Download Dietary - Hodges Weight Loss and Advanced Surgery

Updated 4/12
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M Cameron!
Hodges, MD
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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.!
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Dietary Education Module!
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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. !
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This document will serve
as a general education piece to
help you make a smooth
transition into a post bariatric
healthy diet. !
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Food Labels!
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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! !
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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). !
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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.!
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Carbohydrates (Sugar and
Alcohol)!
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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!
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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.!
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General Eating Tips!
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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!
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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.