Nutritional Guidelines for the Sleeve Gastrectomy

Transcription

1 1 Phebe Bariatrics Weight Lss Surgery at Phebe Sumter Medical Center Nutritinal Guidelines fr the Sleeve Gastrectmy Ashley D Stewart RD, LD Bariatric Registered Dietitian apattersn@phebehealhth.cm

2 2 Table f Cntents Tpic Page Intrductin 3 Diet Prgressin Overview 4 Stage 1: (Pst Op Day 1) 5 Stage 2: (Pst Op Days 2 t 28) & Vitamins/Mineral Requirements 6-7 Stage 3: (Pst Op Day 28 thrugh the next 8-12 weeks) 8-9 Stage 4: when advanced by MD/RD (nging lifetime maintenance) Cmmn Prblems and Slutins with the Gastric Sleeve 13-15

3 3 AN INTRODUCTION TO THE SLEEVE GASTRECTOMY DIET PROGRESSION This bklet has been designed t help yu, yur family and yur friends learn abut the nutritinal guidelines fr sleeve gastrectmy. In rder t be successful at lsing weight and keeping it ff, yu must learn hw t mdify yur eating behavir permanently. The gal f sleeve gastrectmy surgery is t help yu change yur eating habits in rder t prmte weight lss and weight maintenance. The surgery is nly part f the treatment. Yur cmmitment t a healthy diet is the mst vital part f the treatment. The diet yu fllw after surgery and fr the rest f yur life will determine yur ability t cntrl yur weight. Slw dwn yur eating Keep a fd lg Eating slwly is very imprtant after yu have yur surgery. If yu eat t quickly, yu may experience abdminal discmfrt, abdminal pressure, r yu may vmit. Start t becme aware f eating patterns befre surgery and mdify yur pace f eating. Try sme f these tips t help slw yurself dwn: Allw 30 minutes minimum fr mealtimes. Right after yur surgery, yu may need up t 60 minutes t cnsume ne meal. D nt take mre than ne hur t cnsume a meal, as this may result in grazing. Take small bites and chew fd t a liquid cnsistency befre swallwing. Chew each bite 22 times. Chew fr 22 Savr each bite. Pay attentin t flavrs, textures, and cnsistency. Set yur utensils dwn in between bites. Make a reminder sign that says EAT SLOWLY t remind yu t d s. Write dwn the amunt f fd and fluid yu drink in yur fd recrd as yu are eating. Take nte f hw yu feel when eating and drinking. Stp when yu feel full.

4 4 SLEEVE GASTRECTOMY DIET PROGRESSION Yu are usually in the hspital fr 2-3 nights fllwing the sleeve gastrectmy. Yur diet will prgress thrugh 4 different stages ver the curse f the next few mnths. Befre Surgery: What t Buy Beverages that are sugar-free, calrie-free, and nn-carbnated, such as ---- Water, Crystal Light, Fruit2O, Diet Snapple A high-prtein, lw-sugar shake (see Stage 2 fr examples) Fd scale (Walmart; Bed, Bath and Beynd; Amazn.cm; Target) Measuring cups and spns Diabetic Patients Diabetic patients must be aware t mnitr their bld glucse levels carefully nce they begin the prep surgery diet. Lw-carbhydrate diets can alter insulin prductin and affect medicatin dsages. If yu have diabetes, make sure yu talk t yur dctr abut any questins r cncerns yu have during this time. D NOT Splurge! This is nt the time t splurge n yur diet, rather it is the time t shw that yu are serius abut imprving yur health and cmmitted t making the changes necessary t d s. Yur mindset and behavirs shuld be fcused n preparing fr the upcming surgery. Indulging in unhealthy fds as yu apprach yur surgery date will enlarge yur liver and make surgery mre difficult. In sme cases, a surgen will cancel r pstpne a scheduled peratin. It is abslutely necessary that yu fllw the pre-p liver shrinking diet guidelines discussed with yur dietitian and bariatric team.

5 5 Stage 1: Clear Liquids Start: Day One Pstperatively The first day yu are allwed fluids while in the hspital after swallw study Estimated Duratin: 1 day Diet Instructins: Tw t fur unces f sugar-free, calrie-free, nn-carbnated, nn-caffeinated liquids per hur Clear liquids include: Water Fat-free/Lw-fat Brth/Builln Diet Snapple Crystal Light Sugar-free Jell-O Fruit2O Prpel Any ther unsweetened r artificially sweetened beverage Equal (Aspartame), Sweet & Lw (Saccharin), Splenda (Sucralse), Purevia and Truvia (Stevia) are acceptable. Try t limit sugar alchls. When lking at the ingredient label, they typically end in l, example: mannitl, malitl, srbitl. Sugar alchls can cause gas, abdminal pain, and diarrhea. Fluid Gal: 1-4 z per hur (a minimum f z/day is encuraged) Prtein Gal: Nne Imprtant Infrmatin: Stp sipping as sn as yu feel full r if yu have any nausea/vmiting. Use 1-unce medicine cups t help prevent yu frm drinking t fast. Carbnatin will cause abdminal distentin r discmfrt AVOID CARBONATED BEVERAGES. Be cautius with straws. They may intrduce air int yur system and cause abdminal distentin r discmfrt; hwever, sme patients reprt straws help them meet their fluid gal. Avid chewing gum as it may intrduce air int yur system and cause abdminal distentin r discmfrt. In additin, if the gum is accidently swallwed it may bstruct yur puch. Avid gulping; it intrduces air int yur system and may cause gas pains. Juices shuld be avided. They are t high in sugar and calries and may slw dwn weight lss Write dwn the amunt f fluids yu drink n a fd recrd and include the time f day.

6 6 Stage 2: Prtein Shakes Start: Day 2 pst peratively Estimated: 26 days (pstperative days 2-28) Diet Instructins: Cnsume (females) r (males) grams f prtein per day Recmmended Prtein Shakes (cntain lactse) Carnatin Instant Breakfast N Sugar Added (blue bx) (Winn Dixie, Harvey s, Walmart) ~mix with 1%, skim milk r fairlife milk~ EAS Advant Edge Carb Cntrl (Target) Designer Whey (CVS, Target, Walmart, Walgreens) Syntrax Matrix (Vitamin Shppe) Bariatric Advantage High Prtein Meal Replacement ( Bdy Frtress Whey Prtein Pwder (Wal-Mart) Recmmended Prtein Shakes (lactse-free) Syntrax Nectar (Vitamin Shppe) Muscle Milk Light Ispure- clear prtein drink (Vitamin Shppe) Unjury ( Bst Glucse Cntrl Bariatric Advantage Premier GNC lean shake Cre Pwer Lite Fluid Gal: At least 64 z (8 cups) f sugar-free, calrie-free, nn-carbnated liquid per day. Yu may use half f yur prtein shakes ttal vlume tward yur fluid intake. Ex. 64 z prtein shakes 32 z= 32 z (4 cup) fluid gal Water Crystal Light Sugar free Ppsicles Fruit20 Sugar free Jell-O Prpel Fat-free/lw-fat brth/builln Pwerade 0 Diet Snapple Vitamin Water Zer Smart Water

7 7 Multivitamins: Take tw chewable multivitamins (200% RDA fr 2/3 f the nutrients) OR tw tablespns liquid multivitamin that cntain irn (at least 18mg). Adult cmplete multivitamins usually cntain irn. Avid gummy multivitamins. May take bth at the same time. Centrum Adult Chewable Opurity Optimized Multi Chewable (take nly 1) CVS Spectravite Adult Chewable Centrum Liquid Walgreen s Adult Chewable Nature Made Multi Chewable fr Adults Spring Valley Adult Chewable (Walmart) PrCare Health chewable r capsule (take nly 1 per day) Calcium: Take 1200 t 1800mg f a chewable calcium supplement daily (2-3 chews per day). Limit 1 dse t 600 mg (maximum bdy can absrb at ne time). Separate dses by at least 4 hurs. Lk fr a calcium supplement with Vitamin D3 it will help the calcium t be better absrbed. Calcium Citrate is preferred due t better absrptin Rainbw Light Chewable Calcium Citrate Multi-Mins ( Opurity Calcium Citrate Plus ( Twinlab Chewable Calcium Citrate (Vitamin Shppe) UpCal D Calcium Citrate Pwder ( Calcet Citrate ( Wellesse liquid ( Calcium Carbnate is acceptable fr sme patients Caltrate chewable, CVS chewable, Viactiv Other: 1 B12- ral r sublingual 1000 mcg daily 1 B-50 cmplex daily (ptinal) **D nt take the multivitamin cntaining irn and calcium at the same time; they may interfere with each ther s absrptin. Separate the multivitamin and calcium by at least 2 hurs.

8 8 Stage 3: Sft Fds This stage gradually re-intrduces slid fd t yur system. It is imprtant fr yu t listen t yur bdy t tell yu if yu are full. If yu feel full, d nt frce yurself t eat. Remember t stay hydrated and t make prtein fds yur first chice. Keep a fd jurnal t mnitr yur prtein and fluid intake. Start: pst-p day 28 Duratin: Yu may need t be n sft fds fr 8-12 weeks. Yur dietitian will help determine the ttal duratin. Instructins: as tlerated Prtein Gal: Cnsume (females) r (males) grams f prtein per day Fluid Gal: 64 z f sugar-free, calrie-free, nn-carbnated, nn-caffeinated liquid (8 cups) Refer t page 10. Wait 30 minutes after eating slids befre drinking. Drinking with meals may verfill yur puch and cause vmiting Vitamins: Cntinue taking yur multivitamins and calcium supplements Refer t page 10 and 11.

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10 10 Stage 4: Slid Fds Start: Day 60 r when advanced by yur dietitian Duratin: Estimated- Onging lifetime maintenance Diet Instructins: Regular planned meals: 1000, 1200, r 1500 calries Yur dietitian will help yu decide which meal plan is best fr yur needs. Mnitring yur prtein and fluid intake is vital. Mnitring yur calries may be necessary as well. Speak with yur dietitian fr yur calrie gal. Servings Allwed: Prtein Gals: (females) r (males) grams per day Fluid Gals: 64 z f sugar-free, calrie-free, nn-carbnated, nn-caffeinated liquid (8 cups) - Refer t page 10. Vitamins: Cntinue taking yur multivitamins and calcium supplements - Refer t page 10 and 11. Imprtant Infrmatin: The slid fds stage re-intrduces slid fd t yur system. It is imprtant fr yu t eat all f the recmmended prtein. Yur bdy must get the prtein it needs frm yur diet. Listen t yur bdy and d nt verstuff yur gastric puch. Nt everyne will be able t eat all f the recmmended fds, especially right after surgery. It is imprtant t get n a schedule f eating. If yu are nt hungry, make prtein yur pririty and take a few bites just t stay n schedule. As yu are able t eat mre at each meal time, yur frequency f eating will decrease. AVOID PICKING OR GRAZING! This will lead t weight gain. The best advice is t take yur time with eating and chew yur fd well. Write dwn all f the fd yu eat and the fluid yu drink n yur fd recrd. Sme fds may be difficult t tlerate. Wait fr yur dietitian t advance yur diet befre trying these fds: Tugh meats such as red meat, hamburger, lbster, scallps, clams, grilled chicken, and shrimp Membranes f ranges, tangerines and grapefruit Skins and seeds f fruits and vegetables Grapes Fibrus vegetables such as celery, asparagus, and peapds Ppcrn and nuts Dughy breads - tasted breads tend t be better tlerated Rice Pasta

11 11 Sample Stage 4 Meal Plan (1000 Calrie) Time Fd Liquid (z) Prtein 8:00AM 1 scrambled egg (1P), 1 slice lw fat 14 grams cheese (1D), ½ cup chpped peppers (1V), ½ tasted English muffin (1C), 1 tsp light butter (1/3 fat) 9:00AM 8 z decaffeinated cffee (rm temp) 10:00AM 3 z fat free Greek ygurt (1P) 7 grams 11:00AM 1:00PM 2:00PM 3:00PM 4:00PM 5:00PM 6:00PM 7:00PM 8:00PM 9:00PM 3 z tuna fish (3P), 6 saltine crackers (1C), 2 tsp light may (2/3 fat), ½ cup chpped pear (1 fruit) 1 medium apple (1 fruit) 3 z diced chicken (3P), ½ cup mashed sweet ptat (1C), 1 TBS light butter (1 fat), ½ cup green beans (1V) 8 z Crystal Light 8 z decaffeinated tea 21 grams 21 grams 8 z water 8 z Crystal Light Ttal 64 z 63 grams 1200 Calrie Meal Plan Time Fd Liquid (z) Prtein 8:00AM 1 scrambled egg (1P), 2 slice whle wheat tast (2C), 1 TBSP light butter (1fat) 7 grams 9:00AM 10:00AM 11:00AM 12:00PM 1:00PM 2:00PM 3:00PM 1 cup strawberries (1 fruit), 1 lw fat cheese stick (1D) ½ cup cked pint beans (1C, 1P), 3 z grund turkey (3P), 1 cup steamed peppers and nins (1V), 1 tsp live il (1fat) 1 medium apple, chpped (1 fruit), mixed with 1 cup plain lw fat 8 z decaffeinated cffee (rm temp) 8 z Crystal Light 7 grams 28 grams 8 grams

12 12 4:00PM 6:00PM 7:00PM 8:00PM 9:00PM ygurt (1D), ¼ tsp cinnamn 8 z decaffeinated tea 3 z diced chicken (3P), ½ cup 21 grams mashed sweet ptat (1C), 1 TBS light butter (1 fat), ½ cup green beans (1V) 8 z water 8 z Crystal Light Ttal 64 z 71 grams Sample 1500 Calrie Meal Plan Time Fd Liquid (z) Prtein 8:00AM 2 egg mlet (2P) with ½ cup nins and peppers (1V), 1 z lean ham (1P), 1 tasted English muffin (2C), 1 TBSP light butter (1 fat) 21 grams 9:00AM 10:00AM 11:00AM 12:00PM 1:00PM ¾ cup blueberries (1 fruit), 1 cup lw fat plain ygurt (1D) 3 z tuna fish (3P), 1 TBSP light may (1 fat), 2 slices tasted whle wheat bread (2C), 1 cup mixed greens (1V), 2 TBSP light Italian dressing (1 fat), 1 cup hneydew meln (1 fruit) 8 z decaffeinated cffee (rm temp) 8 grams 21 grams 2:00PM 8 z Crystal Light 3:00PM 1 lw fat cheese stick, 1 small peach 7 grams 4:00PM 8 z decaffeinated tea 6:00PM 3 z prk tenderlin (3P), ½ cup mashed sweet ptat (1C), 1 TBS light butter (1 fat), ½ sft steamed brccli (1V) 21 grams 7:00PM 8:00PM 9:00PM 8 z water 8 z Crystal Light Ttal 64 z 78 grams

13 13 Cmmn Prblems and Slutins Cnstipatin Be sure t drink plenty f water (64 z per day 8 cups) Try sugar-free Metamucil r Benefiber Stay physically active Try 1 tablespn f Milk f Magnesia Increase yur fiber intake thrugh fruits, vegetables, and whle grains if yur diet stage permits. Be sure t fllw the diet instructins f the stage yu are in as sme high fiber fds may nt be gd chices fr yur current stage. Diarrhea Limit r avid fds with lactse. Lactse intlerance can ccur after surgery. Eat slwly and chew thrughly D nt drink fluids with meals Avid high sugar, high fat, and spicy fds Limit the amunt f sugar-free prducts (like sugar-free candies). These prducts cntain sugar alchls that can cause diarrhea. See page 8 fr mre details. Limit caffeinated beverages Try a prbitic supplement ask yur dietitian fr suggestins Vmiting G back t an earlier stage that yu can tlerate Chew fds thrughly and eat slwly D nt vereat Make sure fds are mist Avid eating and drinking at the same time If these suggestins d nt wrk, r yu vmit bright red r dark brwn liquid, please call yur dctr right away. Nausea D nt vereat Drink plenty f fluids Chew fds thrughly and eat slwly Avid carbnated beverages Avid fds that yu cannt tlerate Avid eating and drinking at the same time Limit r avid fds with lactse Stmach Blating After Eating D nt vereat D nt drink fluids with meals Avid carbnated beverages Stay physically active

14 14 Cannt Tlerate Dairy Prducts If this ccurs the first few weeks after surgery, make sure yu are drinking a lactse-free prtein shake. See page 9 fr a list f lactse-free prtein drinks. Try Lactaid milk, tablets, r drps. These are available at yur lcal pharmacy. Ygurt may be better tlerated than milk because sme f the lactse is already brken dwn. Aged lw-fat cheese may be better tlerated (i.e. cheddar). Dizziness r Headache Drink plenty f water and ther lw calrie fluids with electrlytes (i.e. Prpel, G2, Pwerade Zer) Add salt t yur fds Drink regular builln Be sure yu are eating enugh Sudden Light Headedness Stay hydrated by drinking lw calrie fluids with electrlytes (i.e. Prpel, G2, Pwerade Zer) Eat n a regular schedule D nt skip meals Be sure yu are eating enugh Tired and Weak Drink plenty f fluids Avid caffeine Sleep n a regular schedule Stay physically active Make sure yu are getting adequate prtein Be sure t take yur vitamins Heartburn Avid caffeinated beverages Avid spicy fds Avid aspirin r ther NSAIDs Take Tums Avid lying dwn fr 2 hurs after eating Leg Cramps Eat a well balanced diet (include ptassium rich fds, ask yur dietitian fr examples) Take yur multivitamins daily Stay physically active Drink plenty f fluids Call yur dctr if cramps persist r present with swelling

15 15 Excessive Hair Lss Hair lss is nrmal in the first few mnths after surgery and will usually reslve n its wn Eat a well balanced diet with adequate prtein Take yur multivitamins daily yu shuld be getting 200% f irn, zinc, and bitin Wund Infectin Call the physician immediately Make sure yu are getting enugh prtein t help with healing Take yur multivitamins daily Very Slw Weight Lss Be sure t keep a fd recrd. Yur dietitian will discuss this with yu. Avid high fat fds Avid high calrie beverages (i.e. juice, sda, cream and sugar in yur cffee, etc.) Stay physically active Dumping Syndrme Dumping Syndrme ccurs when fd passes rapidly frm the stmach int the small intestine. Dumping is usually prvked by: ingestin f cncentrated sweets. There have been reprts f symptms after vereating, cnsuming liquids with meals, and after ingesting fds high in salt r fat. The partially digested fd in the small intestine draws water ut f the bld vessels frm the bdy int the small intestine, thereby causing the fllwing symptms abut ½ hur after eating: nausea, faintness, fullness, cramping, weakness, sweating, rapid heart rate, and pssibly diarrhea. Alternative sweeteners such as Aspartame/Equal, Saccharine/Sweet & Lw, Sucralse/Splenda, and Stevia/Truvia are acceptable substitutes fr sugar. The fllwing fds and beverages shuld be avided. Fds t avid Ice cream Chclate milk Pudding Sweetened, fruited r frzen ygurt Dried fruits Canned r frzen fruits in syrup Fruit juice Sugar cated cereal Dughnut Ppsicles Cakes Pies Ckies Jellies Regular sft drinks Lemnade Kl Aid Sugared ice tea Snapple r fruit drinks Table sugar Hney Candy Regular Jell-O Sugar gum Mlasses Syrups Sherbet / Srbet Jams