Each phase in your diet changes throughout your weight loss journey,  especially as you get near your goal weight.  I have found on maintenance, especially as I am three years out now, that my diet has to be different than it was last year this time, even though I was the same weight. 

I found myself getting into trouble with my blood sugars, as I was having low blood sugar drops and hypoglycemia moments throughout the afternoon.  Even though I was eating 5 or 6 meals a day at 1200 calories, it may not be enough food, protein or some other element causing this problem.  It sounds strange,  however it's not that uncommon in weight loss surgery patients.  

I have now modified and increased my calories by adding more protein supplements.  I still continue to eat 5 or 6 small meals a day.  This includes protein, vegetables, complex carbs, whole grains, beans, fruit and healthy fats.  You need a well balanced diet to maintain good health and to keep your weight under control. 

During the maintenance phase, I had eliminated my protein supplements and have now added them back, we will see if this helps. 

I found that not eating enough food, calories and or protein allows my body to enter a "famine" state and hold on to every calorie, slowing my metabolism down and in the process, as my body tries to conserve energy, producing hypoglycemia.  I was beginning to gain weight and struggling to keep up the activity, fighting with low blood sugars and becoming increasingly frustrated with the "crazy" cycle.  Once my blood sugars drop, my whole body was off the rest of the day as I struggle to regain the balance. 

After discussing the situation with my surgeon during my three year check up, I have now changed my diet to include more healthy calories.  I make sure that I eat enough protein for breakfast or add a healthy protein bar before exercising.  I am currently walking about 3 or 4 miles a day or in the gym.  

I have been doing some research on hypoglycemia and gastric bypass, if you still cannot control your low sugar drops with diet, you may need to see your surgeon for further help in this area.  

I am also in the process of contacting a dietician, which is paid for thru my insurance company. 

For more see the upcoming post on the blog section about moderation and well balanced eating under the "hungry" entries or dealing with emotions entries.

After all is said and done, we can look back to remember our main goal for having weight loss surgery (as far as our diet is concerned) is to resume a normal healthy eating plan. Your diet at this point, during maintenance, can consist of approximately1,200 calorie (this calorie count is for inactive, 1500+ as your activity increases) and may look something like this:

Food Servings

3 oz of protein (225 calories) 2 servings a day

1 starch (80 calories) 3 servings a day

1 fruit (60-100 calories) 2 servings a day

1 vegetable (25 calories) 3 servings a day

1 tsp fat (45 calories) 3 servings a day

1 dairy (90 calories) 2 servings a day

Given by: Sally Myers, RD, CPT

The above diet plan is about 1400 calories. 

At a recent retreat I attended for weight loss surgery patients, I had the opportunity to consult with a dietitian about resuming a healthy diet after weight loss surgery.  Sally Myers was very helpful and offered the following advise: "It is only necessary to keep up protein supplements if you are unable to get enough out of your diet or are having a bad day and not eating well. I assess each patient's status by their labs and food intake. Some people can get away with less protein than others." 

It is very important to stay connected to your nutritional counselor until you have become efficient in maintaining your weight loss.  Your surgeon can help provide additional personal evaluations based on your lab work each year.  Let's stay on tract with good health, equipped with vital information and assume responsibility for our most priceless gift, our health. 

Tips: Avoid the white stuff...which are refined carbs. The less refined carbs you eat, the less craving you will have. Refined carbs are foods with sugar and white flour. Stay with more natural whole foods and less processed foods. Artificial sweetners will not only make you hunger but can also cause sugar cravings. For more information on carbs see post from the blog. 

Maintenance Phase:

In the months after surgery, during the weight loss phase, you will be eating between 400 to 800 calories a day.  These calorie amounts will increase with time and with each food phase.  As time goes by and you get near your goal weight your appetite will increase and so will your calorie intake.  By the time you reach the maintentance phase you should be eating around 1200 calories a day. 

You should try to limit your calories to 1200 a day until you reach your goal weight.  You can increase your calories gradually until your weight is stable.  The amount of calories you can eat will be based on your height, the amount of exercise you do and recommendations of your surgeon and nutritionist.

When maintaining your weight you might eat between 1200 to 1500 calories a day.  Be sure to eat a healthy diet and conscious of not only what you eat but why you eat.  Learning these skills will determine your weight loss success. 

Nutritional excellence:

It is a very good idea so take advantage of your nutritional counseling up to the time you are confident that you can maintain your weight loss.  Remember, we have had a lifetime of practice dieting, but we aren't quite as practiced at maintaining.  Good nutrition and exercise will be an important part of good health both physically and mentally. 

Success for a lifetime:

After all isn't this what our goal was with weight loss surgery, to able to eat normally and remain healthy for a lifetime.  Remind yourself of why you had the surgery.  Maintenance is the key to success.  The key to maintenance is to balance good nutrition, along with vitamins, water, exercise, learing your body's signals and learning strategies for a lifetime. 

Understand that weight loss is not always a straight line, there will be ups, downs and plateaus as your body adjusts to its new set point.  Having a good plan for meals as well as strategies and plans for handling social, relational, and stressful situation as well as set backs will be invaluable. 

Spiritual Health:

Good nutrition and exercise will help you maintain a healthy body.  It's also important to seek spiritual, emotional and relational health as well. 

fat free creamers

fat free margarine

fat free sour cream

sugar free gum

very low sugar jam

sugar free beverages

bouillon

coffee (decafe)

tea (decafe)

mustard

dill pickles

low sodium soy sauce

sugar free popsicles

Vegetables:

artichokes

asparagus

green or italian beans

beets

broccoli

brussels sprouts

cabbage

cauliflower

celery

cucumbers

eggplant

green onions

greens (collards, kale, mustard, turnip greens)

mushrooms

okra

onions

peppers

radishes

salad greens (escarole, lettuce, romaine)

sauerkraut

spinach

summer squash

tomato

turnips

water chestnuts

zucchini

This phase is not the last, but you're almost there.  This phase is the regular food phase you will remain on while still losing weight.  You should be able to start this phase about 6 weeks after surgery.  This phase includes solid food eaten in very small portions.  Most foods, with some exceptions such as tough meats like beef, can be eaten as long as they are reduced in fat and sugar. 

It will be to your advantage to know and comply with this phase well, this phase is the tool you will need for weight loss success.  

The 5-10-15 guideline

A good rule is to keep each meal at no more than 5 grams of fat and 10 grams of sugar.  Carbs should be around 15. 

Portion size for each meal should be no less than 1/2 cup and no more than 1 cup in size.  Meat portions should not exceed 2 ounces per meal.

You will be eating the same foods as on the pureed diet for the most part, but they won't all be soft at this point. 

Protein is important  

At this point you may be able to reduce the protein drink to one a day or bar consumption to one a day and substitute lowfat lunchmeat slices or lowfat cheese slices as a snack between meals.  Make sure your protein intake is 50-60gms from meals and snacks before reducing shake amounts. 

Getting enough food?

If you are able to consume 1 cup worth of food from the protein and carb list and still have room for more, pick a lowcarb free food vegetable to add to the meal.  If you have found that you have stopped losing weight or are starting to gain weight, keep the carb portin to 1/4 cup or one serving and add 1/4 to 1/2 cooked free vegetables. 

Precautions:

Chew food very well.  There is a risk of blockage if you swallow large bites.  After a while this will become a habit, so practice, practice, practice. 

Foods to avoid:

Tough meats or steaks

Untoasted bread

Stringy vegetables like celery, corn, spinach in a can or raw

Membranes of oranges and grapefruit, skins of various fruits and vegetables like apples, pears, and potatos

Coconut, seeds, and nuts

Make difficult foods easier to digest

Toast bread

Remove membranes from oranges and grapefruits

Peel skins of fruits and vegetables such as apples, pears, and potatoes