Transition Nutrition: How to transition from pureed diet to regular textures

Transition Nutrition:
How to transition from pureed diet to regular textures
Transitioning TIPS
 Introduce only one new food per day; try the same food for
2 days before putting it on your “safe foods” list
 Avoid cores and skins of fruits and vegetables at first
 Eat only soft foods that are easy to digest and work up to normal texture
 Chew, chew, chew, before you try another bite
Fluids
 Still aim for 64 oz of fluid/day (4 oz/hr)
 Low calorie (<20 cals per serving), no carbonation/bubbles
 DON’T eat and drink at the same time (wait 30 min after eating to drink)
Food/meal/snack planning
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Goal for first several months 60 grams of protein/day
Volume: approximately ½ cup to ¾ cup at a time (depends on texture)
Measure/weigh your food to know how much you tolerate
Keep a food journal to track intake
Move to more SOLID foods – they SIT LONGER in your pouch/sleeve
Eat breakfast within 2 hours of waking up
Begin to go 3-4 hours between meals
NO added sugar or alcohol
Continue to focus on protein choices: scrambled eggs, tuna/egg/chicken salad
(with low fat mayo/plain greek yogurt), fish/seafood, moist chicken (no skin),
ground turkey/chicken breast, ground beef (96%), beans, lowfat cheese, tofu,
natural peanut butter, skim milk, no added sugar yogurts, cottage cheese
 PAIR up your PROTEIN options with your PRODUCE – soft fruits & cooked
veggies first, then any fruits/veggies (fresh, raw, frozen, canned)
 Limit to 2 starch servings/day (after protein/produce), limit ‘sliders’
Vitamins
 Continue to take multivitamin 2/day (can switch to tablet) and vitamin B12
 Time to start your calcium citrate (1500 mg/day in 3 divided doses)
Exercise
 Start exercising! Faster, longer, harder! Aim for >30 minutes/day
MUSC Bariatric Surgery Program ~ (843)-876-4307~ www.muschealth.com/weightlosssurgery
Rev 7/2014
Helpful hints for transitioning to a solid “regularly” textured diet
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Eat slowly and be aware of when you feel full.
When you feel full, stop eating! If you continue to eat, you may develop intense chest pain and vomit. You may
only be able to eat a few bites of food at a time, eating up to 4-6 “meals” a day.
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Chew, chew, chew!
You need to make sure you chew your food very well before you swallow it. This makes it easier to digest and
pass from your gastric pouch into your small intestine.
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Avoid drinking fluids 30 minutes before and with your meals.
If you fill up your small gastric pouch with liquid, you won't have room for your food. Furthermore, the liquids may
accelerate passage of the solid food out of the stomach and possibly cause some discomfort. If you need to, take
only small sips of liquids while eating, but don’t drink large amounts during meals.
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Drink enough fluid between meals to meet your fluid requirements.
You need eight cups (64 oz.) of fluid per day to avoid dehydration. You should carry a water bottle with you and
sip on low/no calorie liquids throughout the day to get enough fluids.
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Avoid sticky gummy foods.
These foods can stick together and form a ball in your gastric pouch, causing nausea and sometimes vomiting.
Sticky foods include: white bread, rolls, buns, pasta, rice, macaroni and cheese.
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Avoid tough or rubbery meats.
Avoid steak, pork chops, ham, and other tough meats at first. Meat is a great source of protein, but it needs to be
soft and tender for you to digest it. Try a slow cooking method to make your meat tender, such as a crock-pot,
boiling or cooking at a low temperature over a long period of time.
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Avoid food/beverages high in sugar.
High sugar foods can cause "dumping syndrome." After gastric bypass surgery, some people feel light-heated,
sweaty or faint soon after consuming sugar. Sugary foods and drinks are also high in calories and low in nutrition.
Avoid added sugars FOREVER!
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Avoid extremes in the temperature of your foods and beverages.
Some patients experience spasms or cramps with very hot or cold food/beverages. Try lukewarm versions.
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Limit high fat foods.
These foods may make you feel nauseated. They are also high in calories and will slow down your weight loss.
Try changing to a fat-free or light comparable product.
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Only try one new food at a time.
This way if you cannot tolerate the food you will know exactly what your new pouch does not like.
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Start taking calcium citrate supplements.
Because your surgery is designed for malabsorption, you will need to take calcium forever! You need 1500-2000
mg per day in divided doses of 500-600 mg, 3-4 times per day (typically 2 pills, 3 times each day).
Remember that the gastric bypass pouch was designed for you to feel full on SOLID foods. You are
SUPPOSED to get full quickly! Liquids and soft slider foods will travel quickly through your pouch and will not
produce that “full” feeling that you paid for! If a few bites of solid protein foods like meat feel ‘heavy’ in your
pouch, enjoy it! Try not to gravitate to liquid foods that you can consume more of, or that “go down easy”.
MUSC Bariatric Surgery Program ~ (843)-876-4307~ www.muschealth.com/weightlosssurgery
Rev 7/2014
Meal Plan
Meat 
Milk 
Veg. 
Fruit 
Time
Food/Amount
Starch 
Fat 
Fluid 
Group
Grams
Protein
MUSC Bariatric Surgery Program ~ (843)-876-4307~ www.muschealth.com/weightlosssurgery
Rev 7/2014
Choices for Calcium Supplements
Pills
 Citracal petite
1 pill = 200 mg and 250 IU vitamin D
Dosing: 2 pills, 4 times per day (8 pills=1600 mg ca, 2000 IU vit D, 0 calories)
 Citracal Max
1 pill = 315 mg and 250 IU vitamin D
Dosing: 2 pills, 3 times per day (6 pills=1890 mg ca, 1500 IU vit D, 0 calories))
Chewables
 Calcium citrate chew (aka “Chewy Bites”) by Bariatric Advantage (www.bariatricadvantage.com)
1 chew = 250 mg Ca and 125 IU vitamin D (plus 15 calories)
In raspberry, chocolate, caramel or lemon crème
Dosing: 2 chews, 3 times per day (6 chews=1500 mg ca, 750 IU vit D, 90 calories)
Read the label carefully.
You get 630 mg of
calcium from this
supplement for every
TWO tablets you take.
To get over 1500 mg of
calcium, you would have
to take 6 tablets a day.
 Calcet Creamy Bites (www.bariatriceating.com)
1 chew = 500 mg Calcium and 400 IU vitamin D (plus 40 calories)
In Lemon Cream and Chocolate Fudge
Dosing: 1 chew, 3 times per day (3 chews=1500 mg ca, 1200 IU vit D, 120 calories)
 Lozenges by Bariatric Advantage (www.bariatricadvantage.com)
1 lozenge = 500 mg Ca and 300 IU vitamin D
In wild cherry, cinnamon, mint or chocolate
Dosing: 1 lozenge, 4 times per day (4 lozenges=2000 mg ca, 1200 IU vit D, 0 calories)
 Calcium Plus 500 Chewable tablet by Celebrate (www.celebratevitamins.com)
1 tablet = 500 mg Calcium and 267 IU vitamin D (plus 7 calories)
In berries n’ cream, orange burst and cherry tart
Dosing: 1 tablet, 3 times per day (3 tablets=1500 mg ca, 1000 IU vit D, 20 calories)
Powder/Crystals - Dissolves in water or most liquids, in tubs or convenient individual serving packets
 Calcium crystals by Bariatric Advantage (www.bariatricadvantage.com)
1 pkt or 2 level scoops = 600 mg Ca and 500 IU vitamin D (plus 15 calories)
Unflavored
Dosing: 1 dose, 3 times per day (3 dose=1800 mg ca, 1500 IU vit D, 45 calories)
 UpCal D (www.amazon.com)
1 dose = 500 mg and 250 IU vitamin D (plus 10 calories)
Unflavored
Dosing: 1 dose, 3 times per day (3 dose=1800 mg ca, 1500 IU vit D, 30 calories)
Liquid
 Tropical Oasis (www.tropicaloasis.com or www.bariatriceating.com)
1 Tbsp (1/2 fl oz) = 250 mg Ca and 100 IU vitamin D (plus 5 calories)
In orange crème
Dosing: 2 Tbsp, 3 times per day (6 T=1500 mg ca, 600 IU vit D, 30 calories)
1 dose = 2 Citracal Max = 2 BA Chewy Bites = 1 BA Crystal = 1 Calcet
You need 3 doses/day
Don’t forget to check out the ART Outpatient Pharmacy located on 1U for your supplement needs
MUSC Bariatric Surgery Program ~ (843)-876-4307~ www.muschealth.com/weightlosssurgery
Rev 7/2014