Patients who decided to undergo bariatric procedures often ask what should be their diet after weight loss surgery and how much should they eat.
There are no clear guidelines how much patients should eat and what diet plan after weight loss surgery they should follow – the topic hotly debated not only amongst patients of various internet forums but also amongst the bariatric surgeons and dieticians themselves.
Nutrition after weight loss surgery may be tricky – how to provide your body enough of nutrients in an amount of food limited to half or one cup per meal. Also, the post weight loss surgery diet will differ vastly among different types of bariatric surgeries.
Table of contents
- 1 Diet following weight loss surgery in stages
- 2 Stage 1: Clear liquid diet (day one to 2 weeks after surgery)
- 3 Stage 2: Liquid diet (2 to 4 weeks after the procedure)
- 4 Stage 3: Pureed food (4 to 6 weeks)
- 5 Stage 4: Soft diet (6 to 8 weeks after the surgery)
- 6 Stage 5: Stabilization (8 weeks after the surgery)
- 7 Ketogenic diet after weight loss surgery
- 8 High protein diet after weight loss surgery
- 9 Should I take diet pills after weight loss surgery?
Diet following weight loss surgery in stages
The pace you move from one stage to the next is very individual and always depends on how fast your body heals and adjusts to the change in eating patterns. Typically you start eating regular foods about three months after the procedure.
Stage 1: Clear liquid diet (day one to 2 weeks after surgery)
On the first day after surgery, you’ll only be allowed to drink clear liquids like water, then on the second day, you are introduced to more nutritious liquids like milk. You need to drink a lot, keeping yourself hydrated. At first, you may need to dilute fruit juices to avoid nausea or diarrhoea. Once you’re handling those, you can start having other liquids, such as:
- Unsweetened juice
- Decaffeinated tea or coffee
- Milk (skim or 1 %)
- Sugar-free gelatin or popsicles
Stage 2: Liquid diet (2 to 4 weeks after the procedure)
For first weeks after your procedure, the main aim of your diet is to help your body in a healing process, so the biggest thing is to avoid postoperative complications, therefore liquid diet after weight loss surgery is the first stage. For the first few days, you can only drink small amounts of clear liquids at a time to help your stomach heal and avoid stretching by food. After clear liquids, you can introduce additional types of liquids, i.e. blended thin soup and broth, sugar-free pudding, sugar-free & nonfat yoghurt, low-fat cottage cheese.
Stage 3: Pureed food (4 to 6 weeks)
Within 4 weeks after the surgery, you are usually ready to start with the pureed diet consisting of pureed foods (food that can be pureed with a food processor or a blender) with thick, pudding-like consistency. In general, avoid spicy seasonings, as they may irritate the stomach. Fruits with lots of seeds, such as strawberries or kiwi are off the table at this stage, as well as foods that are too fibrous to liquefy, i.e. broccoli and cauliflower.
You may eat three to six small meals per day and each meal should consist of 4 to 6 tablespoons of food. Remember to eat slowly.
From foods that liquify well, you can eat the following:
- apples or applesauce
- canned fruits
- tomato juice
- summer squash
- green beans
- white fish (cod, tilapia, haddock)
- cottage cheese
- ricotta cheese
- scrambled eggs
Stage 4: Soft diet (6 to 8 weeks after the surgery)
You will probably eat nothing but pureed food for several weeks. With the green light from your doctor, you can start introducing soft, easy-to-chew foods into your diet.
You are allowed to eat three to five small meals per day and the proportion of the meal should be one-third to one-half cup of food. Thoroughly chew each bite before swallowing.
The food you may include in your diet:
- soft-boiled eggs
- ground meat
- cooked white fish
- cottage cheese
- cooked or dried cereal
- canned fruits without skin, such as peaches or pears
- cooked vegetables, without skin
Stage 5: Stabilization (8 weeks after the surgery)
The last stage of your diet is the reintroduction of solid food to your weight loss surgery menu. You will need to dice or chop your food into small bites as large chunks of food may cause a blockage leading to pain, nausea, and vomiting.
Reintroduce foods slowly one by one to determine which ones your stomach can tolerate and which ones to avoid. You should completely eliminate from your diet any food that causes adverse reaction such as vomiting or nausea.
You should still refrain from eating certain foods, especially hard to digest foods like:
- fibrous or stringy vegetables (such as pea pods)
- corn on the cob
- carbonated beverages
- tough meat
- fried food
- crunchy foods (such as pretzels, granola, seeds, and nuts)
- dried fruit
- bread and bread products
About four months after surgery, your doctor may decide that you are ready to eat normally. Portion control will be still important though and your main focus will be nutrition after weight loss surgery. Your diet should consist mostly of fruits, vegetables, lean protein, and healthy carbohydrates and vitamin and minerals supplementation will be needed, especially after gastric bypass, gastric sleeve and POSE surgeries. To avoid minerals malabsorption of minerals and vitamins after those surgeries, you will need a high dosage of multivitamins (iron, folic acid, selenium, copper and zinc), supplementation of calcium and Vit D and Vit B complex.
Weight loss surgery is not only about avoiding certain foods – it’s about changing your lifestyle completely. So unhealthy foods high in fat, carbohydrates, and calories should be avoided completely. Eating well means you can enjoy continued health without putting weight back on.
Ketogenic diet after weight loss surgery
“Keto”, an abbreviation standing for ketogenic, refers to a metabolic state known as ketosis meaning the state when your body runs on ketones produced in the liver rather than on glucose and insulin. The ketogenic diet, or in other words low carb high fat (LCHF) diet, supports the transition and maintenance of this metabolic state.
In general, when the body is getting adequate carbohydrates from the diet, it runs on glucose (sugar) as its main source of energy. Providing enough carbs to function allows the body to store the fat, which is also a great source of energy. Keto diet is so low in carbs and sugars that the body is induced into a different metabolic state. During this state, our liver starts to produce ketones from the breakdown of fats to provide fuel to our body and weight loss occurs as a result of this shift. Weight loss is a result of starvation of carbs not a starvation of calories.
Challenge presented by keto diet is a big one, but it tends to be very beneficial and studies show many pros of this diet. Mood’s improvement, increased level of energy, enhance blood sugar control, mental clarity, improved hunger control, lowered blood lipid levels and blood pressure, and clearer and brighter skin are just some of those.
As with every diet, keto is not suitable for everyone, as first and foremost this diet is very restrictive. The only products allowed to eat are meat, fish, seafood, eggs, healthy fats (nuts, avocado), low-carb dairy foods, and non-starchy veggies like leafy greens. The food avoided in this diet are grains, fruit, starchy veggies (i.e. corn and potatoes), legumes, processed or packaged foods high in carbs, and sugar.
During the induction phase, people switching to keto may also experience some unpleasant side effects like fatigue, headaches, muscle cramps, constipation, bad breath, and dizziness caused by dehydration and loss of electrolytes. The name for the symptoms during this transitional period often refers to as “keto flu”.
In general macro ratio of a keto diet is 70% fats, 25% protein, and 5% carbohydrates in your daily food intake. Starting a keto diet carbs shouldn’t exceed 20 grams.
The ratio guidelines for a keto dieter eating 1000 calories per day would have the following breakdown:
70% fat= 700 calories/78 grams fat
25% protein= 250 calories/62.5 grams protein
5% carbohydrates= 50 calories/12.5 grams carbs
However, there are some things that should be considered for bariatric patients, i.e. the guidelines suggest eating at least 60-80 grams of protein per day and many surgical patients may be unable to tolerate such high levels of fat per day. Instead, a Bariatric-modified keto diet may look something like this:
80 grams protein (320 calories) = 32% of total calories
20 grams NET carbohydrates (80 calories) = 8% of total calories
67 grams fat (600 calories) = 60% of total calories
A modified keto diet would look more like a general low carb diet, so instead of reducing your carbs intake to less than 20 grams per day, you might try to eat less than 40-80 grams of carbs per day. Although your body might reach the state of ketosis it is likely that you will still have many benefits of a keto diet including weight loss.
Many people admit that after cutting out their sugar and processed carb intake, their energy increased, they have improved hunger control, lower blood sugar, they lose weight and have better mental focus.
Thinking of weight loss after bariatric surgery it is of paramount importance for the patients to follow a well-balanced diet rich in nutrients. The keto diet, high in fats, may not be ideal, as your stomach and liver may have difficulties to absorb those after bypass or sleeve, however it may be a viable option for patients after gastric plication or gastric balloon. Unhealthy fats can lead to stomach problems for bariatric surgery patients, i.e. gas, nausea, and diarrhoea. In any case, a patient considering a ketogenic diet after bariatric surgery should discuss the options with the surgeon. This diet is not a good option for those with heart disease, Type 1 Diabetes, Type 2 Diabetes or pregnant women.
High protein diet after weight loss surgery
As a part of your surgery, you would be provided by the dietician or surgeon with the guidance and instruction of the best weight loss surgery post-op diet. It is of utmost importance you follow those guidelines to ensure healthy and quick weight loss surgery recovery and best weight loss results. Diet restrictions after weight loss surgery are strict, but you will need to make sure that your protein intake is on a good level, as protein being a cornerstone of the post-bariatric surgery is important in supporting body’s optimal well-being. Protein is a building block of every cell, tissue and organ and they are constantly being broken down and need to be replaced. Your body needs protein to rebuild muscle.
You must always keep in mind, that bariatric surgery alone won’t magically solve your weight problems, your diet and workout regime can make or break the success of your weight loss after the procedure. The surgery itself it’s a 50% of your weight loss effort, physically curbing the amount of food you are able to eat at one go to sate your appetite, but hunger is only one factor that influences your dietary choices.
Your eating strategy needs to change completely after the surgery and you need to make sure that you are choosing well-balanced and nutritious foods that will leave you sated after the meal, which will also be beneficial in fighting with mental or emotional-based reasons for overeating. Keeping an eye on nutrition labels and making sure that you are getting enough protein in your diet per day.
Proteins are a fundamental aspect of any healthy diet and every sample diet after weight loss surgery will be packed with them as your calories intake will be significantly curbed. Every bite you are having should be filled with nutrients. High-protein foods include eggs, meats, fish, seafood, tuna, poultry, soy milk, tofu, cottage cheese, yoghurt and other milk products. Your aim is a minimum of 65 to 75 grams of protein a day, but don’t worry if you aren’t able to reach this goal for the first few months after surgery.
Protein adjustments might include:
- Eating your protein first to ensure that you eat them before feeling full
- Consuming lean proteins low in calories and high in nutrients (grilled chicken or turkey)
- Introducing protein supplements and/or protein shakes to balance your daily intake
Should I take diet pills after weight loss surgery?
Medical therapy can be an alternative to revision surgery when post-bariatric surgery patients fail to lose weight or start to regain weight. Leptin is a hormone responsible for regulating energy balance by inhibiting hunger, and many dieters losing weight, particularly those with an overabundance of fat cells, experience a drop in levels of circulating leptin. This decrease in leptin level leads to slowing your metabolism and increasing hunger. Leptin seems to be a signal for the brain that prevents starvation during times of calorie restriction.
Appetite suppressants may have a significant role in curbing your appetite when your body reaches the plateau in weight loss or when you start to regain weight. These medications act to both decrease appetite and increase the basal metabolic rate and as a result, can balance the effects of the neuropeptides tending to favour weight regain. A long-term use of medications may be required to bring desired effects and this method is becoming more and more accepted among the circles of specialists dealing with obesity.
The United States Food and Drug Administration (FDA) approved the following appetite suppressants: Phentermine (the most commonly used suppressant), Phentermine/Topiramate Controlled-Release, Diethylpropion and Phendimetrazine.
All in all, the appetite suppressants might prove to be a useful adjunct to the bariatric procedure in the long-term management of obesity. However, a thorough assessment is essential when patients have problems with losing the expected amount of weight or begin to regain lost weight. In the majority of cases, a well-balanced diet and exercise regime in addition to the surgery should be enough to lose excessive kilograms, as any weight loss surgery means a complete change of patient’s lifestyle.
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