Bariatric and Metabolic Surgery at
Orlando Regional Medical Center
Sleeve Gastrectomy
Gastric Bypass
Bariatric Surgery
Duodenal Switch
Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy generates weight loss by restricting the amount of food
that can be eaten by removing 75-80% of the stomach. The stomach that remains is shaped
like a long narrow tube, similar to the shape of a banana. The stomach size is reduced to
about 4 ounces. The risk for dumping syndrome, which is commonly experienced after
gastric bypass surgery, is very low following this surgery. Sleeve gastrectomy reduces a
hormone called Ghrelin which is responsible for increasing hunger.
Sleeve Gastrectomy has the potential for greater weight loss than adjustable gastric
banding and has a lower risk for complications than both adjustable gastric banding and
gastric bypass surgery.
Some of the advantages of sleeve Gastrectomy include:
 Minimally invasive procedure
 No bypassing of the intestines allowing nutrition to be absorbed in a normal manner
 No implantable devices are used
 Potential for greater weight loss than gastric banding
 No adjustments are needed
 Lower risk for complications than adjustable gastric banding or gastric bypass
surgery
Disadvantages:
 Possibly less weight loss than with roux-en-Y gastric bypass
*Talk with your surgeon about possible operative risks.
p: 2
Roux-en-Y Gastric Bypass
Roux-en-Y Gastric Bypass Surgery is the most common type of bariatric surgery in the
United States. In this procedure, the surgeon uses staples to create a small pouch; this is
where your food will go after you swallow. The pouch is about the size of an egg and can
hold about one ounce at a time. Because of the pouch size you will feel full sooner and eat
less food. The remainder of the stomach is not removed. The surgeon then attaches part of
the small intestine to the new pouch.
Absorption of calories and nutrients takes place in the small intestine. By bypassing the
small intestine, fewer calories are absorbed. It is important to know that some important
vitamins and minerals will also not be absorbed the same, so vitamin in mineral
supplementation will be necessary. Also because of these changes in your digestive tract,
you may get sick if you consume items too high in sugar or fat. This is called “dumping
syndrome”, which is caused when food rapidly empties the stomach into the intestines.
Advantages:
 The average excess weight loss in gastric bypass is generally higher in a compliant
patient than with purely restrictive procedures.
 Appetite is reduced due to a drop in levels of ghrelin (a “hunger hormone”)
 Inability to tolerate sugar may help with weight loss if you have a “sweet tooth”
 Studies show that after 10-14 years, 60% of excess body weight has been lost and
maintained by patients.
 Many people who undergo Roux-en-Y Gastric Bypass Surgery experience remission
or improvement in co-morbid conditions such as diabetes, hyperlipidemia,
hypertension and obstructive sleep apnea.
Risks:
 You may experience “Dumping Syndrome”
 Lifelong vitamin/mineral supplements will be necessary to prevent deficiencies
 Weight regain may occur if your stomach pouch is stretched.
 The lower stomach and segments of the small intestine cannot be easily visualized
using x-ray or endoscopy if a problem such as an ulcer, bleeding or malignancy
should occur.
*Talk with your surgeon about possible operative risks.
p: 3
Duodenal Switch
In Duodenal Switch surgery, part of the stomach is removed, leaving a 4- to 6-ounce
stomach. Additionally, a part of the intestine is bypassed and digestive juices come into
contact with food at a lower part of the intestine, which doesn’t allow as much absorption.
Therefore, your body will not absorb all of the calories and nutrients in the foods you eat.
Your body’s ability to absorb fat will be especially affected. If you eat too much fat, you will
have gas and diarrhea.
Duodenal Switch surgery also limits the amount of food you can eat at one time, but not as
much as gastric bypass. Also, levels of ghrelin (a “hunger” hormone) drop, so your appetite
is reduced early on.
Advantages and Disadvantages of Duodenal Switch:
Advantages:
 Not all calories and fat eaten will be absorbed.
 Greater percentage of excess weight lost (70% to 80% of excess body weight).
 Weight loss maintenance
Disadvantages:
 Increased stool frequency and smelly gas and stools, especially with fatty foods.
 Poor absorption of fat-soluble vitamins (vitamins A, D, E, and K).
 Poor absorption of certain nutrients.
 Increased likelihood of protein deficiency
p: 4
Two Weeks Prior to Surgery:
In order to reduce operative risks, a weight loss of approximately 10-15 pounds prior to your
surgery is recommended. To achieve this weight loss you will follow a modified diet for the
two weeks prior to your surgery. The purpose of the diet is to reduce the amount of fat
stored in your liver. This diet will consist of:
 Replacing two of your meals with a liquid protein drink, eating only one lean
meal/day. (See pages 7-8 for recommended protein drinks)
 Avoidance of high fat and highly processed foods (ex: fried foods, hot dogs,
sausages, etc.)
 Limited carbohydrate intake; especially concentrated sweets (ex: sodas, juices,
desserts/sweets)
 Sugar free clear liquids are acceptable to drink throughout the day.
Things to Eat
Lean cuts of meat – beef, chicken, pork
Grilled or Broiled Fish
Low fat or fat free cheese and cottage cheese
Non-starchy vegetable – broccoli, green beans
Things to Avoid
High fat processed meats – sausage, hot dogs
Any fried food
Starchy vegetables – potatoes, peas, corn
Breads, pasta, rice, beans
Pre-Surgery Diet and Behavior Modifications:
You may want to immediately begin making some diet and behavior modifications in order
to prepare for life after surgery. Some suggested modifications include:
Start to Limit/Eliminate:
Simple sugars (Sweetened Drinks, Candy,
Desserts)
Carbonation (Soda, Beer, Fizzy Waters)
Snacks/Nibbles
Fried Foods/Added Fats
Drinking Fluids With Meals (30/30 Rule)
Alcohol
Behaviors to Change:
Start out each meal with lean protein
Slow down meals! Take small bites and
avoid distractions
Stop eating/do not eat when you are no
longer hungry
Drink 6-8 cups of calorie-free liquids each
day
Begin regular physical activity
Write down what you are eating
p: 5
Postoperative Nutrition Guidelines
Following surgery, you will progress your diet slowly through four diet phases. It is
important to follow this diet progression to allow your digestive system to heal and reduce
your risk for postoperative complications. Introducing certain foods too early can prolong the
healing process.
Throughout the diet progression you will want to focus on:
 Drinking enough fluid to keep hydrated (64 ounces of fluid per day)
 Eating enough protein
o Sleeve Gastrectomy and Gastric Bypass (60-80 grams of protein per day)
o Duodenal Switch (your goal is 80-100 grams of protein per day)
 Avoiding carbonation, alcohol, and large amounts of caffeine (no more than 2
servings of caffeine/day)
 Taking vitamin/mineral supplements, once your surgeon gives you permission
Following surgery, you will feel full after consuming only a small amount of foods and
liquids. It is important to listen to your body’s signals and stop eating/drinking when you feel
full. It may feel like you are learning how to eat again. Avoid foods that you do not tolerate or
that you feel do not sit well. Listed below are the four phases of the bariatric post-operative
diet progression.
Phase 1: Clear Liquids (sugar-free)
Length: 3 days

Phase 2: High Protein Full Liquids
Length: 1 month (4 weeks)

Phase 3: Soft Foods
Length: 1 month (4 weeks)

Phase 4: Maintenance (regular) Diet
Length: Lifetime
p: 6
Phase One – Clear Liquids
Duration: First 3 days after surgery
This is the first phase of your weight loss surgery diet. After surgery, you will not be able to
eat or drink anything for several hours. Once your surgeon allows you to eat, you will be
able to drink clear liquids. Clear liquids are recommended to prevent common problems at
this stage such as nausea, pain, vomiting, and dehydration.
At this point, staying hydrated is the main nutrition goal. Aim for 64 ounces of fluid each
day. There will be swelling in the stomach after surgery. This swelling will slowly go down
over the first few weeks.
Clear Liquids are non-dairy liquids that you can see through. Clear “solids” that become
liquid at room temperature are also appropriate, such as sugar free gelatin or sugar free
popsicles.
Examples of Recommended Clear Liquids:
- Water
- Broths/bouillons: clear beef, chicken, or vegetable broth
- Sugar-free gelatin and Sugar-free popsicles
- Low calorie/sugar free sports drinks (Propel®, PowerAde Zero®, G2 Gatorade®)
- Sugar-free flavored drinks (Crystal Light ®, Vitamin Water Zero ®, Zero Calorie
SobeLifewater ®, Veryfine Fruit2O ®, Sugar-Free Kool-Aid®, ect.)
- Decaffeinated tea
Tips:
 Sip liquids very slowly. Do NOT gulp liquids. Drinking too fast may cause pain,
discomfort, and may make you vomit.
 Using a straw may cause you to swallow too much air, which will cause pain.
 When you first begin drinking clear liquids take no more than 1 oz of liquid at a time.
This is the size of a medicine cup. Try to drink 1 oz every 10-15 minutes or so.
 Once tolerance is established, sip on liquids freely to the point of fullness.
 Fluids served at room temperature or warm are sometimes better tolerated.
 Avoid all carbonated beverages (soda and soda water).
 Avoid all beverages that contain sugar (lemonade, sports drinks and sweet teas).
 Avoid fruit juices. Introducing fruit juice immediately after surgery may cause
dumping syndrome.
p: 7
Phase Two – High Protein Full Liquids
Duration: 1 month--Day 4 through day 28 (4 weeks) following surgery
This is the second phase of your post-surgery diet. The rationale for taking nothing but
liquids for four weeks after surgery is to allow for healing. Advancing your diet too quickly
can prolong the healing process. During phase two you may begin to add dairy-containing
liquids. They should be low in fat, sugar-free, and have no distinct pieces of solid food or
“chunks.”
Remember:
 Drink small amounts of fluid every 3-4 hours while awake.
 Sip fluid very slowly. Work your way from 4 to 8 ounces in one sitting. Every person
is different and will advance at a different pace.
The following full liquid foods are recommended:
Beverages/Fluids
Skim, 1% or lactose-free milk; water; tea and coffee (up to 2 caffeine
containing beverages per day); sugar-free beverages such as Crystal Light
Meat/Meat Substitutes
Creamy yogurt, yogurt smoothies (with a less than 12 grams of sugar per 4oz),
low-fat, small curd cottage cheese, part-skim ricotta cheese. ***there is no
sugar free yogurt
Soups
Broth; bouillon, low-fat cream soups that have been strained
Vegetables
Vegetable or tomato juice; tomato soup
Fruits
Plain, no sugar added applesauce; pureed (baby food) fruits
Supplements
Protein supplements (preferably 100% whey protein) 3 times per day (see
page 7-8 for more details)
Sweets
Sugar free pudding, sugar-free popsicles or gelatin
***REMEMBER EAT/DRINK ONLY TO THE POINT OF FULLNESS***
Sample meal plan for a high protein full liquid diet
Breakfast
¼ cup plain, no sugar added applesauce
¼ cup skim milk
Mid-Morning
1 cup high protein drink
Lunch
½ cup strained cream soup
¼ cup vegetable juice
Mid-Afternoon
1 cup high protein drink
Dinner
½ cup broth
¼ cup plain yogurt
Evening
1 cup high protein drink
p: 8
High Protein Supplements
Protein is the basic building block the human body uses to repair and replace tissues such as hair,
nails, skin, eyes and all other organs. Protein is necessary for fighting infections. Without
adequate protein, serious consequences can develop including muscle wasting, weakness, fatigue
and excessive hair loss. You will need Sleeve Gasterctomy and Gastric bypass 60-80 grams of
protein per day for Duodenal Switch 80-100 grams of protein per day. During the first few
months following surgery, it will be difficult for you to meet your protein needs with food alone due
to the small amount of food that you are eating. Protein shakes and powders will be used to help
you make up the difference in between meals.
Recommended Protein Powders:
Shake
Calories Protein Sugar
Bariatric
150-160 27g
0.5g
Advantage
Unjury
80
20g
0g
Bariatric
Fusion
EAS 100%
Whey Protein
Pure Protein
100% Whey
138
27g
<1g
75
13g
1g
100-140
15-25g
N/A
Gold
Standard
100% Whey
GNC Whey
Isolate 28
MetRx 100%
Natural Whey
120
24g
N/A
130
28g
2g
130
23g
5g
Vitamin World 100
Soy Protein
Isolate
Syntrax
100
Nectar Whey
Protein
20g
0g
24g
N/A
Flavors
Chocolate, Vanilla,
Iced Latte, Orange
Cream, Banana Cream
Vanilla, Chocolate,
Strawberry, Unflavored
Chicken-Soup
Numerous
Where to Buy
bariatricadvantage.com
Vanilla
Chocolate
Vanilla, Chocolate,
Strawberry, Cookies &
Cream
Numerous
Retail (Vitamin Shoppe,
Publix, Target, etc.)
Retail (CVS,
Walgreens, Walmart,
Target, GNC, etc.)
GNC
Vitamin Shoppe
Optimumnutrition.com
GNC.com
GNC
Retail, metrx.com
Chocolate, Vanilla
Strawberry
Chocolate, Cookies &
Cream, Peanut Butter,
Strawberry, Vanilla
Chocolate, Vanilla,
Unflavored
Apple Ecstasy,
Strawberry Kiwi,
Grapefruit, Lemon Tea
and many more
Unjury.com
bariatricfusion.com
Vitaminworld.com
Vitamin Shop
p: 9
Alternative Protein Shakes:
Shake
Calories Protein Sugar
Muscle-Milk
100
20g
0g
Light
Flavors
Café Latte, Vanilla,
Chocolate
Optisource
**4 oz/serving
100
12g
N/A
Strawberry, Caramel
Atkins
Advantage
160
15g
1g
AdvantEDGE
Carb Control
by EAS
Isopure Zero
Carb
110
17g
0g
Café caramel, chocolate,
Mocha latte, Vanilla,
Strawberry
Chocolate, Strawberry,
Vanilla, Dark chocolate,
Café caramel
Passion fruit, Pineapple
orange, banana, Mango
peach, Alpine punch,
Orange, Grape, Apple
melon, Blue raspberry
Chocolate, Vanilla,
Strawberry, Cappuccino,
Peach, Banana,
Strawberry/banana,
Blueberry, Plain soy
Chocolate, Vanilla,
Strawberries and cream
160
40g
0g
Revival
120
20g
1g
Premier
Protein
160
30
1g
Where to Buy
Retail
Cytosport.com
Retail (CVS,
Walgreens,
amazon.com)
Retail
Atkins.com
Retail
eas.com
GNC
Vitamin Shoppe
Revivalsoy.com
Sam’s, Costco, and
Premierprotein.com
This list is not all-inclusive. Alternative protein shakes can be used. Remember, the best
quality protein supplements come from whey, casein, or soy protein; and should be listed as
one of the first ingredients on the ingredient list. Do not purchase a protein supplement with
“collagen” listed as the first ingredient; these are usually found in the protein “shooters” that
claim to have a large amount of protein in just 1-2 ounces. Use the Nutrition Facts label to
evaluate a supplement before purchasing and follow the following guidelines:
 Less than 180 calories
 Greater than 12 grams of protein per serving
 Less than 12 grams of sugar per 4 ounce serving.
Unflavored protein powders can be used as an alternative to protein drinks and mixed into
any of the liquids listed found on page 6. See page 9 for ideas!
p: 10
Protein Supplement Ideas
Unflavored Protein
Unflavored protein powders can be mixed into any of the full liquids to count towards one of
your protein supplements. Ideas:
 Mix 1 scoop in a fruit flavored Crystal Light or other sugar-free beverage
 Prepare sugar-free gelatin and mix in 1-2 scoops before refrigeration
 Mix 1 scoop in with yogurt or sugar-free pudding
 Prepare strained cream-soup, allow to cool to room temperature, and mix in 1 scoop
Recipe Ideas:
Bananas & Cream
1 cup skim milk
4 ice cubes
½ frozen banana
1 scoop protein powder
*Blend Well
AM Delight
1 cup skim milk
4 ice cubes
1 teaspoon nutmeg
1 teaspoon vanilla extract
1 scoop protein powder
*Blend Well
Chocolate Chiller
1 cup skim milk
1 packet sugar free hot chocolate
1 scoop protein powder
*Blend Well
Fruity Surprise
¼ cup skim milk
¾ cup sugar free beverage
1 scoop protein powder
¼ cup or less canned fruit (canned in juice
or water)
*Blend Well
High Protein Mousse
1 small sugar free pudding mix
16 oz fat free cottage cheese
4 oz Cool Whip Light
1 scoop protein powder
Blend cottage cheese until smooth. Add
pudding and mix well. Empty into large
bowl. Fold in Cool whip. Caution, this
makes several servings.
p: 11
Phase Three- Soft Foods
Duration: 1 month (week 5 through week 8) following surgery
Soft foods may be slowly introduced four weeks following surgery. Soft foods are foods that
are easy to chew, swallow, and digest. A good rule of thumb is that foods must easily be cut
with the side of a fork or spoon. Meats and vegetables should be cooked until they are very
tender. All foods are to be chewed well, to an applesauce like consistency, before being
swallowed. Aim for 20 chews per bite!
There are several rules that are important to follow once you begin eating soft foods
 Always eat protein rich foods, such as meat, chicken, fish, beans and dairy, first.
Protein foods are very filling and must be eaten first to ensure you meet your protein
needs.
 Eat three meals a day. Eat when you are hungry and avoid constant snacking as
this will reduce the effectiveness of bariatric surgery.
 Eat and drink slowly. A meal should take 20-30 minutes to complete. Avoid
distractions.
 *Do not drink fluids with meals.* Drink fluids between meals. Stop drinking fluid 30
minutes prior to a meal and avoid drinking fluid for at least 30 minutes after meals.
However, it is still important to drink plenty of fluids throughout the day in order to
stay hydrated. Aim for 64 ounces.
 Learn your limit. Stop eating before you are uncomfortably full. Overeating will
almost always lead to vomiting and may stretch your pouch over time.
The goal of bariatric surgery is to eliminate dangerous health conditions that are associated
with morbid obesity. The goal of this surgery is not to focus only on weight loss or clothing
size, but rather to improve health and quality of life.
p: 12
The following soft foods are recommended:
Beverage/Fluid
Skim, 1% or lactose-free milk; water; tea and coffee (up to 2 caffeine
containing beverages per day); sugar-free beverages such as Crystal Light
or Diet Snapple; sugar-free popsicles or gelatin
Meat/Meat Substitute
Moist, ground/chopped lean meat or poultry; flaky fish or shellfish; canned
tuna or chicken; lunch meats (outer rind removed); eggs; low-fat cottage
cheese; low fat cheese; low-fat/low-sugar yogurt; legumes (kidney beans,
black beans, garbanzo beans); tofu/soy products; hummus; peanut butter
Soups
Broth; bouillon; low-fat cream soup; broth-based soups
Vegetables
Soft, cooked vegetables without hulls or tough skin; vegetable juice
Fruit
Unsweetened cooked or canned fruit without seeds or skin; bananas; soft
melon, plain, no sugar added applesauce
Whole Grain Starches
Cooked or dry cereals; toasted bread; crackers
Supplements
Continue to take 2 high protein supplements per day until 3 ounces of
protein can be eaten at each meal
Foods to Avoid from each group:








Beverages: carbonation, alcohol, whole milk, any beverages with added sugars, and excessive
amounts of caffeine.
Protein: Fried or high fat meats, fried eggs, spicy/seasoned meats, or tough meats.
Soups: Soups that are high in fat; typically those prepared with heavy creams.
Vegetables: All raw vegetables; any vegetable with tough skin or seeds.
Fruit: Fruits or juices canned in syrup, dried fruits, fruits with peels
Carbohydrates: Refined breads/carbohydrates, sweets, pastries, sugar-coated cereals, course
fiber cereals, and added sugars
Sweets: All sweets and desserts should be avoided after surgery; do NOT eat a sweet on an
empty stomach.
Miscellaneous: Spicy foods, nuts, and seeds. Limit added fats (butter, margarine, sour cream,
salad dressings, and mayonnaise).
Sample meal plan for a soft diet
Breakfast
1 scrambled egg
1 ounce cheese
Mid-Morning Snack
1 high protein shake or bar
Lunch
2 ounces tuna
¼ cup of plain, no sugar added applesauce
Dinner
2 ounces of chopped turkey lunch meat (rind
removed)
¼ cup plain yogurt
¼ cup soft, cooked carrots
Evening Snack
1 high protein shake
13 | P a g e
Phase Four- Maintenance
Duration: Lifetime
Bariatric surgery is not a cure for obesity. Bariatric surgery helps to control obesity.
Surgery provides you with a tool to get your body started to lose weight. Following a diet,
changing behaviors, and increasing physical activity will ultimately determine how much
weight you are able to lose and maintain long term. Surgery is a gateway to a new and
healthy you. Take this opportunity to make healthy changes in your life.
Two months following surgery you will begin the maintenance phase of your diet. This
phase will last for the rest of your life. There are several key rules to keep in mind.
 Eat three, well-balanced, nutritious meals every day. Avoid snacking between
meals.
 Start every meal with 2-3 ounces of protein.
 Protein shakes are not necessary during the maintenance phase. It is okay to
supplement some initially if you are having difficult getting in enough protein at
meals. Continuation of protein shakes can decrease your rate of weight loss.
 Cut meat into very small pieces and chew well.
 Add vegetables slowly to the diet. Start with soft, cooked vegetables before adding
raw vegetables.
 Add fruit slowly to the diet as well. Start with canned, soft or peeled fruit. Slowly add
fruit with skin to the diet making sure that the skin is chewed especially well.
 Sip sugar-free, calorie-free fluids between meals.
There may be some foods that remain difficult to tolerate life-long after surgery. These are
very individual and differ from person-to-person. Try one new food at a time and items such
as meat, starches, fruits, and vegetables slowly, as tolerated.
Foods That May Be Difficult to Tolerate (especially for the first 6 months):
- Tough/grisly meats like pork chops
- Dried Fruits
- High Fiber bran cereals/granola, protein bar
- Citrus Fruit Membranes
- Popcorn
- Fruit Peels
- Non-toasted breads
- Nuts and Seeds
- Fibrous vegetables: dried beans, celery, corn,
- Spicy Foods
cabbage, romaine lettuce hearts, artichokes
- Added fats and sugars
- Raw vegetables Dried fruits
The Bariatric Surgery Plate Model
14 | P a g e




Use a 6-7” plate (usually the salad or dessert plate with a typical dinnerware set)
One half of the plate should be occupied by protein-rich foods (2-3 oz)
One third of the plate should be occupied by non-starchy vegetables (1/4-1/2 cup)
Less than one fourth of the plate should be occupied by carbohydrates such as
starch or fruit (~2-3 tablespoons)
Non-Starchy Vegetables
Carbohydrate-Rich
Foods
Protein-Rich Foods
15 | P a g e
A Word about Carbohydrates
As you may have noticed the amount of carbohydrate, especially starch, included in each of the
diet phases is minimal. There are a few reasons for this.
1. Early introduction of starch has been show to slow weight loss. This is why starch, even
whole grain starch, is not emphasized in the early phases of the diet.
2. It is very easy to replace protein with carbohydrate. Remember to aim for 60-80 grams of
protein daily even during the maintenance phase of the diet.
3. Many starches are difficult to tolerate after surgery. “Gummy” breads, rice, pasta, potato
dishes and pizza are challenging to tolerate after surgery because they give you a heavy
feeling. Bread is best tolerated after it has been toasted. Flat bread pizza with a crispy
crust is more likely to be tolerated than traditional or pan pizza. Rice, pasta and potatoes
can expand as they enter the stomach pouch.
Whole grain carbohydrates contain fiber which can actually promote a feeling of fullness. Legumes
(beans), fruit and starchy vegetables should provide most of your carbohydrate intake. When
choosing cereals, breads, pasta and crackers always read the label. Words, such as, multigrain,
100% wheat or bran advertised on the front of the package may indicate important health benefits
but do not necessarily mean a product is a whole grain. Read the label and the ingredient list. A
whole grain product should have more than 2 grams of fiber per serving and list whole wheat flour
as one of the first two ingredients.
Soft Calorie Syndrome:
Bariatric Surgery helps you to lose weight by leaving you with a full feeling after eating a small
amount of food. Surgery also helps you to prevent frequent snacking by leaving you feeling full or
satisfied for several hours following a meal. How long this feeling lasts depends on what you ate.
Protein rich foods and fiber rich fruits and vegetables prolong the feeling of fullness. Liquids and
soft foods pass through the stomach much more quickly decreasing the feeling of fullness. Eating
a diet rich in soft foods will make it harder to lose weight.
 Soups
 High calorie liquids such as whole or 2% milk; high protein shakes after the phase three
diet is complete
 Mashed potatoes or sweet potatoes
 Yogurt and pudding
 Refined carbohydrates (white cereals and breads)
Sources of Protein
16 | P a g e
Remember that protein is the most important nutritional component of your diet after surgery. You will want
to strive to consume 2-3 ounces of protein at each meal with a goal of 60-80 grams per day. As a rule of
thumb each ounce of beef, pork, fish, or poultry contains about 7 grams of protein. The following list is the
protein content in most foods:
Food/Beverage
MEAT, FISH, POULTRY
Lean ground sirloin
Roast
Corned Beef
Pork chop
Spare ribs
Tilapia
Shrimp, boiled
Tuna, in water
Salmon, baked
Perch, flounder, sole, haddock (baked)
Lobster
Baked ham
Chicken, dark, without skin
Chicken, white, without skin
Turkey, light meat without skin
Turkey, dark meat without skin
Ground turkey (97%lean)
Peanut Butter
MILK, CHEESE, YOGURT
Fat free or low fat cottage cheese
Skim mozzarella
Fat free American cheese
Skim milk
Non-fat dry milk
Yogurt, light
Greek yogurt, nonfat
Egg, large size
Egg white
Egg substitute
Tofu
Vanilla soymilk, nonfat
STARCHES
Fat free refried beans
Beans/lentils
Edamame, shelled
Serving Size
Protein
Calories
2 oz
2 oz
2 oz
2 oz
2 oz
2 oz
6 large
1/4 cup
2 oz
2 oz
2oz
2 oz
2 oz
2 oz
2 oz
2 oz
2 oz
2 tbsp
14g
12 g
15 g
17 g
16 g
15g
7g
14 g
12 g
14 g
15 g
13 g
15 g
19 g
17 g
16 g
11 g
8.5 g
150
130
140
109
224
72
33
45
115
65
80
100
115
90
80
92
60
190
1/4 cup
1 oz
1 slice
1 cup / 8oz
¼ cup
¾-1cup
¾-1cup
1 egg
1 egg white
¼ cup
¼ cup
1 cup
7g
6g
7g
8g
11 g
5-9 g
18-22g
7g
3g
7g
5g
6g
40
80
35
90
110
80-100
100-120
65
20
50
95
70
¼ cup
¼ cup
¼ cup
4.5 g
4g
8g
68
60
95
Solutions to Common Discomforts after Surgery
Dehydration:
17 | P a g e
Dehydration occurs when you do not take in adequate fluids. The goal is to drink at least 64 ounces of fluid
(preferably water) every day beginning immediately after surgery. Take fluids in small sips between meals.
Carry a water bottle with you to ensure that you have access to adequate fluid during the day. You will
need to increase your fluids if you experience diarrhea, increase your physical activity, or spend time
outside on hot days.
Dumping Syndrome:
Dumping syndrome is a group of symptoms that you may experience after Surgery. Dumping syndrome
occurs due to the presence of simple sugars in the small intestines and/or after consuming foods that are
too high in fat. Most people experience symptoms 15-30 minutes after eating. However, some symptoms
may develop 1-3 hours after the end of a meal. Symptoms can range from mild to severe and may include:
nausea, vomiting, abdominal pain/cramps, diarrhea, dizziness/lightheadedness, fatigue, rapid heart rate,
sweatiness, shakiness, fainting, or low blood sugar. To prevent dumping syndrome:
 Follow a low-sugar diet; avoid added sugars (including hidden sugars).
 Choose foods with less than 10-12 grams of sugar per serving.
 Avoid drinking with meals and for at least 30 minutes after meals.
 Avoid fatty/fried foods.
 Avoid alcoholic beverages.
 If dumping occurs, lying down for 20-30 minutes may help
Lactose Intolerance:
Some patients develop intolerance to milk and milk products after surgery. Symptoms include bloating, gas
and abdominal cramping after drinking milk or eating milk products. Use lactose free milk or fortified soy
milk or take Lactaid tablets when consuming dairy.
Nausea:
Nausea can be common during the first few weeks after surgery. Some solutions may include:
 Slow down eating or drinking
 Change the temperature of foods and liquids; sometimes room temperature is best tolerated
 Avoid strong smells
 If protein drinks are the culprit. Try drinking from a covered container or blend with ice.
 Try sugar-free popsicles, ginger tea, or adding lemon water.
Vomiting:
No matter what you read, it is not “normal” to experience vomiting after surgery. Vomiting generally occurs
after eating too much, eating too quickly or swallowing food that is not chewed well. To avoid vomiting,
remember the rules. Chew your food well, slow down and listen to your body’s signal for fullness.
If you experience nausea and vomiting related to the flu, food poisoning or any other reason, contact your
surgeon’s office. Your surgeon will likely prescribe an anti-nausea medication.
Constipation:
Constipation is related to two changes to the diet made after surgery. Many people find that they drink less
fluid after surgery putting them at greater risk for developing constipation. Secondly, undigested food, such
as fiber rich fruits and vegetables, provide bulk that helps to create stool. These foods are eaten in smaller
quantities after surgery increasing risk for constipation. While the volume of your bowel movement may be
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less after surgery, if you are not having a bowel movement every three days after surgery, you are
experiencing constipation. Try the following steps to alleviate constipation.
 Increase your fluid intake to 8-10 cups of water (or sugar-free, caffeine-free beverage) per day
 Increase your physical activity level to 30 minutes of walking per day
 Increase intake of fruits, vegetables, whole grains when able
 Try an over the counter stool softener such as Miralax
 Try an over the counter laxative or stimulant such as Milk of Magnesia
 Try an over the counter fiber supplement such as Benefiber
Remember that over the counter does not mean that a product is harmless. Regular laxative usage can
aggravate constipation and make you dependent on the laxative.
Gas:
Limit intake of gassy vegetables and high fat/greasy foods. Eat slowly and chew thoroughly. Avoid dairy if
you are lactose intolerant. Avoid carbonated beverages and chewing gum. Discuss an over the counter
charcoal tabs or internal deodorant with your physician. You may try an over the counter product such as
Gas-X or simethicone drops.
Hair Loss:
Temporary hair thinning or hair loss can occur after surgery. Stress, changes in weight and poor protein
intake are often the cause of hair loss. Hair loss often begins 3-4 months after surgery and ends 1 year
after surgery. If you are experiencing hair loss or thinning, ensure that you are taking in at least 70 grams
of protein per day. Supplements of zinc and biotin can also help.
Weight Gain/No further Weight Loss:
Make sure that you are eating 3 meals per day and not “grazing” throughout the day. Keep a record of all
foods and beverages to determine the exact reason to why this is happening. Increase the intensity or
frequency of physical activity. Call your dietitian to set up a follow-up appointment to go over what you’ve
been eating.
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Vitamin and Mineral Supplementation
Following bariatric surgery, it is necessary to take vitamin and mineral supplements. Initially, it is important to take
vitamins that are either chewable, in a liquid form, or able to be crushed.
Daily schedule for taking vitamin and mineral supplements:
Gastric Bypass:
Morning
Afternoon
Evening
Multivitamin/Mineral X2
500 - 800 mg Calcium Citrate with
500 - 800 mg Calcium Citrate with Vitamin
(200% of DV)
Vitamin D3
D3
B Complex Vitamin (if thiamine less than 510 mg in multivitamin)
2000 IU Vitamin D3
30- 60 mg Iron with Vitamin C (total of 45-60
mg daily)
Weekly: 500-1,000 mcg Vitamin B12 taken
sublingually OR monthly injection from PCP
Sleeve Gastrectomy:
Morning
Afternoon
Evening
Multivitamin/Mineral X2
(200% of DV)
500 - 800 mg Calcium Citrate with
Vitamin D3
500 - 800 mg Calcium Citrate with Vitamin
D3
B Complex Vitamin (if thiamine less than 510mg in multivitamin)
2000 IU Vitamin D3
Weekly: 500-1,000 mcg Vitamin B12 taken
sublingually OR monthly injection from PCP
Duodenal Switch:
Morning
Multivitamin/Mineral High in
Vitamins ADEK
B Complex Vitamin (if thiamine
less than 5-10 mg in
multivitamin)
Mid-Morning
600 mg
Calcium
Citrate with
Vitamin D3
Lunch
Multivitamin/Mineral High
in vitamins ADEK
30 mg iron with Vitamin C
Afternoon
600 mg Calcium
Citrate with
Vitamin D3
Evening
600 mg Calcium Citrate with
Vitamin D3
30 mg iron with Vitamin C
Weekly: 500-1,000 mcg Vitamin
B12 taken sublingually OR
monthly injection from PCP
Adjustable Gastric Band:
Morning
Afternoon
Evening
Multivitamin/Mineral with iron
*500 -800 mg Calcium Citrate with Vitamin *500-800 mg Calcium Citrate with
D3
Vitamin D3
Choosing vitamin/mineral supplements: Not all vitamins are created equal. Vitamin supplements are required by
law to list “Supplement Facts” on the label. When selecting a vitamin or mineral supplement, read the label. A few
recommended brands are listed below. If you are in doubt about whether your supplement is a good choice, please
bring your supplement to your next appointment so that either your dietitian can evaluate the label.
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Type of Supplement
Multivitamin/Mineral with Iron
Recommended Brands
 Bariatric Advantage
 Vita4Life Multi-Standard Formula
 Centrum Chewable
 Celebrate Vitamins
 Opurity
 Bariatric Fusion
Calcium Citrate with Vitamin D3









Vitamin D3 (2000 IU/day)
B Complex Vitamin** (take if multivitamin
does not contain at least 5-10 mg of
thiamine)
Iron


Bariatric Advantage Chewable
Citracal Petites
Celebrate Vitamins
Opurity
GNC Vitamin D3 1000 IU
Nature Made Vitamin D3
Nature’s Way Vitamin D3
Natrol Vitamin D3
Bariatric Advantage B-50
Complex
Solaray B Complex Chewable
Bariatric Advantage Chewable
Iron with Vitamin C
Celebrate Vitamins
Nature’s Plus Chewable Iron
with Vitamin C
Evaluating the Label
 100% of the Daily Value for at least
2/3 of the nutrients listed
 18 mg of iron preferred
 At least 400 mg folic acid
 5-10 mg of thiamine (B1) preferred
 Preferably has selenium and zinc
 Duodenal Switch patients must take a
vitamin high in vitamins ADEK**
 Do not take calcium carbonate
 Do not take a calcium supplement
without vitamin D3

Must be Vitamin D3 (Cholecalciferol)

Must contain thiamin

Do not take an extended release tab
(such as Slow Fe)

 Take ferrous gluconate, ferrous
fumarate, or ferrous sulfate

 Do not take iron at the same time as
calcium/vitamin D3
 Do not swallow iron with caffeinated
beverages or dairy products
 Supplement should contain at least
100 mg of Vitamin C
Vitamin B12 (Sublingual)
 Bariatric Advantage Sublingual
 Do not swallow the pill. Vitamin B12
B12
must bypass the stomach and enter
the bloodstream directly. Sublingual
 Nutraceutical Sciences Institutes
tablets, prescription nasal sprays, and
Sublingual B12 Dots
injections are the only supplements
 Bariatric Fusion Sublingual B12
that meet these criteria.
Many herbal supplements contain powerful ingredients that can affect the way your body reacts during surgery.
These supplements should be discontinued at least 2 weeks prior to surgery.
 St. John’s Wort
 Kava-kava
 Omega-3 fatty acids (fish oils)
 Vitamin E (greater than 30 IU)
 Ginko Biloba
 Garlic
 Ginger
 Feverfew
 Ginseng
 Ephedra
 Black Cohosh
 Grapeseed Extract
**Please let your surgeon and anesthesiologist know about any supplements or herbal medications that you might be
taking.**
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The Benefits of Physical Activity
Being active each day is an important step to help you achieve lasting weight loss following surgery.
Beginning a daily exercise program can be challenging; this is especially true if you have been inactive for
a long period of time due to poor activity tolerance or physical inability to exercise. You should have your
physician’s approval before beginning an exercise program. If you have a significant history of heart
disease, you should discuss with your physician the possible need for an exercise graded stress test before
starting an exercise program. When beginning an exercise program, start slowly. A good goal would be to
gradually increase your activity to between 30 and 60 minutes each day.
It is easy to think of an excuse not to exercise. It is important to realize that exercise plays a much larger
role in overall heath than just aiding weigh loss. Exercise has been proven to reduce appetite and aid in
digestion, reduce high blood pressure and risk for heart disease and some cancers, reduce stress and
improve sleep as well as increase energy levels. Individuals who participate in a regular exercise program
following bariatric surgery tend to lose more weight at a slightly quicker rate. More importantly, individuals
who exercise after surgery maintain their weight loss for a much longer period of time (lean tissue or
muscle contributes to your metabolic rate).
To make physical activity a priority in your life, you must create a physical activity plan now that you will be
able to follow after surgery. Be prepared to find a solution to any barrier that will prevent you from carrying
out your plan.
I don’t have time to exercise
o Start with 10 minutes per day and slowly add time.
o Walking three 10-minute bouts per day is equally as good as walking one 30 minute bout.
o Try using a step counter (pedometer). Track your average steps for one week then set a goal to
increase your steps by 2,000 per day. Over time, you may be able to increase your goal even
further. Good quality, accurate pedometers can be purchased at accusplit.com, digiwalker.com
and walk4life.com. A cover and security strap are recommended.
I’m too tired after work
o Plan to do something before work or during the day.
o A lunchtime walk may meet your goals.
It’s too hot outside
o Try walking inside of a shopping center.
o Water-walking in the shallow end of a swimming pool provides an excellent work-out.
Exercise is boring
o Find something you enjoy doing.
o Enlist a friend or family member to exercise with you.
o Switching your routine helps prevent boredom
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Resources
Websites:
Academy of Nutrition and Dietetics (www.eatright.org): Information on healthy lifestyles.
Bariatric Eating (www.bariatriceating.com): Weight-loss surgery products, success stories, and support.
Chef Dave (www.chefdave.org): Recipes and cookbooks for weight loss surgery.
My Plate (www.choosemyplate.gov): Daily food plans, dietary guidelines, and food tracker.
National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov): Calculate BMI, weight management tools.
Obesity Help (www.obesityhelp.com): Offers support/support groups.
Binge Eating Disorder (www.helpguide.org/mental/binge_eating_disorder.htm). Addresses binge eating disorder.
Online/Phone Application Food Trackers/Calorie Counters
www.myfitnesspal.com
www.fitclick.com
www.sparkpeople.com
www.calorieking.com
www.thedailyplate.com
www.loseit.com
www.fitday.com
Cookbooks/Recipes:
Before & After – Living and Eating Well After Weight Loss Surgery. Susan Maria Leach.
Eating Well After Weight Loss Surgery. Pat Levine, Michele Bontempo-Saray and William Inabnet.
Extraordinary Taste: A Festive Guide for Life After Weight Loss Surgery. Shannon Owens-Malett
Recipes for Life after Weight Loss Surgery: Delicious Dishes for Nourishing the New You. Margaret Furtado and
Lynette Schultz.
90 Ways to Ditch Your Diet. and Shakin’ it Up! Chef Dave Fouts. Available at www.chefdave.org
Books/Readings:
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The Emotional First Aid Kit: A Practical Guide to Life After Bariatric Surgery. Cynthia Alexander.
The Doctor’s Guide to Weight Loss Surgery: How to Make the Decision that Could Save Your Life. Louis
Flanebaum.
The Body Image Workbook: An 8-Step Program for Learning to Like Your Looks. Thomas Cash, PhD
The Success Habits of Weight Loss Surgery Patients. Colleen M. Cook.
Weight Loss Surgery for Dummies. Marina Kurian, Barbara Thompson and Brain Davidson.
The Weight-Loss Surgery Connection. Melissa Debin-Parish.
A Complete Guide to Obesity Surgery: Everything you need to Know about Weight Loss Surgery and How to
Succeed. Bryan Woodward.
The Real Skinny on Weight Loss Surgery. Julie Janeway, Karen Sparks and Randal Baker.
Obesity Surgery: Stories of Altered Lives. Marta Meana.
A Diary of Gastric Bypass Surgery. Darlene Drummond.
Winning after Losing. Stacey Halprin and Jane Greer.
Overcoming Binge Eating. Christopher Fairburn.
Mindless Eating: Why We Eat More Than We think. Brain Wansink, PhD.
Preparing for Weight Loss Surgery Workbook. Robin Apple, James Lock and Rebecka Peebles.
Real Solutions Weight Loss Workbook. Toni Piechota. Available at https://www.eatright.org/Shop
Fitness Resources
Activity at Any Size: Weight Control Information Network (http://win.niddk.nih.gov/publications/active.htm): Provides
information on how to begin physical activity, regardless of weight or size.
Chair Dancing International (www.chairdancing.com): Fitness routines for those who are unable to stand.
Orlando Health Wellness Center (http://www.orlandohealth.com/wellness): All community members are welcome to
join the Orlando Health Wellness Center. As a member you will have access to fitness equipment, group classes,
and many other additional services.
YMCA (www.ymca.net): Find your local YMCA; offers physical fitness programs
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