Gastric bypass diet: Nutritional needs after weight loss surgery

The gastric bypass diet outlines what you can eat and how much after gastric bypass surgery. Find out ways to establish new eating habits for successful weight loss.

What you eat, how you eat and how much you eat changes after gastric bypass surgery — surgery that alters the anatomy of your digestive system to promote weight loss.
With your stomach pouch reduced to the size of a walnut, you'll need to follow a gastric bypass diet. This diet tells you what type and how much food to eat with each meal and the required consistency and texture of the food. The gastric bypass diet helps you maintain good nutrition while losing weight.

After surgery: The first three months
You won't be allowed to eat for one to two days after the surgery. Then you consume specific foods according to a diet progression. The purpose of the diet progression is to allow your stomach time to adapt to processing food and to allow you to lose weight while maintaining good nutrition.

The following are common phases in the gastric bypass diet progression:

Liquids. Foods and fluids that are liquid or semiliquid at room temperature and contain mostly water, such as broth, juice, milk and cooked cereal. In most cases, you stay on a liquid diet for two to three days.

Pureed foods. Foods with a consistency of a smooth paste or a thick liquid. Pureed foods contain no distinct pieces. You usually eat pureed foods for three to four weeks so that your stomach has time to fully heal.

Soft foods. Foods that are tender and easy to chew, such as ground or finely diced meats, canned or soft, fresh fruit, and cooked vegetables. You usually eat soft foods for eight weeks before progressing to regular-textured foods, as recommended by your dietitian or doctor.

During the diet progression, you eat many small meals a day and sip water frequently. You might first start with six small meals a day, then progress to four meals and finally, when eating regular foods, decrease to three meals a day. Typically, each meal includes protein-rich foods, such as lean meat, yogurt and eggs. Protein is important for maintaining and repairing your body after surgery.
How quickly you move from one step to the next depends on how fast your body adjusts to the change in eating patterns and the texture and consistency of food. In most cases, people start eating regular foods three months after surgery.

Lifelong changes: New eating habits
After three months, expect to eat three small meals and three small, healthy snacks a day. Your meals typically include lean sources of protein (such as poultry without skin or low-fat cottage cheese) fruits, vegetables and whole grains. Limit or avoid high-sugar, high-fat foods, which provide many calories but few nutrients.

The changes in your digestive system restrict how much you can eat and drink with each meal. To avoid problems and to ensure you're getting all the nutrients you need, closely follow these guidelines:

Eat small amounts. Just after surgery, your stomach holds only about 1 ounce of food. Though your stomach stretches over time to hold more food, you won't be able to eat more than 1 to 1 1/2 cups of food with each meal. Eating too much food adds extra calories and can cause pain, nausea, vomiting and abdominal cramps. Make sure you eat only the recommended amounts and stop eating before you feel full.

Eat and drink slowly. Eating or drinking too quickly, especially high-sugar foods such as soda or ice cream, can cause dumping syndrome — when foods and liquids enter your small intestine rapidly and in larger amounts than normal, causing nausea, vomiting, diarrhea, dizziness and sweating. To prevent dumping syndrome, eat your food and sip your beverages slowly. Take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup of liquid.

Chew food thoroughly. The new opening that leads from your stomach into your intestine is very small and large pieces of food can easily block the opening. Blockages prevent food from leaving your stomach and could cause vomiting. Take small bites of food and chew them to a pureed consistency. If you can't chew the food thoroughly, don't swallow it.

Drink most of your fluids between meals. Drinking beverages with your meals may cause pain, nausea and vomiting as well as dumping syndrome. Also, too many liquids at mealtime may leave you feeling overly full and prevent you from eating enough nutrient-rich foods. Expect to drink about 6 to 8 cups of fluids a day to prevent dehydration.
Try new foods one at a time. After surgery, certain foods may cause nausea, pain, vomiting or may block the opening of the stomach. To find out which foods are OK to eat and which cause you trouble, try one new food at a time. Foods that commonly cause trouble include dry tough meats, bread, raw vegetables and carbonated beverages.

Take recommended vitamin and mineral supplements. After surgery, your body has difficulty absorbing certain nutrients because most of your stomach and the first part of your small intestine are bypassed. To prevent a vitamin or mineral deficiency, take vitamin and mineral supplements regularly. These may include a multivitamin-multimineral, calcium, vitamin B-12 and possibly an iron supplement.

Weight loss and weight gain
Within the first two years following surgery, you can expect to lose 50 percent to 60 percent of your excess weight, if you follow the dietary and exercise recommendations. If you continue to follow these recommendations, you can keep most of that weight off long-term.

However, if you return to your old eating habits, you may gain back any weight you've lost. People who regain weight after gastric bypass surgery usually are consuming too many high-calorie foods and beverages and don't exercise enough. And rather than eating three meals a day and small snacks, some people graze — eat food all day long. This eating pattern often leads to consuming too many calories, which causes weight gain.

If you aren't losing weight or are regaining weight after surgery, see your doctor. Your health care team can help reassess your eating and exercise habits and help you confront and overcome any weight-loss obstacles.
Though weight-loss surgery helps you shed the pounds, its success depends on your willingness to adopt lifelong healthy-eating and exercise habits. What you eat and how you eat changes after surgery, but the benefits of weight loss and your improved health are well worth these efforts.

Purpose
Gastric bypass is a type of surgery in which the stomach is reduced in size by one of several methods. This smaller stomach is then reconnected or bypassed to the small intestine. Having a gastric bypass can help speed weight loss by making it difficult to eat too much food at one time and to feel satisfied after very small meals.

After a gastric bypass, the volume the new, smaller stomach can hold is reduced from about 1 quart to about 1 ounce, or 2 tablespoons. Over time, the stomach pouch will stretch until it can hold 4 to 8 ounces, or about 1/2 to 1 cup, at a time. The size of the opening created between the stomach and small intestine is smaller, too&emdash;roughly 1/4 inch wide&emdash;which slows the rate at which food is emptied from the stomach into the small intestine.

Gastric bypass is usually performed only after many other methods of weight loss have been tried and failed. However, the surgery is not an end in itself. It is important to work closely with a physician and registered dietitian (R.D.) to start a program of new eating habits to ensure that weight loss is safe and successful. A regular, simple exercise program and psychological support are often recommended to create a better self-image and a whole new attitude to food.

 Nutrition Facts
The gastric bypass diet is designed to bring about significant weight loss. Learning new eating habits and following the diet correctly will help to maintain this weight loss over time. In general, the gastric bypass diet includes foods that are high in protein, and low in fat, fiber, calories, and sugar. Important vitamins and minerals are provided as supplements.

Protein is the nutrient that the body uses to build new tissue. It is important to get enough protein right after surgery, to make sure that wounds heal properly. Over the long term, protein in the diet will help preserve muscle tissue, so that weight can be lost as fat instead. Foods like lean red meat or pork, chicken or turkey without the skin, fish of almost any type, eggs, and cottage cheese are high in protein and low in fat.

Sugary foods include candy, cookies, ice cream, milkshakes or slushes, soda pop, sweetened juices or gelatin, and most desserts. The gastric bypass diet is low in sweet and sugary foods for three reasons. First, these foods are high in calories and fat. Even in small amounts, they could make weight loss difficult. Second, eating sweet or sugary foods promotes "dumping," a reaction which can occur after the gastric bypass operation. Experiencing the unpleasant symptoms of dumping syndrome may limit the desire to eat sweet foods. Finally, most sweet and sugary foods don't provide many vitamins or minerals for the calories they take up&emdash;and since calories are so limited on the gastric bypass diet, it is important that every food contribute its fair share of nutrients.

Fat may be difficult to digest after gastric bypass surgery. Too much fat delays emptying of the stomach and may cause reflux, a back-up of stomach acid and food into the esophagus that causes heartburn. Fat may also cause diarrhea, nausea, or stomach discomfort. High-fat, fried foods and fatty meats are common offenders.

Fiber, found in foods like bran, popcorn, raw vegetables, and dried beans, is also limited on the gastric bypass diet. There is less space in the stomach to hold these bulky foods, and less gastric acid available to digest them. Some kinds of fiber could get stuck in the pouch itself, or block the narrow opening into the small intestine. Do not take any fiber pills or laxatives without the advice of a physician.

Vitamins & Minerals are an important part of the gastric bypass diet. Since the diet allows only small amounts of a limited variety of foods, it may be difficult to get enough vitamins and minerals from food alone. Deficiencies can develop in a matter of months. Iron, folate, vitamin B-12, and calcium are the nutrients most affected. Most physicians require their gastric bypass patients to take a multivitamin/mineral supplement.

The Gastric Bypass Diet
The gastric bypass diet unfolds in several stages, from "liquids only" to small meals of soft, high-protein foods. Meals on the new menu will be much smaller than normal, and the foods eaten must be very smooth in texture. On all stages of the diet, it is especially important to drink enough water, and to take vitamin and mineral supplements as prescribed.

1.Clear Liquids -- The first stage of the gastric bypass diet, clear liquids (meaning beverages that you can almost see through), usually lasts for a day or two after the operation. The clear liquid diet starts with sips of water, and then allows foods like sugar-free juice, diet gelatin, boullion or clear broth, and flat (no fizz) diet soda in small amounts, usually 2-3 ounces at a time.

2.Low-Fat Full Liquids -- If no problems are experienced with clear liquids, the gastric bypass diet advances to high-protein liquids like diet Carnation Instant Breakfast™, Ensure™, or Sustacal™. This stage of the diet is started before discharge from the hospital and lasts for 1 to 2 weeks. Most patients also begin taking a chewable multivitamin/ mineral supplement at this stage.

3.Soft/Purée Diet -- The physician will indicate when it is time to advance to the soft or purée diet. Some patients are able to start this diet after they have been out of the hospital for about two weeks. Others may need to wait longer. The purée diet includes very soft, high-protein foods like scrambled egg, low-fat cheese or cottage cheese, or blenderized lean meats like tuna fish, chicken, or pork. Some patients find it more convenient to use strained baby foods. It is important to make sure that all foods are puréed or extremely soft and smooth in texture.

4.Regular Diet -- The regular diet starts about 8 weeks or later after gastric bypass surgery. While this diet includes all 5 food groups, it is important to start with high-protein foods, like lean meats or milk, at every meal. Each meal or snack should be small, with liquids consumed in between meals. Ask a dietitian for advice on planning an individualized regular diet pattern.
The ABC's of Eating Right
In all stages of the gastric bypass diet, the way to eat is just as important as what to eat. Things to remember:
The new stomach can only hold 1/2 cup at a time
Eat 3 to 6 small meals a day
Chew food thoroughly and eat slowly
Avoid chewing gum&emdash;it could block the stomach outlet if swallowed
Do not overeat
Relax and enjoy your new life