Description summary: This stage is designed for patients that are at least 2 weeks out of surgery. It adds new ingredients but the texture of all meals should be like that of puree. It will be very important to eat constantly throughout the day and stay hydrated by drinking 48-64 ounces of liquids per day (protein drinks count as liquids).

Duration: 2 weeks (Day 15 to 30 after surgery)

Suggested daily meal schedule: 4 small meals of 2 ounces each + 3 protein drinks of 6 ounces each

Goals:

• Slightly increase food consistency.
• Introduce 8 ounces of pureed foods per day.
• Continue to consume 60 grams of protein.
• Continue to stay hydrated and drink 48 to 64 ounces of liquids per day).

AVERAGE NUTRITION FACTS PER DAY:

• Calories: 760
• Protein: 60 grams
• Carbs: 75 grams
• Fat: 24 grams
• Fiber: 11 grams

Full Description: This stage slightly increases your daily calorie intake so that your stomach won’t feel a very sudden and drastic change in terms of food assimilation, digestion, and absorption. It will help prevent your liver and other organs from overworking themselves.

All food should be pureed or have a consistency similar to baby food. Some ingredients may taste or be tolerated differently than they did prior to surgery. Therefore, it’s recommended that you introduce new foods slowly. This will help you identify foods that are causing gas, stomach upset, diarrhea or any other type of discomfort.

You should continue consuming 60 grams of protein per day and may now add different protein sources such as egg whites, pureed fish, and pureed chicken. By having four small meals and three protein drinks per day, you will be helping your metabolism to gradually speed up and have proper absorption and digestion.

Approved foods: To download a complete list of the approved foods up until this stage please click on the button below.

Tips and Guidelines:

• Prioritize eating or drinking your protein first. You should always drink the protein shakes. All other recipes have very similar amounts of protein.
• This stage has 3 protein drinks per day. To make things easier, we use the same protein drink recipe during each day. That way you only have to prepare it once in the morning and not every time it is listed.
• You must stop drinking all fluids 30 minutes before and after each meal. Drink minimally (or nothing if possible) during meals. Since your stomach has decreased considerably in size, this will help you to fill up with food and not just liquids.
• Eat slowly and chew thoroughly (25 times per bite) to prevent any vomiting. It might be tempting to chew very little the food is already pureed, but we recommend taking this opportunity to practice chewing thoroughly. Doing this also allows gives your saliva enzymes more time to start breaking the food.
• If you are having trouble finishing your food during each meal, it is perfectly fine to take a 30-minute or longer break and then continue eating. Try to finish your food for the day but never if it means pushing your stomach to eat more than you feel it can.
• Continue drinking 48-64 ounces of liquids per day. Protein drinks count as liquids, not meals. As part of this meal plan you should add 8 ounces of diluted 100% fruit juice or undiluted coconut water and 8 ounces of low sugar electrolyte drinks. You should drink the juice if you feel lightheaded at any point during the day. As your recovery progresses we will reduce juice consumption until we eliminate it completely.
• Avoid any foods that are acidic or spicy, as these may still cause some discomfort or irritation.
• If pureed foods cause any discomfort such as nausea or vomiting then it is perfectly normal to go back a stage or even to clear liquids for a day or two and then try again. Experiencing this trial and error process is completely normal during your recovery. If you experience persistent vomiting you should contact your doctor immediately.
• Eggs and dairy are common new intolerances developed after surgery so try them every other day to test them first. If eating them causes discomfort or any intolerance then stop eating it and wait until stage 4 to try them again. If after that you still cannot tolerate them then you can try them one last time in stage 5. If discomfort persists, you may have become intolerant to it and should no longer consume it.
• Use a food scale and measuring spoons. It is very important to use the exact measurements we provide on the meal plan. Our recipes give measurements in both volume/amount and in grams so you are able to weigh everything. We use grams instead of ounces because it can be a more exact measure.
• Do not weigh yourself more than once per week. Pick a day of the week (we recommend Wednesdays or Thursdays) and weigh yourself every week only on that day and in the morning before having liquids or food. Weighing yourself too often can create too much mental pressure.

Exercise: It is recommended that all patients avoid exercise during this stage. It important to take it slow and keep in mind that you will already be losing a lot of weight through diet alone. It is important, however, to walk constantly during the day. Walk around your house or office every 20-30 minutes to keep the blood flowing and your metabolism active. Try aiming for 3,000 to 4,000 steps per day. You may download an app on your phone to help you track this. Longer-term, it is important to keep in mind that exercise is not the best way to lose weight, but rather changes in our diets.

Vitamins and Supplements: Continue taking supplements as indicated in Stage 2. It is recommended that you always take them with food or liquids. The suggested vitamins and supplements are the following:

• Multivitamins
  • Take 2 chewable multivitamins per day, one with breakfast and one with dinner.
  • Chewable vitamins are often more easily absorbed by the body. Make sure they are for adults and not for children.
  • Recommended brand: Centrum Chewable Multivitamin/Multimineral Supplement.
• Vitamin B-Complex
  • Take 1 B-Complex chewable vitamin per day with breakfast.
  • Recommended brand: Vitafusion B Complex Gummy Vitamins.
  • If you choose a different brand just make sure it contains at least 100% of your daily B-12 requirements.
• Calcium Citrate
  • There are 2 different types of Calcium: Calcium Citrate and Calcium Carbonate. Make sure to take Calcium Citrate because absorbed better by the body.
  • Recommended brands: Rainbow Light Calcium Citrate Chocolate Chewable, Solaray Calcium Citrate Chewable.
  • Whichever brand you choose, make sure to get a total daily dose equal to 1,000 mg per day. Take half during breakfast or lunch and the other half during dinner.
• Iron
  • Take during breakfast. Make sure to not take at the same time as calcium.
  • The required dosage is 18 mg to 25 mg.
  • Recommended brands: NutriPure Melts in Mouth Chewable Iron, BariMelts Iron + Vitamin C.
  • It is recommended to take your iron supplements with a dose of Vitamin C for better absorption. The recommended brands already include some Vitamin C.
• Gallbladder pills (optional but highly recommended)
  • When your body loses weight at a drastic pace, your gallbladder may be at risk of developing stones. The purpose of taking these pills is to help prevent any formation of these stones.
  • Take 1 serving per day for the first 6 months. After that, you may discontinue it.
  • Recommended brand: Stone Breaker Chanca Piedra (pulverize and dilute in water).
• Protein Supplements
  • It is somewhat common for patients to develop dairy intolerances after surgery. Whey protein is derived from dairy, so if you are having trouble consuming these types of protein supplements, we highly suggest switching to plant-based sources. You can also start directly with plant-based sources if desired.
  • All of our protein drink recipes use protein powder and other natural ingredients to boost their nutrient content and make them taste nice. If you do not want to drink them, you can replace protein drinks in the meal plan with 1 1/2 pre-made Premier Protein shakes per day of your flavor of choice. Other liquids that you can replace them with are Protein2O (whey-based) and Evolve (plant-based), just make sure to get 60 grams of protein per day.
  • Recommended brands: Gold Standard 100% Plant-based (plant-based powder), Gold Standard 100% Whey (powder), Vega Clean Protein (plant-based powder), Isopure (powder), Protein2O (pre-made drink).
  • If you prefer to buy another brand just make sure it meets the following nutrition requirements per serving.
    • Calories: 110 to 130
    • Protein: 20 to 25 grams
    • Fat: No more than 7 grams
    • Carbs: No more than 5 grams

• Suggested supplements schedule:
  • Morning: Multivitamin, B-Complex, Iron, Gallbladder
  • Lunch: Calcium citrate (half)
  • Dinner: Multivitamin, Calcium citrate (remaining half)