I am very pissed today
Tyshea,
sorry to hear your sitll on clear liquids, my first week was miserable. When do you move up to full liqids? I know ever doc is different. I am almost six weeks out and back to most regular foods in of course very small amounts and eating protein, protein, protein. So hang in there and feel better. Once you can have full liquids it will be much better you will feel more satisified. good luck
JOyce
Hi Tyshea,
First, congratulations on your sucessful wls. I'm glad your realizing that what your feeling is head hunger, just keep thinking positive and how good and healthy you'll feel in a few weeks when those pounds come off. It helped me get thru the tough times...I was even hooked to the food network..lol! Anyway, wanted to let you know that a woman named Chrissie Walsh started a support group in Pitman that meets every other Friday night if you need group support, contact me and I'll give you directions. Here is a link if you'd like to join the yahoo group. I copied a great handout she did that outlines our surgeon's guidelines of the post op diet. Maybe this will give you some food ideas:
Wendy 
1 yr tomorrow 3/15/04 
275/175/150?
Here is the yahoo group also: http://health.groups.yahoo.com/group/SJBSS/
(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 3rd 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 3rd 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 3rd 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.
----------------------------------------------------------------------------------------------------
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.
------------------------------------------------------------------------------------------------------------
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
Turkey 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. Relax and enjoy your meal.
Stop eating as soon as you feel full. In a year, you will probably be able to eat almost anything, just in much smaller quantities than before surgery. For now, take it slow, and give your new system time to adjust.
It is at this point that you will start to begin the important process of learning new eating habits. What you learn during these months will sustain your weight loss in the years to come. Simple practices, such as eating only when you are hungry, eating your protein first, and not grazing all day, will help you to live a long and healthy life.
FOOD JOURNAL
Start a journal as soon as you return from the hospital. Record everything that you eat and how you feel. This will help you identify any problems you are having with specific foods or combinations of foods, and will make you more successful. Recording what you eat makes you more conscious of what you are doing. If you have any physical problems, your surgeon will want to know when the symptoms started. Your journal will have that record.
If you keep a record of what you are eating during your successes, then when your weight loss slows down, you can look back to see what you are doing differently. If there is little difference in what you are eating, you will know that you are experiencing a natural plateau and not because you are eating too much or the wrong foods. You can then wait more comfortably for the plateau to pass. Recording what you eat will also help you not to graze. It will cause you to pause before putting something into your mouth. Remember, one day you may be able to eat a food with no problem and the next day you may not be able to tolerate it. This is normal. It is all part of the adjustment process. Keep a record of your exercise and fluid intake as well.
Before you leave for your surgery (or as soon as you get home, if you forget to do it before), have someone help you take your measurements (neck, upper arms, lower arms, chest, waist, hips, thighs, calves, ankles). Your weight can fluctuate quite a bit, but you can still be losing inches. Keeping track of your measurements periodically can really make you feel better during your weight loss journey, and show you how much improvement you have really made.
BEHAVIOR MODIFICATION
6 Steps to Success
1. **IMPORTANT: Protein, protein, protein
2. Vitamins (Basic 8: Multi, iron, calcium, A, D, E, Zinc, B-12)
3. Water (minimum 64 oz per day)
4. No snacking
5. Exercise
6. Attitude
One step at a time will take you to the top...even baby steps! Set small attainable goals and when you succeed, move to the next one. (Don't set yourself up for failure by overwhelming yourself with the whole picture.) A winner is the person who picks himself up and starts again when he has fallen down. Remember positive thoughts and positive actions bring positive results!
Don't change your eating habits at all for the first few days, but write down every single thing that you are eating. Once the habits have been identified, there are steps that can be taken to establish new eating patterns.
1. Take a list when going grocery shopping and don't go to the store when you are hungry.
2. Plan your meals. Know what you are going to eat ahead of time.
3. Be creative when cooking; try spices and share ideas with buddies.
4. Make sure that you eat your protein first. Protein stays in your pouch longer.
5. Do not skip meals. Avoid feast or famine...you can become too hungry and overeat, or eat too little and slow your metabolism.
6. Eat only at the dining table or designated place that you can eat. Do not eat in front of the television.
7. Use a small plate. PAY ATTENTION TO YOUR BODY and stop eating at the first sign of fullness.
8. Eat slowly and chew your food completely.
9. Water is very important, so make it a top priority, right up there with your protein drinks. Build up to 64 oz of water per day.
10. Exercise (make it fun): walking, swimming, dancing, aerobics, personal trainer or whatever you can do to exercise and enjoy it, or at least know that you will enjoy the results. Exercise releases endorphins that give you a natural high.
11. Don't weigh more than every 2 weeks. It could lead to frustration!!
COME TO THE SUPPORT GROUP AND GET INVOLVED
WE ARE ALL IN THIS TO HELP EACH OTHER
Good Luck!
1 yr tomorrow 3/15/04
275/175/150?
Here is the yahoo group also: http://health.groups.yahoo.com/group/SJBSS/
(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 3rd 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 3rd 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 3rd 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.
----------------------------------------------------------------------------------------------------
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
Turkey 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. Relax and enjoy your meal.
Stop eating as soon as you feel full. In a year, you will probably be able to eat almost anything, just in much smaller quantities than before surgery. For now, take it slow, and give your new system time to adjust.
It is at this point that you will start to begin the important process of learning new eating habits. What you learn during these months will sustain your weight loss in the years to come. Simple practices, such as eating only when you are hungry, eating your protein first, and not grazing all day, will help you to live a long and healthy life.
FOOD JOURNAL
Start a journal as soon as you return from the hospital. Record everything that you eat and how you feel. This will help you identify any problems you are having with specific foods or combinations of foods, and will make you more successful. Recording what you eat makes you more conscious of what you are doing. If you have any physical problems, your surgeon will want to know when the symptoms started. Your journal will have that record.
If you keep a record of what you are eating during your successes, then when your weight loss slows down, you can look back to see what you are doing differently. If there is little difference in what you are eating, you will know that you are experiencing a natural plateau and not because you are eating too much or the wrong foods. You can then wait more comfortably for the plateau to pass. Recording what you eat will also help you not to graze. It will cause you to pause before putting something into your mouth. Remember, one day you may be able to eat a food with no problem and the next day you may not be able to tolerate it. This is normal. It is all part of the adjustment process. Keep a record of your exercise and fluid intake as well.
Before you leave for your surgery (or as soon as you get home, if you forget to do it before), have someone help you take your measurements (neck, upper arms, lower arms, chest, waist, hips, thighs, calves, ankles). Your weight can fluctuate quite a bit, but you can still be losing inches. Keeping track of your measurements periodically can really make you feel better during your weight loss journey, and show you how much improvement you have really made.
BEHAVIOR MODIFICATION
6 Steps to Success
1. **IMPORTANT: Protein, protein, protein
2. Vitamins (Basic 8: Multi, iron, calcium, A, D, E, Zinc, B-12)
3. Water (minimum 64 oz per day)
4. No snacking
5. Exercise
6. Attitude
One step at a time will take you to the top...even baby steps! Set small attainable goals and when you succeed, move to the next one. (Don't set yourself up for failure by overwhelming yourself with the whole picture.) A winner is the person who picks himself up and starts again when he has fallen down. Remember positive thoughts and positive actions bring positive results!
Don't change your eating habits at all for the first few days, but write down every single thing that you are eating. Once the habits have been identified, there are steps that can be taken to establish new eating patterns.
1. Take a list when going grocery shopping and don't go to the store when you are hungry.
2. Plan your meals. Know what you are going to eat ahead of time.
3. Be creative when cooking; try spices and share ideas with buddies.
4. Make sure that you eat your protein first. Protein stays in your pouch longer.
5. Do not skip meals. Avoid feast or famine...you can become too hungry and overeat, or eat too little and slow your metabolism.
6. Eat only at the dining table or designated place that you can eat. Do not eat in front of the television.
7. Use a small plate. PAY ATTENTION TO YOUR BODY and stop eating at the first sign of fullness.
8. Eat slowly and chew your food completely.
9. Water is very important, so make it a top priority, right up there with your protein drinks. Build up to 64 oz of water per day.
10. Exercise (make it fun): walking, swimming, dancing, aerobics, personal trainer or whatever you can do to exercise and enjoy it, or at least know that you will enjoy the results. Exercise releases endorphins that give you a natural high.
11. Don't weigh more than every 2 weeks. It could lead to frustration!!
COME TO THE SUPPORT GROUP AND GET INVOLVED
WE ARE ALL IN THIS TO HELP EACH OTHER
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