Bariatric Phase 2 Diet Guidelines: A Comprehensive Guide to Recovery and Nutrition

Following bariatric surgery, adhering to a structured diet is crucial for healing, preventing complications, and achieving successful weight loss. The bariatric diet typically progresses through several phases, each designed to gradually reintroduce solid foods while ensuring adequate nutrition and minimizing potential side effects. Phase 2, often referred to as the full liquid or thick liquid diet, plays a vital role in this transition. This article provides a detailed overview of the bariatric phase 2 diet guidelines, offering practical advice and recommendations for a smooth and successful recovery.

Introduction to Phase 2: Full Liquid Diet

Phase 2 of the bariatric diet typically begins approximately two weeks following surgery, after the initial clear liquid phase. This phase lasts for about two weeks, until the one-month follow-up visit. The primary goal of this stage is to continue providing the body with essential nutrients while allowing the digestive system to heal. During this period, the stomach size is significantly reduced, making it essential to consume small, frequent meals that are easily digestible.

Key Objectives of the Phase 2 Diet

The phase 2 diet serves several important purposes:

• Hydration: Maintaining adequate hydration is crucial to prevent dehydration, a common complication after bariatric surgery.
• Protein Intake: Ensuring sufficient protein intake is essential for preserving muscle tissue and promoting healing. The goal should be a minimum of 65 to 75 grams of protein a day.
• Nutrient Absorption: Providing essential vitamins and minerals to prevent nutrient deficiencies, as the body's ability to absorb nutrients from food is compromised after surgery.
• Tolerance Testing: Gradually introducing thicker liquids to assess tolerance and identify any potential food sensitivities.
• Preventing Complications: Avoiding foods that can cause complications such as dumping syndrome, nausea, or vomiting.

Approved Foods and Beverages for Phase 2

The full liquid diet consists of foods that are normally liquid or become liquid at room temperature. Here is a list of approved options:

• Water: Drink six 8 oz glasses of water each day.
• Sugar-free pudding: Consider making it with Fairlife milk or adding collagen protein powder or non-fat dry milk powder for extra protein.
• Cream soups: Opt for celery, mushroom, chicken, or broccoli soups.
• Homemade blended liquid soups: Examples include butternut squash soup and carrot ginger soup.
• Sugar-free popsicles: Limit to one per day.
• Lite yogurt: Ensure there are no fruit chunks.
• Refined hot cereals: Cream of rice or cream of wheat, prepared with extra liquid to achieve a soup-like consistency. To increase protein intake, add 2 tablespoons of non-fat dry milk powder, egg substitute, powered egg, or other protein powder to each 1/2 cup of nonfat or low-fat milk.
• Protein shakes: Pre-packaged protein shakes can be used to supplement protein intake, but it's important to choose options that are low in fat and carbohydrates, with 15 to 25 grams of protein and less than 10 grams of both carbohydrates and fat.
• Almond milk or Coconut Milk: Many people become lactose intolerant due to the sugar in lactose after surgery and can experience diarrhea and discomfort.

Foods to Avoid During Phase 2

Certain foods and beverages should be avoided during phase 2 to prevent complications and ensure proper healing:

Read also: Diet Before Bariatric Surgery

• Nuts and seeds: Avoid for 8 weeks post-op
• Too-thick liquids: A liquid is too thick if you can draw lines in it with a spoon.
• Chunky liquids: Chunky pieces in liquids should be blended or strained.
• Sugary liquids: Sugar-packed liquids can slow your weight loss and lead to dumping syndrome and malnutrition.
• Carbonated beverages: These can cause stomach pain and bloating.
• Alcohol: These rinks have extra calories and sugar that is not needed.
• Citric acid: Do not drink anything with citric acid.
• Coffee: It is acidic and may have problems with acid reflux after surgery. It is also a diuretic, causing you to be dehydrated.

Sample Meal Plan for Phase 2

Here's a sample meal plan to provide a general idea of what a typical day might look like during phase 2:

• Breakfast: 1/2 cup cream of wheat (made with skim milk and protein powder)
• Mid-Morning Snack: 1/2 protein shake
• Lunch: 1 cup blended cream of chicken soup
• Afternoon Snack: 5 to 6 oz Greek Yogurt (100 kcal or less)
• Dinner: 1 cup Roasted carrot ginger soup
• Evening Snack: 1 cup fat free Fairlife milk

Important Considerations and Guidelines

• Portion Control: It is important to know that following surgery, your stomach size is very small - less than 1/4 cup, or about the size of an egg. The opening that allows food to pass out of your stomach is also very narrow. For this reason, it is important to take only two to three sips or bites at a time of any new food and then wait 10 minutes before taking more. This will help you learn your limits and tolerance. If you overeat or eat too quickly, you may experience nausea or pain.
• Hydration: Drink 6 or more cups of plain water a day.
• Sipping Liquids: Sip liquids between meals, not with meals. Do not drink fluids 30 minutes before meals, with meals, or for 30 minutes after meals.
• Protein First: Always eat the protein first.
• Avoid Straws: Do not use straws. Air bubbles form in your new pouch and can cause pain.
• Vitamin and Mineral Supplementation: After surgery your body won't be able to absorb enough nutrients from your food. You must take the following supplements on a daily basis to prevent nutrient deficiencies. Please remember that all pills must be crushed or cut into six to eight small pieces. Brands that contain this formula include Trader Joe’s and Centrum Adult chewable multivitamins. Take 1,200 to 2,000 mg of calcium daily to prevent calcium deficiency and bone disease. To enhance absorption, take the calcium in two to three divided doses throughout the day - for example, a 500 to 600 mg supplement taken three times a day. This total amount should be taken in divided doses of 400 to 500 IUs twice a day. Vitamin D should be taken with your calcium supplement. Take 500 mcg of vitamin B daily. Some patients need additional folic acid or iron supplements, particularly women who are still menstruating.
• Regular Follow-Up: Attend all scheduled appointments with your doctor and registered dietitian to monitor your progress and address any concerns.
• Listen to Your Body: Pay close attention to how your body responds to different foods and adjust your diet accordingly.

Recipes for Phase 2

Incorporating flavorful and nutritious recipes can make the phase 2 diet more enjoyable and sustainable. Here are a couple of recipes suitable for this stage:

Roasted Carrot Ginger Soup

Ingredients:

• 1 1.2 pounds (lbs) carrots, peeled and halves lengthwise
• 1 lb parsnips, peeled and quartered lengthwise
• 1 onion, diced
• 1 teaspoon (tsp) ginger
• 2 cups dry milk
• 8 cups chicken broth
• Pinch cayenne pepper
• Brown sugar

Directions:

1. Preheat oven to 350 degrees F.
2. Put the carrots, parsnips, onion, and ginger in a shallow roasting pan.
3. Sprinkle with brown sugar.
4. Pour 2 cups of broth into the pan and cover well with foil.
5. Bake until the vegetables are very tender (about 2 hours).
6. Put the baked vegetables and broth to a large pot.
7. Add the last 6 cups of broth, salt, and cayenne pepper. Bring to a boil, lower the heat, and let it simmer partially covered for 10 minutes.
8. Puree the soup in a blender or food processor, adding 2 cups nonfat dry milk.
9. Put the soup back into the pot, adjust seasonings, and heat through.

Cream Soup

Ingredients:

• 1/3 cup nonfat dry milk powder
• 1 tsp chicken or beef bouillon

Directions:

1. Mix dry ingredients and add hot water to equal 1 cup.

Butternut Squash Soup

Ingredients:

• 1 tablespoon (Tbsp) vegetable oil
• 1 each butternut squash
• 2 cup dry milk
• 3 cups low sodium chicken broth
• 2 tsp fresh ginger, grated
• 1 each medium sweet potato
• 2 each large golden delicious apples
• 1/2 cup skim milk
• 2 tsp cumin
• 1 each medium white onion
• 2 cloves garlic
• 1/2 cup fat free buttermilk
• Pinch pepper

Directions:

1. Peel potato, onion, apple, and squash. Cut it into 1/4 inch chunks.
2. Heat 1 Tbsp oil over medium heat in a large saucepan or stock pot. Stir in onion and garlic until tender.
3. Add broth, potato, apple, squash, and seasoning. Stir well.
4. Lower the heat to medium-low and let it simmer until the vegetables are tender (about 20 minutes).
5. Puree soup in a blender until nicely pureed. While pureeing add 1/2 cup of milk, 1/2 cup of buttermilk, and 1 cup dry milk.
6. Serve hot or chilled.

Transitioning to Phase 3: Pureed Foods

After approximately two weeks on the full liquid diet, you will transition to phase 3, which involves the introduction of pureed foods. This transition should be done under the guidance of your doctor or registered dietitian, who will assess your progress and provide specific instructions.

Read also: Bariatric Surgery Outcomes

Read also: Is Bariatric Surgery Right for You?

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