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FIRST MONTH: Post Operative Dietary Guidelines

• You must follow a liquid diet for the first 4 weeks.
• Choose only foods and beverages from the lists below. All foods must be pureed in a blender and thinned to a texture that will fit through a straw; however, DO NOT USE STRAWS!
• Consume three different items at each of your meals. Sip 1/8 cup (1 oz) of each, never drinking more than 3 oz at one time. Sip slowly. Each 3 oz meal should take 30-45 minutes to consume.
• In addition, drink approximately 3 cups (24 oz) of lactose-free protein supplement daily, or enough to reach your protein goal set with the dietitian. Drink about one cup between each meal and one before bedtime. Sip slowly (2-3 hours per cup). This is important to prevent protein malnutrition. See protein supplement list for examples. Note: Mix powdered supplements only with water, nonfat milk, or any sugar-free beverage. Choose only those supplements with no more than 5 grams of sugar per serving.
• Adequate fluid intake is essential to maintain hydration. Sip on water between meals, and before and after each protein supplement. Try taking one swallow each minute. You need approximately 64 ounces (8 cups) of fluid each day (water, liquids at meals, protein supplements, etc.)
• Sugar substitutes and salt may be included.

Note: The post-op diet includes some sweet foods and beverages that are to be avoided in your lifelong meal plan. Include them in the first few weeks only.

FIRST MONTH: Food & Beverages Allowed

• Beverages: coffee (decaf); tea; fruit juice; nonfat milk; sugar-free hot chocolate; any sugar-free, non-carbonated drink
• Cereals: cream of wheat or cream of rice, thinned with nonfat milk
• Soup: bouillon; broth; meat-based and milk-based soups that have been strained
• Meats: pureed strained meat and poultry, thinned with broth or vegetable juice
• Potatoes: mashed potatoes, thinned with nonfat milk
• Vegetables: all vegetable juices; pureed, strained vegetables thinned with vegetable juice
• Fruits: all fruit juices; strained fruits, pureed and thinned with fruit juice
• Desserts: sugar-free pudding (made with low-lactose milk); applesauce; sherbet; sugar-free Jell-O; custard; sorbet
• Snacks: Drink your choice of protein supplement between meals and after dinner (approximately 1 cup at each time, sipped over 2-3 hours). Sip on water at all other times.

FIRST MONTH: Sample Meal Plan (1/8 cup of each item listed)

• Breakfast: tea; V-8 Juice; cream of rice (thinned)
• Lunch: clear broth; pureed, thinned chicken; strained, thinned applesauce
• Dinner: nonfat milk; mashed potatoes (thinned); sherbet

SECOND MONTH: Post Operative Dietary Guidelines

• Your band will be adjusted at approximately 4-6 weeks after surgery at the discretion of your doctor. At this time, start to add regular foods to your diet.
• Introduce one new food at a time, either at breakfast or lunch (not at your evening meal).
• Chew foods to an applesauce consistency before swallowing.
• Take 10-15 minutes to eat each 1/8 cup of food (30-45 minutes total)
  • Continue to consumer approximately 3 ounces at each meal. Pay attention to your body's signals of fullness. DO NOT EAT BEYOND THE FIRST SIGN OF SATISFACTION. Following this principle will maximize your weight loss.
• Choose at least one food high in protein at each meal. (See the list of protein foods). Eat protein food first to ensure adequate intake.
• Continue drinking the liquid protein supplements. Low sugar, high protein bars may be introduced as alternative options. Continue supplements until protein intake is adequate from your food (per the dietitians' protein recommendation). Discontinue the protein supplements only when and if you are reaching your protein goal with foods alone.
• Choose solid foods only now at meal times. Creamy and soft-textured foods may inhibit weight loss, as they will not provide adequate satisfaction from one meal to the next.
• To stay well hydrated, sip steadily on water or calorie-free beverages between (but not with) meals. Stop drinking about 15 minutes before eating and do not drink for at least one hour after each meal.

SECOND MONTH: Sample Meal Plan (1/8 cup of each item listed)

• Breakfast: 1 egg* omelet with veggies; 1 slice toast
• Lunch: tuna* in lowfat mayo on crackers; melon pieces
• Dinner: ½ tortilla with grilled chicken*; lowfat cheese*; tomato
• Snacks: Drink or eat choice of protein supplement between meals and/or after dinner (enough to achieve daily protein goal). Sip on calorie-free beverages at all other times.

* indicates a good protein source

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Diet after Gastric Bypass

• Fluids: Drink 30cc of fluid every ½ hour while awake for the first two weeks.
  Hint: Carry a water bottle at all times.
• Protein: Take in 60-80 grams of protein supplement daily
• Progression of Diet: You may try a soft diet when you get home from the hospital, then slowly advance to ground meats and chicken over the next few weeks. You may be able to eat regular food by 3-4 weeks. Easy does it. Your eyes will be bigger than your stomach for a while.
• Maintenance Diet: Complex carbohydrates (vegetables and fruits), protein (60-80 grams per day), polyunsaturated fats - avoid simple sugars (colas, fruit drinks, snacks that come in bags) and limit foods high in saturated fats (even though they may be tasty)

Vitamin and Calcium Supplements – A Lifelong Requirement

Take these vitamins in the dosages listed below:

• A multivitamin with iron (Centrum®) daily, with meals.
• Citrical® (1200 mg of calcium citrate): one 400 mg tablet three times daily
• A B12 dot daily. This is a sublingual tablet, which is absorbed through the gums.

Annual blood tests are needed to check vitamin levels. This is not a suggestion – it is your responsibility! Vitamin deficiencies can be life-threatening. The specific blood tests are CBC, B12/Folate, Ferritin, Parathyroid Hormone, Vitamins A and D.

Helpful Hints

1. Eat three very small meals per day - NO SNACKING. Stop eating at the first sensation of abdominal pressure or fullness.
2. Select a balanced diet, choosing foods from all groups in the Food Guide Pyramid. Avoid sugar, sweets and desserts. Also, avoid high fat foods such as cream soups, gravy, butter, etc.
3. Eat very slowly. Take 30-60 minutes to eat each meal.
4. Eat solid food only at meals. Take very small bites and chew your food to applesauce consistency (approximately 15-20 times per bite).
5. Be sure to meet your daily protein recommendation by eating at least one food high in protein in each meal. Use protein drinks and bars as needed to reach your daily protein goal.
6. Drink only calorie-free beverages (except non-fat milk and protein drinks). Consume 6-8 cups of fluid per day but do not drink with meals, 15 minutes before or for 60 minutes after your meals. Do not drink through a straw. Avoid alcohol and carbonated drinks.
7. Avoid foods that often cause stomach upset. Reduce intake of coffee, chocolate, caffeine, and black or red pepper if discomfort results.
8. Take a multivitamin and 1200-1500 mg calcium daily.
9. Exercise at least 30 minutes every day.

Note: If you feel satisfied with a smaller quantity of food than recommended, you should stop eating. If the amount of food recommended does not cause satiety or if you feel hungry one hour after a meal, contact the medical team for further evaluation.

Exercise - The Neglected Link

Patients who exercise for at least 20 minutes three times a week lose the most weight and do not regain any back. Unfortunately most patients ignore this recommendation. You will have access to programs specially designed for post-op bariatric patients. Take advantage of them.

Diabetes and Surgery

While weight control comprises the most important aspect of type 2 diabetes management, the currently available diets and drugs result in only a small, and for the most part, temporary weight loss. There is little, if any, effect on diabetes. The welcome news is that weight loss surgery results in an 85% remission rate of diabetes in morbidly obese patients (BMIs greater than 40). Furthermore there is now good evidence that weight loss surgery also eliminates diabetes in the majority of patients with mild to moderate obesity (BMIs between 30-40).

Gastric bypass has a more dramatic and powerful affect on type 2 diabetes than gastric banding. Diabetes typically resolves in a few days to weeks following a gastric bypass, long before substantial weight loss has occurred. In contrast remission of diabetes after a banding procedure does not occur until a substantial amount of weight has been lost over many months.

To Learn More

Information and Resources for Weight Loss Surgery

Websites:

MyPhonediet.com
ConquerObesity.com
Obesityhelp.com
National Institutes of Diabetes and Digestive and Kidney Diseases
American Society for Metabolic & Bariatric Surgery

Local Support Groups and Information Centers:

Allied Surgical Group (973) 267-6400

Information Seminars are held the first Thursday of each month at 7 p.m. in our office. Please call to make a reservation.