Firstly, let us preface this information by telling you that every patient is different. What’s right for one person may be very different for someone else. But it can be reassuring to know what to expect in a general sense. With that in mind, here’s a general overview of the different bariatric diet stages, and why these might be important for you to adhere to after weight loss surgery. If you have actually had surgery, the best protocol is the one given by your surgeon or dietitian who actually knows you and your unique needs.

Does the protocol differ depending on your procedure?

In general, no. We use the same 2/2/2 rule for all procedures. That is 2 weeks liquids, then 2 weeks puree, then 2 weeks soft, before transitioning to “normal” food. The bariatric diet stages may differ in timing depending on how you tolerate them. We make the 2 weeks liquid mandatory but there is some leeway with the puree and soft phases. Either way it will be six weeks before you start on normal food, albeit in very, very reduced quantities. We don’t typically see much difference in the way patients, post sleeve versus post bypass, tolerate the diet.

Why should I see a dietitian after weight loss surgery?

After the surgery, you will be undergoing a complete change in the way you eat, and how you approach it. What doesn’t differ, is your need for optimal nutrition and hydration. A dietitian is best equipped to help you navigate nutrition and hydration to ensure you are meeting all of your needs. A bariatric dietitian will also be invaluable in providing tips and tricks to thrive on a weight loss surgery diet at every stage. We recommend a protein based diet, along with some healthy fats, and minimal carbohydrates, especially the Roux-en-Y where carbs can lead to dumping syndrome.

What are the bariatric diet stages I should follow after surgery?

There are 4 phases to post-surgery diet and there is also a pre-surgery protocol which you need to follow. This timing is very important for your health and safety and is evidence-based. For post-surgery care, we need to ensure that the normal swelling and oedema you would expect after surgery has subsided. Your stomach needs to be healed before reintroducing solid foods. You may feel well, but adhering to your surgeon’s recommendations will reduce the likelihood of complications.

Preoperative diet

We may ask you to follow a very low-calorie diet (VLCD) for about 1-4 weeks before you are due to have surgery. This varies depending on your BMI. This is to help reduce the size of your liver and help make it more pliable by reducing the amount of fat in it (fatty liver/ hepatosteatosis/ steatohepatitis). This ensures a safer operation. Generally, your preoperative diet will consist of a protein shake/ soup meal replacement such as Formulite or similar liquid diet. We recommend Formulite as weight per volume it has up to 50% more protein and 50% less sugars than other replacement meal shakes and soups. Protein keeps your hunger at bay for longer. The reduced sugar contents helps wean off sugary foods. It also has fibre and macrobiotics essential for gut health. Meal replacement shakes are NOT meant to be fun!! They are NOT the same as a milkshake. They should be palatable, sure, but primarily they are to provide adequate calories and micronutrients for the preoperative weight loss phase of your journey. Most people tolerate Formulite. If not you can talk with our dietitians about a suitable alternative.

Stage 1 bariatric diet post-surgery: liquids

Right after surgery, we need to go very slowly. You will need to sip, sip, sip. Liquids such as plain water, protein water, protein shakes (including those from VLCD phase), clear broths and soups, decaf tea or coffee, sugar-free jelly or flavoured water. The length of this stage is 14 days. You will find each day you can drink just that little bit more as the swelling settles. You need to get AT LEAST 1000 mL each day to avoid dehydration. Sip, sip, sip is the way. Usually around the second post op week you can start on your multivitamin, which you will take indefinitely. If you’re struggling to meet fluid and/or protein requirements contact your surgeon or dietitian.

Stage 2: purees

Stage 3 is the purees stage. and can be likened to the way we introduce food to babies. This is food pureed to a smooth consistency, with a view to providing a gentle introduction back to solid food. Your dietitian will provide recommendations here. Stage 3 is generally 1-2 weeks after stage 1 is completed.

Stage 3: soft foods

Just as with babies, stage 3 is about incorporating more solid (but still soft) foods and an overall protein-based, moderate healthy fats, low card diet. Your dietitian will guide you in eating small meals consisting of protein and vegetables at this stage. This diet will progress to stage 4 depending on your tolerance. generally 3-4 weeks after stage 2. It continues till around week 6 post op.

Stage 4: bariatric diet for life

Over time, you will find your tolerance for solid foods will grow, as will the amount you can eat at each meal. Your goals are to eat for optimal nutrition and of course, enjoyment. For most patients, you will feel full after very small meals. But you will still ENJOY them. The metabolic/ neurohumoral aspect of the surgery tricks your brain- you will feel full, satisfied and content after just a small amount of food. Interestingly your tastes may change. Every patient is different. Some say their tastes gravitate towards healthier options, and foods which are lower in sugar and fat.

As a weight loss surgery patient, you will need to monitor your diet and nutrient levels for life. But it will definitely get easier over time. We recommend seeing your dietitian regularly, especially in the first 12 months. This will help cement the important lifestyle changes you need for lasting weight loss, while the metabolic effects of surgery are in motion. You should also follow-up with your surgeon who will monitor your nutrition and overall wellbeing.

You should check in with your team (surgeon, bariatric G.P, dietitian, psychologist, exercise physio) whenever you feel that you’re steering off course. This happens to the best of us, and your team will quickly help get you back on track. This can be any time in the years after your surgery.

When it comes to fibre, we have high needs. In this article, we explain why fibre is important, and which foods are fibre rich.

We also include some tips especially for you if you’ve had bariatric surgery, to help choose the right fibre-rich foods for you unique needs.

What is fibre and why is it so good for us?

Dietary fibre is found in plant foods such as fruit, vegetables, whole grains and legumes. If you guessed that most Australians are not averaging enough fibre each day, you are right. So why is it so important?

Fibre is the indigestible portion of whole plant foods. Why do our bodies benefit from these indigestible components so greatly? Well, there are three main types of fibre which work well to keep us healthy:

1. Soluble fibre. Found in fruits, vegetables, oats, barley, psyllium and legumes. This fibre dissolves in water and intestinal fluids and turns into a gel. It is then digested by our gut bacteria. it helps to slow the digestion process from our stomach. This in turns does things like lowering our blood sugar and regulates the absorption of dietary fat and cholesterol.
2. Insoluble fibre. Found in foods like whole-grains, nuts, beans, cauliflower, and in the skin and seeds of fruit and vegetables. This type of fibre remains unchanged as it digests. it adds bulk to the stool and moves digestion along, preventing and treating constipation. Because of its high water absorption, it also helps us feel satiated.
3. Resistant starch. Is broken down in the large intestine, this assists in the population of good bacteria in our large intestine. Found in foods like just-ripe bananas, al-dente pasta, rice and cooked and cooled potato.

How much fibre should we eat?

The sweet spot for fibre intake is about 25-30 grams of fibre per day. A study examining the data of 185 observational studies, and 58 clinical trials found that people who had more fibre in their diet were 15-30 percent less likely to die prematurely from any cause or a cardiovascular condition.

What are the symptoms of not enough fibre?

While these symptoms don’t all mean you have inadequate fibre intake, they just might, especially when combined. Symptoms of not enough fibre can include:

• Constipation
• Bloating
• Blood sugar spikes
• Cravings and hunger
• Weight gain
• High cholesterol or blood pressure

Dietetic support is invaluable

It is important to remember that everyone is different and you also will have different tolerances and needs at each stage post-surgery. Keeping a dialogue and regular follow up appointments with your surgeon and dietitian will ensure you aren’t missing out on important nutrients like fibre.

If you aren’t getting enough fibre, your dietitian can help you navigate the decision to supplement. This means deciding on the right supplement for you – containing the appropriate types of fibre. As well, working out the correct amounts in your specific case to maintain a healthy digestive system. We would never recommend supplementing anything without having a conversation with your surgeon/dietitian first. Please remember, that everybody is different. Even if a fellow bariatric patient has had success, this may not mean it is right for you.

The good news is, if you’re able to increase your intake of good quality fibre, it can have a positive impact on your gut microbiome. This in turn will have a positive impact on your weight loss. Another great reason to be proactive.

Image Credit: Trainer Academy

Got more questions about bariatric diet?

Check out our more tips on navigating diet after bariatric surgery.

What is the role of protein?

Protein comes from the Greek work proteis, which means ‘of primary importance.’

Protein is second only to water in its use throughout our bodies.

Proteins are made up of chains of amino acids, linked together by chemicals called peptide bonds. They are found in every cell in the human body. Protein has several vital functions which include providing structure to cells, providing energy, transporting materials like oxygen and waste, and sustaining a healthy immune system. You know, just the basics 🙂

The thing about protein, is that it is used by our bodies, not stored. This means humans need adequate protein intake every day to stay alive and well.

What are the signs of not enough protein?

For the weight loss surgery patient there are a few red flags which may indicate your protein intake is inadequate. These might include the following symptoms:

• Fatigue
• Weakness
• Excess muscle break down
• Thinning or fragile hair or loss of hair
• Swelling of feet and legs (oedema)
• Changes in appetite (either nausea or increased hunger)
• Weight loss stall

It is important to check back with your surgeon if you are experiencing any of these symptoms.

Understanding the focus of protein after weight loss surgery 

After a weight loss procedure your stomach is smaller than it used to be. This means that you have significantly less calories you can consume before you physically feel too full to continue eating. Now that your stomach size is smaller, there is no room for empty calories.

It is important to note, that reducing the size of your stomach does not decrease your protein needs.

In fact, if you have also increased your level of physical activity your protein needs will be higher.

Likewise, being able to consume fewer calories means protein becomes a higher priority.

After your surgery, your surgeon and/or dietitian will confirm your precise protein needs and the right nutrition. Most times, it is important to create a balance to ensure you are consuming the nutrients you need for a healthy vibrant body.

What does “protein first” actually mean?

When we refer to “protein first” we mean making protein a priority. This involves:

• Building your meals around lean high-quality protein and nutrient dense foods
• Consuming the protein part of your meal first to ensure that if you do feel full, you have consumed adequate protein in every meal
• Eating better quality protein – this means you have more room in each meal for vegetables, fruits and other essential nutrients
• Checking in regularly with your surgeon/dietitian about your protein levels and importantly;
• Combining your protein intake with sufficient and regular water consumption

Water and protein: the magic combination

While protein is highly important, it is not helpful without adequate hydration. In fact, too much protein when your body is not hydrated can actually stop you from absorbing other vital nutrients. Working on water and protein are therefore both highly important tasks for the bariatric surgery patient. However, hydration takes careful planning after weight loss surgery. It is not advisable to drink and eat together due to your reduced stomach size. 

Staying on top of hydration means drinking small amounts often throughout the day outside of meal times. Your dietitian is a great resource here for helping you plan this part of your new life. Often it comes down to creating new habits purposefully, until it becomes second nature.

Additional benefits for weight loss surgery patients

• Protein helps maintain and build muscle mass (maintaining protein intake helps prevent your body breaking down your own muscle mass for protein).
• Higher muscle mass contributes to a better metabolism which helps burn more calories for increased and sustained weight loss
• Protein takes longer to digest and keeps you feeling full for longer
• Helps your body function better (better immune system, hormones)
• Builds strong hair and nails

Follow up is key

The delicate balance of adequate protein, hydration and nutrients is not easy to achieve alone. Good consistent follow up is one of the best ways to stay on top of all of your nutrition requirements after weight loss surgery. Your needs can often change over time, as you lose weight or adopt different lifestyle changes such as more rigorous exercise.

It is always a good idea to check in regularly on your nutrient levels so that you know your current diet and lifestyle is being supported by a strong, healthy body.

Maintaining good levels is most times easier with the help of a great dietitian. They can look at ways to balance all of your nutritional needs. At the same time, they are helping you to personalise a plan which fits in with your lifestyle and diet preferences.

You can no longer metabolise alcohol in the same way

Alcohol absorption is highly variable and unpredictable after weight loss surgery. Before surgery, if you drank alcohol, the presence and digestion of food in the stomach would slow down its route into the small intestine and bloodstream. This would allow a gentler rate of absorption. 

When you have had gastric sleeve or gastric bypass surgery the size of your stomach is much smaller. It generally does not hold great volumes of food for digestion. Now that your stomach is reduced and able to hold less food, alcohol can pass at a faster rate. You also pass greater volumes into your small intestines, where it enters your bloodstream. (Hence, why most people find they get more intoxicated if they drink alcohol on an empty stomach).

Put simply, as a result of a smaller or bypassed stomach, you can potentially get drunk quicker than you used to. Also, your blood-alcohol levels remain higher for longer. A glass of wine may feel more like 2 or 3 with the new changes to your gastrointestinal anatomy and metabolism.

What impact could regular or high alcohol consumption have on my health?

Weight regain

Alcohol is basically sugar, and carbs with no nutritional value. Sugar is something you are trying very hard to eradicate as part of a bariatric diet. You are also on a reduced carb intake. So why would you drink them all back into your body again? Sugar and carbs in high doses will spike your blood sugar levels and can cause you to gain weight.

Poor food choices

On top of the sugar and carbs in the alcohol itself, you may be more likely to make poor food choices after you’re drinking. Let’s face it. When we drink, we often don’t reach for a salad. High or regular alcohol consumption could lead to choosing fatty, fried or sugary foods.  Drinking regularly, or too often can therefore be a slippery slope to weight regain.

Alcohol use disorder

Some people may be at an increased risk of developing alcohol use disorder (AUD). A recent study found that the AUD risk in gastric bypass (RYGB) patients could be as high as one in five people. There is no conclusive explanation as to why increased instances of AUD might occur. Certainly, higher alcohol levels in the bloodstream may be one cause. Some also suggest it has to do with addiction transference. This is where we replace an addiction to food with another, such as alcohol. With RYGB another possibility is to do with changes to the hormones which deal with reward circuits in the brain.

Alcohol-related health issues

Surgery is a tool which is designed to help you lose weight and increase your chances of a healthy and long life. But excessive alcohol consumption can really disrupt that chance. Liver damage, hypoglycemia, reflux, inflammation of the intestinal tract, and vitamin malabsorption are just a few of the resulting health concerns around alcohol in the weight loss surgery patient.

This is true also when we talk about alcohol. You may not see any impact to regular or high alcohol consumption at first, but long-term you will see its negative effects on your life. Alcohol is one of those things which we believe should be best left alone, if possible, for the first 12 months after surgery. Give yourself time to develop new habits around eating and socialising without adding alcohol to the mix.

After this time, you are still best to avoid alcohol, but the occasional social drink may be acceptable for some people. Just remember, you won’t be able to drink the same as you did before and will need to monitor this very carefully. At all times, it is important to check in with your alcohol consumption and keep an open dialogue with your surgeon or GP about your alcohol use.

If you are concerned about your alcohol use, now is the time to bring it up with your surgeon or GP, or to seek the help of specialist services in your State. Here is a resource for alcohol and other drugs services in Queensland.

Count your mL’s

It’s a great idea to have some gauge as to how much you’re drinking so that you can stay on track. You can set yourself a goal to reach a certain amount by a certain time of day, which will encourage you to sip more often. Grab a water bottle which has a counter on the side to keep a tally.

Change the temperature

If water is making you nauseous you may find that changing the temperature can help. Try icy cold, room temp or warm with some lemon.

Protein water

After surgery, your protein requirements are also high, and some days it may be a struggle to add in enough of both elements- water and protein. In this case, you can try adding in some protein water. Usually made from whey isolate, protein water can supplement the protein in your diet. So you can see drinking it as an opportunity to increase both necessary elements on those days when you need it. Make sure the type you select is low in sugar and made from a good quality protein which is easily absorbed by the body.

Flavour it up

If you’re struggling with the taste of water after surgery, a little flavour might help. However, don’t go for anything sugary. A little fruit or even herbs will change the flavour and hopefully make it more palatable for you. Experiment until you find your favourite. If you’re adding it to your travel bottle, ensure you only use a glass or stainless steel bottle. Here are some ideas:

• Lemon or lime and mint
• Cucumber and dill
• Mixed berries
• Fresh ginger

Quali-tea

If you’re after a stronger flavour, try tea infusion bags. These are a lovely way to have a ‘special’ drink without added sugars. Make sure to read the back of the jar to ensure that the product you are buying is sugar free. The range of new flavours can be a welcome change if you’re struggling with water.

Failing to plan means planning to fail

Remember, it takes some planning to ensure this part of your new lifestyle is managed, but it is really important you get the hang of it. If you are having trouble, a follow-up chat with your surgeon or dietitian can help you make sure you follow through with hydration goals.

Here are some more tips for diet and exercise which you might find helpful