Transition Nutrition:
How to transition from pureed diet to regular textures
Transitioning TIPS
 Introduce only one new food per day; try the same food for
2 days before putting it on your “safe foods” list
 Avoid cores and skins of fruits and vegetables at first
 Eat only soft foods that are easy to digest and work up to normal texture
 Chew, chew, chew, before you try another bite
Fluids
 Still aim for 64 oz of fluid/day (4 oz/hr)
 Low calorie (<20 cals per serving), no carbonation/bubbles
 DON’T eat and drink at the same time (wait 30 min after eating to drink)
Food/meal/snack planning









Goal for first several months 60 grams of protein/day
Volume: approximately ½ cup to ¾ cup at a time (depends on texture)
Measure/weigh your food to know how much you tolerate
Keep a food journal to track intake
Move to more SOLID foods – they SIT LONGER in your pouch/sleeve
Eat breakfast within 2 hours of waking up
Begin to go 3-4 hours between meals
NO added sugar or alcohol
Continue to focus on protein choices: scrambled eggs, tuna/egg/chicken salad
(with low fat mayo/plain greek yogurt), fish/seafood, moist chicken (no skin),
ground turkey/chicken breast, ground beef (96%), beans, lowfat cheese, tofu,
natural peanut butter, skim milk, no added sugar yogurts, cottage cheese
 PAIR up your PROTEIN options with your PRODUCE – soft fruits & cooked
veggies first, then any fruits/veggies (fresh, raw, frozen, canned)
 Limit to 2 starch servings/day (after protein/produce), limit ‘sliders’
Vitamins
 Continue to take multivitamin 2/day (can switch to tablet) and vitamin B12
 Time to start your calcium citrate (1500 mg/day in 3 divided doses)
Exercise
 Start exercising! Faster, longer, harder! Aim for >30 minutes/day
MUSC Bariatric Surgery Program ~ (843)-876-4307~ www.muschealth.com/weightlosssurgery
Rev 7/2014
Helpful hints for transitioning to a solid “regularly” textured diet

Eat slowly and be aware of when you feel full.
When you feel full, stop eating! If you continue to eat, you may develop intense chest pain and vomit. You may
only be able to eat a few bites of food at a time, eating up to 4-6 “meals” a day.

Chew, chew, chew!
You need to make sure you chew your food very well before you swallow it. This makes it easier to digest and
pass from your gastric pouch into your small intestine.

Avoid drinking fluids 30 minutes before and with your meals.
If you fill up your small gastric pouch with liquid, you won't have room for your food. Furthermore, the liquids may
accelerate passage of the solid food out of the stomach and possibly cause some discomfort. If you need to, take
only small sips of liquids while eating, but don’t drink large amounts during meals.

Drink enough fluid between meals to meet your fluid requirements.
You need eight cups (64 oz.) of fluid per day to avoid dehydration. You should carry a water bottle with you and
sip on low/no calorie liquids throughout the day to get enough fluids.

Avoid sticky gummy foods.
These foods can stick together and form a ball in your gastric pouch, causing nausea and sometimes vomiting.
Sticky foods include: white bread, rolls, buns, pasta, rice, macaroni and cheese.

Avoid tough or rubbery meats.
Avoid steak, pork chops, ham, and other tough meats at first. Meat is a great source of protein, but it needs to be
soft and tender for you to digest it. Try a slow cooking method to make your meat tender, such as a crock-pot,
boiling or cooking at a low temperature over a long period of time.

Avoid food/beverages high in sugar.
High sugar foods can cause "dumping syndrome." After gastric bypass surgery, some people feel light-heated,
sweaty or faint soon after consuming sugar. Sugary foods and drinks are also high in calories and low in nutrition.
Avoid added sugars FOREVER!

Avoid extremes in the temperature of your foods and beverages.
Some patients experience spasms or cramps with very hot or cold food/beverages. Try lukewarm versions.

Limit high fat foods.
These foods may make you feel nauseated. They are also high in calories and will slow down your weight loss.
Try changing to a fat-free or light comparable product.

Only try one new food at a time.
This way if you cannot tolerate the food you will know exactly what your new pouch does not like.

Start taking calcium citrate supplements.
Because your surgery is designed for malabsorption, you will need to take calcium forever! You need 1500-2000
mg per day in divided doses of 500-600 mg, 3-4 times per day (typically 2 pills, 3 times each day).
Remember that the gastric bypass pouch was designed for you to feel full on SOLID foods. You are
SUPPOSED to get full quickly! Liquids and soft slider foods will travel quickly through your pouch and will not
produce that “full” feeling that you paid for! If a few bites of solid protein foods like meat feel ‘heavy’ in your
pouch, enjoy it! Try not to gravitate to liquid foods that you can consume more of, or that “go down easy”.
MUSC Bariatric Surgery Program ~ (843)-876-4307~ www.muschealth.com/weightlosssurgery
Rev 7/2014
My Portions & Meal Plan
It is your turn to PRACTICE.
 Eat within 2 hours of waking up in the morning
 Plan your Meal OR Snack every 3-4 hours apart
 Drink 16 oz of no-calorie, no-bubble beverage between each eating occasion
 Plan for a PROTEIN and PRODUCE at each meal/snack
 Starches/fats are after Protein/Produce (not alone), and max 2 starch, 3 fat
Time
PROTEIN
PRODUCE
EXTRAS
(like Starch, Added
Fat, condiments)
MUSC Bariatric Surgery Program
More Handouts available at:
http://www.muschealth.org/weight-loss-surgery/nutrition/nutrition-information.html
Call your Dietitians: 843-876-4867 or 843-876-4307
Post Bariatric Surgery Vitamin & Mineral Supplements:
Required FOR LIFE
• Calcium Citrate
o
o
o
o
After surgery, you need 1200-1500 mg of calcium CITRATE
You will need to take your calcium in divided doses at least 2-3 times a day
You can take as a tablet/pill, chewable, liquid or powdered supplement
Be sure to read the “supplement facts” so you know how many pills you need to take to get
in 1200-1500 mg a day. When it says, ‘serving size’ = 2, and 2 gives you 600 mg, that
means you need 2 to get in 600 mg, and 2 doses of 2 = 4 per day to get in 1200 mg!
 Tablet
o Citracal Maximum – 2 pills, 2x/day = 4/day (1260 mg)
o Citracal Petite – 2 pills, 3x/day = 6/day (1200 mg)
 Chewable
o Bariatric Advantage Chewy Bites
o 1 chew (500 mg ea), 3x/day = 3/day (1500 mg)
o 2 chews (250 mg ea), 3x/day = 6/day (1500 mg)
o Calcet Creamy Bites - 1 chew (500 mg), 3x/day = 3/day (1500 mg)
o Celebrate Soft Chew Calcium
o 1 chew (500 mg ea), 3x/day = 3/day (1500 mg)
o 2 chews (250 mg ea), 3x/day = 6/day (1500 mg)
o Opurity Calcium Citrate Plus – 2 chewables (300 mg ea), 2x/day = 4/day (1200 mg)
 Powders/Crystals
o Bariatric Advantage Calcium Crystals – 1 pkt (600 mg ea), 2/x day = 2 pkts/day
(1200 mg)
o UpCal D (from Amazon.com) – 1 dose (500 mg ea), 3x/day= 3 doses/day (1500 mg)
• Vitamin D3
o You need a total of 3000 IU of vitamin D3 each day (from your multi, calcium and a
separate vitamin D supplement)
o Your vitamin D3 supplement should have at least 2000 IU per day
o You can take as a gel cap/tablet or some chewable options
o If you are very deficient (with a vitamin D level <20), your bariatric team will prescribe you a
high dosage prescrption supplement, which you will take in addition to this daily dosage
Depending on your individual labwork, you may need additional vitamin/mineral supplements
to correct deficiencies– you will get a letter from the dietitians if labs are abnormal.
o
o
Be sure to get your lab work checked yearly. If you prefer to have your labwork checked by your
primary care physician, please have them fax to (843) 876-4201 or (843) 876-4199
Check the following ANNUALLY: CBC, BMP, Total Protein, Albumin, Prealbumin, Serum Folate, Serum
Iron, UIBC, TIBC, Ferritin, Vitamin B12, Serum 25-hydroxy vitamin D, HgbA1c, Serum Thiamin, Vitamin
B6, Ceruloplasmin, and Zinc
Rev. 1/2015
MUSC Bariatric Surgery Program ~ www.muschealth.org/weightlosssurgery ~ (843) 876-4867