Section 14: Dietary advice for week 5 onwards post - surgery – solid/textured food

Section 14: Dietary advice for week 5 onwards post - surgery – solid/textured food

Most patients should be able to progress onto more solid and textured food from around 5 weeks post-surgery onwards - essentially a ‘normal’ diet, which you should follow long term.

However, it is important to remember that not everyone will progress through the stages at the same rate. There is no rush, but once you feel comfortable to progress, you should do so.

What is solid/textured food?

Solid and textured food is food that requires biting and chewing. A knife should be needed to cut up the food and you shouldn’t be able to eat it with only a fork or spoon.

Why do I need to move away from soft food?

Choosing solid/textured food rather than soft food means:

• You are less likely to rush your food as it takes more time to chew solid food. This means you realise more easily when you have eaten enough.
• You are more likely to feel satisfied because it stays in the stomach for longer therefore will be less likely to want additional snacks.
• Your diet tends to be more nutritious and lower in calories and fat.

Things to be wary of:

1. Dishes where lots of sauce is used as this will make the dish less suitable.  Good examples would be sauce on pasta and gravy on a roast dinner. You can overcome this by reducing the amount of sauce used and adding chunky vegetables, beans, or lentils to the sauce to improve its texture.
2. Soft ‘complete meals’ such as fish pie, shepherd’s pie and lasagne are fine to eat but not on their own – they can fill up half of your small plate but fill the other half with crunchy vegetables or salad to add texture.

Try to choose more textured food rather than soft food. For example, jacket potatoes rather than mashed potato or bran flakes rather than porridge. Sometimes, you might just fancy a soft meal or the meal your family is having is a bit on the soft side and that’s fine - you could always add the texture to it or make some simple adaptations to the recipe. Examples as follows:

• Add chopped solid fruit to softer cereals e.g. chopped apple over Weetabix
• Sprinkle a little no added sugar muesli or low sugar granola over porridge
• Add a side salad to a soft meal like lasagne or steamed crunchy vegetables to fish pie
• Don’t soak your cereal in milk as it goes soggy
• Keep the skin on potatoes
• Make curries with a drier consistency like tandoori and/or add crunchy veg on the side
• Don’t overcook vegetables – keep them a little al dente (with a bite to them) – steaming vegetables is an ideal cooking method for this
• Don’t overcook pasta – keep that a little al dente, too
• You can still have soup but make it high protein and have a small crunchy bread roll with it or a slice of bread
• Have baked beans, tinned fish or scrambled egg on toast rather than on their own
• Add vegetables like peppers and onion to omelettes.

How much should I eat?

At this stage it is likely that you will be able to manage slightly more than during the pureed and soft stages. However, it is still likely to only be a very small amount – perhaps around 6 tbsp of food. It’s important to remember that everyone is different and some people can manage more or less than this. We advise that you continue to use a child’s plate, a side plate, or a BandBoozled plate.

At this stage you should be comfortable having 3 small meals per day, without the need for any snacks in between. However, some patients still find that 4 - 6 smaller meals work better for them – everyone is different.

It is common for you to have very little or no appetite. However, regular nutritious meals are important.

Tip – set a reminder on your mobile phone to prompt eating.

How should I eat?

See “How to eat” in previous section.

What should I eat?

As was the case in the pureed and soft stages, 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 “caution foods” (see later in this section).

Balanced meal plate – week 5 onwards (solid/textured food)

Protein-based foods (½ of the plate)

• Cheese - reduced fat cottage cheese, "light" cheese triangles/cheese spread, reduced fat feta-style cheese, "light" Babybel-style cheese
• Eggs – omelette, boiled, scrambled, poached or dry fried
• Meats and low fat/lean meat products – N.B. caution food
• Lean (ideally less than 5% fat) minced beef/pork/lamb/chicken/turkey - as mince has a tendency to be soft and ‘easy to eat’ when cooked, aim to include chunky vegetables, beans and/or lentils when making meals from these foods.
• Stewing steak/casseroled/slow cooked meats
• Thin sliced sandwich meats (ideally less than 5% fat)
• Skinless chicken thighs
• Lean bacon (fat cut off)
• Lean sausages (ideally less than 5% fat)
• Lean bacon (fat cut off)
• Skinless chicken/turkey breast
• Grilled/dry fried/barbequed beef/pork/lamb
• Fish and seafood
• Fresh or tinned white fish (poached, grilled, steamed, baked)
• Fresh or tinned oily fish (poached, grilled, steamed, baked) e.g. sardines, mackerel, pilchards, fresh tuna, salmon, kippers. Aim for 2 portions per week, as they provide essential ‘Omega 3’ oils.  If you don’t like oily fish, consider taking a flaxseed oil supplement instead.
• Fresh or tinned shellfish e.g. prawns, mussels, clams, oysters, lobster
  • Vegetarian meat substitutes – N.B. caution food
• Quorn products (fillets, chunks, sausages, mince)
• Soya products
• Tofu
• Tempeh
• Beans , pulses and lentils
• All varieties (baked beans, chick peas, kidney beans, mixed beans)
• Products made with these foods e.g. falafel, houmous.

Fruit, vegetables and salad (¼ of the plate)

• Vegetables & salad
• All varieties – fresh, tinned, frozen
• Stir-fry
• Steamed or boiled (retaining a “crunch”)
• Avocados are fine but are quite high in calories so don’t have unlimited amounts
• Remember that baked beans count, but only 1 portion per day
• Note: stringy vegetables such as green beans can be more difficult to tolerate
• Fruit
• All types
• Opt for ‘snack/fun-size’ bananas
• Veg/ salad should be included in your diet in higher amounts than fruit
• Note: dried fruit and stringy fruit such as pineapple can be more difficult to tolerate

Carbohydrate-based foods (¼ of the plate)

• Breakfast cereal
• Bran flakes
• Minibix
• Low sugar granola
• No added sugar muesli
• Fruit and Fibre
• Special K
• All bran
• Bread and bread products – N.B. caution food
• Low fat crackers (e.g. Ryvita, crackerbread, Finncrisp, Krisprolls, oatcakes)
• Pitta bread
• Wraps
• Thins
• Bread/toast – you may find Weight Watchers/Nimble-style bread easier
• Potato and potato products
• Jacket potato (normal or sweet) (with skin)
• Boiled/new potatoes (with skin)
• Home-made potato wedges
• Less than 5% fat oven chips
• Potato waffles
• Pasta and grains
• Small pasta shapes – you may find these easier than spaghetti/linguine
• Noodles (egg or rice-based)
• Couscous
• Bulgur wheat/buckwheat
• Rice - N.B. caution food
• Brown rice is better.
• Ensure you wash it thoroughly before and after cooking to prevent it becoming “sticky”

Caution foods

There are some caution foods, which are more likely to cause discomfort and/or regurgitation when eaten, particularly if introduced into your diet too early. Always take care when introducing foods back into your diet and take note of any discomfort. It is important to experiment with these foods to identify how your body will react. If a food causes problems, remove it from your diet and then re-trial it again later.

The caution foods listed below should:

• Not be attempted until the solid/textured food stage
• Be the last foods you attempt to eat when progressing onto solid foods – try other foods first. Do not rush to reintroduce these foods into your diet; some people find that they need to wait until 3/4 months after the operation before attempting these foods, but everyone is different.

The main caution foods are:

1. Bread & bread products

Follow the below staged approach when introducing these foods:

• Try 1^st: low-fat, high-fibre crackers (e.g. Ryvita, Crackerbread, Finncrisp, Krisprolls)
• Try 2^nd: well toasted wholemeal pitta bread
• Try 3^rd: wholemeal wrap
• Try 4^th: Danish-style bread (e.g. Weight Watchers, Nimble) or wholemeal sandwich thins, toasted to begin with
• Try last: normal wholemeal/granary bread, toasted to begin with
• Try to avoid: soft doughy white bread.

    2.  Boiled or steamed rice

• Brown rice is better
• Ensure you wash it thoroughly before and after cooking to prevent it becoming “sticky”.

 
     3.  Meat, particularly chicken breast, steak and pork chops

You may have already tried lean (ideally less than 5% fat) minced beef/pork/lamb/chicken/turkey in the soft food stage post-operatively. If not, try this first before attempting anything more solid. 

Once you are established on a diet of solid/textured food, start building in other meat products by following the below staged approach:

• Try 1^st: Lean (ideally less than 5% fat) minced beef/pork/lamb/chicken/turkey (N.B. as mince has a tendency to be soft and ‘easy to eat’ when cooked, aim to include chunky vegetables, beans and/or lentils when making meals from these foods)
• Try 2^nd: Stewing steak/casseroled/slow-cooked meats
• Try 3^rd: Thinly sliced sandwich meats (ideally less than 5% fat) – note that ‘wafer-thin’ varieties contain less protein so try to go for the better quality versions
• Try 4^th: Chicken or turkey leg meat (no skin)
• Try 5^th: Lean sausages (ideally less than 5% fat)
• Try 6^th: Lean bacon or turkey bacon (fat cut off)
• Try 7^th: Grilled/dry fried/barbequed chicken or turkey breast (no skin)
• Try last: Grilled/dry fried/barbequed beef/pork/lamb.

Other caution foods

• Stringy vegetables and fruit such as green beans, sweetcorn and pineapple
• Fruit with tough skin e.g. apples and pears, or pith i.e. oranges, satsumas and tangerines
• Nuts
• Dried fruit

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 and blood tests.

Alcohol

See Follow-up and general guidelines on healthy eating and living with a gastric bypass or sleeve.

Discomfort/pain when eating and/or regurgitation/vomiting

Follow the same advice as in Dietary advice for week 4 post surgery – soft foods.

Meal ideas for week 5 onwards

Any amounts are given as a guide only. You may require less or more than stated as everyone’s level of portion size reduction is different, so don’t worry. Remember to stop eating when you feel satisfied – don’t push yourself to overeat

Although it might not always be possible, try to include a source of protein at each meal, regular carbohydrates and regular vegetables, salad and fruit. This will give you a balanced diet and help ensure you get all the nutrition your body needs.

It is better to stick with solid meals and not rely on meal replacement shakes at mealtimes.

Breakfast ideas:

As soon as you feel able in the morning, have something to eat. It can be difficult to meet your nutritional requirements if meals are missed and having breakfast gets the day off to a good start. Try to view food as fuel for your body now that you will be eating less overall, so a healthy breakfast is a good place to start.

Some breakfast ideas could include the following - your portion size will vary depending on your stage after surgery and everybody is different:

• ½ a tin of baked beans on 1 small slice wholemeal or granary toast*
• 2 egg omelette with added vegetables for texture
• 1-2 scrambled eggs on a ½ to 1 toasted sandwich thin
• ½ tin pilchards, sardines or mackerel on 1 slice of toast*
• Breakfast wrap – 1 slice lean, grilled bacon and chopped boiled egg in a mini toasted wrap
• 1-2 boiled/poached eggs on 1 slice granary toast*
• 1 dry fried egg with mushrooms, tinned tomatoes and ½ a toasted bagel*
• High fibre cereal such as bran flakes, All Bran, Shredded Wheat with a splash of low-fat milk – you could use fortified milk (mix 2tbsp skimmed milk powder with 1 pint of skimmed or semi-skimmed milk) for extra protein, try high protein yogurt instead, or even add a few nuts to increase the protein content
• 0% authentic Greek yogurt (this is much higher in protein than ‘Greek-style’ yogurt) + a handful of berries and 1 tbsp toasted oats and grains.

*remember that bread is a caution food (see above) so you may wish to choose to have 2 low fat crackers instead (e.g. Ryvita, Crackerbread, Krisprolls, Finncrisp, oatcakes) or a toasted thin or a mini wrap instead.

Lunch Ideas:

Lunch can be tricky especially if you are out and about and can’t always get access to healthy food. If this is the case, you could take a packed lunch with you, freshly prepared the night before to save time in the morning.

• 2 low fat crackers with 2 tsp low-fat cheese spread/soft cheese, ½ tin of tinned fish or 1 tbsp houmous with a few cherry tomatoes and cucumber sticks
• Try our recipes for houmous, mackerel pate or spicy bean pate – serve with a slice of toast, 2 low fat crackers or a toasted thin and some carrot sticks
• Salad: 30g low fat mozzarella/45g cottage cheese/1-2 eggs/30g wafer-thin chicken/ham/turkey + lettuce, tomatoes, peppers, cucumber + 1-2 egg-sized boiled potatoes/120g cooked (50g dried) pasta or couscous/1-2 low fat (less than 3g fat per 100g) crackers
• Jacket potato (+skin) + filling (e.g. 30g reduced fat cheese + ½ tin beans or ½ tin tuna + 1tsp. extra light mayonnaise + chopped gherkins or 30g reduced fat feta cheese + beetroot & mint or reduced fat mozzarella, cherry tomatoes & basil) and salad
• 1-2 poached/dry-fried/boiled eggs or ½ tin beans or ½ tin pilchards/sardines/mackerel on 1 slice of toast (choose wholemeal or granary bread)*
• Pitta bread or tortilla wrap or 1 slice of wholemeal/granary bread* or 1 wholemeal/granary bagel* + reduced fat cheese/wafer thin ham/wafer thin chicken/tuna/salmon + ½ a cereal bowlful of salad (e.g. lettuce, carrots, peppers, tomato, cucumber, beetroot, gherkin, radish)
• Pasta salad (prepare before work) – 50g dried (120g cooked) wholemeal pasta + chunky diced raw peppers, red onion, cucumber and gherkin + 1 tbsp of a home-made tomato sauce (see recipes online) and 20g of parmesan shavings.

*remember bread is a caution food (see above) so you may wish to choose to have 2 low fat crackers instead (e.g. Ryvita, Crackerbread, Krisprolls, Finncrisp, oatcakes) with these choices.

Evening meal ideas:

• 1 palm-sized fish cake (made with cod, smoked haddock, seasoning, spring onion, mashed potato, lime zest and chilli if desired) + 1-2 portions veg or salad (a portion is around 80g; if you can only manage 1 portion, ensure it includes 2-3 different vegetables for variety
• ½ grilled tuna steak + 2-3 small new potatoes + 1-2 portions veg
• Stir-fry: 50g Quorn/soya meat/king prawns/finely diced chicken + peppers, courgettes, spring onions, mushrooms + 1 tsp sweet chilli sauce + 1 tsp soy sauce + 50g dried (120g cooked) noodles
• 2 tbsp cooked couscous + roasted vegetables + 30g goats cheese or feta
• 60-70g lean mince made into a burger (with onion, seasoning + 1-2tsp. milk) + 6-10 potato wedges (make your own by chopping a baking potato into wedges and tossing in 1 tsp olive oil, 1 tsp ground cumin, 1 tsp ground coriander, 1 tsp cayenne pepper and baking at 220ºC for 30 minutes or so) (no burger bun) + salad
• 2 tbsp cooked bulgur wheat + 2 tbsp mixed beans + salad
• 60-70g mixed beans made into a burger (mashed together with onion, chilli, garlic, seasoning + 1-2 tsp milk or beaten egg to bind) + 6-10 potato wedges (no burger bun) + salad
• 2-egg Spanish-style omelette with finely sliced potatoes, peppers, tomato and mushrooms
• 1 lean sausage/vegetarian sausage* + 2 egg-sized new potatoes + 1-2 tbsp green beans
• Spaghetti bolognese made with extra lean minced beef (1 x 500g pack should make 10+ portions), coarsely diced carrot, peppers, courgettes & onion + 120g cooked (50g dried) pasta + steamed vegetables or salad (remember: ¼ the plate should be crunchy steamed vegetables or salad, ¼ of the plate should be pasta and ½ of the plate should be the meat sauce).

*Remember meat and meat products are caution foods (see above) so take care when introducing these into your diet.

Snacks

Your dietitian can advise you if you need additional snacks to help you to meet your protein requirement. You may find 3 small meals a day is sufficient for you and you are meeting your protein requirements without the need for extra snacks.

If you feel you need a snack in-between meals try some of the options below, all of which provide valuable protein:

• An apple with a teaspoon of peanut butter
• 25g (small handful) of plain nuts and/or seeds
• A cereal bar (<100kcal)
• 1 raw carrot/½ pepper/1-2 sticks celery/1-2 inches cucumber or a high-fibre cracker with houmous, mackerel pate or spicy bean dip (see recipes)
• A handful of plain (not salted/sweet) popcorn
• 1 high protein yogurt
• Glass of fortified milk
• A high protein cereal bar
• A cracker with ham or chicken or low-fat cheese
• Ready-cooked chicken/ham/turkey
• A hard-boiled egg
• Glass of protein water

Sample meal plan 1:

Breakfast: Scrambled eggs on granary toast

Mid-morning: Banana with a spoon of 0% fat authentic Greek yogurt

Lunch: Half a wholemeal pitta bread stuffed with chicken breast slices, spring onion and tomato. Drizzle with a little non-oil-based dressing or lemon juice and freshly ground black pepper

Mid-afternoon: Small bag of nuts

Evening meal: Griddled salmon fillet (use spray oil in a griddle pan) served with steamed green beans, carrots and couscous

Supper: 1 high-fibre cracker with reduced-fat soft cheese

Sample meal plan 2

Breakfast: 2 egg omelette with chopped red and green peppers and a sprinkle of low-fat grated cheese

Mid-morning: Small bag of dried fruit and nuts

Lunch: Noodle and soya bean salad (see recipes)

Mid-afternoon: Homemade cereal bar (see recipes)

Evening meal:  Fish Crunch (see recipes)

Supper: Glass of milk

Long-term solid diet – checklist

• Progress onto normal foods around 5 weeks post-surgery
• Attempt the caution foods last
• Choose textured foods where possible or add the texture to softer meals
• Eat slowly – follow the 20-20-20-20 rule
• Use a small plate and cutlery (a side plate or BandBoozled plate
• Continue to avoid fizzy drinks
• Continue to avoid drinking with food and for at least 30 minutes afterwards
• Go easy on alcohol – your tolerance will be reduced
• Take all of your vitamin and mineral supplements daily
• Remember your blood tests and if needed, vitamin B12 injections (see Supplements and blood tests)
• Exercise regularly