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Cowgirl Jane you are one of my favorite ladys to listen to for words of wisdom. Today is a new day and it starts "Right Now" this meal, limit you carb intake and know that when you have alcohol it take 3 days to clear out of your system so you will start seeing the weight loss come back on the scale. Thought a cold beer does sound good it is a treat and you enjoyed it, simple. Dont beat your self up over it. Now that is a new day just get back on track and be encouraged all your hard work will keep you going on the path you were meant to be on!!

In the beginning of Aprill I stopped smoking but started chewing the nicotine gum.I did fantastic while on the gum with not smoking. But the gum gave me extremely severe gastritis.I started refluxing like crazy and had to stop using the gum.Now this is where my challenge started.One must never ever underestimate the power of an addiction.I have gained 6 pounds in the last month.Yes,boys and girls,all of the buffer weight I allow myself is gone,just like that. What is worse I am eating like I have never had the sleeve.Dont ask me how.I just can.I am never uncomfortable.Never feel like I over eat.I think I just pace myself very nicely and keep eating all day long. IT IS ABSOLUTELY CRAZY TO FEEL THIS OUT OF CONTROL AGAIN. My very worried friend brought me the number of a therapist who works with eating disorders and I am going to go and see her.It feels like before the sleeve when I just couldnt stop.I even eat chocolate,which doesnt taste particularly nice to me.BUT I HAVENT HAD ANY NICOTINE (since stopping the gum) in 4 days now.I ama super b***h,have fired my lazy housekeeper,put my kid on a bus instead of a taxi (she refuses to keep a budget) and gave the little one a permanent tv ban during the week.Everyone hates me but feeling like a maniac at least makes me a little more assertive than usual. But this is sooooo hard.I have a huge oral fixation.My life feels empty and sad when Im not able to get a high from something I stuff into my mouth,all the time.Thank goodness I sorted the alcohol thing out with myself as this would have been the perfect crutch now if I didnt make the choice to never drink to much or too often. Anyhow,this is to warn people.Get into that healthy life style.Exercise.See the shrink,deal with your issues or they will deal with you,like mine are now. I am back on my chicken and am not gaining weight anymore.The evenings are just still a challenge as this is when I want to really smoke.I also need to turf this chocolate ganash that I have in the fridge and I will be ok. My aim is to lose this weight in 2 weeks but I will tell this blog when the 2 weeks starts.My imediate goal is to just get over the smoke thing and stay quit.Boy I sometimes just want to say whatever and have a smoke but I know is is just practicing saying no to myself.Something I am not very good at and the reason I got so fat in the first place. So,no!I will not gain more.No,I will not smoke again!No,I will not eat that chocolate (well,maybe a little...lol.)

What about Protein intake, is it higher than carbs? Frequency of your meals? I find if I go over the 3 hour mark, I get ravenous. Alcohol, any stress, any recent illness ? Any new medications? Anything different for you recently, @@cbruce125 ? This post is really helpful, looking forward to more replies.

So i had my initial consultation. So i met my surgeon, my nurse practioner, and dietician, when i asked questions they had answers but since i left i feel like i didnt ask the right questions or not at all. So anyone willing to help me understand some things would be helpful. A lil about me.. 39yrs old, tubes tied after baby #4, im 5'4" and weight is 242.3 currently, but my highest was 302 mom of 4, divorced and now in a relationship for 4 yrs. Was a scrawny child (67# in 7th grade) ate candy/junkfood mostly my childhood, hit puberty gained a bit, met my ex husband and was in high school, began the sedintary lifestyle, began gaining weight and when i got pregnant at 17, i gained 107# in my 1st pregnancy. Never realized how big i was, never looked in a mirror w/ being depressed. Just kept gaining weight after each child, kept trying diets from watching my calories to only eating before 6p, to not eating anything except 1 time a day, i drank tons of water etc... i stopped working to be the stay at home, homeschooling mom after i got pregnant with baby #4. He cheated n i decided enough was enough. He left me and i lost 102# in 3-4 months of being manic depressed. I slowly gained it back after 6 yrs. Not watching what i ate, going back to the workforce, eating everything on the go, fast food, dine in with kids, i am a massive sweet tooth, and i drank easily 100 oz of dr.pepper a day. I have not drank any pop since 9.29.21. I have started cooking my own meals. Portion control is sooo hard, i could eat forever n either not ever get full or eat til i puke or close to it. I smoke 1-1.5 packs of cigarettes a day. Set to have gastric sleeve surgery after the 1st of the year, tbd based on covid rules. My questions are... 1. What am i supposed to weigh before surgery? Is there x# of pounds or bmi im supposed to lose from the time of my consultation til my surgery? 2. What should my end weight goal be? 3. Can i really not have fruit, potatoes, corn, noodles or breads? These are huge things in my list of foods i would go to eat. I am a big sweet tooth n fruit is 1 way i would want to eat healthier. 4. Has anyone ever experienced any big side effects risks or complications? Ones drs dont usually discuss as risks til... bam u have been diagnosed. 5. Anyone know the death rate, complications or big risks being elevated with certain family backgrounds? Example... maternal family with several cancers? 6. What if i start smoking again? 7. What if i consume alcohol? 8. What if i think my 14 yr old needs this surgery? Sent from my SM-N975U using BariatricPal mobile app

1. Some days I can drink more at once than others. I mostly try to spread it out all day. General rule just keep yourself hydrated to the max. It helps with weight loss. 2. That just depends on your body. 3. I usually tell people I had lap band and that has helped my portion control but that I have had to change my food choices for healthier food and that I also work out a lot. Most negative people are jealous or not informed. 4. YOU WILL! Just make sure you're honest with yourself about what you eat. Track your food and exercise so you can see patterns in how you eat & exercise vs weight loss. Everyone is different and small tweaks to your plan help you specifically. 5. There is a port revision surgery available. 6. If you can't handle chicken breasts you could always try something like skinless thighs, however, I personally do not have any issues with any type of food. There have been times I have had issues but it's usually either that time of the month or me eating too fast. 7. I am down 150 lbs so far and even when i have off days I do not gain like I did before the band. You CAN gain but try to stay on top of being honest and really looking at your eating and exercise habits. 8. You CAN have alcohol but you have to think about those empty calories and sugars in it. Plus you really want to keep your cokes to a minimum for the bubbles and acid. PLUS, diet drinks can have the same reaction regular sugar does on the body in the way that it can make you more hungry. Oh and I've found through this process that my major stress relief is a hard work out. REALLY helps the anxiety levels. 9. I haven't had problem swallowing pills, but everyone is different. Not a bad idea to start a chewable. There are TONS of chewable brands out there. I use Bariatric Choice. 10. I am a 38 DDD I think i started out at like a 44/46DDD and My cup size is the same as before I lost weight I have shrunk a lot around. They are saggier even though they take up as much cup space. It really depends on how badly stretch marked your boobs are. Stretch marks are basically scars and they don't have the elasticity that the unscarred skin will have.

How long after surgery did you have your first alcoholic drink, and what was your reaction to it?

My surgeon says no alcohol the first year and after that in moderation. You don't want to take in all your calories through liquid.

So far nothing. I haven't tried alcohol or strangely enough ice cream, but I also haven't had a desire for them yet.

I have ordered 3 sodas since being banded and with all 3 orders I have drank a total of about a 1/2 cup.I am a karaoke junkie and don't drink alcohol so if I go to a karaoke bar that does not have iced tea or lemonade I order a diet coke but usually just sip at it.I don't drink it otherwise but like I said in my previous post I try to keep drink sugar free drink packets.

I looked online and immodium was on the safe list so I took some last night before bed and so far no more problems, although I'm very gurgly in the tummy. I'll probably take some more tomorrow before the flight just to be SAFE. I am kind of in the "screw it" mode right now and I'm wearing yoga pants with a white paint stain on the butt. Comfort over fashion! Oh and no sugar free stuff, believe me I know those sugar alcohols wreck havoc i've only had some broth, tea and unsweetened apple juice since surgery (and some water - oh and gatorade but the issues happened before I took a sip of gatorade) Plus some kind of Maalox type thing to coat my healing stomach.

LAPAROSCOPIC GASTRIC SLEEVE DIET Introduction The following information provides guidelines for you to follow before and after Gastric Sleeve Surgery and for the rest of your life. Gastric Sleeve Surgery is a weight loss tool. After surgery, you will be required to make lifelong changes in your eating habits and to exercise on a regular basis in order to achieve and maintain your weight loss goals. Gastric Sleeve Surgery reduces the size of the stomach which restricts the volume of food that you can consume at one time. This means that you will feel full after eating a small amount. The surgery also induces hormonal changes which help prevent you from feeling excessively hungry. You should avoid drinking liquids with meals. This is to prevent overfilling of the stomach. Frequent snacking or grazing must also be avoided as this contributes to excess calorie intake and can slow weight loss or cause you to gain weight. Exercise is an important component of weight loss success. Exercise is recommended before and after surgery in order to maximize the amount of weight that you lose and keep off. If you have not been an active exerciser, always consult with your physician for clearance and recommendations before beginning any exercise program. It is important to follow the lifetime Gastric Sleeve diet rules, supplement guidelines, and exercise recommendations in order to achieve and maintain optimum weight loss success. In order to begin preparing for surgery, start implementing the pre-surgery diet goals listed on the next page. 4 Pre-Surgery Diet Practice Tips 1. Choose low-fat foods, and avoid fried foods. 2. Stop using sugar. Use sugar substitutes such as Sweet & low, Equal, or Splenda. 3. Decrease intake of Desserts and candy. 4. Stop drinking sugar-sweetened beverages such as regular soda and sweetened Kool-Aid. 5. Start weaning off of caffeine and carbonated beverages. 6. Start cutting back on fast food and eating out. Begin making healthy meal choices when eating out and at home. 7. Eat 3 meals a day. Do not skip Breakfast. 8. Start decreasing portion sizes. 9. Eat more fruits and vegetables. 10. Practice drinking water and other fluids between meals, not with meals. 11. Drink 64 ounces Water a day. 12. Practice sipping liquids. 13. Avoid alcohol. 14. Begin some form of exercise. 15. Review the following information on the gastric sleeve diet. 16. Practice chewing foods thoroughly, 20 - 40 times or to paste consistency. 17. Purchase your protein drinks or supplements. 18. Purchase your vitamin and mineral supplements. 19. Begin planning a schedule for mealtime, fluids and Vitamin and mineral supplements. 5 Post Gastric Sleeve Surgery Diet Important Diet Guidelines: 1. Eat 3 meals per day. Avoid snacking and grazing. 2. Eat small amounts. Initial portion size should be no more than 1 - 2 ounces - approximately 2 - 4 Tablespoons - of food per meal for the first month. At first you may not be able to tolerate this amount. Over time, you will slowly tolerate more volume at each meal. Long term, the stomach will eventually hold about 4 - 8 ounces (1/2 - 1 cup) of food per meal. 3. Eat Protein foods first. 4. Do not try to eat food and drink liquid together. • Consume liquid 30 to 60 minutes before and/or 30 to 60 minutes after eating meals but not during meals. 5. You are required to take a multi-vitamin with minerals for the rest of your life. 6. Eat slowly! • Each meal should last 30minutes or longer. • Avoid gulping foods and drinks. • All foods must be well-chewed to a paste consistency. • Using a small fork or spoon (i.e. baby utensils) can help control portion sizes. • Have one place to eat (such as at the table) and avoid reading or watching TV while you eat. This helps you to enjoy your food, concentrate on eating slower and to realize when your stomach is full. 7. Drink plenty of calorie-free, non-carbonated, caffeine- free fluids between meals . • Drink slowly-sip fluids, never gulp. • Calorie-containing beverages should be limited to skim milk and Protein Drinks. • Limit juice to no more than 4oz. per day. • Consume zero-calorie beverages throughout the day. 6 Diet Progression After Surgery The diet after gastric sleeve surgery progresses through several stages. Your surgeon will let you know when it is okay to progress to the next stage. Day 1 - 2 after surgery: Clear Liquid Diet The clear liquid diet means fluids or foods that are liquid at body temperature and can almost be seen through. You will be on a clear liquid diet while you’re in the hospital. Examples of Clear Liquid Diet (No Added Sugar/ Sugar Free): • Clear (diluted) fruit juices without added sugar: apple, grape or white grape or diet cranberry • Sugar-free Crystal Light drink mix or popsicles, sugar-free Kool-Aid • Herbal tea, caffeine-free tea • flat soda • Sugar-free Popsicles • Sugar-free gelatin • Clear broth • Water ???? It is best to dilute juices by 50% with water. ???? Avoid citrus juices (orange/grapefruit) and tomato juice for the first three weeks. ???? Coffee and de-caffeinated coffee contain acids which are irritating to the stomach lining and should be avoided for the first few weeks for healing. Day 3 through Week 2: Full Liquid Diet The next stage is the full liquid diet which consists of sugar-free, low-fat milk products and the Clear Liquids listed above. You will need to supplement with protein (drinks or powder) after surgery. Remember to sip liquids, do not gulp. Examples of Full Liquid Diet (No Added Sugar/Sugar-Free, Low Fat): • Skim Milk or Lactaid milk • Soy Milk (non-fat) • Low fat, thin, strained cream Soup (smooth, no pieces of food) • Sugar-free instant breakfast • Protein drinks – Start daily when you get home from the hospital. (See section on protein and protein drinks) • Plain or “light” (no sugar added) yogurt with no fruit pieces • Sugar-free pudding or custard • Thinned cream of wheat or rice cereal 7 Week 3 through Week 8: Pureed Diet You may now begin a pureed diet. This includes all items listed for clear and full liquids, and the items listed for the pureed (blenderized) diet. • Eat PROTEIN foods first • Make sure foods are well blended. • Start slowly. If you do not tolerate pureed foods go back to the liquid diet and try again in a few days. • Remember to drink liquids between meals, not with meals. • Continue protein drinks or protein supplements every day. Examples for the Pureed Diet (Sugar-Free/No Sugar Added, Low Fat): Eggs Cheese Pureed or blenderized scrambled eggs or egg substitute or cheese omelet; melted low-fat cheese, low-fat or non-fat cream cheese, ricotta cheese, very smooth/mashed soft cheese such as mozzarella, string cheese, low-fat or non-fat smooth or small curd cottage cheese Meat, Fish, Poultry, Baby food meat or pureed meat or poultry moistened with broth or low-fat gravy Blenderized shrimp, scallops or fish Pureed tuna or salmon (canned in water) or pureed egg salad with low-fat or non-fat mayonnaise Potted meats thinned with broth; smooth deviled ham Starches Unsweetened instant oatmeal (strained), cream of wheat or rice cereal, mashed potatoes or sweet potatoes, smooth polenta, hummus, refried beans; low-fat or baked crackers or chips Vegetables Baby food vegetables or pureed cooked vegetables (no corn or peas) Mashed winter squash, tomato juice or sauce, pureed salsa, marinara Soup Strained, low-fat cream soup made with skim milk; fat-free broth Blenderized lentil or split pea soup or chili Fruit Baby food fruits (bananas, pears, applesauce, peaches, mango, etc) Unsweetened applesauce (smooth) Unsweetened canned fruit – blenderized Unsweetened fruit juice (diluted, no sugar added) Remember: IF YOU CAN CHEW IT, DON’T DO IT! 8 Tips to Get Started Everything that you eat on the pureed diet should be sugar-free or no sugar added, low fat and blended to the consistency of baby food or smooth applesauce. • You will need a blender or food processor or you can purchase baby food. • Start with 1 ounce (2 Tablespoon) portions - no more than 4 Tablespoons at the most. Listen to your body and stop eating as soon as you feel full. • Eat protein foods first. Then if you are not too full, try vegetables or fruits. • Continue protein supplements (80 g protein per day from supplement). Helpful Hints for Blenderizing • Cut foods into small pieces before putting into the blender or food processor. • Remove seeds, skins and fat. • Add liquid for ease of blending. Add enough liquid to cover the blades. Options include skim milk, broth, strained low-fat cream soup, low-fat gravy, low-fat or non-fat sour cream or fat-free half & half. • Blend the item to a smooth, applesauce consistency. • Make sure there are no particles, seeds or lumps remaining. If so put through a sieve or strainer. • If you have leftover blenderized foods, try freezing in single serving portions in ice cube trays and put the frozen cubes into plastic freezer bags. Meats – Very lean and dry meats puree better by adding a small amount of fat (margarine, oil, light mayonnaise, gravy, etc.) Fish also tends to be dry. Improve the texture by adding small amount of lemon juice, light mayonnaise or strained low-fat tartar sauce. Starches – Try pureed peas, canned Beans, sweet potatoes. Starches puree better when hot. Rice and potatoes tend to puree into a gummy paste and are not recommended. Substitute cream of rice Cereal prepared with a flavorful broth and seasoned with margarine. Pasta or noodles are not recommended as they are not well-tolerated. Vegetables – Cook vegetables until soft. If using canned vegetables, drain first. Add melted margarine and puree. Add a small amount of liquid until it reaches the smooth applesauce consistency. Fruit – If using canned fruit, drain first. Add a few drops of lemon juice to help prevent them from discoloring. Begin to take advantage of your favorite leftovers before surgery. Process these foods, and freeze them in an ice cube tray. (Each cube is approximately 1/2 to 1 ounce). When frozen, pop out into Zip-lock bag; label and date, and freeze cubes until needed. 9 Meal Guidelines for the Pureed Diet (See Sample Pureed Meals listed in the Appendix) Once you begin to eat pureed foods (which are considered solids) you will want to start differentiating between liquids and solids – meals should include pureed foods, and so liquids (including protein drinks) should be taken separately from your meals. • You should eat 3 meals a day with protein drinks between meals. • Protein drinks containing at least 20 grams of protein per serving should be consumed as needed to meet 80 g/day goal. • Start with a portion size of 1 to 2 tablespoons of pureed food for the first month. At first you may not be able to tolerate this amount. Eat your protein source first, and then if you have room a small amount of fruit, vegetables or other foods may be consumed. Hints for Measuring Foods: Liquids or soft/pureed foods are best measured in measuring cups or spoons; they can be measured in ounces, Tablespoons or mls. 1 cup 8 Fluid ounces 240 ml 16 tablespoons 3/4 cup 6 fluid ounces 180 ml 12 tablespoons 1/2 cup 4 fluid ounces 120 ml 8 tablespoons 1/4 cup 2 fluid ounces 60 ml 4 tablespoons 1/8 cup 1 fluid ounce 30 ml 2 tablespoons 1 Tablespoon = 3 teaspoons 1/2 Tablespoon = 1-1/2 teaspoons Week 9-12 After Surgery: Soft solid food Diet If you have been tolerating pureed foods, you may now begin a soft diet. This includes all items listed for clear and full liquids and pureed diets plus items listed for the soft diet. Try 1 to 2 new foods a day. This will help you to learn what foods you tolerate. • Remember your stomach pouch empties more slowly with more solid or dense foods than with liquids, so you will be able to tolerate a smaller quantity of food than you could with liquids . • Go slowly. If you do not tolerate the trial of soft foods, resume pureed foods and try again in a week. • Eat protein foods first • Avoid foods high in sugar and fat. • Space meals 4-5 hours apart • Continue your protein drinks between meals • Drink other fluids constantly between meals 10 Examples of Soft Diet (No Added Sugar/Sugar-Free, Low Fat): • Baked fish (no bones) • Imitation crab meat, baby shrimp • Bananas • Canned peaches or pears in water or juice • Well-cooked vegetables without seeds or skin (no corn or peas) • Scrambled, poached or hard boiled eggs • Tuna or egg salad (no onions, celery, pimientos, etc.) • Finely shaved deli meat • Baked, grilled or rotisserie chicken o Moist foods will be better tolerated. Moisten meats with broth, low fat mayonnaise, or low-fat gravy or sauce. o Fish and seafood Proteins are softer and easier to break down than poultry or red meat proteins. o Reheating foods tends to make them dry out and hard to tolerate. Common Problem Foods (Avoid for 3 months after surgery) • Red meat such as steak, roast beef, pork. Red meat is high in muscle Fiber, which is difficult to separate even with a great deal of chewing. Avoid hamburger for one month after surgery. • Un-toasted bread; rolls, biscuits. (Toasted bread may be better-tolerated.) • Pasta • Rice • Membrane of citrus fruits • Dried fruits, nuts, popcorn, coconut • Salads, fresh fruits (except banana) and fresh uncooked vegetables, potato skins. Month 4 After Surgery: Regular Diet • Problem foods as listed above can now be tried. • Rice, pasta and doughy bread may not be tolerated for 6 months or more. • Try fresh fruits without the skin first. If tolerated, the skin can be tried the next time. Salads are generally well-tolerated if chewed well. • Go slowly. Try a small amount to see how you feel. • Avoid high sugar and high fat foods to avoid a high calorie intake. 11 Foods to Avoid : Hard/crunchy foods may always be poorly tolerated. Nuts and seeds are difficult to break down. Fried foods/greasy foods are hard to digest and are very high in calories. • Corn chips, potato chips, tortilla chips, hard taco shells • Nuts and seeds • Fried foods and greasy foods Points to Remember: • Solid foods will fill your stomach pouch more than liquids so you will be eating smaller quantities of foods versus liquids. • If you don’t tolerate a food the first time, wait a week and try again. • You may find that you tolerate a certain food one day and not the next. It is normal for this to happen. • If you don’t tolerate certain foods or notice nausea, vomiting or diarrhea during or after eating, ask yourself the following questions: o Did I chew to a paste consistency? o Did I eat too fast? o Did I eat too much volume? o Did I drink fluid with my real meal or too close to my meal? o Did I eat something high in sugar or fat? o Was the food moist or was it too dry? Steps for adding solid foods: • Try only 1 small bite of the new food and chew well. Wait awhile and if there are no problems, take another bite. • If at any time you feel too full, nauseated or vomit, stop eating and rest. Take only clear liquids at the next meal and add blended foods and liquids at the following meal. Try one solid food again the next day. 12 PROTEIN Protein is the most important nutrient to concentrate on when resuming your diet. Because the volume of your meals will be limited, you should aim for a minimum of 80 grams of protein per day – this needs to come from your protein supplement . Why is protein important? • Wound healing • Sparing loss of muscle • Minimizing hair loss • Preventing protein malnutrition Remember to eat protein foods first at each meal, followed by vegetables and fruit. These are some good sources of protein: Protein Sources Serving size Protein (g) Skim or 1% milk 1 cup 8 Evaporated skim milk (canned) 1 cup 19 Soy milk beverage 1 cup (8 ounces) 7 Non fat dry milk powder 1/3 cup powder 8 Nonfat, sugar free yogurt 1 cup (8 ounces) 8 Nonfat or low fat cottage cheese ½ cup (4 ounces) 14 Nonfat or low fat cheese slices String cheese *1 ounce/ 1 slice 6 LEAN meats – skinless chicken or turkey breast, fish, beef, ham, Deli meats *1 ounce 7 Egg or Egg substitute 1 egg or ¼ cup subst. 7 Peanut Butter (creamy) 1 Tablespoon 5 Tofu ¼ cup 5 Legumes; dried beans peas or lentils Chili, bean soup ½ cup cooked ½ cup 7-9 6-7 Soy/vegetable patty (like Gardenburger) 1 patty 8 - 10 Hummus ½ cup 6 Measuring Hints: *1 ounce of meat is equal to about 3 – 4 Tablespoons of chopped or ground meat. 1 ounce of grated or cottage cheese, tuna or egg salad is ~ 1/4 th cup (4 Tablespoons). A 3-ounce portion size of chicken or meat is about the size of a deck of cards. 13 High Protein Ideas Chicken or Turkey Pureed – Use baby food or make your own. Try mixing it into strained low-fat cream soup. Breast – baked or grilled Thin-sliced/shaved deli slices Ground – meatballs, meatloaf Canned – works great for chicken salad Strained out of canned soup – tends to be very moist Fish (avoid bones) Baked, broiled, poached, or grilled fish Shrimp Imitation or regular crab meat Fresh or canned salmon in water Canned tuna in water Sushi Beef or Veal (Extra Lean) Ground – meatballs, meatloaf Pork Shaved deli ham Eggs or Egg substitute Scrambled eggs or omelet Homemade eggnog made with skim milk, sugar-substitute Diet custard Egg salad Quiche or frittata Deviled eggs Low-fat Dairy Products Milk (skim or 1%) Yogurt (plain or no-sugar added) Low-fat cheeses including cottage cheese, string cheese, ricotta, or any other cheeses which are reduced-fat or non-fat. Legumes Peanut Butter – smooth Dried beans or lentils – or Soups, stews or chili made from these Hummus Vegetarian or fat-free refried beans Tofu 14 Protein Supplements ???? Because of the limited volume capacity of the stomach, it will be nearly impossible to meet your protein needs from food sources for up to a year after surgery. ???? You will need to consume a protein drinks to get a total of 80 g protein per day – This would be 2 protein drinks with 40 or more grams per serving, or 4 servings of a protein drink with 20 grams of protein per serving. ???? Once off of the liquid diet, it is best to consume your protein drinks between meals, rather than as a meal. How to choose a protein supplement: • Review the label to find a product that is high in protein, low in carbohydrate or sugar and low in fat. • Choose a product with at least 20 grams or more of protein per serving. • Whey protein is preferable, especially whey protein isolate. • Choose a product that is low-sugar or sugar-free and sweetened with sugarsubstitutes such as Nutrasweet (Aspartame) or Splenda (Sucralose) or Acesulfame K. The sugar content listed on the label should be no more than 6 grams per serving. • Avoid drinks such as Ensure, Boost, or Slim Fast. They tend to have a lot of carbohydrate and fat compared to pure Protein Powder mixed with skim milk or water. • Choose a product that is low fat: no more than 3 grams of fat per 100 calories. (For example, Atkins shakes tend to be too high in fat and are not recommended). Where to purchase protein drinks: • GNC • Super Supplements • Trader Joe’s • Fred Meyer • Wal-Mart • Rite-Aid • Walgreen’s • Grocery store pharmacies • On-line (www.Bariatriceating.com) 15 Commercial Protein Supplements Unjury (Flavored or Unflavored powder). 20 grams of protein per scoop. Mix with 6-8oz. skim milk, water, or yogurt Order at www.UNJURY.com or (800) 517-5111 or (703) 925-9390 Check the websites for recipes using Unflavored unjury protein powder. Optimum 100% Whey Protein 1 scoop powder = 24 grams protein Zero Carb Isopure 2 scoops powder = 50 grams protein Available at GNC Met-Rx Protein Plus Whey 2 scoops powder = 46 grams protein Designer Whey Protein Supplement 1 scoop powder = 17.5 grams protein Available at Rite-Aid, Super Supplements EAS 100% Whey Protein 2 scoops powder = 23 grams protein Zero Carb Isopure Ready to Drink 40 grams protein per 20 ounces serving Fruit flavors (clear liquid) EAS Myoplex Carb Sense Ready to Drink Liquid product 25 grams protein per serving MetRxUltra Pure Protein Shake (Ready to Drink) Liquid product 35 grams protein per 11 oz. Worldwide Pure Protein (Ready to Drink) Liquid product 35 g protein per 11 ounces (Available at Trader Joe’s, most large drugstore/pharmacies) Cytosport Protein Pure Performance Drink 40 g protein per 20 ounce bottle Tangerine and Watermelon flavors, clear liquid Available at NW Prescriptions 16 These products are available from Bariatriceating.com: (This website has a large selection of protein powders and ready to drink products. Check the website frequently for availability.) Micellar Milk Ready to Drink 40 g. protein in a 17 ounce serving New Whey Liquid Protein “Bullets” 3 ounce plastic container – 42 g protein, 2 g carbs Orange, Grape or Fruit Punch flavors AchievOne – Ready to drink (contains coffee) 20 g protein per 9 ounce serving Whey Gourmet 23 grams protein per scoop Comes in 12 flavors Nectar 23 grams protein per scoop Also available in single scoop packets Any Whey Tasteless Protein 17 grams protein per small scoop Add to soups, chili, eggs, etc. IsoFruit Delite Protein Cocktail Refreshing Cantaloupe or pineapple flavored 21 grams protein per scoop Matrix Protein 23 grams protein per scoop Elite 22 grams protein per scoop IDS 23 grams protein per scoop Protein Delite on the Go (plastic bottle with pre-filled powder) (contains dried fruit or chocolate bits) 25 grams protein in 8 ounces Additional ideas for adding protein to foods: 17 • Non-fat dry milk powder can be added to milk, hot cereal, cream soups, mashed potatoes, or casseroles – 1/3 cup powder = 8 g protein. • Egg white powder – can also be added to foods as listed above. Adds approximately 6 grams protein per 2 Tbsp. (check label protein content may vary by brand.) Sold at the grocery store (in the baking section). Hints to add variety to your protein drinks: • Flavor extracts or spices that do not contain sugar can be added to protein drinks for flavor. Examples: vanilla or almond extract, cinnamon or nutmeg. • Sugar-free cocoa powder can be added to provide a chocolate flavor. • Instant decaffeinated coffee can be added to drinks or yogurt for a flavor change. • Sugar-free Tang can be added to vanilla drinks to create an orange creamsicle flavor or try adding to an unflavored Protein Drink. • Sugar Free Kool-Aid or Crystal Light powder can be used to flavor protein drinks • Sugar-free syrups can be added to flavor protein drinks • If a drink tastes too thick or too sweet try adding more milk or water. • Mixing with milk provides additional protein and Calcium. • Try freezing your protein drinking after preparing. This can be consumed with a spoon as a frozen treat. Also can be made into “popsicles”. • Try adding ice to the prepared protein drink and blenderize to make a slushy. • Try mixing your protein powder with plain or sugar-free vanilla yogurt. • Try mixing protein powder into sugar-free Gelatin (before it is set). 18 Daily Vitamins and Minerals You are required to take the following vitamin and mineral supplements every day for the rest of your life. Taking a vitamin and mineral supplement is vital to maintain your nutritional health and prevent vitamin and mineral deficiencies. You are now at greater risk for decreased absorption of vitamins and minerals because you are eating a significantly smaller amount of food in a day. o All pills must be crushed, chewed or liquid for the first month after surgery or as directed by your physician. Multivitamin with Minerals (Start the first day that you get home from the hospital). First 6 weeks following surgery • 2 children’s complete chewable Multivitamins with minerals or 2 adult chewable multivitamin/mineral supplements to provide twice the adult RDA. • Take with meals, one in the morning and one in the evening. • Examples: One A Day Children’s Complete, Flintstones Complete. Centrum Children’s Complete, or Centrum Chewable for adults, Kirkland (Costco brand) chewable multivitamin Week 6 after surgery • Decrease to 1 multivitamin with minerals tablet daily for the rest of your life. • Take with a meal. • If the multi-vitamin/mineral supplement makes you nauseous, do not take it on an empty stomach—take it with food or at night. 19 Fluids • Do not drink liquids ½ - 1 hour before, during, or ½ - 1 hour after meals. Drinking liquids with meals or too close to mealtime may cause bloating, nausea, or vomiting. It is best to drink a lot of liquids between your meals • Fluid intake is very important for prevention of dehydration and constipation; adequate water is essential to help rid the body of waste, maintain proper muscle tone and prevent sagging skin. • Sip on water all day between meals. A water bottle with a sport top is a good way to get small sips of water and to avoid gulping. Sucking on ice will also help with fluid intake. • Your initial fluid goal should be a minimum of 4 cups (32 oz. or one quart) of caffeine-free, sugar-free fluid per day. At least half of this should be from water. You should be able to consume this amount within a few days after surgery. Gradually, you want to increase your fluid intake to at least 8 cups (64 oz.) a day. • Do not use a straw. This can cause your stomach to fill with air, causing distention, gas and bloating. • Try varying the temperature of liquids for variety and tolerance. • Most fluids should be non-caloric such as water, Crystal Light, sugar-free Kool- Aid, decaf coffee, unsweetened or artificially sweetened tea, or broth. Avoid all sugar-sweetened beverages. • Fruit juice should be 100% fruit juice with no sugar added. Limit to no more than 4 oz. per day and dilute with 4 ounces of water. • Limit caffeine to no more than 4 ounces per day. • Avoid carbonated beverages and sodas. Flat (diet) soda may be better tolerated. • Avoid alcoholic beverages. They do not have any nutritional value and may cause weight gain and/or liver damage. 20 Sugar and Fat Foods high in sugar and foods high in fat should be avoided due to the high caloric content. Consuming high calorie foods can slow weight loss and even cause weight gain. Be careful to avoid soft calories. Soft calories are foods or liquids that are high in calories and easily tolerated (soft or liquid). This includes items such as chocolate, ice cream and high calorie liquids such as milkshakes, regular soda or soft drinks, sweetened drinks, and alcoholic beverages. Avoid sugar (this also means honey, syrup, molasses and other caloric sweeteners), and foods high in sugar or with sugar added, such as candy and sweets; baked goods such as cookies, brownies, doughnuts, cake, pastries, pie, cobbler; frozen desserts such as ice cream, sherbet, sorbet, frozen yogurt, milkshakes; sweetened cereals; fruit canned in syrup; regular jams, jellies and preserves. Fats High fat foods should be avoided because they are very high in calories. • Avoid fried foods. Remove all visible fat and skin from meats and poultry. • Avoid fast foods. • Choose low fat or fat free products. • Avoid high fat dairy products such as whole milk, full fat cream, cheese or sauce. • Avoid high fat pastries, donuts and desserts. • Avoid high fat meats such as bacon, sausage and hot dogs. • Limit added fats such as butter, margarine, lard, regular mayonnaise or spreads, and regular salad dressing. Try the fat free or low fat alternatives. • Avoid “snack foods” such as potato chips, tortilla chips, cheese curls. You need to eat some “healthy fats” daily (for example, vegetable oils such as olive, canola or soybean; nuts or nut butter, or avocado). However, since they are so high in calories, they need to be limited to no more than 2 – 3 teaspoons total per day. 21 Possible Complications Nausea/Vomiting This is often caused by eating too much – taking too big of a bite, eating too fast, not chewing well enough or drinking liquids with solid foods. It can also be caused by lying down after meals, or eating foods that may not agree with you. Be sure to eat in a slow, calm manner. • Call your doctor if you are having frequent or persistent vomiting. Hair Loss Hair loss is a side effect of weight loss surgery. You may not see hair loss initially due to the time it takes hair to grow from the root. You will see hair loss or breakage as the hair grows through the scalp. Often it takes several months after surgery for hair loss to show; and several more months for you to see the hair start growing back. Hair loss can occur from a low protein and zinc intake, and a severe decrease in overall nutrition intake. You must take in a minimum of 70 grams of protein per day. Adequate protein intake may help reduce (but not prevent) hair loss. If protein intake is meeting the minimum recommended guidelines and hair loss continues to be bothersome, you can try supplementing with zinc (no more than 50 mg per day.) Ongoing hair loss can also be a sign of iron-deficiency anemia. Constipation Constipation after surgery is common, but can be prevented. It is usually due to a decreased intake of fiber-containing foods; also, Iron in the Multivitamin supplements can be constipating. Tips to prevent constipation • Drink plenty of fluid -- a minimum of 8 cups (64 ounces) per day. • Exercise regularly. • Try baby food prunes or unsweetened diluted prune juice or oatmeal. When you are allowed to resume regular foods, you can start eating high fiber foods such as high fiber cereals (3 or more grams of fiber per serving), fresh fruits, fresh vegetables and legumes. • Add high-fiber foods gradually • Chew all fiber-containing foods very well. • Drink plenty of fluids when increasing fiber in the diet. If constipation persists, try a daily fiber supplement. Inulin-based soluble fiber supplements such as Fiber Sure are less prone to cause bloating. * If constipation continues, call your doctor; do not take laxatives without consulting your doctor first. 22 Key Points to remember 1. You may never be able to eat the portions you consumed prior to surgery. 2. For a safe weight loss, you need to eat a healthy, well balanced diet. 3. Be sure to make healthy food choices to obtain the most nutrition per serving. 4. Choose low-calorie, nutrient-dense foods. 5. Be patient. At first, you will fill up after just a few bites. This is normal. Stop eating when you feel full. 6. Initial meal size should be approximately 1 – 2 oz. (2 - 4 Tbsp) per meal, 3 meals per day. Volume tolerance will increase after healing (usually about 2 to 4 ounces). Continue to eat slowly, chew foods thoroughly and drink in-between meals. 7. When you try a new food, take one bite to see if it is comfortable for you. 8. You must take the recommended multivitamin/mineral supplement every day for the rest of your life. 9. You should consume protein drinks or supplement with protein powder until your protein intake from foods is adequate. 10. Following the recommended diet rules will help you to lose weight and keep it off. 11. Your dedication to diet, exercise and lifestyle changes will dictate your success after surgery. 12. You can defeat the surgery, resulting in weight gain. 13. Grazing, drinking fluid with meals, or consuming high calorie foods or liquids are examples of ways that the surgery can be defeated. 14. Keep a food and exercise diary. Record the time of meals, food consumed, portion size and preparation method. (You may be asked to bring a food and exercise diary to your surgeon and/or dietitian visits.) 15. Attend Bariatric Support Group meetings on a regular basis before and after surgery. 16. Exercise regularly and follow your doctor’s orders or restrictions when exercising. Continue to follow the guidelines provided throughout this education packet. You have been provided the tools necessary to achieve and maintain a healthy weight loss. 23 Checklist : The following tasks should be completed before surgery: ___ Purchase supplements: ___Protein Supplements – try to have a variety of ones you like ___Multivitamin/mineral supplement ___Any needed equipment (see Equipment Checklist in Appendix) ___Any other foods and beverages you will need during the liquid and blenderized phases of the diet (Review diet sections) ___ Prepare some pureed foods to be used after surgery ___ Complete Meal, Supplement, and Exercise Schedule (see example in Appendix) ___ Keep working on these behaviors to make them become habits: • Practice eating meals without liquids • Practice taking small bites and chewing thoroughly • Pay attention to what you are doing while you are eating • Try to make your meals last at least 30 minutes • Sip fluids slowly – do not gulp! • Begin to wean yourself from caffeine • Find alternatives to coffee and sodas • Do not chew gum • Do not use straws • Find ways to incorporate 30 minutes of activity into your daily routine. Resources: The following websites are highly recommended: www.bariatriceating.com www.obesityhelp.com These books may be helpful: Exodus from Obesity – The Guide to Long-Term Success After Weight Loss Surgery by Paula F. Peck, RN Eating Well after Weight Loss Surgery by Patt Levine and Michele Bontempo-Saray Websites for calculating calorie and protein intake: www.fitday.com www.sparkpeople.com 24 Appendix: Equipment Check List The following is a list of helpful items to consider. For your Dining Pleasure: ___ Baby Spoon, Cocktail Fork (Helps you to take small bites) ___ Small Decorative Plates (Helps control portions and increases the eye appeal of the meal) ___ Insulated dish or warming plate (Helps keep food warm while you slowly enjoy your meal) ___ Sippy Cup (For those that have difficulty with gulping liquids) ___ Water bottles with a sports top (Re-use to carry other sugar free, non-carbonated beverages with you Other ideas – candles, new placemats, and fresh flowers to create a pleasurable eating experience at the table… For Meal Preparation These are vital pieces of equipment: ____ Mini food processor/food chopper ____ Hand Blender or the “Magic Bullet” (available at Walgreen’s) ____ Measuring spoons and cups ____ Small kitchen scale These are very helpful: ____ Extra ice Cube Trays ____ Small Freezer bags ____ Permanent Marker or freezer labels ____ Small plastic containers OR ____ The Food Saver (to vacuum pack foods) (A $100 investment, available at Wal-Mart) For Medications: ____ Pill Crusher ____ Pill Splitter ____ Large pill case (1 week’s worth) 25 Appendix: Pureed Diet Sample Meals: The following are ideas for pureed meals. Each meal consists of about ¼ cup. Use your own creativity to add variety to your diet. Spices and seasonings are not limited after surgery. Remember to make each of your 3 daily meals protein-based and include the essential fats (i.e., margarine, mayonnaise, oil) in your food preparation. Example 1: 2 Tbsp of a pureed cheese omelet made with Eggbeaters 1 Tbsp hot cereal 1 Tbsp sugar-free or plain yogurt Example 2: 2 Tbsp blended low fat cottage cheese 2 Tbsp pureed fruit (i.e., applesauce, peaches, pears or baby food fruit) Example 3: 1 Tbsp smooth peanut butter 2 saltine crackers 1 Tbsp pureed fruit (banana) Example 4: 2 Tbsp grated cheese 1 Tbsp polenta 1 Tbsp pureed roasted vegetables or marinara sauce Example 5: 2 Tbsp fat-free refried beans or hummus 2 baked tortilla chips 1 Tbsp grated cheese; garnish with pureed salsa and low-fat sour cream Example 6: 2 Tbsp mashed tuna or salmon salad made with 1 tsp light mayo 2 low-fat crackers 1 Tbsp pureed fruit or baby food fruit Example 7: 2 Tbsp mashed/smooth egg or chicken salad made with 1 tsp light mayo 2 low-fat crackers 1 TBS pureed fruit or diet pudding Example 8: 3 Tbsp ricotta cheese 1 Tbsp marinara sauce 1 Tbsp pureed roasted vegetables Example 9: 2 Tbsp pureed turkey or chicken with 1 tsp gravy or broth 1 Tbsp mashed potatoes or sweet potatoes 1 Tbsp pureed vegetable or fruit Example 10: 2 Tbsp pureed crab or lobster with 1 tsp light mayonnaise Sprinkle with Old Bay Seasoning 1 Tbsp pureed acorn squash 1 Tbsp pureed fruit Example 11: 2 Tbsp pureed chili 2 Low fat crackers 1 Tbsp diet pudding 26 Appendix: Meal Schedule Example Sample: Your Schedule: Time Meal/Supplement Or Vitamin Time Meal/Supplement or Vitamin 7:00 – 7:30 Meal 1 Multivitamin 8:15 Start Fluids 9:00 Walk 15 minutes 10:00 Protein Supplement 11:15 Stop Fluids 12:00 – 12:30 Meal 2 1:15 Start Fluids 3:00 Protein Supplement 4:15 Stop Fluids 5:00 – 5:30 Meal 3 Multivitamin 6:15 Start Fluids 7:00 Walk 15 minutes 8:00 Protein Supplement Daily Goals: Drink a minimum of 64 ounces of fluid. Sip fluids between meals Walk for 30 minutes Eat 3 meals and Protein Shakes to meet protein needs Supplements: Multivitamin – 2 chewables daily with meals (after 6 weeks, may use 1 tablet per day, cut small) Reminders: Meals should be 4 to 5 hours apart Do not drink 30 – 60 minutes before, during or 30 – 60 minutes after a meal No alcohol No carbonated beverages No caffeine No acidy or citrus juices/foods/beverages for first month 27 BEHAVIOR MODIFICATION TECHNIQUES 1. Don’t eat in front of the TV. 2. Don’t read while eating. 3. Pre-portion your food and put the box or package away. 4. Keep tempting foods out of the house. 5. Don’t go to the grocery store hungry. 6. Make a shopping list. 7. Use smaller plates and bowls. 8. Keep healthy foods available. 9. Focus on activities other than eating. 10. Brush your teeth after meals or if feeling the desire to eat. 11. Don’t eat standing up at parties or buffets. 12. Don’t stand at the food table at the parties. 13. Offer to bring a healthy food item to a party. 14. Park your car far away from your destination. 15. Get up to change the TV channel instead of using the remote control. 16. Take the stairs instead of the elevator. 17. Keep a food and exercise diary.

I would definitely go easy on alcohol the night before, just because anesthesia alone could make you sick at your stomach. A hangover on top of that??? Oy.... Also, You'll be having lots of gas anyway, post op. If you stuff yourself the night before, this could only add to that. Gas will be your biggest discomfort, most commonly. Welcome and good luck with your surgery!

Pretty thick, what happens when you have alcohol, if you don't mind me asking. Symptoms like I am describing? Thank you! Me too.

I know I don't need to drink and I plan on making good choices. I just know it will be a little bit hard when everyone else is drinking and eating and I'm sorta sitting there. I was told carbonated drinks are out and the only carbonated drink I have is beer....so non-alcoholic beer won't work. I was also told that you cannot gulp water...that you have to sip and you cannot use a straw? This is from NUT clases. The most important thing to me is that I am successful with this band. I am not happy or healthy being obese and able to eat/drink everything so I am going to have to make lots of changes. I appreciate the suggestion for drinking the protein drink, etc. My life will be changing in so many ways. :-) It's all good! Thanks for all of your replies!

Find out when your doc clears you to drink. Alcohol is empty calories so just keep that in the back of your mind. Also crossover addiction is a concern. But one night after doc clears you probably won't be too risky. Beer may make you feel bloated, but it wouldn't stretch your stomach. If any excess gas is stuck you will burp it out just like pre-op. With the fundus removed, the stretchy part is gone. Alcohol on a fresh cut probably doesn't feel too good. So at least six weeks. But again ask your surgeon.

I have a concert at the end of July and my surgery is end of June how long before you can have a glass of wine ? Not sure if I will ever want to have another drink after the surgery bit I'm just curious

No judgement here. You have the instructions from your surgeon but, if you go out and have drinks (I'm guessing alcohol) and Mexican food will that throw you off track mentally?

"Hi! My name is Lynn B and I am a Diet Coke-aholic!" They say that the first step to overcoming an addiction is to admit that you have an addiction? Well, I am addicted!! A full fledged addiction. I'm an addict! I absolutely LOVE the feeling of the sweet taste complimented by the extra ordinary fizzy bubbles, which go through the body... the feeling of the fizz rushing throughout me, is a high in itself. I'm in heaven. It all started years ago when with just 1 can of Diet Coke. Ironically, I disliked the taste and the fizz. But, it was a 0 calorie drink - a way to lose weight. (It worked - for a while.) One can grew to approximately 1-2 cases a day of 12 oz cans. I admit, It's horrible, but at that time the taste grew on me with each pound that I lost. I quickly graduated to the "hard stuff" ... the 20 oz icy cold bottle of pure fizz! One sip is so exhilarating - only the bottle can give you this immediate rush! That first sip the fizz is so extreme, I can feel it coursing throughout my whole body. I love the feeling and, cant do without. I can identify with an alcoholic or drug addict... I am a Diet "Coke" addict!!! I admit it, I carry my 20 oz bottle with me everywhere I go. I even carry it in my pocketbook for a quick fix! No matter where I am I have access to my 20 oz bottle... And when I run low, I rush to the nearest store for more. My surgery is in less than 8 days... Yes... E-I-G-H-T Days!!! I've actually weaned myself down to only one 20 oz bottle a day. I actually thought this was such an accomplishment! But, the reality... I'm sweating with fear! I'm in panic! My gastric-by-pass new "tummy" will not tolerate this drug of choice. I will hurl over in severe pain with just a little tiny sip of fizz... I will have to go "Cold Turkey"! HOW!?? And, then comes the withdrawal. How will I survive?! How do I get through this? I need help! I need suggestions! I have to do this! Where is "DCA" (Diet Coke Anonomous) when you need it most? Help me!

I would suggest staying away from Sugar free! Although youth think its " sugar fee " itore than likely is loaded with sugar alcohol. Sugar free candy makes me dump believe it or not so I make sure I stay away from that stuff. Try not to start on the chocolate or chips again! I now on a carb free, sugar free diet to break my sugar addiction. My goal is 20 lbs by the end of the summer. I keep telling myself that every 5 lbs is a bag of sugar (lol how ironic)

Eat slowly and chew thoroughly Food can pass through the new stoma only of it has been into very small pieces. Always remember to take more time for your meals and chew your food very well. Stop eating as soon as you feel full Once your stomach is full, your body receives a signal that you have eaten enough. It takes time, though, for you to become aware of this signal. If you rush through your meal, you may eat more than you need. This can lead to nausea and vomiting. Take time to eat you meal. Try to recognize the feeling the fullness - then stop eating at once. Do not drink while you are eating This operation can work only if you eat solid food. If you drink at mealtimes, the food you have eaten becomes liquid and the effectiveness of the LAP-BAND System is greatly reduced. You should not drink anything for one to two hours after a meal. This allows you to keep the feeling of fullness as long as possible. Do not eat between meals After a meal, do not eat anything else until the next meal. Eating snacks between meals is one of the major reasons for weight-loss failure. It is very important to break this habit. Patients with proper "fill" levels do not feel hungry in between meals. If you are, this may be a sign that your band is too loose and you should tell your clinician. Eat only good quality food With the LAP-BAND System in place, you should be able to able to eat only a small amount so the the food you eat should be as healthy as possible. Do not fill your small stomach pouch with junk food that lacks vitamins and other important nutrients. Your meals should be high in protein and vitamins. Fresh vegetables, fruit, meat and cereals are good foods to choose. Foods high in fat and sugar are not. You may eat apples and oranges, but try to avoid orange juice and and apple juice. Ask your doctor or dietician before you take any vitamin supplements. Avoid fibrous food Food such as asparagus that contains many fibers can block the stoma. That's because you can't chew this food well enough to break it up into small pieces and your saliva can't break it down. Fibrous food should be avoided. If you would like to eat asparagus or other fibrous foods once in a while, then you must be sure to cook them well, cut them into very small pieces and them chew them thoroughly. Drink enough fluids during the day If you lose weight, your fat content will drop. This results in waste products. You will need to drink large amounts of liquid every day in order to urinate more and excrete these waste products from your body. Individual needs will vary, but you should drink at least 6 to 8 glasses of water a day. Drink only low-calorie liquids. Drinks, including those containing calories, simply run through the narrow outlet created by the band. If you drink liquids high in calories, you will lose little weight, even if you otherwise follow your diet. Exercise at least 30 minutes a day This rule is just as important as the other nine rules. Since physical exercise consumes energy and burns calories, it is very important to successful weight loss. Exercise can help improve your general health. Your size may make it hard for you to exercise as much as you should. But get started, even if it is a little at first. The more weight you lose, the easier it should get. Start with simple exercises such as walking and swimming. Gradually expand you program to include more vigorous forms of exercise such as cycling, jogging and aerobics. Increase your activity level in the course of daily living. For example, stand rather than sit, walk rather than stand, be outside rather than inside, walk rather than drive, climb the stairs rather than use the elevator, etc. Remember you should always check with your doctor about the amount and type of exercise that is best for you. Food Choices Use this section to help you plan what you eat. you may choose what you would like from each of these food groups on a daily basis: Fruits and vegetable 1 to 2 servings of fresh fruit daily 2 to 3 servings of fresh vegetable daily Bread and Cereals 1 small portion of corn flakes for breakfast 1 to 2 slices of whole wheat or rye bread each day Meat, Fish, Poultry, Eggs 1 oz. to 2 oz. of meat, fish or poultry or one egg each day (remove all visible fat from the meat. remove the ski from poultry. Grilling, steaming, microwaving or boiling are best ways to prepare them with low fat). Dairy Products Milk and yogurt are calories in liquid form. In theory, then, they should be avoided. But these types of food have calcium. That makes them an important part of a healthy daily diet. Choose a maximum of 2 cups of skimmed milk or low-fat yogurt and 1 oz. of cheese a day. Fats Restrict the use of fat to 3 to 4 teaspoons of margarine, butter or oil per day. You can have low-fat salad dressing and mayonnaise in moderation. Drink as many calorie-free liquids per day as you wish. Suitable drinks are: Tea or black coffee with low-calorie sweetener Water Non-carbonated beverages containing few or no calories Clear soup Note: Some doctors have reported that carbonated beverages may contribute to enlargement of the small pouch and should be avoided. Foods to Avoid Some foods have a concentrated supply of calories with little nutritional value and should be avoided as much as possible. They include: Sugar and foods containing large quantities of sugar, such as: High-calorie soft drinks Syrups Cakes Biscuits Sweets Jam Marmalade Honey High-fat foods including: Chocolate Pies Chips pastries Alcoholic drinks should also be consumed in moderation

they should fall off on their own in about 2weeks, if they have not gently remove them, by that time they should be lifting a lot so it wont be hard. As long as they are bleeding or puss coming out of them, it would be okay to remove them yourself. I was just like you. I called my doctors office twice because i was so anxious. Also, when you take them off there will be alot of sticky tape around the incisions. soap and water wont get it off. i used a cotton ball dipped in alittle of alcohol and went around my incisions carefully. it came right off.

This may seem like a dumb question but... Why do you have to drink alcohol at all?

I agree with you im tired of going under the knife and just want mt life back. Its looking like i will probably go with the bypass I just wanted to know if there's anything i should know that's not really talked about or published on bypaas I know i will have to take supplements for the rest of my life. (I currently don't take any with vsg and blood work is perfect) And i have to be careful on what pills i take. Dumping syndrome i understand. What about an occasional alcoholic drink? Anything else?

420 friendly here and i like my drinks as well. Smoked two weeks post op and loved it. My only concern is will it give you munchies & will you be able to handle that or will you want to binge. As far as alcohol. I've only had one drink cuz I'm still healing so I have no reference there. Sent from my iPhone using the BariatricPal App

I would be honest with your surgeon and ask them these questions. I know they have you quit smoking because it delays the healing process after surgery & can cause ulcers. I am not sure if marijuana has the same effect though but they would know. The other concerns I've read from other posters was the munchies sidetracking weight loss. Most doctors for drinking suggest 6 months to a year and some say never again. I am three months out and had two sips of a drink and was done not only could I not hold any more liquid physically I was buzzed, so your sleeve may force you to change your habits. There is actually a WLS Magazine article about alcohol on this site I would recommend it, it was a good read. http://www.bariatricpal.com/page/articles.html/_/healthy-living/bariatric-realities-%e2%80%93-medical-professionals%e2%80%99-guidelines-about-alcohol-use-wls-r601