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Download Dietary - Hodges Weight Loss and Advanced Surgery
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Updated 4/12 ! ! ! ! M Cameron! Hodges, MD ! ! ! carbohydrates proteins as well as various other additives. One important thing to understand is that you always have to look at the serving size. If a label lists the serving size as 2, and grams of protein per serving as 4, then the total amount of protein is actually 8 g. This really applies to all aspects of the food label. You have to pay attention because food manufacturers will frequently label a fairly small package as two servings to hide the number of calories per serving and fat per serving. People will generally assume that given the small size of the package that the package equals one serving.! ! Dietary Education Module! ! The first thing to understand about dietary education is that our goal after weight loss surgery is for you to be a healthy eater of a wide variety of fresh perishable foods. Learning to eat from the periphery of the grocery store 90% of the time is a significant change for some people but can generally be done quite easily. What we mean by this is that generally the grocery store is arranged so that perishable fresh foods without preservatives are located on the periphery parts of the grocery store while foods loaded with preservatives, and high fructose corn syrup are more located in the central portion of the grocery store. ! ! This document will serve as a general education piece to help you make a smooth transition into a post bariatric healthy diet. ! ! Food Labels! ! Understanding food labels is critically important to building a healthy diet. The food label is mandated by the food and drug administration on every product sold. It will give you a breakdown of serving size, calories and amount of fats ! Proteins! ! ! Proteins are an essential part of dietary intake. Proteins are critical for making energy in the body. They also serve various roles in cellular function. Most of the signals and enzymes that control cell function are protein driven. Your body is less likely to convert protein into fat as well. This is why we generally focus on patients having good protein intake and will recommend supplementation during the early phases of post-op diet. Most of the protein sources in our diet come from meat. While meat is generally tolerated very well after a few weeks, early on patients will typically supplement with protein drinks, cottage cheese, and greek yogurt. After 3–4 weeks your sleeve should be able to start tolerating meats which are the most widely available source of protein. When snacking, proteins work well to create good satisfaction. Examples would include beef jerky, edamame beans, nuts, peanut butter (low sugar). ! ! Fats! ! Fats are an essential part of dietary intake as well. Several important vitamins including vitamin A, D, E, and K are only available though dietary fat intake. These vitamins are important for healthy nails and skin.! In the past, the American Heart Association has come down heavily on fat intake being bad. However, this seems to be much less important than initially thought. I generally want patients to focus much more heavily on watching protein and carbohydrate intake than worrying too much about fat intake.! ! Carbohydrates (Sugar and Alcohol)! ! This category of food produces the most significant problems for the American diet. Carbohydrates come in several forms. The simplest form includes sugar and high fructose corn syrup (HFCS). Other forms include complex carbs like bread rice pasta and alcohol. HFCS is by far the single greatest contributor to obesity in the United States. This stuff absolutely wrecks our metabolism. The effects of HFCS on the liver are also identical to alcohol. From the standpoint of the liver, HFCS and alcohol are biochemically identical. In the last 5 years the number one cause of liver transplant have changed from alcohol indeed to fatty liver caused by obesity. Unfortunately HFCS is cheap and the food manufacturers love it to add flavor to processed foods and drinks. HFCS produces very little satisfaction and studies have shown that when drinking sugary drinks, individuals will eat more calories than if they just drank water with their meals. We recommend absolutely no routine daily intake of sugar or HFCS. The other problem with HFCS is that when your body metabolizes HFCS 50% of the molecule is turned into fat and stored. When consuming carbohydrates the best type is complex carbs. Complex carbs include bread, rice, pasta as well as crackers. Most generally your sleeve will not hold a large volume of these substances and you will feel full very quickly when eating complex carbs. However, the exception would be chips and crackers. These substances turn to liquid very quickly and it's easy to consume a large number of calories in this form of complex carbs. Finally, alcohol is also a form of carbohydrate. Alcohol unfortunately has the highest calorie content per gram ingested. This doesn't mean that you can't ever consume alcohol. It just means that you have to consider the amount of calories in alcohol when making choices and counting calories.! Fiber! ! Getting enough fiber in your diet without supplementing can be difficult. Fiber rich foods tend to be a little more bulky and with the limited space in a sleeve, can be an issue. Getting up to 30gms is ideal and should help to keep you from getting constipated. Probably the best source of fiber is psyllium found in a Metamucil type product. There are also Metamucil pills as well as Fibercon pills. Fiber will also help to block some of the absorption of carbohydrates in your gut. This can produce more flatulence so if you are wanting to decrease flatulence then decrease carbs.! ! ! General Eating Tips! ! During the first few weeks after surgery you will want to refer to the early post-op diet one page document. Once you graduate to eating more solid foods there are several things that will help you eat well with minimal chance of discomfort.! • If you question whether you should eat one more bite …… DON’T. At the first sign of fullness stop. Sometimes patients will hiccup when full or even get a little sweat on their upper lip. If you put that one more bite in after feeling full you will likely feel pain and discomfort and may bring the food back up. That being said, everyone does this a few times during the learning curve with limited side effects.! • You are at highest risk for over eating your sleeve when you are out eating in a social situation. Pay extra attention to small bites and chewing well.! • Using a small shrimp fork will really help you eat smaller bites.! • You can drink while eating with a sleeve but if you eat a heavier food like rice and then drink on top of the food it may float a few peaces of food back into your esophagus that come back out. ! • Use the Internet as a resource for helping you build your own cook book of things you like. Sites like google images and pinterest can be an excellent resource. Use searches like bariatric recipes or more specifically bariatric seafood recipes. This will help you to not get board with eating the same thing all the time.! • Don’t always avoid difficult foods. Difficult foods are ones that may be a little more challenging to get through your sleeve such as rice, pasta, broccoli. When eating difficult foods you tend to eat less calories.! • Snack on protein rich foods like beef jerky, and edamame. Raw almonds are good as well as raw vegetables.! Thoughts on Calories! ! There is nothing really magical about weight loss surgery that melts the weight off. Patients just eat much less and are very satisfied with less calories. Patients that undergo gastric bypass or sleeve with duodenal switch do have an increase in their bodies metabolism and burn more calories during the day. This is why heavier patients do better with these operations. The metabolic rate (number of calories you burn in a day) can vary widely from one person to the next even with individuals who are the same sex and height. I do think it is important to track and count your calories. My fitness pal seems to be a fairly good app for tracking calories. The biggest factor that determines how many calories you should take in per day is your height. A general guide to average patient calorie in taker would be:! • 5’0” - 650-750 calories/day! • 5’5” - 700-800 calories/day! • 5’9” - 850-900 calories/day! • 6’0” - 950-1100 caloires/day! These do seem like very small amounts but a low calorie diet is still very healthy. Most studies show increased life expectancy with low calorie diets. Your friends may tell you you’re not eating enough but this is rarely the case.