Bariatric Nutrition

BEFORE SURGERY

You are getting ready to make many permanent changes in your eating behavior. Try to start practicing the principles of eating and food choices before your surgery to help you make the transition a smooth one.
 
  1. Eat slowly, chew food to applesauce consistency.
  2. Take bites the size of a dime.
  3. Leave a minute between bites, put down all utensils and food.
  4. Take 30 minutes to eat.
  5. Do not drink at meals. Wait 30 to 45 minutes to drink after meals.
  6. Start taking a multivitamin/mineral supplement like Centrum and at least 1,000 mg of calcium citrate daily.
  7. Discontinue the use of carbonated and caffeine drinks. Replace with non-carbonated flavored waters, water, herbal or decaffeinated teas, decaffeinated coffee, etc.
  8. Start exercising. Chair exercise, water walking, water aerobics, elliptical machines, recumbent bikes, and walking are all doable choices. Start with 10 minutes and add a couple of minutes each week to build up to at least 30 minutes daily.
  9. Below is a balanced eating plan to follow. Every meal should have two to three ounces of protein, a fruit or a vegetable, and a serving of whole grains. Space meals about five hours apart, have planned snacks in between. Stop eating two hours before going to sleep. If you would like a treat, replace a planned snack. Treats should be 150 calories or less. Meals should be no more than 400 calories for women, 500 calories for men. Start tuning in to signs of hunger and fullness. Fullness should not be stuffed, bloated, can’t move, just okay, enough to take the hunger away.
Meal One
 
¾ cup whole grain cereal (5 grams of fiber or more)
1 egg or ¼ egg substitute
1 medium piece of fruit
8 ounces 1% or skim milk (if you drink milk)
 
Snack
 
8 ounce 100 calorie yogurt
1 fruit
OR
Protein shake (150 calories or less)
 
Meal Two
 
3 ounces of lean, low sodium turkey, ham, chicken or beef
1 slice of whole grain bread
1 tablespoon of low-fat mayonnaise
Lettuce, tomato, onion, mustard, etc. as you like
2 cups of mixed greens with your favorite veggies
1 tablespoon of real salad dressing OR 2 tablespoons of low-fat/non-fat dressing
1 medium piece of fruit
Non-carbonated, sugar-free beverage, tea, water, or 8 ounces of milk
 
Snack
6 crackers (whole grain)
1 tablespoon of peanut butter
OR Protein shake OR 1 ounce of jerky
 
Meal Three
 
3 to 4 ounces of beef, chicken, fish, seafood, pork, lamb, turkey, chicken, etc.
½ cup whole grain like brown rice, barley, kamut, potato, pasta, or corn
1 cup of your favorite vegetable
Any no calorie, non-carbonated drink
 
Snack
 
100 calorie popcorn
OR ¼ cup of nuts
 
You will be receiving a nutrition reference guide before surgery at your nutrition class with detailed information.
 

AFTER SURGERY

It can feel overwhelming getting used to your new eating schedule and habits. Take it a meal at a time. The first week home the main things to focus on are:
  • Try to drink 64 ounces per day. This includes everything liquid like broth, protein supplements, ice tea, V-8, water, 1% milk, etc.
  • Take your chewable or liquid supplements as directed. Remember to take calcium by itself, the rest can be taken together.  Take one multivitamin at breakfast, one at lunch. Iron can be taken at the same time if needed. Leave at least two hours between vitamins and calcium. B12 should be sublingual 500 mcg daily or a shot once a month.
  • Follow your meal schedule of three meals, two to three protein supplements daily. Half your meal or one ounce should be protein, the other half, two tablespoons of pureed fruit or vegetable, or one tablespoon of vegetable, one of starch.
  • Stop drinking 15 minutes before a meal. Only take 20 to 30 minutes to eat your meal, throw out what you don’t finish. Wait 30 to 45 minutes to drink.
  • Sip constantly between meals. Aim for 8 ounces each hour if you can. Sometimes drinking hot or flavored beverages helps you drink more.
Bottom line, do the best you can, it will get much easier by the third week. Keep a daily food journal to help you keep track of what you are doing and show your dietitian. Remember, foods are soft and pureed the first seven weeks after surgery.
DAILY PROTEIN REQUIREMENTS
 (1.5 grams per kilogram of ideal body weight)
Women
 
Height                         Grams
5’0”                                 68
5’1”                                 72
5’2”                                 75
5’3”                                 78
5’4”                                 82
5’5”                                 85
5’6”                                 89
5’7”                                 92
5’8”                                 95
5’9”                                 99
5’10”                             102
5’11”                             106
6’0”                               109
Men
 
Height                         Grams
5’3”                                87
5’4”                                90
5’5”                                93
5’6”                                97
5’7”                              101
5’8”                              105
5’9”                              109
5’10”                            113
5’11”                            117
6’0”                              121
6’1”                              125
6’2”                              129
6’3”                              134
6’4”                              138
Protein is needed for growth and repair. Your needs are increased because of surgery. You will be unable to get enough from your food for at least 6 months. You will need to take protein supplements until you can get enough protein from your food.
 
What to Look for in Protein Supplements
 
a.    Protein supplements should be no more than 300 to 400 calories total for the day including the milk or yogurt you mix with them.
b.    Whey, soy, or egg proteins are fine.
c.    Products should have no lactose and less than 3 grams of sugar, 6 grams of fat.
d.    If you have a family history of breast cancer, limit intake of soy to 25 grams per day.
e.    Unflavored supplements are much more versatile than flavored. They can be mixed into yogurt and made into fruit smoothies (3 or 4 pieces of frozen fruit works well) or mixed with drinks like Crystal Lite, tea, or Sugar-free Tang.
     One half cup of sugar-free pudding is also an acceptable food to mix them into.
    You can even make an iced coffee drink. I highly suggest buying samples as a lot
     of patients have problems with things tasting too sweet after surgery.
 

Stores like Vitamin Shoppe, Vitamin World, and GNC will usually let you return any product with the receipt even if you have used some of it. Check their return policy.

PROTEIN FOODSGrams of Protein
Pea or Lentil Soup5 g per ½ cup serving
Vegetarian Chili8 g per ½ cup serving
Legumes (black, pinto, navy, etc.)8 g per ½ cup serving
Beef, Poultry, Pork, or Fish7 g per 1 oz. serving
Tuna (canned, water packed)7.5 g per 1 oz. serving
Salmon (canned)6 g per 1 oz. serving
1 egg6 g
1 oz. low-fat or non-fat cheese6 g
Soy ground round6 g per 1 oz. serving
Low-fat cottage cheese3.5 g per 1 oz. serving
Spam spread (lite)4 g per 1 oz. serving
Smooth peanut butter4 g per 1 tablespoon
Crabmeat3.5 g per 1 oz. serving
Tofu3 g per 1 oz. serving
Yogurt1 g per 1 oz. serving

Always check the nutrition label for protein content, sugar, fiber, sodium, and fat.

IRON

Symptoms of Iron Anemia

  • Headaches
  • Muscle Weakness
  • Nervousness
  • Shortness of Breath
  • Loss of Appetite
  • Fatigue
  • Pale skin
  • Brittle nails, can be spoon-shaped

If you are experiencing these symptoms, contact your physician and discuss having a serum ferritin blood test done to check for anemia as well as serum B12 and folate. Restless Leg Syndrome (when legs feel jumpy at night) has also been attributed to low iron stores.

The most absorbable forms of iron are ferrous gluconate, ferrous fumerate or polysaccharide iron. Iron supplements are best absorbed when they are taken between meals with a vitamin C source. However, if it upsets your stomach, it may work better for you to take it with a meal. Calcium, magnesium, the tannins in tea and coffee, and the phytates in dietary fiber, inhibit or reduce iron absorption. Coffee or tea should not be consumed until 3 hours after taking an iron supplement.

The most absorbable forms of iron are contained in animal sources (heme) versus plant sources (non-heme).

Iron from animal sources:

  • Meats- beef, pork, lamb, and liver
  • Poultry – chicken, duck, and turkey, especially the dark meats and liver
  • Fish – clams, mussels, oysters, sardines, tuna, and anchovies
  • Eggs (contain non-heme iron)

Iron from plant sources:

  • Enriched bran flakes
  • Prune juice
  • Kidney, navy, or black beans
  • Spinach
  • Legumes
  • Dandelion greens
  • Lima beans
  • Strawberries

Plant sources are best absorbed when eaten with a food source of vitamin C. Good sources of vitamin C are broccoli, cantaloupe, cauliflower, grapefruit, bell peppers, guava, papaya, oranges, kiwi, raspberries, and tomatoes.

POTASSIUM

Signs of Deficiency:

  • Irregular heart beat
  • Loss of appetite
  • Muscle cramps
  • Dizzy spells
  • Constipation
  • Fatigue

Food Sources:

  • Dairy products – skim milk and fat-free yogurt
  • Juices – grapefruit, low sodium V-8, orange
  • Fruits – oranges, tomatoes, bananas, cantaloupe, prunes, dates, mangoes, raisins, guava
  • Legumes – kidney beans, pinto beans, peas, lentils
  • Vegetables – potatoes, sweet potatoes, winter squash, swiss chard, broccoli, spinach
  • Salt substitute i.e. Morton Lite

THIAMIN (B1)

Signs of deficiency:

  • Numbness, burning or tingling in hands or feet
  • Double vision
  • Trouble with memory

Food Sources

  • Pork
  • Ham
  • Brewer’s yeast – 1 heaping tablespoon
  • Sunflower seeds – 1/3 cup
  • Wheat germ – 2/3 cup
  • Green beans
  • Organ meats
  • Peanuts
  • Dried beans
  • Milk
  • Cereal
  • Enriched breads

LIFETIME HABITS

  1. Take a multivitamin/mineral supplement with a B50 complex daily. Example: Solaray Twice Daily Energy
  2. Take 1500 mg of calcium citrate with vitamin D and magnesium daily. Examples: Bariatric Advantage, Citracal, Vitalady’s Super Calcium
  3. Take 500 mcg of B12 daily or 1,000 mcg every other day, sublingual. Examples: Trader Joes’s, Bariatric Advantage
  4. Take iron if your labs are low or you are a menstruating female, 65 mg daily or as recommended by your surgeon.
    Examples: Vitron C, Nature’s Plus Chewable, Niferex
  5. Move daily, 30 minutes minimum
  6. 64 ounces of fluid or more, at least 50% from water
  7. Meal pattern:
    Protein, all meals – 2 to 3 ounces
    Vegetable or fruit, all meals – ¼ to ½ cup
    Grains, all meals – ¼ to ½ cup
    Meals should last no longer than 30 minutes.
  8. Avoid or limit alcohol.
  9. Only 3 starch servings daily.
  10. Protein supplements as needed. Consider taking fish oil capsules daily like Omega 3/6/9 if you do not eat fish.
  11. No grazing.
  12. Labs every year for life.

Failure to make permanent changes in eating behavior, food choices, and physical activity may cause weight regain. The secret to a full pouch is eating solid protein like meat and fiber at all meals.

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