13 January 2021


Section 12: Dietary advice for week 3 post surgery – pureed foods


 

Once you have finished the 2-week post-operative liquid diet, you should be ready to progress onto pureed food for 1 week. It is important to follow the post-operative diet step-by-step, progressing onto pureed foods first before you try any soft foods. This is to ensure your stomach can heal properly and reduce risk of any complications.

 

What is pureed food?

 

Pureed food is food that has a smooth consistency with no lumps, similar to the consistency of baby food. No chewing should be required at this stage. To puree food, you will need a food processor, blender or liquidiser. If extra liquid is required to thin the mixture down, ideally use milk as it will add more valuable protein. Aim to use water or stock minimally as these will dilute the nutrient content of the food.

 

How much should I eat?

 

At this stage it is likely that you will only be able to manage very small amounts of food. Each meal is likely to be around 6dsp (dessertspoons) or 4tbsp (tablespoons), however everyone is different, and some people can manage more or less than this. Just take it slowly and try not to be anxious about trying this new texture. Using a child’s plate or bowl and smaller cutlery can be helpful.

 

You will probably find you need to have four to six small meals a day to ensure your body is getting enough nutrition. At this stage, if you are not managing much, you can continue to supplement your intake with the high protein liquids as before, but in smaller quantities.

 

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?

 

During this stage it is important to start thinking about the lifestyle changes that you are going to have to make with regards to your diet. One of the main things is getting used to having balanced, healthy meals. Including all three food groups from the diagram on the next page is vital to make sure that your body is getting all the nutrients it needs and to help you get the best results from your surgery.

 

Please take note of the foods you should avoid during this stage.

 

Protein is the most important food group with regards to healing. There is also strong evidence to suggest that gastric bypass and sleeve patients have an increased requirement compared with the general population – at least 60g per day.  Aim to include a protein-based food at every meal you have (5-6 portions of protein foods a day). You can add skimmed milk powder (e.g. Marvel) to meals to boost their protein content.

 

Tips:

  • When cooking use lots of flavourings, lemon juice, herbs and spices to make the food more appealing
  • To help make the food look more attractive on your plate, puree each food separately rather than altogether, otherwise it may end up like an unappealing brown mush

 

 

       
   
 
   

REMEMBER: All food needs to be pureed

 


 

 

What and when should I drink?

 

Suitable drinks are listed in Follow-up and general guidelines on healthy eating and living with a gastric bypass or sleeve

 

Do not drink at mealtimes or for 30 minutes after meals. This is to avoid washing food through the stomach too quickly which may result in discomfort or Dumping Syndrome. The stomach is also much smaller now, so the food and fluid together are too much in terms of volume. Try to sip on fluids between your meals instead.

 

Continue to avoid fizzy drinks – they may put unnecessary pressure on the internal stitches and staples and can cause discomfort and reflux.

 

We recommend that you avoid alcohol until at least 5 weeks after surgery where you will be starting to get back onto a normal diet.  See further guidance in Follow-up and general guidelines on healthy eating and living with a gastric bypass or sleeve.

 

Vitamin and mineral supplementation

 

See Supplements and blood tests

 

Problems during this stage

 

Nausea

 

Some people find that the texture of pureed food can cause nausea (feeling sick).  If this happens, try to flavour foods more with herbs and spices and drink plenty between meals. Remember to puree the foods separately and if you can’t manage much, supplement your diet with high protein liquids but in smaller quantities than before.

 

Discomfort/pain when eating and/or regurgitation/vomiting

 

If eating is uncomfortable, or if you are struggling to swallow and/or you are regurgitating food, firstly think about whether you are taking small mouthfuls and resting between mouthfuls. Ensure your mouthfuls are no bigger than a 20-pence piece and have at least a 20-second rest between each mouthful.

 

Proper posture is important – aim to eat sitting at a table so your torso is upright.

 

Stress and anxiety can also be associated with pain/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.

 

Eating and drinking at the same time can cause you to feel bloated or over-full and result in pain, discomfort and/or regurgitation. See “what and when should I drink?” earlier in this section.

 

If you are still struggling, contact us immediately for advice. You may need to return to the fluid stage for another week or two. Your dietitian can advise you on this if necessary.  However, if you have not progressed to pureed food by 4 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. Make sure it is well pureed with no lumps, and that you are eating very slowly.

 

Sample meal plan 1

 

Most of the meal ideas given in Dietary advice for week 4 post-surgery – soft foods can be pureed.

 

Breakfast: Pureed Weetabix (or supermarket equivalent) and milk fortified with skimmed milk powder

 

Mid-morning:  Smooth strawberry yogurt

 

Lunch: Pureed fish, pureed potato and pureed vegetables

 

Mid-afternoon: Pureed rice pudding and 1 tsp skimmed milk powder

 

Evening: Hearty lentil soup (see recipe below)

 

Supper: Low fat custard and stewed fruit

 

Sample meal plan 2

 

Breakfast: Blender breakfast (see recipe below)

 

Mid-morning: Low fat smooth vanilla yogurt

 

Lunch: Carrot, chicken and barley soup (see recipe below)

 

Mid-afternoon: Pureed banana with natural yoghurt and a sprinkle of cinnamon

 

Evening meal: Mixed bean and butternut puree (see recipe below)

 

Supper: Decaf latte made with fortified milk

 

Sample meal plan 3

 

Breakfast: Soya yogurt with pureed banana

 

Mid-morning: Blender breakfast (see below) but omit the milk powder and substitute the milk or yogurt for a non-dairy equivalent and add 1 tbsp vegan protein powder or smooth peanut butter 

 

Lunch: Hearty lentil soup (see below) and substitute milk powder for vegan protein powder and blend with non-dairy milk such as soya

 

Mid-afternoon: Pureed apple with coconut yogurt

 

Evening meal: Mixed bean and butternut puree (see recipe below)

 

Supper: Blended soya milk and 1 tbsp smooth peanut butter

 

 

 

Blender Breakfast (1 x portion, around 200ml) – blend all the ingredients together until smooth.  Contains 10g protein.

  • 1 fun-size banana, peeled and chopped
  • 1 peach/nectarine, peeled and chopped
  • 120ml of skimmed milk or natural yoghurt
  • 1 tbsp of natural bran/porridge oats
  • 1 tbsp skimmed milk powder

 

Hearty puy lentil soup

Makes 8 x 200ml portions

Contains 10g protein per portion

 

Did you know? Dried puy lentils contain three times the amount of protein than dried red or green split lentils.

 

Ingredients

  • 1 large carrot, peeled and chopped
  • 1 stick of celery, finely copped
  • 1 onion, finely chopped
  • 2 cloves garlic, crushed
  • 1 tsp vegetable oil
  • 1 tsp dried cumin
  • 1 tsp dried coriander
  • 1 tsp dried turmeric
  • 1 tsp dried oregano
  • 200g dried puy lentils, rinsed
  • 750ml vegetable or chicken stock
  • 4 tbsp skimmed milk powder, blended with 500ml semi-skimmed or skimmed milk
  • Pepper and Worcestershire sauce for seasoning

 

  1. Heat the oil in a large saucepan and cook the carrot, celery, onion and garlic gently for 5-10 minutes until they begin to soften.
  2. Add the herbs and spices and stir through for a minute.
  3. Add lentils and stock and bring to the boil. Boil for 25-30 minutes, stirring every now and then until the lentils are soft.
  4. Add the skimmed milk powder blended with the milk and warm through.
  5. Season with pepper and a splash of Worcestershire sauce. Puree with a processor/hand blender until completely smooth.

 

Carrot, chicken and barley soup

Makes 8 x 200ml portions

Contains 10g protein per portion

 

  • 450g carrots, peeled and sliced
  • 1 leek, cleaned and sliced
  • 2 litre chicken stock
  • 75g pearl barley
  • 175g cooked chicken, broken into bite sized chunks
  • 175g potatoes, peeled and chopped
  • 100g cooked vegetables such as peas, broccoli or green beans

 

  1. Place carrots, leek, potatoes, other vegetables and pearl barley into a large saucepan. Cover with chicken stock and bring to the boil. Simmer for 30 minutes until the vegetables are soft.
  2. Add in cooked chicken and simmer for a further 5 minutes.
  3. Combine all the ingredients in a blender and process until smooth (be careful not to spill as the mixture will be hot).

 

Mixed Bean and butternut puree

 

Hearty and plant-based

 

Makes 2 portions

Contains 4g protein per portion

 

Ingredients

 

  • Spray oil or 1/2 tsp oil
  • ¼ small onion, peeled and finely diced
  • 1 medium garlic clove, peeled and finely sliced or crushed
  • ½ tsp tomato puree
  • 50g butternut squash, cut into 1cm cubes
  • ½ a drained 400g can of mixed beans, washed and drained
  • 100ml vegetable stock
  • ¼ tsp mixed herbs
  • Black pepper
  • 20g pasta

 

Method

 

  1. Heat the oil in a small saucepan.
  2. Add the onion and cook until very soft and translucent.
  3. Add the garlic and tomato puree, then cook for a further minute.
  4. Add the butternut, beans and cover with the stock. Add the herbs and a pinch of ground black pepper.
  5. Bring to the boil, cover with a lid and then simmer until everything is very soft (this will probably take around 15 minutes).
  6. Meanwhile, cook the pasta until also very soft (about 15 minutes).
  7. Puree the sauce until completely smooth in an appropriate container (there should still be no lumps at this stage and the overall consistency needs to be similar to yogurt/custard, requiring no chewing - add a little more stock, if required, to achieve this).
  8. Divide the sauce into two portions and add your pasta to one.
  9. Re-blend and serve.

 

Top tip: vegetarian sources of protein, such as beans, tend to be lower in protein than animal products. Consider adding 1-1.5 heaped tbsp of skimmed milk powder to help boost the protein content. Re-adjust consistency, if required, as it can thicken sauces slightly.

 

Try these additional recipes:

 

Butternut squash and sweet potato soup

Makes 8 x 200 portions

Contains 8g protein per portion

 

Ingredients

  • 3 sweet potatoes, peeled
  • 1 butternut squash, peeled
  • 3 onions, peeled
  • 2 cloves garlic, peeled
  • 2 tsp vegetable stock powder
  • 2 litres of skimmed, 1% fat or semi-skimmed milk (or lactose-free alternatives) or soya milk, blended with 5 tbsp skimmed milk powder or flavourless rice/pea/soya protein powder

 

Method

  1. Roast the potatoes, squash, onions and garlic until soft and charred at the edges.
  2. Place the vegetables in a blender and blend with the stock powder and milk until smooth. Reheat and season to taste.

 

Pea and ham soup

Makes 10x 200ml portions

Contains 8g protein per portion

 

  • 1 onion, chopped
  • 1 potato, diced
  • 500g frozen peas
  • 1 litre pork stock
  • 300g cooked gammon, shredded

 

  1. Cook onion & potato for 2-3 minutes in 1 tsp of oil.
  2. Add the stock and simmer until the potato is soft.
  3. Add the peas and simmer until soft. Add the ham and blend until smooth.

 

 

Apple and Cinnamon Breakfast Yogurt

 

A flavour combo that never fails.

 

Makes 2 portions

Contains 10g protein per portion

 

Ingredients

  • ½ small apple, peeled, cored and cut into pieces
  • 1 tbsp porridge oats
  • 2 tbsp skimmed milk powder
  • 30ml skimmed milk
  • 5 tbsp (75g) 0% fat plain authentic Greek yogurt (not “Greek-style”)
  • Sprinkle of cinnamon

 

Method

  1. Gently stew the apple and porridge oats in a small, covered saucepan with a couple of tablespoons of water, until the apple is very soft, then allow to cool.
  2. Put the skimmed milk powder and milk in a tall jug/container and stir to form a paste.
  3. Add the oats, apple and yogurt and blend until smooth (there should still be no lumps at this stage). Add a little more milk if the yoghurt mix is too thick.
  4. Add the cinnamon to taste and serve half.

 

Top tips:

  • For a slightly different taste, you could replace the skimmed milk powder with 2 scoops of vanilla (low sugar/low fat) whey protein powder instead.
  • Due to the way it is made, authentic Greek yogurt is higher in protein than other plain yogurts. However, remember to ensure you use the fat-free variety as they can be very high in fat too. Please note: Greek-style yogurt is not the same as authentic Greek yogurt.

 

 

Cod in parsley puree with pureed celeriac and potato

 

Makes 2 portions

Contains 14g protein per portion

 

Ingredients

  • 1 cod loin or fillet (140g)
  • 1 tbsp parsley (no stalks), finely chopped
  • 75ml skimmed or semi-skimmed milk plus a little extra for the potato and celeriac mash
  • Salt and ground black pepper
  • 60g celeriac, cut into small strips - finely cut
  • 80g potato, peeled and cut into four

 

Method

  1. Preheat oven to 180°C (160°C fan).
  2. Loosely wrap the cod in foil and cook in the oven for around 20 minutes (or as per packet instructions) until the fish is cooked through.
  3. Whilst the fish is cooking, boil some water in a small saucepan and cook the potato and celeriac until very soft (this will probably take about 15-20 minutes).
  4. A few minutes before everything is ready, heat the milk and parsley gently in another small saucepan.
  5. Once the fish is cooked, flake it into the milk (leave the skin in the tin foil).
  6. Blend until smooth, in an appropriate container (there should still be no lumps at this stage and the overall consistency needs to be similar to yogurt/custard, requiring no chewing - add a little more milk, if required, to achieve this).
  7. Season to taste and add a little more parsley if you want it, remembering to re-blend after.
  8. Puree the potato and celeriac with a bit of milk to achieve the right consistency and serve with your fish.

 

Checklist for puree phase (marketing add infographic)

 

  • You will need a blender or liquidiser
  • Use milk (or if you can’t tolerate it, stock or gravy) to thin the consistency of pureed food if needed
  • Take small amounts on the spoon – less than a 20p piece
  • Wait at least 20 seconds between mouthfuls
  • Wait at least 30 minutes after eating before having a drink
  • Avoid alcohol and fizzy drinks at this stage
  • Take all of your vitamin and mineral supplements.
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