Just curious...I've been checking this site several times a week and haven't seen any new posts. Ihope everyone's ok and enjoying the start of 2007! Marie

Hi Marie! Happy New Year to you and to everyone that comes over to the Diabetes board. I usually check the site once a week, but with the holidays and the kids, it got hectic to get online. Hope everyone is okay, and if anyone has any questions ask away! I'm trying to get back on track and started the gym again......I was barely there in December. It was great to see that I maintained since my last measurement and weight check, but I really would love to get off another 40 lbs. My goal this month is more protein shakes and excersize. Take care! Wendy :wave:

Hi Wendy!! That's great news about your measurements staying the same! Good for you! I've a question for you....post-op, how long did you need to stay on a liquid and theh soft food diet? I know each of us is different, but I'm curious about this! My sugars are still swinging fairly wildly, and that's got me feeling very down. I have to get my eyes dialated today for retina pictures to assess more damage, so that's always nerve-wracking. But at least I woke up today! :) There's always a positive side!! Have a great day! Marie

Hi Marie, I'm sorry to hear that your sugars are swinging around and your eye situation! I hope all is better soon. As far as the stages of liqud/puree/soft foods post-op. I copied and pasted a 21 page information sheet that was created from my surgeon's office and the support group leader. She is a wealth of information, and I'm glad I can pass along her information for being successful & healthy post op  by following this guideline. I'm almost 3 yrs post op and I regulary use this information regarding protein, supplements, lab work, etc. Hope this helps you and others! Wendy :wave:

SOUTH JERSEY BARIATRIC

 

SUPPORT SYSTEM

 

 

Phone# 856-256-9066         Fax # 856-256-0042

 

 

ROADMAP TO SUCCESS

 

 

Don’t worry about yesterday, for today is a new beginning!

 

 

Focusing on our goal and working toward it will bring results that are unbelievable!!

 

Think back to when you first decided to have gastric bypass surgery.  The reason most people go through with this surgery is that for the first time there is a ray of hope for long-term success and better health.  Now you have the chance to make it happen!  You are in the driver’s seat!

 

 

Plan ahead:  Without planning you don’t know where you are going, so you probably will end up someplace else.

 

 

1. Focus on your goal each day and do some positive self-talk.  Such as,” I made it through this morning and I am so proud of myself”…”I feel in control right now!”  “This time I have the tool that can help me lose the weight and keep it off.”  “If I lose 10 pounds a month, one year from now I will be 120 pounds lighter.”

    

 

2. Make sure that you have proper food available in your house.  It is easy to grab the wrong thing when you are hungry, frustrated or bored.

    

 

 

3. It is good to have someone to share the successes and also the problems with…so if you don’t have someone to talk to that is supportive, get the name of a fellow patient who can relate with what you are going through and call them.  Also, try to attend support groups regularly and find out new tips on staying on the right track.

    

 

4. Make sure you give your body what it needs not wants.  3-5 protein drinks per day, plenty of water (64 oz minimum daily), mostly protein foods, avoid carbs, stop snacking, take your vitamins, exercise, and keep a positive attitude.

    

 

 

5. Don’t forget to exercise.  Cardiovascular activity and muscle growth cause your metabolism to speed up and burn more calories.  The exercise releases endorphins in the brain that transmit a sense of well-being.  Make the exercise fun by including things that you enjoy doing…dancing, sports, swimming, or walking in a park or along a beach.  While you are doing the exercise, also use that time to daydream about what you will be able to do once your goal has been attained.  Each step you take is carrying you closer to your goal.

    

 

MAKE YOUR OWN LIST OF SOME OF THE THINGS THAT YOU CAN START TODAY THAT WILL HELP YOU TO WORK WITH THIS PROGRAM.  FOLLOW THIS AND I’M SURE THAT YOU WILL HAVE SOME POSITIVE RESULTS TO SHARE AT OUR NEXT MEETING.

 

 

(Alter based on your particular surgeon’s post-op plan)

 

 

General Eating Guidelines Following Gastric Bypass Surgery

 

 

You have had your surgery, and now you need to know where to go from here.  You will start out slowly and work your way through liquids, purees, and into solids.  You will be developing new eating habits along the way.  You are embarking on a new eating adventure.  Sometimes the road will be difficult, but in the end, it will all be worth it.

 

 

After surgery, you wlll find that you need to make changes in the way you eat, not only to prevent pain and vomiting, but also to achieve your desired weight.  Perhaps even more importantly is development of appropriate eating habits to prevent disruption of the staple line and obstruction of the stoma (opening leaving the stomach).  Below are changes that are considered to be important.

 

 

STAGE 1 – CLEAR LIQUIDS (hospital)

 

Clear liquids will be started while you are in the hospital.  A clear liquid is any liquid you can see through. If you remember this simple rule, you will avoid trouble during these first few days, as long as the clear liquids are non-carbonated, and decaffeinated.  Avoid very sweet liquids.

 

 

ALLOWED:  broth, bouillon, herbal teas such as chamomile, sugar free ice Popsicles, diet gelatin, apple or grape juice diluted with 50% water (because of the natural sugar content in the fruit juice), sugar free Italian ice

 

 

AVOID:  Carbonated beverages and sodas, juices that contain pulp, like Orange and grapefruit juices, juices with high natural sugar content.

 

               

 

If you are nauseated during this time, check the sugar content of the juice you are drinking and consider eliminating the juice until your stomach settles down.  If vomiting, you can also try switching to Pedialyte to avoid dehydration.   Pedialyte also comes in freezer pops. Pedialyte is not sugar free, so only use for severe dehydration purposes, not as an everyday beverage. Your doctor should be informed if you are vomiting so that you can be checked for any serious complications.  Do not worry about drinking too much.  During this stage you should be careful to drink enough fluid so that you don’t become dehydrated.  Hydration is your main goal at this stage.  You will be trying to get up to a minimum of 64 ounces of fluid per day.  Do not gulp; just slowly sip.  Some patients can’t tolerate cold liquids, and some can’t tolerate hot liquids. 

 

 

Stop when you feel the slightest bit full.  Indications of fullness may be a feeling of pressure or fullness in the center just below your rib cage.  Other signs might be a choking sensation or a feeling of pain.  DO NOT TRY TO GO BACK TO EATING for at least 45 minutes.  It is important to eat nourishing foods and not to get into the habit of snacking.  Individuals who continuously munch on crackers, potato chips, or other foods not only have failed to lose but also have gained weight.

 

 

STAGE 2:  FULL LIQUIDS (From hospital release to 3^rd week)

 

Includes all liquids from the clear liquid stage and also those you cannot see through.  The basic rule of thumb here is that if you can suck it through a straw, you can have it.  (You don’t have to use a straw, but food should be blended to that consistency.)

 

 

Full liquids have more consistency to them than clear liquids.  Keep on hand: broth, skim milk, tap water, and a blender.  Many foods can be blended to a full liquid consistency by adding broth, skim milk, or water and blending until very smooth and liquid.

 

 

Add foods one at a time, so that you can identify the ones that may bother you.  Adding foods should, preferably, be done at home where you will be more comfortable if you have an adverse reaction to some particular food.

 

 

ALLOWED:  (From hospital release to 3^rd week)          

 

All of stage 1 food

 

**IMPORTANT:  Protein drinks should be added go your diet regimen now - work your way up to 3-5 shakes per day, 30g protein each. Do not mix ahead of time.  Drink within one hour.  Space your shakes at least 2 hours apart. The amount of water in each shake is up to you and your taste.  Protein shakes are VERY IMPORTANT to your continued nutritional health. **(See below - “Why Protein Drink Supplementation?”)

Blenderized homemade or canned soups – broth based or cream soups *

 

Skim milk, low fat milk, buttermilk, half and half

 

Note:  Try milk very tentatively.  Many people cannot tolerate milk after gastric bypass surgery as many become lactose intolerant.

 

Alba sugar free hot chocolate mix

 

Very thin mashed potatoes *

 

Very thin oatmeal *

 

Very thin cream of wheat *

 

Sugar free fudgsicles

 

Thinned no sugar added yogurt (no fruit pieces) *

 

No sugar added yogurt drinks (NO fruit pieces) *

 

Thinned sugar free pudding *

 

Cottage cheese blenderized with some skim milk to a thin consistency *

 

 

* REMEMBER: All foods in this stage have to be of a consistency to be able to suck them through a straw.  If it won’t go through a straw – it is not a full liquid!

 

AVOID: (From hospital release to 3^rd week)

 

Orange juice, tomato juice, V-8 juice (These are too acidic for your new pouch at this point.  

 

Milkshakes, eggnog, chocolate milk, evaporated milk, sweetened condensed milk.

 

Any liquid with high sugar content.  You should read labels and avoid anything with over 2g of sugar per serving. 

 

**Why protein drink supplementation?

It’s about Absorption

 

 

Proteins form the body’s main structural elements and are found in every cell and tissue.  Take away the water, and about 75 percent of your weight is protein.

 

Your body uses proteins:

 

● for growth

 

● to build and repair

 

Bone                                       Skin

 

Muscles                                  Internal organs

 

Hair                                         Blood

 

Connective tissue                 Virtually every other body part or tissue

 

Besides building cells and repairing tissue, proteins form antibodies to combat invading bacteria & viruses; they build nucleoproteins (RNA & DNA). They make up the enzymes that power many chemical reactions. They also carry oxygen throughout the body and participate in muscle activity. 

 

 

At least 10,000 different proteins make you what you are and keep you that way.

 

                                                                                                                       

 

Hormones, antibodies and enzymes that regulate the body’s chemical reactions are all made of protein.  Without the right proteins, blood won’t clot properly and cuts won’t heal. 

 

 

Each protein is a large complex molecule made up of a string of building blocks called amino acids.  The 20 amino acids the body needs can be linked in thousands of different ways to form thousands of different proteins, each with a unique function in the body.

 

 

Your body can’t use food protein directly.  So after protein is ingested, digestive enzymes break the protein into shorter amino acid chains, and then into individual amino acids.  In the gastric bypass patient, this normal digestive process is bypassed. These digestive enzymes are not available until they meet with the food protein in the common channel of the small intestine, and then have only about 5 – 7 ½ ft (compared to 20 ft in a “normal” digestive tract) to do their job.  The amino acids then enter the blood stream and travel to the cells where they are incorporated into proteins the body needs.

 

The average*** person (the “normal”, NON-gastric bypass patient) needs 50-65 grams*** of protein each day.  Considering malabsorption, the RNY patient will need 100-140 grams per day minimum, which cannot be eaten as food because of the small size of the pouch. 

 

**Note:  Depending on the length of bypass, the RNY patient may absorb as little as 25% or less.  But it is normally agreed that even a short proximal will malabsorb significantly.

 

***Note:  Adults need a minimum of 1 gram of protein for every kilogram of body weight per day to keep from slowly breaking down their own tissues.  That’s about 8 grams of protein for every 20 lbs.  Malnourished, septic, pregnant, injured or burned patients will require more protein, in the order of 1.5-2.0 g/kg daily.  Extra protein is also required after surgical procedures and illness.

 

 

Lack of protein can cause

 

Growth failure

 

Loss of muscle mass

 

Decreased immunity

 

Weakening of the heart and respiratory system

 

Death

 

 

For the post gastric bypass patient, protein drink supplementation is one of the most important factors in your continued nutrition. Think of your protein drinks as your food and your food as extras from now on.  Also remember that protein bars are equal to food protein, not protein drinks.  Bars should NOT be used as a substitute for your recommended daily protein drink requirements.

 

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STAGE 3 – PUREED/SOFT FOODS (Weeks 3-5)

These are foods of a soft consistency. Start with foods, which are the consistency of baby food meats or mashed potatoes.  Gradually progress to the soft foods, which aren’t pureed like cereals and crackers.

 

 

ALLOWED:  (Weeks 3-5)

**IMPORTANT:  Protein drinks - work your way up to 3-5 shakes per day, 30g protein each. Do not mix ahead of time.  Drink within one hour.  Space your shakes at least 2 hours apart. The amount of water in each shake is up to you and your taste.  **(See above - “Why Protein Drink Supplementation?”)

All of Stage 1 and 2 foods

 

Soft scrambled eggs, soft cooked egg beaters or egg whites, cottage cheese, ricotta cheese, sugar free puddings, no sugar added yogurt (no fruit pieces), low fat sour cream, cream cheese, pureed chicken, pureed tuna, pureed ham salad made with meat and low fat mayonnaise, applesauce, tofu, pureed water packed canned fruits such as peaches or pears, mashed banana, mashed squash, pureed carrots, pureed green beans, potted meats, hummus, mashed potatoes, farina, grits, cream of wheat, cream of rice, toast, saltine crackers, cream style peanut butter, liverwurst, no sugar added yogurt, vegetables cooked very well and mashed (except those which are naturally stringy and hard to chew), mashed sweet potatoes or yams, cereals (without sugar, nuts, raisins or dried fruits), margarine, vegetable oils, butter, shortening, mayonnaise, Miracle Whip, Crystal Light, diet decaffeinated soft drink mixes and teas, decaffeinated coffee and tea, calorie free beverages (non-carbonated), mineral or spring waters, sugar free preserves, jams, jellies (no chunks), salt, pepper, herbs, vinegar, mustard, catsup, sugar free syrups, tomato juice, vegetable juice, V-8, tomato paste, tomato puree,  soft steamed vegetables (such as squash, carrots, pureed turnips), mashed vegetables with low fat cheese sauce, milled flax seed can be added to yogurt or cereals or oatmeal to add needed Omega 3 fatty acids and fiber to your diet (Remember to chew well), pintos and cheese, mashed legumes (lentils, chick peas, garbanzos, kidney beans, black beans), mashed scallop potatoes, mashed au gratin potatoes,

 

 

AVOID:  (Weeks 3-5)

 

Fruited yogurt, crunchy peanut butter, meats with tough connective tissue (as they don’t puree well), fried foods, broccoli, celery, asparagus, okra, candied sweet potatoes or yams, shellfish, nuts, seeds, shredded wheat, cereals with dried fruits (raisins, etc), sugar coated cereals, pie, cake, pastries, sherbet, ice cream, regular pudding, popcorn, potato chips, corn chips, nuts, carbonated beverages, beverages with sugar, sugar sweetened soft drink mixes, alcoholic beverages, regular preserves, jams, and jellies, honey, sugar, molasses, pickles, candy, raw vegetables, vegetable salads, rhubarb, candied or glazed fruit, maraschino cherries, glazed carrots.

 

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STAGE 4 – SOLIDS (Weeks 5 and beyond)

 

It is now time to gradually add all other foods as you can tolerate them.  Every person is different.  Try one food at a time, preferably at home.  And remember: even if you can’t tolerate something right now, you may be able to later on.  Don’t jump right into extremely dense meats, like steak.  Add foods GRADUALLY, one at a time.  This is a continuing journey!! Relax and enjoy your new life.  Savor your foods.  You are eating much less now, but by eating slowly and really tasting each item, you can have much more enjoyment out of your meals than you ever did before. 

 

 

Eat slowly and chew food until it is a mushy consistency.  Swallowing food in chunks may block the opening and prevent food from passing into the gastrointestinal tract.

 

Here are some guidelines to help you eat more slowly:

 

1)     Set aside 30-45 minutes to eat each meal.

 

2)     Explain to family members why you must eat slowly so they will not urge you to eat faster.

 

3)     Make a sign, EAT SLOWLY, and place it on the table as a reminder.

 

4)     Put on some calming music.

 

5)     Light a candle.

 

6)     Add a flower to your table. 

 

7)     Use a luncheon plate or saucer rather than a dinner plate.

 

8)     Take very small bites of food.  You may want to try eating with a baby spoon and fork.

 

9)     Actually count the number of times you chew each piece. Aim for 30 times per piece.

 

10) Drink fluids BETWEEN meals, NOT with meals.  Drinking fluids with meals can have two effects.  One, you may flush the food out of your pouch easily and therefore be able to eat more and defeat the purpose of your surgery.  The other effect is that your food will fill the pouch. When fluid is then added on top of the food, it will cause you to vomit or get a pain in your pouch from over fullness that may not go away for hours.

 

11) Eat protein first, then vegetables, then starches.  You probably won’t get past the protein, which is good.

 

12) Relax and enjoy your meal.

 

 

Stop eating as soon as you feel full.  Besides possibly causing you to vomit, extra food over a period of time may stretch your pouch.  At first you may be eating only ½ cup of solid food (2-3 teaspoons of each item).  Suggestion:  Measure out your food into a small ½ cup container or 2-3 teaspoons per serving until you learn correct portion size.

 

 

ALLOWED:  (5 weeks and beyond)

**IMPORTANT:   Protein drinks - 3-5 shakes per day, 30g protein each. Do not mix ahead of time.  Drink within one hour.  Space your shakes at least 2 hours apart. The amount of water in each shake is up to you and your taste.  **(See above - “Why Protein Drink Supplementation?”)

All foods from stages 1,2,and 3

 

5-6 weeks

 

Fruited yogurt (no added sugar)

 

Olives

 

Fish filet (broiled or baked, NOT fried)

 

Shrimp (boiled, NOT fried)

 

Crabmeat

 

Broiled crabcake (NOT fried)

 

Imitation Crabmeat

 

Lobster

 

Broiled scallops (NOT fried scallops)

 

Steamed clams (NOT fried clams)

 

Canned tuna in water

 

Canned white meat chicken in water

 

Salmon (broiled, baked or canned, NOT FRIED)

 

Omelets, plain or with melted cheese

 

Cheeses – mozzarella, cheddar, Swiss, American, Monterey Jack, feta

 

Broiled or baked chicken (skin removed) moist, white meat

 

Broiled or baked turkey (skin removed) moist, white meat

 

Legumes, such as lentils, chickpeas, black beans, navy beans

 

            Dried bean soups

 

Baked or boiled potato

 

Riced potatoes

 

            Scallop potatoes

 

            Au Gratin potatoes

 

Luncheon/Deli meats - turkey, chicken, ham, bologna, liverwurst.  Look for ones with the least amount of additives, preservatives, fillers, sodium and fat).

 

 

Add as you can tolerate them.  Everyone is different.

 

6-8 weeks

 

Peas, green beans, corn

 

Grilled cheese (cooked with vegetable spray or very little butter)

 

 

10 weeks

 

Very lean ground beef - hamburger, meat balls, Salisbury steak, meatloaf

 

Chili with beans

 

Chunky peanut butter (CHEW WELL)

 

Hard boiled egg whites (yolks are much drier and may cause a problem)

 

Deviled eggs

 

12-14 weeks

 

Macaroni, noodles, spaghetti, orzo (cooked very well)

 

Rice

 

Spinach, cabbage, broccoli

 

14-16 weeks

 

Ham

 

Canadian bacon

 

Steak (tender cuts-sirloin, etc.)

 

Roast beef

 

London broil

 

Pork chops and roast

 

Lamb chops and roast

 

Lean bacon  - cooked crispy

 

pepperoni

 

Brown rice

 

Wild rice

 

Barley

 

16-20 weeks

 

Peeled crunchy vegetables and fruits (CHEW WELL)

 

Lean spare ribs

 

Untoasted bread and rolls, pancakes, waffles, French toast

 

Small burrito, or chicken, beef, or bean taco

 

Salad

 

Taco salad

 

Pickles

 

Pizza

 

Peanuts, cashews, walnuts, pecans, pistachios (CHEW ALL NUTS VERY WELL)

 

Save to try later on

 

Beef jerky (chewed very very well)

 

Popcorn

 

Potato skins

 

            Celery stalks, rhubarb, asparagus spears, whole okra (stringy vegetables)

 

            Anything you have tried and not tolerated well up until now

 

 

AVOID: (5 weeks and beyond)

Meats with tough connective tissue (such as Corned beef, or chuck steak)

 

Fried foods

 

Sugar, brown sugar, honey, molasses, corn syrup, regular pancake syrup

 

Caffeine

 

Caffeine causes dehydration and also contributes to the malabsorption of calcium.  Gastric bypass patients are already susceptible to osteoporosis and therefore need added calcium supplementation in their diets.

 

Caffeine counteracts this.

 

Carbonated beverages

 

Chewing gum (accidentally swallowing chewing gum could cause a blockage)

 

Ice cream, milkshakes, candy, cake, donuts, pastries, potato chips, junk food, sweetened fruits and fruit juices, chocolates, cookies, Tastykakes, Twinkies, Little Debbies, Ho Hos, Ding Dongs (and all other brands of snack cakes).

 

(Desserts and snack foods contain few nutrients and are not required for good health.)

 

Some medications: NSAIDS, Ibuprofen, Motrin, Advil, Aspirin, any meds that can cause ulcers or internal bleeding.  Your pouch is all you have left of your stomach.  Be careful with it.

 

 

LIMIT:  (Always)

Orange juice and other juices high in natural or added sugar – may cause dumping and will add empty calories

 

Bananas, dried fruits, maraschino cherries, raisins (high sugar content)

 

Coffee creamers – both dry and liquid (high in sugar)

 

Alcoholic beverages (empty calories and many are high in sugar also-it is best to avoid alcoholic beverages altogether)

 

 

REMEMBER:  Eat protein first, then vegetables, then starches.