By Dr. Thomas Cerebona, Dr. Ashutosh Kaul and Dr. Edward Yatco

Nutritional Expectations:
After Gastric Bypass you will need to make changes to your eating patterns. The diet after surgery progresses from a liquid diet to a pureed diet to a soft diet and then a modified regular diet. The diet progression is designed to allow your body to heal.

Initially, it will help you meet your protein and liquid requirements, and later, to assist you in meeting your nutritional needs. It is imperative that you follow the diet’s progression and adhere to this regimen to maximize healing and minimize the risk for unnecessary complications.

The size of your stomach pouch is about one ounce or one to two tablespoons. At first, you may find that two to three teaspoons of food fills you up. By six months after surgery, it may stretch to eight ounces or one cup. Long term, the size of your pouch is likely to be eight to twelve ounces or 1 to 1 ½ cups, limiting the amount of food you can eat at one time.

Eating Techniques:
"Slow, small, moist and easy."
Swallowing food in chunks may block the stoma and prevent foods from passing into the intestine. It is CRITICAL that you eat slowly and chew your food well to lower the risk for getting anything caught in this area. You may find the following tips helpful:
• Set aside 30 to 45 minutes to eat each meal. Aim to chew your food 30 times with each bite. Ground or soft foods may be necessary if you have dentures.
• Explain to friends and family why you must eat slowly so they do not urge you to eat faster.
• Take small bites of food. For a visual aid you may want to use a saucer in place of a plate to help with portion control.
• Pay attention to taste; learn how to savor your food.
• Stop eating as soon as you are full; over-eating even one ounce can make you vomit and can lead to stretching your pouch.
Remember to eat your protein first to ensure adequate amounts before becoming full.

Recognizing Fullness:
Indications of fullness may not feel the same as before surgery. Some signs that your pouch is nearly full may be a feeling of pressure or fullness in the center of your abdomen, just below your rib cage, or feelings of nausea, regurgitation or heartburn. Remember, stop eating as soon as you are full; over-eating even one ounce can make you vomit and can lead to stretching your pouch.

Protein:
Protein is the essential stuff, of which our muscles, organs, heart and brain are all constructed. Our bodies require a constant supply of protein building materials, to repair and replace tissues that become worn out or damaged. It is important to get at least 60 grams of protein each day. Remember that if you have not taken in adequate amounts of protein after three weeks, your body will start to break down its own source of protein – muscle. This will cause you to feel nauseated and week. It is important to prevent this from happening. Protein also helps with cell tissue repair and helps fight infection.

Because the small stomach pouch reduces the capacity of the stomach to a very small volume, protein containing foods should be carefully eaten with each meal. This is crucial to be sure that the body gets enough protein to maintain itself. If the focus of each meal is protein-rich foods, deficiency is very unlikely to occur. Early on, when you are taking in protein drinks, it is easy to keep track of how much protein you are consuming, but later, when you are eating regular food, it may be a little more difficult. Use the nutrition labels as your guide.

Lifetime Success:
To maintain a healthy weight and to prevent weight gain, you must develop and keep healthy eating habits. Be aware of the volume that you can tolerate and do not try to go beyond that. Frequent snacks slow down the weight loss. However, you should not go long periods without any food. You will be more prone to overeat later and not meet your protein requirements.

Try to eat at least three high proteins, nutrient dense meals and one to two protein snacks per day – every day. You body needs a minimum of 60 grams of protein each day to preserve lean muscle mass, which in turn is going to help you continue loose weight. You also need lots of protein for your body to heal properly. In the beginning, this may force you to eat mostly protein in order to reach the minimum requirement of protein.

Make healthy food choices to ensure maximum nutrition and minimum volume. Over the long term, good, well-balanced nutrition is important: Protein first (Beans, tofu, tempeh, eggs, fish, seafood, dairy products, poultry and meats), then vegetables, and then whole grains. To use protein properly, your body needs adequate amounts of complex carbohydrates.

Stay away from empty calories such as starches and sugars. Even though you may not always experience “dumping syndrome”, too much fruit, fruit juice, sugars and soft drinks will slow down your weight loss. It is best to restrict them all to allow your surgery to work for you.

Introduce one food at a time in order to rule out food intolerance. Don’t be afraid to try new foods, but in small amounts to start. What does not agree with you now may be more acceptable in a few more weeks. These problems eventually disappear, so don’t be discouraged if they happen occasionally.

Labels are a great source of information. They give you in-depth information about the product you are purchasing with regards to the amount of fat, protein, carbohydrates, sugar, and fiber it contains. Become a label reader and become more aware of what you put into your body.

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