Advice following a gastric bypass

Transcription

1 Advice following a gastric bypass Patient information Bariatric Surgery SWSH Telephone: Website: Huh-tr.homertonbariatricservices@nhs.net Incorporating hospital and community health services, teaching and research

2 This leaflet is aimed at people who have had a gastric bypass operation for weight loss. The leaflet provides information about eating and drinking after this operation What is a laparoscopic gastric bypass and how does it work? During a laparoscopic gastric bypass operation the stomach is made smaller and part of the intestine is bypassed which stops you from absorbing some of the food that you eat. It may also be called a Roux-en-Y gastric bypass. A very small pouch about the size of an egg cup is made out of the upper stomach. This new small stomach is made using special surgical staples which separates it from the lower part of the stomach. The large lower part of the stomach can no longer hold any food. The small stomach pouch restricts the amount of food that can be eaten at one time. A section of the small intestine is then cut, moved up and attached to the new small stomach. Food passing through this shortened section of small intestine does not stay in contact with the digestive juices for long enough. This means that some of the food that you eat is not absorbed completely. The operation is performed laparoscopically using keyhole surgery under general anaesthetic. Five small incisions are made in the abdomen into which a camera scope and surgical instruments can be introduced. How much weight can I expect to lose? Weight loss tends to be most rapid in the first year after your surgery, with maximum weight loss achieved at eighteen months to two years. You may expect to lose about 60-70% of your excess weight, providing you work with the surgery. Your long term weight loss success can only be achieved by making permanent dietary and lifestyle changes in addition to the surgery. The long term success of a gastric bypass depends upon the individual. This surgery will aid weight loss by reducing your food intake, producing an earlier feeling of fullness and by not absorbing some of the food that you eat. It will not take away the desire to eat. You must work with the surgery by changing the way you eat and making healthy food choices whilst increasing your physical activity. Failure to do so may lead to disappointing weight loss and in some cases even weight gain. The specialist bariatric team will support you in your efforts to make permanent changes, but the responsibility to put this into practice is yours. Vitamin and mineral supplements after surgery It is recommended that you take a multivitamin and mineral supplement for the rest of your life after a gastric bypass. For four weeks after surgery you should not have any whole tablets in case they get stuck. All your tablets should be converted to liquid, chewable or crushable form. For the first four weeks you should take Dalivit liquid vitamin drops 14 drops a day and two Adcal (calcium) tablets a day. After four weeks you should stop the Dalivit and start an A-Z multivitamin and mineral tablet once a day, such as Centrum Advance, Sanatogen A-Z Complete or an own brand A-Z multivitamin and mineral for example, Tesco, Asda, Morrisons or Sainsburys. You should continue your Adcal tablet twice a day for the rest of your life. Dumping syndrome After a gastric bypass operation you may experience dumping syndrome if you eat or drink something sugary or eat and drink at the same time. Symptoms you can experience with dumping syndrome are dizziness, light headedness, sweating, a racing heart, feeling sick or diarrhoea. If you do feel any of these symptoms then lying down usually takes them away. Try to work out what caused you to having dumping syndrome so you can 2 avoid it in the future.

3 Eating and drinking after surgery Stage one: liquid diet from day two for two weeks For the first two weeks you will need to take only liquids. This is to allow your new stomach pouch to heal and avoid it over-stretching. The stomach can be quite swollen after surgery and it is difficult to swallow anything thicker than a liquid. It is most important that you are having liquids that contain protein. Liquids should be the consistency of thin, runny custard with no lumps or bits. The following liquids are good sources of protein: milk (semi-skimmed) or soya milk clear, cream or light soups with no bits Build-up soups and shakes Complan, Ovaltine, Horlicks, Milo made with semi-skimmed milk Slimfast thin yoghurt drinks with no bits (low fat or diet types e.g. Flora Pro-activ yoghurt drink, Actimel 0.1%, Benecol Light) thin custard (low fat) Try fortified milk to add more protein to your diet. Add four tablespoons of skimmed milk powder to a pint of semi-skimmed milk. The following are also suitable liquids: fruit squashes (sugar-free or low calorie varieties) water or flavoured water (sugar free varieties) but not sparkling tea or coffee (with sweetener if needed) stock cubes for example, OXO, Marmite or Bovril in hot water fruit juice (diluted with water) fruit smoothies made with pureed fruit and low fat or diet yoghurt Liquids to avoid Fizzy or sparkling drinks (these will make you feel bloated and uncomfortable) Alcohol (this can irritate the stomach and also provides empty calories) Any liquid with bits or lumps High sugar, high calorie milky liquids including Nourishment, Nutriment, evaporated or condensed milk How much and when? You should aim for at least two and a half pints (1.5 litres) of fluid a day You should aim to have at least one pint of semi skimmed milk or milky products for example, Slimfast, Complan, yoghurt drinks and one to two cups of diluted fruit juice each day It is important that you only drink small amounts of liquids at a time so you do not cause the new stomach pouch to stretch You will need to drink very slowly, so take small sips. Perhaps try using a straw It may take you about thirty minutes to drink half a cup of fluid It is useful to carry a bottle of low calorie fruit squash or water with you at all times Sucking on ice cubes can be a useful way to get some fluid Sip fluids throughout the day to make sure you stay hydrated Suggested meal plan Breakfast 1 small glass (200ml) of Slimfast or Buildup drink Mid-morning 1 small glass (200ml) of milk Lunch 1 small cup (200ml) of soup cup (100ml) of low fat yoghurt drink Mid afternoon 1 small glass (200ml) of flavoured milk Evening meal 1 small cup (200ml) of soup or Complan (savoury) or Slimfast Supper 1 small cup (200ml) of chocolate or Ovaltine (made with milk) or a small glass of milk You can drink small amounts of tea, coffee, water and low-calorie fruit squashes in between meals. Make sure they do not fill you up so much that you cannot drink the nutritious liquids at mealtimes.

4 Stage two: puree/blended diet: weeks three and four Foods should have a smooth texture with no lumps, similar to the consistency of baby food. You will need to use a blender or food processor. The overall nutrition content of a puree diet can be low when you are only managing a few spoonfuls of food. It is recommended that you still try to have one pint of protein-rich fluids, for example milk or milky products a day. Stage three: textured food diet: weeks five and six Foods should have a soft texture and be mashable with a fork. You should not need to blend foods at this stage. Why you need to know this information The soft food stage continues to allow your body to heal. Eating large amounts of food or having solid food at this stage may cause you to vomit. Progression from one stage to the next depends on the individual. In some cases it may take longer than the recommended time but it should never take less. If you have any concerns about your tolerance to certain foods then you should contact the specialist bariatric dietitian. Suitable foods for stage two and three Suitable protein-rich foods are: (You must blend the foods on stage two) Weetabix, Ready Brek, oat, corn or maize porridge made with semi skimmed or soya milk Minced chicken or meat blended with a sauce, gravy or stew Flaked fish mashed with a sauce or stew Scrambled egg or soft omelette Cottage cheese, low-fat cream cheese or grated reduced-fat cheese Well-cooked pulses such as mashed baked beans, chick peas, kidney beans, moi moi Smooth yoghurt with no bits or fromage frais (low fat or diet varieties) Low fat custard. Other foods you can eat at this stage: mashed potato or sweet potato soft cooked pasta blended with a sauce preferably tomato mashed vegetables without skin such as carrots, parsnips, swede, pumpkin, butternut squash, aubergine, cocoyam leaves or okra stewed fruit (either tinned in natural juice or fresh) with sweetener or mashed banana sugar free jelly soft fruit or tinned fruit in natural juice e.g. peach, apricot, mandarins, pear, ripened pawpaw (stage three only) yam, cassava, plantain or semolina (stage three only) well cooked rice (stage three only) breadsticks, crispbreads, crackers, dry toast or matzo (stage three only). Foods and drinks to avoid Any solid food Stringy or fibrous vegetables such as celery, asparagus or sweet corn Fizzy or sparkling drinks will make you feel bloated and uncomfortable Alcohol can irritate the stomach and is high in calories Any food with a tough skin such as sausages, bacon rind, tomato skins or apple skins

5 How much and when? On stage two, you should only have two to three tablespoons of food at each meal. Aim to have three to four small meals a day. On stage three your meals should be served on a small side plate. Aim to eat three small meals a day. You will need to eat very slowly and chew food well, thirty times each mouthful. Do not forget it should take you about thirty minutes to eat your meal. You must stop eating as soon as you feel full. If you eat too much you will stretch the new stomach pouch. It will also become painful and you will vomit. You need to aim to drink at least two and a half pints (1.5 litres) of fluid a day. It is important that you do not eat and drink at the same time. Fluids will dilute the food in the pouch and allow it to pass through the stomach too quickly. Try not to drink for thirty minutes before or after eating. You may find that there are some foods that you cannot manage at this time so leave them and try again later. Tips for preparing meals You will need a food processor or blender to prepare some of your food Remove skin, gristle, bone or fat before blending meat or fish. Try using minced meat, chicken or turkey Meat and chicken can be dry so you will need to add a low fat sauce, gravy or semi skimmed milk when blending Add mashed potato or sweet potato to thicken up blended foods Meat and chicken that has been casseroled or stewed blends well Potatoes can be mashed with semi skimmed milk and a low-fat spread or use instant mash. Well cooked pasta in a sauce (preferably a tomato based sauce) can be blended to a smooth soft consistency. Most fruit and vegetables mash well Blended food can be put into ice cube trays and frozen for later use. Small amounts of ready-made meals such as cottage pie or fisherman s pie could be used with some extra mashed vegetables Make sure your meals are low in fat; when cooking, only use one teaspoon oil per person per meal. Suggested meal plan - stage two This is only a suggestion; you may want to choose other foods from the suitable list. When you get up A cup of tea or coffee or glass of fruit juice (diluted with a small amount of water) Breakfast 1 Weetabix with 200ml of semi- skimmed milk. Throughout mid morning 1 glass of milk a glass of Buildup/ Complan soup/ shake Lunch 1 scrambled egg, 1 tablespoon of mashed potato, 1 tablespoon of mashed vegetables Throughout mid afternoon a pot of low fat smooth yoghurt a glass of Buildup/ Complan soup/ shake Evening meal 1 tablespoon of blended fish, chicken or meat, 1 tablespoon of blended pasta or rice, 1 tablespoon of mashed vegetables Supper 1 tablespoon of stewed fruit or half a mashed banana with small amount of low fat custard or half a pot of low fat yoghurt Bedtime A glass of flavoured milk You can drink small amounts of tea, coffee, water and low calorie fruit squashes in between meals.

6 Stage four normal foods: week seven onwards Why you need to know this information This stage allows you to introduce a greater variety of textured foods into your diet. The type of eating plan that you develop now is important for your long term health and successful weight loss You will still need to chew food well in order to prevent it getting stuck and causing discomfort. You will still need to eat slowly; allowing thirty minutes to eat your meal. It is important that you stop eating as soon as you feel full so you do not overload the stomach. It is still important that you do not eat and drink at the same time. Eating too much and eating too quickly will cause pain and vomiting. You may find that there are some foods that you cannot manage at this time so leave them and try again later. Why is a balanced eating plan important? The amount of food that you can eat at one time is reduced therefore it is important that the food you do eat is nutritious in order to provide the nutrients that your body needs. A balanced eating plan will help you to lose fat tissue rather than muscle. In the short term a poor diet can result in dry skin and hair loss while in the longer term you may be at increased risk of osteoporosis, anaemia, protein deficiency and vitamin and mineral deficiencies. Balanced eating plan Food provides the essential nutrients that the body needs to stay healthy. No one food can provide all the nutrients that your body needs, so it is necessary to eat a wide variety of foods. Eating foods from the different food groups ensures that you get a wide variety of nutrients. Food groups Protein Foods such as meat, poultry, fish, eggs, beans, pulses, tofu and Quorn These foods are important for the growth and repair of the body. As well as providing protein they also provide some essential vitamins and minerals including B vitamins, iron and zinc. Choose low fat varieties such as lean meat, chicken or turkey You need to have a food that is high in protein and low in fat at each meal. Dairy Foods such as cheese, milk, yoghurt and fromage frais These are important sources of calcium, needed for long term bone health They are also a useful source of protein Choose low fat varieties such as skimmed or semi-skimmed milk, low fat or diet yoghurts and low fat cheese You need to have three servings each day. One serving is: o 1 glass of skimmed or semiskimmed milk o 1 matchbox size piece of reduced fat cheese o 1 small low fat or diet yoghurt. Fruit and vegetables These provide essential vitamins and minerals that help protect the body against some diseases (such as cancer and heart disease) and infections. They are also a valuable source of fibre needed for a healthy gut and to prevent constipation. You should try to have at least three portions of fruit and vegetables a day in order to provide you with the fibre, vitamins and minerals that your body needs. As time progresses after surgery you should aim for five portions. One portion is: o 1 banana, apple, orange or pear o a small handful of grapes o 1 tablespoon of vegetables

7 Carbohydrate Foods such as breakfast cereals, potatoes, rice, couscous, pasta, noodles, chapattis, plantain, yam, cassava and semolina Doughy bread is difficult to eat after surgery, you may find toast easier. These foods are important because they provide the body with energy. They also provide fibre and some vitamins and minerals. They are not particularly high in calories, providing you do not fry them (chips), add butter to them (mashed potatoes, bread) or sugar to breakfast cereal You should aim to have a small amount of starchy food at each meal. Sugary and fatty foods These include sugar, cakes, biscuits, puddings, chocolate, sweets, sugary drinks, ice cream, sweet and savoury pastries, crisps, chevda, butter, ghee, margarine, cooking oils including palm oil, cream, salad dressings and mayonnaise. These foods are high in calories and can contribute to weight gain. It is best to keep these foods and drinks to a minimum, as a treat, because they will not help you lose weight. Choose low fat alternatives such as low fat spreads. Try grilling, baking, poaching, steaming and microwaving food to cut down on oil or fat in cooking. Use sweeteners rather than sugar in drinks and on cereal. Try having sugar free, no added sugar or diet drinks. Caution foods There are some foods that are not well tolerated after weight loss surgery. Every patient is different and their tolerance to certain foods varies from person to person. Sometimes you may only have a temporary intolerance to a specific food and it may be worth trying it again a few weeks later. The following foods are generally never well tolerated. Bread especially white bread and white bread rolls (but toast and crispbreads like Ryvita are generally better tolerated). Starchy foods such as gari, fufu, eba, pounded yam or kenkey. Roast meat (casseroles and stews are better tolerated) Stringy vegetables, such as celery, asparagus and sweetcorn Skin on fruit such as apples Nuts Sparkling or fizzy drinks When you are trying new foods, you should only introduce one food at a time. How do I know if a food is low in fat/ sugar? Food labels often give us an important clue in choosing foods or drinks that are suitable for us and allow us to avoid hidden fats and sugars. Always read food labels using per 100g....Of which sugars Aim for a product that has below 15g of sugar per 100g, ideally less than 5g per 100g Total fats Aim for a product that has below 20g of total fat per 100g, ideally less than 3g per 100g Per 100g High (Try to avoid) Medium Low (Fine most (healthier of the time) choice) Of which Sugars 15g g 5g Fat (Saturated fat) g (1.6-5g) 3g (1.5g) 20g (5g) Sodium 0.6g (Salt equivalent) (1.5g) g 0.1g ( g) (0.3g)

8 Suitable foods for stage 2 and 3 Advice on constipation After surgery, you may experience some change in the frequency of your bowel habits; this is because the quantity of food you are now eating is considerably smaller than before the operation. Initially you might find your bowels open less frequently i.e. every two or three days, due to the change in your diet. By including some of the foods listed below, your bowel movements should become more regular. High fibre foods Whole wheat breakfast cereals e.g. All Bran, Shredded Wheat, Weetabix, porridge oats Pulses e.g. baked beans, kidney beans, lentils, chick peas Whole wheat crackers e.g. Ryvita, wholemeal crispbreads, Jacob s multigrain. Fruit and vegetables for example, cauliflower, broccoli, carrots, salad, green beans, pealed fruit, tinned fruit in juice. It is also important to drink plenty of fluid between meals, aim for at least two pints (1.2 litres) a day. If constipation persists, try taking Milpar or lactulose, both available from your local pharmacy. If this does not help, talk to your GP or one of the specialist bariatric nurses Alcohol Alcohol can irritate the stomach. It is high in calories (almost as many calories as fat) and can slow down weight loss. Alcohol is an appetite stimulant so you may find that you are tempted to snack or eat more when you drink. After weight loss surgery you will feel the effects of alcohol much more. Can I plan pregnancy after having weight reducing surgery? Weight loss can increase fertility and therefore increases a woman s chances of becoming pregnant (whether planned or not). Adequate contraception needs to be considered. Having weight loss surgery does not prevent you from becoming pregnant; pregnancy is not advisable during the first eighteen months after surgery during the period of most rapid weight loss. In the event of pregnancy, it is important that you contact the bariatric team. You will need to speak to the specialist bariatric dietitian or bariatric nurse specialist about your diet and vitamin supplements. Hair loss Hair loss after bariatric surgery is quite common. It tends to happen about three to four months after surgery and can carry on for up to one year. You will not lose all your hair but you may notice it thinning around the parting and coming out when they brush or wash their hair. The hair loss does stop and the hair will re-grow. Hair loss is due to rapid weight loss, it is not related to any vitamin and mineral deficiencies. It is important you take your vitamin and mineral supplements as suggested but you do not need any extra vitamins and minerals. You must also ensure you are having plenty of protein in your diet (for example, meat, chicken, fish, beans, pulses, eggs, cheese, milk or yoghurts). Homerton patient support group Homerton bariatric surgery patient support group is held on a monthly basis in the Education Centre at Homerton Hospital on a Thursday evening. It is open to patients before and after surgery. Please contact our administrator on to reserve your place.

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12 References and useful contacts Homerton University Hospital website Weight Loss Surgery Information and Support ( ) British Obesity Surgery Patient Association ( ) Weight concern TOAST - The Obesity Awareness and Solutions Trust NICE Guidance British Obesity and Metabolic Surgery Society Bariatric Surgery Department: Press option four for the bariatric nurses or option five for the bariatric dietitians Patient Advice and Liaison Team (PALS) PALS provide information and support to patients and carers and will listen to your concerns, suggestions or queries. The service is available between 9am and 5pm. Telephone or pals@homerton.nhs.uk For information on the references used to produce this leaflet, please ring /5144 or patientinformation@homerton.nhs.uk The Trust endeavours to ensure that the information given here is accurate and impartial If you require this information in other languages, large print, audio or Braille please telephone the Patient Information Team on /5144 Author(s): Bariatric Surgery Department Homerton University Hospital NHS Foundation Trust Homerton Row, London, E9 6SR T W E enquiries@homerton.nhs.uk Produced date: August 2013 Review date: August 2015