Post-Op Diet

(Always Follow "Your" Surgeons Dietary Plan)

DISCLAIMER STATEMENT

This information is for general purposes only, and should not be construed as definitive or binding medical advice. Because each person is medically different, individuals should see their personal physicians for specific information and/or treatment.

This is aimed at post-op patients, but the pre-op patients who want to get started adjusting to the new lifestyle required for post-op patients can gain some great insight and information too. Protein is necessary for proper wound healing and fighting infections after surgery. It also helps your body to repair and strengthen cells, and it helps you to build new cells as well. Taking your protein as directed will also help to prevent or lessen hair loss (provided you are also taking your vitamin/mineral supplements as instructed). Some surgeons have diffrent opinions on this follow his/her advice. How much protein do you need after surgery? You need about 80/85 grams of high biological value (good) protein per day following gastric bypass surgery. Sixty/Sixty-five of the 80/85 grams should come from your diet and the other 25 grams should come from your protein supplement (Designer Protein, Promod or Advanced Health System). Myself I take in 65/70 grams in food and another equal to that in protein suppliment. You may have a little trouble meeting this goal your first five weeks following surgery because your body is still adjusting to it's new stomach. However, if you focus on eating your good protein foods first, you will find this task much easier. In other words, don't fill up on starches, fruits or vegetables, before eating your good protein foods. Let's look first at the 65/70 grams good quality protein from your diet. Good quality protein foods include all meats, poultry, fish, and dairy products (eggs, cheeses, milk, and yogurt). Each one ounce serving of meat, poultry, fish, cheese, one egg, or eight ounces of skim milk or nonfat yogurt (may need to be lactose free) has about seven grams of good quality protein. If you take in two ounces of good quality protein at breakfast, lunch, and dinner with a one ounce for an evening snack you will meet your protein requirements from your diet every day. This may seem like a lot of food right after surgery and it may be difficult to reach this goal of seven ounces of good quality protein per day at first. The key to success here is to focus on the good quality protein foods first at meal time. Don't eat anything on your plate until you have first finished your good protein. Also, remember to separate solids and liquids. You should stop drinking liquids one-half hour before meals, no fluids with meals, and no fluids up to one-half hour after eating. Caution: Remember that you may not tolerate red meats, cheeses, milk or yogurt right after surgery and should probably not start these foods for a while but do try fish, white meat, and eggs. You could even try Vitamite (a soy based milk substitute), Lactaid milk, milk treated with Lactaid drops, or chew Lactaid tablets with cheeses or yogurt but red meat is definitely out. Also don't forget that for the first five weeks following surgery you must use only pureed consistency foods (this includes your good quality protein selections). In regards to the 25/30 grams of good quality protein you need from your protein supplement, Promod has 5 grams of protein per scoop. If you use Promod as your protein supplement, you will need to take three scoops per day, every day. Advanced Health System has 12 grams of good quality protein per packet. GNC Challenge has 17 grams for every 3 Tbls. I found a Protein Bar "Promax" Lemon Chiffon that is 20g of protein and is great tasting to substitute a meal if on the run and can't stop to eat proper, however bars are filled with calories and if you're on 600 calories as I am that's one bar could take 1/2 my intake for the day. Again it is very important that you not skip taking your supplement. It must be taken every day otherwise you may develop a protein deficiency which could lead to some of the problems mentioned earlier. Above all follow your own surgeon's diet recommendations to the letter, all have different dietary requirements and regiments.

YOUR NEW ANATOMY

The Roux-en-Y gastric bypass uses a staple line to separate the stomach into two parts, with a very small "pouch" above the staple line. This tiny pouch can hold about 1 ounce, about the size of a shot glass. The pouch is then hooked up to a loop of intestine in a way which often makes people sick if they eat a lot of sugar. The small pouch makes it difficult to eat a large amount of solid food, but provides very little barrier to liquids taken slowly. The vertical banded gastroplasty operation works the same way without the difficulty with sugar. While the tissues of your surgically-altered stomach are healing, you will be on the "soft diet" which is designed to maintain adequate protein intake while minimizing stress on the raw tissues in the early period after surgery.

DIET PROGRESSION IN THE HOSPITAL

Again I will repeat all Surgeons have diffrent protocol. Follow his/her instructions..

After surgery, the stomach tube is removed (usually the morning after surgery) and clear liquids are given. You should sip on these liquids gradually, and begin to learn how to sense fullness of the new stomach pouch. It is important to avoid high calorie liquids such as fruit juices and sugared soft drinks. When you are tolerating clear liquids (usually one or two days), the soft diet is started. The soft diet is the diet you will be on for your first week or so at home.

DIET PROGRESSION AT HOME

The first diet priority for the initial home diet is to maintain your body’s hydration by taking frequent small sips of liquid. Depending on when your surgeon says you can start a soft diet some say 4 weeks some say 8 weeks..Please consult your surgeon...The next goal of the soft diet is to maintain an adequate nutrition over the first 4 to 8 weeks after surgery until you begin eating a regular diet.

MORE ON FLUIDS

One of the main challenges for a gastric bypass patient over time is to maintain hydration. Your body needs just as much fluid after the surgery as it did before surgery, yet you are limited by the stomach pouch to intake of 1-2 ounces at a time. Maintenance of fluid intake may also be difficult because of the necessity to take in food or fluids, and not both at once. You must compensate for this by taking small amounts of fluid on a near-constant basis. Usually this means that you should carry your fluid source (a small bottle, or "sippy jug", or something similar) with you at all times. We cannot overemphasize that the liquid must be a calorie-free liquid such as water, Crystal Light, diet Kool-aid, or other diet products. Patients who use fruit juice or other calorie-containing liquids for hydration may experience inadequate weight loss because of the calories in these fluids.

Fluids should be consumed on a near-constant basis, but not during meals and not soon following solid food. If the patient drinks during a meal, they will tend to wash the food out of the stomach pouch, and consume more than ideal. It may seem strange at first to eat without drinking but it works fine. In addition to reducing overall food intake, this new habit will encourage the patient to chew more thoroughly before swallowing.

Liquids should not be consumed for about an hour after eating. This is because the food actually forms a plug that blocks the outlet from the pouch until it has all passed through. If the patient drinks liquids on top of this plug it will create a very uncomfortable sensation and may also force food downstream more quickly than it should go.

THE SOFT DIET AFTER GASTRIC BYPASS

In the first month or so following your surgery, you can eat foods which are high in protein and yet are "soft and mushy" and foods which are "crispy." Foods which are "mushy" can be put into one of four categories:

MUSHY FOODS:

Eggs - scrambled, soft boiled, and in the form of egg salad. The whites of fried eggs are usually too rubbery to be eaten this soon after surgery. Remember: egg whites have the protein, the yolks are mainly fat. Dairy products - although these are high in saturated fats, they are also high in protein and will go down easily. Soft cheeses, low fat yogurt, (flavorings optional), low fat frozen yogurt, and skim milk are the best dairy products for weight reduction. Hard cheese may be taken in moderation. Avoid: whole milk, cream, ice cream, whipped cream, and ice milk.

As sources of protein, eggs and cheese are excellent, but they also contain a fair amount of fat. Therefore, Eggbeaters (or just egg whites), and fat-free, or low-fat cheeses will give greater weight loss, but are not 100% essential to have a decent weight-loss result. Legumes - this includes beans, lentils, and peas. All must be in a mushy form which will pass through the pouch easily. Good examples would be: split pea soup, bean soups, refried beans. At this time, the only form of whole cooked beans you can eat, such as ranch beans or canned baked beans, or whole pinto beans, must be mashed up well. Do not try fresh or frozen green beans yet, because they are too fibrous to digest easily. Canned green beans can be tried only if they're very soft. Peanut butter should be used only in small amounts as a substitute for butter or margarine. Peanut butter is very high in fat, so use sparingly. A good choice for beans would be "fat-free refried beans."

Animal protein - examples of this would be tuna salad, chicken salad, deviled ham, potted meats, pates, and liverwurst. Avoid any gristly meats (including Spam) at this time because gristle tends to get stuck in the pouch. Spam must be chewed very well. "Potted meats" include any soft meats that you can spread on a cracker.

You may use real mayonnaise, light mayonnaise, or non-fat mayo.... the only difference to you will be how quickly you want to lose weight. The same applies to your choice of tuna packed in water, or packed in oil: If you choose "in water," you will take in less fat, and consequently, lose weight faster. It is up to you.

CRISPY FOODS:

"Crispy foods" are: foods that will disintegrate if you place them in a glass of water. Examples of crispy foods would be: Melba toast, crackers, well-toasted bread, tortilla chips, or very crispy bacon. You can eat tortilla chips that are baked or fried. Again, if you always choose "baked tortilla chips," you will lose weight faster because you are taking in less fat. Foods that must be chewed well in order to be swallowed are crispy. Example: very crispy bacon, or crackers. You may put any spread on your crispy toast. However, if you put regular butter on your crispy toast, you will lose weight more slowly than if you select low-fat butter or margarine. The same principle applies to regular cream cheese vs. low fat, or non-fat cream cheese. If you want to lose weight faster, make the lower fat choices. To avoid all fat on toast, eat it very toasted and dry, or add just jam or jelly on top. There's no fat in jams. To minimize sugar intake, buy "all fruit" or "spreadable fruit" instead of regular jam.

You can combine any "mushy" food on top of any "crispy" food. Examples: tuna fish on crackers, or refried beans on tortilla chips, or egg salad on crispy toast.

On the other hand, fried salty snacks such as potato chips, Cheetos, Dorito’s, etc. are ABSOLUTELY FORBIDDEN. If you get the urge for a salty snack, we recommend beef (or other meat) jerky. This fills your mouth, you get to chew it a long time, and it is high in protein, as well.

NOTE: "Crispy foods" are not the same as crunchy foods. Raw vegetables are the best example of crunchy foods. During this soft diet, do not eat any raw vegetables because they are too fibrous and can get tangled in the outlet. Example: do not put any celery in your tuna salad or chicken salad. NO RAW VEGETABLES YET. Canned vegetables can be eaten for variety, because they are more mushy. By the second week after surgery, you may start adding more of a variety of foods to your diet, but still keeping the consistency of the foods in the "mushy" or "crispy" categories only.

TRANSITION FROM SOFT DIET TO REGULAR GASTRIC BYPASS DIET

As the weeks go by after surgery, additional foods may be added, such as ground meats, spices, and well-cooked vegetables.

By the second week, you may try peeled fruits (apples, pears). Remember to take small bites and chew well before swallowing. Grapefruit may be tried by the fourth week. Don't just peel and eat, but rather eat each grapefruit section with a spoon between the membranes. Always avoid swallowing chewy membranes. The trick with all citrus fruits is to eat just the sections and avoid eating any white membranes which don't pass through the outlet well. Note that fruits do contain natural sugar, which can cause dumping syndrome if consumed in large amounts. Usually dumping is not a problem because the fruit also takes up space in the stomach pouch and the patient doesn’t get a large load of sugar. Also, the natural fiber in the fruits seems to slow the absorption of the sugar and reduce the chance of dumping. Note also that fruit juices (especially orange juice and grape juice) are rather likely to cause dumping syndrome because they contain natural sugar and go down easily in significant quantity.

It is best to wait until at least the 5-8 week following your surgery before trying to add regular meats to your diet. (consult your surgeon)

WEIGHT LOSS AND MAINTENANCE DIET AFTER GASTRIC BYPASS

About four to five to eight weeks after surgery, the patient should have transitioned to a diet totally different from the above Soft Diet. The main purpose now should be weight loss. To maximize weight loss and to maintain nutrition, solid foods should be taken almost exclusively.

You should now begin eating the same foods as the rest of the family, only in much smaller amounts (e.g. a chicken wing might constitute an entire lunch). The best foods here are meats and salads. Since the quantity of your intake is very limited, it is very important that you eat highly nutritious foods and don't waste valuable space in your new "stomach pouch" with empty calorie, junk foods. This is a great incentive to "eat healthy."

All meats can now be eaten. The two most important things to remember when eating meats are:

To cut up each piece of meat to the size of the eraser on a wooden pencil. To chew up each piece of meat individually, before swallowing. These two new habits may take you several weeks to work on before you feel comfortable doing them every time. Keep trying, even though at first, it may seem very strange on your plate and in your mouth!

NOTE: The overwhelming majority of bariatric surgery patients should NOT be using a blender for meats. A few patients may need to use the blender, if they can't keep meats down any other way even after practicing the above two new habits for some time. However, before giving up to the blender, if you think you are in this category, see your surgeon first for details.

Each patient has certain foods which "don't agree with me." It is important to recognize that these are usually the very foods which fill up the pouch the fastest! If a bite of a hamburger fills up your pouch and makes further eating impossible, often it isn't because "the hamburger doesn't agree with me", but rather, because that small amount of hamburger was enough to fill up your pouch! STOP eating right then and there! To have that "second bite" is often to overeat. Your new restricted stomach can't handle it – even one more bite will distend the pouch and make you feel miserable. When you have an experience like this (all patients do) use it to learn how much of different kinds of food it takes to feel full. Try to train yourself to recognize an adequate amount of food while it is still sitting on the plate, and avoid that "painful full" feeling altogether.

This is a new concept and it will take time to adjust to it. So, go easy on this new eating pattern in the first few months until you know what that new "feeling of fullness" is like. Eating such small amounts of foods seems strange, but it is all you need to be healthy and will promote maximum weight loss.

Remember: when you go to eat out in a restaurant bring our card so you may be entitled to get the "child's plate."

http://www.obesityhelp.com/morbidobesity/restaurantcard.html

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