Section 13: Dietary advice for week 4 – soft food

Once you have finished your week on the puree diet, you should be ready to progress onto soft food for one week before finally progressing back onto a solid diet at week 5 post-surgery. It is important to follow the post-operative diet step-by-step, progressing onto soft foods before you try any solid foods. This is to ensure your stomach can heal properly and reduce risk of complications.

What are soft foods?

Soft foods are foods that are moist and can be mashed with the back of a fork – a knife is not required. These foods can be a mixture of solid food and thick sauces and have a sloppy consistency.

How much should I eat?

At this stage it is likely that you will only be able to manage small amounts of food. Each meal is likely to be around 6 dsp (dessertspoons) or 4 tbsp (tablespoons), however everyone is different, and some people can manage more or less than this.  Using a child’s plate or a side plate can be helpful. Smaller cutlery can also be useful. You may notice you can manage a little more than during the pureed stage – this is normal due to internal swelling subsiding.

You may find you need to eat 4 to 6 small meals daily in order to meet your nutritional requirements.

It is common for you to have very little or no appetite, so you may find you want to skip meals.  However, regular nutritious meals are important so please try and eat regularly – just remember to take your time and don’t rush.

Tip – you might find it helpful to set reminders on your phone to prompt eating.

How should I eat?

See “How to eat” in Follow-up and general guidelines on healthy eating and living with a gastric bypass or sleeve.

What should I eat?

As was the case in the pureed stage, balance your meals according to the diagram on the next page and ensure you have a source of protein at every meal. Take note of the foods that should be avoided at this stage.

What and when should I drink?

Follow the same advice as in Dietary advice for week 3 post surgery – pureed foods.

Vitamin and mineral supplementation

See Supplements & blood tests

Discomfort/pain when eating and/or regurgitation/vomiting

If eating is uncomfortable or if you are struggling to swallow and/or regurgitating food, firstly think about whether you are taking small mouthfuls and resting between mouthfuls. If not, remember to follow the correct eating technique – take mouthfuls no bigger than a 20p piece, chew well (although soft food shouldn’t need any chewing!) and rest for 20 - 40 seconds between bites.

Stress and anxiety can also be associated with pain and discomfort on eating/drinking and regurgitation. Try to ensure you are calm and relaxed before you start eating. Relaxation techniques are useful in this respect, as well as the use of herbal teas such as camomile.

Good posture is important. Aim to eat sitting upright at a table rather than on the sofa.

Eating and drinking at the same time can cause you to feel bloated and over-full, resulting in pain, discomfort and/or regurgitation. See “what and when should I drink?” in Dietary advice for week 3 post surgery – pureed foods.

If you are still struggling, contact us immediately for advice. You may need to return to the puree stage for another week or two – your dietitian can advise you on this. However, if you have not progressed to soft food by around 5 weeks post-surgery, we may need to inform your surgeon as there could be stenosis present (see Risks of surgery / potential complications and side effects). Furthermore, excessive vomiting can lead to thiamine deficiency. If vomiting continues for more than 5 days you will need to see your GP to obtain a thiamine supplement of 200-300mg to be taken daily and 1 tablet of vitamin B co strong three times a day – your dietitian can advise you on this if you have any queries.

If you have problems with any particular food, stop eating it for a few days and then reintroduce it a few days later.

Meal ideas

Breakfast

• ½-1 Weetabix/20g shreddies (left to soak in milk)/20g (dry weight) Readybrek/ 20g (dry weight) porridge oats with skimmed, 1% fat, semi-skimmed, calcium-enriched soya or lactose-free milk. You also could use fortified milk to increase the protein content.

• Thick fruit smoothie with a selection of fruits (banana/strawberries/summer fruits/mango) blended with low fat Greek yogurt or skimmed milk (fortified milk or yogurts or high protein yogurts could be used).

• 2 tbsp low fat natural/soya yoghurt (fortified can be used) + 1-2 tbsp stewed fruit (plums/apple/berries). You could use artificial sweetener instead of sugar if needed.

• 1 egg omelette made with semi-skimmed milk + reduced-fat cheese and tinned tomatoes

• 1 soft scrambled/poached egg with ¼ tin of chopped tomatoes/1-2 tinned plum tomatoes

• Mashed banana with low fat and low sugar yogurt/custard (again fortified can be used for extra protein).

Lunch and evening meal ideas

• Mashed avocado and 1 mashed boiled egg

• Soft poached salmon with mashed potatoes

• Mashed or pureed tofu/soya/Quorn with vegetarian gravy/stock and mashed potatoes & well mashed vegetables

• Well-cooked cauliflower cheese (1-2 florets) + 1-2 florets broccoli + 1 scoop mashed potato

• Cottage pie/shepherd’s pie (if homemade: a 500g pack of minced beef or lamb will make a large pie of which 1-2 tablespoons should be an adequate portion) + 2 tbsp of vegetables such as soft carrots, cabbage and brussel sprouts

• Spaghetti bolognese – ensure the pasta is cooked for 15-20 minutes so it is very soft; a 500g pack of minced beef or 300g pack of minced Quorn should make a batch large enough to yield 8-10 portions, as long as you use tomatoes, carrots, peppers, onions etc to bulk out the sauce. Make sure all the vegetables are cooked thoroughly so they are soft.

• Mexican beef chilli – a 500g pack of minced beef or 300g pack of minced Quorn and 415g can of mixed beans should make a batch large enough to yield 8-10 portions, as long as you use onions and peppers to bulk up the sauce. You may need to add beef stock to thin the consistency. You could add 1 tsp chilli powder and 1 tbsp chipotle paste to add some flavour. Serve with some yogurt.

• Lasagne (again, a 500g pack of mince should yield 8-10 portions) – try making the white sauce by using 500ml semi-skimmed milk + 3 tbsp corn flour (mix 50ml milk with the corn flour initially, then add to the remaining milk + heat gently until thickened) + 1tbsp wholegrain mustard. Only use cheese on the top of the lasagne (try a reduced-fat, strongly flavoured cheddar – 50g should be adequate) and serve with soft vegetables.

• Soft pasta shapes + tomato sauce (1 x tin chopped tomatoes, onion, garlic, tomato puree, basil & seasoning – should make 3 or 4 portions) and 30g grated reduced-fat cheese

• Centre of a jacket potato + 40g cottage cheese or ½ tin of tuna mixed with 1 tbsp light or extra light mayonnaise or 1 chopped boiled egg mixed with 1 tbsp light or extra light mayonnaise.

• Well-cooked lentils or dhal with mashed potato and soft vegetables

• Fish in parsley sauce with mashed potato and soft vegetables

• Ratatouille (roast peppers, aubergine, courgette, red onion, cherry tomatoes & garlic for 30-45 minutes until soft; then place in a pan with 1-2 tins of chopped tomatoes and simmer for 20 minutes until very soft). Serve with soft pasta or mashed potato.

• 1 x mashed sweet potato + 1-2 tbsp reduced fat houmous or home-made houmous (see below).

• Make 6 servings of houmous by placing all ingredients into a food processor; alternatively mash together. Ingredients: 400g can chickpeas, drained & rinsed, 1 clove garlic, 2 tbsp olive oil, 2 tbsp tahini paste.

Desserts

• Pureed/stewed fruit with low fat custard

• Mashed banana and low-fat custard

• Low-fat/sugar yogurt, mousse, fromage frais jelly or sorbet

• Low-fat crème caramel/Angel Delight/blancmange

• Low-fat semolina/fat-free sponge soaked in fruit juice

Sample Meal Plan 1

Breakfast: Spicy pear and peanut butter porridge (see recipe below)

Mid–morning: Mashed banana with fromage frais

Lunch: Jacket potato with tuna with a little low-fat mayo (avoid the skin)

Mid–afternoon: Stewed apple with fortified low-fat custard

Evening meal: Fish in parsley sauce with mashed sweet potato and soft-boiled broccoli

Supper: Small pot of flavoured high protein yogurt

Spiced Pear and Peanut Butter Porridge

A warming breakfast for a cold day

Serves: 1

Contains 11.5g protein

Ingredients

• 1 tbsp/7g porridge oats
• 100ml skimmed milk
• 1 tbsp skimmed milk powder
• 1 tbsp 0% fat plain greek yogurt
• 1/4 pear, peeled, cored and cut into three-four small pieces
• Light sprinkle of ground cinnamon
• Pinch of ground nutmeg
• Pinch of ground ginger
• 1/2 tsp smooth, no added sugar/salt peanut butter

Method

1. Put the pear into a small saucepan with the spice and a drop or two of water.
2. Cover and stew gently until very soft (the time will depend on how ripe the pear is to start with, so keep an eye on it).
3. Mix the skimmed milk powder with a little of the skimmed milk to make a smooth paste, before mixing with the remaining milk and adding to a small saucepan with the oats. Slowly bring to the boil, stirring regularly, then reduce the heat and simmer for two-three minutes until the porridge has thickened slightly.
4. Once everything is cooked, add the porridge to a glass, mix in the yogurt and peanut butter then top with the pear.

Sample meal plan 2

Breakfast: Porridge made with fortified milk and a few chopped raspberries on top

Mid morning: Milk jelly made with fortified milk

Lunch: Scrambled tofu and tomato brunch (see recipe below)

Mid–afternoon: Reduced sugar Angel Delight made with fortified milk

Evening meal: Curried mince beef one pot (see recipe below)

Supper: Small pot of smooth fromage frais

Scrambled Tofu and Tomato Brunch

Maybe it’s time you try something new?

Serves: 1

Contains 15g protein

Ingredients

• 1/4 tsp sesame oil
• 100g plain tofu pieces
• A pinch of turmeric (for colour)
• 1 rounded tsp nutritional yeast
• Pinch of salt
• Few turns of black pepper
• Few chilli flakes (optional)
• 2-3 tbsp chopped tinned tomatoes

Method

1. Use a fork to crumble the tofu into small bite-size pieces.
2. Put all the ingredients, except the tomatoes in a frying pan. Heat gently for a few minutes until heated through, scrambling all the ingredients together.
3. Once all cooked, place the scrambled tofu on your (warmed) plate.
4. Put the tomatoes into the frying pan and heat through for a few minutes before transferring to your plate.
5. Enjoy!

Curried Mince Beef One Pot

A take on an Indian Keema.

Makes 2 portions

Contains 13g protein

Ingredients

• 125g lean 5% fat beef mince
• 1/8 onion, peeled and finely diced
• 1 small garlic clove, peeled and crushed or finely chopped
• 1/4 tsp dried ground ginger
• 1/2 tsp dried sweet paprika
• 1 tsp mild curry powder
• 1/2 medium tomato, peeled and cut into smaller pieces
• 40g potato, peeled and cut into a maximum of 1cm cubes
• 20g green pepper, cut into a maximum of 1cm cubes
• 1 tbsp fresh coriander (no stalks), finely chopped
• 250ml stock
• 1 tsp tomato puree
• Pinch of black pepper

Method

1. Gently brown the mince in a small saucepan.
2. Add the onion and cook in the meat’s juices for about 5 minutes, until it’s soft and translucent.
3. Add the garlic, ginger, paprika, curry powder, potato, pepper and tomato and cook for a further minute.
4. Add the stock, tomato puree and coriander.
5. Bring to the boil, then simmer gently for 1 hour (add a little more stock, if at any point, it starts to dry out).
6. After this time, the vegetables should be very soft, making it possible to mash everything with the back of a fork. There should also be a little stock left, so that the overall texture is slightly sloppy (adjust as required, if this is not the case).
7. Season with black pepper and serve.

Try these additional recipes – all soft, perfectly portioned and a good source of protein:

Turkey Mince Bolognese with Courgette and Pasta

Makes 4 portions

Contains 17g protein per portion

Ingredients

• Spray oil or 1/2 tsp oil
• 1/4 small onion, peeled and finely sliced
• 250g lean turkey mince
• 1 small garlic, peeled and finely sliced or crushed
• 5 tbsp tinned chopped tomatoes
• 1 tsp tomato puree
• 1 tsp dried oregano
• Around 250ml stock
• Pinch black pepper

Per portion:

50g courgette, use a peeler to cut into long strips

20g pasta

Method

1. Heat the oil in a small saucepan.
2. Add the onion and fry until soft and translucent.
3. Add the mince, break into small pieces and brown all over.
4. Then add the garlic and cook for a further minute.
5. Add the remaining ingredients and cook for 45 minutes - 1 hour. You want the final dish to be slightly sloppy, so add a little more liquid if it dries out too much or if too watery, cook for a little longer.
6. About 15-20 minutes before the sauce is cooked, boil some water in a separate saucepan.
7. Add the pasta and cook until very soft.
8. Add the courgette about 2-3 minutes before the pasta is ready and also cook until very soft.
9. Season your sauce to taste and serve a portion with your pasta and courgette. The rest can be frozen in portions.

Deconstructed Shepherdess Pie

A twist on the classic to allow all to enjoy

Serves: 1

Contains 12g protein

Ingredients

• 2g dried porcini mushrooms
• Spray oil or 1/2 tsp oil
• 1/8 small onion, peeled and finely sliced
• 15g carrot, peeled and cut into very small cubes (less than 1cm squared)
• 20g pepper (orange, yellow or red), cut into small cubes
• 1 garlic clove, peeled and finely sliced or crushed
• 1/4 tsp dried mixed herbs
• 1/2 tsp tomato puree
• 45g frozen Quorn mince
• 3 tbsp tinned chopped tomatoes
• 1/8 tsp reduced salt marmite (be cautious)
• Pinch black pepper
• 40g sweet potato, peeled and quartered
• 1 tbsp skimmed milk powder mixed with enough milk to make a smooth thin paste

Method

1. Rehydrate the dried mushrooms in 125ml of hot water for 30 minutes.
2. After 20 minutes, heat the oil in a small saucepan.
3. Add the onion, carrot and pepper, cover and sweat gently for 10-15 minutes or until the vegetables have softened (stir occasionally and be careful not to let them burn, cautiously add a splash of water if needed).
4. Add the garlic, herbs, tomato puree and Quorn.
5. Remove the mushrooms from the water and chop them finely. Add them and 100ml of the liquid to the pan, using a sieve for the water so that you don’t add the gritty residue.
6. Add the chopped tomatoes, marmite and black pepper.
7. Bring to the boil, cover, them simmer for 25-40 minutes or until the vegetables are very soft (if at any point the mixture becomes too thick, add a bit more liquid as you want the final product to be soft and sloppy and mash-able with the back of a fork).
8. Whilst the above is simmering, cook the sweet potato until it is also very soft (this will probably take around 15 minutes).
9. Once cooked, mash the potato with the skimmed milk powder mixture, to create a smooth, moist consistency.
10. Put the sauce onto your plate and place the mash on top.

Soft phase - check list (marketing - add in an infographic)

• Soft, sloppy foods only
• Should be able to mash with the back of a fork - no knife needed
• Add extra sauces, gravy, fluid to soften meals
• Follow the 20/20/20/20 rule
• Continue to avoid drinking whilst eating and for at least 30 minutes after meals
• Use small cutlery and a small side plate/BandBoozled plate
• Continue to focus on protein-rich foods
• Avoid alcohol and fizzy drinks
• Take all your daily vitamin and mineral supplements