Nutrition for Bariatric Surgery

Transcription

1 Surgical Clinic of Louisiana POB Suite South Medical Center Blvd. Marrero, LA Phone: (504) Fax: (504) Nutrition for Bariatric Surgery Dietitian Marian Vigo, MSPH, RDN, LDN, CSOWM Phone: (504) Fax: (504)

2 Pre-op Liquid Protein Diet Two weeks prior to surgery, you will start a liquid protein diet. This will help you lose a modest amount of weight before surgery, as well as reduce risks of complications during surgery. The first 12 days should consist of: 2-3 protein shakes, and one meal of lean protein and vegetables. The last two days should consist of 3-4 protein shakes (if using protein powders, mixed with water only) and clear liquids. Your goal should be to get at least 60 grams (g) of protein per day, Ready-to-Drink Protein Shakes Sugar per Protein per Carbs per Pure Protein 35g Shakes: Cookies n Crème, Vanilla Cream, Frosty Chocolate, Banana Cream, Strawberry Cream Pure Protein 23g Shakes: Cookies n Crème, Frosty Chocolate, Rich Chocolate, Vanilla Cream Atkins Shakes: Cookies and Crème, French Vanilla, Strawberry, Café Caramel (contains caffeine), Mocha Latte (contains caffeine), Dark Chocolate Royale, Milk Chocolate Delight Atkins Lift Protein Drink: Berry, Lemon, Orange Muscle Milk 100 Calorie: Chocolate, Vanilla Crème Muscle Milk PRO Series: Crushing Cookies N Crème, Go Bananas, Intense Vanilla, Knockout Chocolate Muscle Milk Genuine/Coffee House: Banana Crème, Chocolate, Strawberries N Crème, Chocolate Caramel Kick, Cookies N Crème, Vanilla Crème, Vanilla Latte (contains caffeine), Mocha Latte (contains caffeine), Café Latte (contains caffeine) EAS AdvantEDGE: Strawberry Cream, Milk Chocolate, Creamy Vanilla, Deluxe Dark Chocolate EAS 100% Whey: Chocolate, Vanilla, Strawberry ICONIC: Chocolate Truffle, Vanilla Bean, Café au Lait (contains caffeine) Smoothie King The Gladiator (20oz) *without fruit*: Vanilla, Chocolate, Strawberry Premier Protein: Chocolate, Strawberries & Cream, Bananas & Cream, Vanilla, Caramel, and Clear (Orange Mango, Raspberry, and Tropical Punch) Isopure Zero Carb: Grape Frost, Apple Melon, Lemonade, Coconut, Blue Raspberry, Pineapple Orange Banana, Peach Mango, Passion Fruit, Icy Orange GNC Total Lean Shake: Vanilla Bean, Banana Cream, Strawberries & Cream, Swiss Chocolate, Snickerdoodle

3 Protein Powders Mix protein powder according to package directions with skim milk or water. Protein powders can easily be found at the West Jeff Fitness Center, GNC, Vitamin Shoppe, Target, Wal-Mart, Sam s Club, Winn-Dixie, Rouses, and on many websites. Make sure to always read the nutrition labels before purchasing. Also, try all your new protein foods and powders in small quantities first. Protein Powders Sugar per Protein per Carbs per Pure Protein: French Vanilla, Chocolate, Mixed Berry, Rich Chocolate EAS 100% Whey Protein: Vanilla, Chocolate, Strawberry Muscle Milk 100 Calorie: chocolate, vanilla crème Isopure Zero/Low Carb: Alpine Punch, Apple Melon, Banana Cream, Cookies & Cream, Creamy Vanilla, Dutch Chocolate, Mango Peach, Mint Chocolate Chip, Pineapple Orange Banana, Strawberry & Cream, Toasted Coconut Whey Gourmet: Chocolate, Strawberry Banana, Vanilla, Peanut Butter Chocolate Unjury: chocolate splendor, classic chocolate, vanilla, strawberry sorbet, chicken soup, unflavored Syntrax Nectar (Whey Protein Isolate): chocolate truffle, strawberry kiwi, roadside lemonade, lemon tea, fuzzy navel Cytosport 100% Whey: cocoa bean, cookies n crème, strawberry banana, vanilla bean Musclegen Genepro: Unflavored New Whey Liquid Protein: Grape, Watermelon, Fruit Punch, Acai Berry Chike: chocolate bliss, strawberry burst, orange crème, banana magic, very vanilla, Original Iced Coffee (contains caffeine), Mocha Iced Coffee (contains caffeine) Bariatric Advantage High Protein Meal Replacement: unflavored, banana, vanilla, orange cream, chocolate, strawberry, iced latte Body Fortress: Strawberry, Chocolate, Vanilla, Chocolate Peanut Butter, Mocha Cappuccino (contains caffeine), Banana Crème, Cinnamon Swirl, Cookies n Crème

4 Food Labels S P E C I A L P O I N T S O F I N T E R E S T F O R B A R I A T R I C P A T I E N T S : Carbohydrates should be less than 15g (grams) per serving* Total sugars should be restricted to 0-5g per serving Protein should be at least 15g of protein per serving Protein is a must! W E S T J E F F E R S O N F I T N E S S C E N T E R Reading the Food Label Step 1: Check the serving size of the product, this tells you the amount of food that the rest of the label describes Step 2: Notice the amount of calories in one serving. After surgery calorie intake is very low. Please note that food labels are made based on a 2,000 calorie per day diet. Step 3: The % Daily Value shows what percentage of your daily needs this food provides for a 2,000 calorie per day diet. Step 4: Total Fat, Saturated Fat, Cholesterol and Sodium are all nutrients that should be limited each day. Choose foods that have less than 20% Daily Value for these nutrients. After surgery, total fat should be limited to 30-45g per day. Trans Fats should be completely avoided. Step 5: Dietary Fiber, Protein, Vitamins and Minerals are nutrients that are important to get every day. Protein requirements for bariatric patients are a minimum of 60g per day. Nutrition label: MUSCLE MILK LIGHT

5 Clear and Full Liquid Diet After Surgery Clear Liquids For the first week after surgery you will be on a clear liquid diet. * Day 3 after surgery, may start drinking watered down protein drink. Examples of acceptable clear liquids: Sugar free Crystal Light, sugar free Kool Aid, and other sugar free drink mixes Herbal tea, caffeine free tea (no added sugar) Sugar free popsicles Sugar free Jell-O Water Broth Clear liquid protein supplements Full Liquids By week 2 you should be able to progress to a full liquid diet (follow your doctor s orders!). Your full liquid diet should be high protein, sugar free, and low fat. Remember to sip liquids; do not gulp! The following are examples of full liquids: Skim or 1%, no sugar added: cow s milk, Fairlife, Lactaid milk, soy milk, etc. Low-fat, strained or pureed creamy soups (smooth, no pieces of food) Liquid protein supplements Low carbohydrate yogurt, NO fruit pieces Sugar free pudding Cottage cheese Sugar free applesauce V-8 juice or V-8 Splash Lite Thinned cream of wheat or rice cereal Additional Information During the clear and full liquid diet phases you need to consume at least 60g of protein and 48 oz. (6 cups) of fluids per day (this includes the liquids from your protein drinks). Start with 1/4 cup and give yourself 15 minutes to sip it. If you want more, give yourself another 15 minutes to sip another 1/4 cup. Sip on protein drinks or sugar free beverages all day. Avoid caffeinated, carbonated, and alcoholic drinks. Be cautious with milk: try 1/4 cup at a time. If you experience intolerance (gas, cramping, bloating, diarrhea) make sure you are drinking low fat (1% or skim) milk. If you continue to have problems, try lactose-free milk, such as Lactaid or soymilk. Make sure to take your multivitamins every day!

6 Soft Diet After Surgery High Protein Soft Diet Week 3 post-surgery you should be able to follow a soft diet. This diet stage will last anywhere from a couple weeks to a couple months. Foods should be the consistency of soft baby food. Always eat protein-rich foods first to: help maintain muscle mass, increase healing, and increase weight loss. Protein-rich foods include: milk, yogurt, cheese, eggs, soft meats, seafood, and beans. Eat 3-5 meals per day (2-4 Tbsps. each) with a protein drink in between meals to meet protein needs. Signs of inadequate protein intake are: hair loss, delayed wound healing, and muscle breakdown. Your goal should be at least 60 grams of protein and 64 ounces of fluid every day. Remember no liquids with meals. Do not drink within 30 minutes before or after eating. Chew foods slowly and stop eating when you feel full. Avoid any foods that are high in sugar, high in fat, high in starch, and are crunchy. Additionally, avoid fruits canned in syrup and vegetables cooked with oil, butter, or bacon. Examples of acceptable soft foods: Soft cooked vegetables (no corn) Ripe fruits (no peel) Fish Lean meats cooked tender and cut into small pieces Canned tuna or chicken (packed in water) Strained baby food meats or homemade pureed lean meats and shrimp Beans (red, white, black, lima, pinto, fat free refried) and lentils Low fat/fat free cottage, mozzarella, or ricotta cheese Boiled eggs, scrambled eggs, or egg beaters Strained soups Sugar-free pudding Mashed tofu Low fat yogurt or pudding Non-fat dry milk powder (add to low fat soups or sugar free pudding) AVOID Caffeine (at least for the first 2 months) because it can dehydrate you Alcohol: alcohol is just empty calories that will impede weight loss efforts Carbonated beverages: causes gas, bloating, and can possibly stretch the stomach pouch

7 Sample Soft Meal Plan Your goal should be at least 60 grams of protein and 64 ounces of fluid per day. Aim for 3-4 small meals and 2-3 protein drinks per day, with liquids in between. Sip fluids continuously between meals. Drink at least 1/4 cup every 15 minutes. 1/4 cup fluids = 2 oz. = 4 Tbsp. 8am 9am 10am 11am 12pm 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm Pureed Recipe Ideas* 1 egg or 1/4 cup egg beaters or egg whites 1 cup water, decaf coffee, or decaf unsweetened tea Protein drink, 20g protein 2 Tbsp. low-fat cottage cheese, 1 Tbsp. pureed peaches 1 cup water or crystal light 2 Tbsp. pureed chicken breast, 1 Tbsp. pureed carrots 1 cup water or sugar free lemonade Protein drink, 20g protein 1 cup water, decaf coffee, or decaf unsweetened tea 1 cup high protein creamy chicken soup, 14g protein (recipe below) 1 cup of water or sugar free Kool aid Protein drink, 20g protein 1 cup of water High Protein Creamy Chicken Soup (Provides 14g protein per 1 cup serving) Mix 1/3 cup nonfat dry milk powder, 1tsp chicken bouillon, and 1/2 scoop unflavored protein powder Add enough warm water to equal 2 cups Note: soup may clump if water is too hot High Protein Pudding (Provides 14g protein per 1/2 cup serving) Add 2 scoops protein powder to 2 cups cold skim milk and mix well. Stir in dry Jell-O sugar free instant pudding mix. Chill and enjoy! Cottage Cheese and Fruit (Provides 12g protein per 1/2 cup serving) Blend 1 cup non-fat or 1% cottage cheese, 1/2 cup canned fruit (in own juice/low-sugar), and 1/2 cup 100% fruit juice in a blender. Makes 2 servings. * ask dietitian for more pureed recipes

8 Vitamin Supplementation Vitamin and mineral supplements are a mandatory part of bariatric surgery. You will take these for the rest of your life! Make sure to talk to your doctor, surgeon, or dietitian if you have questions about proper vitamin/mineral supplementation, types, and amounts. Vitamins are only appropriate in: chewable (not gummy), liquid, or capsule. Vitamins needed Post-Surgery (Daily) Adult Strength Multivitamin: must provide at least 200% RDA (DV%) for Iron (16mg Men & 36mg Women), Folic Acid (800mcg), and Thiamine (3mg). It is best if multivitamin also contains selenium, copper, and zinc. Vitamin B12: 350 micrograms (mcg) per day. You can also get a monthly B12 injection from your primary care physician. Calcium Citrate with Vitamin D: mg per day *take at least 2 hours apart from your multivitamin to maximize absorption. Breakfast Lunch Dinner Bedtime B-50 Complex and Calcium Citrate: mg Calcium Citrate: mg Adult Strength Multivitamin Calcium Citrate: mg

9 Physical Activity Physical activity is essential to achieving and maintaining your weight loss. Being active and exercising right after surgery will help you feel better, recover faster, and minimize the likelihood of post-surgical complications. You should choose an exercise program that is appropriate for your fitness level. A personal trainer or physical therapist can assist you in setting exercise goals and adjusting them as needed. Things to consider Choose a form of exercise that you enjoy and know you want to participate in Find a friend or family member to exercise with Join an exercise club and/or group fitness classes Listen to your favorite music while you exercise Park in the farthest location from your destination and walk Always use stairs instead of elevators, whenever possible Prioritize exercise in your daily schedule Keep a journal of your activities West Jefferson Fitness Centers 2 locations 2 registered dietitians on staff Marrero has a swimming pool Oakwood has childcare 14 excellent personal trainers Dozens of group fitness classes Bootcamp classes available Updated equipment Locations Marrero 1121 Medical Center Blvd. Marrero, LA (504) Terrytown (next to Oakwood Mall) 175 Hector Avenue Terrytown, LA (504)

10 Nutrition Guidelines and Foods to Avoid Bariatric weight loss surgery is designed to help people lose weight after previous attempts at weight loss have failed. Safe and successful weight loss requires a permanent commitment: you must be committed to changing your current eating habits and behaviors in order to develop and maintain substantial weight loss. Why should I follow these diet guidelines? If you do not adhere to your diet and supplement regimens, you may develop nutrient deficiencies which may have negative consequences to your health. Additionally, you may not achieve maximal weight loss, or your rate of weight loss may slow down. The following guidelines should be followed immediately after surgery, as well as for the rest of your life. Eat slowly: eating too quickly can over fill your stomach and cause discomfort Eat and drink small amounts at a time: learn to sip. Do not fill your entire mouth with food or fluids. Use a baby spoon or a 2oz medicine cup to assist with this Stop eating or drinking when you feel full: Do not overeat. Listen to your body. If you are not able to recognize fullness, then eat only the quantity of food recommended. Overeating can stretch your stomach and prevent optimal weight loss. Chew food thoroughly before swallowing: Large chucks of foods can get caught and cause discomfort. Try to chew each bite 30 times before swallowing. Drink adequate fluids between meals: drink at least 64oz (8 cups) a day to avoid dehydration. NO drinking with meals. Eat protein rich foods first: aim for more than 60g of protein a day to promote healing, and help you maintain lean body mass while losing weight Keep your food choices sugar-free and low-fat: foods high in sugar and fat can cause dumping syndrome, and can inhibit maximum weight loss Foods to Avoid High in Fat/Sugar Tough/Crunchy High fat milk (whole, 2%) Tough or dry meats Raw veggies May add to diet 3 months after surgery Butter, margarine, oil, mayo Corn Plain, unsalted nuts Ice cream, candy Granola/cereal with nuts Light or air-popped popcorn Cakes, cookies, pies, desserts Shredded coconut Lettuce Sour cream, cream cheese, salad dressing Starchy Foods Foods to ALWAYS Avoid Fried foods Bread, rice, pasta, cereal Sugary drinks Luncheon meats Cooked cereals (grits, oatmeal) Carbonated beverages Sausage, bacon Crackers, pretzels, chips Alcohol Gravy Corn, peas, potatoes Straws

11 Helpful Resources The resources listed on this page may be helpful for patients who wish to have weight loss surgery, or who have already undergone weight loss surgery. West Jefferson Fitness Center offers a free support group on the 4th Monday of every month, at 6:30 pm, for all interested in the surgery. *3rd Monday in December. Gastric Sleeve Support Group on Facebook Bariatric Recipes on Pinterest CheatClean Cookbook: QuestNutrition.com/Cookbook The World According to Eggface: TheWorldAccordingToEggface.blogspot.com Unjury Protein Recipes: Bariatric Advantage: BariatricAdvantage.com/Catalog West Jeff Medical Center Surgical Weight Loss: WJMC.org/WeightLoss Bariatric Eating: BariatricEating.com Obesity Action Coalition: ObesityAction.org Eating Well After Weight Loss Surgery by Patt Levine and Michele Bontempo-Saray. Marlowe & Co. Press, 2004 Exodus from Obesity: The Guide to Long-Term Success After Weight Loss Surgery by Paula Peck. BP Press, 2004 The Don t Diet, Live-It Workbook by Andrea LaBue and Marsea Marcus Online Food Databases: MyFitnessPal.com CalorieKing.com Baritastic App ndb.nal.usda.gov