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Nutrition Class #3 •Eating after Surgery •Protein First, Forever •Vitamins and Water •Special Considerations Protein • • The importance of Protein: – Important nutrient pre- surgery to ensure proper nutrition and get you from one meal to the next – Needed for building lean muscle tissue – Needed for healthy blood, skin, hair, nails – Essential for growth and maintenance of cells and chemical processes for body functioning – The most important nutrient after surgery – Must be the main focus of your meals: eat all protein first – Eating lean protein will help you feel fuller longer – Drink your protein supplement beginning the day after surgery – Lean protein is found in lean meat, poultry without the skin, fish, egg whites or egg substitute, low-fat/non-fat dairy, low-fat soy based products and beans (kidney, garbanzo, lentil, black, etc.)( refer to Lean Sources ) – Remember that about 1 ounce of meat or its equivalent equals 7 grams of protein Protein Supplementation: – At least 120 calories,15 grams of protein and less than 3 grams of fat and less than 10 grams of carbohydrate – In the beginning while on liquids, the protein supplement will be your main source of protein – As your diet progresses to solid food, lean protein sources + some protein supplement will be your main source of protein (see sample meal plans) – Initially, work toward an intake of 40 grams Protein – By 1 month after surgery, your goal is to obtain 60 grams of protein daily. – By 2mos after surgery ,your goal is a minimum of 72 grams of protein and your maximum goal is 80 grams – Mix protein powders with water to keep calories lower. Right after surgery skim milk is acceptable to add calories and protein. – Some products such as Proteinex can be added to a calorie free drink or full liquid items like oatmeal, cream of wheat and applesauce Purpose of the Bariatric Diet • • • • • This diet specifies what type and how much food you can eat at each meal. Closely following your bariatric diet can help you lose weight safely. To allow the staple line in your stomach to heal without being stretched by the food you eat To get you accustomed to eating the smaller amounts of food that can be digested comfortably and safely in your smaller stomach To help you lose weight and avoid gaining excess weight To avoid side effects and complications Diet Details • • • Diet recommendations after weight loss surgery vary depending on the type of surgery, where the surgery is performed and your individual situation. There are five phases to help you ease back into eating solid foods. How quickly you move from one step to the next depends on how fast your body heals and adjusts to the change in eating patterns. You can usually start eating regular foods with a firmer texture about three months after surgery. After surgery, you must pay extra attention to signs that you feel hungry or full. You may develop some food intolerances or aversions. Notes:_________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ Post-Bariatric Surgery Meal Progression ________________: Phase 1 Clear Liquid Diet + Protein supplement. This is for breakfast, lunch and dinner. No soda, no creamer, no sugar. Drink 2 to 3 oz at a time, SLOWLY! Allowed foods: Broth Unsweetened juice Sugar free gelatin Caffeine free coffee or tea (sugar substitutes may be used) Skim milk (mix with protein supplement) Crystal Light Sugar free popsicles ** Avoid fruit nectars, juices with pulp and sports drinks ________________: Phase 2 Full Liquid Diet + Protein supplement. All food chosen should be non fat, sugar free, and non carbonated. Your protein consumption should be close to 60 grams per day. Drink/eat meals slowly over 20 minutes. Use a kitchen timer. Allowed foods: All foods on clear liquid diet Strained/pureed/low fat soups (no pieces or chunks) soups should be broth based or a low fat cream soup Sugar-free and low fat or fat free yogurt, unsweetened applesauce and fat free or low fat whipped cottage cheese. Scrambled EggBeaters are permitted and may also be added to boiling broth for a higher protein soup For at least the first 4 weeks after surgery, it is very important to drink at least 1 high protein supplement over the course of the day until you are getting in enough protein **Avoid milkshakes, 2% or whole milk, cream, half and half, alcohol ______________: Phase 3 Pureed Foods (Daily protein goal = 60 grams) After liquids are well tolerated, it is time to progress to your more solid meals. Pureed: Most foods(low in sugar and fat) can be eaten as long as they are put into a blender and the final consistency is puree, similar to prepared baby food. Be sure there are no pieces of food in the mixture. To puree your foods, choose solid foods that will blend well, such as: Lean ground meats Beans Fish Egg whites Yogurt Soft fruits and vegetables Cottage cheese Blend the solid food with a liquid, such as: Water Fat- free milk Juice with no added sugar Broth Fat-free gravy Keep in mind that your digestive system might still be sensitive to spicy foods or dairy products. If you’d like to eat these foods during this phase, add them into your diet slowly and in small amounts. * Refer to Food Choices and Sample Menu Handouts Notes:______________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ______________: Phase 4 Soft, solid foods (Daily protein goal =60-80 grams) With your surgeon’s OK, after a few weeks of pureed foods, you can add soft, solid foods to your diet. If you can mash your food with a fork, it’s soft enough to include in this phase of your diet. These soft food may have small, soft chunks, so be sure to chew very well before swallowing. Foods Allowed: Ground or finely diced meats Canned or soft, fresh fruit Cooked vegetables You usually eat soft foods for eight weeks before eating foods of regular consistency with a firmer texture, as recommended by your dietician or surgeon. _________________: Phase 5 Solid foods ( Daily protein goal = 80 grams) After approximately 2 months (8 weeks) on the soft phase, you can gradually return to eating firmer foods. You may find that you still have difficulty eating spicier foods or foods with crunchy textures. Start slowly with regular foods to see what foods you can tolerate. If you have difficulty with any stage, your stomach may not be ready to progress and you can always go back to the previous stage. ** Foods to avoid: Nuts and seeds, Popcorn Dried fruits Sodas and carbonated beverages Granola Stringy or fibrous vegetables, such as, celery, broccoli, corn or cabbage Tough meats or meats with gristle Breads These foods are discouraged because they typically aren’t well tolerated in the weeks after surgery and may cause gastrointestinal upset. Over time, you may be able to try some of these foods again, with the guidance of your surgeon. Returning to Normal Living Three to four months after weight loss surgery, you may be able to start returning to a normal healthy diet, depending on your individual situation and any foods you may not be able to tolerate. It’s possible that foods that initially irritated your stomach after surgery may become more tolerable as your stomach continues to heal. Throughout all phases of the Bariatric Diet • Keep meals small. During your diet progression, your should eat several small meals a day and sip liquids slowly throughout the day (not with meals). You may first start with six small meals a day, then move to four meals and two to three snacks per day and finally, when following a regular diet, decrease to three meals and two to three snacks per day. Each meal should include approximately a half cup to 1 cup of food. Make sure you eat only the recommended amounts and STOP eating BEFORE you feel full. • Take recommended vitamin and mineral supplements. After surgery, your stomach is much smaller and your body won’t be able to absorb enough nutrients from your food. You’ll need to take a multivitamin supplement every day for the rest of your life. Start your multivitamin and calcium supplements within the first week after surgery. • Multivitamin with iron(Flinestones Complete) – 2 tablets daily taken separately at least 3 hours from each other Calcium Citrate with Vitamin D- 1500mg calcium citrate with vitamin D daily. Take 500mg separately 3x day For the first month after surgery, use only liquid or chewable forms of calcium citrate with vitamin D supplements Vitamin B12 it recommended at 3 months post surgery sublingual for gastric bypass patients. Check with your surgeon on exact dosage. Drink liquids between meals, NEVER with meals. Drinking liquids with your meals can cause pain, nausea and vomiting as well as dumping syndrome. Also, drinking too much liquid at or around mealtime can leave you feeling overly full and prevent you from eating enough nutrient rich foods. Expect to drink at least 6 to 8 cups of fluids a day to prevent dehydration. Always wait at least 30 min before a meal and 30 min after a meal to drink fluids. Drinking with meals will flush foods out of your stomach too soon. Throughout all phases continued • Eat and drink slowly. Eating or drinking too quickly may cause dumping syndrome – when foods and liquids enter your small intestine rapidly and in larger amounts than normal, causing nausea, vomiting, dizziness, sweating and eventually diarrhea. To prevent dumping syndrome, choose foods and liquids that are low in fat and sugar, eat and drink slowly and wait 30 to 45 minutes before or after each meal to drink liquids. Take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup of liquid. Avoid foods high in fat and sugar, such as non diet soda, candy, candy bars and ice cream. • Chew food thoroughly. The new opening that leads from your stomach into your intestine is very small and larger pieces of food can block the opening. Blockages prevent food from leaving your stomach and can cause vomiting, nausea and abdominal pain. Take small bites of food and chew to a pureed consistency before swallowing. If you can’t chew the food thoroughly, don’t swallow it. • Try new foods one at a time. After surgery, certain foods may cause nausea, pain or vomiting or may block the opening of the stomach. The ability to tolerate different foods varies from person to person. Try one new food at a time and chew thoroughly before swallowing. If a food causes discomfort, don’t eat it. As time passes, you may be able to eat this food, so you may try it again in the future. Foods and liquids that commonly cause discomfort include, meat, bread, pasta, rice, raw vegetables, milk and carbonated beverages. Food textures not tolerated well include dry, sticky or stringy foods. • Focus on high protein foods. Immediately after your surgery, eating high protein foods can help heal your wounds, re grow muscle and skin, and prevent hair loss. High protein, low fat choices remain a good long-term diet option after your surgery, as well. Try adding lean cuts of beef, chicken, pork, fish or beans to your diet. Low fat cheese, cottage cheese and yogurts also are good protein sources. • Avoid foods that are high in fat and sugar. After your surgery, it may be difficult for your digestive system to tolerate foods that are high in fat or added sugars. Avoid foods that are fried and look for sugar free options of soft drinks and dairy products. Results Bariatric surgery can result in long term weight loss. The amount of weight you lose depends on the changes you make in your lifestyle habits. It may be possible to lose half, or even more, of your excess weight within two years. Following your bariatric diet phases can help you recover from surgery and return to enjoying many of the healthy foods you enjoyed before surgery. If you find unhealthy eating habits creeping into your life, you may regain any weight that you have lost. Risks • Dumping Syndrome. This complication occurs most often after eating foods high in sugar or fat. These foods travel quickly through your stomach pouch and ‘dump’ into your intestine. Dumping syndrome can cause nausea, vomiting, dizziness, sweating and eventually diarrhea. • Dehydration. Because you’re not supposed to drink fluids with your meals, some people may become dehydrated. You can prevent dehydration by sipping 64 ounces of water or other low calorie, decaffeinated beverage throughout the day. • Nausea and vomiting. If you eat too much, eat too fast or don’t chew your food adequately, you may become nauseated or vomit after meals. • Blocked opening of your stomach pouch. It’s possible for food to become lodged at the opening of your stomach pouch, even if you carefully follow the diet. Signs and symptoms of a blocked stomach opening include ongoing nausea, vomiting and abdominal pain. Call your doctor if you experience these symptoms for more than two days. • Weight gain or failure to lose weight. It is possible to gain weight or fail to lose weight after weight loss surgery. There are many reasons why people may gain weight after weight loss surgery. If you experience any weight re-gain, see your surgeon and/or dietitian as soon as possible. Pre Op Liquid Diet Low Fat, Low Carb, High Protein • • When: Start this diet two weeks before your surgery date. Why: To shrink your liver for a safer surgery and to mobilize fat stores for optimal weight loss after surgery. Protein goal: 80 grams per day Fluid goal: 64 ounces per day (8 cups) Permitted Beverages: • • • – – – – – – – – – • Water, ice Nonfat skim milk, soy milk, lactaid High protein supplements Sugar free beverages Decaf coffee or tea Broth (chicken, beef, shrimp or vegetable) Sugar free gelatin Sugar free popsicles Sugar free water ices Permitted Extras: – – – – Low fat or non fat yogurt Cottage cheese Fresh fruit Vegetable soup Sample Pre Op Liquid Diet Menu • • • Breakfast – 8 oz protein supplement • – Decaf coffee with skim milk and artificial sweetener • AM Snack – Sugar-free gelatin – 1 small piece of fruit • Lunch – 1 cup vegetable soup – ½ cup cottage cheese – 1 cup sugar free or diet juice PM Snack – 8 oz protein supplement Dinner – 1 cup beef broth – 8 oz protein supplement Bedtime Snack – Sugar-free popsicle – 6 oz Greek low fat yogurt Bariatric Meal Progression Calorie, Carbohydrate, Fat and Protein Recommendations Time Diet Calories Fat Carbs Day 2 to Day Clear 6 Liquids Protein Min 20g Day 7 to Day Full 20 Liquids 200-400 Less than 8g Min 40g Day 21 to Day 35 Pureed 300-400 Less than 11g Min 60g Day 36 to Day 49 Soft 400 Less than 11g Min 72g 2 to 4 Months Regular 500 15g 50g Min 72g 5 Months Regular 600 16g 60g Min 72g 6 Months Regular 700 19g 70g Min 72g 7 Months Regular 800 22g 80g Min 72g 8 Months Regular 900 25g 90g Min 78g 9 Months Regular 1000 28g 100g Min 88g Lifelong Regular 10001200 33g 120g 105g Individual calorie, fat and protein needs may vary. Please schedule a post-op visit with your registered dietitian to determine individual needs. Full Liquid Sample Menu Days 7-20 Breakfast 8am Breakfast 8am Breakfast 8am ¼ cup unsweetened cooked or cold cereal with ¼ cup skim milk ¼ cup unsweetened applesauce and ¼ cup non-fat cottage cheese ¼ cup unsweetened cooked or cold cereal with ¼ cup skim milk Snack 10am Snack 10am Snack 10am Protein supplement Protein supplement Protein supplement Lunch 12pm Lunch 12pm Lunch 12pm 1 Tbsp Polaner All Fruit® ½ cup non-fat and low ¼ cup non-fat cottage sugar yogurt cheese ½ cup pureed low-fat soup Snack 2pm Snack 2pm Snack 2pm ¼ cup non-fat and low sugar yogurt ¼ cup non-fat ricotta cheese with cinnamon and/or nutmeg ¼ cup pureed skinless fresh fruit Dinner 6pm Dinner 6pm Dinner 6pm ¼ cup Eggbeaters®, 1/8 cup unsweetened applesauce ½ cup low-fat cream soup ½ cup non-fat low sugar yogurt Daily Totals: Calories – 353 Fat – 3.5 grams Protein – 38 grams Daily Totals: Calories – 383 Fat – 5 grams Protein – 37.5 grams Daily Totals: Calories – 373 Fat – 4 grams Protein – 35.5 grams Pureed Sample Menu Days 21-35 Breakfast 8am Breakfast 8am Breakfast 8am ½ cup Cheerios with ½ cup skim milk ½ cup Eggbeaters® 1 oz fat free cheddar ½ cup unsweetened oatmeal with ¼ cup skim milk Snack 10am Snack 10am Snack 10am Protein supplement Protein supplement Lunch 12pm Lunch 12pm Lunch 12pm ½ cup fat free/low fat cottage cheese 4 oz pureed Progresso® Light Soup ½ cup nonfat Greek yogurt and ¼ small banana mashed Snack 2pm Snack 2pm Snack 2pm Protein supplement ½ Protein supplement Dinner 6pm Dinner 6pm Dinner 6pm 3 oz pureed chicken, 1 oz 3 oz pureed turkey, 1 oz pureed carrots, 1 oz green beans, 1 oz mashed potatoes mashed potatoes Daily Totals: Calories – 410 Fat – 11 grams Protein – 60 grams Daily Totals: Calories – 380 Fat – 8 grams Protein – 60 grams 3 oz pureed fish, 1 oz pureed zucchini, 1 oz mashed acorn squash Daily Totals: Calories – 420 Fat – 4.5grams Protein – 64 grams Pureed Food Choices Food Group Food Choice Bread, cereal, pasta, starchy vegetables and rice Unsweetened cold cereals soaked in milk to soften, Unsweetened hot cereals- oatmeal, cream of wheat, farina, grits Mashed potatoes, mashed sweet potatoes Fruit Mashed bananas, unsweetened applesauce, pureed canned fruit packed in water or natural juices, pureed skinless soft fresh fruit (Avoid fruits in syrup or added sugar!) Vegetable Pureed carrots, green beans, beets, acorn squash, zucchini, broccoli, cauliflower, tomatoes, tomato sauce, 2 oz low sodium vegetable juice Meat, Poultry, Fish, Beans and Eggs Pureed skinless chicken, turkey and fish, soft scrambled egg whites, Eggbeaters®, finely mashed beans- kidney, chick peas, cannelloni Milk, Cheese and Yogurt Fat free, 1% milk, Lactaid®, or low fat soy milk, Fat free or low fat sugar free yogurt- no pieces of fruit, Greek style fat free sugar free yogurt, whipped or small curd fat free/low fat cottage cheese, fat free/low fat ricotta cheese Fats and Oils Pam® coating spray, 1 teaspoon olive/canola oil or low fat mayonnaise, fat free ot low fat salad dressing Miscellaneous Sugar free popsicles, smooth consistency baby foods are acceptable – choose high protein and low sugar varieties (meats) Liquids Non carbonated, Sugar Free, Fat Free beverages only- Water, Crystal Light®, regular and decaf coffee/tea, fat free milk Soft Sample Menu Days 36-49 Breakfast 8am Breakfast 8am Breakfast 8am 4 hard boiled egg whites 1 Morning Star Farms® sausage patty and ½ cup Greek yogurt ½ cup unsweetened oatmeal with 1/8 cup mixed berries Snack 10am Snack 10am Snack 10am Protein supplement Lunch 12pm Lunch 12pm Lunch 12pm ½ cup minestrone soup and 2 oz canned chicken ½ cup Health Valley® turkey and bean chili 3 oz turkey breast and 1/8 cup sweet potato Snack 2pm Snack 2pm Snack 2pm Dinner 6pm Dinner 6pm Dinner 6pm 3 oz broiled tilapia, 1/8 cup soft vegetable, 1/8 cup soft boiled potatoes 3 oz fat free ricotta cheese, 2 oz tomato sauce, 1 oz Polly-O® fat free mozzarella cheese ½ cup Eggbeaters®, 1 oz fat free cheddar, 1/8 cup diced well cooked vegetables (peppers, onions, mushrooms) Protein supplement Daily Totals: Calories – 425 Fat – 8 grams Protein – 70 grams Daily Totals: Calories – 485 Fat – 11.5 grams Protein – 58 grams Daily Totals: Calories – 430 Fat – 6.5 grams Protein – 61 grams Soft Food Choices Food Group Food Choice Bread, cereal, pasta, starchy vegetables and rice Unsweetened cold cereals soaked in milk to soften, Unsweetened hot cereals- oatmeal, cream of wheat, farina, grits TOASTED only 100% whole wheat or rye bread, reduced calorie, soft cooked potatoes, sweet potatoes or yams Fruit Soft banana, unsweetened applesauce, pureed canned fruit packed in water or natural juices, skinless soft fresh fruit Vegetable Soft cooked carrots, green beans, beets, acorn squash, zucchini (no seeds), tomato sauce, 2 oz low sodium vegetable juice NO CORN, ASPARAGUS, CELERY Meat, Poultry, Fish, Beans and Eggs Canned chicken breast, turkey breast, tuna packed in water, soft cooked fish, crab, lobster, shrimp, scallops, ground chicken or turkey breast, scrambled egg whites, Eggbeaters®, mashed beans,- kidney, chick peas, cannellini beans, low fat tofu Milk, Cheese and Yogurt Fat free, 1% milk, Lactaid®, or low fat soy milk, Fat free or low fat sugar free yogurt- no pieces of fruit, Greek style fat free sugar free yogurt, whipped or small curd fat free/low fat cottage cheese, fat free/low fat ricotta cheese Fats and Oils Pam® coating spray, 1 teaspoon olive/canola oil or low fat mayonnaise, fat free or low fat salad dressing Miscellaneous Sugar free popsicles, smooth consistency baby foods are acceptable – choose high protein and low sugar varieties (meats) Liquids Non carbonated, Sugar Free, Fat Free beverages only- Water, Crystal Light®, regular and decaf coffee/tea, fat free milk Regular Diet Sample Menu for 800-1000 calories/day Breakfast 8am Breakfast 8am Breakfast 8am ½ cup Eggbeaters®, 1 slice fat free cheese, 1 slice light whole wheat toast with ICBINB spray ¾ cup Kashi Go Lean Crunch® with ¼ cup skim or 1% milk ½ cup fat free cottage cheese with ¼ cup fruit Snack 10am Snack 10am Snack 10am 1 Light Cheese Stick with ¼ cup fruit 6 Almonds ½ cup fat free and low sugar yogurt Lunch 12pm Lunch 12pm Lunch 12pm 1 slice light whole wheat toast, Crab melt: 4 oz imitation crab, 4 oz canned chicken breast, 1 1 slice fat free cheese, 1 tbsp tbsp light mayo, ¼ cup fruit light mayo 1 lettuce leaf, 2 hard boiled egg whites, 1 tbsp light or fat free dressing, 1/3 cup tuna in water Snack 2pm Snack 2pm Snack 2pm 2 wedges Laughing Cow Light Cheese®, 8 reduced fat Wheat Thins® 2 oz low sodium ham made into rolls with 8 reduced fat Wheat Thins® 1 light cheese stick Dinner 6pm Dinner 6pm Dinner 6pm 4 oz fish (halibut, flounder, shrimp, etc), ¼ cup cooked veggies, 1/8 cup banana 5 oz chicken breast or turkey breast, ¼ cup cooked veggies, ¼ cup fruit 4 oz extra lean pork tenderloin, ½ cup brown rice, 1/8 cup cooked veggies Snack 8:30pm Snack 8:30pm Snack 8:30pm ½ tbsp peanut butter and ½ cup fruit Light cheese stick 1 tbsp peanut butter and 1 small skinless apple Daily Totals: Calories – 905 Fat – 17 grams Protein – 92 grams Daily Totals: Calories – 823 Fat – 18 grams Protein – 95 grams Daily Totals: Calories – 828 Fat – 20.5 grams Protein – 82 grams Regular Diet Sample Menu for 1000-1200 calories/day Breakfast 8am Breakfast 8am Breakfast 8am ½ cup Eggbeaters®, small whole wheat tortilla baked in toaster, 1/8 cup salsa 1 egg & 3 egg whites, 2 oz canadian bacon, ½ toasted whole wheat english muffin Protein shake and light cheese stick Snack 10am Snack 10am Snack 10am 1 slice light whole wheat toast and 1 slice fat free cheese ½ cup fat free and low sugar yogurt, ¼ cup Kashi® Go Lean Crunch cereal 3 hard boiled egg whites and 8 reduced fat Wheat Thins® Lunch 12pm Lunch 12pm Lunch 12pm 4 oz canned chicken breast, 1 tbsp light mayo, 4 pieces of melba toast, ¼ cup skinless apple Tuna melt: 4 oz tuna in water, 1 slice low fat cheese, 1 slice whole wheat toast 5 oz ground turkey breast or veggie ground round with ¼ cup beans and 1/8 cup banana Snack 2pm Snack 2pm Snack 2pm ½ cup fat free ricotta cheese with cinnamon 1 oz 50% reduced fat cheese and 8 reduced fat Wheat Thins® ½ cup fruit and ¼ cup low fat (1%) cottage cheese Dinner 6pm Dinner 6pm Dinner 6pm 4 oz 95% lean ground beef hamburger patty with 1 slice fat free cheese, ½ toatsed english muffin and ¼ cup cooked green beans 4 oz ground turkey breast fajita or taco seasoning, 1 taco shell, ¼ cup 2% milk shredded cheddar cheese, chopped lettuce and tomato 5 oz cooked shrimp with garlic and 1 tsp olive oil, ¼ cup cooked brown rice, 1/8 cup steamed spinach Snack 8:30pm Snack 8:30pm Snack 8:30pm 2 tbsp reduced fat peanut butter 4 oz sugar free, fat free pudding ¼ cup chopped walnutsCAUTION and chew well! Daily Totals: Calories – 1042 Fat – 25 grams Protein –102 grams Daily Totals: Calories – 1144 Fat – 31 grams Protein – 113 grams Daily Totals: Calories – 1207 Fat – 36 grams Protein – 122grams Regular Diet Food Choices Food Group Food Choice Bread, cereal, pasta, starchy vegetables and rice Limit to 1 seving/meal or snack (15 grams of carbohydrates) 100% light whole wheat or light whole grain breads, pastas, cereals. Keep sugar less than 6g/serving for food and cereal. Unsweetened cold cereals- Cheerios®, Crispix®, Rice Krispies®, etc. Brown rice (well cooked). All bread should be toasted. No soft bread until 18 months after surgery. Fruit Avoid the stringy membrane of oranges and grapefruits. Avoid other stringy fruits. Otherwise all fruits are acceptable, no skins or seeds (unless you chew well). Avoid fruit juices with a limit of 2 oz 100% juice/day Vegetable All vegetables are acceptable. If having difficulty with any vegetables, cook them well to help with digestion. Avoid skins or seeds. Be careful of gas producing vegetables such as broccoli and cauliflower. Meat, Poultry, Fish, Beans and Eggs Make sure all meats are moist. Extra lean white meat chicken breast or turkey breast (no skins), egg beaters or egg whites. Cooked fish, crab, lobster, shrimp, scallops, ground chicken or turkey breast. For the first 2 months avoid nuts, skins and seeds. When you try them, start with a small amount and chew well. Beef, pork, or lamb 1-2x/month. Choose leaner cuts (round, sirloin, flank and pork tenderloin) with no visible fat and cook off the bone. Milk, Cheese and Yogurt Skim, 1% or Skim Plus milk, low fat or fat free and low sugar or sugar free yogurt with less than 110cal/serving. Choose low fat cheeses with less than or equal to 3g fat/serving. i.e. Laughing Cow Light® or reduced fat Cabot® cheese Fats and Oils Nuts, peanut butter and olive oil are to be used sparingly. i.e. 1 tsp daily of oil or peanut butter OR 6 almonds, 4-5 walnut halves or 10 peanuts Miscellaneous Alcohol should be limited to 1x/month if okay with surgeon or eliminated as it has a high caloric content and is quickly digested. Keep empty calories to about 25 per day. These are foods that have NO nutritional value and take the place of healthy more filling foods. Liquids Water, water, water. Get in at least 64-96 oz per day. Keep to no more than 8-16 oz of caffeinated beverages/day, non caloric sweeteners, fat free or low fat milk only and no creamer unless fat free. No carbonation, sugar free beverages only. Keep drinks to no more than 5 calories per 8 oz serving. Bariatric Problem Foods and Beverages • • • Sugar: Sugar can cause ‘Dumping Syndrome’ which results in dizziness, shaking, rapid heart rate, nausea, stomach cramping and diarrhea. Dumping syndrome occurs when the undigested stomach contents are released or ‘dumped’ into the small intestine too quickly. Most people experience symptoms several hours after eating problem foods and may also experience symptoms of low blood pressure (feeling faint) and low blood sugar. Avoid products that list any of the following in the first 5 ingredients: sugar, sucrose, honey, corn syrup, corn sweetener, glucose, maltose, and dextrose. Sorbitol is a sugar alcohol. It is sugar free but may cause diarrhea. Avoid excess. Read labels carefully to avoid all sweeteners except Splenda®, Equal ®, Stevia ® and Sweet’N Low ®. Fat: Fat may be difficult to digest after surgery. Eating too much fat will delay gastric emptying and may cause heartburn, nausea, diarrhea, or stomach discomfort. Excess fat above recommendations will also slow weight loss. Alcohol: Consumption should be discussed with your physician. Intake should be limtied! – – – • Some alcoholic beverages contain carbonation which causes gas, bloating and discomfort. All carbonated beverages are prohibited. Alcohol provides empty calories which are limited to 25 per day. Alcohol will affect you differently after surgery causing intoxication much quicker. Your risk for alcohol dependence increases post surgery. Seek assistance if you are consuming alcohol on a consistent basis. Empty calories: Any food with no or little nutritional value must be limited to 25 calories per day. These foods will quickly increase your calorie intake and slow or STOP weight loss. Some examples includepretzels, sugar free/fat free pudding, sugar free ice pops, fat/free sugar free ice cream, etc. Constipation- A Common Complaint • • • Constipation after bariatric surgery is a common complaint. It may be caused by decreased food and water intake, and in some people, supplemental iron, narcotic pain killers, tranquilizers and antidepressants. You should not expect your bowel pattern after surgery to be exactly the same as it was before surgery. Many patients experience less frequent bowel movements. If infrequency and discomfort are present, we recommend the following: – Drink plenty of fluids: a minimum of 64 ounces per day. In hot weather or times of increased physical activity/sweating, fluid needs increase. – Consider increasing your fiber intake. Unprocessed bran can be added to meat mixtures such as turkey meatloaf. It can be sprinkled over food, too. Dried beans and peas are high fiber foods that can be used as a portion of a meal (if problems with gas occur try adding a drop of Beano® to your first bite of food.) Include a small portion of vegetables with meals. Fiber supplements such as Benefiber® or Citrucel® powder can be added to foods or liquids. These powders can best be used by mixing with water. – Increase physical activity once cleared by your physician to do so. – Check your calcium supplement. Calcium citrate is recommended. Calcium carbonate is not well absorbed and often contributes to constipation. Choosing a calcium/magnesium combination with a ratio of 2:1 works well and promotes softer more frequent bowel movements. – If you take iron supplements, choose ferrous fumerate or ferrous gluconate since they are less constipating and better absorbed. – Try avoiding ‘binding’ foods such as applesauce, banana, rice, cheeses, peanut butter and potatoes. – You may need a stool softener. Ask your physician for recommendations to meet your specific needs.