Diet after bariatric surgery

Even after bariatric surgery, it is necessary to follow a regular, varied, balanced, high-quality diet that contains all important substances for our body - macronutrients (carbohydrates, fats, proteins) and micronutrients (minerals, vitamins). It is all about making the outcome of bariatric surgery as effective as possible (weight loss + long-term weight maintenance.

The basic rule of thumb after bariatric surgery will be to stick to the portion sizes, while ensuring that the important nutrients mentioned above are not missing from the diet.

In the first weeks after surgery, the diet should be adjusted to be gentle and have the desired consistency. All irritating, spicy, hot, flatulent and indigestible foods should be eliminated from the diet, e.g. peels, grains, seeds, nuts, flatulent fruits and vegetables (grapes, cauliflower, cabbage, onions, garlic...), legumes (beans, lentils, peas...), citrus juices and sparkling water.

Introduction:

Protein is the basis of every cell in our body, so it is extremely important for humans. Proteins are divided into animal (meat, fish, ham, eggs, milk, and dairy products...) and vegetable (cereals, legumes, soy, nuts...). Protein should be consumed in a 1:1 ratio (animal to vegetable). The recommended protein intake after bariatric surgery is 60-80 g per day (1.1-1.5 g protein per kg of ideal weight).

Carbohydrates are divided into simple (sugars) and complex (starches).

Sugars as such should be limited (sugar, honey, syrups, juices, sweet yoghurt, chocolates, biscuits, cakes, pastries, sweetened drinks, candies, ice cream...).

Starches are a source of energy, so we include them in the diet in reasonable quantities (wholegrain bread, rye bread, rice, pasta, potatoes, legumes, couscous, bulgur, buckwheat, oatmeal...).

Of course, you should include fruits and vegetables!

Fats can also be divided into vegetable (nuts, seeds, avocados, vegetable oils...) and animal (fattier meats and fish, whole milk and dairy products, eggs, lard, butter, sausages...). Fats should be consumed in a 1:1 ratio (animal to vegetable). Animal fats generally contain more saturated fatty acids, which can be harmful to health and cause cardiovascular disease. When cooking, we prefer to use vegetable fats (e.g. rapeseed oil) over butter or lard. Quark, cottage cheese, gervais, fresh cream cheese, etc. are preferable for spreading on bread.

Energy intake in the first year after bariatric surgery ranges from 700-900 kcal/day (= 2960-3800 kJ). Later it rises to 1000-1400 kcal/day (= 4200-5880 kJ). About 30-32% of this intake should be protein (about 77 g of protein/day), 30-33% fat (31-35 g of fat/day) and 35-40% carbohydrates (85-94 g of carbohydrate/day). The recommended intake of fiber is about 12 g per day.

The bariatric food pyramid can help you better understand what your diet should look like after surgery. It has 5 tiers. The base consists of supplements (calcium, iron, magnesium, zinc, vitamin D, vitamin B...), liquid intake, and physical activity. The second tier contains mainly protein foods. The third tier includes fruits, vegetables, nuts, seeds, and olive oil. The fourth tier belongs to cereals, potatoes, and legumes. The last tier consists of foods that should be eaten only rarely (sweets, alcohol, fatty foods...).

The bariatric plate will also help you navigate the composition of meals. It shows us how food should be divided - half the plate is protein, a quarter of the plate is reserved for vegetables and a quarter for carbohydrates. Proteins should always be eaten first, followed by vegetables and finally carbohydrates.

Diet after surgery

1-7 days after surgery = CLEAR LIQUIDS

This phase begins the day after surgery. Liquids should be unflavored and without added sugar. In general, these are liquids that are transparent. Liquids should be consumed regularly in small sips. These include e.g. tea, diluted juices, broths, sugar-free waters and sodas (possibly sweetened with stevia), sugar-free water-based popsicles, etc. The diet should be gradually thickened.

Approx. 1-2 weeks after surgery = LIQUID DIET

This food has the consistency of yogurt milk and should flow through a fork. It includes milk, yoghurt milks, kefirs, buttermilks, milkshakes, broths, bouillons, creamy soups, diluted vegetable or fruit purees... The diet should be thoroughly blended so that there are no chunks. The necessary consistency can be obtained by adding water, milk, or broth.

Liquid food should be taken in small sips throughout the day. The total amount of liquid food per day is about 500 ml + 750 ml of water (liquids).

The diet can be supplemented with special liquid nutrition from the pharmacy (Fresubin Protein Energy Drink, Nutridrink protein, etc.).

e.g.

Breakfast: 200 ml kefir

Lunch: 100 ml broth

Dinner: 200 ml Fresubin

Approx. 3-4 weeks after surgery = PORRIDGE DIET

This diet is similar in consistency to mashed potatoes or baby food. Again, the fork should pass through it smoothly. Food should continue to be blended (blender or food processor). It is advisable to include other proteins in the diet (meat, fish, yoghurt, kefir, cottage cheese, quark, low-fat gervais...). Side dishes include mashed potatoes, cereal porridge, or fruit puree.

You should always take your time, eat slowly, and chew everything thoroughly. If you feel pressure in the stomach area, do not continue eating. The drinking regime should include about 1 liter of fluids per day (unsweetened water, unsweetened tea). Meal portions should not exceed 80-100 ml. Protein foods should always be eaten first. It is recommended to separate liquids from food (drink 30 minutes before eating and 30 minutes after eating). Do not lie down after eating (heartburn).

Meat and meat alternatives: tuna in brine, chicken, turkey, fish, eggs (yolks, whites), tofu, tempeh - all blended!

Dairy products: low-fat and semi-fat milk, vegetable drinks (almond, soy, etc.), kefir, buttermilk, cottage cheese, ricotta, low-fat and semi-fat plain yoghurt, skyr, Greek yoghurt, pudding without added sugar...

Vegetables: cooked, blended, tomato puree, vegetable soups and broths, purees (e.g. pumpkin)... Raw vegetables could cause bloating at this stage!

Fruits: soft varieties (bananas, melon, avocado), sugar-free compotes (blended), applesauce, boiled peeled apples...

Cereals: smooth blended oatmeal porridge, semolina porridge, buckwheat porridge, mashed potatoes...

Spices and seasonings: salt, pepper, herbs...

E.g.

Breakfast: 80-100 g plain yoghurt

Snack: 80-100 g fruit puree

Lunch: 80-100 g mashed potatoes + minced fish fillets

Snack: 80-100 g yoghurt milk/kefir

Dinner: 80-100 g quark/cottage cheese

5 weeks after surgery = SOLID DIET

Other foods can now be included in the diet depending on individual tolerance (non-bloating and non-irritating foods) - other fruits, vegetables, whole grains, legumes... It is advisable to avoid fried and fatty foods, deli meats, sweetened yoghurt and drinks, candy, etc. Make sure that you have enough protein in your diet. Meals should be taken about 5-6 times a day. Increase liquids (unsweetened) to a minimum of 1.5 l/day. The food portion should not exceed 100 ml (g). It is recommended to separate liquids from food (drink 30 minutes before eating and 30 minutes after eating). It is advisable to keep a food diary - write down everything you eat so you can best see which foods are good for you and which are not. If a food makes you unwell, don’t get discouraged and try it again in a few days.

e.g.

Breakfast: 25 g toast bread, 25 g edam cheese, 50 g chicken ham

Snack: 80 g skyr, 20 g banana

Lunch: 60 g turkey meat, 40 g pasta

Snack: 100 g cottage cheese

Dinner: 20 g potatoes, 60 g chicken, 20 g steamed carrots

Dinner: 100 ml kefir

Taking vitamins, minerals, and food supplements

It is advisable to use multivitamin products with minerals (iron, calcium, zinc, magnesium, vitamin D, B vitamins...) after bariatric surgery. Ideally, you should undergo regular laboratory checks with your GP.

Proteins can be supplemented with e.g. Protifar, Fresubin Protein Powder, or other protein preparations for athletes.

Choice of foods

Meat: lean, non-fatty (chicken, turkey, rabbit, fish, beef, pork), premium quality ham

Eggs: whites contain mainly protein, yolks contain fat/cholesterol, (1-2 eggs per day)

Milk and dairy products: semi-skimmed/low-fat milk, kefir, buttermilk, yoghurt, quark, skyr, Greek yoghurt - all ideally unflavored!

Cheeses: edam 20-30%, cottage cheese, gervais, plain cream cheese, mozzarella, Olomouc curd cheese (there are also low-fat or light versions of these products)

Bread: ideally wholegrain bread, rye, rye-wheat...

Side dishes: potatoes, potato puree, rice, pasta, legumes, couscous, bulgur, buckwheat, oats...

Fruit: source of fiber, about 100 g/day

Vegetables: source of fiber, approx. 200 g/day

Legumes: source of fiber, depending on individual tolerance

Seeds, nuts: 10-20 g/day

Fats: vegetable oils (rapeseed, olive), high quality butter or margarine

Liquids: unsweetened water, teas, caro, chicory, coffee (no sugar!)

What to avoid:

Fatty meat - duck, goose, pork neck and belly…

Deli meats- pâté, wieners, sausages of all types, dry salamis, pork feast specialties, bacon...

Fatty cheeses - cheddar, camembert, blue cheese, gouda, processed cheese...

Whole cream and flavored dairy products

Seasonings - mayonnaise, tartar sauce, dressings, sauces, soy sauce, Maggi, salt, salty seasoning mixes, stock cubes, whipped cream, cream, mascarpone...

Snacks - chips, sticks, salted nuts...

Sweets - cakes, pies, candies, chocolate, ice cream, Nutella, pancakes, cookies, sweet pastries...

Compotes, dried fruits, candied fruits, marmalades...

Fast food - pizza, fried food, burgers, baguette sandwiches...

Sweet drinks - juice, cider, cola, Fanta, Sprite, juice, energy drinks, sweetened mineral water..

Alcohol

Some final advice

- check your weight regularly

- exercise regularly (walking, hiking, cycling, dancing, Zumba, home exercises, exercise bike, swimming, group classes...)

- regular check-ups with a doctor