Northumbria Healthcare
NHS Foundation Trust
Eating plan after
gastric bypass
Issued by Nutrition and Dietetics
Dietitian
……………………………………….
Bariatric Specialist Dietitians
Telephone: 0191 293 2707
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This leaflet will provide you with advice on how to eat well
following your weight loss surgery and is based on our
experience of what seems to work well for most people.
With weight loss, you may see an improvement in weight-related
health conditions that you may have such as type 2 diabetes, high
blood pressure and sleep apnoea.
Follow the suggestions in this leaflet to help prevent your smaller
stomach from stretching; to get the nutrients you need for good
health and to prevent nutritional deficiencies and side effects such as
nausea, vomiting, bloating and blockages.
Physical activity remains important to help manage your weight in
the long term. The guidelines for adults are that they should aim to
be active daily and should do at least:
•
•
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150 minutes of moderate-intensity aerobic activity each week
plus muscle strength activities on two or more days each week
OR
75 minutes of vigorous-intensity aerobic activity plus muscle
strength activities on two or more days each week
OR
An equivalent mix of moderate and vigorous aerobic activity each
week plus muscle strength activities on two or more days a week
Your nutrition plan after bariatric surgery is for life.
How does the gastric bypass work?
The gastric bypass is a restrictive and malabsorptive procedure:
a small part of the stomach is used to create a small pouch which
means you will feel full more quickly with a very small amount of
food. The small stomach pouch is then connected to the middle part
of your small intestine, bypassing the rest of your stomach and first
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portion of your small intestine. This means only a certain percentage
of the food you eat will be absorbed. This will lead to weight loss.
Due to this malabsorption it is vital that you take your vitamin and
mineral supplements.
Many people report that their tastes and food preferences change
after surgery and this is entirely normal.
Weight loss – what to expect
You will lose most of your excess body weight in the first 1-2 years
after surgery. Your commitment to healthy eating and lifestyle habits
will help you to lose the weight, maintain your weight loss and help
you feel well.
The speed that you lose weight will vary from person to person.
Whilst you may lose weight very quickly, it is common for your weight
loss to slow down after the first few months. Do not panic - your body
will take time to adapt to the reduction in calories and if we eat too
little over a long period of time, our metabolism (the speed at which
we burn calories) slows down. You may find that you are losing
inches instead. You can help your weight loss by eating regularly
and choosing healthy foods.
Vitamin supplements
It is vital that you take the recommended supplements to prevent
any vitamin or mineral deficiencies as the amount you are able to eat
and/or absorb will be vastly reduced. Take these for life.
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Multivitamin and Minerals
• First month only after surgery take chewable/liquid supplements
twice a day. Choose a variety which says: ‘multivitamins with
minerals’ and is suitable for adults
• After the first month you should be able to take tablet
multivitamins. Choose a variety which says on the label: ‘A-Z
multivitamins and minerals’ or ‘Complete multivitamins and
minerals’. Take two tablets a day
Additional Supplements
• Calcium and vitamin D supplement which your GP will prescribe
for you
• Vitamin B12 injections. Most people need a maintenance dose
once every 3 months. Your GP will be able to arrange this for
you.
• Iron supplement(s) will be prescribed for you by your GP
• Take your multivitamin and mineral supplement and iron
supplement at a different time from the calcium and vitamin D
supplement i.e. 1-2 hours before/after
You may need to take additional supplements on the advice of your
bariatric dietitian or consultant. This is usually because your blood
tests have shown a deficiency and/or your diet is lacking a
nutrient(s).
Do not take any extra supplements without checking with your
bariatric dietitian.
Food re-introduction
Please refer to the ‘meal ideas booklet’ for more information.
Initially your stomach will have some swelling and tenderness from
the operation therefore it is important that you gradually increase the
texture of your diet from liquids to solids over a 6-8 week period.
If you have trouble eating a certain food at first, stop eating it and try
again in a week or so. It may be helpful to keep a food diary to
record what you ate and how you tolerated the food.
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The diet after surgery is split into four stages:
Your date of surgery……………
Stage
Texture
When to start
1
Fluids only
Day of surgery
3
Soft foods
4
Solid foods
Week 4 post
operatively
2
Pureed foods
Day 1-2 (as advised)
post operatively
Week 6-8 post
operatively
For how long
1 day
4 weeks
2-4 weeks
Ongoing
Remember the time to progress from one stage to the next can vary
between individuals. It is important not to rush each stage. Only
move onto the next stage when you are ready. You are less likely to
experience problems if you begin carefully.
Portions
It is difficult to give set portion sizes for each stage. This is because
we have found that the amount people can eat after surgery varies
between individuals. It is important to eat slowly and stop eating as
soon as you feel full.
As a guide, we expect your first few meals to be no more than 3-4
teaspoonfuls. This will slowly increase to an egg cup size portion. By
the time you are on stage three (soft foods) you should be taking no
larger than a saucer sized portion. Eventually your normal portion in
the longer term will be a side plate sized portion, this is a seven inch
or 18cm plate. It is important that you increase the portion sizes
slowly so as not to stretch your new pouch – if this happens it will
affect your long term weight loss.
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How to eat after surgery
• Eat slowly. Take small bites of food and chew very well
• Do not eat and drink together – avoid drinking 30 minutes before
a meal and one hour after a meal
• Food should be chewed to a paste before swallowing
• Choose foods that are easy to chew so that they break down into
small pieces
• You may find it helpful to eat your food using smaller cutlery
• Focus on enjoying your food
• Avoid distractions such as the television, telephone and computer
while you are eating
• Pay attention to your body’s signals of hunger and fullness. Stop
eating as soon as you feel full or have any chest pressure or
discomfort
• Always follow the 20:20:20 Rule
– chew every mouthful 20 times
– pause for 20 seconds between mouthfuls
– a meal should last approximately 20 minutes
Meal Pattern
• Eat 4-6 times a day
• Include 3 small meals a day and 2-3 small, nutritional snacks
each day.
• Plan your meals and snacks in advance
• Choose foods from all the main food groups (see meal ideas
leaflet)
• Include protein at each of your meals and snacks. Higher
amounts of protein are found in lean meats, poultry, fish, eggs,
beans, lentils and low-fat dairy products
• Each main meal should contain protein, vegetables and
carbohydrates. Eat a mouthful of each food in turn
• Choose foods that are mostly solid (from week six after surgery)
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Fluids
• Do not drink with food. Avoid drinking 30 minutes before a meal
and one hour after a meal
• Try to drink two litres of fluids each day – keep a drink with you
throughout the day
• Sip drinks slowly – do not gulp quickly. Initially a small glass
should take one hour to drink
• Do not drink fizzy liquids as they may cause bloating and could
stretch the small stomach you have left. Drink water, sugar free
still drinks, tea or coffee instead
• Do not use straws to drink your liquids. This may cause gas or
bloating
Alcohol
People who have had a gastric bypass do find that they feel the
effects of alcohol quicker and with only a small amount. Alcohol can
also cause dumping syndrome and is best avoided. Also, alcohol
provides calories and no nutrition. We recommend that you avoid
alcohol completely for at least three months after surgery.
Foods to avoid
It is common not to be able to eat certain foods after a gastric
bypass.
• Some foods may stick in your stomach pouch or cause
blockages. Foods such as overcooked rice, overcooked pasta
and soft doughy breads are more likely to be sticky and are best
avoided
• Avoid foods which are hard to chew. This includes dry tough
meats, stringy vegetables or fruits, vegetable or fruit skins, nuts
and popcorn
• Avoid chewing gum as it can cause bloating
• Large pieces of food can cause blockages and vomiting
The following list gives examples of the foods which you may
struggle to eat and should avoid and alternative suggestions:
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Foods to avoid
Alternative to try
Overcooked rice, overcooked
pasta
Rice and pasta cooked still
in“pieces”/al dente
Couscous
Bread
Tough, dry meats
Skins on fruit and vegetables
Crackers
Crispbreads/breadsticks
Toast
Pitta bread / wraps
Cook meats in slow cooker/
oven for longer time until soft
and tender
Wafer thin cold cuts
Minced meats
Add low fat gravy/sauce to
moisten
Peeled fruit and vegetables
Ripe soft fruits
Tinned fruits in natural juice
Fibrous and stringy vegetables Cauliflower, broccoli, carrots,
root vegetables (buy frozen
such as cabbage/onions/
to reduce waste)
lettuce/sweetcorn
Chop onions finely
Try grating fruit or vegetables
Oranges/grapefruit
Nuts, dried fruits, seeds and
foods containing these
Coconut
Popcorn
Soft ripe fruits e.g. peeled
peach/plum/pear/tinned fruit in
natural juice
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Potential problems
Dumping syndrome
This occurs after the consumption of sugary or fatty foods and
drinks.
“Dumping” syndrome has a range of symptoms from feeling tired
and lightheaded to fainting and diarrhoea. It can also cause you to
feel shaky, clammy, and nauseated.
You can prevent it by avoiding foods/drinks high in sugar and fat or
alcohol.
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Foods to avoid include:• Biscuits and cakes
• Chocolates and sweets
• Sugar and sugary drinks
• Pure fruit juice - dilute with
water and take in small amounts only
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Tomato soup
Full fat dairy products
Pastry
Fried foods
Oils
Hair loss
This is usually due to the physical stress of rapid weight loss but can
occasionally be linked to a poor diet.
• Include protein rich foods with each meal and snack
• Take an A-Z multivitamin and mineral supplement twice a day
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Normal hair growth usually returns after a year.
Do not take additional supplements unless advised by your
dietitian/doctor.
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Vomiting
This may be due to eating too quickly, eating too much, not chewing
food well or eating the incorrect texture of food.
• Eat slowly, chew well and stop eating when you are full
• Check the texture of your foods to ensure they are not too dry,
tough or sticky
• Do not eat and drink together
If you cannot keep any food or fluid down seek medical advice.
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Constipation
Often due to lack of fibre and/or fluids, anxiety and depression can
also make it worse:
• Choose high fibre cereals and include plenty of fruit and
vegetables
• Eat regularly
• Ensure you drink two litres of fluids each day
• Exercise regularly
• See your GP if the problem persists as you may need laxatives
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Dizziness / light-headedness
Often due to lack of food, irregular meals and/or dehydration:
• Eat regular meals with a starchy carbohydrate at each meal
• Try to eat every 3-4 hours during the day
• Ensure you drink two litres of fluids each day
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If you have any questions regarding your diet please do not
hesitate to contact us on 0191 293 2707. There is an answering
machine if we are not in the office, please leave us a message
and we will contact you as soon as possible.
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PIN 650/V2
Review date: July 2018