Nutrition
Pre-Surgery Diet (start 2 weeks before surgery)
1. Choose low-fat foods, and avoid fried foods.
2. Stop using sugar. Use sugar substitutes such as Sweet & low, Equal, or Splenda.
3. Decrease intake of desserts and candy.
4. Stop drinking sugar-sweetened beverages such as regular soda and sweetened
Kool-Aid.
5. Start weaning off of caffeine and carbonated beverages.
6. Start cutting back on fast food and eating out. Begin making healthy meal
choices when eating out and at home.
7. Eat 3 meals a day. Do not skip breakfast.
8. Start decreasing portion sizes.
9. Eat more fruits and vegetables.
10. Practice drinking water and other fluids between meals, not with meals.
11. Drink 64 ounces water a day.
12. Practice sipping liquids.
13. Avoid alcohol.
14. Begin some form of exercise.
15. Review the following information on the gastric sleeve diet.
16. Practice chewing foods thoroughly, 20 - 40 times or to paste consistency.
17. Purchase your protein drinks or supplements.
18. Purchase your vitamin and mineral supplements.
19. Begin planning a schedule for mealtime, fluids and vitamin and mineral
supplements.
Post –Operative Diet Guidelines
1. Eat 3 meals per day. Avoid snacking and grazing.
2. Eat small amounts. Initial portion size should be no more than 1 - 2 ounces -
approximately 2 - 4 Tablespoons - of food per meal for the first month. At first you
may not be able to tolerate this amount. Over time, you will slowly tolerate more
volume at each meal. Long term, the stomach will eventually hold about 4 - 8
ounces (1/2 - 1 cup) of food per meal.
3. Eat protein foods first.
4. Do not try to eat food and drink liquid together.
• Consume liquid 30 to 60 minutes before and/or 30 to 60 minutes after
eating meals but not during meals.
5. You are required to take a multi-vitamin with minerals for the rest of your life.
6. Eat slowly!
• Each meal should last 30minutes or longer.
• Avoid gulping foods and drinks.
• All foods must be well-chewed to a paste consistency.
• Using a small fork or spoon (i.e. baby utensils) can help control portion sizes.
• Have one place to eat (such as at the table) and avoid reading or watching TV
while you eat. This helps you to enjoy your food, concentrate on eating slower
and to realize when your stomach is full.
7. Drink plenty of calorie-free, non-carbonated, caffeine- free fluids between
meals.
• Drink slowly-sip fluids, never gulp.
• Calorie-containing beverages should be limited to skim milk and protein drinks.
• Limit juice to no more than 4oz. per day.
• Consume zero-calorie beverages throughout the day.
Diet Progression After Surgery
The diet after surgery progresses through several stages. Dr Shillingford will
let you know when it is okay to progress to the next stage.
Day 1 - 2 after surgery:
Clear Liquid Diet
The clear liquid diet means fluids or foods that are liquid at body temperature and can
almost be seen through. You will be on a clear liquid diet while you’re in the hospital.
Examples of Clear Liquid Diet (No Added Sugar/ Sugar Free):
• Clear (diluted) fruit juices without added sugar: apple, grape or white grape or
diet cranberry
• Sugar-free Crystal Light drink mix or popsicles, Sugar-free Kool-Aid
• Herbal tea, caffeine-free tea
• flat soda
• Sugar-free Popsicles
• Sugar-free gelatin
• Clear broth
• Water
It is best to dilute juices by 50% with water.
Avoid citrus juices (orange/grapefruit) and tomato juice for the first three weeks.
Coffee and de-caffeinated coffee contain acids which are irritating to the stomach
lining and should be avoided for the first few weeks for healing.
Day 3 through Day4:
Full Liquid Diet
The next stage is the full liquid diet which consists of sugar-free, low-fat milk products and
the clear liquids listed above. You will need to supplement with protein (drinks or
powder) after surgery. Remember to sip liquids, do not gulp.
Examples of Full Liquid Diet (No Added Sugar/Sugar-Free, Low Fat):
• Skim Milk or Lactaid milk
• Soy Milk (non-fat)
• Low fat, thin, strained cream soup (smooth, no pieces of food)
• Sugar-free instant breakfast
• Protein drinks – Start daily when you get home from the hospital. (See section on
protein and protein drinks)
• Plain or “light” (no sugar added) yogurt with no fruit pieces
• Sugar-free pudding or custard
• Thinned cream of wheat or rice cereal
Day 5 through Week 3:
Pureed Diet
You may now begin a pureed diet. This includes all items listed for clear and full liquids,
and the items listed for the pureed (blenderized) diet.
• Eat PROTEIN foods first
• Make sure foods are well blended.
• Start slowly. If you do not tolerate pureed foods go back to the liquid diet and try
again in a few days.
• Remember to drink liquids between meals, not with meals.
• Continue protein drinks or protein supplements every day.
Examples for the Pureed Diet (Sugar-Free/No Sugar Added, Low Fat):
Eggs
Cheese
Pureed or blenderized scrambled eggs or egg substitute or cheese
omelet; melted low-fat cheese, low-fat or non-fat cream cheese,
ricotta cheese, very smooth/mashed soft cheese such as mozzarella,
string cheese, low-fat or non-fat smooth or small curd cottage cheese
Meat, Fish,
Poultry,
Baby food meat or pureed meat or poultry moistened with broth or
low-fat gravy
Blenderized shrimp, scallops or fish
Pureed tuna or salmon (canned in water) or pureed egg salad with
low-fat or non-fat mayonnaise
Potted meats thinned with broth; smooth deviled ham
Starches Unsweetened instant oatmeal (strained), cream of wheat or rice
cereal, mashed potatoes or sweet potatoes, smooth polenta, hummus,
refried beans; low-fat or baked crackers or chips
Vegetables Baby food vegetables or pureed cooked vegetables (no corn or peas)
Mashed winter squash, tomato juice or sauce, pureed salsa, marinara
Soup Strained, low-fat cream soup made with skim milk; fat-free broth
Blenderized lentil or split pea soup or chili
Fruit Baby food fruits (bananas, pears, applesauce, peaches, mango, etc)
Unsweetened applesauce (smooth)
Unsweetened canned fruit – blenderized
Unsweetened fruit juice (diluted, no sugar added)
Remember: IF YOU CAN CHEW IT, DON’T DO IT!
Tips to Get Started
Everything that you eat on the pureed diet should be sugar-free or no sugar added, low fat
and blended to the consistency of baby food or smooth applesauce.
• You will need a blender or food processor or you can purchase baby food.
• Start with 1 ounce (2 Tablespoon) portions - no more than 4 Tablespoons at the
most. Listen to your body and stop eating as soon as you feel full.
• Eat protein foods first. Then if you are not too full, try vegetables or fruits.
• Continue protein supplements (80 g protein per day from supplement).
Helpful Hints for Blenderizing
• Cut foods into small pieces before putting into the blender or food processor.
• Remove seeds, skins and fat.
• Add liquid for ease of blending. Add enough liquid to cover the blades. Options
include skim milk, broth, strained low-fat cream soup, low-fat gravy, low-fat or
non-fat sour cream or fat-free half & half.
• Blend the item to a smooth, applesauce consistency.
• Make sure there are no particles, seeds or lumps remaining. If so put through a
sieve or strainer.
• If you have leftover blenderized foods, try freezing in single serving portions in ice
cube trays and put the frozen cubes into plastic freezer bags.
Meats – Very lean and dry meats puree better by adding a small amount of fat (margarine,
oil, light mayonnaise, gravy, etc.) Fish also tends to be dry. Improve the texture by adding
small amount of lemon juice, light mayonnaise or strained low-fat tartar sauce.
Starches – Try pureed peas, canned beans, sweet potatoes. Starches puree better when
hot. Rice and potatoes tend to puree into a gummy paste and are not recommended.
Substitute cream of rice cereal prepared with a flavorful broth and seasoned with
margarine. Pasta or noodles are not recommended as they are not well-tolerated.
Vegetables – Cook vegetables until soft. If using canned vegetables, drain first. Add
melted margarine and puree. Add a small amount of liquid until it reaches the smooth
applesauce consistency.
Fruit – If using canned fruit, drain first. Add a few drops of lemon juice to help prevent
them from discoloring.
Begin to take advantage of your favorite leftovers before surgery. Process these foods, and
freeze them in an ice cube tray. (Each cube is approximately 1/2 to 1 ounce). When
frozen, pop out into Zip-lock bag; label and date, and freeze cubes until needed.
Meal Guidelines for the Pureed Diet
(See Sample Pureed Meals listed in the Appendix)
Once you begin to eat pureed foods (which are considered solids) you will want to start
differentiating between liquids and solids – meals should include pureed foods, and so
liquids (including protein drinks) should be taken separately from your meals.
• You should eat 3 meals a day with protein drinks between meals.
• Protein drinks containing at least 20 grams of protein per serving should be
consumed as needed to meet 80 g/day goal.
• Start with a portion size of 1 to 2 tablespoons of pureed food for the first month.
At first you may not be able to tolerate this amount. Eat your protein source first, and then
if you have room a small amount of fruit, vegetables or other foods may be consumed.
Hints for Measuring Foods: Liquids or soft/pureed foods are best measured in
measuring cups or spoons; they can be measured in ounces, Tablespoons or mls.
1 cup 8 fluid ounces 240 ml 16 tablespoons
3/4 cup 6 fluid ounces 180 ml 12 tablespoons
1/2 cup 4 fluid ounces 120 ml 8 tablespoons
1/4 cup 2 fluid ounces 60 ml 4 tablespoons
1/8 cup 1 fluid ounce 30 ml 2 tablespoons
1 Tablespoon = 3 teaspoons
1/2 Tablespoon = 1-1/2 teaspoons
Week 4-8 After Surgery:
Soft Solid Food Diet
If you have been tolerating pureed foods, you may now begin a soft diet. This includes all
items listed for clear and full liquids and pureed diets plus items listed for the soft diet.
Try 1 to 2 new foods a day. This will help you to learn what foods you tolerate.
• Remember your stomach pouch empties more slowly with more solid or dense
foods than with liquids, so you will be able to tolerate a smaller quantity of food
than you could with liquids.
• Go slowly. If you do not tolerate the trial of soft foods, resume pureed foods and
try again in a week.
• Eat protein foods first
• Avoid foods high in sugar and fat.
• Space meals 4-5 hours apart
• Continue your protein drinks between meals
• Drink other fluids constantly between meals
Examples of Soft Diet (No Added Sugar/Sugar-Free, Low Fat):
• Baked fish (no bones)
• Imitation crab meat, baby shrimp
• Bananas
• Canned peaches or pears in water or juice
• Well-cooked vegetables without seeds or skin (no corn or peas)
• Scrambled, poached or hard boiled eggs
• Tuna or egg salad (no onions, celery, pimientos, etc.)
• Finely shaved deli meat
• Baked, grilled or rotisserie chicken
o Moist foods will be better tolerated. Moisten meats with broth, low fat
mayonnaise, or low-fat gravy or sauce.
o Fish and seafood proteins are softer and easier to break down than poultry
or red meat proteins.
o Reheating foods tends to make them dry out and hard to tolerate.
Common Problem Foods
(Avoid for 3 months after surgery)
• Red meat such as steak, roast beef, pork. Red meat is high in muscle fiber, which is
difficult to separate even with a great deal of chewing. Avoid hamburger for one
month after surgery.
• Un-toasted bread; rolls, biscuits. (Toasted bread may be better-tolerated.)
• Pasta
• Rice
• Membrane of citrus fruits
• Dried fruits, nuts, popcorn, coconut
• Salads, fresh fruits (except banana) and fresh uncooked vegetables, potato skins.
Month 2 After Surgery:
Regular Diet
• Problem foods as listed above can now be tried.
• Rice, pasta and doughy bread may not be tolerated for 6 months or more.
• Try fresh fruits without the skin first. If tolerated, the skin can be tried the next
time. Salads are generally well-tolerated if chewed well.
• Go slowly. Try a small amount to see how you feel.
• Avoid high sugar and high fat foods to avoid a high calorie intake.