* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project
CHI St Vincent- Hot Springs Gastric Sleeve Nutrition Guide Jennifer Felgate, MS, RD, LD [email protected] 501-622-1752 1 Dietitian Visits The following is what you will be expected to bring with you at each dietitian visit. Initial visit Please bring the following: Completed nutritional assessment Detailed plan for your exercise regimen Method that you will be using to track your diet and exercise List of any questions that you have First follow-up visit Please bring the following: Your completed diet log that includes your daily food intake and caloric intake Your completed exercise log demonstrating progressive increase in physical activity List of protein supplements you have tried and decision on which one you prefer Three examples of dietary changes that you have made to reduce your overall intake of calories Your copy of the gastric sleeve diet manual Second follow-up visit Please bring the following: Your completed diet log that includes your daily food intake and caloric intake Your completed exercise log demonstrating an increase in physical activity from the previous month and approaching 30 minutes of physical activity most days of the week Your copy of the gastric sleeve diet manual Third follow-up visit Please bring the following: Your completed diet log that includes your daily food intake and caloric intake Your completed exercise log demonstrating you are completing 30 minutes of moderate intensity physical activity most days of the week Your copy of the gastric sleeve diet manual List of any questions that you have regarding the 10 day pre-op diet Consultation with the dietitian is a vital part of the program and requires you to provide detailed information regarding your food and exercise habits. It is important that you are adequately prepared for your monthly meetings so that appropriate consultation can be provided by the dietitian. If you are not prepared for your visit, it will be rescheduled. 2 Advantages of Gastric Sleeve Weight Loss Surgery The Sleeve Gastrectomy surgery is a restrictive type of weight loss surgery that permanently reduces the size of the stomach. It promotes weight loss and reduces medical problems (related to obesity) by limiting food intake and lessening the sensation of hunger. Permanent removal of 70-85% of the stomach along the greater curvature is removed, leaving only a small tube, or “sleeve” for the stomach pouch that extends from the natural stomach opening to the natural stomach outlet (pyloric valve). It is important for you to make healthy food choices after your surgery to help with weight loss and to maintain nutritional health. Promotes weight loss by restricting the amount of food that can be eaten at any one time Reduces hunger since it removes the part of the stomach that produces the hunger stimulating hormone ghrelin Digestion occurs normally as the digestive system is not altered Does not cause malabsorption or nutritional deficiencies as it does not involve rerouting or bypassing the small intestine Less chance of developing ulcers than with other gastric surgeries Dumping syndrome is not likely to occur as the stomach outlet (pyloric valve) remains intact Less complicated procedure than other gastric surgeries Can usually be preformed laparoscopically Does not require a gastric band being implanted into the body Does not require adjustments or fills as with other surgeries Expected excess weight loss is 60-70% at two years 3 Gastric Sleeve Basics Eat slowly and chew thoroughly- at least 25 times- should take up to 20 minutes to eat Avoid concentrated sugars, especially those in liquid form. They are filled with non-nutrient calories and slow down weight loss Limit fats and fried foods; they are a concentrated source of calories Remember the stomach can only hold 4-6 oz after surgery. You will probably feel satisfied after 2-3 tablespoons of food. Do Not Overeat! Over time your stomach will stretch if you over fill it. Stop eating when you feel comfortably satisfied- if ignored, vomiting will follow and you can stretch the size of the stomach. If you are unable to keep anything down and are having extreme difficulty staying hydrated, sip on Gatorade which also has electrolytes necessary for normal cell function. Once you feel better, return to non calorie beverages such as water and diet drinks. Drink at least 6 - 8 cups (8oz) of fluid per day to prevent dehydration. (Monitor for the following signs: headache, dizziness, nausea, lethargy, a white-ish coating on the tongue and dark urine.) Do not drink alcohol- it is dehydrating and has no nutrients. Carbonated beverages may give you gas. Stop drinking liquids 15-30 minutes before meals and resume minutes after meals Eat 3 small nutrient dense meals + 2-3 high protein snacks a day Meals should include: protein first, then fruits and vegetables, and then whole grains Set up a schedule for supplements (vitamins, minerals and protein shakes; refer to supplement page) and medications; remember to take Calcium with meals and separate from iron supplements Introduce new foods one at a time in order to rule out intolerance. If a food is not tolerated, reintroduce it in 1 week If you cannot tolerate dairy, substitute Lactaid for milk. You may need to take lactase pills with dairy to help digest the lactose. You can also try soy milk fortified with calcium and vitamin D, Almond milk, or other milk substitutes. Exercise! This is the key to long term weight loss and maintenance. Walking should be the main exercise for the first 6 weeks. Between 6-8 weeks, more strenuous exercises can be added. 4 Pre-Operative Preparation Start doing this NOW- do not wait or else it will be difficult to follow guidelines for pre and post-op surgery. Preparation for bariatric surgery includes several steps to optimize a patient’s health in anticipation of an operation. • Stop all carbonated beverages • Limit all beverages which contain caffeine • Begin a routine exercise program (consult your physician first) • Begin cutting food into small pieces and practice chewing very well • Join a monthly support group Begin the practice of not drinking with your meals. Stop drinking 30 minutes before you eat and do not drink again until 30 minutes after your eat. This will be a requirement following your surgical procedure and needs to become a lifetime habit. Gastric Sleeve Pre-Op Surgery Diet 10 days before surgery. Start ______ Surgery Date_____ The pre-op operative diet is desirable to decrease the risk of complications for our patients scheduled for the gastric sleeve surgery. The pre-operative diet also reduces the severity of co-morbidities, reduces operating room and recovery time. The following overview describes the general requirements of a pre-op surgery diet. It is not meant to take the place of the specific instructions given to you by your surgeon, but provides information on the basic dietary and nutritional guidelines that are common to most gastric sleeve patients. To be specific, pre-op diet: Reduces liver size and intra-abdominal fat Improves visual field Reduces co-morbidities Increases patient’s understanding of post-op requirements Reduces operating time Reduces post-operative risks Do NOT Splurge! This is not the time to splurge on your diet. It is the time to show that you are serious about improving your health and committed to making the changes necessary to do so. Your mindset and behaviors should be focused on preparing for the upcoming surgery. It is very important that you adhere to the pre-op diet that your surgeon is recommending for you. Situations can occur where a patient’s surgery is cancelled due to noncompliance with the pre-op diet. Please understand this can occur to you if you do not follow the guidelines. If you find yourself struggling with the guidelines, please call the office for support and guidance. 501-622-1750 5 Diet and Nutrition Guidelines 10 days before surgery, patients will begin a full liquid diet (this differs from the full liquid diet after surgery) Diet will consist of high-protein supplements that are low-carbohydrate and low-fat (see page 15) To prevent dehydration, drink six to eight glasses (48 - 64 oz) of water each day; and/or other lowcalorie, sugar-free, caffeine-free, and non-carbonated liquids (such as Crystal Light) Solid foods are not allowed unless you are eating raw vegetables or raw fruit. Low Fat creamed soups Low fat cottage cheese Natural applesauce Non-fat Yogurt, Greek Yogurt Skim milk, lactose free skim milk, or milk alternative V-8 juice (low sodium), V8 Fusion, tomato juice and all other no added sugar fruit juices. Try light versions sweetened with sweetener Hot cereal- grits, oatmeal, cream of wheat, etc. Protein Supplement Guidelines Protein is necessary to preserve and protect muscle tissue and to help the body heal and recover after surgery. The recommended protein intake ranges from 60 to 80 grams each day. Protein supplements are available as ready-to-drink or powders. Generally, supplements with whey protein isolate are better absorbed by the body than those with whey protein concentrate, which contain lactose/milk sugar. If you are making protein shakes, consider these tips: Mix with non-fat plain yogurt to increase protein and creaminess Freeze skim milk into "ice cubes" and blend into shake to make it cold and slushy Add 1 teaspoon of decaffeinated instant coffee to create a protein shake latte If you cannot tolerate dairy, try fat free Lactaid milk, plain soy milk, almond milk or other milk substitutes. Liquids to Avoid High-sugar liquids (such as fruit juices, sports drinks, and alcoholic beverages) Whole or 2% milk Carbonated beverages (including regular and diet soda) Caffeinated beverages (including coffee and tea) Diabetic Patients Diabetic patients must be aware to monitor their blood glucose levels carefully once they begin the pre-op surgery diet. Low-carbohydrate diets can alter insulin production and affect medication dosages. If you have diabetes, make sure you talk to your doctor about any questions or concerns you have during this time. Sample meal plan: 7:00 AM- protein shake with oatmeal 10:00 AM- light yogurt cup 1:00 PM- low fat cream soup, protein shake 4:00 PM- cottage cheese and 1 piece raw fruit 6:00 PM- low fat cream soup, protein shake 8:30 PM- raw vegetables to munch on if needed 6 Your diet progression during and after your hospital stay: Gastric Sleeve Clear Liquid Diet – day 1-3 In the hospital you will receive meals of clear, sugar free liquids. It is begun immediately after surgery or after the results of your “swallow test” are back. Exercise is important in recovery of surgery- walk during your hospital stay. Recommended Clear Liquids: • Clear Broth or Bouillon – Chicken, Beef, or Vegetable, can add protein powder • Crystal Light or sugar-free Kool-Aid • Decaf tea and coffee (artificial sweeteners allowed, non-dairy creamer is ok) • Fruit juice sweetened with artificial sweetener. • Herbal Tea or un-sweet tea – Caffeine Free • Propel Water by Gatorade, or PowerAde Zero, or Gatorade • Sugar Free drinks – no carbonated drinks • Sugar-free popsicles, Sugar Free Italian Ice, Sugar Free Sherbet • Try to sip fluids at the rate of ½ to 1 oz every hour; do not drink too fast. • To prevent nausea and vomiting, do not drink too much or overfill your stomach Start children’s chewable multiple vitamins with iron on the first day home Gastric Sleeve Full Liquid Diet – day 4-7 On day 4, you will begin a full liquid diet. Thicker liquids must be taken slower than thin liquids. Sip on liquids at a rate of 1-3 ounces per hour. Vitamin and mineral supplementation should begin at this time. Iron should be taken at bedtime and not consumed with Calcium. All items from the clear liquid diet can be consumed in addition to the full liquids. RECOMMENDED FOODS: All food from previous stages Protein powder of choice with non-fat milk or milk alternative. Low Fat creamed soups – thinned (no chunks). Add protein powder Low fat cottage cheese- add protein powder Natural applesauce (no chunks) dairy Yogurt, Greek Yogurt (no chunks) Skim milk, lactose free skim milk, or milk alternative Sugar-free Fudgesicles pudding- make with skim milk or milk alternative and add protein power Unsweetened 100% Fruit Juice diluted with water without pulp (no orange juice, grapefruit or tomato juice). Limit to 4 ounces per day. V-8 juice (low sodium), V8 Fusion, tomato juice and all other no added sugar fruit juices. Try light versions sweetened with sweetener. Sample meal plan for Full Liquid diet: Breakfast: Mid morning: Lunch: Dinner: Snack: 7 2-3 oz. light yogurt 3 oz. low fat cottage cheese ½ serving of protein drink 2-3 oz. low fat cream soup ½ serving of protein drink Gastric Sleeve Pureed/ Blended Soft Diet – day 8- week 6 You will progress to a diet composed of pureed/ blended foods low in fat and with no sugar. You will be on a pureed diet for approximately 3-4 weeks. Aim for about 4-6 small meals per day. Start with baby food consistency and work towards very soft textured foods (ones you can mash with a fork). Eating solid foods too soon will put pressure on the staple line and may cause breakage or leaking. You will need 6-8 cups of fluid per day between meals. Continue to take the vitamin/ mineral supplements. You will only be able to eat a few tablespoons of food at each meal (Approximately 4-8 Tbsp. or 2-4 ounces) It is up to you to control how much you eat Pureed Diet to Soft Diet Add one new food at a time Aim for 48 to 64 ounces of fluid per day to prevent dehydration. Avoid drinking 30 minutes before and after meals. Avoid starch foods like white rice, pasta, breads Chew completely and slowly Continue full liquids to pureed adding one new food at a time, as tolerated. Eat three (3) meals a day and (2) two snacks. Limit fats and avoid sugars. Protein is the priority (60-80 grams per day). RECOMMENDED FOODS: All foods from previous stages. Baked potatoes (no butter), sweet potato Blended protein shakes with non-fat, sugar-free frozen yogurt, pureed fruit Box mashed potatoes Canned peaches, apricots, mandarin oranges or pears (sweetened with non-caloric sweetener) Cream of Wheat, Oatmeal, Grits or Cream of Rice cereal. Start with 1-2 Tbsp at a meal. Dried beans and peas-navy beans, kidney beans, low fat refried pinto beans, lima beans, lentils, split peas cooked without added fat until very tender (remember that these foods may cause abdominal discomfort and/or gas). Eggs, scrambled or egg whites Hummus Lean meats (fish, tuna fish, chicken, turkey) make sure the meats are moist and very chewed up before swallowing. Pureed and blend them. Low fat cheese containing less than 6 grams of fat per ounce (most 2% cheese), Low fat or nonfat cottage cheese (¼ cup), ricotta cheese Smoothies, watch sugar content! (Best to make with protein powder at home) Soft canned fruits (pears or peaches) sweetened with non-caloric sweetener Soft cooked vegetables and mashed with a fork Tuna fish made with low fat mayo or avocado Tuna, canned salmon without skin, ground white meat turkey, ground chicken 8 Sample meal plan: Breakfast: Mid morning: Lunch: Dinner: Snack: cottage cheese and pureed peaches ½ protein supplement Pureed tuna made with avocado pureed beef with diced tomatoes ½ serving of protein drink Instructions for pureeing foods: 1. Cut food into small pieces about the size of your thumbnail. 2. Place food in the blender. 3. Add enough liquid (fat free chicken broth or fat free gravy) to cover the blades. 4. Blend until smooth like applesauce and enjoy! Strain out the lumps, seeds, or pieces of food. Use spices (avoid spicy ones) to flavor food. Sample Menus for pureed/ blended soft diet Breakfast 8 am Breakfast 8 am Breakfast 8 am ¼ cup unsweet applesauce ¼- ½ cup fat free cottage cheese ½ -1 soft poached egg ¼ cup unsweet applesauce Supplement/ Snack 10 am Supplement/ Snack 10 am Supplement/ Snack 10 am ½ cup skim milk with 1 scoop protein powder ½ cup skim milk with 1 scoop protein powder ½ cup skim milk with 1 scoop protein powder Lunch 12 pm Lunch 12 pm ¼- ½ cup cooked cereal ¼- ½ cup skim milk Lunch 12 pm ¼ - ½ cup light yogurt ¼ cup pureed peaches ¼ - ½ cup blended soup ¼ cup egg salad w/ low fat mayo ¼ - ½ cup blended soup ¼ cup tuna w/ low fat mayo Supplement/ Snack 2 pm Supplement/ Snack 2 pm Supplement/ Snack 2 pm ¼ - ½ cup unsweet applesauce 1 sugar free popsicle ½ cup fat free cottage cheese 1 sugar free popsicle ¼ - ½ cup low fat ricotta cheese with cinnamon Dinner 6 pm ¼ - ½ cup blended soup (add protein powder) ¼ cup pureed fruit Dinner 6 pm ¼ - ½ cup blended soufflé ¼ cup mashed potato 9 Dinner 6 pm 1-2 oz. flaked fish ¼ cup puree vegetable Gastric Sleeve Solids/ Regular – week 7 If you can tolerate the items in the blended soft diet after 3-4 weeks, you will gradually advance the food choices in your diet. This is a diet which emphasizes lean protein, fruits/vegetables, whole grains, and fiber. It is important to keep a food record of your tolerance for texture, volume, and intake. Remember: Add one new food at a time Chew completely and slowly Food intake will be limited to 4-6 ounces per meal. (Approximately 8-12 Tbsp.) Continue your fluid intake of 6-8 cups per day. Limit foods high in carbohydrates: (Pasta, Rice, breads, Crackers, Potatoes) Limit Foods high in saturated fats and avoid trans fats Avoid Sugar beverages such as juice and soda. Avoid fried foods Continue to take your vitamin/ mineral supplements. Continue supplemental protein if needed (70-80 grams of protein is the daily goal) This diet is very individualized. It is normal to experience food intolerances. Try to reintroduce that food a week later while focusing on eating slowly, chewing thoroughly, and not overeating. You will eventually be able to tolerate a variety of foods from each of the food groups. While surgery will trigger significant weight loss, you must also do your part to maintain the weight loss by making lifelong changes in your eating habits. It is counterproductive to eat high calorie and high fat foods after surgery. You need to be committed to making healthy choices and eat high protein and low fat nutritional foods that will provide you with essential vitamins, minerals, and nutrients to keep you well nourished and feeling healthy. Exercise is also important. Regular exercise during the first year after surgery will result in more weight loss (twenty pounds or more) from surgery than if you do not exercise. 10 Foods not recommended while healing from surgery “Sticky” Foods • Soft bread • Sticky or sweet rice • Spaghetti and other pasta • Macaroni and cheese • High-fat cheese, melted cheese • Raisins, prunes, and other dried fruits Crunchy Foods • Granola and other cereals with nuts • Raw vegetables, salad • Nuts, seeds, and popcorn • Chips Tough Foods • Tough or chewy meat • Whole pieces of corn or whole peas (puree these foods) High-Fat Foods • Butter, margarine, and oil • Whole milk and half-and-half • Ice cream, cakes, cookies, pies, and other desserts • Bacon • Sausage • Luncheon meats • Gravy Regular mayonnaise, sour cream, cream cheese, salad dressing Foods with Seeds, Peels, or Husks • Strawberries and other berries • Corn (unless pureed) • Peas (unless pureed) 11 Concentrated Sweets Most of the foods and beverages that contain concentrated sweets are filled with “empty” calories in the form of sugar. These products provide mainly calories with limited nutritional value. After surgery, every bite counts. Filling up on these “concentrated sweets” can prevent weight loss and can replace healthier foods in your diet with high calorie, high sugary foods. Note: Artificial sweeteners such as nutrasweet/Equal ®, saccharine/ Sweet & Low ®, and sucralose/Splenda ®, Truvia, etc. are OK to use. Ice cream Regular soft drinks Chocolate milk Lemonade Pudding Kool Aid Sweetened, fruited or frozen yogurt Sugared ice tea Dried fruits Snapple or fruit drinks Canned or frozen fruits in syrup Table sugar Fruit juice Honey Sugar coated cereal Candy Doughnut Regular Jell-O Popsicles 12 Sugar gum Cakes Molasses Pies Syrups Cookies Sherbet / Sorbet Jellies Jams Supplement List It is important that you take vitamin supplements every day. The key vitamins that are necessary include vitamin B12, iron, and calcium. We recommend that you take multivitamin, plus extra calcium, iron. These Vitamins need to be started before the surgery. Please consult your physician for the start date. Multivitamin/mineral supplement: Chewable supplements are necessary for the first two to three months after surgery because you cannot swallow large pills (bigger than an aspirin) and they are easier to digest and absorb. Choose one of the following: o Flintstone’s Complete o Centrum Chewable A few months after surgery, or when you feel you are able to swallow large pills (bigger than an aspirin), you may switch to non-chewable supplements if you would like to. Choose one of the following: One-A-Day Maximum One-A-Day Today Centrum Performance Centrum with lycopene Centrum Carb Assist Calcium with vitamin D, twice daily with food for at least 1000mg per day. Again, chewable supplements must be taken for the first two to three months after surgery because you cannot swallow large pills (bigger than an aspirin) and they are easier to digest and absorb. Because calcium is such a large mineral, many patients prefer to stay on chewable calcium supplements because the non-chewables are just too big. Choose one of the following: o Caltrate with Vitamin D- Chewable Citracal Creamy Bites Solgar Calcium Please remember not to take your calcium with your iron supplement as the two interfere with one another. Calcium and iron should be taken at least two hours apart. o o Iron, once daily with food. If you become constipated after surgery and believe your iron supplement is the cause, please call the office for suggestions on how to alleviate this problem. Check you multivitamin to see if it continues iron. Choose from the following: o o Ferro-Sequels Fergon o o 13 GNC Iron 18 Slow-Fe Protein shakes: Tips When Choosing a Protein Shake: Approximately 15-20 grams of protein per serving Less than 200 calories per serving Less than 10 grams of sugar per serving No added sugars or oils You must read product labels to determine the nutritional value. The bests are the ones that have a protein source/main ingredient such as: milk, soy, egg, whey protein isolate or soy protein isolate. You can find protein shakes at a vitamin or health food store such as Vitamin Shoppe, GNC, a local health market, or online. Everyone has different taste buds, so find the shake that tastes the best to you. There are 2 types of protein shakes: Pre-mixed and Powders mixed with milk Pre-mixed (Ready to Drink) o Atkins o Myoplex Low Carb o Perfect Zero Carb o Isopure o Slimfast Low Carb Powders mixed with milk* o Juice Plus o Unjury o No Added Sugar Carnation Instant Breakfast o Revival Soy *Directions for powders: Add protein powder by the scoop/tablespoon to 8 oz Skim plus Milk, Skim Milk, or Fat Free Lactaid daily. You may choose to drink your shake in 2- 4 oz servings. After surgery you will need between 50-80 grams of protein a day. In order to meet your protein needs, protein shakes such as the ones listed above, will supplement your meal plans. Once you are able to get enough protein from your food, you will not need to continue using protein shakes on a daily basis. 14 Protein Supplements Liquid Premade Shakes Worldwide Pure Protein Myoplex Original Myoplex Lite Achiev One Amount Protein Sugar Flavors include 11 oz 35 grams 1 gram Strawberry cream 17 oz 42 grams 2 grams Strawberry cream 11 oz 9.5 oz 25 grams 20 grams 1 grams 3.5 grams AdvantEdge Carb Control * 11oz. 17 grams 0 grams Choc Fudge Coffee flavors (all contain caffeine, OK after 1 month) Café caramel, choc Fudge, French Vanilla, choc., strawberry cream Brand Name Powder Designer Whey Protein Vitamin Shoppe 100% Soy Protein Revival Soy* (unsweetened or made with Splenda) Isopure – Perfect Zero Carb Myoplex Original Atkins Unjury ** Amount Protein Sugar Flavors include 1 scoop 18 grams 2 grams 2 scoops 26 grams 0 grams Chocolate, Strawberry, French Vanilla No flavor 1 packet 20 grams 1 grams Chocolate, Vanilla, Strawberry, Blueberry, Cappuccino 2 scoops 50 grams 0 grams Vanilla, Apple Melon, PineappleOrange Banana 1 packet 42 grams 2 grams 2 scoops 1/3 cup 15 grams 22 grams 2 grams 3 grams Matrix ProCel 1 packet 0.23 oz/6.6 grams/1 env 20 grams 5 grams 2 grams <1 gram Chocolate, Strawberry Vanilla, unflavored, choc, strawberry Unflavored, Vanilla Unflavored Water/juicy consistency Isopure – Perfect Zero Carb Nectar (best mixed w/water) Amount Protein Sugar Flavors include 2 scoops 50 grams 0 grams Apple Melon, Pineapple-Orange Banana 1 scoop 23 grams 0 grams Fuzzy Navel, Cherry Apple, Lemonade *Call 1-800-Revival or www.revivalsoy.com **Call 1-800-517-5111 or www.unjury.com 15 RecipesPlease use these recipes as suggestions. The consistency of the shakes will depend on the fluid/ ice added. You may want to increase or decrease fluids, depending on your likes and dislikes. You may be creative and make recipes of your own. Remember, the key is to adhere to the guidelines and again, please do not forget to call the office, should you need additional information and support. Pineapple Blast Mocha Shake 4 ice cubes 1 tbsp. milk 2 scoops protein powder 4 ice cubes 6 oz. water 2 scoops vanilla protein powder 1/3 cup pineapple chunks Frozen Chocolate Banana Pina Colada 8 oz. water 4 to 5 ice cubes 1/2 medium banana 2 scoops chocolate protein powder 6 oz. water 4 ice cubes 2 scoops vanilla protein powder 1/3 cup pineapple chunks 1 tsp. sugar free coconut extract Chocolate Strawberry Shake Orange Creamsicle 2 scoops of chocolate protein powder 6 ounces of water 4 to 6 ice cubes 6 small strawberries 2 scoops of vanilla protein powder 6 ounces of water 4 to 6 ice cubes 1 small orange (size of tennis ball) Raspberry Chocolate Blueberry Blaster 2 scoops of chocolate protein powder 6 ounces water 6 ice cubes 3/4 cup fresh raspberries 2 scoops of vanilla protein powder 6 ounces water 6 ice cubes 3/4 cup blueberries 16 Protein Content of Selected Foods FOOD NAME Beans, Cnd Beef eye of round Beef top loin Cheese, American, fat free Cheese, cottage, 1% fat Cheese cottage creamed Cheese, parmesan, grated Cheese, mozzarella, part-skim Cheese, ricotta, part skim Chicken, white breast meat, no skin Chicken, leg no skin Cod, white, baked Crab, steamed Egg, hard cooked Flounder Halibut Ham, lean Hamburger (lean ground beef) Lobster, steamed Milk, skim Milk, skim plus Peas, chick, cnd Pork tenderloin Pork loin chop Salmon, baked Shrimp, steamed Soybeans (edemante) Soy flour, defatted Soymilk, plain Soynuts Steak, sirloin, trimmed Swordfish, baked Tempeh Texturized soy protein Tofu Tuna, cnd, water packed Turkey, white meat Veal loin Veal leg (top round) Yogurt, frozen, sugar free Yogurt, fat free, low sugar PORTION ½ cup 3 oz. 3 oz. 1 oz. ½ cup ½ cup ¼ cup 1 oz. ½ cup 3 oz. 3 oz. 3 oz. 3 oz. 1 3 oz. 3 oz. 3 oz. 3 oz. 3 oz. 1 cup 1 cup ½ cup 3 oz. 3 oz. 3 oz. 3 oz. (15 large) ½ cup ¼ cup 1 cup ¼ cup 3 oz. 3 oz. ½ cup ½ cup ½ cup 3 oz. 3 oz. 3 oz. 3 oz. ½ cup 1 cup 17 PROTEIN (grams) 7 21 21 6 14 13 12 8 14 26 21 21 17 6 21 21 21 21 16 8 11 7 21 21 16 21 18 14.3 12.8 6.6 15 26 21 11 10 25 21 21 21 5 8 How to Fit New Diet to Family Lifestyle: Clear Liquid & Full Liquid Diet: At this time you may find it difficult to find foods that fit both you and your family’s diet. Phase 1 and 2 of the diet are very short. Convenience items, such as fat free broth, sugar free popsicles, and sugar free gelatin, are easy items to fit into your diet. Other ideas: Vegetable/ chicken noodle soup for the family. You will need to strain soup so that you are only eating the broth Enjoy a sugar free gelatin or pudding snack with your children Pureed Diet: Two weeks after surgery, you will begin Phase 3 of your diet. This will include food that is blended to a pureed consistency. During this phase it will be easier to cook for you and your family. Remember that you set the example for your family. You will be able to share your new healthy eating habits with your family. Foods should be prepared in the healthiest possible way. We want to limit margarines, butter, and other fat. During each diet progression it is important to try one new item at a time. At this point in the diet you will be able to use the same foods that you cook for your family. You will need a blender to puree your foods. Portions sizes are still limited to 2-4 oz. If meats are dry, you can add fat free broth to help make it moist. Include a balance meal for your family. Include a vegetable, meat, fruit, carbohydrate and dairy. This way you will be able to choice a variety of food to puree. Soft Diet: A month after your surgery you will progress to the soft diet. During this phase you will be able to eat well cooked vegetables and fruit. Also you will be able to eat fish and other tender meats without pureeing them. Even though you are still drinking the protein shake, it is still important to eat protein items. Eat a variety of fruit and vegetables. Try to challenge your family to see how many different fruit and vegetables they can consume. Breakfast is the most important meal of the day, not only for you but your whole family. Set your family up on a regimen of toast and eggs or oatmeal. Regular Diet: Congratulations! You are now at the regular diet. At this time you can eat foods without any special preparations. It is important to remember that your stomach holds 4-6 oz in capacity. Eat slowly and stop eating once you start to feel satisfied. It is important to make the healthiest choicest possible. You are recommended to avoid the following food for the long term. Foods high in carbohydrates: allowed to eat once per month (Pasta, Rice, breads, Crackers, Potatoes) Foods high in saturated fats and avoid trans fats Fried foods Sugar beverages such as juice and soda. 18 FOOD LOG Date: Name: Time Amount (tsp, oz, Tbs, cups) Time Is this a good source of Protein? Amount Food/Condiment/Supplement (be as detailed possible- brands, method of cooking, etc.) Breakfast Yes or No? Time Amount Lunch Yes or No? Time Amount Dinner Yes or No? Time Amount Snack(s) Yes or No? Time Amount Beverages 19 FOOD LOG Date: Time Name: Amount (tsp, oz, Tbs, Food/Condiment/Supplement (be as detailed possible- brands, method of cups) cooking, etc.) Amount Breakfast Yes or No? Time Amount Lunch Yes or No? Time Amount Dinner Yes or No? Time Amount Snack(s) Yes or No? Time Amount Beverages Time 20 Is this a good source of Protein?