Nutrition Guidelines after Gastric Bypass, Gastric Band & Gastric Sleeve Surgery

Transcription

1 Nutrition Guidelines after Gastric Bypass, Gastric Band & Gastric Sleeve Surgery The information in this packet will help guide you immediately after your surgery and for the months and years to come. The 6 major recommendations are outlined on this page and you can find additional details about each recommendation on the following pages. The Bariatric Surgery Dietitians are always available to answer questions by phone at and will see you during clinic visits. 1. Diet Progression After 1-2 meals of Phase 1: Clear Liquids, you have advanced to Phase 2: Blended/Pureed. Continue the Phase 2 Diet until your first clinic appointment after surgery (about 3 weeks) when the surgeon and dietitian can evaluate your progress. In the Phase 2 Diet, all foods must have a pureed consistency. 2. High Protein Food Sources Your diet after surgery requires grams of protein per day. High protein foods include low-fat or fat-free dairy foods, beans, eggs, nuts, peanut butter, lean meat, fish and poultry. There are many protein supplements available. 3. Low-Sugar & Low-Fat Foods and Beverages High-sugar and high-fat foods and beverages will cause unpleasant side effects ( Dumping Syndrome ) and make it more difficult for you to lose weight. Read food labels to make sure your foods have less than 5 grams Total Fat and less than 10 grams Sugars per serving. All beverages should be sugar-free Small Meals per Day Portion size should be ½ cup or less at every meal. Eat slowly and chew each bite well. Stop eating as soon as you feel SATISFIED oz. (6-8 cups) Fluid per Day Do not drink from 30 minutes before until 30 minutes after a meal. Avoid carbonated beverages and caffeine until Phase 4: Regular Foods. 6. Vitamins and Minerals Taking vitamins every day for the rest of your life is essential to make sure you get all the nutrients your body needs. o Multivitamin with minerals (Children s Chewable or Adult Multivitamin): one a day o Calcium Citrate with Vitamin D: Gastric Bypass: 500 mg twice a day for a total of 1000 mg per day Gastric Band/Sleeve: 500 mg once a day o Iron (ferrous gluconate): 325 mg twice a day, taken separate from calcium Only if you had Gastric Bypass surgery and are a woman still menstruating OR your blood work showed low iron levels

2 1. Diet Progression The weight loss surgery diet is divided into four phases. The diet progression is outlined below: Phase 1: Clear Liquids (1-2 meals) - For 1-2 meals after surgery you will be given clear liquids such as water, broth, a small amount of unsweetened juices, diet Jell-O and diet drinks to see how you tolerate eating. - Sip slowly and pay attention to your feelings of fullness. Phase 2: Blended/Pureed Food (3 weeks) - For approximately 3 weeks after surgery, you will need to eat blended or pureed foods. - All the food you eat should be the consistency of thin, smooth applesauce or yogurt. - Put cooked foods in a blender, then add liquid such as skim milk, broth, fat free gravy or low fat creamy soup and blend until smooth. - Eating solid foods too soon will put pressure on the staple line and may cause breakage or leaking. Food Choose Avoid Pureed fish, tuna, poultry, or pork; low fat cottage cheese; low-fat or non-fat cheese; baby-food meats (all types); mashed or pureed tofu; pureed egg or egg substitute; blended low fat casseroles with soft vegetables Protein and Protein Substitutes Milk and Milk Products Fruit and Vegetables Bread and Cereals Other Fat-free (skim) or 1% milk; sugar free or low fat yogurt (approximately 80 calories per serving) Applesauce, pureed banana, mashed potato or other fruit & vegetables without seeds or hulls that have been pureed Hot cereals cooked in milk (oatmeal, grits, cream of wheat) Sugar free gelatin or popsicles; sugar free fat free pudding/custard Crunchy peanut butter; all others Chocolate milk; sweetened condensed milk; 2% or whole milk; ice cream All others Bread and crunchy cereals Chewing gum; sweets Sample Phase 2 Menu: Breakfast 1 package No Sugar Added Carnation Instant Breakfast made with 1 cup skim milk & 1/3 cup powdered nonfat milk Snack ½ cup cottage cheese Lunch ½ cup fat-free refried beans 1 ounce melted reduced fat cheese Snack ½ cup Light yogurt Dinner 2 oz meat blended with 1/4 cup low-fat cream soup and 2 Tbsp skim milk powder This provides approximately 70 grams protein and 800 calories.

3 Phase 3: Soft Food (1 week) - About 3 weeks after surgery, with your doctor s approval, you may advance to Phase 3. - The general rule is Can I mash this food with a fork? to determine if it will be soft enough. - Phase 3 of the diet should include about 3 to 4 meals per day. Each meal should not exceed 4 ounces or ½ cup. - You will need to eat and drink slowly. Take small bites and chew very well. - Keep in mind that you are re-educating your stomach. If you eat too fast, too much, or don t chew enough, you will feel uncomfortable and could vomit. Food Choose Avoid Lean soft and moist meats including fish, tuna, poultry, or pork; low fat cottage cheese, low-fat or non-fat cheese; soft tofu; eggs or egg substitute; soft low fat casseroles with soft vegetables Protein and Protein Substitutes Milk and Milk Products Fruit and Vegetables Bread and Cereals Other Fat-free (skim) or 1% milk; sugar free or low fat yogurt (approximately 80 calories per serving) Any fruit & vegetables without seeds or hulls that have been cooked soft; soft unsweetened canned fruits or vegetables; fresh soft fruit Hot cereals cooked in milk (oatmeal, grits, cream of wheat); cold cereal (high protein) soaked in milk Sugar free gelatin or popsicles; sugar free fat free pudding/custard Crunchy peanut butter; fried eggs; any meat that is dry, tough or chewy. Red meat may not be tolerated in this phase. Chocolate milk; sweetened condensed milk; 2% or whole milk; ice cream All others including raw vegetables (such as salads) and raw crunchy fruits (especially those with tough skins/ seeds) Soft gummy bread; crunchy cereals; sweet cereals Chewing gum; sweets Sample Phase 3 Menu: Breakfast 1 egg with 1 slice reduced fat cheese Snack 1/3 banana with 1 Tbsp Natural Peanut Butter Lunch 3 oz lean, soft meat (turkey, low-fat ham) with ¼ cup low-fat gravy ¼ cup light canned fruit Dinner ¼ cup tuna canned in water with 1 Tbsp light mayo ¼ cup cooked vegetables Snack ½ cup Low-fat cottage cheese This provides approximately 70 grams protein and 700 calories.

4 Phase 4: Solid Food - About 4-6 weeks after your surgery, you may begin to try solid foods, one item at a time to test your tolerance to them. - Do not worry if you cannot handle foods that you used to eat. Most people experience some problems at first with food tolerances, especially with meats and breads. - Once you are eating solid foods you can reduce the number of meals that you eat to 3 meals per day. Be as regular as possible with meals and meal times. - You will always need to get grams of protein per day, and if you skip meals you will not get in enough protein. Food Choose Foods that may be difficult to tolerate Lean meats, eggs or egg Tough meat or meat substitute and tofu; with gristle; Some regular low fat patients do not tolerate casseroles or crock pot red meat. meals Protein and Protein Substitutes Milk and Milk Products Fruits Vegetables Bread Cereals Potatoes, Rice and Pasta Other Fat-free (skim) or 1% milk; sugar free or low fat yogurt (approximately 80 calories per serving) Fresh, canned, frozen or cooked fruit Fresh, canned, frozen or cooked vegetables Dry, coarse, or welltoasted bread; crispy low fat crackers or baked tortillas All cooked and dried cereals without added sugar Boiled, mashed or baked potatoes; well cooked whole wheat pasta or rice Sugar free gelatin or popsicles; sugar free fat free pudding/custard Chocolate milk; sweetened condensed milk; 2% or whole milk; ice cream Be cautious with apples, grapes, or other fruits with tough peels or skins and dried fruits. Vegetables with very tough skins or a lot of seeds Soft breads that become gummy; breads with a lot of nuts and seeds or dried fruit Cereals containing fruits or nuts Potato skins; rice; noodles Chewing gum; sweets; popcorn; nuts; chili; extremely spicy foods Foods to limit/avoid for best weight loss Fried or breaded meat products; fried eggs Chocolate milk; sweetened condensed milk; 2% or whole milk; ice cream Fruits that have added sugars or sauces Fried or breaded vegetable products Sweet breads; danish; doughnuts; pastries Cereal with added sugar over grams per serving Instant noodle dishes Fried, salty snack foods; creamed soups unless low fat versions

5 Sample Phase 4 Menu: Breakfast ½ slice whole wheat toast 1 scrambled egg 1 turkey sausage patty Lunch ½ sandwich (1 slice whole wheat toast with 3 thin slices lean ham, 1 slice reduced-fat cheese and 1 Tbsp light mayo) Dinner 3 ounces grilled chicken breast without skin with ¼ cup cooked vegetables sauteed in 1 Tbsp olive oil Snack ¼ cup almonds This provides approximately 68 grams protein and 1,000 calories.

6 2. High Protein Food Sources - PROTEIN will be an essential part of your diet after surgery. - Protein helps with wound healing, muscle and skin re-growth, and repair, as well as preventing hair loss. - We recommend a daily protein goal of 60 grams for females and 70 grams for males each day. Every meal and snack should have a good source of protein in it. See the list below. - Sometimes for the first 1-2 weeks after surgery it is helpful to consume a protein supplement (as long as it is low in added fats and sugars). See the list below. GRAMS OF PROTEIN FOODS SERVING SIZE Beans and Nuts Fat-free refried beans ½ cup 6 Beans (cooked) baked, black, black-eyed peas, brown, garbanzo/chick peas, kidney, lentils, lima, pinto, white Nuts & Seeds almonds, cashews, peanuts, pistachios, pumpkin seeds, sunflower seeds, walnuts ½ cup 7.5 (average) 1 oz. 6.5 (average) Hummus ¼ cup 4 Reduced-fat peanut butter 2 Tbsp 8 Dairy Skim or 1% milk 1 cup 8 Low-fat/Light yogurt 4-6 oz. 5 Reduced-fat cheese 1 ounce 7 Low-fat cottage cheese ½ cup 13 Sugar-free fat-free instant ½ cup (made with skim milk) 4 pudding Carnation Instant Breakfast, No 1 packet (made with 1 cup skim milk) 12 Sugar Added Non-fat milk powder 1 Tbsp 1.5 Meat and Seafood Egg (scrambled or boiled) 1 large 6 Lean Beef (cooked) 1 oz. (3 oz. = size of a deck of cards) 8 Lean Pork (cooked) 1 oz. (3 oz. = size of a deck of cards) 8 Lean Chicken (cooked) 1 oz. (3 oz. = size of a deck of cards) 8 Fish (cooked) 1 oz. (3 oz. = size of a deck of cards) 6 Tuna (canned) 1 oz. (3 oz. = size of a deck of cards) 7 Alternative Items Egg beaters ½ cup 12 Tofu 3 oz. (size of a deck of cards) 11 Veggie burger (soy, bean, veggie) 1 burger 11-16

7 Protein Supplements A protein supplement may be beneficial during the first few weeks after your surgery if you are having trouble consuming enough protein from food. A good supplement can help you reach your daily protein needs. Follow the package directions for mixing protein supplements with food or drinks. The following is a list of some appropriate supplements, which provide protein without high amounts of sugar: Protein Supplement Amount Grams of Protein GNC 100% Whey Protein 1 scoop 20 EAS AdvantEdge 100% Whey 1 scoop 23 Protein Beneprotein 1 scoop 6 Carb Solutions Shake Mix 1 scoop 11 Carnation Instant Breakfast No 1 package with 1 cup skim milk OR 12 Sugar Added 1 11oz. Ready-To-Drink bottle Designer Whey 1 scoop 18 Isopure 1 scoop powder 25 Isopure 1 20 oz. clear drink 40 Unjury 1 scoop 20 Twinlab 100% Whey Protein 1 scoop 25 Fuel Body Fortress Super Advanced 1 scoop 26 Whey Protein Optimum Nutrition Gold Standard 100% Whey 1 scoop 24 Protein supplements are available at the following stores: GNC Target Walmart The Vitamin Shoppe Sam s Club Some drug stores Some grocery stores

8 3. Low-Sugar & Low-Fat Foods and Beverages SUGAR - After weight loss surgery you will also need to follow a diet that is LOW IN ADDED SUGARS. This will help not only with tolerance to foods/beverages after surgery, but will also help with optimal weight loss. - Dumping Syndrome: After gastric bypass surgery, some patients experience a phenomenon known as dumping syndrome after eating concentrated sweets, fatty foods and/or drinking fluids with meals. This occurs when food exits the pouch rapidly and dumps into the intestine. This part of your intestine does not tolerate concentrated foods (sweet or fatty foods), so it immediately pulls water out of the rest of the body to dilute the food. It then rapidly flows down the remainder of the small intestine; it enters the large intestine (still flowing rapidly) and exits via the rectum. Some patients have shared stories about their dumping syndrome, describing the sudden onset of diarrhea and have reported having accidents in public places. Dumping syndrome can cause not only urgent diarrhea, but often patients will also feel nausea, lightheadedness, flushing, and stomach cramps. - Read Food Labels: Foods may have hidden sugar, so be sure and read food labels carefully. Aim for approximately 10 grams or less of sugar per serving. To prevent dumping syndrome you will need to avoid eating sugar and foods containing real sugar. Avoid products which list any type of sugar as one of the first three ingredients: including sugar, maple syrup, honey, molasses, corn syrup, corn sweeteners, glucose, lactose, maltose, dextrose, sorghum, sorbitol or mannitol. - Artificial Sweeteners: NutraSweet, Splenda, Sweet and Low and other artificial sweeteners are acceptable substitutes for real sugar. They will not cause dumping and will help with weight loss and maintenance since they contain very few calories. FAT - Your food choices will also need to be LOW-FAT. Fat may be difficult to digest or tolerate after weight loss surgery, especially fried foods, fast foods and snack foods. Small amounts of fats are fine such as those found in lean meats and fish or low fat dairy products and in fact, your body needs a certain amount of fat each day. - Cooking Methods: Use low-fat cooking methods to prevent adding fat to your foods. Try baking, broiling, or grilling and avoid frying foods. - Added Fat: A healthy, low-fat food can be made unhealthy from added fat. Be careful of the following ways that fat can be added to food: salad dressing, butter, sauces, gravies, mayonnaise, cheese, and nuts. - Read Food Labels: Read food labels for TOTAL FAT content. Total fat should be around 5 grams per serving as an average. **** NOTE: If a food is labeled Low-fat it does not necessarily mean it is also low in sugar and vice-versa. So, it is important to read the entire food label.

9 Small Meals per Day - The diet has been designed to be gentle on your new stomach, to ensure proper healing of the staple line, and to help you to avoid overeating. - A normal stomach can hold approximately 4-6 cups at a time. After surgery your stomach pouch will only be able to handle about ½ cup! o You will need to GO SLOW! o It is important to chew your foods well, eat very slowly and pay attention to how you are feeling. Stop eating as soon as you feel full oz. (6-8 cups) Fluid per Day - Weight loss surgery patients need to drink AT LEAST 6-8 cups of LOW calorie fluids per day to prevent dehydration. (See list below.) - Do not drink fluids for 30 minutes before meals, during meals, or for 30 minutes after a meal. o Drinking too close to a meal may overfill the stomach pouch and cause vomiting. It can also cause the food to be washed through the intestines too quickly and may cause Dumping Syndrome or may leave you feeling hungry more quickly. - Sip slowly, but consistently between meals. - You may not be able to tolerate carbonated beverages or caffeine until you are in Phase 4. Beverages to Choose: WATER is best!! Juices Sports Drinks Soft Drinks Coffee & Tea Milk Other Flavored Water (Fruit 2 O, Sparkling) Crystal Light Wyler s Minute Maid Light Diet Juices Diet V8 Splash Gatorade G2 Propel Vitamin Water Zero Powerade Zero Diet soft drinks Zero soft drinks Diet Iced Tea Unsweetened Tea Coffee with sugar-free, fat-free creamer and sweetener Skim or 1% milk Light Soymilk Sugar-free Kool-Aid Sugar-free, fat-free hot chocolate Diet Snapple Fuze **If a beverage is sugar-free or diet, it is a good choice for you! **Sweeteners can be used: Equal, Sweet N Low, Splenda, Stevia, NutraSweet

10 6. Vitamins and Minerals - It is critical that you take vitamins every day for the rest of your life after any weight loss surgery. You will not be able to meet your daily requirements for vitamins and minerals with food because of malabsorption after gastric bypass surgery and because you will not be able to eat a lot of food with any weight loss surgery. Daily Vitamin Regimen Complete Multiple Vitamin With Minerals 500mg Calcium with Vit D 1000mg Calcium Citrate with Vit D Gastric Bypass ** Gastric Band & Gastric Sleeve ** Iron only needs to be taken by menstruating females and those who are anemic. Iron should be in the form of ferrous gluconate or ferrous fumarate. Notes: Avoid Mens formula vitamins and Silver vitamins for those over 50 years old these typically do not contain iron. Calcium should be taken in 500mg doses. So, if you need 1000mg daily, you will need to take calcium 2 times a day. Avoid taking iron and calcium at the same time since they cannot both be absorbed at the same time. Iron Gastric Bypass Daily Supplements Example At Breakfast: Take 1 multivitamin and 2 calcium tablets. At Lunch: Take 2 iron tablets (if needed). At Dinner: Take 2 calcium tablets. Gastric Band & Sleeve Daily Supplements Example At Breakfast: Take 1 multivitamin. At Dinner: Take 2 calcium tablets.