Northumbria Healthcare NHS Foundation Trust Eating plan after gastric bypass Issued by Nutrition and Dietetics
Dietitian. Bariatric Specialist Dietitians Telephone: 0191 293 2707 2
This leaflet will provide you with advice on how to eat well following your weight loss surgery and is based on our experience of what seems to work well for most people. With weight loss, you may see an improvement in weight-related health conditions that you may have such as type 2 diabetes, high blood pressure and sleep apnoea. Follow the suggestions in this leaflet to help prevent your smaller stomach from stretching; to get the nutrients you need for good health and to prevent nutritional deficiencies and side effects such as nausea, vomiting, bloating and blockages. Physical activity remains important to help manage your weight in the long term. The guidelines for adults are that they should aim to be active daily and should do at least: 150 minutes of moderate-intensity aerobic activity each week plus muscle strength activities on two or more days each week OR 75 minutes of vigorous-intensity aerobic activity plus muscle strength activities on two or more days each week OR An equivalent mix of moderate and vigorous aerobic activity each week plus muscle strength activities on two or more days a week Your nutrition plan after bariatric surgery is for life. How does the gastric bypass work? The gastric bypass is a restrictive and malabsorptive procedure: a small part of the stomach is used to create a small pouch which means you will feel full more quickly with a very small amount of food. The small stomach pouch is then connected to the middle part of your small intestine, bypassing the rest of your stomach and first 3
portion of your small intestine. This means only a certain percentage of the food you eat will be absorbed. This will lead to weight loss. Due to this malabsorption it is vital that you take your vitamin and mineral supplements. Many people report that their tastes and food preferences change after surgery and this is entirely normal. Weight loss what to expect You will lose most of your excess body weight in the first 1-2 years after surgery. Your commitment to healthy eating and lifestyle habits will help you to lose the weight, maintain your weight loss and help you feel well. The speed that you lose weight will vary from person to person. Whilst you may lose weight very quickly, it is common for your weight loss to slow down after the first few months. Do not panic - your body will take time to adapt to the reduction in calories and if we eat too little over a long period of time, our metabolism (the speed at which we burn calories) slows down. You may find that you are losing inches instead. You can help your weight loss by eating regularly and choosing healthy foods. Vitamin supplements It is vital that you take the recommended supplements to prevent any vitamin or mineral deficiencies as the amount you are able to eat and/or absorb will be vastly reduced. Take these for life. 4
Multivitamin and Minerals First month only after surgery take chewable/liquid supplements twice a day. Choose a variety which says: multivitamins with minerals and is suitable for adults After the first month you should be able to take tablet multivitamins. Choose a variety which says on the label: A-Z multivitamins and minerals or Complete multivitamins and minerals. Take two tablets a day Additional Supplements Calcium and vitamin D supplement which your GP will prescribe for you Vitamin B12 injections. Most people need a maintenance dose once every 3 months. Your GP will be able to arrange this for you. Iron supplement(s) will be prescribed for you by your GP Take your multivitamin and mineral supplement and iron supplement at a different time from the calcium and vitamin D supplement i.e. 1-2 hours before/after You may need to take additional supplements on the advice of your bariatric dietitian or consultant. This is usually because your blood tests have shown a deficiency and/or your diet is lacking a nutrient(s). Do not take any extra supplements without checking with your bariatric dietitian. Food re-introduction Please refer to the meal ideas booklet for more information. Initially your stomach will have some swelling and tenderness from the operation therefore it is important that you gradually increase the texture of your diet from liquids to solids over a 6-8 week period. If you have trouble eating a certain food at first, stop eating it and try again in a week or so. It may be helpful to keep a food diary to record what you ate and how you tolerated the food. 5
The diet after surgery is split into four stages: Your date of surgery Stage Texture When to start For how long 1 Fluids only Day of surgery 1 day 2 Pureed foods Day 1-2 (as advised) 4 weeks post operatively 3 Soft foods Week 4 post 2-4 weeks operatively 4 Solid foods Week 6-8 post Ongoing operatively Remember the time to progress from one stage to the next can vary between individuals. It is important not to rush each stage. Only move onto the next stage when you are ready. You are less likely to experience problems if you begin carefully. Portions It is difficult to give set portion sizes for each stage. This is because we have found that the amount people can eat after surgery varies between individuals. It is important to eat slowly and stop eating as soon as you feel full. As a guide, we expect your first few meals to be no more than 3-4 teaspoonfuls. This will slowly increase to an egg cup size portion. By the time you are on stage three (soft foods) you should be taking no larger than a saucer sized portion. Eventually your normal portion in the longer term will be a side plate sized portion, this is a seven inch or 18cm plate. It is important that you increase the portion sizes slowly so as not to stretch your new pouch if this happens it will affect your long term weight loss. 6
How to eat after surgery Eat slowly. Take small bites of food and chew very well Do not eat and drink together avoid drinking 30 minutes before a meal and one hour after a meal Food should be chewed to a paste before swallowing Choose foods that are easy to chew so that they break down into small pieces You may find it helpful to eat your food using smaller cutlery Focus on enjoying your food Avoid distractions such as the television, telephone and computer while you are eating Pay attention to your body s signals of hunger and fullness. Stop eating as soon as you feel full or have any chest pressure or discomfort Always follow the 20:20:20 Rule chew every mouthful 20 times pause for 20 seconds between mouthfuls a meal should last approximately 20 minutes Meal Pattern Eat 4-6 times a day Include 3 small meals a day and 2-3 small, nutritional snacks each day. Plan your meals and snacks in advance Choose foods from all the main food groups (see meal ideas leaflet) Include protein at each of your meals and snacks. Higher amounts of protein are found in lean meats, poultry, fish, eggs, beans, lentils and low-fat dairy products Each main meal should contain protein, vegetables and carbohydrates. Eat a mouthful of each food in turn Choose foods that are mostly solid (from week six after surgery) 7
Fluids Do not drink with food. Avoid drinking 30 minutes before a meal and one hour after a meal Try to drink two litres of fluids each day keep a drink with you throughout the day Sip drinks slowly do not gulp quickly. Initially a small glass should take one hour to drink Do not drink fizzy liquids as they may cause bloating and could stretch the small stomach you have left. Drink water, sugar free still drinks, tea or coffee instead Do not use straws to drink your liquids. This may cause gas or bloating Alcohol People who have had a gastric bypass do find that they feel the effects of alcohol quicker and with only a small amount. Alcohol can also cause dumping syndrome and is best avoided. Also, alcohol provides calories and no nutrition. We recommend that you avoid alcohol completely for at least three months after surgery. Foods to avoid It is common not to be able to eat certain foods after a gastric bypass. Some foods may stick in your stomach pouch or cause blockages. Foods such as overcooked rice, overcooked pasta and soft doughy breads are more likely to be sticky and are best avoided Avoid foods which are hard to chew. This includes dry tough meats, stringy vegetables or fruits, vegetable or fruit skins, nuts and popcorn Avoid chewing gum as it can cause bloating Large pieces of food can cause blockages and vomiting The following list gives examples of the foods which you may struggle to eat and should avoid and alternative suggestions: 8
Foods to avoid Bread Overcooked rice, overcooked pasta Tough, dry meats Skins on fruit and vegetables Fibrous and stringy vegetables such as cabbage/onions/ lettuce/sweetcorn Oranges/grapefruit Alternative to try Crackers Crispbreads/breadsticks Toast Pitta bread / wraps Rice and pasta cooked still in pieces /al dente Couscous Cook meats in slow cooker/ oven for longer time until soft and tender Wafer thin cold cuts Minced meats Add low fat gravy/sauce to moisten Peeled fruit and vegetables Ripe soft fruits Tinned fruits in natural juice Cauliflower, broccoli, carrots, root vegetables (buy frozen to reduce waste) Chop onions finely Try grating fruit or vegetables Soft ripe fruits e.g. peeled peach/plum/pear/tinned fruit in natural juice Nuts, dried fruits, seeds and foods containing these - - - - - - - - - - - - - - - Coconut Popcorn - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9
Potential problems l Dumping syndrome This occurs after the consumption of sugary or fatty foods and drinks. Dumping syndrome has a range of symptoms from feeling tired and lightheaded to fainting and diarrhoea. It can also cause you to feel shaky, clammy, and nauseated. You can prevent it by avoiding foods/drinks high in sugar and fat or alcohol. Foods to avoid include:- Biscuits and cakes Chocolates and sweets Sugar and sugary drinks Pure fruit juice - dilute with water and take in small amounts only Tomato soup Full fat dairy products Pastry Fried foods Oils l Hair loss This is usually due to the physical stress of rapid weight loss but can occasionally be linked to a poor diet. Include protein rich foods with each meal and snack Take an A-Z multivitamin and mineral supplement twice a day Normal hair growth usually returns after a year. Do not take additional supplements unless advised by your dietitian/doctor. 10
l Vomiting This may be due to eating too quickly, eating too much, not chewing food well or eating the incorrect texture of food. Eat slowly, chew well and stop eating when you are full Check the texture of your foods to ensure they are not too dry, tough or sticky Do not eat and drink together If you cannot keep any food or fluid down seek medical advice. l Constipation Often due to lack of fibre and/or fluids, anxiety and depression can also make it worse: Choose high fibre cereals and include plenty of fruit and vegetables Eat regularly Ensure you drink two litres of fluids each day Exercise regularly See your GP if the problem persists as you may need laxatives l Dizziness / light-headedness Often due to lack of food, irregular meals and/or dehydration: Eat regular meals with a starchy carbohydrate at each meal Try to eat every 3-4 hours during the day Ensure you drink two litres of fluids each day If you have any questions regarding your diet please do not hesitate to contact us on 0191 293 2707. There is an answering machine if we are not in the office, please leave us a message and we will contact you as soon as possible. 11
PIN 650/V2 Review date: July 2018