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17.doc

  1. 1. Dietary Guidelines for Post-Bariatric SurgeryAfter surgery it is important to follow special dietary guidelines to ensure properhealing, to obtain adequate nutrition, and to avoid complications. Because ofyour stomach’s reduced size, the amount of food you eat at one time is verysmall at first. Your diet will be advanced and additional foods added as youtolerate each diet phase. However, keep in mind that people have variedtolerances to different foods following this type of procedure. A RegisteredDietitian can help you identify food intolerances, make appropriate food choices,and help you plan a balanced meal plan.Timetable and Diet Progression for Different Types of SurgeryVertical Banded Gastroplasty (VBG)• Day after Surgery o Water, up to 2 ounces per hour o Add clear liquids, up to 4 ounces per hour, as tolerated o Initiate clear liquid protein supplements• Three Days after Surgery o Add full liquids, 4 to 6 ounces per hour o Drink at least 8 cups per day to help ensure adequate hydration• One Week after Surgery o Add pureed foods, using a blender or food processor to puree o Eat small meals and focus on high protein foods o Continue to monitor fluid intake• Three Weeks after Surgery o Add soft foods, 2 to 4 ounces soft cooked foods every 3 to 4 hours o Continue to focus on high protein foods such as fish, seafood, low fat cheese, cottage cheese, yogurt, eggs and/or egg substitute• Five Weeks after Surgery o Continue with soft foods, focusing on those high in protein o Add poultry and pasta as tolerated• Two to Three Months after Surgery o Add poultry, low fat beef and pork as tolerated o Add soft fruits and cooked vegetables• Four Months after Surgery o Add salads, crunchy fruits and vegetables, dried beans, peanut butter, cereal, toast, crackers and potatoes as tolerated• When goal weight is achieved, begin maintenance plan based on a 1200 to 1600 calorie diet using the diabetic exchange lists as guidelines.Laparoscopic Adjustable Gastric Band (LAGB)• Day after Surgery o Clear liquids
  2. 2. • Three Days after Surgery o Add full liquids as tolerated o Drink non-caffeinated, non-carbonated clear liquids for hydration• One Month after Surgery o Add pureed foods, using a blender or food processor to puree o Eat small meals and focus on high protein foods o Continue to monitor fluid intake• Two Months after Surgery o Add soft foods, 2 to 4 ounces soft cooked foods every 3 to 4 hours o Continue to focus on high protein foods such as fish, seafood, low fat cheese, cottage cheese, yogurt, eggs and/or egg substitute o Add soft fruits and cooked vegetables as tolerated o Add lean chopped/ground beef, turkey or chicken as tolerated o Limit high meats high in saturated fat o Continue to monitor fluid intake• Three Months after Surgery o Add solid protein foods, crunchy vegetables and fruits as tolerated o Avoid stringy foods such as celery, rhubarb and asparagus, unless well cooked. o Continue to monitor fluid intake• Six Months after Surgery o Add whole grain complex carbohydrates o Continue to monitor fluid intake• When goal weight is achieved, begin maintenance plan based on a 1200 to 1600 calorie diet using the diabetic exchange lists as guidelines.Biliopancreatic Diverson with Duodenal Switch (BPD/DS) • Day after Surgery o Clear liquids o Add low lactose full liquids once clear liquids are tolerated • Three Days after Surgery o Add pureed foods, using a blender or food processor to puree o Continue to monitor fluid intake and protein supplementation • One Month after Surgery o Add soft foods with focus on high protein foods such as low fat soft cheeses, eggs/egg substitute and fresh seafood o Add soft fruits and cooked vegetables as tolerated o Reintroduce milk gradually• Two Months after Surgery o Add poultry as tolerated o Continue to monitor fluid intake • Three Months after Surgery o Add lean red meat and pork
  3. 3. o Add salads and crunchy fruits, vegetables, beans and nuts as tolerated• When goal weight is achieved, begin maintenance plan based on a 1200 to 1600 calorie diet using the diabetic exchange lists as guidelinesRoux-N-Y Gastric Bypass Surgery (RNY)• Day after Surgery o Clear liquids• Three Days after Surgery o Add high protein pureed foods and supplements• Two Weeks after Surgery o Add soft foods with focus on high protein foods such as fish, seafood, cottage cheese, eggs/egg substitute, soft cheese and yogurt o Continue with high protein supplements as needed• One Month after Surgery o Add poultry and lean meat as tolerated• Three Months after Surgery o Add soft fruits and cooked vegetables as tolerated• Four Months after Surgery o Add salads and crunchy fruits, vegetables and beans as tolerated• Six Months after Surgery o Add seeds and nuts as tolerated• When goal weight is achieved, begin maintenance plan based on a 1200 to 1600 calorie diet using the diabetic exchange lists as guidelinesGeneral Guidelines• Clear liquids include chicken or beef broth, sugar-free gelatin, and artificially sweetened, non-carbonated beverages• Full liquids include strained cream soups, protein shakes, milk, yogurt and sugar-free pudding• Take small bites of food, chew thoroughly, and eat slowly, allowing at least 30 minutes to finish each meal. Use child-sized silverware or chopsticks (for solid foods) to force you to eat slowly.• Do not drink while eating. Avoid drinking liquids during, and at least 30 minutes before and after each meal. Sip on fluids (low calorie, sugar-free, non-carbonated, and caffeine-free) throughout the day to prevent dehydration - at least 48 to 64 fluid ounces total.• Stop eating when you begin to feel full. Overeating can lead to vomiting.• Add new foods one at a time to determine how well you tolerate them. If you do not tolerate something, then wait about one week before trying it again.• Avoid concentrated sweets and sugar found in cakes, pies, cookies, candy, jelly, syrup, regular soda and other sweetened beverages, etc.
  4. 4. • Avoid high fat foods such as fried foods, regular snack chips, gravies, cream sauces, cream soups, high fat meats, butter, margarine, oil, regular cheese, sour cream, cream cheese, etc.• Remove all visible fat from meat when you are able to eat meat.• Drink protein supplements daily for up to six months after surgery, or as prescribed by your Surgeon or Registered Dietitian. Supplements should provide at least 60 to 80 grams of protein daily.• Avoid carbonated beverages for at least the first 6 months following surgery to prevent abdominal discomfort or distention. If you do choose them, limit to 1-2 per week, choose sugar-free varieties, and allow the beverage to sit open for at least one hour to decrease carbonation.• Avoid foods that are high in fiber residue such as coconut, orange pulp and the skins of some fruits and vegetables (e.g., apples, pears, cucumber) until indicated in the progression of your meal plan. These foods may obstruct the opening of your stomach.• Take the vitamin and mineral supplements prescribed by your Surgeon or Registered Dietitian every day for the rest of your life! Have your blood levels checked annually.• Limit alcohol. It is likely that your tolerance to alcoholic beverages has significantly declined. Also, avoid mixed drinks high in sugar such as Daiquiris and Pińa Coladas, and those mixed with regular fruit juices.• Avoid extreme hot or cold food temperatures, which may produce chest pain when ingested.• Participate in a lifestyle modification program that will coach you on making healthy food decisions, adopting positive eating behaviors that support a healthy lifestyle, and incorporating exercise into your daily routine.Common Nutritional Problems and Prevention Tips• Nausea and vomiting o Cause: overeating or eating too quickly o Prevention tip: eat slowly, chew your food very well, and stop eating as soon as you feel full• Chronic malnutrition problems o Cause: nutrients are absorbed differently following surgery o Prevention tip: eat a healthy diet and always take your vitamin and mineral supplements• Lactose intolerance o Symptoms: gas, bloating, cramping and diarrhea after drinking milk o Prevention tips: drink smaller amounts of milk at a time, use lactose-free or lactose-reduced milk, or try soy milk.• Temporary hair loss o Cause: rapid weight loss and/or lack of protein in the diet o Prevention tip: eat the amount of protein recommended by your Registered Dietitian• Dehydration
  5. 5. o Symptoms: dark and strong smelling urine, dry mouth, headache and fatigue o Prevention tip: take frequent sips of liquid throughout the day• Dumping syndrome o Cause: food emptying too quickly from the stomach o Symptoms: diarrhea, nausea, cold sweats and light-headedness o Cause: consuming sugary foods or beverages, drinking fluids too soon after a meal, or eating high fat foods
  6. 6. • Constipation o Cause: food and fiber intake are reduced following surgery o Prevention tips: • Eat applesauce, oatmeal or prunes daily • Drink plenty of water • Exercise regularly • Take a fiber supplementProtein Shakes• Basic Vanilla or Chocolate Shake (28 grams protein) o 1 scoop vanilla whey protein powder o 1 cup fat-free milk o 1 tablespoon cocoa powder (for chocolate shake)• Banana-Peanut Butter Shake (12 grams protein) o 1 cup fat-free milk o 1 tablespoon peanut butter o 1/4-1/2 banana• Creamy Orange Shake (28 grams protein) o 1 scoop vanilla whey protein powder o 1 scoop sugar-free orange powder drink mix o 1 cup fat-free milkTips for Making Protein Shakes• Use vanilla, almond and coconut extracts to improve flavor.• Use bananas, strawberries and/or peanut butter for the most flavor.• Add unflavored cocoa powder for a deeper chocolate flavor without added fat.• Freeze milk in ice cube trays to make milk cubes. Blend these with your shake to make it icy cold and to add protein without diluting the shake.• Add yogurt to increase creaminess and add protein.• Use lactose-free milk or soy milk if you are lactose intolerant.REFERENCESAdapted with permission from: Nutrition Education for Bariatric Surgery, The Florida MedicalNutrition Therapy Manual 2005 Edition. Florida Dietetic Association, 2005.OTHER REFERENCESBariatric Surgery Diet Manual, Bariatric Solutions. Accessed March 17, 2006 at:http://www.bariatricsolutions.com/index_files/Page1291.htm.Diet Tips & Recipes, Department of Bariatric Surgery, Temple University Hospital. AccessedMarch 17, 2006 at: http://bariatric.templehealth.org/content/diettips.asp.

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