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Nutrition After Weight Loss Surgery Gastric Bypass Sleeve Gastrectomy Gastric Banding “HOW TO USE YOUR NEW TOOL SUCCESSFULLY” TEXAS CENTER FOR MEDICAL & SURGICAL WEIGHT LOSS Basics Nutrition and Behavior Modifications for long-term success Diet Progression Remember your new stomach or pouch is delicate and healing Vitamin Program WEPNSS W- water E- exercise P- protein first N- no snacking or grazing S- supplements (vitamins and minerals) S- support group WEPNSS These are the basic rules to live by. They work. Following them will make you as successful as you want to be. Remember them. Live by them. (WEPNSS) Water Water Water Minimum 64 oz daily. This is critical. The single most important thing for you to do after surgery is to get in at least 64 oz water daily! “Rinse out” waste products that you will be producing during weight loss. Maintain adequate hydration of tissues. Required for proper wound healing. It is okay to add a small amount of sugar-free flavoring but limit to a couple per day. Water! Consequences of not getting in enough water: Dehydration Nausea Vomiting Kidney problems Poor wound healing Stricture of anastomosis (connection site) Re-hospitalization Dehydration Cycle Inadequate Water Intake Vomiting Nausea Dehydration Low Potassium Spacing Water and Meals Separate water from your meals. Wait 1 hour after meals. Water during meals flushes your food through faster, making you hungry again sooner. Water Water Water Meal ……………… Water Water Water (WEPNSS) Exercise Helps to preserve lean body mass. Helps to burn more calories day to day. Increase PURPOSEFUL MOVEMENT! Wear a pedometer Take the stairs Park further away Increase housework Exercise Cardiovascular + Resistance (weights/bands/body weight) Cardiovascular exercise helps to burn fat Strength training/resistance helps to maintain your muscle mass while you are losing fat Speeds up metabolism Helps to maintain good bone health Goal = minimum of 30 minutes cardio 5x/wk and 15 minutes strength/resistance 3x/wk Cardiovascular Activity Start walking from day 1 after surgery and progress from there. Gradually increase your time each week Week 1: 10 minutes/day 5/week Week 2: 12 minutes/day Week 3: 14 minutes/day Work up to the a minimum of 30 minutes Once you stop adding time than focus on intensity Focus on your target heart rate (220-Age x 80%) Increase speed Interval training MIX IT UP and make it fun! Strength Training Start 3-4 weeks after surgery or use light weights less than 20 pounds Progression is key Gradually increase repetitions, sets, weight as it should be challenging for you Work with a trainer to get on a program that works for you. Mix it up over time to jump over plateaus (WEPNSS) Protein 60 – 80 grams daily At least 50% of every meal you eat should be protein Try to eat your protein foods first Early benefits of protein Helps protect against loss of lean body mass (muscle) Main building blocks of our bodies Late benefits of protein Protein gives a feeling of satiety (satisfied) Fewer calories per gram than fat and more satiety (satisfied) than carbohydrates Protein Protein Early on, getting enough protein in every day is difficult. Therefore, most people need to have a protein supplement for one meal per day in the beginning. Texas Center for Medical & Surgical Weight Loss offers shakes, soups, and several other forms of high-protein meal replacements that are easy to tolerate. Track your protein intake using a checklist or a food tracking system such as myfitnesspal Meal Composition No Snacking or Grazing Fasting periods lead to fat-burning. Grazing lessens your body’s need to burn its fat stores because you are frequently giving it energy (calories). Snacks are habit-forming. Improving your protein intake at each meal and increasing the amount of water you drink during the day will decrease your desire to snack. (WEPNSS) No Snacking or Grazing Our bodies cannot differentiate well between hunger and thirst When you want to snack your body may actually need the water in the food. Drink water instead of snacking Don’t be fooled!!! Theoretically, it only takes an extra 100 calories per day to gain 10 pounds in a year! ( WEPNSS) Supplements YOU NEED VITAMINS FOR THE REST OF YOUR LIFE, NO MATTER HOW GREAT YOU FEEL! Why Do I Need Vitamins? We need vitamins and minerals every day in adequate amounts in order for our bodies to function properly. Weight loss surgery can contribute to deficiencies because of: Decreased intake of food Eating different foods Decreased absorption of certain foods due to change in anatomy Deficiencies develop slowly and you may not notice them until they are severe! Why Will I Need Vitamins and Minerals After Weight Loss Surgery? Why Will I Need Vitamins and Minerals After Weight Loss Surgery? Why Will I Need Vitamins? When our body is lacking in nutrients of days, weeks, or months, life threatening or debilitating consequences can occur. Fatigue/anemia Poor immune function contributing to cancer risk, cardiovascular disease, side effects of diabetes Bone loss/fractures Neuropathy or neurological impairment Damage to the heart Blindness Why Will I Need Vitamins? To protect your health it is important to: 1. Be compliant with a supplement program. 2. Get your vitamin profiles checked EVERY year. Deficiencies are easy to correct if found early Difficult to correct if we wait for visible signs of vitamin deficiencies. Which supplements will I need? High Potency Multivitamin which includes a minimum of: 100-300% of daily value of B2, B3 (niacin), B5 (pantothenic acid), Folate and Biotin At least 200% of B1 (thiamin) 30-200 IU of vitamin E (preferably in a natural form, will have a “d-” in in front such as d-alpha tocopheryl acetate or succinate not a “dl-”, which is synthetic) 100-200% of vitamin A 60-500mg of vitamin C 100% of daily value for zinc, selenium, copper, manganese, chromium, molybdenum Ideally also contains choline and inositol Which supplements will I need? Iron Up to 45 mg daily in gastric bypass and some sleeve gastrectomy patients Your provider will help evaluate the type and quantity of iron that you should be taking Separate from calcium by 2 hours as it inhibits absorption Vitamin B12 1000 mcg sublingual (under the tongue) weekly Oral methylcobalamin Nasal sprays or injections are also an option Which supplements will I need? Calcium Needs to be in the form of calcium citrate for improved absorption 1500-1800 mg per day total (may include amount in multiple and/or the diet) Body can only absorb 500 mg at a time, so needs to be divided into 3 doses throughout the day Vitamin D 3000 IU per day (can include amounts in multi and calcium) Why take a bariatric vitamin? Vitamin preparations vary a lot in terms of contents, nutrient forms, and nutrient levels. We recommend bariatric specific vitamins because they are delivering the dosage of nutrients needed with your new anatomy as well as in a way that the new anatomy can actually absorb and utilize the nutrients. They are specifically designed with the needs of the weight loss surgery in mind! Less gastric acid post surgery to break down particularly tablets to the point the body is able to absorb the nutrients We see improved vitamin profiles in patients taking bariatric vitamins. Why take a bariatric vitamin? Cost Bariatric Vitamins typically cost $35-65 per month for all of the recommended nutrients depending on the type of form that you choose to take. Compared to increased quantity of over the counter supplements as well as the cost of vitamin deficiency complications, you may not be saving moving. INVEST in Your New Healthy Life! Consider these comparisons Cost The average American consumes 2 soft drinks per day $2/day for soft drinks=$60/month The average American eats at a fast food restaurant 2-3 times per week $6/3 times per week=$72/month INVEST in YOU and PROTECT YOUR HEALTH! Supportive Nutrients Probiotics Support healthy digestive and immune function Studies are showing a statistically significant greater weight loss in post bypass patients Fiber Soluble fiber to promote regularity Anti-inflammatory Omega 3 fatty acids Curcumin Amino Complex Promotes and maintains lean muscle mass (WEPNSS) Support General support groups are once a month. Join us 3rd Thursday at 6:30 Check the schedule and videos of past support groups at www.texasbariatric.com The people who do the best attend support groups regularly. It’s fun . It’s educational. Your attendance, questions, and support, will help other people, even if you think that you don’t necessarily need it. You will almost always walk away with something you gained from the meeting. (WEPNSS) Support Website (www.texasbariatric.com) Post-Operative Resources Recipes, tips, etc Password: Tex@s2013 Smart Phone App Search “Texas Center for Medical and Surgical Weight Loss” Like us on facebook https://www.facebook.com/texasbariatric Follow us on Pinterest Post – Operative Eating EATING AFTER BARIATRIC SURGERY Post-Op: Week 1 Liquid Diet Sugar-Free Clear Liquids Supplements Water Plain Sugar-free flavoring You will start supplements at post-op class Broth Sugar-free Jell-O Sugar-free popsicles Decaf coffee or tea Post-Op : Week 2- Advancing Diet Week 2: you are now allowed to advance your diet You will do best if you start with semi-solid foods: Low fat, low carb yogurt Protein meal replacement shakes, soups, gelatins, etc. Cottage cheese - low fat or fat-free Refried beans - fat free and moistened Low fat cheeses – i.e. string cheese Eggs- cooked any way, but not fried May add soft cooked veggies and small amounts of canned fruit. Start all vitamin supplements. 3 Weeks and Beyond : Advancing Diet If you tolerate the semi-solid foods, SLOWLY add one new food item from the list (one at a time) gradually: Fish Chicken Turkey Shellfish Tofu Soy Pork Lean beef Foods should be baked, barbecued, or broiled– NOT fried! CHEW, CHEW, CHEW Poorly Tolerated Foods in the first 6-12 weeks Spicy foods (such as curry, salsa, chili peppers) Acidic foods (such as tomato sauce or citrus fruits) Rice, pasta, bread, and other sticky or doughy foods Stringy and fibrous foods (such as coconut, corn, popcorn, whole beans, seeds, nuts) Stringy vegetables (such as celery or asparagus stalks) Bran cereals Dried fruits, seeds, skins of fruit Dry meats (may need to moisten with broth) Sugary foods including undiluted fruit juice, cookies, candy, sweets, sauces and condiments that contain added sweetenersthese foods should also be avoided for the long term ADD NEW FOODS SLOWLY! Nutritional Numbers Protein: 60-80 grams per day Carbohydrate: <60 grams per day <15 grams of sugar per meal Fat intake: <20 grams per day Low fat is considered <3 grams of fat per 100 calories A Word (or two) on Carbohydrates Sugars = carbohydrates. Carbs/sugars give little satiety and cause you to Blood glucose become hungry again sooner. Time A Word (or two) on Carbohydrates Foods like white bread, rice, potatoes, soft drinks, bagels, crackers, and fruit juices are bad choices. Watch out for the hidden sugar in sauces and dressings. Carbs by themselves can cause dumping symptoms. They are addictive/habit forming and lead to snacking behaviors. Dumping Syndrome When sugars/starches/fats from your stomach enter your intestine, hormones can be released from your intestine and cause you to feel ill. Flushing, sweating, heart pounding, lightheadedness, nausea, abdominal discomfort, sometimes vomiting and sometimes diarrhea are typical symptoms. A Word (or two) on Fats Fats are higher in calories (9 calories/gram) than protein and carbohydrates (4 calories/gram). They are habit forming/addictive. Diets high in fat can lead to heart disease (primary cause of death in our country.) Our bodies are very efficient at storing fat. A Word (or two) on Fats Look out for hidden fats Salad dressings, butter, other dressings Fats can cause dumping symptoms A Word (or two) on … Milk– has lactose (sugar) and fat in it– may cause dumping symptoms. Lactaid milk/fat-free is okay. If you cannot tolerate lactose, try fat free Mootopia® milk – 1 ½ x the protein and ½ the sugar Fruit: Do not eat by itself. Small amounts with your meal are fine Coffee/tea Caffeine is a stomach irritant None for the first 3 months because it can dehydrate you. Limit MAX 1 per day after that. Decaffeinated is ok, but watch out for hidden calories (milk, sugar) A Word (or two) on … Artificially sweetened drinks (like diet soft drinks): Many artificial sweeteners may stimulate appetite. Consuming regularly may increase craving for sweets. Use very small amount of flavoring for your water. Alcohol: New anatomy makes you particularly sensitive to alcohol. 1 alcoholic beverage has the toxicity of 4 drinks now. This does not mean you will necessarily feel 4 times more inebriated. No alcohol for first 3 months; max one drink in 24 hour period thereafter. WEPNSS REMEMBER THESE RULES!! They will serve you well. They are the key to maximizing your success with your new tool! Contacts Texas Center for Medical & Surgical Weight Loss 210-651-0303 www.texasbariatric.com Patient Support Post-Operative Education and Resources Password: Tex@s2013 Congratulations on starting the journey to a new you! TEXAS CENTER FOR MEDICAL & SURGICAL WEIGHT LOSS