Post-op Food Phases

hypoglycemia (maintenance)

2009-05-07T16:58:44Z

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.

returning to a normal eating plan (maintenance)

2009-01-05T19:49:26Z

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.

a plan for life

2009-01-05T19:47:25Z

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.

free foods list for phase 4

2009-01-02T15:15:23Z

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

regular diet (weight loss) phase 4

2009-01-02T04:08:57Z

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

soft foods -purees phase three

2008-12-01T23:07:23Z

After three weeks on liquids you will graduate to eating soft or blended foods. These are foods that dissolve easily in the mouth. The key here is to keep the texture and consistency of baby food. Remember your tummy is quite small and does not work as efficient at digestion as your old tummy; you will need to “baby” it for a while.

This phase should included foods that are creamy and smooth, but provide greater variety of foods and more nutrition. Foods should be eaten in small bites chewed well or pureed in the mouth before swallowing.

Protein continues to be a key concern at this stage. You need to have a protein serving at each meal and continue to have at least 3 (15grams) protein drinks a day or 4 (12 grams) Optisource drink containers a day. Can have one Optisource high protein chocolate bar snack as a substitute for one drink a day.

Be sure you’re getting enough liquids between meals and remember to wait at least 30 minutes to an hour to resume fluids, the longer the better.

Compliance to these guidelines cannot be overemphasized in order to avoid negative consequences, discomfort, vomiting, medical complications and emergencies.

Food tolerance or intolerance is very individual and may vary from person to person. Foods that cause problems can be identified and avoided. In her book, “Living a Lighter Lifestyle” by author, Dr. Gaye Andrews, suggests: IF foods seem to cause problems in the beginning it might help to eat the very softest foods first, such as foods that are more liquidity, and then add more solid foods that digest more slowly, to be eaten last. The order would look something like this: jell-o, mashed or creamed potatoes, soft vegetables, and meat. Remember eating proteins first is recommended and important to get in, eating meat last is only suggested if problems occur otherwise.

Did I mention: Don’t forget the protein shakes and supplements.

Time: You will be on this phase for 3 weeks.

Your portion size: ½ cup

Selections: Select one serving from carbohydrates and one serving from proteins for each meal. It is very important that you choose both protein and carbs; you will need some carbohydrate for energy, so do not skip this. If you do not eat carbs at all, the body will turn muscle into sugar and you will lose hair and muscle. Your body will also "steal" protein in which to make carbs and sugars, to feed the brain, which depletes your protein efforts.

Food Items:

Carbohydrates / Vegetables / Fruits

¼ cup Oatmeal (smooth is preferable)

¼ cup Cream of Wheat

¼ cup Grits

¼ cup cream of rice

¼ cup well cooked pasta

¼ cup whipped or very well cooked lima beans, navy beans, black beans, pinto beans, kidney beans, lentils or split peas

¼ Bean pastes like humus

2-3 Saltine Crackers

¼ cup acorn squash

¼ cup mashed potatoes

¼ cup creamed/blended corn

¼ cup whipped sweet potatoes

¼ cup boiled potato or baked without skin

¼ cup applesauce

¼ cup whipped or baby food pears

¼ cup whipped or baby food apricots

¼ cup whipped or baby food peaches

No sugar added yogurts

No sugar added puddings

Notes: make sure that cereals, rice and pastas have absorbed as much liquid as possible before eating.

Protein / Meat / Dairy / Eggs

¼ cup canned, pureed or whipped turkey, chicken, ham, tuna, (or light fish, such a tilapia) seafood (shrimp or scallops)

¼ cup tofu

Low fat lactose free milk

Soy milks

Eggs and eggbeaters

1 chopped hard-boiled egg, 1 eggbeaters or 1 egg scrambled

1 egg crepe

¼ cup low fat ricotta and cottage cheese

¼ cup or 1 ounce light or 2% cheese melted

Note: Even though you cannot eat red meat yet, you may, however, try Wendy’s chili.

Miscellaneous

All seasonings and spices of any kind

Light or fat free mayo

Reduced calorie dressings

Sugar free drinks (no carbonation)

Butter sprays and cooking sprays

full liquid - phase two

2008-11-24T15:42:43Z

I remember well the transition from clear liquids to full liquids. I was really afraid to eat food again, even if it was mostly soup, milk, yogurt and applesauce. I recall my tummy demanding something besides broth and I was pleasantly surprised and satisfied when I was able to have soup for the first time.

Once you can handle clear liquids without complications you will begin the second or full liquid phase. This is usually the phase you will start when you return home from the hospital.

The most important thing is to take it slow and easy. Your new pouch will fill quickly and empty slowly.

This phase could start as early as two days to two weeks after surgery. Be sure that you follow the advise of your surgeon, who is the one who will decide when you should transition from the clear liquid phase to having full liquids. This phase of full liquids is defined as thin pureed food and including the clear liquids on phase one.

It may be about this time that you begin to experience the “What have I done?” or “What was I thinking?” barrage as you begin to realize that life as you have known it, will be a bit different from this point forward. Be assured this is normal and part of the “grieving” and healing process and once you have accepted the change in your life, these feeling will be replaced with jubilation and victory as you embrace the new you.

Let’s review what’s new in this phase two or full liquid phase. To obtain energy and adequate protein select 2 servings for a total of ½ cup per meal. Make soups with lactose free milk to increase protein content.

Choices

¼ cup all lactose free milk; low carb, skim, 1% acidophilus, or soy,

Sugar free or no sugar added yogurt (carb grams should be less than 15 per cup) and 100-120 calories per container

Sugar Free Carnation Instant Breakfast drink

Low carb or low fat smoothie like Dannon Light n Fit carb control smoothie

¼ cup Healthy Request or low fat cream soups including: split pea, chicken, celery, mushroom, tomato, sweet potato, squash, white potato, cream of black bean, cheese or lentil.

2 no sugar added fudgesicles

¼ cup tomato or V-8 juice

all juices and drinks listed on clear liquid phase, diluted 50/50 with water

¼ cup creamed potatoes

¼ cup sugar free ice cream, pudding or custard

applesauce

infant strained fruits

non-sugar sweeteners

Protein drinks and powders list under protein

Portion: each meal is about ½ cup

It's imperative that you measure everything!

Rou en Y gastric bypass patients will need to avoid sugar. Sugar grams should be 10 grams or less per serving.

Lap-band patients, although you will be able to tolerate more sugar, it provides excess calories with no additional volume, or nutritional needs and does not aid in weight loss.

Length on full-liquid phase 2-3 weeks for gastric bypass patients and sometimes longer for lap-band.

Protein

To get proper nutrition you will need to consume high protein drinks either as one meal such as breakfast and between meals. Total protein from drinks should equal 50-60 grams. It’s important to find as many protein supplements that you like before surgery so that you will have plenty of choices and options after surgery. Choose high quality proteins that offer high protein, low fats, carbs, and sugars.

Sample Meals and Snacks

Breakfast : 1/2 cup no sugar added yogurt

Snack: (drink over 2 hour period) 8 oz protein drink (1 cup)

Lunch: 1/2 cup no sugar added pudding

Snack: (drink over 2 hour period) 8 oz protein drink (1 cup)

Dinner: 1/2 cup lowfat cream of chicken soup

Snack- bedtime (drink over a period of 3 - 4 hours) 16 oz protein drink (2 cups)

early post op and clear liquids - phase one

2008-11-17T18:55:15Z

I am always so excited to hear from those of you who have your surgery date...I can remember the excitement and I rejoice along with you. Weight loss surgery is a life-changing experience and you are on your way to a brand new life.

Until now you have been considering all the facts about the surgery itself...you've been busy making lots of decisions. You have probably been dreaming about how much weight you will lose, how you will look after weight loss, and what you will be able to do after improved health. But now it's time to switch our focus to taking care of our bodies after surgery, getting familiar with the eating plan and allowing our mindset to become aligned with compliance. So let's clear our mind of all the decisions of the last few months and let's get ready to begin our new life. We will start by reviewing the first phase, clear liquids.

The first stage after weight loss surgery is a clear liquid phase. You will only be on this for a few days. There are two phases to this stage, first clear liquids, then, you will progress to full liquids. After these two phases you will progress through several more such as soft and regular meal stages during your weight loss journey to success.

Compliance:

Compliance is the first key to success. Different surgeons may give their patients different plans, this doesn’t mean it’s wrong, just different. Well-meaning friends, relatives, or yourself, for that matter, may have a different plan, so who should you listen to? Your surgeon. These time frames as well as liquids and foods are given by your surgeon and are for your safety and health based on the type of surgery you were given and your unique health situation. Follow the plan laid out by your surgeon; there are very specific reasons for the diet he gives you. Support is crucial, but make sure the advice you are given lines up with your surgeons. Understanding “why” we have rules makes it much easier to be compliant. Here are a few things that may help:

Below is a list of clear liquids and information that will be helpful for those who are on the clear liquid phase, the first few days after surgery.

What is a clear liquid?

Any thing you can see thru, and NOT carbonated. This plan is intended to maintain vital body fluids, salts, and minerals and will give you energy until you can resume a normal diet. Liquids pass through the stomach quickly and allow your stomach to heal, and it will help you lose weight!

This excludes all solids, including noodles in soup, orange, grapefruit or milk products.

Tip:

Sip, sip, sip, sip, sip, sip, sip…and sip! Got it? Liquids will empty from the pouch quickly and won’t stretch your new stomach…unless you gulp. Think of your tummy as a funnel. The liquid you put in needs time to go down, or it will overfill. So sip, sip, sip.

Do not use a straw because it can trap air in the stomach pouch and can be very uncomfortable.

Warm drinks are often soothing as the heat relaxes the muscles and tissues in the pouch. “Ice cold' sometimes 'clenches' the pouch and restricts the flow of liquids. Some of us find that drinking water irritates the pouch and is difficult after our bariatric procedure. Some find it helpful to add a little something, such as a packet of sugar substitute or a little low sugar juice, tea, or drink mix.

Nausea

Your tummy is trying to heal and it is common to experience nausea during the first few weeks. Your tummy has been sutured and is probably not happy about it’s newly tailored appearance, and it wants to rebel! Although nausea can come from anesthesia during surgery after the first day or so, most nausea comes from overfilling your tummy with too much liquid or food. It is important to get in liquids so you won’t become dehydrated, which may lead to more nausea, so take it slow. Some herbal tea can help with nausea, such as Lemon, Peppermint, and Ginger. No ginger ale or “fizzy” stuff, please. Soft drinks can actually cause dehydration, stretch your pouch or disrupt your staples.

Portions:

Liquids are to be taken in small amounts throughout the day.

Clear liquid choices:

Begin with:

Diluted low sugar pulp free juices- diluted 50 /50 (this is what you will be given while in the hospital)

Portion size: 2 Tablespoons at a time.

Then you will move to broths and gelatins, before leaving the hospital. This is the diet you will stay on for 2 to 3 days.

Portion size: 3 Tablespoons broth and 3 Tablespoons gelatin, or ½ cup per meal

Minute Maid light, Tropicana Light, Arizona no carb green tea cranapple, peach, blueberry.

Sugar Free Jell-O

Sugar Free or no sugar added fruit juice bars and popsicles

Fat free chicken or beef broth

Decaffeinated teas herbal teas and coffees

Chicken, beef, or ham bouillon, gelatin

Sugar Free drinks like Crystal Light, or flavored waters like Fruit O2, sugar free Kool-Aid

Non-carbonated bottled water or tap water

Protein Intake while on clear liquid phase

Protein during the first few days will be extremely low. You can increase it by adding clear liquid protein products.

Isopure Protein Zero carb

Myoplex Carb Sense Fruit flavored drink, with 22gm protein

Use up to 10 ounces (1 bottle of Myoplex Carb Sense drink, or ½ bottle of Isopure) per day.

Mix each ½ ounce Myoplex or Isopure with ½ oz no cal flavored drink or water.

Measurement helps

2TB = 1/8 cup = 1 fl oz

4 TB = ¼ cup = 2 fl oz

8 TB = ½ cup = 4 fl oz

16 TB = 1 cup = 8 fl oz

Sample Menu

Breakfast

2 TB diluted apple juice

3 TB chicken broth

3 TB diet gelatin

Lunch

2 TB diluted cranberry juice

3 TB beef broth

3 TB diet gelatin

Dinner

2 TB grape juice

3 TB chicken broth

3 TB diet gelatin

The above guidelines are in compliance with dietitian Heidi Kaufman, MS, RD, LDN, and are given for purposes of support for Gastric Bypass and Lap-Band patients of Dr. David R. Miles, MD, FACS, ASBS, Miles Surgical Coastal Bariatric Center, Wilmington, NC.