Gastric Sleeve Resection

Transcription

1 Huntington VA Medical Center 1540 Spring Valley Drive Huntington, WV or Extensions 3356, 2391 or 2328 Gastric Sleeve Resection Gastric sleeve resection is a restrictive type of laparoscopic bariatric surgery which reduces the size of your stomach. With gastric sleeve resection more than half of the stomach (the greater curvature) is surgically removed. A new stomach if formed. It is about the size and shape of a banana and has a volume of 3-6 ounces ( cc). This part of the surgery can not be reversed. There is no intestinal bypass, only stomach reduction. The stomach functions normally so most food items can be eaten but in small amounts. Other names for the surgery are sleeve gastrectomy, vertical sleeve gastrectomy, and tube gastrectomy. Advantages of this surgery no foreign objects are placed in the body, all nutrients are absorbed, no dumping syndrome occurs because the lower part of the stomach (pylorus) which connects to the small intestine is preserved, and the portion of the stomach that produces hormones (ghrelin) which stimulate hunger is removed. For about six (6) weeks after surgery, you will need to follow a liquid or semi-liquid diet to provide healing time. You must follow specific dietary instructions once solid foods can be used. You will only be able to eat a small quantity of food at a time to avoid stretching the stomach. All food must be chewed thoroughly. You can not eat and drink at the same time. You must avoid lying down too soon after you eat. What are the side effects and risks of GSR? The most common side effects are sore and swollen abdomen, vomiting, nausea, reflux, diarrhea and constipation. There are some risks associated with general abdominal surgery as bleeding, pain, pneumonia, infection, pulmonary embolism, heart attack or stroke. Possible problems with the gastric sleeve resection are a fistula or leaking of the sleeve. Questions? Call the Bariatric Surgery Specialty Nurse at the Huntington VAMC or Extension 2106

2 Nutrition and Food Services Bariatric Surgery Instructions Huntington VA Medical Center 1540 Spring Valley Drive Huntington, WV or Extensions 3356, 2391 or The day before surgery you must only use a clear liquid diet. You will drink magnesium citrate that evening for surgery preparation. You should not eat or drink anything after midnight. 2. You will need to report to the Huntington walk-in Nutrition Clinic in either the Green or Blue Team Primary Care areas for pre-surgery diet instruction. A scheduled appointment is not required. The ambassador desk located on the ground floor once you enter the revolving glass doors can provide directions to the clinic. 3. Immediately after surgery, you will be NPO or have nothing by mouth, including ice chips. You will not be allowed to eat or drink anything until a special test is done the morning after your surgery. If there are no problems, a clear liquid diet (Stage 1) is ordered by the surgeon. Your portions will be very small, no more than 2-3 ounces. 4. You will be discharged on the Post Bariatric Stage 1, clear liquid diet with protein powder provided by the Huntington VAMC. 5. It is required that you telephone the Huntington outpatient (PACT) dietitian each week after your surgery for diet progression from one stage to the next. See the checklist on the next page for sample points of discussion extension 3356, 2391, or It is important to have routine follow-up sessions with the registered dietitian at the same time as the Bariatric Clinic. If you have an appointment at the Huntington VAMC, use the walk-in Nutrition Clinic as listed above in #2. If you have a CVT- Telehealth appointment from your local facility, the Huntington registered dietitian will be available. 7. If you are enrolled in Myhealthevet, you can send a "secure" message to Nutrition at the Huntington VAMC with any questions or concerns. A registered dietitian will reply electronically.

3 1. Current Weight 2. Home Blood Sugar Bariatric Telephone Call Checklist Please be prepared to provide this information to the dietitian. 3. GI status: Nausea? Vomiting? Reflux? 4. Hydration: Total ounces of fluid Types of fluid 5. Diet Stage: 6. Protein Intake Name of Supplement Content per serving: Grams of protein Grams of carbohydrate Calories Total grams protein per day 7. Nutritional supplements MVI with minerals Chewable or tablet? Calcium Calcium with vitamin D Vitamin B12 Iron (begin week 5) 8. Bowel routine Frequency Discomfort? Bowel changes 9. Physical activity 10. Any concerns? 11. Local follow up appts? Notes:

4 Gastric Sleeve Resection Diet Huntington VA Medical Center 1540 Spring Valley Drive Huntington, WV or Extensions 3356, 2391 or 2328 With the gastric sleeve resection, you will need to make changes in your lifestyle and eating habits. You must eat smaller portions and make good choices, avoiding high calorie food and beverages. Although you feel full faster and longer with a smaller stomach, this does not eliminate the emotional desire to eat. Your long-term goal is volume restriction while consuming a nutritionally balanced diet. Weight loss varies with each individual but is usually from 1 to 3 pounds per week during the first year. After you have lost weight, you may be able to take less medicine. Check with your doctor on how to adjust all of your medications. NUTRITION RECOMMENDATIONS Gastric sleeve resection removes over half of your stomach. With the smaller stomach ( cc s) you will feel full faster and learn to reduce the amount you eat. No surgery is without risk. Potential complications include nausea, vomiting, dehydration, diarrhea, excessive gas, lactose intolerance, constipation, gallstones, mineral and vitamin deficiency, protein calorie malnutrition, hair loss. Following instructions provided by the bariatric team will keep these problems to a minimum. Learning new eating habits is essential. You will advance through 4 stages to a final low fat, low calorie, high protein diet which you should follow permanently. The amount of weight you lose will depend on how committed you are to the required lifestyle changes. Advancing from one diet or stage to the next depends on the rate that you heal from surgery. It is important that you move from one stage to the next only when directed by the registered dietitian or surgeon.

5 OUTPATIENT POST BARIATRIC DIET SUMMARY Post Bariatric Diet Stage Protein Supplement Daily Vitamins and Mineral Supplements Week 1 and Week 2 Stage 1 - clear liquids Portion size: 2-3 ounces Minimum of 60 grams from protein supplement 2 adult or 4 children's chewable complete multivitamins with minerals Chewable calcium antacid or chewable calcium tablet = 1500 mg Vitamin B12 sublingual tablet, 500 micrograms Week 3 and Week 4 Stage 2 - full liquids Portion size: 2-4 ounces Minimum of 60 grams from protein supplement 2 adult or 4 children's chewable complete multivitamins with minerals Chewable calcium antacid or chewable calcium tablet = 1500 mg Vitamin B12 sublingual tablet, 500 micrograms Week 5 and Week 6 Stage 3 - pureed Portion size: 2-4 ounces Do not drink minutes after eating grams protein from food or combination food and supplement 2 adult tablets - multivitamin with minerals Calcium citrate tablets with vitamin D = minimum of 1500 mg calcium, 600 units vitamin D Vitamin B12 tablet, sublingual 500 micrograms Elemental iron tablet, 27 milligrams or Elemental iron tablet, milligrams for menstruating female Week 7 and Week 8 Stage 4 - soft Portion size: 4-6 ounces Do not drink minutes after eating grams protein from food or combination food and supplement 2 adult tablets - multivitamin with minerals Calcium citrate tablets with vitamin D = minimum of 1500 mg calcium, 600 units vitamin D Vitamin B12 tablet, sublingual 500 micrograms Elemental iron tablet, 27 milligrams or Elemental iron tablet, milligrams for menstruating female Week 9 and Lifelong Maintenance - High protein, low fat, Low calorie Portion size: 4-6 ounces grams protein from food or combination food and supplement 2 adult tablets - multivitamin with minerals Calcium citrate tablets with vitamin D = minimum of 1500 mg calcium, 600 units vitamin D Vitamin B12 tablet, sublingual 500 micrograms Elemental iron tablet, 27 milligrams or Elemental iron tablet, milligrams for menstruating female

6 GASTRIC SLEEVE RESECTION DIET BASICS Avoid overeating. It is usually best to eat 6 small meals per day. Do not skip meals. Drink most of your fluids between your meals. Avoid constant nibbling. Chew all food thoroughly. Eat and drink very slowly. Right after your surgery, it should take minutes to eat about 2 tablespoons of food. You will advance but still should take 30 minutes for each meal. Stay hydrated. Drink at least 8 cups (64 ounces) of water or sugar free liquids daily. Drink only 1/4-1/3 cup at a time due to the pouch size. Do not use alcohol, beer, high sugar products, caffeine, or carbonated beverages. Listen to your smaller stomach. Stop drinking and eating if you feel full. Pushing yourself to eat more will cause the stomach to stretch. Monitor portions. Measure amounts carefully. Use measuring spoons and measuring cups. Remember your stomach can only hold a few tablespoons at a time after surgery. Eventually it will hold about 1/2 to 1 cup. Medicine cup = 2 ounces Measuring spoons: Measuring Cups: 2 tablespoons = 1 ounce 1/4 cup = 2 ounces 1 tablespoon = 1/2 ounce 1/2 cup = 4 ounces 1 teaspoon = 1/3 ounce 3/4 cup = 6 ounces 1 cup = 8 ounces Avoid foods or liquids with added sugar or fat. Do not add sugar, cream, or fats to any of your foods or liquids. These foods can lead to nausea and weight gain. Have a high protein food with each meal. You will need grams of protein daily. It may be necessary to use a protein supplement. Take nutrition supplements (vitamins and minerals) as advised. Set up a schedule for taking your supplements and medications. Introduce one new food at a time. If you do not tolerate a food, wait at least one week before trying it again. Foods that are dry, sticky, gummy, or stringy in texture, with hard skins, nuts and seeds may present the biggest problems. Each person has different foods that work best for them. Avoid foods, called "trigger" foods, which you have craved and eaten in excess before.

7 GASTRIC SLEEVE RESECTION DIET BASICS, CONTINUED Substitute lactase-treated milk or calcium-fortified soy milk if you cannot tolerate regular milk. You may need to take lactase pills with dairy to help digest the lactose. They are available in a drug store. Ask your dietitian or pharmacist. It is best to avoid chewing gum. If you do chose to use gum, do not swallow it. HIGH FAT FOODS TO AVOID Fat seems to be difficult to digest after bariatric surgery. Too much fat slows the emptying of the stomach and causes reflux (back-up of food and stomach acid into the esophagus). Eating high fat foods may cause cramping, diarrhea, nausea and vomiting. In addition, these foods are high in calories and may prevent you from reaching your goal weight. Whole milk and whole milk dairy products Butter, margarine Oils, shortening, lard Cream cheese, sour cream Mayonnaise and regular salad dressings Olives, nuts High fat meats as bacon, sausage, hot dogs, luncheon meats, canned meats Fried foods Gravy, Sauces Potato chips and other ''fried snacks" Donuts, pastries, icing Ice Cream Restaurant meals HIGH PROTEIN IS REQUIRED It is important to have protein in your diet after the surgery and with each stage of the gastric sleeve resection diet. to heal your incision and new stomach pouch to keep your muscle mass while you are losing weight. to prevent poor healing, hair loss, and a feeling of low energy The amount of protein you will eat or drink is measured in grams. Your total protein depends on your body size, nutritional status, and possible need for increased protein. You should consume grams of protein each day. Protein Supplements You will need a protein supplement after surgery to add at least 60 grams of protein daily. A whey protein powder is the best one to use. Read the product label and purchase one that has the following in one serving: grams of protein no more than 100 calories 5 grams or less of total carbohydrates

8 Protein Foods Since you will be eating only small amounts of food at a time after surgery, you need to use high protein foods first at each meal, before you eat other foods. Choose lean or low fat, lower calorie sources to prevent unwanted weight gain. The Nutrition Facts section on the food label provides information on the calories and grams of protein and fat in one serving. Prepare all foods without added fat. Food/Beverage Serving Size Protein Calories Meat, Fish, Poultry Shrimp, boiled 6 large 7 g 33 Peanut Butter 2 tbsp 8.5 g 190 Baby food meat (plain) 1 jar (2.5oz) 9-11 g Ground turkey (97% lean) 2 oz 11 g 60 Salmon, baked 2 oz 12 g 115 Roast 2 oz 12 g 130 Baked ham 2 oz 13 g 100 Tuna, in water ¼ cup 14 g 45 Perch, flounder, sole, haddock (baked) 2 oz 14 g 65 Lean ground sirloin 2 oz 14 g 150 Tilapia 2 oz 15 g 72 Lobster 2oz 15 g 80 Chicken, dark, without skin 2 oz 15 g 115 Corned Beef 2 oz 15 g 140 Turkey, dark meat without skin 2 oz 16 g 92 Spare ribs 2 oz 16 g 224 Turkey, light meat without skin 2 oz 17 g 80 Pork chop 2 oz 17 g 109 Chicken, white, without skin 2 oz 19 g 90 Milk, Cheese, Yogurt Egg white 1 egg white 3 g 20 Tofu ¼ cup 5 g 95 Yogurt, light ¾ - 1cup 5-9 g Vanilla soymilk, non-fat 1 cup 6 g 70 Skim mozzarella 1 oz 6 g 80 Fat free American cheese 1 slice 7 g 35 Fat free or low fat cottage cheese ¼ cup 7 g 40 Egg substitute ¼ cup 7 g 50 Egg, large size 1 egg 7 g 65 Skim milk 1 cup / 8oz 8 g 90 Fat free cheddar, shredded ¼ cup 9 g 35 Non-fat dry milk ¼ cup 11 g 110 Greek yogurt, non-fat ¾ - 1 cup 18-22g

9 Protein Foods, continued Starches Mashed potatoes ¼ cup 1 g 50 Baked potato, no skin ½ small 1.5 g 65 potato Beans/lentils ¼ cup 4 g 60 Fat free refried beans ¼ cup 4.5 g 68 Barley ¼ cup 6.5 g 50 Edamame, shelled ¼ cup 8 g 95 Soups Broth ½ cup 1.5 g 25 Low fat creamed soup 1 cup 6-9 g 90 Chicken noodle soup 1 cup 4-6 g Bean, Pea, or Lentil soup 1 cup 6-9 g Minestrone soup 1 cup 5 g 100 Key: oz = ounce 1 oz = 2 tablespoons 2 oz = ¼ cup 3 oz = ⅓ cup 4 oz = ½ cup 6 oz = 3/4 cup 8 oz = 1 cup g = grams

10 SUPPLEMENTS Taking vitamins and minerals is required after gastric sleeve resection surgery and for the rest of your life. Without daily vitamin and mineral supplements, you could develop nutritional deficiencies with severe side effects. 1. Take a multivitamin with minerals daily. a. Before surgery and for the first month after surgery, take 2 adult or 4 children s chewable complete multivitamins with minerals or a liquid product. b. After 1 month, 2 adult tablets/capsules may be used. c. Avoid time-released supplements and enteric coating on tablets or capsules. 2. Vitamin B-12 is required. a. 500 micrograms as sublingual tablet once a day or b micrograms injection once a month. 3. Take extra calcium with vitamin D. a. Before surgery and for the first month after surgery take chewable calcium antacids or chewable calcium with vitamin D = 1500 milligrams of elemental calcium. b. After 1 month, change to calcium citrate with vitamin D. Take enough tablets to provide at least 1500 mg of calcium and 600 international units of vitamin D. c. Take the calcium and vitamin D two hours before or after the multivitamin/mineral supplement. 4. After one month, begin an iron pill daily with 27 milligrams of elemental iron. For menstruating females, a larger dose ( mg) is recommended. 5. Additional thiamine, folic acid, vitamin C, vitamin D and magnesium may be necessary. Your provider will tell you if one of these is needed and how much to take. 6. Do not take any fiber pills or powders or laxatives without permission from your physician. 7. Do not take over the counter medicines or herbal products unless approved by your physician.

11 GASTRIC SLEEVE RESECTION - STAGE 1 - CLEAR LIQUIDS - 2 weeks Stage 1 is the first diet ordered after surgery. Clear liquids will be started after an upper GI series test with gastrografin contrast shows that is safe for you to begin drinking. You may not feel hungry but need to drink liquids to prevent dehydration. Signs of dehydration include thirst or dry mouth, headache, feeling dizzy, muscle cramps, and small amount or dark colored urine. Sip liquids slowly. Gulping liquids may cause pain, nausea and vomiting. It is best to avoid using a straw as this adds air to your pouch and can cause discomfort. Pay attention to your feeling of fullness. Drink 64 ounces (8 cups) of water or sugar/caffeine free, non-carbonated beverages, every day. You should only drink 2-3 ounces at a time due to size of your stomach pouch. You will be on clear liquids for 2 weeks. You must use a protein supplement daily to add 60 grams of protein. An unflavored protein powder can be added to 1/3 cup of the clear liquid beverages or if flavored can be mixed with 1/3 cup of skim milk. Take chewable forms of the multivitamin/mineral tablet and calcium. STAGE 1 CLEAR LIQUIDS - 2 weeks Food Group Choose Do not Use Beverages Water Sugar free, non-carbonated flavored waters Sugar free fruit drinks, ades Caffeine free coffee or tea Carbonated beverages Sports Drinks Sweetened fruit drinks, ades Regular coffee or tea Caffeine Alcohol or beer Fruit Diluted fruit juice Full strength fruit juice Other fruits Meat None All meat and meat products Meat Alternate/Protein Milk Miscellaneous Protein powder Small amount of skim milk if needed to mix with flavored protein powder Sugar substitute Sugar free gelatin Sugar free popsicles Soups/Broth Clear beef, chicken, or vegetable broth Starches None All Vegetables None All All other milk and milk products Sugar, honey, syrups Regular gelatin or popsicles All solid food Cream soups

12 GASTRIC SLEEVE RESECTION - STAGE 2 FULL LIQUIDS - 2 weeks Stage 2 prevents dehydration and provides protein for healing. 1. You will be on Stage 2 full liquids for 2 weeks. 2. Use six small feedings and no more than 1/2 cup (4 ounces) each feeding. 3. Introduce one new item at a time to see how your stomach will tolerate it. 4. Stop eating when you begin to feel full. 5. Drink 64 ounces (8 cups) of water or sugar free beverages every day. You should only drink 1/4-1/3 cup at a time due to size of your stomach pouch. Sip liquids slowly. 6. If you cannot tolerate milk, use lactase-treated milk and lactase enzyme products. 7. Continue the chewable vitamin and mineral supplements and calcium. STAGE 2 FULL LILQUID Food Group Choose Do Not Use Beverages Water Sugar free, non-carbonated flavored waters Sugar free fruit drinks, ades Caffeine-free coffee or tea Carbonated beverages Sports Drinks Sweetened fruit drinks, ades Regular coffee or tea Caffeine Alcohol or beer Fruit Diluted fruit juice All fruit Meat Meat Alternate/Protein Milk/Milk Products Protein powder Low fat soy milk 1 % or skim milk Lactase-treated milk Non-fat dry milk powder Low carbohydrate or sugar free instant breakfast powder mixed with non-fat milk Sugar free hot chocolate Sugar free ice cream Sugar free pudding Non-fat blended yogurt made with sugar substitute Full strength fruit juices All meats and meat products Whole, 2 % milk, Cheese Sweetened condensed milk Chocolate milk Regular hot chocolate Regular milkshakes Regular ice cream, sherbet Regular pudding Regular yogurt Miscellaneous Soups Sugar substitute Sugar free gelatin Sugar free popsicles Spices Low fat strained cream soups made with skim milk Chicken, beef or vegetable broth Sugar, honey, syrups Regular gelatin Regular popsicles Sorbet Regular soups Starches Very smooth cooked cereal as cream of Dry cereal, breads, crackers, wheat, farina, grits, oatmeal potatoes, pasta, rice Vegetables Tomato or vegetable juice cocktail All solid vegetables

13 GASTRIC SLEEVE RESECTION - STAGE 3 - PUREED- 2 weeks All foods must be blended or pureed to the consistency of smooth applesauce. All foods should be cooked without added fat. Spices and herbs as tolerated may be added to flavor the food. For homemade: cut cooked food into small pieces and place in blender or food processor. Add liquid as fat free broth, non-fat milk, or fat free gravy and mix until smooth. If you cannot tolerate milk, use lactase-treated milk and lactase enzyme products. 1. Stage 2 - Pureed is used for 2 weeks. 2. Eat protein food first. 3. Eat very slowly and chew food well. 4. Only eat 4-8 tablespoons (1/4 cup to 1/2 cup) of pureed food at each meal. 5. Stop eating as soon as you feel full. 6. Eat six (6) small meals daily. 7. Add new food gradually, one at a time. 8. Drink 64 ounces (8 cups) of water or sugar free beverages between meals. You should only drink 1/4-1/3 cup at a time due to size of your stomach pouch. Sip liquids slowly. 9. Do not drink liquids 15 minutes before a meal and wait minutes after a meal or snack to sip liquids. 10. You can begin taking a tablet form of multivitamin/mineral supplement. calcium citrate with vitamin D, vitamin B12 and elemental iron.

14 STAGE 3 PUREED - 2 weeks Food Group Choose Do Not Use Beverages Water Sugar free, non-carbonated flavored waters Sugar free fruit drinks, ades Caffeine-free coffee or tea Carbonated beverages Sports Drinks Sweetened fruit drinks, ades Regular coffee or tea Caffeine Fruit Meat Meat Alternate/Protein Milk/Milk Products Miscellaneous Soups Pureed no sugar added canned fruit No sugar added applesauce Diluted fruit juice Eggs, egg substitute Pureed low fat chicken, turkey, pork, beef, veal, lamb, seafood Pureed legumes, lentils Smooth peanut butter Low fat soy milk, Tofu Whey protein 1 % or skim milk Lactase-treated milk Non-fat dry milk powder Low carbohydrate or sugar free instant breakfast powder mixed with non-fat milk Sugar free hot chocolate Sugar free ice cream Sugar free pudding Non-fat blended yogurt made with sugar substitute Low fat cottage or ricotta cheese Fat free sour cream Sugar substitute Sugar free gelatin Sugar free popsicles Spices and mild herbs Low fat strained cream soups made with skim milk Chicken, beef or vegetable broth Alcohol or beer Solid fruit Full strength fruit juice Raw fruit Fruit skin or seeds Fried or high fat meats Crunchy peanut butter Nuts Whole, 2 % milk, Sweetened condensed milk Chocolate milk Regular hot chocolate Regular milkshakes Regular ice cream, sherbet Regular pudding Regular yogurt All other cheeses Regular sour cream Sugar, honey, syrups Regular gelatin Regular popsicles Sorbet Mayonnaise Salad dressings Popcorn Regular soups Starches Vegetables Very smooth cooked cereal as cream of wheat, farina, grits, oatmeal Pureed cooked rice, noodles, pasta Tomato or vegetable juice cocktail Mashed white or sweet potatoes Pureed, cooked vegetables Dry cereal, Bran Breads, crackers whole grains Raw or fresh vegetables Vegetables with seeds Corn

15 GASTRIC SLEEVE RESECTION - STAGE 4 SOFT- 2 weeks The soft diet includes solid foods that can be mashed with a fork. All foods must be prepared without added fat. This stage begins six weeks following your surgery. 1. You will be on Stage 4- Soft for 2 weeks. 2. Eat protein food first. 3. Eat very slowly. 4. Take small bites (about the size of a dime) and chew food well. 5. Only eat 1/2-3/4 cup (4-6 ounces) of food at each meal. 6. Stop eating as soon as you feel full. 7. Eat 4 6 small meals daily. 8. Add new food gradually, one at a time. 9. Drink 64 ounces (8 cups) of water or sugar free beverages every day. You should only drink 1/4-1/3 cup at a time due to size of your stomach pouch. Sip liquids slowly. 10. Do not drink liquids 15 minutes before a meal and wait 15 to 30 minutes after meals. 11. Take your multivitamin/mineral supplement, calcium citrate with vitamin D, vitamin B12 and elemental iron.

16 STAGE 4 SOFT - FOOD/BEVERAGES Food Group Choose Do Not Use Beverages Water Sugar free, non-carbonated flavored waters Sugar free fruit drinks, ades Caffeine-free coffee or tea Carbonated beverages Sports Drinks Sweetened fruit drinks, ades Regular coffee or tea,caffeine Alcohol or beer Desserts Sugar free products Cakes, candy, cookies, Fats Fruit Meat/Meat Alternates Milk/Milk Products Non-fat margarine Fat free gravies, sauces Fat free mayonnaise Fat free cream cheese Lite or unsweetened canned fruit Diluted fruit juice Lean meats chicken, turkey, pork, beef, veal, lamb, fish, shellfish, Eggs, egg substitute Tofu and soy protein products, low fat soy milk Dried beans cooked without fat Reduced fat smooth peanut butter Whey protein 1 % or skim milk Lactase-treated milk Non-fat dry milk powder Low carbohydrate or sugar free instant breakfast powder mixed with non-fat milk Sugar free hot chocolate Sugar free ice cream Sugar free pudding Non-fat blended yogurt made with sugar substitute Low fat cottage or ricotta cheese Low fat mild cheese Low fat sour cream Sugar substitutes Sugar free gelatin Sugar free popsicles Spices Herbs doughnuts Regular mayonnaise or salad dressings Regular cream cheese Full strength fruit juice Canned or frozen fruits in syrup Fruit with peel or seeds Dried fruits Fried or high fat meat Highly seasoned meat Spiced meats Fried eggs Raw eggs Chunky peanut butter Whole, 2 % milk, Sweetened condensed milk Chocolate milk Regular hot chocolate Regular milkshakes Regular ice cream, sherbet Sorbet Regular pudding Regular yogurt Regular cottage cheese Strong flavored cheese Regular sour cream Miscellaneous Sugar, honey, syrups Sugar alcohols Regular gelatin Regular popsicles Sorbet Coconut Pickles Snacks Low fat crackers Popcorn, nuts, seeds Soups Starches/Breads Vegetables Low fat cream soups made with skim milk Vegetable soup Cooked cereal oatmeal, cream of wheat, farina, grits, cream of rice Unsweetened dry cereal Pasta, rice (if tolerated) Toasted white bread Low fat crackers Tomato or vegetable juice cocktail Soft cooked fresh, canned or frozen vegetables Creamed corn Cooked white or sweet potatoes without skin High fat soups Presweetened or sugar coated cereals Bran, whole grain cereals Whole grain breads Bread with nuts or seeds Whole kernel corn Raw vegetables Fried vegetables

17 GASTRIC SLEEVE RESECTION- REGULAR DIET Eight (8) weeks after your surgery, you will have progressed to a low fat, high protein diet with regular texture foods, including raw fruits and vegetables. Eating a sensible low fat and low calorie diet with controlled portions will help you to continue to lose weight and sustain your weight loss once you have reached goal. 1. Eat slowly and chew foods well. 2. If you experience nausea or abdominal discomfort, you may have eaten too quickly or too much. 3. Stop eating when feeling full. 4. Continue 4 to 6 small meals with 1/2-3/4 cup (4-6 ounces) of food at each meal. 5. Use moist, tender lean meats. 6. Eat a variety of low fat food for nutritional balance. 7. Eat protein with every meal and use grams of protein daily. 8. Trim all fat from the meat before cooking. 9. Use low fat cooking methods: bake, broil, grill, roast, sauté, stir-fry in fat free broth, microwave, or steam. 10. Add new foods one at a time. If you do not tolerate a particular food well, wait about 1 week before trying it again. If you still do not tolerate the particular food, avoid it. 11. Avoid high fat foods, fried foods, sauces and concentrated sweets. 12. Add raw fruits and raw vegetables as tolerated. 13. Maintain adequate fluid intake with 8 cups (64 ounces) daily. It is still best to avoid carbonated beverages, fruit juices, caffeine and alcohol Spices and herbs can enhance the flavor of food without adding fat. 15. Continue tablet form of the multivitamins with mineral, calcium citrate with vitamin D, vitamin B-12 and iron. Questions? Call the Primary Care PACT Registered Dietitian at the Huntington VAMC or Extension 3356, 2391 or 2328

18 REFERENCES Bariatric Nutrition: Suggestions for Surgical Weight Loss Patient, Article in Press, Surgery for Obesity and Related Diseases, American Society for Metabolic and Bariatric Surgery, 3/08 Bariatric Sub-unit of the Weight Management Dietetic Practice Group, The American Dietetic Association Center for Surgical Weight Control, Suite 101, 1115 Twentieth Street, Huntington. West Virginia Criteria and Standards for Bariatric Surgery, VHA Handbook , Department of Veterans Affairs, Veterans Health Administration Nutrition Guidelines for Bariatric Surgery Patients, Nutrition and Food Service, Clinical Resources, Clinical Practice Guidelines, March 2010 with revisions, vaww.nutrition.va.gov Patient Education Material for Bariatric Surgery, Clinical Nutrition, Nutrition and Food Services Intranet, United States Department of Veterans Affairs, vaww.nutrition.va.gov NUTRITION RESOURCES Academy of Nutrition and Dietetics Veterans Health Administration Weight Management Program My HealtheVet Gateway to Veteran s Health and Wellness Food and Nutrition Information Center - National Heart Lung and Blood Institute, Obesity Education Initiative National Institute of Diabetes and Digestive and Kidney Disease, NIH free site for nutritional content of foods The VAMC is not responsible for the availability or content of these external sites, nor does the VAMC endorse, warrant or guarantee the products, services, or information offered at these sites, references or facilities. 7/09 3/13 revised 3/13