January 29, 2019

Your Guide to the Bariatric Pureed Diet

The pureed diet after bariatric surgery is one of the most feared stages.

Pureed? Really? That sounds gross. Can I just skip it?

As a dietitian, these are common concerns I get from bariatric candidates. And understandably so. Eating pureed food does not sound appetizing. But rest assured there are some good pureed food recipes ideas out there for you during this stage.

This article will discuss the importance of the pureed phase, goals to aim for, and provide you with pureed food recipe ideas.

What is the pureed diet stage after bariatric surgery?

After you have completed the pre bariatric surgery diet, the pureed diet stage is usually the first stage your doctor will advance you to after surgery. Each surgery center has their own specific guidelines but the pureed diet stage usually involves blending your food to a thin, lump free texture. It resembles an “applesauce like consistency.”

Why do I need to eat a pureed diet?

Your new pouch is still swollen from surgery so you want to make your first experience with food as easy as possible. The purpose of the pureed diet is to help ease your body into digesting real food. Think of it as priming the pump. When you blend your food up, you are relieving your body of doing the work for you.

It’s also a great opportunity to begin introducing a reliable meal pattern into your schedule. Even if you only eat one bite, you are setting an intention for yourself to start eating a meal at that time. Essentially you are retraining your body to eat at set meal times. This will be helpful for your weight loss, recovery, and mood in the months to come.

How long do I need to be on a pureed diet?

Every surgery center has different guidelines. Generally this stage can last anywhere from one week to one month after surgery. Please follow the specific guidelines from your facility. Advance your diet to the soft diet stage once your doctor says it’s okay.

How much protein should I be getting during the pureed stage?

Ideally you will be meeting the minimum protein goal of 60 g protein set by the ASMBS. Many post bariatric patients can meet this requirement within 2-3 weeks after surgery. However, most of your protein will be coming from your protein drinks at this stage and not your real food.

You likely will not be able to eat more than 20 g of protein a day. Even if you had the the perfect diet, your new pouch size is not big enough (remember it’s still swollen) to hold as much protein as you need which is why the protein drinks are so important.

If you need more info about which protein drink to choose, please check my previous article on the pre bariatric surgery diet. There is a small section that discusses protein drinks.

What if I am not getting enough protein at this stage?

This is a common concern at this stage. Despite many people able to reach their protein goals, there are also a significant amount of people who are struggling getting in their protein. If this is you then I encourage you to contact your surgery center to let them know what it is going on. They may want to monitor you more closely.

One tip that may help is to follow a structured schedule. Write down your meal times and the times you are drinking a protein shake. Here is an example of what that may look like.

Aim to eat protein at every meal. Even though cream of wheat may be allowed, it does not mean it is the best choice. Including pureed protein such as cottage cheese, eggs, or beans, in my experience, tend to be the most tolerated proteins early on.

What foods can I eat during the pureed stage?

Each surgery center has different guidelines but here are typical foods that are allowed during this stage:

All previous liquids allowed from the pre-bariatric surgery diet
Sugar-free low fat yogurts without fruit pieces. Needs to be smooth and thin.
Blended cottage cheese
Blended poultry, fish or eggs
Blended cooked non-starchy vegetables like carrots, zucchini, green beans
Blended beans

Although the following foods are typically allowed I suggest relying less on these items:

Sugar-free popsicles
Sugar-free jello
Sugar-free custards
Store bought soups blended up
Strained cream soups
Cream of wheat
Mashed potatoes
Grits

You may notice I left out beef on the options list. This is because I have found that bariatric patients have a challenging time tolerating beef immediately after surgery. I usually suggest saving this for later.

How much food can I eat at a time during the pureed stage?

Many people are alarmed that they can only eat one small bite during their first meal after surgery. This is completely normal. Within a week you will likely reach up to 1-2 tablespoons at a time. Then as the swelling goes down in your new pouch you will be closer to ¼ a cup around one month after surgery.

Please remember these are just basic guidelines and not goals. It is more important to listen to your body. If you are feeling any pressure or pain then this is a signal to stop. Everyone advances differently and that’s okay. Please contact your bariatric surgery center if you are concerned with your progress.

How do I puree my food?

If you have never pureed food before, it can seem like a daunting task. Once you try it though, you will build confidence in yourself that you can do it again. Just do it once to get over your fears.

So here is how you do it!

Step 1: Cook the food you want to eat such as chicken or vegetables. Steaming your vegetables works best.

Step 2: Add your food to the blender or small food processor. If using a large pieces of food (aka chicken breast) then cut up before placing in blender.

Step 3: Add liquid to help you reach your desired consistency. Broths work great to thin out your food and add a little flavor. You will not need much if you are preparing food in small amounts.

Step 4: Puree until smooth and thin in texture.

As an extra bonus you could even freeze your pureed food in ice cube trays and freeze it for another time. Each ice cube is about two tablespoons.

Freeze your pureed food in ice cube trays to save for another time

Sample High Protein Pureed Diet Menu

Breakfast: 1-4 tablespoons plain, thin yogurt (no fruit pieces)

Mid-morning snack: Approved protein drink

Lunch: 1-4 tablespoon high protein chicken soup

Mid-afternoon snack: Approved protein drink

Dinner: 1-4 tablespoon pasta fagioli (without the pasta)

Night time snack: Approved protein drink

An easy to follow Post Bariatric Pureed Diet Meal Plan

High Protein Pureed Food Recipes

Can I eat baby food during the pureed stage?

Technically, yes, but most surgery centers and dietitians advise against it. First and foremost, homemade pureed food tastes way better than store bought baby food. When you prepare your own food you can season it and prepare it in ways that are familiar to you. Baby food may turn you off from eating and you may lose your opportunity to develop a solid meal structure during this phase.

Second, lots of baby food have added sugar to help make them taste better. Make sure to read the label to reduce your sugar intake.

So in a nutshell, yes, you can eat baby food if you are in a bind, but most surgery centers recommend avoiding it.

Tips for Success During the Pureed Stage

Have a plan

Knowing what you will be eating everyday will help relieve a lot of stress. I suggest knowing what meals you are going to have at least 1 day before. If you are really proactive you can puree all your meals before having surgery and store in the freezer. This way all you need to do is heat them up.

Go slowly

Nausea and vomiting are a common concern immediately after surgery. You will minimize these unwanted feelings by going slow. It helps to use a small baby spoon to regulate your bite sizes.

Drink your water

As you add real food back into your diet it can be easy to forget to drink enough fluids. This can become even more difficult since you are separating your fluids from your meal. Carry a water bottle with you at all times and set a timer to remember to drink water if you find it helpful.

Move your body

If cleared by your doctor begin walking leisurely. Moving your body will help maintain your muscle mass and begin training your mindset that activity is going to be important for your long term success.

Focus on your protein

Eating and drinking enough protein is crucial during this stage. Improve your chances of meeting your protein goals by eating your protein first. This way if you become full you already ate some protein in your meal.

Begin taking your multivitamin

If your surgeon has cleared you to take a multivitamin begin getting into the habit as soon as possible. It can be a challenging habit to develop and the sooner you start the sooner you will find a routine that works for you. Plus, taking your vitamins minimizes the likelihood that you will fall prey to nutritional deficiencies that may cause you to lose your hair or become fatigued.

Conclusion

The pureed stage after bariatric surgery may sound intimidating, but once you find a few good recipes to support you during this stage it becomes much easier. Although the texture is different than what you are used to, if it is made correctly it should taste just like the real thing.