Description summary: Congrats! You’ve made it past the hardest stages. Everything from now on will start getting easier and easier. This stage is designed for patients that are at least 2 months out of surgery. It introduces slightly larger portions per meal and 2 small snacks per day. It also reduces the amount of protein shakes per day by 1, as we continue to increase protein intake from food rather than from liquids. As with all previous stages, it is important that you stay hydrated by drinking 48-64 ounces of liquids per day (protein drinks count as liquids, not meals).

Duration: 1 month (Days 60 to 90 after surgery)

Suggested daily meal schedule: 3 meals of 3-4 ounces each + 2 small snacks of 1 ounce each + 1 protein drink of 6 ounces

Goals:

• Slightly increase the size of each meal.
• Introduce firmer food textures.
• Continue to consume 60 grams of protein.
• Continue to reduce dependency on protein drinks.
• Stay hydrated and drink 48 to 64 ounces of liquids per day.
• Comfortably eat 3-4 ounces of food per meal by the end of this stage.

AVERAGE NUTRITION FACTS PER DAY:

• Calories: 890
• Protein: 60 grams
• Carbs: 90 grams
• Fat: 31 grams
• Fiber: 13 grams

Full Description: Congrats! You’ve made it past the hardest stages. Everything from now on will start getting easier and easier. It is still important to still keep in mind the tips from previous stages, such as chewing your food thoroughly and eating slowly, but you should now be able to start eating more per meal and introduce new foods into your diet.

Because you are already consuming enough protein, the added ounces of food per day are recommended to come from other types of foods. These include fruits, vegetables, whole grains, and legumes. These will provide your body with tons of micronutrients that will keep you in good health.

With each stage also comes a slight increase in daily caloric intake (due to the higher volume of food per day). It is important to consume sufficient calories at each stage to keep energy levels balanced and prevent your metabolism from slowing down too much, as this may work against your weight loss goals.

Approved foods: To download a complete list of the approved foods up until this stage please click on the button below.

Tips and Guidelines:

• Eat your protein first! If you are having trouble finishing your meal then prioritize the protein (protein drinks, chicken, turkey, fish, eggs, and tofu).
• You must stop drinking all fluids 30 minutes before and after each meal. Drink minimally (or nothing if possible) during meals. Since your stomach has decreased considerably in size, this will help you to fill up with food and not just liquids.
• Eat slowly and only small bites at a time to prevent any vomiting or discomfort (some patients experience the unpleasant feeling of food getting stuck at the entrance of their stomach when they take too big of a bite).
• Chew your food thoroughly (25 times per bite).
• If you are having trouble finishing your food during each meal, it is perfectly fine to take a small break of a couple of minutes and then continue eating. Try to finish your food for the day but never if it means pushing your stomach to eat more than you feel it can.
• Add new foods one at a time so that you can easily identify any that don’t sit too well with your new pouch.
• Continue drinking 48-64 ounces of liquids per day. Protein drinks count as liquids, not meals. As part of this meal plan you should add 4 ounces of diluted 100% fruit juice or undiluted coconut water and 8 ounces of low sugar electrolyte drinks. You should drink the juice if you feel lightheaded at any point during the day. As your recovery progresses we will reduce juice consumption until we eliminate it completely. All other liquids should consist of mostly water.
• You can now begin trying slightly citric fruits such as lime. Incorporate them into your diet in small amounts and begin testing them every other day to see if they cause any irritation. Discontinue if they still provoke discomfort and wait until the next stage to try them again.
• You can replace the strawberries in this meal plan with an equal amount of any fruit you’d like from the list of approved foods, such as watermelon or plums. Cut fruit into small pieces and remember to chew thoroughly.
• If solid foods cause any discomfort then it is perfectly normal to go back a stage or even to clear liquids for a day or two and then try again. Experiencing this trial and error process is completely normal during your recovery.
• Avoid beef or any steaks, as this is food especially common to cause the feeling of food getting stuck given its tough texture. Ground beef is ok as long as it is at least 90% lean.
• One part of the stomach that was removed during surgery was in charge of producing the Ghrelin hormone, also known as the “hunger hormone.” This will help you to feel less hungry but it is very important to eat constantly throughout the day to keep your body nourished. Set reminders on your phone if you are having trouble remembering to eat.
• Eggs, dairy, and rice are common new intolerances developed after surgery, so add them slowly back into your diet. If eating them causes discomfort or any intolerance then stop eating them and wait until stage 6 to try them again. If you have already experience symptoms of intolerance in previous stages and they persist during this stage, you should consider the possibility that you may have become intolerant to them and should no longer consume them.
• Use a food scale and measuring spoons. It is very important to use the exact measurements we provide on the meal plan. Our recipes give measurements in both volume/amount and in grams so you are able to weigh everything. We use grams instead of ounces because it can be a more exact measure.
• Do not weigh yourself more than once per week. Pick a day of the week (we recommend Wednesdays or Thursdays) and weigh yourself every week only on that day and in the morning before having liquids or food. Weighing yourself too often can create too much mental pressure.
• Everyone’s bodies are slightly different so your recovery could be slightly faster or slower than others. It will be important, however, to remember that the size of your stomach has shrunken considerably and that you will not be able to eat as much as before. This stage continues to slowly incorporate real food back into your diet, but it may take up to 6 months after surgery for you to be able to eat most foods again.

Exercise: It is recommended all patients avoid exercise during this stage. It important to take it slow and keep in mind that you will already be losing a lot of weight through diet alone. It is important, however, to walk constantly during the day. Walk around your house or office every 20-30 minutes to keep the blood flowing and your metabolism active. Try aiming for 4,000 to 5,000 steps per day. You may download an app on your phone to help you track this. Longer-term, it is important to keep in mind that exercise is not the best way to lose weight, but rather changes in our diets.

Vitamins and Supplements: Continue taking supplements as indicated in Stage 4. It is recommended that you always take them with food or liquids. The suggested vitamins and supplements are the following:

• Multivitamins
  • Take 2 chewable multivitamins per day, one with breakfast and one with dinner.
  • Chewable vitamins are often more easily absorbed by the body. Make sure they are for adults and not for children.
  • Recommended brand: Centrum Chewable Multivitamin/Multimineral Supplement.
• Vitamin B-Complex
  • Take 1 B-Complex chewable vitamin per day with breakfast.
  • Recommended brand: Vitafusion B Complex Gummy Vitamins.
  • If you choose a different brand just make sure it contains at least 100% of your daily B-12 requirements.
• Calcium Citrate
  • There are 2 different types of Calcium: Calcium Citrate and Calcium Carbonate. Make sure to take Calcium Citrate because absorbed better by the body.
  • Recommended brands: Rainbow Light Calcium Citrate Chocolate Chewable, Solaray Calcium Citrate Chewable.
  • Whichever brand you choose, make sure to get a total daily dose equal to 1,000 mg per day. Take half during breakfast or lunch and the other half during dinner.
• Iron
  • Take during breakfast. Make sure to not take at the same time as calcium.
  • The required dosage is 18 mg to 25 mg.
  • Recommended brands: NutriPure Melts in Mouth Chewable Iron, BariMelts Iron + Vitamin C.
  • It is recommended to take your iron supplements with a dose of Vitamin C for better absorption. The recommended brands already include some Vitamin C.
• Gallbladder pills (optional but highly recommended)
  • When your body loses weight at a drastic pace, your gallbladder may be at risk of developing stones. The purpose of taking these pills is to help prevent any formation of these stones.
  • Take 1 serving per day for the first 6 months. After that, you may discontinue it.
  • Recommended brand: Stone Breaker Chanca Piedra (pulverize and dilute in water).
• Protein Supplements
  • It is somewhat common for patients to develop dairy intolerances after surgery. Whey protein is derived from dairy, so if you are having trouble consuming these types of protein supplements, we highly suggest switching to plant-based sources. You can also start directly with plant-based sources if desired.
  • All of our protein drink recipes use protein powder and other natural ingredients to boost their nutrient content and make them taste nice. If you do not want to drink them, you can replace protein drinks in the meal plan with 1/2 of a pre-made Premier Protein shake per day of your flavor of choice. Other liquids that you can replace them with are Protein2O (whey-based) and Evolve (plant-based), just make sure to get 60 grams of protein per day.
  • Recommended brands: Gold Standard 100% Plant-based (plant-based powder), Gold Standard 100% Whey (powder), Vega Clean Protein (plant-based powder), Isopure (powder), Protein2O (pre-made drink).
  • If you prefer to buy another brand just make sure it meets the following nutrition requirements per serving.
    • Calories: 110 to 130
    • Protein: 20 to 25 grams
    • Fat: No more than 7 grams
    • Carbs: No more than 5 grams

• Suggested supplements schedule:
  • Morning: Multivitamin, B-Complex, Iron, Gallbladder
  • Lunch: Calcium citrate (half)
  • Dinner: Multivitamin, Calcium citrate (remaining half)