Vitamins and Minerals
Lifelong Eating Behaviors for Success
Post-Surgery Meal Plan
Post-Surgery Meal Plan
The Kaiser Permanente post-surgery meal plan is designed to be your guide to nutrition after metabolic and bariatric surgery. Surgery gives you a brand new digestive tract, so you must treat it with care. Slowly reintroducing different textures and foods is important for helping your new digestive tract adjust, healing from surgery, maximizing weight loss, and making sure you are able to tolerate more foods in the long run. The four sections of the book provide everything you need to know about post-surgery nutrition.
- Section 1: The Fundamentals of Eating After Surgery
- Section 2: Caution Foods After Surgery
- Section 3: Post-Surgery Meal Plan Stages
- Section 4: Quick References (choosing protein and vitamin and mineral supplements)
The Fundamentals of Eating After Surgery
Eat protein first at meals.
Protein helps with healing. It also helps to prevent loss of muscle mass, which is important for weight loss.
Take your vitamin and mineral supplements every day.
Surgery changes the way your body absorbs nutrients and decreases the amount of food you can eat. You must take vitamin and mineral supplements for the rest of your life.
Drink enough fluid (at least 64 ounces or 8 cups a day) to avoid dehydration and constipation.
Dehydration is the number one cause of hospital readmission after metabolic and bariatric surgery. To meet your needs, you must sip fluids throughout the day. For hydration tips and infused water recipes, check out pages 64 to 65 of the Options Workshop Guide.
Follow the meal plan stages after surgery.
Following the meal plan after surgery helps to reintroduce food in a healthy and safe way that reduces complications and promotes long-term weight loss.
Eat slowly and chew small bites of food well. It should take 30 minutes for each meal.
Eating slowly and chewing your food helps to avoid complications like vomiting and dumping syndrome, which happen when foods and liquids enter your small intestine rapidly and in larger amounts than normal. This causes nausea, vomiting, dizziness, sweating, and diarrhea.
Plan your eating. Snacks can be healthy when well planned.
Because the size of your stomach is so small after surgery, you can only eat so much. Therefore, it’s important to make sure you get the nutrients you need. By planning your meals and snacks, you are more likely to be successful with long-term weight loss and feeling full and satisfied.
Avoid liquid calories.
Your calorie intake will be very limited after surgery, which should help you lose weight quickly. Don’t work against your surgery by drinking liquid calories like juices, alcohol, sweetened coffee drinks, soda, and aguas frescas (horchata, tamarindo, and jamaica). Make every calorie count by focusing on protein from food and supplements, fruits, and vegetables.
Avoid sugar, foods and drinks with sugar, and concentrated sweets.
Sugar is the ultimate empty calorie. It can cause your blood sugar to spike, followed by a sudden drop, which can increase hunger pangs. It can also cause dumping syndrome. Avoid sugar and any foods that list sugar in the first three ingredients whenever possible.
Do not eat and drink at the same time.
Liquids flush the solid food out of your stomach before you get the sensation of being full. That means you eat more, and the weight won’t come off as fast. Eating and drinking at the same time can also cause stomach pain and/or vomiting. Sip liquids between meals, not with meals. Avoid drinking anything both 30 minutes before and after a meal.
Don’t use straws, drink carbonated beverages, or chew gum.
These can cause you to swallow too much air, which can cause stomach pain and discomfort.
Limit starches (bagels, cereal, crackers, noodles, pretzels).
Starches like rice, bread, and pasta can expand in the stomach, which can cause pain and discomfort. These foods can cause a blockage or take up too much space in the stomach, which can reduce your intake of protein.
Avoid larger meals.
Remember that your stomach can only hold a few tablespoons after surgery. Eating too much can stretch your pouch. In time, it will hold about 1 to 1½ cups.
Caution Foods After Surgery
Many people worry whether life after surgery will mean that they’re restricted in everything they can eat. This isn’t true! Following the post-surgery meal plan will help make sure you can still enjoy many of your favorite foods. As you move through the stages of the post-surgery meal plan, you will learn which foods work for you. However, there are some key foods and drinks to be cautious of for the rest of your life.
Foods that may cause weight gain and dumping syndrome
Eating these foods can make you very uncomfortable and lead to diarrhea and vomiting. While eating too much of any food can cause weight gain, the high-fat foods on this list can have major health impacts.
- Cake (especially the sugary frosting)
- Coffee drinks*
- Creamy sauces
- Fast food
- French fries
- Fried foods
- Frozen yogurt
- Hash browns
- High-fat cheeses
- Hot dogs/sausages
- Ice cream
- Juice smoothies
- Pan dulce
- Pork rinds/chicharrones
- Potato chips
- Spicy foods
- Sports/energy drinks (zero- or low-calorie sports drinks are OK)
- Sugar alcohols (sorbitol, mannitol, xylitol, isomalt)
*See caution notes on coffee and alcohol below.
Foods that may cause bloating, pain, and acid reflux
- Carbonated/fizzy drinks (soda, sparkling water)
- Fatty/greasy foods
- Spicy food
*See caution notes on coffee and alcohol below.
Foods that may cause a blockage
These foods can block the connection between the stomach and small intestine.
- Celery, raw (cooked in soup is OK)
- Dried fruit
- Hot dog/sausage skins
- Potato skins (for at least 6 months after surgery)
- Skins/seeds of fruits and vegetables (for at least 6 months after surgery)
- Avoid: Gum
Foods with limited nutritional value and may cause complications
These foods have limited nutritional value, may cause pain and discomfort, and take up a lot of space in your tiny stomach pouch. This leaves less room for the important nutrients you need to get after surgery.
- French toast
- Pita bread
- Rice cakes
Follow the post-surgery meal plan to learn how to incorporate small amounts of starches back into your diet at the right time.
Caution note on alcohol
Overall, it’s recommended that you avoid all alcohol (beer, wine, liquor, cocktails) after surgery.
- Alcohol is high in calories. It can reduce weight loss and lead to weight gain.
- Tolerance of alcohol changes. It’s absorbed much faster into the bloodstream and stays in your system longer.
- Alcohol may increase the risk of an ulcer.
- Alcohol increases the risk for low blood sugar (a dangerous condition that can lead to loss of consciousness, and brain or nerve damage).
- Alcohol can increase the risk for developing a new addiction, especially in people with a history of addiction.
- One in five patients develop alcohol-use disorder within 7 years after surgery.
Caution note on caffeine
Some surgeons recommend that caffeine in all forms (coffee, tea, energy drinks) be avoided forever after surgery. Others say that small amounts can be allowed starting in stage 4 of the post-surgery meal plan or later, when you are able to get all your fluid requirements.
- Caffeine causes the body to increase urination and the flushing of water out of the body. Too much caffeine can lead to dehydration, which you are already at high risk for after surgery.
- Caffeine drinks are often acidic, which can cause irritation to your stomach.
- Caffeine can reduce absorption of some vitamins and minerals because your digestive system has changed.
- Caffeine often comes paired with sugary, high-calorie drinks, which can lead to weight gain and/or dumping syndrome.
- Too much caffeine can cause digestive issues, which can lead to diarrhea or gastric reflux.
While caffeine recommendations vary by surgeon, here are some general tips to follow if you do choose to drink caffeine:
- Avoid caffeine until at least stage 4 (5 to 6 weeks after surgery).
- Consider avoiding or limiting decaf coffee as well. It contains small amounts of caffeine and tannins that can block the absorption of some vitamins and minerals.
- Limit coffee or tea to 1 small cup (12 ounces or 200mg of caffeine) a day and observe your tolerance. Stay hydrated. Aim for 64 ounces (8 cups) of no-calorie, noncaffeinated drinks a day.
- Take all your recommended vitamin and mineral supplements, but avoid taking them with caffeinated drinks like coffee or tea. Don’t take your supplements within 2 hours of a caffeinated drink.
- Be mindful of what you add to coffee or tea.
The Bariatric Healthy Plate
The bariatric healthy plate can be a useful guide starting at stage 4 of the post-surgery meal plan (about 5 to 6 weeks after surgery).
Key differences between the general healthy plate and bariatric healthy plate:
- The bariatric plate has smaller portions.
- The bariatric plate encourages you to enjoy protein first.
- The bariatric plate recommends that you don’t eat and drink at the same time.
- The bariatric plate recommends that you limit starches in the beginning, and slowly reintroduce them by following the post-surgery meal plan.
Protein forms the building blocks of muscles and can help your body repair itself.
There are three main sources of protein:
- Plant-based sources (edamame, beans, lentils, soy milk, tofu, tempeh, seitan, other plant-based meat alternatives)
- Lean animal sources (lean skinless chicken or turkey, fish, egg whites, egg substitute)
- Dairy/dairy alternative sources (yogurt, cheese, milk, milk alternatives)
Nonstarchy vegetables are an important source of vitamins, minerals, and fiber. They are important for your overall health and have few calories and carbohydrates, so you can enjoy more.
There are many kinds of nonstarchy vegetables. It’s important to vary your choices and eat a variety of colors. You can get them in many forms:
- Raw or cooked
- Fresh, frozen, canned (no sugar added), or dried/dehydrated
- Whole, cut up, or mashed
Fruit is another good source of carbohydrates, vitamins, minerals, and fiber. It’s important for your overall health and nutrition. Because fruit tends to have more sugar than nonstarchy vegetables, it may be important to watch portion size.
There are many sources of fruit:
- Canned (no sugar added)
Starches are an important source of carbohydrates, which fuel your body. You need them for energy. It’s important to focus on healthy starches like whole grains and starchy vegetables.
There are two main sources of starch:
- Starchy vegetables (potatoes, corn, beans, lentils)
- Grains (corn tortillas, brown rice, oatmeal, whole-grain breads, whole-wheat pasta)
Fat gives you satisfaction and helps you feel full. It’s a very concentrated source of calories, so you only need a small amount.
Not all fats are the same.
- Choose more monounsaturated and polyunsaturated fats (avocado, olive oil, nuts, fatty fish like salmon, and seeds)
- Choose fewer saturated fats (whole-fat dairy; fatty, processed, and red meats; poultry skin; butter, cream, cream cheese; and coconut or palm oil)
- Avoid trans fats (foods with the words hydrogenated or partially hydrogenated oils in the ingredients list)
Enjoy flavorings like lemon juice and fresh or dried herbs instead of salt.
Drink 8 cups of water throughout the day.
Post-Surgery Vitamin and Mineral Supplements
Surgery changes the way the body absorbs vitamins and minerals. This makes it important to take vitamin and mineral supplements for the rest of your life to stay healthy.
What happens if you don't get enough vitamins and minerals after surgery?
Not getting enough vitamins and minerals can lead to:
- Bad breath
- Bone loss
- Brain damage
- Dry skin
- Hair loss
- Hearing loss
- Heart disease
- Lack of energy
- Lack of sex drive
- Muscle weakness
- Skin changes
- Tooth decay
- Weight gain
How does surgery change how your body absorbs vitamins and minerals?
A small stomach pouch is created, and most of the stomach and part of the small intestine is “bypassed.” The pouch is then reconnected at the small intestine. Because a lot of vitamins and minerals are absorbed in the small intestine, bypassing parts of it means that a lot of vitamins and minerals are not absorbed well.
The stomach size is reduced, and a portion is removed. Because the stomach is a lot smaller and there are changes in the stomach acid, important vitamins and minerals are not absorbed as well.
What vitamin and mineral supplements do I need after surgery?
Whether you have gastric sleeve or bypass, you must take vitamin and mineral supplements for the rest of your life. Check out the Post-Surgery Vitamin and Minerals Supplement Guide (links below), which breaks down everything you need to know.
Tools and Tips for Nutrition After Surgery
There are a lot of tools that can help you put healthy eating into practice. Check out a few ideas below and find the tools that work for you!
Protein Supplement Label Reading
For the first few weeks after surgery, you will not be eating solid foods. Most of your protein will come from protein supplements. As your body heals and your stomach pouch adjusts, you will get more protein from food. However, most people who have had surgery continue to use at least 1 protein supplement a day for life.
What should you look for in a protein supplement?
Post-Surgery Days 1 to 3: Clear Protein Supplements
The first few days after surgery, you will need to have clear liquids only, so you will be choosing clear protein supplements.
Post-Surgery Day 4+: Protein Supplements
Starting in Stage 2 of the meal plan, use the guide below to pick your protein supplement.
- Serving Size: All information is for 1 serving
- Calories: Less than 200
- Fat: Less than 4g
- Sugar: Less than 6g
- Protein: At least 20 to 30g
- Protein Source:
- Choose: Protein isolate (whey or soy) or protein concentrate (whey, soy, milk, or egg)
- Avoid: Collagen, collagenic protein isolate, hydrolyzed collagen
For more information on protein supplements, explore pages 54 to 55 of the Options Workshop Guide.
- Create a list of foods for breakfast, lunch, dinner, and snacks that fit in the healthy plate, and plan your meals for the week.
- Shop the outside aisles first. Fresh foods like fruit, vegetables, dairy, meat, and fish are usually located around the outside aisles.
- Choose “real” foods that:
- Are fresh (fruits, vegetables, lean proteins)
- List the healthiest ingredients first (for example, for breads or cereals look for whole grain or whole wheat as the first ingredient)
- Contain ingredients you can understand
- Have fewer total ingredients
- Try shopping online for pickup or delivery:
- Shop while looking in your refrigerator and pantry to see what you need.
- Reduce temptation in the store.
- Keep an eye on the total cost while shopping.
- Don’t shop hungry. To reduce temptation, bring a snack or eat a healthy meal before you go.
Healthy Cooking Skills
Cooking at home can give you more control over what you eat. Start by making a few changes to the way you prepare foods you already eat. If you don’t do most of the cooking at home, share these tips with the person who does.
- Use cooking spray, vegetable broth, or small amounts of olive or canola oil instead of frying.
- Grill, broil, bake, and stir-fry instead of frying.
- Trim any visible fat off meat before cooking. Remove the skin before cooking chicken and turkey.
- Steam or microwave vegetables in water or low-sodium broth.
- Use lemon, herbs, and spices instead of salt while cooking. Aim for a daily goal of less than 2,300mg of sodium (about 1 teaspoon of salt).
Plan and Track
Planning and tracking are powerful tools when it comes to making any behavior change. Whether you use an online app or the Lifestyle Log (see below), planning and tracking can help you take small steps toward bigger changes, like healthy eating.
Remember, you don’t have to track every day. Maybe you’ll track habits for a few days every once in a while to identify habits or patterns that may not be serving you. Or maybe you’ll plan and track every day to provide daily inspiration when you meet your goals. Make these tools work for you!
- Use cookbooks or online recipes to plan several main meals.
- Plan some quick meals or double some recipes that freeze well for busy nights.
- Make sure you have the ingredients you need for your recipes by using lists.
- List foods that you use to make all meals and snacks. Include plenty of fruits and vegetables.
- Post this list on the refrigerator. Add to it as you think of more things you need.
- Take the list to the store to do your weekly shopping.
Daily Lifestyle Log
Keeping track of your progress toward a goal, even if only for a few days a week, can help you focus on clear goals, get motivated, identify patterns or habits, and see your progress. This simple tracking log is designed for our members who have had metabolic and bariatric surgery.
Check out the Daily Lifestyle Log.
Looking for More Support?
Explore more resources offered by Kaiser Permanente to help support your nutrition after surgery and long term, including recipes, support groups, member stories, coaching, self-care apps, and more.
Options Support Group:
Center for Healthy Living: