- HEALTH TRACKER
But What Will I Be Able To Eat?
Your anatomy is about to be altered and the normal digestive process is going to be disrupted. Before surgery you have many areas that can absorb all your nutrients, but weight loss surgery limits nutrient absorption and/or reduces food intake. Gastric banding (adjustable or vertical) requires that you totally commit to diet changes since it reduces the size of your stomach and slows gastric emptying. The Roux-en-Y gastric bypass (RYGB) not only limits the volume of food you can eat, but also the absorptive capacity of the small intestine. Nutrient deficiencies following a RYGB are more common. If nutrient deficiencies develop after gastric banding, it is more likely due to inadequate intake and not poor absorption.
You still need to eat carbohydrates, protein and fat but the emphasis is on protein. A chewable multivitamin as well as a chewable calcium supplement will be needed on a daily basis. Your physician may suggest additional Vitamin B12, folate and iron.
A question often asked is, “What can I do before my surgery to help me adjust to my new eating habits?”
Dumping? It is an uncomfortable feeling of nausea, cramping, diarrhea, weakness, sweating and a fast heart rate. It can occur when food passes quickly from the stomach into the intestine. This is more prevalent after gastric bypass than with gastric banding.
Journaling your food intake is also a good idea before and after surgery. Do not just write down what you eat, and how much, but why you are eating and how you feel at the time of your meal or snack. Are you anxious, bored or stressed? Recording those feelings can reveal what comfort foods you seek. Stressful situations, boredom and happy times will still be there after your surgery, so you must learn how to deal with them now. You may want to seek the guidance of a psychologist who will help you develop the psychological skills necessary for a successful weight loss outcome.
The diet following weight loss surgery is divided into stages of dietary progression. You should be working with your physician and dietitian to determine your appropriate stage. You will consume a liquid to semi-liquid diet that progresses to soft foods and finally a regular, healthy low fat diet. While the food consumed is similar for gastric banding and gastric bypass, the progression for the gastric bypass is slower. No matter which type of surgery you have, one of the most important things to remember is that everyone will advance at his or her own pace. The guidelines for dietary progression are:
Clear liquids are consumed in 30cc (1 ounce or 2 Tablespoons) increments every 15-20 minutes. Fluids are sipped not gulped! Examples of clear liquids that may be consumed are decaffeinated tea and coffee, clear broth, clear juices such as apple, grape, light cranberry, sugar-free Popsicles and sugar-free gelatin. Remembering to take a sip so frequently can be difficult. Use a kitchen timer to remind you to drink every 15-20 minutes. If you work daily on a computer, an automated reminder to “take a sip” can be useful.
Full liquids are the next dietary progression. You are still consuming one to two tablespoons every 15-20 minutes. Now you have a protein goal of 30 grams a day. You will alternate your full liquids with your clear liquids and consume six cups of liquid over a 12-hour period each day. When starting the full liquid diet you also incorporate low carbohydrate protein powders or shakes as well as milk, yogurt, cream of wheat or rice, farina and grits. In order to help you meet your protein goal, you may want to try double milk that has 16 grams of protein in approximately 1 cup. It is made by adding 1/3 cup nonfat dry milk powder to one cup of skim milk and is often used when making sugar-free pudding. With the initiation of dairy products, symptoms of lactose intolerance may be a problem. If you were lactose intolerant prior to the surgery, you will probably remain so after surgery. Some develop it after surgery but usually it is temporary. If the symptoms remain, try using lactose-free or soymilk. Chewable pills or drops that break down the lactose are also available.
The pureed diet provides more variety in food choices. Pureed foods are the consistency of baby food. You will gradually increase to ¼ cup (2 oz. or 60 cc) and will eat OR drink every 30 minutes. You will never eat and drink at the same time. Your protein goal is 60 grams a day. If you eliminate one source of protein then remember to substitute another good source of protein, such as exchanging a light yogurt for a scrambled egg. Examples of foods that can be introduced in this stage are shown in Table 1.
Maintenance Phase I consists of soft, low-fat food. It contains 5-6 small meals a day of ½-3/4 cup of food each consumed approximately 3-4 hours apart. You will continue taking a multivitamin and calcium supplement. The daily protein goal is 60 grams for gastric banding and 60-80 grams for gastric bypass. Phase I includes soft foods that are easy to chew or digest. It eliminates foods such as raw fruits and vegetables, chewy breads, fibrous cereals, popcorn, whole beans, nuts and tough meats. Rice and pasta need to be well chewed or avoided. Food should be chewed to the consistency of applesauce. Cooking and mashing the food may help you tolerate the consistency. Continue to sip water between meals, consuming at least 64 ounces a day. You should stop drinking 15-30 minutes before meals and may need to wait up to 30 minutes to one hour after meals. If you drink while you are eating, the pouch will fill with liquid quickly and your food intake will be decreased! When you do this you sacrifice good nutrition from food and are not allowing yourself to adjust to normal eating. Drinking following a meal results in the pressure of the liquid forcing the food out of the stomach too quickly. Examples of foods that can be introduced in Phase I are smooth peanut butter, frozen low fat convenience foods that are “carb controlled” and food that can be easily chewed such as tofu, flaky fish, moist chicken without the skin, mashed beans, soft fruit and cooked vegetables.
Phase II is a regular, low fat diet that establishes a permanent guide for new eating habits. It continues to provide 60-80 grams of protein every day. Most will have transitioned to this phase in about three months. You may now add favorite foods from your diet prior to surgery as long as they are low in fat and sugar. Five or six meals a day that are less than or equal to 1 cup per meal are the standard. Usually during this phase, your physician prescribes B12 supplements.
Other tips that can make dietary progression easier are:
AND DON’T FORGET ---
Whether you are attending or hosting a party it can be a challenge and planning should be a priority. Incorporating some of the following ideas may reduce some of the stress and make those events more enjoyable.
Someone once said, “If we don’t put effort in creating what we want, we have to put effort toward coping with what we get.” These words certainly ring true in losing and maintaining weight loss. Your bariatric surgery is a major tool in helping you lose your weight but by itself it will not give you the results you desire. Achieving the optimum weight loss you want and developing the tools for successful weight maintenance requires a life long commitment to a healthier lifestyle. You can do it!