Eating Smarter After A Gastric Bypass Nikki Talacek, NZRD

Eating Smarter After A Gastric Bypass Nikki Talacek, NZRD Eating after a gastric bypass is entirely different t eating befre surgery. Remember yu are nw surgically altered n the inside. Healing and early pst p diet: Yur diet after yur gastric bypass is designed t allw the staples t heal and the tissue t knit tgether (think f an internal cut which yu want t heal well, and frm a gd scar, such as yu wuld if yu cut yurself n the utside f yur bdy). It is imprtant t try t avid vmiting and reduceirritatin arund the staple line. Fr this reasn it is vital that yu fllw the fluid diet fr the first 2 weeks, and then the puree diet fr the next 2 weeks until yu see us. The imprtance f prtein: Once yu mve ff the puree diet, yur intake is much less than yu were eating prir t surgery, therefre it is imprtant that yu eat high quality fd fcusing n prtein. A gastric bypass has a maladaptive cmpnent, which means nt all f the prtein which yu eat will be absrbed, and hence yu need t be extra vigilant with what yu eat. Therefre prtein needs t be the fcus f yur intake. Prtein als helps with satiety (fullness r feeling replete). Wrking with yur gastric bypass: Listen t yur bdy and stp eating when yu feel full. Yu d nt want t vmit, as this can cause irritatin. Yu will start with a few teaspns, and then ½ a cup. At a year r s pst surgery mst peple manage up t 1½ cups f fd (ttal) per meal r a bread and butter plate. At least ½ f this shuld be high quality prtein. Supplements: Yur intake f fruit and vegetables is als reduced, and this cmbined with the malabsrptive cmpnent f yur surgery means yur intake f vitamins and minerals is als reduced. Hwever yur need fr these is nt reduced. Fr this reasn yu will need t take a multivitamin fr the rest f yur life. Due t the malabsrptive nature f a gastric bypass, we recmmend a duble dse f multivitamins, 2 per day (in a split dse). We currently recmmend Centrum (available frmsupermarkets / chemists/ nline) r Band Buddies NutriChew (available frm www.bandbuddies.c.nzr frm the rms). Other individual nutrients may need t be supplemented e.g. irn and vitamin B 12 and we will advise yu if this is s. This is why regular bld tests are als vital after surgery. After yur peratin Please refer t the detailed infrmatin prvided t yu by Nikki fr detailed infrmatin regarding yur pst perative nutritin The first 2 weeks after surgery yu are n a fluid diet Day 0 (Op day) Sips f water Day 1 30-60mls per hur f water Day 2 1 x ½ Strength Optifast (400mls), water and ther lw calrie thin fluids 1 x Flat Bercca Perfrmance r Band Buddies NutriChew chewable vitamin 1500mls minimum fluid, 60-100mls per hur Day 3-6 2 x ½ strength Optifast (400mls), water and ther lw calrie thin fluids 2 x Flat Bercca Perfrmance r Band Buddies NutriChew chewable vitamin 1500-2000mls minimum fluid, 100mls per hur, increasing as tlerated Day 7-14 As abve, thugh Optifast n lnger needs t be diluted t half strength Puree diet: After the 2 weeks f the fluid diet, yu will mve nt a puree diet. Ensure yu pureeyur fd well, t 1 st baby fd cnsistency, but baby fd is nt suitable (nt enugh prtein).stick t½ f a cup maximum per meal. This is nt a gal, yu d nt have t aim fr this - stp eating the instant yu feel full Yu cntinue with yur Bercca r Band Buddies NutriChew vitamins (2 per day). Yu need t stp drinking 30 minutes prir t eating, and nly start drinking again 30 minutes after eating. Drinking t sn befre a meal will fill yur puch and yu will feel uncmfrtable and nt have rm fr fd, and culd als verstretch yur puch. This culd als lead t vmiting. If yu drink t sn after a meal yu will dilute the fd in yur puch and wash it thrugh yur gastric bypass t sn, and lse the satiety the fd / meal gives yu, and hence eat mre and the effect f the gastric bypass is lst. This can als lead t dumping. Yu need t chew yur fd well, at least 25 times per muthful. Wait between muthfuls als. Initially a minute, but as time prgresses this can be reduced. Try t put yur frk (r spn) dwn between bites. Yu als need t take 30

minutes per meal. After abut 6 mnths hwever, I generally like t limit meal times t n lnger than 20 minutes. Yu shuld sit dwn when yu are eating. Initially yu need t have snacks after surgery. Yu have had surgery and yu need extra nutrients (especially prtein) t heal and yur quantities initially after surgery are s small yu are nt able t manage this with just meals. Yu shuld be aiming fr: Meal: Optin examples: Breakfast: Prridge (blend the ats befre cking) made with calcium enriched trim milk - ttal ½ cup Pached r scrambled egg - this des nt need t be pureed ½ weetbix with ½ cup calcium enriched trim milk - allw t g mushy (this is essentially pureed) Plain unsweetened yghurt with pureed fruit t flavur Mrning tea: ½ Optifast diluted as desired / ½ cup calcium enriched trim milk ½ reduced cheese slice (des nt need t be pureed) Having a liquid snack such as milk r Optifast is preferable as it means yu d nt need t stp and start with yur ther fluids arund snack time Lunch: Water r rice (smth) crackers x 1-2 with prtein tpping (d nt need t puree crackers, but they d need a tpping[therwise they will stick]) Tinned salmn / tuna with 95% fat free cream cheese - pureed Reduced fat cheese slice - d nt need t puree Tinned chicken / hardbiled egg with light may - pureed Prtein and vegetable sup (at least ½ prtein) pureed until smth Leftvers / dinner type meal Afternn tea: As per mrning tea Dinner: At least ½ f yur meal shuld be prtein (but mst have arund 80-90%) - at least ¼ f a cup Ttal ½ cup - this includes prtein and ther fd (e.g. green vegetables) Mince with Weight Watchers r ther lw fat gravy r blgnaise sauce - pureed until smth Chicken (r ther meat) with light Chicken Tnight sauce (r similar light sauce) - pureed until smth Casserle with majrity meat, and sme free vegetables - pureed until smth Fish in white sauce - pureed until smth Vegetarian prtein alternative and small amunt f free vegetables with reduced fat sauce - pureed until smth Supper: As per mrning tea Sft diet and snacks: After yur puree diet, and nce yu have mved nt yur sft diet yu d nt need snacks, and they are discuraged. It is nly in the immediate pst perative healing phase we recmmend these as it culd lead t vercnsumptin and reduce yur weight lss in the lng term, r lead t weight gain. Prtein: Prtein is yur main fcus after surgery and yu need t eat this first. This shuld cmprise f at least ½ f what yu eat, and fr the first cuple f mnths mst peple have arund 80-90% f their diet as prtein. Animal based prducts are the best surces f prtein. If yu are vegetarian yu will be t be extra vigilant regarding prtein intake, and it needs t cmprise mre than ½ f yur diet, generally ¾.Fr a cmparisn f prtein amunts in cmmn fds, refer t the sheet Nikki gave yu, and there are als varius websites which have extensive fd databases. The ne I have fund which has the mst New Zealand fds iswww.calrieking.cm.au. Anther site which is very gd is www.myfitnesspal.cm A shrt list f high prtein fds are: Optifast Calcium enriched trim milk / Sun latte milk Beef / lamb / chicken (thigh is better tlerated than breast) / prk / fish / seafd Tinned fish and tinned chicken Lw fat yghurt Reduced fat cheese slices (<10g fat per 100g) Cttage cheese / 95% fat free cream cheese Lentils / ther legumes / Tfu Fluids:

Yur fluid requirements are still the same after surgery as they were pre surgery. A minimum f 1500mls per day is needed, mre if it is htter, yu are ding exercise r if yu are tall. We like nn-caffeinated fluid fr the first 3 mnths after surgery. Caffeine is a gut stimulant and irritant and has been implicated in gastric ulceratin(ne f the reasns we recmmend against this initially). We advise against carbnated fluids fr the first 3 mnths after surgery as this puts t much pressure n yur puch. After this yu may try a small amunt f carbnatin. Yur fluids shuld be lw calrie, and as mentined nn-caffeinated, but after 3 mnths a small amunt f caffeinated fluids (such as a cffee r 2 per day) is fine. Examples f recmmended fluids are: Water - preferred fluid Thriftee / Lw calrie Baker and Halls r ther diet crdials Flavured water - diluted t half strength Decaffeinated tea and cffee Herbal tea / green tea V8 r tmat juice - dilute t half strength Dumping: There are 2 types f dumping, sugar dumping and fat dumping. Dumping can be cnsidering a gd r bad thing. Mst peple think it is a gd thing as it puts them ff eating nn-desirable fds. But cntinual dumping is nt gd, as it means that ther fds are nt being absrbed, and yu are missing ut n ther vital nutrients Sugar dumping: Fat dumping: Symptms: Usually within 30 minutes f eating, r can be a few hurs after eating (this is delayed hypglycaemia) Nausea / vmiting Sweating Rapid heart rate Diarrhea (less cmmn) Blackuts (mre s fr delayed hypglycaemia) Trigger fds: High sugar / refined carbhydrate fds (think white carbhydrates) Eating t many carbhydrates in islatin Sugar / jam r hney Chclate Ice cream Cakes etc Fruit juice / regular fizzy drink / sprts drinks etc Milkshakes / thickshakes / flavured milk High sugar cereals Dried fruit Symptms: Cramping Diarrhea - lse mtins with urgency Nausea Trigger fds: High fat fds Butter / margarine etc Fried fds Fast fd Chclate Ice cream Ptat / crn chips Pastries Milkshakes / thickshakes / flavured milk Sausages Lng Term Eating Recmmendatins: The lng term gal f surgery is t eat smaller amunts f regular fd (with a prtein fcus). At a abut a year pst surgery, yu shuld be eating a variety f fds frm all the fd grups. Dn t think f lng term eating after yur surgery as a diet but rather as a sustainable lifestyle chice. The fd grups yu want t chse frm are:

Prtein: At least ½ f yur intake (mre if yu are vegetarian) Lean meat, skinless chicken (thigh is better tlerated than breast which is dry), fish, seafd Lw fat dairy prducts such: Calcium enriched trim milk / Sun latte milk Lw fat, lw sugar yghurt Cttage cheese Reduced fat cheese slices 95% fat free cream cheese (Philadelphia is gd) Sy milk falls int this categry Free vegetables and fruit: ¾ f the ther ½ f intake after prtein (mst f the ther ½) Aim fr mre vegetables than fruit (keep starchy vegetables and rice t a minimum) Green leafy vegetables such as salad (watch the stalks), brccli, carrts etc This des nt include ptat, kumara r crn Yu may need t peel fruit, and watch the pith n citrus fruit If yu have tinned fruit, chse thse in natural juice, and ideally drain Be careful with mushrms - they can get stuck Be careful with tmat skins - they can frm a seal ver the sialistic ring if yu have ne Carbhydrates: Only a small prprtin f yur diet shuld be carbhydrates (arund ⅛ f yur intake) This includes starchy vegetables such as ptat, kumara and crn (but watch crn, this can be tugh) Vgels bread is preferable (extra thin) - white bread can frm dugh balls and get stuck Cmmercial gluten free bread is generally fine Wraps and pita bread (the unleavened breads) may be easier tlerated than regular bread - try these first Yu d nt have t have the carbhydrates if yu d nt want t, this is just an ptin. Yu may find hwever, if yu hungry, that this can help t cntrl hunger, if eaten in the crrect prprtin - as mentined abve. T much refined carbhydrates ( white carbhydrates ) will increase hunger Eating t many carbhydrates will have an impact n yur weight, and these d need t be limited lng term, plus they take rm away frm prtein Yu d need sme carbhydrates, particularly if yu are ding a lt f high energy exercise Snacks: Yes, nt a fd grup, but des need t be mentined Ideally yu want t avid snacks, as this will have an effect f yur weight Prtein based snacks are ideal such as: Lw fat, lw sugar yghurt (<2g fat and <5-6g sugar per 100g) Calcium enriched trim milk / Sun latte milk Few nuts (6-10 almnds r cashews, 2-3 brazil nuts etc) - limit hw ften yu have these thugh as these are high in fat 1-2 whlegrain crackers with cttage cheese f 95% fat free cream cheese (Philadelphia is gd) r lw fat hummus (<10g fat per 100g) Fruit - watch the peel and r pith Watch fr nuts, these are high in fat and it is easy t have t many f these Alchl: Yu have lst the enzyme which breaks dwn the alchl, as this is in the part f the stmach which is n lnger being used. Hence alchl nw enters yur bld stream straight and undigested Yu will feel the effects f alchl sner Fr this reasn, we recmmend yu d nt drink and drive (even after 1 drink) - we are nt sure f levels at which yu will be ver the legal bld alchl limit. This will be much lwer than befre, thugh we d nt knw after hw many drinks - be it 1,2r 3 and ver what time frame. This will differ fr everyne and hence ur blanket recmmendatin. Unfrtunately there have been sme peple wh after 1 drink, eating and waiting, have then driven hme and been caught ver the legal limit. Nt excessive alchl cnsumptin by anyne s standards, but due t the nature f their surgery, they were ver. Smething t be aware f

Weight lss des have an effect n alchl tlerance, and yu may find that when yu lse weight yur tlerance decreases (in cnjunctin with lsing the enzyme that breaks dwn the alchl in yur stmach) Alchl is high in calries, and an increased intake, r even a regular mderate intake will have an effect n yur weight and this des need t be taken int accunt Avid alchl fr at least the first 3 mnths pst surgery. Yur liver is prcessing the fat yu are burning and we d nt want t add any additinal strain n yur liver. Occasinally the 3 mnth avidance is extended, hwever this will be discussed if required. Als, alchl is calrie rich, therefre will have an effect n yur weight lss. Exercise: This is needed fr successful weight lss lng term. The current recmmendatins are 200 minutes f cardi exercise per week - 30 minutes per day r 40 minutes 5 times per week r 50 minutes 4 times per week. Weights r tning exercise is n tp f this. Exercise als helps t imprve energy levels. Yu shuld aim t get yur heart rate up t 100-120 beats per minute. A heart rate mnitr is a gd mtivatr and will help yu t mnitr this. A pedmeter is als a gd idea, aim fr mre than 10,000 steps per day. Dn t frget t chew yur fd well, at least 20-25 times per small muthful and eat slwly. Eating t fast will decrease fd tlerance. Enjy each and every bite! Nikki