a minimum of 60 grams of protein per day
○ Eat about 20g per meal
○ Eat protein first
● After eating protein, if you still have room, add raw or cooked vegetables
○ Start with small amounts of non-fibrous, non-starchy, vegetables
○ Raw carrots, parsnips, rutabaga, tomatoes, zucchini, or mushrooms tend to go better
than broccoli, cauliflower, asparagus, celery, cabbage, or artichoke
○ Avoid hard, tough peels
○ Avoid potato, corn, and peas, as these are starchy vegetables
● After eating vegetables, if you still have room, add fruits or whole grains
● Chew foods to a paste-like texture
○ Start with a dime-sized bite
Examples of foods to add in this stage:
Food Serving size Protein (grams)
Raw or cooked carrots 1-2 Tablespoons 0
Raw cucumber, peeled 1-2 Tablespoons 0
Diced tomatoes, raw or cooked 1-2 Tablespoons 0
Apple, peeled and diced into small pieces 1-2 Tablespoons 0
Banana, 2 inch section 1-2 Tablespoons 0
35Stage 6
(Bariatric regular meal plan)
Sample Menu
Day 1
Serving Protein
Meal Food Recipe
Size (Grams)
Breakfast Protein Shake 11 ounces Atkins protein shake 30g
1/4 cup canned lentil soup +
Lentil Soup
Lunch ½ cup total 2 ounces finely chopped ham + 15
with ham
1 Tablespoon cheese
Snack beans ¼ cup ¼ cup white beans, lightly mashed 5
1 ounces cooked white fish (tilapia, bass) with
Cheese fish
2 ounces paprika, lemon pepper, or dill +
Dinner filet with 13
total 1 ounce cheese melted on top +
cucumber
1 slice cucumber, peeled
Total Protein 63
Day 2
Serving Protein
Meal Food Recipe
Size (Grams)
For a batch of 12 muffins: scramble 12 eggs +
12 ounces lean turkey meat +
1 cup cooked spinach +
1 each red and green diced bell peppers +
Breakfast egg
Breakfast 1 muffin 1 jalapeno + 10
muffin
1 clove minced garlic +
1 tsp onion pepper.
Divide veggies and meat evenly amongst
muffin tin holes, bake until eggs are solid.
Cottage ¼ cup cottage cheese
Snack ¼ cup 8
cheese
3 medium grilled shrimp +
Asian shrimp 3 leaves spinach +
Lunch ¼ cup total 12
salad 2 canned mandarin orange slices, +
1 Tablespoon vinaigrette dressing
Dinner Protein Shake 11 ounces Premier Protein, vanilla flavor 30g
Total Protein 60
36Post-op week 6 and Beyond - Continued Guidance
(Bariatric regular meal plan)
When
Post-op week 6 and beyond Start__/__/__
Advance meal plan as tolerated as hunger increases. Eat a healthy, balanced meal plan consisting of
adequate protein, vegetables, fruits, and whole grains. See page 47. Always eat protein first.
Guidance for post-op week 6 and beyond
● Advance your diet as your stomach size allows
○ At 6 weeks post-surgery, portion size of a meal should be about ¼ cup
○ At 3 months post-surgery, portion size of meal should be about ¼ to ½ cup
○ At 6 months post-surgery, portion size of meal should be about ½ to ¾ cup
○ At 1 year post-surgery, portion size of meal should be about 1 cup
● It is important to know how much your stomach size should allow for each meal
○ Eat 15-20 grams of protein at each meal
○ If you are still hungry, eat the volume of vegetables your stomach currently should hold.
○ If you are still hungry after the vegetables, you may have fruit or grains.
■ Fruit or grains should not exceed your vegetable volume.
■ If you are hungry enough to eat more fruits or grains, increase your vegetables.
● Drink 64 ounces (8 glasses) of fluid per day. You may have any of the liquids from page 25.
○ You may resume alcohol after 6 months post-surgery
○ You may resume carbonation 3-6 months post-surgery
■ You may resume calorie-free carbonated beverages in small amounts, only if it
does not cause pain.
■ It can be uncomfortable for many individuals.
○ You may resume caffeinated drinks when you are successfully drinking 64 ounces of
non-caffeinated beverages daily on a regular basis.
■ Do not count caffeinated beverages toward your fluid goal for the day.
● Read the nutrition facts and ingredient labels for sugar alcohols, which can cause dumping
syndrome. See pages 48 to 50 for more information.
● Track your calorie and protein intake with a food journal or an app on your phone
○ See page 57 for more information about choosing a food journal
● There may be certain foods, including some fruits or vegetables that you may never tolerate
because they make you feel sick or cause diarrhea because of their fibrousness
○ Artichokes ○ Corn
○ Broccoli stems ○ Potatoes
○ Coconut ○ Rhubarb
○ Celery ○ Gristly meat
● Each person will have different intolerance, some that may last six months after surgery
● You may need a soluble fiber supplement such as Benefiber™
● Avoid very processed foods that do not provide nourishment (page 51):
○ Fried foods ○ Baked goods
○ Bologna, sausage ○ Chips
○ Ice cream ○ Cracker
37Post-op week 6 and Beyond - Continued Guidance
(Bariatric regular meal plan)
Sample Menu
Day 1
Protein
Meal Food Serving Size Recipe
(Grams)
Breakfast Protein shake 11 ounces Ensure max protein 30
1 ounces chicken breast +
Lunch Greek salad ¼ cup total 1 tablespoon chickpeas + 10
1 cherry tomato
2 ounces salmon burger (half a patty) +
Snack Salmon burger 2 ounces 14
Dijon mustard
1 1-ounce bison meatballs
[combine 1 pound each ground bison
and ground turkey +
Italian spice +
1 egg +
Meatballs ¼ cup bread crumbs +
Dinner 1 meatball 10
parmesan ½ cup grated parmesan cheese =
to make 16 meatballs], +
1 floret steamed broccoli +
1 Tablespoon marinara
(less than 5g sugar per ½ cup) +
Pinch of parmesan cheese
Total Protein 64
38Vitamins and Minerals
After weight loss surgery, you will have to take vitamins and minerals every day for the rest of your life to
prevent deficiencies. You will be at risk for deficiencies due to your decreased intake of food and
surgically modified gastrointestinal system. Even if you are eating a balanced meal plan, you will still need
supplementation with vitamins and minerals. Some people need a little more or less of a particular vitamin
or mineral based on their lab results. The dietitian will help you know if you should change your
supplements, but the best place to start is with the guidelines from the American Society for Metabolic
and Bariatric Surgery (ASMBS).
Iron
Iron is important for creating red blood cells, which carry oxygen in your body. After surgery, your iron
levels may become low, causing anemia. Iron deficiency can happen because of difficulty tolerating
high-iron foods and shorter intestinal length, resulting in less absorption of iron. Menstruating women are
most at risk. Take your iron separately from calcium for best absorption (2 hours, if possible). Taking iron
with vitamin C helps improve absorption. Iron may be included in your daily bariatric multivitamin. Iron can
be found in different forms. Some forms are absorbed more easily, such as ferrous gluconate or ferrous
fumarate; other forms are less absorbed, like ferrous sulfate.
● 45-60mg of elemental iron per day
● Menstruating women may need more
Calcium
Calcium is important for bone health. Your calcium levels may become low because you are not
absorbing as much calcium as the food is bypassing part of the digestive system. Take calcium spread
out, with meals to reduce the risk of oxalate stones. Take calcium separately from iron supplements.
● 1,500-2,000mg of calcium citrate per day
● Take 500mg three to four times per day
B-12
B-12 is important for having enough energy. After surgery, your levels can become low because of low
intake and poor absorption due to the surgical changes to your stomach. B-12 may be included in your
daily bariatric multivitamin.
● 750-1,000 mcg per day
Thiamine (B1)
Thiamine is important for having enough energy. It may be included in your daily bariatric multivitamin. It
can turn your urine bright yellow.
● 12-13 mg per day
Folate (folic acid)
Folate is important for having enough energy. It may be included in your daily bariatric multivitamin.
● 800mcg per day
Vitamin D
Is important for building healthy bones and immune health. After surgery, your vitamin D levels may
become low because you have less stomach acid.
● 75mcg or 3,000 I.U. per day
● If deficient, 1,250mcg or 50,000 I.U. once or twice a week for 5-8 weeks
39The best way to be certain you are not lacking any vitamins or minerals is to continue regular lab tests. If
you develop a deficiency, you will need to take vitamins or adjust the way you eat. You should start your
vitamin and mineral supplements two weeks after surgery.
Vitamins can be purchased here, but even over-the-counter vitamins can be used:
● Bariatric Advantage – www.bariatricadvantage.com
● Bariatric Fusion – www.bariatricfusion.com
● Celebrate Vitamins – www.celebrate vitamins.com
● Centrum Vitamins – www.centrum.com
● Opurity Vitamins – www.unjury.com
Vitamin (best form) Amount needed
Vitamin B1 (Thiamin) 12-13 mg per day
Vitamin B12 (Cobalamin) 750-1,000 mcg per day
Folate/Folic acid 800 mcg per day (or 0.8 mg per day)
Iron (Ferrous fumarate not ferrous sulfate) 45-60 mg per day
Vitamin D 75 mcg or 3,000 I.U. per day
Vitamins A,E and K Ideally 2 times the RDA per day
Zinc and Copper Ideally 2 times the RDA per day
Calcium (Calcium citrate not calcium carbonate) 1500-2000 mg
(taken as 500 mg 3 or 4 times per day)
Wait 2 hours between calcium and iron, as they can
compete for absorption.
Bariatric vitamins ought to meet all of the above guidelines, but not all do. It is important that you check
your multivitamin has all of the above amounts and contain the form of the vitamin written above. If your
multivitamin does not contain the amounts listed, you will need to purchase and take a separate
supplement of that pill to reach the goal amount. The correct forms, written in parenthesis above are
absorbed best and minimize side effects, including stomach upset. Prenatal vitamins and general adult
vitamins do not contain the amounts needed. Avoid gummies, patches, or liquid vitamins, even if they
say ‘complete’ as they often lack the vitamins needed after surgery.
40Timing of vitamin supplementation is important. It is critical to separate your bariatric multivitamin from
your calcium by at least two hours. It is also critical to take each of the 500mg servings of Calcium at least
two hours apart from each other. Here are two example schedules that would meet these goals:
Option 1 Option 2
Time of day Vitamin Time of day Vitamin
Breakfast Calcium citrate Breakfast Bariatric multivitamin
Lunch Calcium citrate Lunch Calcium citrate
Dinner Calcium citrate Dinner Calcium citrate
Bed time Bariatric multivitamin Bed time Calcium citrate
Optional:
Probiotic
● May start as early as 1 week post-surgery
● Probiotics are live microorganisms (bacteria and yeast) that have health benefits. Probiotics help
your body function properly, especially your digestive system. The body is full of bacteria, both
good and bad. Bacteria that naturally reside in your intestines help your body digest food,
produce vitamins (specifically vitamin K), and play a role in immunity. These “friendly” bacteria
help your body maintain a healthy balance and keep bad bacteria from overwhelming your
system and causing problems.
Fiber
● May start as early as 1 week post-surgery
● Daily insoluble fiber supplement such as Benefiber™
4142
Protein Supplements
For Liver shrinking diet (pre-surgery plan) and
Stage 2 (bariatric full liquid or post-op full liquid)
Ready-to-Drink Protein Shakes
Shake Bottle size Calories Protein Sugar Fiber Flavors
Coconut, pineapple, orange,
Isopure Zero Carb 20 ounces 160 40 0 0 grape, apple melon, peach,
berry, punch, mango
Slim Fast High
Protein 10 ounces 180 20 2 1-2 Chocolate, Vanilla
(20g protein)
Boost Glucose Chocolate, Vanilla,
8 ounces 190 16 4 3
Control Strawberry
Chocolate, Vanilla,
Atkins 11 ounces 160 15 1 1-4
Strawberry, Mocha
Optisource 8 ounces 200 24 0 0 Caramel, Strawberry
Muscle Milk Light 11 ounces 160 20 0 4 Chocolate, Vanilla
Pure Protein 12 ounces 190 23 1-2 2-3 Chocolate, Vanilla
Chocolate, Vanilla,
Strawberry, Cookies &
Premier Protein 11 ounces 160 30 1 3 Creme, Bananas & Creme,
Strawberries & Creme,
Caramel
Premier Protein Orange, Raspberry, Tropical
17 ounces 90 20 1 0
Clear Punch, Peach
You may choose any protein supplement that meets these three requirements:
● 200 calories or less
● 15 grams protein or more
● 5 grams of sugar or less
43Protein Supplements
For Liver shrinking diet (pre-surgery plan) and
Stage 2 (Bariatric full liquid or post-op full liquid)
Protein Powders
Mix with water, milk, or unsweetened almond milk
Protein Powders Portion Calories Protein Sugar Fiber Flavors
365 Whey Protein Vanilla only (chocolate
1 scoop 90 16 1 0
Powder contains too much sugar)
Unjury Protein 1 scoop or Vanilla, Chocolate,
100 21 2 0
Powder packet Strawberry, Unflavored
Solgar Whey to Vanilla only (chocolate
1 scoop 90 20Protein Supplements
For Stage 6: Regular bariatric meal plan
Protein Bars
Bar Calories Protein Sugar Fiber Flavors
Chocolate almond caramel, vanilla pecan,
Atkins
180-210 15-16 1-3 8-13 raspberry chia, peanut fudge, almond mocha
Meal
or coconut, chocolate peanut
0-2
Choose Chocolate, chocolate peanut butter, chocolate
Pure 16 in the
180-200 20 2-4 chip, chocolate cookie dough, blueberry,
Protein PLUS
calorie bars strawberry, mocha brownie, red velvet
bars
Chocolate mint, espresso, coconut, raspberry,
NuGo Slim 180-190 16-18 3 6-7
peanut butter, brownie
Birthday cake, s’more, blueberry, cookie
Quest 180-200 21 1-2 14-15 dough, cookies & creme, oatmeal chocolate,
rocky road, mocha
Brownie, caramel, maple almond, white
Think Thin 230 13-20 0-5 0-3 chocolate, cookies & creme, lemon, mint
chocolate, sea salt almond chocolate
coconut, banana, mint brownie, black cherry,
Built 110 15 4 6 salted caramel chocolate, double chocolate
mousse, orange, vanilla, raspberry
Chocolate peanut butter, vanilla almond,
Premier
230 20 1 2 chocolate brownie, chocolate caramel, yogurt
Protein
peanut crunch
Protein bars are a processed food that tends to provide protein as a low-bioavailability source. It is much
preferred to choose meat, poultry, fish, or dairy sources of protein.
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