A Thorough Pre And Post Op Sleeve Diet And Tips(Long)

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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.< /span>

4.

Stop drinking sugar-sweetened beverages such as regular soda and sweetened

Kool-Aid.

5. Start weaning off of

caffeine and carbonated beverages.< /span>

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.< /span>

•

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.< /span>

????

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.< /span>

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.< /span>

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.< /span>

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.

[peacequeen 434]

Sorry, I hate not being able to edit my posts once I post them..I didn't know all the "font" info would be on my post.

[ladyvm 12]

Thanks great post.

[luvs2laff 3]

This information is amazing... Can't wait to share with my family and friends who'll be my support system... How can I save it?