Guide to Weight Loss after Sleeve Gastrectomy Surgery

Table of Contents
Page
Introduction 1

Lifestyle Goals 2
Goal 1 – Small Volumes 3
Goal 2 – Adequate Fluids 4
Goal 3 – Nutrition and Protein 5
Goal 4 – Vitamin and Mineral Supplements 13
Goal 5 – Physical Activity 14

Nutrition Concerns after Surgery 15

FAQs 16

Diet Phase Progression 18

Phase 1 19
Phase 2 20
Phase 3 22
Phase 4 24
Phase 5 27

Beyond Phase 5 40

Overview of Phases 41

Pre-surgery Shopping List 42

Internet Resources 43
References 44
What is Vertical Sleeve Gastrectomy?
The Vertical Sleeve Gastrectomy is a surgical weight loss procedure that reduces the size
of the stomach. Your surgeon will create a narrow tube stomach between your esophagus
and pylorus. The new stomach will be about 1/3 the size of a full stomach. The excess
portion of your stomach will be removed. Because the surgery reduces the size of the
stomach, it reduces the amount of food you are able to eat and causes weight loss

Following surgery, weight loss occurs because:

1. The new stomach holds a much smaller amount of food

2. You will feel satisfied more quickly
3. Hormone changes may alter your hunger and satiety

As you follow the guidelines set out in this book, remember that the guidelines are meant
to help you achieve your goals. Your goals may include maximizing your weight loss,
eliminating disease (diabetes, high blood pressure), and minimizing complications (such
as malnutrition, poor healing and unnecessary discomfort). It is our hope that by meeting
your goals you are able to create a new, healthy lifestyle.

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Lifestyle Goals
Sleeve gastrectomy surgery is the beginning of a new life. Your eating habits, meal
timing and food behaviors will likely change dramatically. In addition, your physical
activity and exercise patterns will become more important than ever before. As you
prepare for surgery, start preparing yourself for these major life changes in your food and
activity.

The guidelines outlined in this book will provide the tools you need for:
o Healing immediately following surgery
o Safe and maximal weight loss during the months following surgery
o Weight maintenance for a lifetime as you create healthy food habits

With so many different surgical weight loss procedures being offered, you may become
confused by the various nutrition advice you receive. Please know that the Sleeve
Gastrectomy procedure has specific nutrition guidelines developed by your surgeon.
Always follow your own surgeon’s nutrition directions. This booklet will also serve as
the main tool for your individual nutrition needs.

The following sections will address your lifestyle keys following surgery.

Lifestyle Goals:

1. Small Volumes
2. Adequate fluids
3. Proper nutrition
4. Vitamin & mineral supplementation
5. Physical activity

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Lifestyle Goal #1 – Small Volumes
Following surgery your new stomach will hold a much smaller amount. Because the new
stomach is smaller there are a few things to consider when you eat and drink:

Liquids
Following surgery you will only be able to drink small sips of liquid. This means you will
be drinking all throughout the day in order to stay hydrated. Sipping your liquids slowly
can help to prevent the discomfort of taking too much fluid too quickly and overfilling
the stomach. Even swallowing excess air can be uncomfortable for the new stomach.
Prior to surgery you may practice taking very small sips.

Solid food
As you transition toward eating solid food, chewing becomes very important. Make it
your goal to chew all of your food until it is toothpaste texture before swallowing. As you
take time to chew your food, slow down with you meals. It should take you at least 20
minutes to eat each meal. If you eat too quickly your stomach may become overly full
and cause complications and discomfort. Sit down at mealtimes to focus on chewing
thoroughly. Set a timer or make a plan to sit undistracted for 30 minutes at each meal.
Prior to surgery, you may practice taking small bites and eating slowly to adjust to this
new habit.

Consistency
As you progress through the phases of the diet, the consistency of your food will change
from liquids to pureed food and on to solid food. This change will happen gradually.
Your surgeon will guide you through this progression.

Volume
The portion size of your food will also gradually increase. You will start by eating small
meals (about ¼ cup). Gradually you will be able to increase the amount you eat. Many
people are able to consume about 1 ½ cups of food at a meal when they are several
months out from surgery. This volume is about the size of half of a sandwich. Remember
that the amount you are able to eat might change from day to day. Each person is
different in the amount of food s/he is able to eat at meals. Do not worry if you are not
able to eat 1 ½ cups of food at every meal. Including several mini-meals during the day
may help you to obtain enough nutrition from food.

As you transition through the diet phases, you will eventually be eating normal food
again. The portions that you eat will remain relatively small, but you will find that you
are able to tolerate most healthy foods.

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Lifestyle Goal #2 – Adequate Fluids
Fluids are an essential part of your recovery following Sleeve Gastrectomy surgery. Your
ability to keep hydrated is one of the things your surgeon will monitor.

Following surgery fluids are important because they:

o Prevent dehydration
o Eliminate waste products that form during weight loss

Your goal is to drink at least 64 ounces of fluid each day. This is a standard amount of
fluid for most healthy adults. Sixty-four ounces is equal to 8 cups or 2 liters of fluid.
Using a measuring cup may be helpful to ensure that you are meeting your daily goal. Do
not limit your fluid. You may drink more than 64 ounces as you feel thirsty. Fluid is
considered any beverage that melts in your mouth. For example, sugar free popsicles will
melt in your mouth so they count as part of your fluid for the day.

The fluid you drink may come from several sources:

o Pure protein supplement drinks

o 8 ounces of fruit or vegetable juice (during phases 2 and 3 only)
o Nonfat, 1% or soy milk (during phase 3 and beyond)
o Water
o Very low calorie beverages – look for beverages with 20 calories or less
o Sugar free jello and sugar free popsicles
o Clear broth

Fluid and beverages should serve as hydration only. Fluid should not contain significant
calories. Most of your beverages should contain less than 20 calories per serving. The
only beverages with calories that you may consume are pure protein supplement drinks
and milk. For maximal weight loss, avoid all other high calorie beverages. The beverages
to avoid include:

o Fruit juices
o Smoothies (Jamba Juice, Robeks)
o Milkshakes
o Ice cream, sorbet, regular popsicles and sherbet
o Frappuccinos
o Eggnog and flavored milk (chocolate, strawberry milk)
o Sports drinks (Gatorade, Powerade, Vitamin Water)
o Regular sodas
o Fruit punch, lemonade, Tang, Kool-Aid
o Sweet tea (Snapple, Nestea, Arizona)
o Meal replacements (e.g. Slimfast, Boost, Glucerna)

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Lifestyle Goal #3 – Proper Nutrition
Sleeve gastrectomy surgery is a tool that allows you to restrict your calories and lose
weight. This tool does not work all by itself. In order to make your tool work most
effectively, you will need to make healthy food choices everyday. You may even choose
to avoid less healthy foods completely to help yourself lose weight. You may also desire
to spend some time before surgery preparing yourself for these food changes.

Hopefully you will use this surgical tool to the best of its ability by working to build a
healthy lifestyle. This includes choosing healthy foods from all of the food groups each
day. The phases of the diet have been developed to encourage eating a variety of healthy
foods. Over a lifetime, healthy balanced eating helps to maintain weight loss and prevent
chronic diseases.

Carbohydrate Foods
Carbohydrates provide energy for our bodies to function. We would not survive without
carbohydrates because they are the nutrient that our brain uses for energy. Carbohydrates
are also needed to burn fat.

Immediately after surgery you will eat very little of the carbohydrate foods. As you
transition through the diet phases, you will be able to slowly increase the amount of
carbohydrate that you eat at each meal. During this transition, practice building good
lifestyle habits by choosing carbohydrate with important nutrition.

Carbohydrate foods include starches and grains, fruit and vegetables, and milk. In
addition, most sweets and desserts contain carbohydrates. Carbohydrate foods may
contain either important nutrition (fiber, vitamins and minerals) or little nutrition (refined
sugar), depending on which ones you choose. Most of the carbohydrate foods in your diet
should come from fruit, vegetables, starches and milk. The best carbohydrate choices are
found by following the food groups:

Fruit and vegetables should be your primary source of carbohydrates after sleeve
gastrectomy surgery. They are key sources of vitamins and minerals; they are also
relatively low in calories. Aim to vary the color of fruit and vegetables that you eat.
Different colored fruit and vegetables provide more antioxidant variety. Remember that
frozen fruit and vegetables provide the same nutrition as fresh ones. Aim to include fruit
and/or vegetables at nearly every meal. Fruit should only be consumed after a protein has
been eaten.

Starches and grains provide important nutrition, such as fiber, vitamins and minerals.
The foods in this group include cereals, bread, rice, noodles, and crackers. Aim to include
as many whole grains as you are able to tolerate. You may find that you have difficulty
tolerating some starches after surgery. It may take time and practice for you to be able to

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eat these foods again. Be cautious when you try these foods for the first time. Remember
to take small bites and chew these foods well. You may transition slowly back to eating
these foods.

Milk is an important nutrient because it provides carbohydrate, protein, vitamin D and

calcium. Low-fat buttermilk or yogurt may be substituted for milk because they provide
similar nutrition. It is recommended that you drink skim or 1% milk and choose light
yogurt. If lactose intolerance is an issue, you may also consume almond milk with
calcium (unsweetened) or lactose-free products.

Following sleeve gastrectomy surgery, you may notice changes in how your body digests
carbohydrate. Some carbohydrate foods may be more difficult to tolerate than others.
High fiber carbohydrate foods, such as whole grains and vegetables, may be harder to
digest and cause stomach cramping. To avoid discomfort, slowly increase your fiber
intake by slowly increasing the portion of whole grains and vegetables you eat. Be
cautious when you try these foods for the first time- take small bites and chew very well.

The carbohydrates that provide little nutrition (refined sugars) are best avoided after
sleeve gastrectomy surgery. These foods are high in calories and contain few important
nutrients, such as vitamins, minerals or fiber. Strictly monitor your intake of cakes,
cookies, candy, chocolate, doughnuts, pastries, pies and other desserts. These foods
should be eaten rarely – perhaps only a few times each year – and the portion sizes eaten
should be very small. The more sweets, desserts and refined carbohydrates you eat, the
less weight you will lose. By eating these foods, you also run the risk of protein
malnutrition because you will not be receiving enough of the more important nutrients.
Rice should be limited and may cause difficulty in digestion.

Fat Containing Foods

Like carbohydrate, our bodies cannot run without fat. Most people eat more than 60
grams of fat each day but, we only need about 5 grams of fat per day to keep our brain
and nerves working. Fat is higher in calories than carbohydrate or protein, so limiting the
amount of fat you eat will help with weight loss.

Not all fats are created equal. Fats are classified into 2 categories- heart healthy fats and
saturated fats. Choosing heart healthy fats most of the time can help to prevent chronic
diseases. These good fats are called monounsaturated and polyunsaturated fats. They
include olive and canola oils, soft margarine spreads, avocado and seeds. Use these good
fats in place of saturated fats most of the time. The saturated fats include butter, cream,
bacon and sour cream. Remember that, for whichever type of fat you choose, only a small
portion is needed. Aim for not more than 1 teaspoon of fat at each meal.

Following sleeve gastrectomy, be cautious when adding fat to your food – only a small
amount is needed to flavor your smaller portion of food. Also, notice how the preparation
method may add fat to your food. Foods that are sautéed or fried will be higher in fat.

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Most breaded meats are higher in fat. Foods that are made with cream, such as alfredo
sauce, are also higher in fat. Make a habit of choosing lower fat foods, like light
mayonnaise and reduced fat salad dressings.

It is important to choose lower fat foods options to help promote sustained weight loss.
Because high fat foods pack more calories, it is easy to consume too many calories from
a small portion of these foods. So use these foods sparingly and eat appropriate portions.

Protein foods
Protein is an essential nutrient. In the body, protein functions in vital organs, enzymes,
hormones, antibodies and fluid balance. It plays an especially important role following
sleeve gastrectomy surgery because it:

o Helps your body heal from surgery

o Spares muscle mass
o Ensures healthy weight loss
o Helps prevent malnutrition

After sleeve gastrectomy surgery, protein will become the main focus of the food you eat.
This focus on protein will last a lifetime. As you begin eating solid food, you will be told
to always eat your protein foods first. A list of high protein foods is provided on page 39.

High protein foods mainly come from animal products. Meat, poultry, fish, eggs and
some dairy products are good sources of protein. Protein is also found in some plant
foods, such as soy products, dried beans, lentils and nuts. Your body is able to use protein
that comes from animal products more efficiently than protein from plant foods. Animal
protein is made up of the right proportion of building blocks (amino acids) for your body
to use.

Pure Protein Supplement

Following surgery, you will not be eating solid food for about 2 months. So, you will take
a pure protein supplement drink to ensure that you are getting enough protein until you
begin eating again. You will take the protein drink for at least 4-5 months. Some people
continue to take smaller amounts of protein supplement for many years after surgery.

Your goal for protein intake is at least 70-80 grams of protein per day.

A pure protein supplement means that the product has minimal fat and minimal
carbohydrate. When you check the Supplement Facts label, look for products where one
serving contains:
o At least 15 grams of protein per 8 oz. serving
o Less than 5 grams of fat per 8 oz. serving
o Less than 20 grams of carbohydrate per 8 oz. serving
o 200 calories or less per 8 oz. serving

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By doing this, you help to ensure that you are receiving adequate protein from the
product, while minimizing the calories from too much fat and carbohydrate.

Pure protein supplements will come in powder form or as ready to drink beverages.
Protein that comes in powder form may be mixed with water, milk (skim, 1% or soy
milk), and very low calorie beverages (such as crystal light) to provide flavor variety.
You may also add very low calorie flavorings to pure protein drinks, such as vanilla
extract, sugar-free flavored syrups or unsweetened cocoa powder. Ready to drink protein
tends to be more expensive than powder protein, though many people prefer the
convenience of ready to drink products.

The source of protein will vary by product. Most pure protein supplements are made from
casein or whey (cow’s milk protein), egg white protein, pre-digested collagen protein, or
soy protein. Each source of protein may have slight flavor differences. While soy is an
acceptable protein, avoid using other plant based proteins (hemp or rice protein) because
these proteins are not made up of the right building blocks (amino acids) for your body to
use effectively.

Pure protein supplements are widely available. They may be purchased at:
o Nutrition stores- such as GNC, Vitamin Shoppe and Max Muscle
o Grocery stores
o Drug stores
o Health food stores- such as Trader Joes and Whole Foods
o Internet website- exercise caution with internet purchases and please be
sure to choose reputable websites

Because adequate protein is essential, it is important to find several products that you
enjoy and can use for the next 4 to 5 months. Make it your goal to find at least three to
five products that you enjoy. Go out and taste products at various stores. Aim to taste 15
products or more. Keep in mind which flavors you enjoy (for example, chocolate, vanilla
or fruit flavors). Also notice which textures you prefer. Some products are thick and
creamy like a milkshake, while others are clear and look more like sports drinks. The best
type of protein for you is the type that you will be able to drink everyday and enjoy!

Each protein product will vary in how concentrated it is. Some products will provide 60
grams of protein in 12 ounces of liquid. Other products may have 60 grams of protein in
36 ounces of liquid. All of the fluid that your pure protein drink provides will count
toward your fluid goal of 64 ounces per day (see lifestyle key #2).

Before surgery be sure to:

o Taste many products and find 3-5 that you enjoy (both flavor and texture)
o Purchase a 2-3 weeks supply of these different products
o Avoid purchasing too much of any one product because your taste
preferences may change after surgery

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 o Learn how to calculate the amount of product you need to reach your daily
protein goal
Calculate Your Protein

Prior to surgery, it is important to calculate the amount of pure protein product you need
to meet your daily protein goal. Do the following calculations for every pure protein
supplement you purchase to ensure you will receive adequate protein daily.

The following is a step-by-step guide to calculating your pure protein supplement intake.
If you have difficulty with these calculations at any time, please contact the outpatient
dietitian for support.

1. Find the Nutrition Facts or Supplement Facts label on the pure protein product.

2. Determine the Serving Size at the top of the label (e.g. 1 scoop, 2 tablespoons, 1
bottle, 24 fluid ounces).

3. Note how many grams of protein are found in one serving of the product.

4. Divide the total protein required for one day (60-70 grams) by the grams of
protein in one serving of the product.
This tells you the amount of product you need to meet your protein goal for the
entire day.

5. Determine the total ounces of fluid provided by this pure protein supplement
(usually 12-36 fluid ounces per day).
*For powder protein products, follow the mixing instructions listed on the
container. If no specific guidelines are provided for your powder product, mix
your total daily protein in 16 ounces of fluid.

6. Remember to sip on your protein supplement throughout the day. Take two to
four ounces servings of your protein supplement at a time.

See the sample calculations on the following 2 pages.

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 Designer Whey Protein Powder

Supplement Facts
Serving Size 1 level scoop (~24g)
Servings Per Container ~15

Amount Per % Daily

Serving Value

Calories 90
Calories from Fat 15
Total Fat 1.5 g 2%
Saturated Fat 0.5 g 3%
Cholesterol 30 mg 10%
Total Carbohydrates 2g 1%
Dietary Fiber 0g 0%
Sugars 2g -

Protein 18 g 36%

From the Supplement Facts label:

Serving size: 1 scoop
Protein in 1 scoop: 18 grams

To calculate amount of protein product needed for the day:

Divide the total daily protein needed: 60 to 70 gm
by the grams of protein in 1 serving: 18 gm

60 = 3 1/3 scoops per day to 70 = 4 scoops per day

18 18

To calculate fluid provided by the protein supplement:

Directions for Mixing: mix each scoop of protein powder with 4 ounces of water.
Four scoops of protein powder should be mixed to make 16 fluid ounces.
Total Daily Fluid Provided by this Protein Supplement: 16 oz

Sip protein supplement throughout the day in two to four ounce servings.

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Isopure Zero Carb – Apple Melon

Supplement Facts
Serving Size 1 bottle (20 fl oz)
Servings Per Container 1

Amount Per % Daily

Serving Value

Calories 160
Calories from Fat 0
Total Fat 0 0%
Saturated Fat 0 0%
Cholesterol 0 0%
Total Carbohydrates 0 0%
Dietary Fiber 0 0%
Sugars 0 0%

Protein 40 g 80%

From the Supplement Facts label:

Serving Size: 1 bottle or 20 oz
Protein in 1 bottle: 40 gm

To calculate amount of protein product needed for the day:

Divide the total daily protein needed: 60 to 70 gm
by the grams of protein in 1 bottle or 1 serving: 40 gm

60 = 1 and ½ bottles per day to 70 = 1 and ¾ bottles per day

40 40

To calculate fluid provided by the protein supplement:

Total fluid provided (1 bottle = 20 oz)

30 oz (1 ½ bottles) to 36 oz (1 ¾ bottles)

Sip protein supplement throughout the day in two to four ounce servings.

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 Protein Drink Comparison Chart

Product Name Protein Serving Protein Carb Fat Servings for Serving for Total
& Flavor Examples Type Size gm/ serving gm/ serving gm/ serving 60 gm protein 70 gm protein fluid/day
Isopure (GNC) Ion exchange
Frosty Grape whey protein 20 oz 40 grams 0 grams 0 grams 1 ½ bottles 1 ¾ bottles 30-36 oz
Alpine Punch isolate
Premier Nutrition Milk protein, whey
11 oz 30 grams 5 gram 3 grams 2 containers 2 1/3 containers 22-26 oz
Protein (Costco) concentrate, calcium
Chocolate Shake caseinate
ABB Pure Pro Shake Milk protein, whey
11 oz 35 grams 5 grams 1 grams 1 ¾ cans 2 cans 14-22 oz
(Vitamin Shoppe) isolate,
Cookies and Cream calcium caseinate
High 5 Blend Protein Whey concentrate &
1 scoop 26 grams 1 grams 1 gram 2 1/3 scoops 3 scoops 14-18 oz
(Max Muscle) isolate, soy, egg
Cappuccino white, caseinate
Worldwide Pure Protein Calcium caseinate,
(GNC, Trader Joe’s) milk protein 11 oz 35 grams 4 grams 1 gram 1 ¾ cans 2 cans 14-22 oz
Banana Cream concentrate
Soy Protein Powder
2 scoops 25 grams 1 grams 1.5 grams 2 1/3 scoops 3 scoops 16 oz
(Trader Joe's) Soy protein isolate
Vanilla
MaxPro (Max Muscle) Whey 1 scoop 30 grams 4 grams 1 grams 2 scoops 2 1/3 scoops 12-16 oz
Orange Blast protein
Designer Whey
1 scoop 18 grams 2 grams 1.5 grams 3 1/3 scoops 4 scoops 16 oz
(Rite Aid, Trader Joe’s) Whey protein
Strawberry

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Lifestyle Goal #4 – Vitamin & Mineral Supplementation
Taking a daily vitamin-mineral supplement will be an important part of your routine
following sleeve gastrectomy surgery for healing and good health. After surgery, you will
not be eating enough food to provide these nutrients. Your body may also need extra
amounts of these nutrients while you are losing weight.

You will take one multivitamin-mineral supplement everyday for the rest of your life to
ensure good health and avoid nutrient deficiency. During the first 6 weeks following
surgery this vitamin-mineral supplement must be chewable. You may use one of the
following chewable multivitamins:

o Flinstones Complete
o Centrum Multivitamin and Multimineral Chewable Tablets (orange flavor)
o Kirkland Signature Children’s Chewable Complete Multivitamin
o One A Day Kids Scooby Doo Complete Multivitamin/Multimineral

After the first six weeks, when you are eating solid food again, you may switch to a tablet
or capsule multivitamin. Examples of the tablets or capsule multivitamins that you may
use are:

o Centrum Multivitamin Multimineral Supplement (Original A-Zinc formula)

o Kirkland Signature Daily Multivitamins and Minerals
o Nature Made Multi Complete
o One A Day Maximum

Your daily vitamin-mineral supplement is best absorbed with meals. You may take your
multivitamin with either breakfast, lunch, or dinner as long as it is taken on a daily basis.

In addition to the daily multivitamin, you will need to take vitamin B12. After the
surgery, you will not be able to absorb vitamin B12 through your stomach. It must be
taken by an alternative route. Vitamin B12 may be given by injection at the doctor’s
office or as a “sublingual” or “under-the-tongue” supplement. If you take the sublingual
supplement, you may take:

o 500 mcg vitamin B12 supplement everyday

o 1000 mcg vitamin B12 supplement 2-3 days per week

Continue taking your vitamin and mineral supplements as directed by your surgeon. Do
not stop taking your supplements, no matter how well you may feel.

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Lifestyle Goal #5 – Physical Activity
Physical activity is essential after sleeve gastrectomy surgery. It helps with:
o Weight loss and weight maintenance
o Building endurance; Improving muscle mass
o Increasing energy level and strength
o Lowering cholesterol, blood pressure and blood sugar
o Lowering risk of heart disease, stroke and diabetes
o Strengthening heart and bones
o Improving circulation
o Decreasing stress; Beating the blues
o Keeping your body and joints flexible
o Maintaining skin elasticity

Following surgery, you will start by doing 20 minutes of physical activity daily. This will
begin even while you are in the hospital. Over time you will increase to 30 minutes of
physical activity everyday. Your surgeon will direct you individually when to increase
activity and which types of activity are safe for you. Start with activities that are
comfortable for you. Most people choose to do walking for their physical activity,
especially immediately following surgery.

Aim to incorporate a minimum of 150 minutes per week to a goal of 300 minutes per
week including strength training 2-3 times a week. Below are sample activities that can
be completed:

o Walking (15-20 minute miles or 3-4 miles per hour)

o Golf (without a cart)
o Swimming or cycling (leisurely)
o Yoga
o Exercise equipment (rowing machine, elliptical, stair climber)

When you are well healed from surgery, you may begin light weight training. This
usually happens 3 to 6 weeks after surgery. Your surgeon will direct you when it is safe
to begin.

And remember that all activity is important- including everyday chores. Housecleaning,
laundry, gardening, dog walking, and climbing stairs can help you achieve your physical
activity goals. The best type of physical activity for you is the type you will do daily and
enjoy.

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Nutrition Concerns
Some people may experience the following nutrition concerns. If you experience any of
these, you may use this list to help treat your symptoms. Call your doctor immediately if
you have persistent nausea, vomiting, constipation or diarrhea.

Concern How to deal with it…

- Avoid foods that are spicy, greasy and fried
Nausea and
- Avoid sweets, desserts and sweetened beverages
Vomiting - Avoid eating or drinking too fast
- Chew slowly and thoroughly; sip beverages slowly
- Go back one phase in your diet- you may have advanced too quickly to
the next diet stage before your body was ready

- Drink at least 64 oz of fluid daily

Dehydration - Make a fluid schedule to help you count how much you are drinking

- Avoid greasy and fatty foods; avoid high fiber foods

Diarrhea - Avoid eating tough skins on fruits and vegetables
- Try decreasing dairy products or use low-fat Lactaid milk
- Be sure to drink liquids between meals, not with them

- Include foods with moderate amounts of fiber in your meals (fruits,

Constipation cooked vegetables, cereals, whole grains) according to the foods
allowed in your diet phase
- Drink at least 64 oz of fluid daily
- Exercise daily

- Avoid or limit dairy products, use low-fat Lactaid milk

Excessive Gas - Limit legumes (dried beans and peas)
- Limit gas producing vegetables (broccoli, cauliflower, Brussels
sprouts and onions)
- Avoid foods containing sugar alcohols (mannitol, sorbitol)
- Avoid carbonated beverages & do not use straws

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Frequently Asked Questions

Will I experience weight loss plateaus?

Plateaus are normal during long term weight loss. They may result from:
o Eating too few calories, which causes the body to go into starvation mode
o Eating too many calories
o Not exercising enough or needing to increase your physical activity as
weight loss progresses

To reduce the duration of a plateau, increase your time spent in physical activity.
Remember that your body may be changing, even though the scale stays the same. So,
take body measurements to note how your body is changing in other ways.

Is it normal to experience hair loss?

Hair loss is common with rapid weight loss and is related to hormonal changes in the
body. Hair loss may also be caused by protein and iron deficiencies. Thinning of the hair
may begin 3 months after surgery and could continue for 6 months or more. Increasing
your protein intake may help decrease hair loss. Also, make sure you are taking your
vitamin-mineral supplement as directed. Hair loss does tend to grow back.

What are sugar alcohols?

Sugar alcohols are low calorie sweeteners used in some diet products. Common types are
maltitol, mannitol, sorbitol and xylitol. If a food product contains them, sugar alcohols
are listed on the Nutrition Facts label right below sugar. Be cautious with your intake of
sugar alcohols. They can tend to have a laxative effect similar to prunes, beans or other
high fiber foods.

Can I use meal replacements for my protein supplement?

Meal replacements, such as Optifast, Slimfast and Glucerna contain too much fat and
carbohydrate to be used for your protein supplements. When choosing a pure protein
supplement, look for a product with adequate protein while having limited fat and limited
carbohydrate. By limiting the fat and carbohydrate you will be limiting the overall
calories to promote weight loss.

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What beverages can I drink after surgery?
Very low-calorie beverages that count toward your daily fluid goal include:
o Sugar free flavored waters (crystal light & sugar free Kool-Aid)
o Herbal teas
o Sugar free jello & sugar free popsicles
o Fat free broth
o Sugar free sports drinks (propel water)

Look for beverages with less than 20 calories per serving. Follow your diet phase for
more beverage options.

What beverages should I avoid after surgery?

After surgery, avoid the following beverages for 2-3 months because they may irritate the
lining of the new stomach:
o Caffeinated beverages (coffee, black tea, energy drinks)
o Carbonated beverages (soda, seltzer water)
o Acidic beverages (decaffeinated coffee, pineapple juice, orange juice)

How does alcohol fit in?

You will avoid alcohol for the 1 year after surgery. Even long term, it is recommended
that you avoid beverages with alcohol for the following reasons:
o Alcohol is a diuretic and will dehydrate your body
o It is rich in calories, especially when added to mixers, juice and sodas. The
calories from most alcohol beverages range from 100-250 per drink. Some
mixed drinks contain more than 400 calories per serving.
o Alcohol may cause stomach irritation, resulting in abdominal pain and
cramping
o Alcohol may be absorbed differently and may have a greater effect on
your liver

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Diet Phase Progression
Following surgery, your diet will progress along the following phases. Your surgeon will
direct you when to advance to each new phase.

Phase 1 – Clear liquid

Days 1-2
Sip of water and diluted juice while you are in the hospital.

Phase 2 – Clear liquid and Protein Supplement

Weeks 1-2
Continue sipping water and diluted juice. Add pure protein supplement with a chewable
vitamin-mineral supplement.

Phase 3 – Full liquid

Weeks 3-4
Begin eating very small meals, using dairy products and cream of wheat.

Phase 4 – Pureed & Mashed

Weeks 5-6
Increase the consistency of your food to mashed potato texture. Focus on high protein
foods. Avoid drinking liquids with meals.

Phase 5 - Regular
Weeks 7-16
Slowly transition from soft to regular foods. Slowly increase the amount of food you eat
at each meal. Focus on high protein foods. As you eat more protein foods, you may
decrease the amount of pure protein supplement you take.

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Phase 1 – Clear Liquid
Days 1-2

You will follow phase 1 while in the hospital. The nursing staff will provide you with
water and diluted juice. They will also provide 1 ounce medicine cups for you to drink
from. Using the medicine cups may help you keep track of how much you are drinking.
Over the day focus on taking adequate fluids. Your ability to keep hydrated is one of the
things your surgeon will monitor to decide if you are ready to go home from the hospital.
Your surgeon may instruct you to follow phase 1 for several days even after you go home
from the hospital

Purpose:
o Tolerate sips of water
o Drink enough fluids to keep yourself hydrated

Keys:

1. Fluids
Aim to drink 4 ounces of fluid per hour (1 ounce every 10-15 minutes) for a total of
64 oz. fluids daily. Sip your fluids slowly. Do not take any large gulps of fluid
because this will cause discomfort. You may use water or diluted juice. Avoid using
straws to prevent swallowing air.

19
Phase 2 – Clear Liquid and Protein Supplement
Weeks 1-2

Purpose:
o Drink enough fluid to maintain hydration
o Consume adequate protein from a pure protein supplement drink

Keys:

1. Fluids
Aim to drink 64 ounces of fluid per day. Sip your fluids slowly. In the beginning
it may take you one hour to drink 4 ounces of fluid. Aim to drink 4 to 6 ounces of
fluid for every hour that you are awake. This fluid will come from your pure
protein supplement, juice and other beverages. The other beverages you drink
may include:
o Water
o Very low calorie flavored waters (crystal light or sugar free Kool-Aid)
o Sugar-free jello & Sugar-free popsicles
o Herbal tea
o Very low calorie sports drinks (propel water)
o Broth

2. Protein
Begin taking 70-80 grams of protein per day from your pure protein supplement
drink. Take small amounts of your protein drink throughout the day.

3. Juice
You may drink a small amount of juice during phase 2. Limit your intake to only
8 ounces per day of a clear liquid juice to provide your body with carbohydrate.
Look for apple, cranberry or grape juice. Sip your juice throughout the day.

4. Vitamins & Minerals

Begin taking your chewable vitamin-mineral supplement when directed by your
surgeon.

20
 Phase 2 – Sample Schedule
This sample schedule provides a structured framework for drinking adequate fluids.
Avoid drinking from 2 ounce shot glasses during this phase. Aim to drink from measured
8 or 12 ounce glasses. This will help you transition back to drinking normally.

Very low calorie beverages listed on the previous page may be used in place of water on
this schedule. These beverages will help to provide some variety.

Sample Home Schedule Sample Work Schedule

7:00 AM 2 ounces water 7:00 AM 2 ounces Protein Supplement
7:30 AM 2 ounces Protein Supplement 7:30 AM 2 ounces Protein Supplement
with multivitamin with multivitamin
8:00 AM 2 ounces water 8:00 AM 2 ounces juice
8:30 AM 2 ounces juice 8:30 AM 2 ounces water
9:00 AM 2 ounces water 9:00 AM 2 ounces water
9:30 AM 2 ounces Protein Supplement 9:30 AM 2 ounces water
10:00 AM 2 ounces water 10:00 AM 2 ounces juice
10:30 AM 2 ounces water 10:30 AM 2 ounces water
11:00 AM 2 ounces water 11:00 AM 2 ounces water
11:30 AM 2 ounces Protein Supplement 11:30 AM 2 ounces water
12:00 PM 2 ounces water 12:00 PM 2 ounces Protein Supplement
12:30 PM 2 ounces juice 12:30 PM 2 ounces Protein Supplement
1:00 PM 2 ounces water 1:00 PM 2 ounces water
1:30 PM 2 ounces Protein Supplement 1:30 PM 2 ounces water
2:00 PM 2 ounces water 2:00 PM 2 ounces water
2:30 PM 2 ounces water 2:30 PM 2 ounces water
3:00 PM 2 ounces water 3:00 PM 2 ounces juice
3:30 PM 2 ounces Protein Supplement 3:30 PM 2 ounces water
4:00 PM 2 ounces water 4:00 PM 2 ounces water
4:30 PM 2 ounces juice 4:30 PM 2 ounces water
5:00 PM 2 ounces water 5:00 PM 2 ounces water
5:30 PM 2 ounces Protein Supplement 5:30 PM 2 ounces Protein Supplement
6:00 PM 2 ounces water 6:00 PM 2 ounces Protein Supplement
6:30 PM 2 ounces water 6:30 PM 2 ounces water
7:00 PM 2 ounces water 7:00 PM 2 ounces juice
7:30 PM 2 ounces Protein Supplement 7:30 PM 2 ounces water
8:00 PM 2 ounces water 8:00 PM 2 ounces Protein Supplement
8:30 PM 2 ounces juice 8:30 PM 2 ounces Protein Supplement
9:00 PM 2 ounces water 9:00 PM 2 ounces water
9:30 PM 2 ounces Protein Supplement 9:30 PM 2 ounces water
10:00 PM 2 ounces water 10:00 PM 2 ounces water

21
Phase 3 – Full Liquid
Weeks 3-4

Purpose:
o Tolerate thicker liquids and semi-solid food items
o Begin eating small meals

Keys:

1. Fluids
Aim to drink 64 ounces of fluid per day. Sip your fluids slowly. As the days pass, you
will be able to drink fluid more normally – taking liquid more quickly than during
phase 2. Your fluid will come from your protein supplement, juice, water and other
very low calorie beverages.

2. Protein
Continue taking 70-80 grams of protein per day from your pure protein supplement
drink. Drink of your protein throughout the day.

3. Juice
You may drink a small amount of juice during phase 3. Limit your intake to only 8
ounces per day of any pulp-free fruit or vegetable juice to provide your body with
carbohydrate. Sip your juice throughout the day. Be cautious of highly acidic juices,
such as orange, pineapple or tomato juice.

4. Meals
You will begin to eat 3 meals per day. Aim to eat 2 fluid ounces or ¼ cup at each
meal. You meals will be mostly liquids. You may use the following items to make up
your meals:
o Skim or 1% milk
o Soy milk (plain or vanilla)
o Fat-free, no-sugar-added pudding
o Thin cream of wheat, rice cereal, or grits (plain)
o Fat-free, light yogurt (smooth texture, no chunks)
o Strained soup (cream or broth based)

5. Vitamins & Minerals

Continue taking your chewable multivitamin, as directed by your surgeon.

6. Physical activity
You may increase to 30 minutes of moderate activity daily, as directed by your
surgeon.

22
Phase 3 – Sample Schedule
Please note the 2 ounce (1/4 cup) samples meals inserted in the schedule. You may take
your chewable multivitamin with one of these meals. Very low calorie beverages may be
used in place of water on this schedule.

Sample Schedule Home Sample Schedule Work

7:00 AM 2 ounces water 7:00 AM 2 ounces water
7:30 AM Full Liquid Meal 7:30 AM Full Liquid Meal
2 oz vanilla soy milk 2 oz thin cream of wheat
with multivitamin with multivitamin
8:00 AM 4 ounces water 8:00 AM 4 oz Protein Supplement

9:00 AM 4 ounces water 9:00 AM 4 ounces water

10:00 AM 2 ounces juice 10:00 AM 2 ounces juice

2 ounces water 2 ounces water
11:00 AM 4 ounces Protein Supplement 11:00 AM 4 ounces water

12:00 PM 2 ounces water 12:00 PM 2 ounces water

12:30 PM Full Liquid Meal 12:30 PM Full Liquid Meal
2 oz strained broth soup 2 oz fat-free, light yogurt

1:00 PM 4 ounces water 1:00 PM 4 oz Protein Supplement

2:00 PM 4 ounces Protein Supplement 2:00 PM 4 ounces water

3:00 PM 4 ounces water 3:00 PM 4 ounces juice

4:00 PM 4 ounces juice 4:00 PM 4 ounces water

5:00 PM 4 ounces Protein Supplement 5:00 PM 4 ounces water

6:00 PM 2 ounces water 6:00 PM 2 ounces water

6:30 PM Full Liquid Meal 6:30 PM Full Liquid Meal
2 oz no-sugar-added pudding 2 oz strained cream soup

7:00 PM 4 ounces water 7:00 PM 4 oz Protein Supplement

8:00 PM 2 ounces juice 8:00 PM 4 ounces water

9:00 PM 4 ounces water 9:00 PM 2 ounces juice

10:00 PM 4 ounces Protein Supplement 10:00 PM 4 oz Protein supplement

23
Phase 4 – Pureed & Mashed Foods
Weeks 5-6

Purpose:
o Tolerate semi-solid and soft foods
o Increase the texture of the food you are able to eat

Keys:

1. Fluids
Aim to drink 64 ounces of fluid per day. Sip your fluids slowly. Your fluid will come
from your protein supplement, water and other calorie-free beverages.

Avoid drinking fluids with your meals – do not drink for 30 to 60 minutes after you
finish the meal. This will help prevent discomfort and help you to feel more satisfied
by what you have eaten.

2. Protein
Continue taking 70-80 grams of protein per day from your pure protein supplement
drink. Drink your protein throughout the day.

3. Meals
You will eat 3 meals per day. Aim to eat 2 fluid ounces or ¼ cup at each meal. Within
each meal, eat 1 fluid ounce or 2 tablespoons of high protein food. Eat this high
protein food first. You meals should use mashed potato or applesauce texture foods.

At mealtimes, eat slowly and stop eating at the first sign of fullness. Do not worry if
you are not able to eat your whole meal. Gradually you will be able to tolerate more
food at each meal. Plan time for your meals and enjoy your food. Introduce new
foods gradually. Try one new food at a time to ensure that you tolerate it.

4. Vitamins & Minerals

Continue taking your chewable multivitamin, as directed.

5. Physical activity
Continue 30 minutes of physical activity daily, as directed by your surgeon.

24
Phase 4 – Sample Meals

Aim to eat 2 fluid ounces (¼ cup) per meal. The first 1 ounce (2 tablespoons) that you eat
should be high protein food.

The following chart contains sample meals that you may use. Be creative, using herbs
and seasoning to help flavor your small meals.

Breakfast
High protein food Mashed, soft 2% cottage Low-fat ricotta cheese
(2 tablespoons) cooked egg cheese

Canned, chopped
Other food Oatmeal pears Cream of wheat
(2 tablespoons)

Lunch
High protein food Mashed or pureed Pureed turkey Smooth vegetarian
(2 tablespoons) soft cooked lentils refried beans
Other food Mashed carrots Mashed potato Unsweetened applesauce
(2 tablespoons)

Dinner
High protein food Pureed chicken Mashed or Finely mashed tuna
(2 tablespoons) pureed soft tofu with light mayonnaise
Other food Mashed peaches Fat-free, light Mashed banana
(2 tablespoons) yogurt

25
 Phase 4 – List of Foods to Use

Food Group Foods to use Tips

- 2% cottage cheese - Always eat protein foods first

Meat and high
- Low-fat ricotta cheese - Choose low-fat or lean protein
protein foods
- Mashed, soft cooked egg foods
- Pureed lean meat, poultry, fish - Avoid adding fats (butter, oil,
- Use 2 - Smooth vegetarian refried beans sour cream, etc) to your food. If
tablespoons of - Smooth pureed beans or lentils (use a you do use these, add them in
high protein food processor and puree to a smooth very small amounts (1/8
food at each texture) teaspoon only)
meal - Mashed soft tofu - Be cautious with spicy or highly
- Stage 2 baby food meats seasoned foods

- Cream of wheat, rice cereal or grits - Choose plain, unflavored cereals

Starches, grains - Oatmeal - Use cinnamon and/or Splenda to
and starchy - Mashed potato flavor your food
vegetables - Mashed sweet potato or yam - Avoid using extra fats (butter,
- Mashed winter squash (acorn or oil). If you use them, add small
butternut squash, pumpkin) amounts (1/8 teaspoon only)
- Mashed green peas - Avoid adding sugar (white or
brown) to your food

- Unsweetened applesauce - Choose canned fruit packed in

Fruit (no-sugar-added) juice (not heavy syrup)
- Soft mashed banana - Avoid eating the seeds and skins
- Stage 2 baby food fruits of fruit (e.g. apple peels)
- Chopped soft fruit (canned is best) - Do not use dried fruit

- Mashed carrots - Avoid eating the seeds and tough

Vegetables - Mashed soft vegetables skins of vegetables (e.g. tomato,
- Stage 2 baby food vegetables corn, celery)
- Mashed crushed tomatoes without - Be cautious with gas-prone
seeds vegetables (broccoli, cabbage,
Brussels sprouts)

- Fat-free, light yogurt - Avoid liquids with your meals.

Dairy
- Fat-free, no-sugar-added pudding This means limiting milk and
soymilk at meal times

26
Phase 5 – Soft and Regular Foods
Weeks 7-16

Purpose:
o Increase the texture of the food you are able to eat from soft foods onto
regular consistency food
o Slowly increase the amount or quantity of food you are able to eat at
each meal
o Learn to eat balanced, healthy meals. Eat from each of the food groups
daily (protein, starch, fruit, vegetable, dairy)
o Develop good food habits and behaviors

Phase 5 is a long transition phase that is broken down into sections. Over the next 10
weeks you will be trying new foods and eating larger quantities to transition back to
normal eating. This is a more independent phase. Your surgeon may allow you to
increase your portions sizes on your own, as directed by this book. Your surgeon will
likely not advance you to each new section as he may have done for the prior phases.
Choose your foods wisely and start forming healthy habits.

To help you form good food habits and behaviors:

o Cut your food into small pieces and chew well before you swallow.
o Try one new food at a time. If it does not agree with you right off, stay
away from that food for a few weeks. You may try that food again
later. Sometimes healthy, high-fiber foods require some adjustment
time.
o Enjoy your food and eat slowly. It should take you 20-30 minutes to
eat each meal. Stop eating at the first sign of fullness. Do not worry if
you cannot finish the whole meal. Gradually, you will be able to eat
more at each meal.
o Develop the routine of planning and preparing meals ahead. Make
time to eat and sit down to enjoy your meals. Pick a relaxing
environment for eating.
o Avoid grazing throughout the day. This can lead to extra calorie
intake. If you do have snacks, make them structured. Portion out your
snacks in a bowl or on a plate, instead of eating out of the food
container. Always include protein with snacks.
o Always eat your protein foods first because these are the most
important part of the meal. Follow your protein foods with fruit,
vegetables, and dairy products, and/or starches.

27
Phase 5 – Weeks 7-10

Keys:

1. Fluids
Aim to drink 64 ounces of fluid per day. Sip your fluids slowly. Your fluid will come
from your protein supplement, water and other calorie-free beverages.

Avoid drinking fluids with your meals – do not drink for 30 to 60 minutes after you
finish the meal. This helps to prevent discomfort and helps you feel more satisfied by
what you have eaten.

2. Protein
Continue taking 70-80 grams of protein per day from your pure protein supplement
drink. Drink your protein throughout the day.

3. Meals
You will eat 3 meals per day. Aim to include one ounce (¼ cup) of meat or high
protein food at each meal – eat this high protein food first. Beyond your protein
foods, eat until you are just satisfied at each meal ( ¼ to ½ cup of other foods).

Start by choosing foods that are soft in texture- easy to eat, chew and digest. These
foods are usually low in fiber. Introduce new foods to your diet gradually. Try one
new food at a time to ensure that you tolerate it.

4. Vitamins & Minerals

You may switch to taking a tablet or capsule vitamin-mineral supplement, instead of a
chewable. Continue taking your multivitamin everyday.

5. Physical activity
Continue 30 minutes of physical activity daily, as directed by your surgeon. Add light
weight training when directed by your surgeon.

28
Phase 5 – Weeks 7-8 Sample Meals

The first ¼ cup that you eat should be a high protein food. One ounce of meat or high
protein food equals ¼ cup. You may aim to eat a total of ½ cup of food per meal.

The following chart contains sample meals that you may use. Be creative and use herbs
and seasoning to help flavor your meals. Eat the foods that you like.

Breakfast
High protein food Poached egg 2% cottage Thinly sliced deli ham
(¼ cup or 1 oz) cheese
Other food Crushed
(¼ cup) Oatmeal pineapple Cream of wheat

Lunch
High protein food Tuna made with Thinly sliced deli Egg salad made with
(¼ cup or 1 oz) light mayonnaise turkey meat light mayonnaise
Other food
(¼ cup) 2-3 Crackers Diced peaches Light yogurt

Dinner
High protein food Thinly sliced deli Soft cooked tofu Lean meatball(s)
(¼ cup or 1 oz) chicken meat
Other food Cooked green
(¼ cup) Peeled apple beans Mashed potatoes

29
Phase 5 – Weeks 9-10 Sample Meals
The first ¼ cup that you eat should be a high protein food. One ounce of meat or high
protein food equals ¼ cup. You may aim to eat a total of ¾ cup of food per meal.

The following chart contains sample meals that you may use. Be creative and use herbs
and seasoning to help flavor your meals. Eat the foods that you like.

Breakfast
High protein food Scrambled egg Low-fat ricotta Canadian bacon
(¼ cup or 1 oz) cheese
Other foods
(½ cup) Cornflakes cereal Cantaloupe & Plain grits
with nonfat milk honeydew melon

Lunch
High protein food Reduced-fat, Thinly sliced deli Chicken salad
(¼ cup or 1 oz) smooth peanut turkey meat made with light
butter (1 Tbsp mayonnaise
only)
Other foods
(½ cup) Peeled apple Peeled cucumber Light yogurt

Dinner
High protein food Lean meatball(s) Soft cooked tofu Vegetarian refried
(¼ cup or 1 oz) beans

Other foods Sweet potato & Cooked green beans & Baked tortilla chips
(½ cup) cooked zucchini bell peppers and mild salsa

30
Phase 5 – Weeks 11-14

Keys:

1. Fluids
Aim to drink 64 ounces of fluid per day. Sip your fluids slowly. Your fluid will come
from your protein supplement, water and other calorie-free beverages.

Avoid drinking fluids with your meals – do not drink for 30 to 60 minutes after you
finish the meal. This helps to prevent discomfort and helps you feel more satisfied by
what you have eaten.

2. Protein
When you are able to eat more protein from food (about 2 ounces or ½ cup per meal)
you may decrease your pure protein supplement drink to just 40 grams of protein per
day.

3. Meals
You will eat 3 meals per day. You should include 2 ounces (½ cup) of meat or high
protein food at each meal – eat this high protein food first. Beyond your protein
foods, eat until you are just satisfied at each meal (¼ to 1 cup of other foods).

Adding one new food at a time, you may slowly increase the amount of fresh and
regular foods you eat. This includes whole grains, fresh fruit and raw vegetables.
Keep food moist and tender; this will help you tolerate your food better.

You may want to break up your meals to include 3 meals and 2-3 snacks per day.
This may help you to eat enough protein food. Always include a high protein food
with each snack.

4. Vitamins & Minerals

Continue taking your vitamin-mineral supplement as directed.

5. Physical activity
Continue 30 minutes of physical activity daily, as directed by your surgeon. Include
light weight training, as directed by your surgeon.

31
Phase 5 – Weeks 11-12 Sample Meals
Aim to eat 2 ounces or ½ cup of high protein food at each meal. Each ounce of meat or
high protein food equals ¼ cup. You may aim to eat a total of 1 cup of food per meal.

At this point you may want to have smaller meals with snacks in between. Make your
snacks structured and always include a high protein food. Aim to eat at least 6 ounces (1
½ cups) of high protein food everyday- whether you eat snacks or not.

Breakfast
High protein food 2 egg omelet 2% cottage cheese Smoked salmon
(½ cup or 2 oz)
Toast with
Other foods with sautéed no-added-sugar jam Light yogurt
(½ cup) vegetables

Lunch
High protein food Tuna made with ½ veggie burger Tender, skinless
(½ cup or 2 oz) light mayonnaise patty chicken breast
Other foods Small bread roll or Noodles & marinara
(½ cup) crackers Chopped sauce
strawberries
Dinner
High protein food Moist pork loin Baked white fish Edamame (soy
(½ cup or 2 oz) beans)
Other foods Baked potato & Steamed green Rice crackers and
(½ cup) asparagus beans & carrots mandarin oranges

Snacks ¼ cup low-fat ½ mozzarella 1 Tbsp reduced-fat

cottage cheese string cheese smooth peanut butter
Include a high
protein food ¼ cup peaches ¼ cup sliced apple 2 crackers

32
Phase 5 – Weeks 13-14 Sample Meals
Aim for the first 2 ounces or ½ cup that you eat to be high protein foods. Each ounce of
meat or high protein food equals ¼ cup. You may aim to eat a total of 1 ¼ cup of food
per meal.

At this point you may want to have smaller meals with snacks in between. Make your
snacks structured and always include a high protein food. Aim to eat 6 ounces (1 ½ cups)
of high protein food daily- whether you eat snacks or not.

Breakfast
High protein food 2 poached eggs Canadian bacon 2 Tbsp reduced-fat
(½ cup or 2 oz) smooth peanut butter
Other foods Rice Krispies with Plain oatmeal with Eggo waffle
(¾ cup) 1% milk splenda & cinnamon

Lunch
High protein food ½ turkey burger Chicken salad with Cooked tofu
(½ cup or 2 oz) patty light mayonnaise
Other foods Baked chips & Salad greens with Stir fry vegetables
(¾ cup) fruit reduced-fat dressing

Dinner
High protein food Baked salmon Tender roasted Lean meatballs
(½ cup or 2 oz) with dill chicken

Other foods Couscous & Baked yams & Egg noodles & mixed
(¾ cup) grilled vegetables spinach salad vegetables

Snacks ½ protein bar – 6 oz Ralphs brand 8 oz skim milk

about 100 calories Carb Master fruit
Include a high (Luna, Designer yogurt
protein food Whey, Adkins)

33
Phase 5 – Weeks 15-16

Keys:

1. Fluids
Aim to drink 64 ounces of fluid per day. Sip your fluids slowly.

Avoid drinking fluids with your meals – do not drink for 30 to 60 minutes after you
finish your meals. This helps to prevent discomfort and helps you feel more satisfied
by what you have eaten.

2. Protein
You may decrease your pure protein supplement intake to 20-30 grams of protein per
day. Continue taking this 20-30 grams of pure protein supplement until your weight
loss is complete.

Make sure you are able to eat 3 ounces (¾ cup) of high protein food at each meal or 9
ounces (2 ¼ cups) of high protein food total for the day in addition to your pure
protein supplement shake.

3. Meals
You will eat 3 meals per day. Aim to include 3 ounces (¾ cup) of meat or high
protein food at each meal – eat this high protein food first. Beyond your protein
foods, eat until you are just satisfied at each meal (¼ to 1 cup of other foods).

You may want to break up your meals to include 3 meals and 2-3 snacks per day.
This may help you eat enough protein from food sources. Continue adding new
healthy foods to your routine, one at a time. Enjoy your food and eat slowly. Always
stop eating at the first sign of fullness.

4. Vitamins & Minerals

Continue taking your vitamin-mineral supplement, as directed.

5. Physical activity
Continue 30 minutes of physical activity daily, as directed by your surgeon. Include
light weight training, as directed by your surgeon.

34
Phase 5 – Weeks 15-16 Sample Meals
Aim for the first 3 ounces or ¾ cup of every meal to be high protein foods. Each ounce of
meat or high protein food equals ¼ cup. You may aim to eat 1 ½ cups of food per meal.

If you are not able to eat 1 ½ cups of food per meal, plan for smaller meals with snacks in
between. Have structured snacks and always include a high protein food. Aim to eat 9
ounces (2 ¼ cups) of high protein food daily- whether you eat snacks or not.

Breakfast
High protein food 2 egg omelet with 2% cottage cheese Chopped ham &
(¾ cup or 3 oz) ¼ cup low-fat low-fat cheese
shredded cheese Cheerios & 1% milk
Other foods On a toasted English
(¾ cup) Cantaloupe & muffin
honeydew melon

Lunch
Vegetarian refried
High protein food 1 lean hamburger Sliced turkey deli beans with low fat
(¾ cup or 3 oz) patty (3 oz) meat ( for sandwich) shredded cheese
Other foods Green salad with On toasted bread Baked tortilla chips
(¾ cup) light dressing with mustard & salsa

Dinner
High protein food Grilled Halibut Roasted chicken Tender steak
(¾ cup or 3 oz)

Other foods Rice pilaf & snap Peeled cucumber & Mashed potato &
(¾ cup) peas tomato salad cooked carrots

Snacks ½ cup pudding 1 oz sliced turkey 1-2 Tbsp reduced-

(low-fat, no-sugar- meat fat, smooth peanut
Include a high added) with small butter
protein food amount of protein With 2-3 crackers
powder mixed in Sliced apple

35
Phase 5 – Transition from Softer to Regular Foods

As you transition back to normal eating, there are certain foods to be cautious of because
these foods can be more difficult to tolerate. Each person is different in the foods that he
or she tolerates. Food intolerance may cause general discomfort such as bloating, gas or
nausea.

Listen to how your body responds as you try new foods. Try one new food at a time. If a
food causes you discomfort, avoid that food for a short time. You may try that food again
later. Be sure to take small bites and chew your food well to help you tolerate it.

Take caution when you try the following foods for the first time. These are foods may be
the most difficult to tolerate, though many people are eventually able to eat these foods.

o Sticky foods (soft or doughy carbohydrates)

Bread, rice and pasta
Raisins, prunes and dried fruit

o High fiber foods

Orange and grapefruit membranes
Dried beans, peas and lentils
Whole grains

o Cruciferous vegetables
Cabbage, cauliflower, broccoli, squash and brussels sprouts may cause
uncomfortable gas

o Crunchy foods
Granola and coarse bran cereal
Raw vegetables like salad greens
Nuts and popcorn, coconut, crunchy peanut butter
Chips and crackers

o Tough foods
Red meat; stringy or chewy meat
Tortillas

o Seeds, peels and husks

Berries, corn, celery, apple peels

o Highly seasoned foods

Jalapenos, salsa, curry, cayenne pepper

36
 Phase 5 – Softer Foods to Use

Food Group Foods to use Tips

- Low-fat ricotta or 2% cottage cheese - Choose low-fat or lean protein

Meat and high - Shredded reduced-fat cheese; foods
protein foods mozzarella cheese - Avoid adding extra fats (butter,
- Soft cooked eggs oil, sour cream, etc) to your
- Tuna packed in water food. If you do use these, add
- Always eat - Tender fish them in very small amounts
protein foods - Tender skinless chicken & turkey - Be cautious with spicy or highly
first - Lean pork, beef (very tender) seasoned foods
- Low-fat deli meats, thinly sliced - Stay away from tough or chewy
- Vegetarian refried beans meat
- Soft cooked tofu
- Smooth, reduced-fat peanut butter
- Use cinnamon and splenda to
- Plain, unflavored hot cereal flavor your food; avoid adding
Starches, grains - Plain cold cereals (corn flakes, rice sugar to your food
and starchy krispies, cheerios, special k) - Be cautious with “sticky” foods
vegetables - Potato, sweet potato or yam (rice, bread, pasta)
- Lower fat crackers - Be cautious with tortillas
- Well toast bread - Be cautious with crunchy foods
(granola, popcorn, chips)
- Avoid canned fruit packed in
- Soft fresh fruit, peeled syrup
Fruit - Canned fruit packed in juice - Be cautious with the seeds and
skins of fruit (apple peel, berry
seeds)
- Be cautious with dried fruit
- Be cautious when eating the
- Cooked vegetables- fresh, frozen or seeds and tough skins of
Vegetables canned vegetables (corn, celery)
- Vegetable juice (avoid drinking with - Be cautious with gas-prone
meals) vegetables (broccoli, cabbage,
Brussels sprouts) - they may
cause discomfort

- Fat-free, light yogurt - Avoid liquids with your meals.

Dairy
- Fat-free, no-sugar-added pudding This includes limiting milk and
- Nonfat and 1% milk, soymilk (avoid soymilk at meal times
drinking with meals)

37
 Phase 5 – Regular Foods to Use

Food Group Foods to use Tips

- Low-fat ricotta or 2% cottage cheese - Choose low-fat and lean protein

Meat and high - Eggs - Avoid adding fats (butter, oil, sour
protein foods - Lean meat, poultry, fish cream, etc) to your food. If you do
- Vegetarian refried beans use these, add them in very small
- Dried beans, peas or lentils amounts
- Always eat - Tofu or soy beans - Be cautious with spicy or highly
protein foods - Smooth, reduced-fat peanut butter seasoned foods
first - Reduced-fat cheese, mozzarella - Choose tender, moist protein foods
cheese

- Unflavored hot cereal - Be very cautious when trying new

Starch, grains - Unsweetened cold cereals foods for the first time- they may be
and starchy - Potato, sweet potato or yam difficult to tolerate
vegetables - Lower fat crackers, baked chips, - Avoid sweetened starches and
pretzels desserts (sugared cereals, donuts,
- Bread pastries, etc.) – these are the foods
- Rice, couscous and pasta/noodles with little nutritional value that will
limit your weight loss
- Avoid canned fruit packed in syrup
- Fresh fruit - Limit/avoid fruit juices
Fruit - Canned fruit packed in juice - Be cautious with dried fruit
- Frozen fruit - Chew membranes of citrus fruit and
skin of fresh fruit very well

- Cooked vegetables - Be cautious when eating seeds and

Vegetables - Raw vegetables skins of vegetables- chew very well
- Salad - Be cautious with gas prone
- Vegetable juice (avoid drinking vegetables (broccoli, cabbage,
with meals) Brussels sprouts) because they may
cause discomfort

- Fat-free, light yogurt - Avoid liquids with your meals. This

Dairy
- Fat-free, sugar free pudding means limiting milk and soymilk
- Nonfat or 1% milk, soy milk (avoid at meal times
drinking with meals)

38
Phase 5 – High Quality Protein Sources
In general, 7 grams of protein is equivalent to 1 ounce. Aim for 60-70 grams of food
protein daily (equals about 9 ounces or 2 ¼ cups of food protein).

Food item Portion Protein

(grams)
Beans (canned):
black, garbanzo, kidney, lima, pinto, vegetarian refried ½ cup 6-8
Beans (canned): great northern, navy ½ cup 10
Peas, split (cooked) ½ cup 8
Lentils ½ cup 9
Peanut butter (reduced fat, smooth) 2 Tbsp 8
Cheese (reduced fat – less than 5 gm fat per ounce):
mozzarella 1 ounce 7
Cottage cheese (2% low fat) ½ cup 14
Ricotta Cheese (low fat) 1/2 cup 14
Egg (hard boiled or poached) 1 each 6
Egg (egg beaters) 1/4 cup 6
Egg (whites) 2 each 7
Milk (nonfat) 8 ounces 8
Pudding (no-sugar-added, nonfat) ½ cup 3
Yogurt (light, nonfat) 6 ounces 5
Soybeans (cooked): edamame 1/2 cup 11
Soybeans (dry roasted) 1/2 cup 34
Soy milk (vanilla) 8 ounces 6
Tofu (firm) 1/2 cup 20
Beef (cooked):
filet, new york steak, sirloin, roast beef, tenderloin 3 ounces 24-26
Beef (cooked): pot roast 3 ounces 28
Chicken 3 ounces (1/2 breast) 24
Chicken or Turkey (canned in broth) 3 ounces 19-20
Chicken (deli meat, smoked breast) 2 ounces 11
Fish/seafood (cooked):
cod, flounder, halibut, herring, salmon, shrimp, sole, trout 3 ounces 18-23
Fish/seafood (canned):
crab, salmon, shrimp, tuna 3 ounces 15-20
Pork (cooked): tenderloin 3 ounces 24
Ham (deli sliced meat) 3 ounces 19
Turkey breast 3 ounces 25
Turkey ground 3 ounces 23
Nutrition information for high protein foods obtained from www.calorieking.com

39
Beyond Phase 5

Habits for Long Term Success

Remember that the Sleeve Gastrectomy surgery is a tool that allows you to lose weight.
You are the one who determines how successful the tool will be. For the long term
weight loss, follow these best practices for success:

Eat 3 meals with planned snacks as needed

Choose protein foods first
Drink adequate fluids
Take your vitamin-mineral supplement daily
Get at least 7 hours of sleep each night
Engage in physical activity on a daily basis
Practice personal responsibility

Red Flag Behaviors that Predict Failure

Over time poor food habits can creep back into daily life. These red flag behaviors cause
weight gain and poor health. Monitor yourself on a regular basis to avoid these behaviors.
If you find that you are engaging in these red flags, seek support from mentors, your
surgeon or the outpatient dietitian.

Starting to eat sweets

Eating fast foods often
Skipping meals
Eating after your stomach is full
Eating rapidly
Grazing mindlessly
Eating when you are bored, upset, angry or depressed
Clinging to the couch and not being physically active
Choosing favorite carbs first
Snacking from vending machines

Give yourself the best gift by striving for success and avoiding these red flags.
Remember that the choice to be successful is yours. All the best to you as you navigate
along this journey!

40
 Overview of Diet Phases

Beyond
Phase 1 Phase 2 Phase 3 Phase 4 Phase 5
Phase 5
Clear Liquid Pureed &
Stage Clear Liquid Full Liquid Soft to Regular Regular
& Protein Mashed

Time Days 1-2 Week 1-2 Week3-4 Week 5-6 Week 7-16 Past week 16

Food Food Texture & Healthy

Focus Hydration Hydration
Texture Texture Quantity Eating

Fluids 64 oz daily 64 oz daily 64 oz daily 64 oz daily 64 oz daily 64 oz daily

60-70 gm
protein
(weeks 7-10)
20-30 gm
pure protein
60-70 gm 60-70 gm 60-70 gm 40 gm protein
Protein - until weight
pure protein pure protein pure protein (weeks 11-14)
loss is
complete
20-30 gm
protein
(week 15+)
Chewable Chewable Chewable Tab or Capsule Tab or Cap
Vitamin
- Multivitamin Multivitamin Multivitamin Multivitamin Multivitamin
& Minerals
and B12 and B12 and B12 and B12 and B12

30 minutes +
Physical 20-30 30 minutes +
- 20 minutes 30 minutes weight
Activity minutes weight training
training

41
Pre-surgery shopping list

o Very low calorie beverages

 Crystal light or sugar-free Kool-Aid
 Sugar free flavored water (propel)
 Diet V8 Splash
 Sugar free popsicles
 Diet or sugar-free jello
 Decaf herbal teas

o Clear liquid juice (for phase 2 only)

 100% apple juice
 Cranberry cocktail
 100% grape juice
o Vegetable juice (for phase 3)
 Carrot juice
 Original or low sodium V8

o Broth
 Swanson broth (chicken, beef, vegetable)
 Campbell’s chicken or beef broth
 Progresso chicken or beef broth
 Other broth based soups (chicken noodle, vegetable, miso) – strain
out all food and drink liquid only

o Milk
 Skim or 1% milk
 Soy milk - plain or vanilla

o Vitamin and Mineral Supplements

 Chewable vitamin-mineral supplement (e.g. Flintstones Complete,
Centrum Chewables)
 Tablet or capsule vitamin-mineral supplement (e.g. Centrum
Original, Nature Made Multi Complete)

o Pure Protein supplements (2-4 week supply to start with)

o Measuring tools
 Measuring cups
 Measuring spoons

42
Internet resources
General Health Information
These resources provide reliable information about diseases and disease prevention,
health promotion, and general nutrition.
HealthierUS.gov
Consumer.gov/ncpw/everyone/health
MedlinePlus.gov
MayoClinic.com
www.nhlbi.nih.gov

Professional Associations
AmericanHeart.org (American Heart Association)
ASMBS.org (American Society for Metabolic & Bariatric Surgery)
www.Diabetes.org (American Diabetes Association)
EatRight.org (American Dietetic Association)
www.ACSM.org (American College of Sports Medicine)
Obesity.org (American Obesity Association)

Nutrition Information
These resources provide guidance for food choices and nutrition information. Meal
planning tools and nutrition articles are also included here. Please note that not all
meals plans or nutrition advice provided by these sites is appropriate for you after Sleeve
Gastrectomy surgery.
Nutrition.gov
CalorieKing.com – includes nutrition facts for over 40,000 foods
MyPlate.gov

Recipes
Not all recipes provided by these sites are appropriate following Sleeve Gastrectomy
surgery. Look for recipes that are high in protein, while being low in fat and
carbohydrate. Use these sites for basic recipe ideas – but modify them to meet your
nutrition goals.
CookingLight.com
AllRecipes.com
BettyCrocker.com
KraftFoods.com

Obesity Specific Resources

ObesityHelp.com
win.niddk.nih.gov/publications
www.nwcr.ws (National Weight Control Registry)

43
References

American Dietetic Association. (2009). ADA Evidence Library, from

http://www.adaevidencelibrary.com/default.cfm.

American Dietetic Association. (2013). Nutrition Care Manual. October 20, 2008, from
http://nutritioncaremanual.org/index.cfm?ip_id=4616.

Mechanick, J., Kushner R., Sugerman, H., Gonzalez-Campoy, J., Collazo-Clavell, M.,
Guven, S., et al. (2013). American Association of Clinical Endocrinologists, The
Obesity Society, And American Society for Metabolic & Bariatric Surgery
Medical Guidelines For Clinical Practice for the Perioperative Nutritional,
Metabolic, and Nonsurgical Support of The Bariatric Surgery Patient. Endocrine
Practice, 14 (Suppl1).

Ohio State Medical Center. (2008). Patient Education Materials.

http://www.medicalcenter.osu.edu/patientcare/patient_education/Pages/index.aspx
?topic=74#198.

RD 411 (2009), from http://rd411.com/index.php.

University of Rochester Medical Center. (2008). Bariatric Surgery Center at

Highland Hospital from,
http://www.stronghealth.com/services/surgical/bariatric/index.cfm

44