What Food to Eat After Weight Loss Surgery - FAQ on Macros & Calories

Weight Loss Surgery 0 – 3 Months Post-op

As part of your post-operative care, you will be given special dietary guidelines that you will need to follow closely during the first 6 weeks from surgery to prevent complications and for proper healing of your new stomach pouch.

After 6 weeks, when able to eat solid foods, you will be on the bariatric nutritional plan meant to heal your body from the inside out, prevent nutrient deficiencies and be ready for massive weight loss!

What to Expect While on Weight Loss Surgery Recovery?

The amount of food that you can have immediately after surgery will be limited. This restriction will change over the first months, letting you eat a little bit more at each time. The pouch will change from being rather stiff — due to inflammation from surgery — to recovering its plasticity at about nine months after surgery. This is normal and expected. If you notice that you have less restriction as time passes by it doesn’t mean that you have stretched the pouch; it only means that swelling is subsiding. Stretching of the pouch is doubtful to have happened during the first year unless you are forcing the food or combining solids with liquids; this stretching is noticeable from vomiting frequently, “foaming” (P’Bing) or feeling pain immediately after eating. These symptoms can be prevented by slowing down while eating, sitting down to have your “meal,” chewing thoroughly, avoiding drinking while eating and paying attention to feeling satisfied rather than full (the difference between feeling satisfied or full may be a teaspoon size bite!).

During the first 6 weeks, as you move from liquids to solid foods, you do not need to establish mealtimes, count calories or try to figure out a dietary plan; inflammation will only allow a few bites of food or sips of liquids. During this period, since eating and drinking is limited, your main objectives are to meet protein intake, fluid intake and to establish a regimen for supplementation. Protein intake through either liquids or foods should be accounted for and calculated in as many “meals” as necessary until the minimum of 60 grams of protein per day is met. Eat as often as necessary — this may mean eating every 2 hours, up to 8 times in a day. Once protein intake is at 60g/day, you will need to include vegetables and fruit as long as either one has the specific texture described in each of the diet stages — “pass through straw,” “baby food,” or “moist.” Including produce is necessary to boost fiber, micronutrient and phytochemical intake which will promote bowel movements, improve digestion and absorption of nutrients, and fuel fat-burning metabolism! Intake of vegetables and fruit should be alternated at each meal and comprise half the volume of food that you can eat.

How Should I Eat After Recovery?

During the first three months, the new stomach (“the pouch”) can hold as much as a baby could. Thus, eating often to prevent hunger and meet nutrient needs is expected. Some patients can have 2 tablespoons of food at one time, others may have up to ¾ cup. The difference in how much food can be eaten depends on healing and inflammation — this is different for each patient and will determine how often you will need to eat. It is important to be aware that carbs from grains and flours slip through the pouch a lot faster than other foods and will allow you to eat more than expected.

Early postoperative (0–3 months) patients increase average calorie intake from 400 kcal/day to about 850 kcal/day. But we highly recommend paying close attention to the quality of food and tracking protein intake instead of choosing food depending on its caloric content. Energy balance is not about “calories-in or calories-out” but about whether your body can burn them or not.

To put the caloric intake debate to rest, consider this:

For each kilogram of fat-free mass lost (mainly constituted by muscle mass), metabolic rate drops by about 18 kcal per day. Therefore, retaining more fat-free mass (muscle) relative to the amount of weight lost will enable you to have a more sustainable caloric intake without the risk of weight regain.
Certain bacteria help reduce the number of calories you absorb from food. They also affect hormones related to appetite and fat storage and help reduce inflammation, a known cause of obesity. These are good reasons why we recommend supplementing with specific probiotics.

Thus, not all calories are created equal and not all calories are burned as efficiently. The same number of calories from different foods have very different biological effects: processed foods will have a detrimental effect on organ function and quality foods will optimize cellular function, boosting metabolism and weight loss.

Once on solid foods — after 6 weeks from surgery — it is important to differentiate between nutrition and food. The first is eaten with the intention to heal (homemade food, meal prepping) and optimize cellular function, speeding up weight loss. The second comes usually in the form of “tasty and convenient” products, eaten when hungry, and readily available as pre-made or pre-packaged items; these are pouch fillers which lack nutrition and may even contain anti-nutrients.

Wholesome organic produce, grass-fed animal sources and pharmaceutical graded supplements, which avoid additives and pesticides, are the best sources to get the nutrients that will facilitate the liver’s work of detoxification processes and fat burning. The most common factor leading to weight gain after a year from weight loss surgery is relying on the surgery instead of using its restriction to facilitate changes related to exercise, eating habits and food choices.

The early months from surgery are the best window of opportunity to establish a new lifestyle, a supplement regimen and choose healthier foods.

To Meet Your Daily Nutrient Needs, Your Nutritional Plan Consists of the Following Foods:

Protein Intake

Our bodies do not have a storage for protein; this nutrient must come from our diet on a daily basis. Protein is the main component of hair, muscle and blood plasma, including proteins that help make up your immune system. Protein supports your body in building healthy tissues, including healing of the stomach after surgery. It also boosts metabolism and fat-burning. You will need to have at least 60g of protein per day to heal adequately, prevent hair loss, anemia, muscle breakdown and risk of infections.

Eat protein first and track its intake.
Protein should be at least half of the volume of the food that you can eat.
Calculate mealtimes depending on how much protein you can have per meal. For example, if you can only have 10 grams of protein in one meal, you will need to eat at least 6 times in a day.
Cheap protein shakes are usually either incomplete or diluted and will not help you meet protein intake.
Collagen has great benefits for hair, nails, skin, and joints but it is not a complete protein. Do not rely on collagen to meet your protein needs.

Carbs

Fruit and vegetables are the only type of carbs your body needs. They provide fiber, vitamins, minerals and antioxidants — compounds that nourish and repair the damage from “chronic inflammation” caused by being overweight or obese.

Any nutrient-void carb sources such as those from grains and flours are limited to 2 tablespoons of complex carbs such as quinoa, wild rice, brown rice, sweet potatoes, potatoes, yam, whole wheat spaghetti, whole oatmeal, or ½ whole wheat bread or tortilla — but only after meeting your daily nutrient needs coming from protein, fruit, vegetables and healthy oil intake, and preferably before or immediately after exercising.

Include two pieces of fruit per day, eaten at different times; fresh or frozen.
Have as many vegetables as possible, at least 3 cups daily; cooked vegetables occupy less space in the pouch allowing you to eat more.

Healthy Oils or Fats

Include 5 to 7 servings daily; at least one serving at each meal. Do not avoid these — you need fat to burn fat.

Fat is essential as it constitutes part of each of our cell membranes maintaining its function. The human brain is nearly 60% fat. There are many other reasons why fat is essential:

It produces hormones — we have more than 100 hormones, not just reproductive hormones, but hormones that have the purpose of keeping the body alive!
Fat is an energy source better than glucose, as it can be maintained over longer periods of time, improving performance and clarity of mind, without suffering sugar crashes.
Fat triggers satiety hormones and reduces the speed at which your stomach empties, therefore keeping hunger at bay.
Fat is a carrier of vitamins and antioxidants which are disease-fighting compounds.

Quality fats include fatty meat or fish, pasture-raised or grass-fed butter and ghee, lard, duck fat and some vegetable-sourced oils such as avocado oil, olive oil, olives, avocado, nuts and seeds.

How Can You Get the Proper Ratio Between Omega-3 and Omega-6?

Reduce the consumption of Omega-6 found in almost every processed food and any type of baked product (bread, “healthy” protein bars and cookies).
Increase intake of Omega-3 from fish, grass-fed butter or ghee, nuts, seeds (flaxseed, chia, hemp, saccha inchi).
Take an Omega-3 supplement — make sure this supplement doesn’t have Omega-6 and that it has been tested for dioxins, PCB, heavy metals, pesticides and rancidity values.

Each serving of fat consists of your choice of 1 teaspoon of healthy oils or fats, 1/8 avocado or 1 oz of nuts or seeds.
Healthy oils and fats include organic coconut, MCT, olive, avocado or hemp oil; or grass-fed butter, ghee, or lard.

Other Recommendations

In addition to the macronutrient recommendations, you may include as many herbs or spices as you want as these are high in phytochemicals and enhance the flavor of food. You can also use a small amount of either stevia, monk fruit or erythritol for added sweetness; although it is best to avoid all types of sugary and sweet products as doing so will change your taste buds into appreciating food as it is and help reduce sugar cravings.

In Summary

Leave the pouch’s room for quality food, establish a regimen for supplementation, eat protein and produce along with healthy fats at each meal, and determine the amount of meal times you need to have depending on protein intake.

Daily Approximate Macros	Protein	Carbs	Fats
0 – 6 weeks (post-op)	60 – 80g/day	2 cups of veggies and 2 pieces of fruit (~30g)	3 – 5 servings (~30g)
6 weeks – 6 months	60 – 80g/day	2 cups of veggies and 2 pieces of fruit (~30g)	5 servings (~30g)
6 months – 1 year	Personal goal (Women ~60–80g; Men ~80–110g)	2–3 cups of veggies and 2 pieces of fruit (~60g)	5–7 servings (~60g)