Merle Shapera, MS, RD, CDE, LD
Coordinator, Diabetes Center for Education
West Suburban Health Care
3 Erie Court Suite L300
Oak Park, IL 60302
708 763-1368
mshapera@yahoo.com
Merle has been working with weight managament for her entire career as a masters prepared registered dietitian. She currently coordinates the Diabetes Center for education at West Suburban Hospital in Oak Park, IL and counsels patients undergoing bariatric surgery. She has worked at major medical centers throughout the Chicago area including University of Chicago, Rush Presbyterian, and Children's Memorial Hospital and still finds weight management training among the most challenging and rewarding areas of nutrition and behavior change.
Gastric Bypass Diet: Clear Liquid
At week three (3) post-op, you can advance to full liquids including
- All clear liquids
- Strained Cereal
- Sugar Free Custard or Low Fat Pudding
- Skim Milk
- Sugar Free/ Low Fat Ice Cream or Frozen Yogurt
- Coffee/Tea
- Fat Free Half n Half
- Cream Soup (strained)
- Choice DM/Boost Breeze/ Glucerna Supplement
Gastric Bypass Diet: Full Liquids
At week three (3) post-op, you can advance to full liquids including:
- All clear liquids
- Strained Cereal
- Sugar Free Custard or Low Fat Pudding
- Skim Milk
- Sugar Free/ Low Fat Ice Cream or Frozen Yogurt
- Coffee/Tea
- Fat Free Half n Half
- Cream Soup (strained)
- Choice DM/Boost Breeze/ Glucerna Supplement
Gastric Bypass Diet: Pureed Diet
At week five (5) post op you can advance to the pureed diet including:
- All liquids
- Any brand of strained baby food: meats, fruits, vegetables
- Blenderized baked or broiled meats without skin or fat
- Blenderized low fiber vegetables such as: green beans, beets, carrots
- mushrooms, zucchini, eggplant
- Blenderized low fiber, non citrus fruits such as: apple, banana, peaches,
- nectarines, plums, fruit cocktail, melon, honeydew
- Avoid bread, crackers, whole grains, spicy foods, nuts, seeds
- Can use smooth peanut butter and other fats in moderation
Gastric Bypass Diet: Low Fat Soft/Bland
At week eight (8) post op you can advance to a low-fat soft/bland diet including:
- Meats should be well cooked and cut up in very small pieces
- Eat the same fruits and vegetable as on the pureed diet but in the canned or cooked form
- Can add bread, rice, pasta, potatoes, non-crunchy cereals, soft crackers
- Avoid whole grains, nuts and seeds, high fiber fruits or vegetables
- Avoid fried foods and very spicy foods
- Avoid gas producing foods such as broccoli, cabbage, dried peas or beans, cauliflower, greens, peppers, Brussel sprouts
- Avoid high fat crunchy snacks such as chips, pretzels, popcorn
- After 3 months on the soft/bland diet, you will be ready to progress to a regular solid diet.
Gastric Bypass Diet - Progression
- In hospital up to 6 days
Clear Liquid Diet only
- Week 2
Continue on Clear Liquid Diet
- Week 3
Full Liquid Diet
- Week 5
Pureed Diet
- Week 8
Soft/Bland Diet
- Week 20
Regular Solid Diet
Gastric Bypass Diet: Behavior Modification
- Eat meals very slowly, taking ~30 minutes to eat
Remember: your stomach is the size of an egg and holds less than ½ cup volume
- Chew food 25-30 times each bite
Remember: swallowing foods not chewed properly can block the opening of the pouch and cause vomiting and discomfort
- Use very small plates at home: a bread plate is perfect
- Do not eat on the run or nibble while cooking
- Measure all your food in a 1 oz. medicine cup or ¼ cup (2 oz)
- Take small bites; use a baby spoon or chopsticks to help you
- Use calorie-free fluids and beverages throughout the day
Remember: You need 8-10 8 oz. glasses (64-80 oz/day)
- Wait at least 30 minutes before or after a meal before drinking
- Introduce solid foods one at a time
Remember: Food tolerances vary with each patient
- Take all of your recommended supplements each day
- Foods Which May Be Difficult To Tolerate:
Beef, chicken or turkey; fibrous vegetables such as corn, celery; Bread, Lettuce, Spicy Foods such as chili; Milk, Fried Foods
Gastric Bypass Diet: Meals
3 oz. solid food x 3 meals/day
1 oz. Protein: fish, chicken, turkey, veal, lamb, beef
- Size of ping-pong ball or 1 inch cube
- Cut into small pieces, ground or part of a pattie
1-2 Tbsp. Vegetables (1-2 bites)
1-2 Tbsp. Fruit (1-2 bites)
1-2 Tbsp. Starch (1-2 bites)
Sample Breakfast Meal Plans
- #1 ¼ c. (2oz) oatmeal cooked in skim milk; ¼ small banana
- #2 ¼ c. cold cereal with 1 oz. milk; 1 thin slice cantaloupe
- #3 1 poached, small soft/hard boiled, fried or scrambled egg; ½ sl bread w/ 1 tsp low sugar jelly
- #4 ½ frozen waffle with spray margarine and sugar-free syrup
- #5 ¼ c. sugar free/nonfat yogurt; 2 T. canned fruit
- #6 Smoothie: Blend ¼ c. yogurt, ¼ c. blueberries, 1 Tbsp skim milk, 3 ice cubes
- #1 ¼ c. cottage cheese; 2 T. applesauce; 1 graham cracker
- #2 ¼ cup tuna; 4 baby carrots; 3 thin red delicious apple slices
- #3 ½ turkey sandwich with 1 oz turkey; 6 grapes
- #4 ½ c. salad with 1 oz. grilled chicken; 1 T. ranch dressing; ½ roll
- #5 ½ peanut butter sandwich; 3 slices granny smith apple
- #6 ½ grilled cheese sandwich; 2 slices tomato
- #7 1/3 c. chili with meat and beans; 12 oyster crackers
- #1 ½ (1oz) baked chicken thigh; 2 T. cooked spinach; 2 T. baked potato
- #2 1/3 (1 oz) thin grilled pork chop; 2 T. applesauce; 2 T. corn
- #3 ½ small (1oz) baked fish filet with 1 T. salsa; 2 T. rice; 2 T. peas
- #4 ¼ c. spaghetti with 2 T. marinara sauce; ½ small slice garlic bread
- #5 1/3 c.hamburger helper; 2 T. cooked carrots
- #6 1/3 c. mostaccioli; 2 T. green beans
- Eat only 3 times per day and space your meals every 5 hours
Example: Breakfast at 8:00am, Lunch at 1:00pm and Dinner at 6:00pm
This will allow you plenty of opportunity to drink fluids between meals
- Eating too much food will cause discomfort and can stretch your stomach; when this happens, your weight loss drastically slows down
- A weight loss of 2-4# per week is quite appropriate; regular exercise will help you continue this rate of weight loss for many months, allowing you to lose up to 100-150# during the first year.
- Liquid Supplements
It may be necessary to supplement your diet in protein and calories
You may choose from the following:
2-4 oz milk between meals (Lactaid, if lactose intolerant)
2-4 oz Choice DM, Boost Breeze, Glucerna
2-4 oz protein shake
- 1200 mg Calcium Citrate each day (2 Ultra Tums OK)
- 500-1000 mcg oral B12 or sublinqual B12 each day
- 325mg ferrous fumerate, crushable tablets with Vit C once/week, esp females still menstruating
- Chewable Flinstones 2/day or Vista Vitamin capsules 4/day
- B complex after the first 6 months
- Flax Seed Oil 1-2 capsules/day
- To prevent hair loss:
Zinc lozenges with Vitamin C (zinc oxide and gluconate)
(20mg elemental zinc/lozenge
Biotin, small crushable tablets 300mcg or 600 mcg/tablet
