Northumbria HealthcareNHS Foundation Trust

Eating plan aftergastric bypass

Issued by Nutrition and Dietetics

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Dietitian ……………………………………….

Bariatric Specialist Dietitians Telephone: 0191 293 2707

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This leaflet will provide you with advice on how to eat wellfollowing your weight loss surgery and is based on ourexperience of what seems to work well for most people.

With weight loss, you may see an improvement in weight-relatedhealth conditions that you may have such as type 2 diabetes, highblood pressure and sleep apnoea.

Follow the suggestions in this leaflet to help prevent your smallerstomach from stretching; to get the nutrients you need for goodhealth and to prevent nutritional deficiencies and side effects such asnausea, vomiting, bloating and blockages.

Physical activity remains important to help manage your weight inthe long term. The guidelines for adults are that they should aim tobe active daily and should do at least:

• 150 minutes of moderate-intensity aerobic activity each weekplus muscle strength activities on two or more days each week

OR• 75 minutes of vigorous-intensity aerobic activity plus musclestrength activities on two or more days each week

OR• An equivalent mix of moderate and vigorous aerobic activity eachweek 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 whichmeans you will feel full more quickly with a very small amount offood. The small stomach pouch is then connected to the middle partof your small intestine, bypassing the rest of your stomach and first

portion of your small intestine. This means only a certain percentageof 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 andmineral supplements.

Many people report that their tastes and food preferences changeafter surgery and this is entirely normal.

Weight loss – what to expectYou will lose most of your excess body weight in the first 1-2 yearsafter surgery. Your commitment to healthy eating and lifestyle habitswill help you to lose the weight, maintain your weight loss and helpyou 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 weightloss to slow down after the first few months. Do not panic - your bodywill take time to adapt to the reduction in calories and if we eat toolittle over a long period of time, our metabolism (the speed at whichwe burn calories) slows down. You may find that you are losinginches instead. You can help your weight loss by eating regularlyand choosing healthy foods.

Vitamin supplementsIt is vital that you take the recommended supplements to preventany vitamin or mineral deficiencies as the amount you are able to eatand/or absorb will be vastly reduced. Take these for life.4

Multivitamin and Minerals• First month only after surgery take chewable/liquid supplements

twice a day. Choose a variety which says: ‘multivitamins withminerals’ and is suitable for adults

• After the first month you should be able to take tabletmultivitamins. Choose a variety which says on the label: ‘A-Zmultivitamins and minerals’ or ‘Complete multivitamins andminerals’. Take two tablets a day

Additional Supplements• Calcium and vitamin D supplement which your GP will prescribefor you

• Vitamin B12 injections. Most people need a maintenance doseonce every 3 months. Your GP will be able to arrange this foryou.

• Iron supplement(s) will be prescribed for you by your GP• Take your multivitamin and mineral supplement and ironsupplement at a different time from the calcium and vitamin Dsupplement i.e. 1-2 hours before/after

You may need to take additional supplements on the advice of yourbariatric dietitian or consultant. This is usually because your bloodtests have shown a deficiency and/or your diet is lacking anutrient(s).

Do not take any extra supplements without checking with yourbariatric dietitian.

Food re-introductionPlease refer to the ‘meal ideas booklet’ for more information.Initially your stomach will have some swelling and tenderness fromthe operation therefore it is important that you gradually increase thetexture 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 tryagain in a week or so. It may be helpful to keep a food diary torecord what you ate and how you tolerated the food. 5

The diet after surgery is split into four stages:

Your date of surgery……………

Stage Texture When to start For how long

1 Fluids only Day of surgery 1 day

2 Pureed foods Day 1-2 (as advised) 4 weekspost operatively

3 Soft foods Week 4 post 2-4 weeksoperatively

4 Solid foods Week 6-8 post Ongoingoperatively

Remember the time to progress from one stage to the next can varybetween individuals. It is important not to rush each stage. Onlymove onto the next stage when you are ready. You are less likely toexperience problems if you begin carefully.

PortionsIt is difficult to give set portion sizes for each stage. This is becausewe have found that the amount people can eat after surgery variesbetween individuals. It is important to eat slowly and stop eating assoon as you feel full.

As a guide, we expect your first few meals to be no more than 3-4teaspoonfuls. This will slowly increase to an egg cup size portion. Bythe time you are on stage three (soft foods) you should be taking nolarger than a saucer sized portion. Eventually your normal portion inthe longer term will be a side plate sized portion, this is a seven inchor 18cm plate. It is important that you increase the portion sizesslowly so as not to stretch your new pouch – if this happens it willaffect your long term weight loss.6

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 beforea 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 intosmall 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 computerwhile you are eating

• Pay attention to your body’s signals of hunger and fullness. Stopeating as soon as you feel full or have any chest pressure ordiscomfort

• 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 snackseach day.

• Plan your meals and snacks in advance• Choose foods from all the main food groups (see meal ideasleaflet)

• Include protein at each of your meals and snacks. Higheramounts of protein are found in lean meats, poultry, fish, eggs,beans, lentils and low-fat dairy products

• Each main meal should contain protein, vegetables andcarbohydrates. 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 mealand one hour after a meal

• Try to drink two litres of fluids each day – keep a drink with youthroughout the day

• Sip drinks slowly – do not gulp quickly. Initially a small glassshould take one hour to drink

• Do not drink fizzy liquids as they may cause bloating and couldstretch the small stomach you have left. Drink water, sugar freestill drinks, tea or coffee instead

• Do not use straws to drink your liquids. This may cause gas orbloating

Alcohol People who have had a gastric bypass do find that they feel theeffects of alcohol quicker and with only a small amount. Alcohol canalso cause dumping syndrome and is best avoided. Also, alcoholprovides calories and no nutrition. We recommend that you avoidalcohol completely for at least three months after surgery.

Foods to avoidIt is common not to be able to eat certain foods after a gastricbypass. • Some foods may stick in your stomach pouch or causeblockages. Foods such as overcooked rice, overcooked pastaand soft doughy breads are more likely to be sticky and are bestavoided

• Avoid foods which are hard to chew. This includes dry toughmeats, stringy vegetables or fruits, vegetable or fruit skins, nutsand 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 maystruggle to eat and should avoid and alternative suggestions:8

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Foods to avoid Alternative to try

Bread CrackersCrispbreads/breadsticksToast Pitta bread / wraps

Overcooked rice, overcookedpasta

Rice and pasta cooked stillin“pieces”/al denteCouscous

Tough, dry meats Cook meats in slow cooker/oven for longer time until softand tenderWafer thin cold cutsMinced meatsAdd low fat gravy/sauce tomoisten

Skins on fruit and vegetables

Fibrous and stringy vegetables such as cabbage/onions/lettuce/sweetcorn

Peeled fruit and vegetablesRipe soft fruitsTinned fruits in natural juiceCauliflower, broccoli, carrots,root vegetables (buy frozento reduce waste)Chop onions finelyTry grating fruit or vegetables

Oranges/grapefruit Soft ripe fruits e.g. peeledpeach/plum/pear/tinned fruit innatural juice

Nuts, dried fruits, seeds andfoods containing these - - - - - - - - - - - - - - -

Coconut - - - - - - - - - - - - - - -Popcorn - - - - - - - - - - - - - - -

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Potential problems

l Dumping syndromeThis occurs after the consumption of sugary or fatty foods and drinks. “Dumping” syndrome has a range of symptoms from feeling tiredand lightheaded to fainting and diarrhoea. It can also cause you tofeel shaky, clammy, and nauseated.You can prevent it by avoiding foods/drinks high in sugar and fat oralcohol.

Foods to avoid include:-• Biscuits and cakes • Tomato soup• Chocolates and sweets • Full fat dairy products• Sugar and sugary drinks • Pastry • Pure fruit juice - dilute with • Fried foodswater and take in small amounts only • Oils

l Hair loss This is usually due to the physical stress of rapid weight loss but canoccasionally 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

Normal hair growth usually returns after a year.

Do not take additional supplements unless advised by yourdietitian/doctor.

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l VomitingThis may be due to eating too quickly, eating too much, not chewingfood 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 togetherIf you cannot keep any food or fluid down seek medical advice.

l Constipation Often due to lack of fibre and/or fluids, anxiety and depression canalso make it worse:• Choose high fibre cereals and include plenty of fruit andvegetables

• 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

l 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

If you have any questions regarding your diet please do nothesitate to contact us on 0191 293 2707. There is an answeringmachine if we are not in the office, please leave us a messageand we will contact you as soon as possible.

PIN 650/V2Review date: July 2018