This information should be used as a resource.  Please be sure to discuss pre and post-surgical protein needs with
your physician and dietician.

Bariatric surgery has become a mainstream treatment for obesity. It has been shown to be effective for long term treatment for extreme obesity. Nutrition is an essential part of pre and post surgery. Because of the nature of bariatric surgery, the patient is able to ingest minimal amounts of food after the procedure. Nutritional monitoring of the surgical patient becomes imperative in order to minimize post surgical complications. In order to induce healing, it is important to encourage protein during the postoperative period. Clear liquids are best tolerated during the immediate postoperative and are introduced on day two post surgery. Clear liquid protein supplement is well tolerated and can induce healing during the post surgical period. The diet then progresses to full liquid and then soft, pureed foods ⁽¹⁾. 

It is recommended that a liquid protein supplement like Provide® be continued for six to twelve months post surgery.

Provide® Liquid Protein supplement:
• Helps surgical wound healing
• Is well tolerated
• Is the major macronutrient to encourage post surgery
• Provides one to two meals post surgically
• Helps the recovering patient achieve optimal health

Hydrolyzed protein supplements⁽²⁾ such as Provide® Liquid Protein are particularly useful after bariatric surgery
because they:
• Are easily absorbed
• Encourage healing
• Decrease complications of surgery
• Are well tolerated

Before surgery

It's been shown that a high protein, restricted calorie diet prior to surgery with a goal of losing around 10-15 pounds can help decrease the risks of complications from bariatric surgery. This diet helps preserve lean body mass and prepares the body for recovery as well as initially reducing body fat.

The diet should ideally begin between 2-3 months before bariatric surgery. Adequate protein intake will protect lean muscle; therefore, even on calorie restrictions, you should calculate between .5g-.67g protein per pound of ideal body weight in your diet regime. Using protein supplements before surgery will help prepare for the specialized diet protocols needed after surgery.

After surgery

After gastric bypass surgery, the stomach pouch is about the size of a walnut and can only hold a few ounces, about 3 oz. This is also a surgical site and should also be treated for healing initially. Therefore it is crucial to follow specific bariatric diet protocols that will assist in healing and provide adequate nutrition. You can expect this protocol to last for approximately three months. Then once the pouch has healed, you can move into the phases, depending on your tolerance.

Watch out for nutritional deficiencies! Vitamin and mineral deficiency are common in obesity, and need to be addressed before and after the procedure. Remember that surgery has 2 goals; to shrink the volume of the stomach and decrease the transit time for food in the intestine. This means that the stomach really cannot participate in digestion after surgery and food will bypass a large portion of the intestine. The result is that any nutrition absorbed from diet severely drops. This means it can be tricky to have adequate nutrition after surgery, which means you will need to carefully follow the diet protocols given by your physician and/or dietitian.

In determining adequate nutrition, you will find a diet rich in protein. Protein is of vital importance because it is needed for wound healing, for preserving lean body mass, for providing energy and is necessary for metabolism. The body needs protein to recover from surgical trauma and to help you return to good health.

In light of the small stomach pouch, it is also important to consider the type of protein ingested. As the stomach doesn’t have as much capacity, it is better to have a pre-digested protein to assist the body in assimilating the amino acids/peptides. Provide Sugar Free is a pre-digested (hydrolyzed), concentrated liquid protein supplement with 15g of protein in 1 ounce, enhanced with Taurine for anti-oxidant properties. This supplement can be used immediately after surgery and for as long as you need protein supplementation.

1. Clear liquid diet – Only clear liquids for the first 1-2 weeks after surgery. It is vital to keep well hydrated; you will need a minimum of 64 ounces of fluids per day. Therefore, continue to sip slowly throughout the day, 1-2 ounces over a 30 minute period.
          Recommended protein supplementation is 6-8oz Provide® Sugar Free per day

2. Full liquid diet – Typically you can add full liquids, reaching 700 calories per day, within a week after surgery. It is necessary to include between 120-130g protein per day in your diet protocol. 
          Recommended protein supplementation is 6-8oz Provide® Sugar Free per day

3. Pureed diet – Moving into pureed foods, it is important to note that you should not eat and drink at the same time. Wait 20-30 minutes after eating before drinking fluids. You must keep your protein intake at a minimum of 90-120g per day and you will need to continue to hydrate.  You will continue to need vitamin supplements and may need protein supplements to reach the ideal protein intake per day. The pureed diet typically lasts 3-4 weeks to allow final healing of the pouch.
          Recommended protein supplementation is 6-8oz Provide® Sugar Free per day

4. Soft foods, regular diet – Transition into this diet protocol within 5-6 weeks from surgery. It is fundamental to remember small meals! Eat about six small meals a day and sip water in between meals. Your dietician and surgeon will guide you through the transition of soft foods into a regular diet.
          Recommended protein supplementation is 4-6oz. Provide® Sugar Free per day with
               soft foods and move into…
          Recommended protein supplementation is 3oz. Provide® Sugar Free per day once
               reaching a regular diet protocol

In about ninety days after surgery, the dietician and/or surgeon will prescribe a diet to continue your weight loss with a diet rich in protein, fruits, vegetables and whole grains. Based on professional recommendations, you may expect to need supplements for the rest of your life. Please remember that this is critical as you will need to compensate for the nutrients you are no longer able to absorb.

Sources and Resources:
1. Beuchamp-Johnson, B. M., Scale down bariatric surgery’s risks: be prepared to manage complications and help patients adhere to lifestyle and diet changes following surgical intervention for obesity, Nursing Management, 2006 (Sept):27-32
2. Hirschfeld, L., Stoernell, C, Nutritional considerations in bariatric surgery, Plastic Surgical Nursing. 2004; 24(3):102-106

www.obesityhelp.com - A surgical and non-surgical resource

www.mayoclinic.com - A general healthcare resource

www.nlm.nih.gov - The National Library of Medicine

http://www.asbs.org/ - American Society for Metabolic and Bypass Surgery

http://www.obesity.org/ - The Obesity Society

http://www.eatright.org - American Dietetic Association

http://www.gastro.org - American Gastroenterological Association

Critical Care Nursing Quarterly 26, no. 2:133-138.
Nutritional considerations after bariatric surgery.
Elliot, K. 2003.

Diabetes Spectrum 18:82-84, 2005 © American Diabetes Association ®, Inc., 2005.
Nutrition Management After Gastric Bypass Surgery
Dowd, Judy, MA, RD