peacequeen

I've only made suggestions of therapy only because I'm in therapy myself,,and it has helped..me. I think most have to go through a psychological eval anyway so whether I suggest it or someone else does,,more than likely they will see a psych if they want the surgery. I agree,,it's all in the words and how you say it. I certainly don't want to offend anyone. This is a place to come for information,,sometimes it comes in the form of advice from experience and sometimes from opinion,,you just have to be open minded enough to accept it and try not to be so uptight over it. I learned that here after being smacked down a couple times.

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.

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.

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.

Yes, I had an upper gi before leaving the hospital, heard the radiologist say there was no sign of a leak. I had the symptoms a week later. My surgeon said it could have been when I coughed hard, moved the wrong way,,it's just hard to tell..so baby your sleeve. (This was the case for me)

I had a fever, nausea (no vomiting), stomach cramping, left shoulder pain (this can also be due to air left during surgery) and lightheadedness. Mine is a small leak and caught early.

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.

Well, I know others on the site that were treated for a leak differently..I know there has been mention of a stent put in. I had all food and liquids stopped and I was put on tpn for a month. My leak closed up on it's own. Then I was back to square one..clear liquids, full liquids..mushies..etc. It was not a pleasant experience but I'm glad I didn't have a stent,,I hear they are painful.

It happens. I don't know the statistics at this point since so many people have had the surgery but don't go into it thinking there are no risks. Keep that in mind so if something does happen you can be prepared. Most important is if you are afraid of the risks, make sure you have a good surgeon who can deal with complications. I don't mean to scare anyone but just wanted to give an honest answer,,no candy coating from me.

I had a fever, nausea, flu like symptoms, pain in my left shoulder and center of my abdomen. I was not deathly ill or felt as though my stomach was being ripped apart but it was an obvious ill that could tell something was definitely wrong. I don't think the leak test they give right after surgery is fool proof because your stomach is so swollen. Don't EVER ignore symptoms that are out of sync with normalcy.

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.

I have United Healthcare ChoicePlus and have been told to qualify for surgery that I must have a 5 year consecutive record of a bmi of 40 or higher. I'm curious to know if anyone has been approved without meeting this requirement throught UHC? I'm concerned I'll be denied because I've only had a bmi over 40 for close to 3 years but have had one over 35 for 8 years..and over 30 probably my whole life.

I am on permanent disability due to several ailments but mostly because of myasthenia gravis. Unfortunately, losing weight will not make it go away but it will help some of the symptoms such as muscle function in my limbs. Trying to go back to any kind of work,,even if just seasonal, prn or part time has always been my goal.

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.

Thank you, ladies. I should've thought about the food section :blush5:

Yes, I feel that way sometimes..especially during stalls. I just keep pushing forward and keep trying to do different things to keep the scale moving. I think we just need to be patient because when we lose so much, our bodies have to make all sorts of adjustments.

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.
????
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

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.
????
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

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.
????
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

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.

Mine is a mystery. I followed the rules to a t and I still got one. I got to watch my upper gi's and it looked like an area that hadn't been stapled..a small area at the top of my stomach,,we could see it bubble as I swallowed. My surgeon said it could've been from lifting myself from laying down to a sitting position, it could've pulled it loose as well as a coughing spell I had. You can eat things you aren't supposed to eat and over stuff your sleeve by eating too much or lift things that are too heavy and cause a strain on the stomach..I don't really know but these are things my surgeon and I discussed as well as some of the nurses told me while I was in the hospital. Just follow your doctors orders, take it very easy the first few weeks,,don't be afraid to ask for help.

Those who know me at this site know what I've been through during the whole sleeve process. I've had my share of complications and difficulties and I've also had my share of regrets. But I can honestly say I have overcome all of it. The weight will start dropping and you'll feel better everyday. You'll be able to do things you either never have done or wanted to be able to do again. You will get surprising comments from people, wonderful compliments. Children will even take notice and you know how honest they can be. food will become something for survival and necessity instead of a habit and you will wake up one morning and realize it and things will just change..your eyes will open. You are so early out, it's very difficult to put things into perspective at this time so I would just focus on doing what your supposed to do..fluids, Protein, excercise,,etc..and let the warm fuzzy feelings come with time. I know it's so hard but you made a decision to take charge of your life. It doesn't seem like the perfect thing having the surgery right now but you will be so glad someday soon and all the bad experiences you are having will fade. Although it's so wonderful, it's not just about the cute clothes or the compliments for me. I'm going to be so much healthier and live my life instead of watching others around me live theirs.