Key Messages

Protein

Meeting my protein needs after surgery is a top priority because it helps my health and minimizes muscle loss and hair loss.

Vitamins and Minerals

For my long-term health, it’s essential that I take my post-surgery vitamin and mineral supplements every day for the rest of my life.

Hydration

It’s important to drink enough water after surgery to prevent dehydration and maintain a healthy weight. Dehydration is the number one reason for hospital readmission after surgery.

Lifelong Eating Behaviors for Success

I recognize that surgery is only a tool, and my lifestyle changes are the key to getting to and staying at a healthy weight and feeling my best.

Post-Surgery Meal Plan

Following the post-surgery meal plan will help me prevent surgery complications and safely transition to eating solid foods.

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

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.

  • Alcohol*
  • Bacon
  • Cake (especially the sugary frosting)
  • Candy
  • Coffee drinks*
  • Cookies
  • Creamy sauces
  • Doughnuts
  • Fast food
  • French fries
  • Fried foods
  • Frozen yogurt
  • Hamburgers
  • Hash browns
  • High-fat cheeses
  • Horchata
  • Hot dogs/sausages
  • Ice cream
  • Juice
  • Juice smoothies
  • Mayonnaise
  • Milkshakes
  • Pan dulce
  • Pastries
  • Pizza
  • Pork rinds/chicharrones
  • Potato chips
  • Refrescos
  • Soda
  • 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

  • Alcohol*
  • Caffeine*
  • Carbonated/fizzy drinks (soda, sparkling water)
  • Chocolate
  • 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)
  • Coconut
  • Corn
  • Dried fruit
  • Hot dog/sausage skins
  • Nuts/seeds
  • Popcorn
  • 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.

  • Bagels
  • Biscuits
  • Bread
  • Croissants
  • French toast
  • Granola
  • Muffins
  • Pancakes
  • Pasta
  • Pita bread
  • Rice cakes
  • Rolls
  • Stuffing
  • Waffles

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.

Why?

  • 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.

Why?

  • 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.

 

There’s no need to feel deprived! There are many ways you can make some of your favorite foods on this list healthier. Check out the stage-specific recipes on the Recipes page.

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.

 

 

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:

  • Anemia
  • Bad breath
  • Bone loss
  • Brain damage
  • Depression
  • Dry skin
  • Fatigue
  • Hair loss
  • Headaches
  • Hearing loss
  • Heart disease
  • Insomnia
  • 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?

Gastric Bypass

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.

Gastric Sleeve

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.

Smart Shopping

  • 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).

Sodium/salt recommendations may be different for you depending on other health conditions.
Follow the advice of your health care team.

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!

Meal Planning

  • 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: