Developed by Barrie Wolfe MS RD 1
Revised by Cristina Caracoti RD and Rachel Lustgarten MS RD 2/2011
Roux-en-Y Gastric Bypass Nutritional Guidelines
Nutrition Staff:
Dietitian
Phone
Number
Email Address
Fax Number
Despina Hyde, RD
212-263-8495
Despina.hyde@nyumc.org
212-263-3757
Shannon Carey, MS RD
212-263-1019
Shannon.carey@nyumc.org
212-263-3757
Developed by Barrie Wolfe MS RD 2
Revised by Cristina Caracoti RD 2/2011
Pre-Op Liquid Diet Instructions- Start 2 weeks before surgery
Product
Brand Name
Available
Drinks/Day
2 scoops + 8 oz water
Bariatric
Advantage
High Protein Meal
Replacement
27gms protein
7gms total carbs
5gms fiber
Online Product
Please see order
attached order form.
6 per day
1 packet + 9oz water
New Direction
protein powder
(kosher – dairy)
27gms protein
10gms total carbs
Medical Product
(can only be
purchased in our
office)
5 per day
11oz bottle
Carnation Instant
Breakfast
(kosher – dairy)
12gms protein
16gms total carbs
Supermarkets
Drugstores
Online
6 per day
11oz can
Slim Fast High
Protein
(kosher – dairy)
15gms protein
24gms total carbs
5gms fiber
Supermarkets
Drugstores
Online
5 per day
11oz can
Slim Fast Lower
Carb
(kosher – dairy)
20gms protein
4gms total carbs
2gms fiber
Supermarkets
Drugstores
Online
5 per day
14oz bottle
Muscle Milk Light
(kosher – dairy)
Lactose Free
20gms protein
12gms total carbs
5gms fiber
Supermarkets
Drugstores
Online
5 per day
8oz bottle
Glucerna Shake
(kosher – dairy)
Lactose Free
10gms protein
27gms carbs
5gms fiber
Supermarkets
Drugstores
Online
5 per day
1 scoop + 8oz fat free milk
Challenge Whey
Kosher Protein
Powder (Kof K)
Cholov Yisroel
Dairy
16gms protein
14gms total carbs (with
milk)
0gms fiber
Health Food Store
Online
5 per day
1 scoop + 8oz fat free milk
Naturemax Plus
Soy Protein Power
(kosher – soy)
28gms protein
14gms total carbs (with
milk)
Health Food Store
Online
5 per day
OTHER OPTIONS (to be used for protein supplementation or to help meet protein needs)
Product
Brand Name
Available
Comments
1 scoop + 8oz fat free milk
Unjury
(not kosher)
28gms protein
15gms total carbs
(with milk)
www.unjury.com
(800)517-5111
*Chicken soup
flavor available
Isopure Plus
(not kosher)
Lactose Free
15gms protein
GNC
*Clear, fruit
flavored drink
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 3
Revised by Cristina Caracoti, RD 2/11
More Pre-op Diet Instructions
You will have 1000 calories per day and at least 50 grams of protein. No
more than 35 grams of fat daily. Most of the calories, protein and fat in your
diet will come from the shakes.
Additional Permitted Beverages:
You may also drink sugar free beverages throughout the day. Water,
diet soda, diet ice tea, crystal light, diet lemonade, diet Snapple and the
like are unlimited. Limit caffeinated beverages as they will make it
more difficult to stay hydrated. Limit coffee and diet soda to 2 cups
daily. Caffeine free is OK. You may have skim milk and artificial
sweetener in coffee.
NO ALCOHOLIC BEVERAGES ALLOWED during this time as it
also impacts your liver adversely.
Additional Permitted Snacks:
Sugar Free Gum, Sugar Free Popsicles and Sugar Free gelatin are
permitted. Limit to 30 calories per day.
Low sodium broth (i.e. Herb Ox or bouillon cubes).
Vegetables (raw or cooked) steamed, boiled, grilled or in a soup.
Limit 2 cups daily.
Permitted vegetables include lettuce, spinach, cucumber, onion,
tomato, broccoli, cauliflower, carrots, mushroom, zucchini, string
beans, okra, cabbage, asparagus, Brussels sprouts and peppers.
No corn, peas, potatoes, or beans-too many calories.
- Mustard, salsa, vinegar are permitted in small amounts.
- Limit fat free dressing to 2 tablespoons daily.
- NO added fats, oils, butter, margarine, mayonnaise, etc.
Compliance to this pre-op diet is mandatory. This is to help shrink or
“de-fat” your liver. Shrinkage of the liver makes the surgery significantly
safer and easier.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 4
Revised by Cristina Caracoti, RD 2/11
First 10 days After Surgery – Thin Liquid Diet
♥ For the first 10 days after the surgery you will be on a thin liquid diet.
Anything that is thin enough to be sipped through a straw is fine. For
example, choose caffeine-free
beverages like Wyler’s Light, diet ice tea,
Crystal Light, broth, skim milk, sugar free hot chocolate, tomato juice, tomato
soup, water, V8 vegetable juice, Vitamin Water, Decaf coffee/tea, ices,
Propel. No Jello. Avoid carbonated drinks as they may stretch your new
pouch and cause gas. Drinking straws may cause gas too, and should be
avoided.
♥ Include AT LEAST, but not limited to, 2 protein shakes per day. You
should opt for a high protein shake Ensure High Protein, Slim Fast Lower
Carb, World Wide Pure Protein, Herbalife, Shaklee or prepare your own. To
prepare your own, blend one scoop of a protein powder such as Designer
Whey Protein or Unjury into 4 oz of liquid (preferably milk) with some ice.
Carnation Instant Breakfast, ALBA mix, Weight Watcher shake mix can be
used as well.
♥Limit fluid intake to sips at a time. Sip your fluid slowly all day long.
Do not gulp. HINT: Drink fluid as if you were drinking hot tea. This will
prevent your pouch from stretching, and prevent nausea/vomiting. It may
take 1 hour to drink 8 ounces of fluid.
♥Adequate hydration prevents dehydration and constipation. Have a
goal of consuming 6-8, eight oz glasses of fluid per day.
♥ All medications will be chewed or crushed for the first three weeks
after surgery. You are advised to take a multivitamin supplement after
surgery due to your low caloric and nutrient intake. Take 2 chewable
children’s multivitamins (i.e. Flintstones). Or take an adult liquid or
chewable multivitamin each day (i.e. Centrum adult multivitamin chewable
or liquid, Maxi Health chewable multivitamins (kosher)or Freeda Monocaps
multivitamin (kosher and vegetarian) in chewable or liquid form. Start taking
a chewable calcium: Tums 400 or (chew 1 with breakfast, 1 with lunch and 1
with dinner). Take calcium 3 times/day.
* YOU WILL COME BACK IN 7-10 DAYS AFTER SURGERY FOR A CHECK
UP.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 5
Revised by Cristina Caracoti, RD 2/11
POSTOPERATIVE VITAMIN SUPPLEMENTATION: RNY GASTRIC BYPASS
Multivitamin:
200% of Daily Value
•
Begin on day 1 after hospital discharge
What to look for:
• “Complete Formula” containing the RDA for iron and zinc.
• Choose chewable or liquid form. Avoid time-released
supplements and enteric coating.
•
Children’s formulas are ok if they are listed as “Complete.”
Tips:
• May be taken with food.
• Do not mix multivitamin containing iron with calcium
supplement (take at least 2 hr apart).
•
Take 2-3 doses day; spread out doses.
Brands:
• Centrum Chewable Multivitamins (2/day)
• Flintstones Complete Multivitamins (2/day)
• Bariatric Advantage VitaBand Multivitamin (3/day)
• Maxi Health Chewable (Kosher - 3/day)
Foods:
• Choose a variety of foods including fruits, vegetables, lean
protein and whole grains, to optimize nutrition status.
Calcium & Vitamin D:
1500-2000 mg/day calcium & 1200-1600 IU vitamin D
•
Begin on day 1 after hospital discharge
What to look for:
• Choose a brand that contains calcium citrate and vitamin D3
(cholecalciferol).
•
Choose chewable form.
Tips:
• Take 3x/day; split into 500–600 mg calcium doses evenly
throughout day for optimal absorption.
• Do not combine calcium with iron containing supplements.
• Also include calcium-containing low fat dairy beverages/foods
in diet; up to 3 servings daily.
Brands: Wait one month before starting all creamy/chewy bites
• Chewable Caltrate 600-D Calcium with Vitamin D (3/day)
• Chewable OS Cal 500 + D (3/day)
• Calcet Citrate Creamy Bites (3/day)
•
Bariatric Advantage Calcium Citrate Chewy Bite (3/day)
Food with Calcium & Vit D:
• Dairy products, broccoli, kale, collards, calcium fortified foods,
canned fish with bones.
In case of deficiency:
•
50,000 IU/WEEK Vitamin D2 orally/intramuscularly for 8 weeks
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 6
Revised by Cristina Caracoti, RD
Iron:
36-45mg/day
What to look for:
• Low risk patients may meet iron requirements by taking 2
complete multivitamins/day.
•
Higher risk patients may be prescribed additional iron by MD.
Tips:
• Vitamin C may enhance iron absorption.
• Calcium supplements, dairy foods, coffee or tea inhibit
absorption – do not take within 2 hrs of these items.
Brands:
• Slow Fe (1/day)
• Vitron C (1/day)
• Maxi Health Maxi Liquid Gentle Iron (kosher – 1/day)
• Rx: Niferex or Chromagen Forte
Food with Iron:
• Beef, tofu, mussels, clams, organ meats, black beans, chick
peas, spinach, canned tuna/salmon
In case of deficiency:
• ≤300mg/day (given in 3-4 doses throughout the day on empty
stomach)
Vitamin B12
Tips:
• 1000 mcg/month from liquid drops/nasal spray/ intramuscular
injection (IM) or 350-500 mcg/day orally.
• Supplements in crystalline form are best absorbed.
Brands:
• Nature’s Bounty Natural B-12 Sublingual Vitamin
• Nature Made Vitamin B-12 tablets
•
Maxi Health B-12 Lozenges (kosher)
Food with B12:
•
Beef, trout, liver, clams, tuna, yogurt, fortified breakfast cereal
In case of deficiency:
• 1000 mcg/week IM for 8 weeks
• After 8 weeks continue with 1000 mcg/month IM or 350-500
mcg/day orally
***NOTE: Have bloodwork monitored annually by your surgeon or dietitian to
assess nutrition status ***
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 7
Revised by Cristina Caracoti, RD
Sample Liquid Diet
(Day 2- Day 10 after surgery)
MORNING IDEAS
1 cup protein shake
1 cup Propel or tea or coffee
AFTERNOON IDEAS
1 cup protein shake
½ cup vegetable juice or water
½ cup “Cream” of tomato soup (tomato soup with skim milk-no chunks)
EVENING IDEAS
1 cup protein shake
½ cup Crystal Light or Wyler’s Light
½ cup broth
1 diet ice pop
REMINDER!
Try to consume at least 2 high protein shakes (Slim Fast Lower Carb,
Muscle Milk Light, Pure Protein, Myoplex Lite, etc.) every day! They will
help give you energy and protein. It will help promote wound healing and
help preserve muscle.
Shake idea: take 4 oz milk, crushed ice, and blend with 1 scoop protein
powder (i.e. Unjury Whey Protein or Isopure) to make a protein smoothie.
HINT: The first two weeks are the most challenging! It is suggested that
you avoid watching TV during this time due to the large number of food
commercials. Choose other activities such as reading books, knitting,
writing, using the Internet, talking on the telephone, etc., to help keep your
mind off of food.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 8
Revised by Cristina Caracoti, RD
Second 10 days after Surgery - Puree/Soft Diet
*You can begin eating pureed foods after your 10 days of liquids is
completed.
* From this point on you will begin to avoid drinking with meals. Remember
to stop drinking 30 minutes before your meal and wait 30 minutes after your
meal to drink.
*Focus on a balanced healthy diet with an emphasis on protein and nutrient
rich foods. Sample food ideas are below.
* To puree food, cut food into small pieces (size of an eraser) and then cook.
Drain the fluid and set it aside. Blend the food and liquid (can be juice or
broth, too) in a blender/food processor. Blend until applesauce consistency.
Strain any lumps or pieces. Use spices to flavor food. Final consistency
should be smooth.
Food Group
Food Choices
HIGH PROTEIN CHOICES
→
Meat, Poultry, Fish, Nuts, Beans
and Eggs
Chopped up soft poached eggs or scrambled eggs.
Blenderized meat or poultry and flaked fish cooked very soft
and moist, blenderized tuna salad with no added vegetables.
Very soft meatloaf (blended), fork mashed gefilte fish and
silken tofu. Non fat refried beans, hummus, creamy peanut
butter
HIGH PROTEIN CHOICES
→
Milk, Cheese and Yogurt
Low fat or non fat cottage cheese or ricotta cheese, sugar
free custards and puddings, non-fat unsweetened / sugar free
yogurt
Vegetable
Any vegetable (except corn) cooked soft and blended or
mashed with the back of a fork. Make sure broccoli and
cauliflower are cooked very well
Fruit
Unsweetened applesauce, pureed canned/jarred peaches and
peas in their own juice (not syrup), any fruit pureed with out
the skin, mashed ripe banana
Bread, Cereal, Pasta and Rice
Hot cereal – unsweetened oatmeal, cream of wheat, grits or
mashed potatoes with out skin
Fats and Oils
Limit all
Miscellaneous
Blended soups (no chunks of vegetables or meat) – limit
cream soups. Try Healthy Choice, Progresso Lite and
Healthy Request, egg drop soup and miso soup
Liquids (Do not drink during
meals. Try and drink at least 8
(8oz) cups of fluid per day)
No carbonation. Flat diet soda, skim milk or Skim Plus,
Crystal Light, nutrasweet Kool – Aid, coffee, tea, all broths,
any sugar free beverages, diet Snapple and water!
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 9
Revised by Cristina Caracoti, RD
Sample Puree Diet
(Second 10 days after surgery)
BREAKFAST
2 chopped poached eggs
or
3 oz cottage cheese
or
Protein Shake
LUNCH
2-3 oz moist tuna (use reduced fat mayo), 1-2 tbsp. pureed peaches
or
2-3 oz silken tofu, 1-2 tablespoons pureed broccoli
or
Protein Shake
DINNER
2-3 oz flaky, moist fish, 1-2 tablespoons pureed vegetables
or
2-3oz blended meatloaf (soft, moist), 1-2 tablespoons pureed cauliflower
**NOTE: You can always replace a meal with a shake.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 10
Revised by Cristina Caracoti, RD
Bypass Basics
THE POST –OP DIET:
For the first 10 days after surgery you will be on a liquid diet.
For the second 10 days after surgery you will be on a pureed diet.
Meals should include protein first, then fruits and vegetables, and then
whole grains. Protein will help preserve lean muscle and help promote
wound healing.
Protein rich foods usually come from animal products (chicken, fish,
eggs, cheese, yogurt, etc). Beans, nuts (peanut butter) and tofu and also
great sources of protein.
Avoid concentrated sugars; they can cause the “Dumping Syndrome”
Limit fats; they can lead to nausea and weight gain
Eat 3 small nutrient dense meals daily.
IMPORTANT EATING BEHAVIORS:
Eat slowly – it should take ½ hour for each meal!
Chew slowly and thoroughly – at least 25 times!
Remember the stomach can only hold a few Tablespoons right after
surgery. Eventually it can hold about ½ to 1 cup per meal. (After 6
months a ½ sandwich could be a meal. After 1 year a Lean cuisine
sized entrée can be a meal.)
Stop eating when you feel full – if ignored, vomiting will follow.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 11
Revised by Cristina Caracoti, RD
More Bypass Basics
PREVENTING FOOD INTOLERANCES:
Introduce new foods one at a time in order to rule out intolerance. If a
food is not tolerated, take it out of your diet for a week and reintroduce
it one week later.
If you cannot tolerate dairy, substitute Lactaid for milk. You may need
to take Lactase pills with dairy to help digest the lactose.
FLUIDS:
Drink at least 6 – 8 cups (8oz) of fluid per day to prevent dehydration
and constipation. You can carry a water bottle around with you.
Stop drinking liquids 30 minutes before meals and resume 30 minutes
after meals.
SUPPLEMENTS:
Set up a schedule for supplements (refer to supplement form) and
medications; remember to take Calcium with meals and separate from
Iron supplements.
PHYSICAL ACTIVITY:
Exercise! This is the key to long term maintenance of weight loss.
Walking should be the main exercise for the first 6 weeks. After 6
weeks, more strenuous exercises can be added. After 6 weeks, weight
lifting or using weights in your aerobic exercise is encouraged as it
helps build muscle.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 12
Revised by Cristina Caracoti, RD 2/11
Dumping Syndrome
The “Dumping Syndrome” occurs when food passes rapidly from the stomach
into the small intestine. Dumping can be provoked by: ingestion of
concentrated sweets, overeating and consuming liquids with meals. The
partially digested food in the small intestine draws water out of the blood
vessels from the body into the small intestine, thereby causing the following
symptoms: nausea, fullness, cramping, diarrhea, weakness, sweating and a
rapid heart rate. The following foods and beverages should be avoided.
Foods to Avoid
Sugar free and artificial sweeteners are ok
Ice cream Regular soft drinks
Chocolate milk Lemonade
Pudding Kool aid
Sweetened, fruited or frozen yogurt Sugared ice tea
Dried fruits Snapple fruit drinks
Canned or frozen fruits in syrup Table sugar
Fruit juice Honey
Sugar coated cereal Candy
Doughnut Regular Jell – O
Popsicles Sugar gum
Cakes Molasses
Pies Syrups
Cookies Sherbet/Sorbet
Should this syndrome occur, it usually passes within 15 – 20 minutes but can last 4-6
hours. Drink lots of water or take Imodium AD or Pepto – Bismol and wait for symptoms
to pass.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 13
Revised by Cristina Caracoti, RD 2/11
Diet Progression after Gastric Bypass
This is a general guideline on when to add in various foods. Individual
tolerance of certain foods will vary.
Day 1 Post – op: Nothing by mouth.
Day 2 – Day 10 Post – Op: Progress from Clears to No
concentrated sweets liquid diet. Try to consume 2oz of fluid every
hour.
Second 10 Days Post – Op: Puree/soft high protein diet (see
attached sheet). Try and consume 4 – 6 oz of fluids every hour.
Start the habit of eating protein first and avoiding drinking with
your meals. Your goal is 60 grams of protein daily.
3 Weeks Post – Op: Firm tofu, and seafood, thinly sliced deli
turkey or ham, boiled dark meat chicken (cut up into small pieces)
in broth, crisp toast and crackers, beans and peas, and well cooked
pasta. The goal is 75 grams protein per day. A high protein diet
may prevent hair loss.
2 Months Post – Op: White meat chicken (no skin), soft cooked
vegetables, soft fruits (watermelon, honeydew, peaches, plums).
Moist grounds meat in red sauce.
3 Months Post – Op: Rice, soft bread, lean ground meat and
turkey, duck.
4 Months Post – OP: Veal, crunchy fruits and vegetables including
salads.
6 Months Post – OP: Beef and pork (choose poultry and fish more
often in view of lower fat content).
*** The diet should always be high in protein and low in refined
carbohydrates. Protein first, then vegetables, then fruit and then preferably
whole grains.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 14
Revised by Cristina Caracoti, RD 2/11
Nutritional Supplements
You will require vitamin and mineral supplements for the rest of your life in
order to prevent deficiencies. Remember, you are eating much less food, as well
as absorbing fewer nutrients, and therefore requires supplemental vitamins,
minerals and protein.
First 3 Weeks after Surgery: All pills must be chewed or crushed!
Chewable Multi – Vitamin (chewable children’s): Flinstones
Complete or Centrum Jr. with iron (chew 1 in the AM and 1 in the
PM). 2/day.
Chewable Calcium: Tums or Calcet Creamy Bites 1200mg per day
(chew 1 with breakfast, 1 with lunch and 1 with dinner). 3/day.
Protein Shake: Make protein shake by choosing a protein powder (i.e:
Designer Protein, GNC Challenge 95, Unjury Whey Protein). *1
scoop powder equals about 20 grams protein and 100 calories. Blend 1
scoop of protein powder with ½ cup milk, ice and 2 tsp. fruit. Premade
shakes are also available (i.e.: Isopure-in the clear glass bottle,Ultra
Pure Protein) Have 1 shake per day as a meal replacement.
3 Weeks After Surgery: You may start swallowing pills.
Adult Multi – Vitamin: Centrum with Iron, Geritol Complete, or GNC
Ultra Mega (may need to broken in half) once daily
Calcium: 1200mg Calcium Citrate (i.e.: Citrical with Vitamin D,
www.Vitalady.com
brand). You can only absorb 500mg of calcium at a
time. Take throughout the day. Example: take a calcium supplement with
each meal and one with a snack. If you are taking thyroid medication, take
separately.
Iron: As prescribed by your doctor. Take on an empty stomach (i.e. first
thing in the morning and/or before bed). Take with vitamin C to increase
absorption (chewable).Do not take with milk, calcium supplements,
coffee, tea or antacids!
Protein Shake: If unable to consume 60 – 70 grams of protein / day from
diet, then protein supplement may be indicated (protein bar or shake).
(Labs will be followed and other supplements may be prescribed as needed.)
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 15
Revised by Cristina Caracoti, RD 2/11
Estimating Your Protein Intake
Your average protein intake for the first 3 weeks after
surgery is about 60 grams per day. After 3 weeks it increases
to 75 grams.
Every 1-ounce of protein (meat, poultry, fish, cheese) will have
about 7 grams of protein. (i.e. 2 ounce of tuna fish has about 14
grams of protein in it).
An ounce looks like a thin deli slice of turkey or cheese or 1
prepackaged wrapped slice of cheese.
An ounce looks like the size of a small matchbook or the size of
a thumb.
A cup of milk or yogurt has about 8 gram of protein in it.
An egg has about 7 grams of protein.
½ cup cottage cheese has 14 grams of protein.
Read your food labels to help estimate the protein content of
other foods.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 16
Revised by Cristina Caracoti, RD 2/11
IMPORTANT REMINDERS!
* Keep in mind that your diet needs to be low fat, low calorie, sugar free and
portion controlled for the rest of your life. This is the commitment you must
make to achieve maximal weight loss.
* If you experience increased hunger in the first 2 weeks, drink more calorie
rich drinks (i.e. protein shakes, milk). Do NOT advance your diet prematurely
as you will increase your chances vomiting. You are on a thin pureed diet to
help promote healing.
* If you experience excess gas make sure you are not using drinking straws as
it promotes swallowing excessive air. Other possible causes of gas include
Lactose Intolerance, high consumption of sugar free foods, excess dietary
fiber, and calcium carbonate. Make the appropriate changes if needed. For
example, try Dairy Care, lactaid milk or soy milk if you are lactose intolerant.
Talk to the MD or RD about products such as GasX, Mylanta or Beano to
help reduce gas.
* If you experience constipation, increase fluid, dietary fiber and physical
activity as medically feasible. Fiber rich foods include beans, oatmeal, fruits,
whole grain breads and high fiber cereals. Add fiber slowly into your diet to
avoid stomach upset. Increase your fluid intake as you increase your fiber
intake. Talk to the MD or RD about products such as Phillip’s Milk of
Magnesia, Colace or Benefiber to help with constipation.
* It is recommended that you keep a food journal. This will help you keep
track of your eating habits. Bring the food journal to your nutrition follow up
visits to review your progress with the nutritionist.
* It is very common to hit a weight loss plateau (weight loss stops for a period
of time). Most people will experience one or more plateaus during their
weight loss journey. This is NORMAL!!! Your body is becoming more
adjusted to consuming fewer calories. At this time review your diet and your
eating behaviors. Are you eating protein first? Are you limiting your fats and
starches? Are you consuming “soft calorie” foods (i.e. ice cream)? Are you
drinking at your meals? Review the original guidelines in this packet and
adhere to them. Meet with your nutritionist to review your diet.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 17
Revised by Cristina Caracoti, RD 2/11
TOP TIPS FOR SUCCESS
Chew food well (until it is pureed).
-Try cutting up food into small pieces (the size of a pencil eraser).
-Liquefy food in mouth before swallowing (chew food 15 times before
you swallow).
-Put your fork down between bites (count to 60 before you take another
bite).
-Try using cocktail forks or baby utensils to help take small bites.
Watch your portion sizes at meals.
-The less food you put in front of you, the less you will eat.
-Use saucer plate for meals or buy small Tupperware for portion
control.
Stop eating when you feel comfortable satisfied.
-It takes 20 minutes for your brain to identify that your stomach is full.
When you feel a pressure in your upper stomach area, this is your new
full feeling. If it is painful, you probably took one too many bites! DO
NOT OVEREAT!
-Eat slowly to recognize this feeling.
-Keep a timer on your table when eating. Set it for 20 minutes. This
visual will be a constant reminder to SLOW DOWN!
Only eat when hungry.
Drink adequate fluids to prevent dehydration.
-Aim for 48-64 oz (6-8 cups) of fluid a day.
-Do not drink and eat at the same time. Stop drinking 30 minutes
before your meal then wait 30 minutes after a meal to resume drinking.
-For the first week post-op your stomach is swollen and it may take 30-
60 minutes to drink a cup of liquid. Keep sipping all day to help
prevent dehydration; it gets easier as the weeks pass. Soon it will only
take 5-15 minutes to finish a cup. Beverages must be sipped, no
gulping!
-Try sippy cups or sports top water bottle to slow you down, keep
fluids with you all day long and keep sipping.
-Avoid setting a glass at your place setting. It is too tempting to drink if
there is a beverage at your meal.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 18
Revised by Cristina Caracoti, RD 2/11
-Increase your fluid intake if any of the following signs are present:
dark urine, headache, dizziness, confusion, a white coating on the
tongue. And call your doctor.
Avoid carbonated beverages and beverages containing sugar.
-The bubbles may cause irritation and gas.
-Choose sugar free/calorie free, non carbonated drinks such as: Crystal
Light, Fruit 2O, Diet Snapple, Light Minute Mais, etc…
-Limit caffeinated beverages to no more than 16 oz a day.
-Caffeine can irritate the lining of the stomach and may increase your
risk of developing ulcers after surgery.
-Wean off carbonated and caffeinated beverages before surgery to help
prevent withdrawls.
Avoid alcohol beverages.
Alcohol, beer and wine, in excess, can cause weight gain and result in
poor nutrition since they are high in calories and low in nutrients.
Alcohol may be absorbed more quickly than before due to your small
stomach. You may feel the effects of the alcohol after consuming a
small amount.
Read food labels.
-Food choices should be no sugar added and low in fat.
-Foods that are high in sugar and fat may cause diarrhea and abdominal
discomfort or cause “Dumping Syndrome”.
-These poor food choices can slow down the rate of weight loss and
may even cause weight regain.
-Avoid concentrated sugar. (It’s high in calories and leaves you hungry
for more!)
-Keep sugar out of the first 3 ingredients no the food label.
-The following ingredients are also known as sugar and commonly
found on food labels: dextrose, high fructose corn syrup, glucose,
sucrose molasses and honey.
-Artificial sweeteners such as NutraSweet/Equal, saccharine/Sweet &
Low and sucralose/Splenda are acceptable to use.
-Watch out for foods containing sugar alcohol such as sorbitol. Large
amount of sugar alcohol found in sugar-free candies, cookies, or ice
cream may lead to cramping, abdominal pain, excess gas or diarrhea.
Limit high fat foods.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 19
Revised by Cristina Caracoti, RD 2/11
Low fat is 3 grams or less per serving on a food label.
Protein is the most important nutrient you need to consume after
surgery.
-You need at least 60-80 grams of protein a day.
-Protein should be consumed first at each meal, then vegetables and
fruits, then “whole” grains.
-You may drink a protein supplement if you are not able to consume
adequate amounts of protein.
-Look for drinks made with whey protein isolate (this is absorbed well).
-Strive for a protein shake with at least 20 grams of protein per serving.
-Mix with skim or 1% milk for an additional 8 grams of protein per
serving.
-Aim for a product with less than 3 grams of sugar per serving.
Exercise!
-Aim for at least 30 minutes every day.
-Exercise helps maintain long term weight loss.
-The first 6 weeks, walking should be used as the primary exercise.
-After 6 weeks, try introducing strength exercises.
-Always speak to your doctor if you have never exercised.
Nutritional Quiz:
You must complete the nutritional quiz provided to you in this packet and
return it to the office prior to or on the day of your pre-surgical testing.
You may drop off the quiz at the front desk or you can fax it to the office at:
(212) 263 – 3757.
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 20
Revised by Cristina Caracoti, RD 2/11
NYU LANGONE WEIGHT MANAGEMENT PROGRAM
Patient Name: ____________________ Date Of Birth:___________________
Surgery Date: _________________
QUIZ - Gastric Bypass
1. This surgery for obesity will require me to have periodic follow up visits with my
physician and nutritionist for the rest of my life. TRUE or FALSE
2. List 3 items you will be able to consume for the first 10 days after your surgery.
1.________________ 2.________________ 3.________________
3. List 3 items you will be able to consume for the second 10 days after your
surgery._____________________________________________________
4. When can you eat solid foods after surgery?_____________________________
5. Briefly explain why you can’t drink and eat at the same time after your surgery.
______________________________________________________________________
_____
6. How long do you have to avoid beverages before and after your meal?
a. 5 minutes
b. 10 minutes
c. at least 30 minutes
7. What foods may cause dumping after surgery and must be avoided?
__________________________________________________________________
8. What are some signs that may indicate dumping syndrome? _________________
_________________________________________________________________
9. How much food can your stomach hold at each meal immediately (first 3 weeks)
after your surgery?
a. 1-3 tablespoons per sitting
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 21
Revised by Cristina Caracoti, RD 2/11
b. ½ - 1 cup food per sitting
c. 2 cups per sitting
10. How much fluid should you consume daily?
a. 1-2 cups
b. 3-5 cups
c. 6-8 cup
11. List 2 important eating behaviors that will be important after surgery to prevent
vomiting?
1.____________________________ 2._____________________________
12. How long should it take you to consume a meal? ______________________
13. If I continue to consume high calorie foods and or beverages (i.e. cookies, ice
cream juices) I will still lose weight easily after this surgery. TRUE or FALSE
14. List some foods that are high in protein.
1.___________________ 2.__________________ 3.__________________
15. I will require vitamin and mineral supplementation every day for the rest of my life
after the gastric bypass. TRUE or FALSE
16. List the supplements that you will be required to take for the first 3 weeks after
surgery?
1.______________ 2.________________ 3._________________
Then, after the first 3 weeks you will have to take….
1.______________2._________________3._________________
17. How do you prepare a protein shake? ________________________________
18. Your goal of protein after the first 3 weeks is :
Developed by Barrie Wolfe MS RD and Nicole Siegel MS RD 22
Revised by Cristina Caracoti, RD 2/11
a. 40 grams
b. 60 grams
c. 75 grams
19. Why is it important to consume your protein first?
___________________________________________________________________
___________________________________________________________________
__________
20. What type of diet should be followed 2 weeks before your surgery? Why?
___________________________________________________________________
_____
21. I will have to have my blood tested regularly to prevent serious nutrient
deficiencies. I may have to take additional supplements as instructed by my RD
and/or MD if needed. TRUE or FALSE
22. After surgery, I will be discharged from the hospital
a. 2 days after surgery
b. 3 days after surgery
c. 1 week after surgery
23. When is your first office visit after surgery? ___________________
24. After surgery, weight loss is a guarantee and I will never regain weight.
TRUE or FALSE
For Office Use Only
Reviewed by:________________via:__________________date:____________________