Hi, I’m Jessica Snyder, Registered Dietician, and Outpatient Nutrition Director.
Welcome to your post-operative soft food diet class. During this class, we’ll be discussing your questions, concerns, and making sure we’re bringing together, all of your experiences into the normal healing process. We’ll be discussing soft food diet instructions, as well as preparation and label reading, and we’ll be discussing upcoming events, as well as any questions you have. Following precise diet progression after surgery, will help to ensure proper healing. It is important that your food is modified in texture, to help decrease inflammation post-surgically. Liquids move through rather quickly, however, soft foods are something we’re still working on, and we wanna avoid tough, stringy foods at this point.
Once again, portion size will depend, on the procedure you had, and the healing process. Bypass during this point, is typically between one to two ounces. Sleeves typically tolerate between two to three ounces, and duodenal switch between two to four ounces. This is measured volume in a measuring cup, not on a food scale. Always start with foods that are easy to tolerate, and remember, 60-70 grams of protein a day is your goal. The primary source of nutrition is protein. Also, listening to your pouch and your tool, are incredibly important.
Why is protein such a big deal? It helps to ensure healing, it maintains and replaces tissue cells in the body, it’s important for your muscles, organs, and hormones, it helps to produce hemoglobin that carries oxygen, throughout the blood, and it produces antibodies, that help against infection, as well as disease. Protein is a great energy source for you at this point, as it allows you to feel full, and have greater satiety. It’s slower-digested than the other nutrients, and this is helpful in your healing process. Whenever you’re eating, you should be focusing on protein first. Be sure that you’re reaching, the minimum amount of protein per day, with a goal of 60 to 70 grams per day. You should be eating between, five to ten grams of protein per meal, and trying to eat five to six mini-meals per day. One ounce of animal meat, is typically between five to seven grams of protein. Visually, one ounce of animal meat, looks like the size of a sausage link. Protein should be your priority, and first thing you’re thinking about when eating. At least 90 to 100% of your portion of what your eating, should come from protein that’s low in fat. You should be using supplementation, to help meet the rest, of your protein needs throughout the day, so keeping a food journal of your protein can be helpful.
Carbohydrates should be a very small percentage, between zero to ten percent of what you’re eating. And they should be complex carbohydrates, such as fruits and vegetables, and they should be in soft form at this phase. If you’re using any type of condiment, such as mayo, or salad dressing with your proteins, make sure it’s low in fat, and you’re using it in small amounts. Often, patients find that foods that are very dry, are difficult to get down, so it is okay to use condiments in small amounts. When it comes to fruits and vegetables, you need to make sure that you’re not eating, too many carbohydrates. Once again, try and stay less than 15 grams, of carbohydrates per meal, and really focus on protein as the priority. Your portion of carbohydrates will slightly increase, as your pouch size increases over time. On the soft food diet, which is day 21 to day 41, it is a gradual transition away from your liquids to solids. These foods should be easy to chew, very moist, a soft combination of soft foods to pureed foods, and nothing that’s crunchy. Also, you should not have to use, a knife or fork to cut anything, and avoid spicy foods. Pureed foods can be made at home into a thick paste, by using a masher or blender, and this should be a similar consistency to yogurt. Your soft foods are soft, but they can easily be forked apart. It’s similar to a flaky fish, and this is appropriate on this diet phase. Soft and pureed protein choices, are now a big part of your protein intake.
One ounce every two to three hours is important, but no more than three ounces per meal. Listen to your tool and to your pouch. Portion sizes always depend on you. And we strongly suggest that you always, measure your volume, not weigh it.
So you may be asking what food sources are appropriate? You wanna make sure that it’s a low-fat, soft protein choice, that you can make, into a soft or pureed consistency. Most commonly, animal meats are, the optimal sources of protein, as they give you higher protein for calories, that you’ll be consuming. Egg whites and egg beaters can be continued, but no egg yolks until six weeks. You can also do dairy, such as cottage cheese, string cheese, Greek yogurt. Fish or shellfish, even canned tuna, salmon, tilapia, cod, lobster, and shrimp, are great choices, as well as crab. With poultry, you can do canned or ground chicken, or turkey and pork. But no baked or grilled chicken yet, because it’s too dense. With beef, you can do lean ground beef, like 93 over seven, but it may be difficult for some people, to tolerate postsurgery. You can also incorporate plant sources, of protein during this phase, it does take a little bit more work, to make sure you’re getting your protein needs, if this is something that you consider, but these are options, things like almond butters, nut butters, soy protein products such as tofu, edamame or soybeans, as long as they’re made into that soft consistency. Protein powders and protein shakes, are still consumed during this point, as it helps you to meet your protein needs, and making sure that you’re starting, to put food as the priority, and wean down on the supplements. No more than one protein shake a day at this point, and drink protein shakes in between meals, starting to separate out those liquids from those meals, and utilizing the supplements, only for supplement purposes. Make sure you don’t forget your fluids. Once again, it’s crucially important, that you prevent dehydration, as not drinking enough fluids, can end you back up in the hospital. Our goal is 64 ounces of fluid a day. This should be getting easier, but continue to sip on your fluids throughout the day, and make sure your not overfilling your pouch, by drinking too big of a gulp too fast. You don’t need to separate out your liquids from your meals, until the six week phase.
During the soft food phase of three to six weeks post-op, go slowly with your new food choices. No more than one to two new food choices a day, until you know you tolerate that food. You can, however, try mixing different foods together, so that you get a better variety of options. Avoid raw fruits and vegetables at this point, especially if they have skins, or seeds, or if they’re incredibly stringy. Those can be difficult to digest, and not well-tolerated. Avoid spicy foods, because those can cause irritation, and all protein consumed should be moist, or falling apart and easy to chew. No tough, stringy, or overcooked meats, especially meats that are reheated tend to cause difficulty. Everything should be measured in a measuring cup, and nothing should be consumed off of a bone. Remember our food preparation techniques, include things such as baking, broil, grill, poach, barbecue, and crock pots also work great. Try and remove all visible fat prior to cooking. Make sure you’re not frying your foods. The puree technique is easy to do, just put your meat in the blender, and use your food processor with a little bit of liquid, like water or chicken broth, to create that pureed consistency. Your food should be, about the consistency of yogurt at this phase. Remember, reading your label is important. You wanna start with he serving size, as the first place that you’re looking at, and then really assess what your pouch can hold. Determine how many grams of protein, you’re gonna be consuming, based off of the serving you’re going to be eating. Then, look at the label and consider, is this a good option for me? And is this going to fuel my body? Remember that protein is our focus, and making sure you’re getting the lowest amount of calories, for protein consumed, also known as your relative protein value, which we’ll be reviewing. Your relative protein value, is where you divide the total calories, by the total grams of protein to find the RPV. For example, if you’re looking at the label, and the product has 90 calories for the serving, and three grams of protein, we would take 30 calories divided by the grams of protein, to find if it’s a good choice. We prefer if you consume 15 or fewer calories, for gram of protein, as this helps to keep you in a safe place, in terms of the cost of calories, for each protein gram consumed. Good choices will be low-calorie gram protein, which is 10 or less. Moderate is 10-20 calories per gram of protein, and high calorie choices, which we wanna avoid, are 20 calories for gram of protein. So once again, no more than, one to two high RPV foods per day. So if you have a 200 calorie food item, and you’re only getting in five grams of protein, this is not considered an ideal choice. You need to get more protein per calorie, to get a better bang for your buck. The goal for protein is to have at least five, but more like 15 grams of protein per meal, during the soft food phase.
You may have more than five to six meals a day, until you get to the solid food phase. You’re really trying to make sure, you’re getting adequate protein per day by food, and supplements are meant for supplemental purposes only. We prefer low RPV foods, so keep the fat down in what you’re consuming. Also, take time to make sure that you’re, eating and planning out your meals, and reading ingredient lists, so you make sure you’re fueling your body, with nutrient-rich properties. We wanna make sure that you’re not getting, too many carbohydrates. There should be a max of 10 to 15 grams, of carbohydrates per meal. If you’re eating too many carbohydrates, then you’re not gonna be leaving enough room, for adequate amounts of protein, which is your best fuel source. Also, try and consume foods that are higher in fiber, that have between three to five grams per serving, as this helps with digestion. If you’re looking at sugar on the food label, try and keep less than five grams per serving, as sugar is not the best fuel option. Sugar alcohols are listed on the ingredient list, we like to keep those low in your diet as well. Things like sorbitol, mannitol, and xylitol in your ingredients list, are something we want to minimize. Keep less than five grams per serving, as this can cause digestive issues.
So some common questions, that we get asked by patients at this point, is what if I get hungry? And it’s normal for your pouch to gradually increase in size, as inflammation is decreasing. If and when this happens, you wanna make sure you’re increasing your protein grams, so that you get fuller longer. Also, starting to wait 45 to 60 minutes after your meals, before you start drinking can be helpful. Increasing the density of your food, can also be helpful, so, starting to focus on soft versus pureed. Decreasing the low gram protein foods, such as plant proteins can be helpful, and making sure you’re staying on top of your meal timing, eating every two to three hours your scheduled mini-meals. Also start identifying if it’s head hunger, or emotional eating, as these things are behavioral habits, that we’ll want to adjust, and help you transition away from. Next we’ll be discussing the solid food plan. The solid food plan begins at six weeks. We’ll also be discussing at that point, starting calcium supplementation, as well as fiber supplementation. At six weeks, we really want protein drinks, to only be used as supplementation, but not as a meal replacement, so start weaning those down.