STAGE I: WATER (while in the hospital)

Guidelines:

• You will not receive a meal tray in the hospital.
• Drink one ounce (30 cc) of water every hour.

• Eat three meals per day consisting of clear liquids.
• Drink small amounts of unsweetened clear liquids between meals
• Liquids should be sipped very slowly to avoid stretching your pouch. Do not use a straw. Drinking through a straw can overfill your pouch with liquid and air. If the pouch gets full very quickly, you may experience nausea, vomiting, and pain
• A minimum of 48-64 oz. (6-8 cups) of liquids should be consumed daily to replace fluid losses and prevent dehydration. It should take you 12-16 hours to drink 48-64 oz. of liquid.
• Avoid caffeinated, carbonated and alcoholic beverages.
• Avoid juices, they have too many calories. 64oz juice = 960 calories

Examples of Clear Liquids:

Crystal Light Herbal Tea Diet Gelatin Water Roses lime juice (diluted with water) Wyler’s Diet Lemondade

Sugar Free Koolaid Broth/ Consomme Ocean Spray lite juices Diet Tang Non-caloric fruit flavored Water (Fruit 2 O) Country Time Diet Lemonade

Decaffeinated tea Propel Water Sugar Free ice Pops Miso Soup Diet Snapple Smart Water

STAGE III: CLEAR LIQUIDS SUPPLEMENTED WITH PROTEIN SHAKES
(Post-op day 2 [usually the day after hospital release], continue for 2 weeks)

Guidelines:

• You may select from the protein supplements listed below to achieve your minimum protein target of 60 gms/day
• Drink eight ounces per meal. If you are mixing a protein powder with milk, we recommend “Skim Plus” brand skim milk, which comes in a purple carton. Note: If you have problems tolerating milk (lactose intolerance), try using lactose reduced milk like Lactaid, or Dairy Ease or add Lactaid drops to your Skim Plus milk.
• Drink unsweetened liquids between meals in order to provide adequate fluid to your body, so you do not become dehydrated. You need to drink a minimum of 48 fluid ounces every day.
 

STAGE IV: PUREED FOODS
(Post-op day 16. Gastric Bypass patients continue for 6 weeks. Lap Band patients continue for 3 weeks.)

Guidelines:

Eat three meals per day consisting of up to three ounces of pureed high protein food. Begin with one ounce and gradually work up to three ounces at a meal. You may eat two ounces of pureed high protein food and one ounce of pureed vegetable or fruit for more variety. Always eat high protein food first. High protein foods include:

• Lean beef
• Lean pork
• Lean lamb and veal
• Skinless poultry
• Fish (does not need to be pureed)
• Eggs or egg substitute (does not need to be pureed)
• Low fat cheese (does not need to be pureed)
• Tofu (does not need to be pureed)
• Soups (may contain vegetables, meat or beans) NOT CREAMY
• All beans especially lentils and chick peas.

Portion Size: It is important to purchase measuring cups, spoons, and an accurate weighing scale so you learn appropriate portion size.

1 oz = 2 tablespoons
2 oz = 4 tablespoons
4 oz = ½ cup

Cooking Tips

A. Remove fat and skin before cooking and blenderizing poultry

B. Trim all fat from veal, beef, lamb, and pork before cooking and blenderizing

C. Bake, boil, stew, poach, grill or microwave instead of frying foods; use a non-stick coated pan or vegetable cooking spray if frying is necessary.

D. Use a rack when baking, broiling, or roasting to allow the fat to drain off; do not baste with drippings, which return some of the fat to the food!

E. Purchase low fat or fat free cheese (those with two grams of fat per ounce).

F. Purchase lean cuts of meat; beef round, chuck, sirloin, 90% lean ground beef, pork tenderloin, lean ham.

Eating Tips

A. Blenderize/puree all foods thoroughly, except those noted above, until advised to Advance to Stage V by your physician or dietician.

B. All food consumed must be pureed to avoid blockages of the opening.

C. Eat very slowly. Take thirty minutes for a meal. Using a clock or timer is helpful.

D. Eating protein-rich foods, is especially important. Protein is essential for healing and ensures muscle mass maintenance during weight loss. Insufficient protein intake can result in impaired healing, hair loss, muscle wasting, dry and scaly skin, and poor resistance to infection.

E. Do not lie down after eating or drinking.

F. Continue to drink at least 48 ounces of unsweetened liquids between meals choosing from:

• Water
• Plain tea or coffee (preferably decaffeinated)
• Broth or Bouillon
• Crystal Light/ Diet Snapple
• Stop drinking at least 30 minutes before eating a meal. Wait thirty minutes after eating before you begin to drink again. Combining food and liquids together can result in bloating.
• Try not to eat for 3 hours prior to bedtime. This helps with digestion and prevents regurgitation.

STAGE V: REGULAR DIET/SOLID FOODS

(Gastric Bypass patients start 8 weeks after surgery [Post-op day 60]. Lap Band patients start 5 weeks after surgery [Post-op day 37].)

Guidelines:

About five to eight weeks after surgery, your dietitian will advance your diet from puree to regular. This stage focuses on three small meals per day. It will still be important to follow the concepts you have learned during the previous four stages.

Eating Recommendations:

• Your stomach still only holds three to four ounces of food or fluid at any one time. When you feel full, stop eating. It is still possible to overstretch your new stomach by not being careful about the amount of food you eat.
• Consume your meals slowly (10 minutes per ounce), so that a meal should last at least thirty minutes. Put your fork or spoon down between bites and if need be, use a watch to time yourself while eating.
• Avoid distractions and stressful situations while eating, i.e. T.V., radio, or working, because your stomach will need a calm environment to properly digest food.
• When dining out, order a side dish or child’s portion of an entrée or a low-fat appetizer for your meal. The size of a regular portion may be overwhelming and a smaller portion may be more appealing (Ask about our “Special Diet Request” card)
• Remember the ounces of solid food refer to weight whereas ounces of liquid refer to volume.
• Never chew gum! If swallowed, it can obstruct your stomach outlet.

Extra Tips

Sometimes trapped gas can cause chest discomfort. You may try using Gas-X to relieve the pain. If it persists you must contact your doctor.

REMEMBER to take your vitamins and supplements!

Ice cube trays are handy for storing pureed food (each cube section is about one fluid oz)

Baby warmer trays may be helpful for keeping pureed food warm while it is slowly being eaten.

Colace (Docusate Sodium) is good for CONSTIPATION. You should first make sure you are drinking enough water and eating enough fiber. For extreme cases you may take Milk of Magnesia.

Do not swallow any pills whole. They may be crushed and mixed with sugar free applesauce. You may also use liquid forms of medication if available.

If you are having trouble tolerating food, you may substitute solid or pureed foods with a protein shake.

Take SMALL bites and CHEW well. Once you transition to solid foods, chew each bite at least twenty times before swallowing

Eat a balanced diet as much as possible. Because the amount of food eaten at each meal will be small, it is important that they be high in nutritional value.

If you plan your meals ahead of time and have the ingredients on hand, you are less likely to make poor food choices.

It is best to prepare your own foods so you know exactly what you are eating. If a recipe yields too much food, you can either divide the recipe in half, or freeze leftovers in small containers to save for other meals.

Exercise is encouraged and may be included in your daily regimen with your physician’s consent.

When advancing from liquid to puree or later on to soft food, you may experience problems with vomiting. This occurs with overeating, not chewing well or mixing liquid and solid food. If you do vomit, make sure you are not eating too much at one time and that you are chewing well. You must call your doctor if it persists.

Food intolerances will vary on an individual basis. If you have a problem with a new food, wait several days before trying it again. Record any recurrent problems with new foods in a food diary. Bring this to your next visit with the physician and/or dietician.

Remember, eating high carbohydrate or foods rich in sugar can cause Dumping Syndrome. This will result in sweating, palpitations, diarrhea, nausea and discomfort. (Gastric Bypass Patients Only)

Gastric Bypass patients may also experience body odor. Devrom pills and capsules are available and may help with this. Call 1-800-453-8898 for more information.

Alcohol may be consumed on occasion, however, it is very high in calories and sugar, and may cause dumping syndrome.

Remember, if you have any questions or problems, please feel free to call the Center at any time. We are here to help you!