Page 1 of 8. คาแนะน าทางด านโภชนาการหล งการผ าต ดโรคอ วน Patient information for a Successful Weight Loss

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1 Page 1 of 8 It is important to note that lifestyle and behavioral changes are necessary to be successful with your weight loss journey. 1. Eat three meals a day and limit unnecessary snacking in-between meals. This weight loss surgery is a restrictive procedure, which means that the success of weight loss depends on what you are eating. Unhealthy snacking in-between meals (e.g. pretzels, crackers, cookies, etc.) or eating frequently may prevent successful weight loss or cause weight gain due to excess calorie intake. 2. Eat slowly and chew your food until LIQUID. Failure to do so can cause pain, nausea, vomiting, and irritate your new pouch. It is very important to chew very thoroughly until it s liquid. Also, remember to cut your food into small pieces before eating it. Try waiting one minute in between bites. Allow at least 30 minutes for a meal 3. Avoid concentrated sugar. Keep sugar out of the first 3 ingredients on the food label. The number of sugar grams on the label includes both added and natural sugars; therefore, it is important to read the ingredients to find out what type of sugar the food contains. Aim to keep the sugars down to 15 grams or less per serving to help limit empty calories in your diet. Avoid these simple sugars, especially if within the first 3 ingredients on food labels: sugar, dextrose, high fructose corn syrup, corn syrup, glucose, sucrose, molasses, and honey. Note: Artificial sweeteners such as nutrasweet/equal, saccharine/sweet & Low, and sucralose/splenda are acceptable to use. 4. Limit high fat foods. Low fat is 3 grams or less per serving on a food label. Examples of high fat foods: potato chips, fried foods, fast food, bacon, sausage, hot dogs, bologna, pepperoni, cream soups, alfredo sauce, donuts, cakes, cookies, and pastries. 5. Stop eating when you feel comfortably satisfied. Overeating can cause nausea, vomiting, and the size of your stomach to stretch. It can take 6-9 months for your new stomach size to stabilize. 6. Drink adequate fluids to prevent dehydration. Aim for fl oz (6-8 cups) of fluid per day. Sip on your beverages, no gulping! Avoid carbonated beverages, beverages containing sugar and alcoholic beverages.

2 Page 2 of 8 Choose sugar-free, non-carbonated drinks such as: Crystal light, Fruit 2O, Diet Snapple, Propel Fitness Water, Light Minute Maid drinks, Diet Ice Tea, etc. Limit fat free milk to less than 16 ounces per day, limit 100% real fruit juice to less than 8 ounces per day (try diluting with water). Tips: Wean off carbonated and caffeinated beverages before surgery to help prevent withdrawals. Choose beverages with 10 calories or less per serving. If plain water sits heavy and you are having problems tolerating it add a sugar-free flavoring (e.g. True Lemon, lemon or orange slice, etc.) Increase your fluid intake if any of the following signs are present: dark urine, headache, dizziness, lethargy, a white coating on the tongue. 7. AVOID eating and drinking at the same time. Avoid drinking with your meal, then wait at least 30 minutes after a meal to resume drinking. 8. Choose your food choices wisely. Protein should be consumed first at each meal, then vegetables and fruits, then whole grains. 9. Exercise! Aim for at least 30 minutes every day. Exercise helps maintain long term weight loss. Even 5 minutes at a time, as tolerated, is a start, and increase the time and frequency as tolerated. The first four weeks, walking should be used as the primary exercise. After four weeks, try introducing strength exercises. Always speak with your doctor if you have never exercised. 10. Protein. You need to consume at least grams of protein per day in the form of food and/or supplements.

3 Page 3 of 8 Protein Content of Common Foods Meats, Poultry, and Fish Portion Size Grams of Protein Beef/Turkey Jerky 1 oz dried Beef, Pork, Poultry, Fish 1 oz (2 Tbsp.) 7 Cheese, hard (low-fat) 1 oz 7 Kraft free/healthy Choice/Bordon fat free singles 1 oz or 1 slice 5 Cottage cheese, Ricotta (part skim) 2 Tbsp 3.5 Imitation Crab Meat 1 oz 3 Crabmeat 1 oz (2 Tbsp.) 6 Shrimp, Lobster 1 oz 6 Egg 1 6 Baby Food Meat 1 oz (2 Tbsp.) 4 Potted Meats/Spam Lite 2 oz 8.5 Hot Dog, Low -fat (average) 1 oz 3.5 Tuna Fish 1 oz 7 Legumes and Nuts Almonds 1 oz 6 Cashews 1 oz 4 Lentils ½ cup cooked 9 Lima Beans ½ cup cooked 7 Peanut butter 2 Tbsp 7 Red kidney beans ½ cup cooked 8 Soy beans ½ cup cooked 14 Tofu 1 slice 5 Refried beans ½ cup 6 Sunflower seeds 1 oz 5 Chili with beans, drained ½ cup 10

4 Page 4 of 8 Diet Progression In the Hospital A diet will be prescribed for you while in the hospital Bariatric Surgery Diet Clear Liquids 1 ounces (oz) per hour (one medicine cup) Food tray will contain: 4 ounces of: sugar free gelatin, low sodium broth, crystal light ; Prosource (protein supplement) Mix the Prosource with the crystal light in the 1 oz medication cup the nurses will provide At Home Once discharged from the hospital you must follow a Full Liquid Diet for one week, followed by a Pureed Diet for three weeks. To consume grams of protein per day, drink at least two high protein supplements per day. Liquid Diet: Week 1 You will be on a liquid diet for the first week after surgery. : Broth (the salt in the broth can help your body hold on to fluid better) Low-fat/light yogurt Sugar-free Jell-o Sugar-free Popsicles Sugar-free Fruit drinks Sugar-free Pudding Sugar-free Sherbet or Sugar-free Italian Ice Water Diluted fruit juice (maximum of 4 ounces juice per day, diluted with 4 ounces water) 1% or skim milk Protein supplements (please see approved list)

5 Page 5 of 8 Sample Full Liquid Meal Plan (1st week post-op gastric bypass surgery) 8:00 am. 2 Tablespoons fat-free plain Greek-style yogurt (high in protein) 11:00 am. 8 ounces whey protein isolate drink (e.g. Isopure Zero Carb) with 8 ounces of skim or 1% milk (16 oz total, taking at least minutes to drink) 1:00 pm. 8 ounces of broth 3:00 pm. 8 ounces whey protein isolate drink (e.g. Unjury) 6:00 pm. 8 ounces Crystal Light; 4 ounces sugar-free pudding 8:00 pm. 8 ounces whey protein isolate drink made with skim or 1% milk Pureed Diet: Week 2-4 For safe weight loss you need to eat a healthy, well-balanced diet. Everything needs to be blended to the consistency of applesauce for three weeks. This will be a challenge for you. Stick to it and be creative! Buy or borrow a blender or food processor if you do not own one. Instructions for pureeing foods: 1. Cut food into small pieces about the size of you thumbnail. 2. Place food in the blender. 3. Add enough liquid (fat free chicken broth or fat free gravy) to cover the blades. 4. Blend until smooth like applesauce. 5. Strain out the lumps, seeds, or pieces of food. 6. Use spices (avoid spicy ones) to flavor food. 7. Blend and enjoy! Tip: Use ice cube trays. Each cube holds about 1 ounce. This will help you to control portion sizes. Try preparing reduced fat cream soups or pureed meats and vegetables and storing them in the trays. Instructions: 1. Limit food to 2 to 4 ounces per meal (approximately 4 to 8 tablespoons). Do not forget to consume protein first at each meal, then vegetables and fruits, then whole grains. 2. Aim for 6 small meals per day at this point. *See pureed food recipes

6 Page 6 of 8 3. Drink at least 6-8 cups (48-64 ounces) of fluid per day. Liquids should be sipped in between meals. Liquids taken will meals may cause nausea, vomiting, or dumping syndrome. Also, they may fill you up and you may not be able to consume all of the foods and nutrients you need. 4. Treat your new stomach (called a pouch after surgery) like a baby stomach in training, and avoid anything too spicy, too hot or cold, and try only ONE new food at a sitting so that you know what you can tolerate. Soft Diet After 4 weeks of following the Pureed Diet, you may proceed to a Soft foods diet. Instructions: 1. Limit food to 4 to 6 ounces per meal (approximately 8 to 12 tablespoons). Do not forget to consume protein first at each meal 2. Aim for three meals per day with one high protein snack. 3. Eat slowly!!! Chew your food until it s liquid. 4. Food choices should be low in fat and low in sugar (less than 15 grams sugars per serving) 5. Use any of the foods recommended on the pureed diet. After 2-4 weeks of the soft food diet you should gradually introduce more food choices. Keep food records of your tolerance and intake. Remember that food intolerance is highly individualized. Take your time at meals and chew very well to help increase your tolerance to these foods. Eventually you should be able to tolerate diced meats and a wider variety of breads, cereals, fresh fruits, and fresh vegetables. Keep in mind that your diet needs to be low-fat, low calorie, sugar-free, and portion controlled for the rest of your life. This is the commitment you must make to achieve maximal weight loss. Some possible nutrition problems that may occur post-op: Trouble tolerating dairy products or lactose intolerance: Milk and other dairy products may cause cramping, bloating, excessive gas, and diarrhea. If these problems occur, try Lactaid 100 milk or natural soymilk. Hair loss: This is usually due to rapid weight loss, and typically presents about 3-6 months after surgery. The good news, is that it s usually just all-over thinning, not noticeable (maybe only to you), and usually

7 Page 7 of 8 resolves in another 3-6 months. Biotin supplements may help, as well as ensuring that your fluid, protein, iron and zinc levels or intake are good. Nausea or Vomiting: Usually caused by eating too fast, too much, or drinking with your meals. If it is not food related, call your surgeon s office. Bad taste in mouth: This is common right after the surgery and should go away after a few weeks. Decreased appetite and taste changes. It is very common to not feel hungry right after surgery and to have altered taste sensation. You need to eat ensure that you get proper nutrition and to prevent complications. Increased gas: This is also common after the surgery, especially during the first few weeks. It can be a sign of a lactose intolerance. If you have gas pains at home, try simethicone drops (Gas X ). Deverom can help with the smell. Excess skin: With significant weight loss, there is usually excess skin, but the level will depend on several factors, including how much weight you lose, where you lose it, genetics, age, and whether you re a man or a woman. Weight training may help minimize the appearance of loose skin, but only plastic surgery will help to get rid of it. Most people find it s really not a big issue, especially in light of how great they feel at a much lower weight, and how they re improved their health with the surgery and weight loss. Pregnancy: This must be avoided for the first months following surgery. Pregnancy during this time could cause complications and deficiencies for you and your baby and may result in birth defects. For this reason you need to take precautions to prevent pregnancy. Rapid weight loss increases fertility so you must be very careful.

8 Page 8 of 8 CHECKLIST AFTER GASTRIC BYPASS SURGERY grams of protein a day Eat protein first at all meals Eat slowly and chew well Meals should take minutes Avoid snacking on high calorie foods in between meals oz of fluid a day (more if your urine is dark or you re dizzy) Beverages less than 10 calories per serving Vitamin/mineral supplementation for life Multivitamin (two a day, with food; not with calcium or dairy) Calcium mgs a day in divided doses (at least 3 times a day) and no more than 600 mgs at one time, and apart from multivitamin and iron) Iron (bed-time best, not with calcium) Exercise Aim for at least 30 minutes on most days of the week 5 minutes at a time, and gradually build up, as tolerated Incorporate light weights (about 2 months after surgery, and/or as your surgeon recommends) Consider stretching and the importance of a stress management program in your regimen DIETITIAN VISITS: 2-4 weeks post-op 3 months post-op 6 months post-op 1 year post-op Once a year after first year NOTE: You may need to see your dietitian more often than above if you re having any nutrition problems and/or if your doctor feels you need to be seen for any reason.