Nutrition Guidelines: A Mindful Way of Eating
Mindful eating page 2-8
The Components of Eating
Calories Carbohydrates
Protein Fat Fluids page 9
page 10
page 12
page 14
page 16
1200 calorie meal plan Food Log (make copies) 7 days of sample meals for 1200 calorie plan page 17-23
page 22
page 23
Success Habits: Before and After Surgery page 24
Nutrition Guidelines for Gastric Bypass and Sleeve Vitamin and Mineral Supplementation Meal Guidelines page 32
Post Operative Stage I Bariatric Clear Liquids Post Operative Stage II Bariatric Soft/Blended
Modified Full Liquid Protein Supplements Post Operative Stage III Bariatric Soft Foods Post Operative Stage IV Bariatric Solid Foods Nutrition Problems After Bariatric Surgery page 26
page 27-31
Nutrition Guidelines for Lap-Band page 54
Additional Resources
Restaurant Survival Cooler Emergency Measure Equivalents Reading Food Labels Websites and Books page 58
page 59
page 60
page 61
page 64
page 33
page 35
page 37
page 40
page 42
page 49-53
Vitamin Charts for Gastric Bypass, Sleeve and Lap-Band end of chapter 4
Mindful Eating and Eating Behaviors
SUCCESS
For maintenance of long term weight loss,
patients:
• Must exercise
• Must follow a low calorie diet
LIFELONG
Surgery Is Just The Beginning!
Mindful Eating Exercise
Learning to eat mindfully is essential to long term weight loss maintenance. It takes practice. Be
patient with your learning process. Use the table on the next page at least once a month for the
rest of your life to pick up on non mindful eating practices.
You eat mindfully when you:
• Tune in to your body’s sense of hunger
• Start eating only when you experience moderate hunger- NOT just the urge to eat. Hunger
feels like a hollow or empty feeling in your stomach.
• CHEW your food well before swallowing.
• LOOK up from your plate often.
• PAUSE and ENJOY the taste of what you are eating.
• PUT DOWN your utensils occasionally or between bites.
• Check to see if you are still hungry between bites or have reached MODERATE fullness.
• STOP eating when you are moderately full.
Understanding the relationship between your eating, your hunger and your emotions is critical to
changing NON HUNGER eating. If you ate for reasons other than hunger (e.g. boredom, stress,
“it was there”) identify these and make VERY CONCRETE changes to address NON HUNGER
EATING. For example: if you eat when you are stressed, address the stress. If you cannot do this
yourself then GET HELP. Consider seeing a counselor or psychologist. BE PROACTIVE.
Use the following table at least once a month LIFELONG. This exercise may be especially helpful
if you have reached a weight plateau or experienced weight regain.
What you ate
Hunger level before
eating
Hunger level after eating
Why did I eat?
What was I feeling?
THE EATING PROFILE QUESTIONNAIRE (EPQ)
by
Cynthia G. Last, Ph.D.
Read each question and circle the answer that best describes your behavior.
1.
2.
3.
4.
5.
6.
Do you often eat standing up?
Is it difficult for you to remember everything you ate today or yesterday?
Do you often eat between meals
Do you tend to finish your food before others?
Do you often not use plates or utensils when eating?
Do you frequently do other activities while eating?
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
7.
8.
9.
10.
11.
12.
Is the quality of food more important than quantity?
Do you tend to eat slowly?
Do you enjoy trying different types of food?
Do you love high-fat or high-sugar foods?
Do you pass on food that isn’t tasty?
Is eating one of your greatest pleasures?
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
13.
14.
15.
16.
17.
18.
Are you a nervous or high-strung person?
Do you snack when you are tense or uptight?
Is it hard for you to resist eating something that is right in front of you?
Is it difficult for you to relax?
Is the act of eating often more important than what you are eating?
Are you a worrier?
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
19.
20.
21.
22.
23.
24.
Is it difficult for you to be assertive?
Do you have upsetting dreams?
Do you often eat to avoid thinking about upsetting things?
Is it hard for you to identify your feelings?
Do you have problems that seems impossible to overcome?
Are you a people pleaser?
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
25.
26.
27.
28.
29.
30.
Do you have special feel good foods?
Does eating initially give you a lift or a high?
Do you often feel sad, bored, or down in the dumps?
Do you often plan out foods treats for yourself?
Are you over critical of yourself?
Do you lack energy or enthusiasm?
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Last, Cynthia, Ph.D. (1999), the 5 Reasons Why we Overeat; How to Develop a Long-Term Weight Control Plan
That’s Right for You, Carol Publishing Group, 1999. Permission fo ruse granted by Dr. Last
Use the questionnaire on the previous page to help identify your eating personality. It is beyond the
scope of these guidelines to address each of these issues in detail but being able to identify possible
areas of weakness will help you to better address them.
Interpretation:
Mostly YES to questions 1-6:
IMPULSE eater: not paying attention, often unplanned meals. Look at the mindful eating tips above.
Mostly YES to questions 7-12:
ENJOYS FOOD: These foods often tend to be higher in fat or sugar.
Mostly YES to questions 13-18:
STRESS eater: Look in to alternatives to help address your stress such as meditation, exercise or yoga. If you cannot do this yourself then GET HELP. Consider counseling or psychiatry.
Mostly YES to questions 19-24:
AVOIDANCE eater: You would rather eat than face a difficult situation or undertake an unpleasant task. You may need assertiveness training.
Mostly YES to questions 25-30.
PICK ME UP eater: You use food to try to improve your mood or give you comfort. Ex
plore other ways to give yourself a boost. Exercise is a well recognized mood enhancer
Eating Triggers
Common eating triggers are listed below. Again the idea is to identify these and make concrete
changes to address the issues. Use the action table on the next page to help. Pick those that apply to
you. Add to the list as you identify other triggers.
• Thoughts and excuses such as “It doesn’t matter what I eat, I’ll never lose the weight” or “I deserve it” or “I’ve already blown it”
• Emotions such as boredom, anger, sadness, anxiety
• Sensations such as fatigue or physical discomfort
• Dissatisfaction with taste, texture, or quantity even when you are full
• People who encourage you to eat or drink excessively
• Environmental cues that trigger the desire to eat, e.g. the mall food court
• Social cues such as parties, holidays, special events
Other triggers:
Changing Behavior Tips
Below are suggested diversions and stress management techniques. Add to this list yourself. Try
to plan in advance for potential “danger situations.” Have your technique ready to put into action.
Weight loss surgery will not change the stresses you face in life. It is ESSENTIAL that you
have mechanisms to lower the impact of these stresses.
Diversions: To replace my urge to eat, I
can:
Environmental Changes: To help avoid
temptation, I can:
Read
Work on a predefined project
Do a puzzle (Have it Ready to use)
Call a friend
Take a class
Take up a new hobby
Play an instrument
Walk
Stretch
go to the gym
Do an exercise video
Keep temptation out of the house, office,
and car
Aviod places that tempt me
Aviod people that tempt me
Change my routine/route to avoid temptation
Use the buddy system in places or situations that tempt me.
Stress Management/Relaxation Techniques:
Challenges: I need to prepare for
Journal
Deep breathing
Deep relaxation
Take a shower or bath
Talk to someone
Meditate
Listen to music
Do yoga
the food available at work
Work/school schedules that interfere with
regular meals
Social eating with family or friends
Ordering meals from menus
Food shopping temptations
The food court at the mall
Travel
Action Plan Review
Review your action plan. NOte things that are working and consider adjustments to your plan fo
rthose things that are not working. Use a table similar to the following:
Action Item/Behavior Change
Working or not Working
Example:
Don’t eat while watching TV
Not working
Bring healthy food to work
instead of using vending machines
Working
Judge Effectiveness and Suggest Changes
Its too hard just to sit there...I’ll
try knitting while the TV’s on
instead.
Continue...I’m surprised its so
easy
Calories
The Components of Nutrition
Calories are talked about a lot in any discussion of obesity. They are necessary to consume and
important to understand. A calorie is simply a “unit of energy.” Energy is the ability to do work. Work
can be physical work, like carrying a suitcase up the stairs, or biological work, like the ongoing beats
of your heart pushing blood throughout your body. When the body gets too many calories, from any
source – carbohydrate, protein or fat, it will store those extra calories as body fat. When the body
uses more energy than it takes in, you will lose weight.
3500 calories is equivalent to approximately 1 pound
If you are currently taking in 3200 calories a day you can lose approximately 4 pounds a week by following a low calorie diet (1200 calories). Your surgeon may ask you to lose weight prior to your surgery and follow a low calorie diet.
EXCESS calories add weight!
100 calories extra a day
=
36,500 calories extra a year
=
10 pound weight gain a year
Over ten years = 100 lbs weight gain.
Food
Food provides calories which in turn provide the energy we need to get us through our daily activities. Although people eat real food like an apple or a peanut butter sandwich, dietitians describe food
by breaking it down into its biochemical components which are carbohydrate, protein, and fat. If you
were to have surgery, you would need to work with a dietitian who might tell you that you will need 7080 grams of protein a day or that over 10 grams of fat in a meal is too much.
CARBOHYDRATES
Carbohydrates are the major source of energy for your body prior to surgery. After surgery, protein
and fat become the primary energy sources. Your body still needs carbohydrates (for your brain and
to fuel muscles for activity). After surgery, you will get most of your carbohydrates in the form of vegetables, fruits, and dairy.
Simple Carbohydrates: Sugar
Sugar is a simple carbohydrate and is found in many foods. Before and after surgery, it is important to
avoid foods that are high in sugar.
Too much sugar can cause:
• Dumping Syndrome (Problems after Surgery Page 48)
• Hypoglycemia (Problems after Surgery Page 50)
• Slow the rate of weight loss by providing extra calories
Read labels carefully to be sure foods are low in sugar.
Avoid foods with more than 5-10 grams of sugar per serving.
Foods that contain any of the following types of sugars, listed as one of the first 3 ingredients, are
likely to be high in sugar.
Sugar
Fructose
Brown sugar
Glucose
Corn Syrup
Sucrose
High Fructose Corn Syrup
Dextrose
Modified food starch
Maltose
Honey
Maple syrup
Powdered sugar
Molasses
Foods High in Sugars
Gum
BBQ Sauce
BBQ Sauce
Jam/Jelly
Chocolate milk
Juice Bars
Sweetened Juices
Honey
Kool Aid
Frozen yogurt
Pies
Donuts
Sweetened Tea
Fudgesicles
Regular Soda
Ice cream
Cake
Popsicle
Regular pudding
Sports drinks
Flavored syrup
Complex Carbohydrate (Bread/Pasta/Rice Products)
Complex carbohydrates (untoasted bread, pasta, rice, etc.) can be a problem after gastric bypass
surgery because these foods can become doughy and can be difficult to tolerate. In addition, eating
too many carbohydrates can fill up the stomach pouch and crowd out protein foods. A small amount
of very well toasted bread, crackers, and baked/sweet potato (no skin) may be eaten after surgery but
only after you have eaten your protein first.
A word on the “Low Carb”
You can’t go to the grocery store these days and not notice all of the “low carb” products on the
shelves. You’ll see everything from “low carb” beer to “low carb” vitamin supplements. Keep in mind
that there is no true definition for the phrase “low carb” and the use of this phrase is not regulated by
the FDA or any other governing body. Some of these “low carb” products only have 1 or 2 grams of
carbohydrate less than the original version of the food, but still put “low carb” on the food label to entice shoppers to buy the product. REMEMBER THAT YOUR PRIORITY IS TO EAT PROTEIN FIRST.
Even if the “low carb” tortilla looks inviting, it is still not high in protein. Also, “low carb” products are
often high in fat and contain sugar alcohols which may lead to gas, bloating, diarrhea and general
stomach discomfort.
“Sugar-Free” Craze
Be aware of the “sugar-free” products. Most “sugar-free” products are dessert-type foods and have
very little protein and no nutritional value. “Sugar-free” does NOT mean calorie-free. Calories from
excessive use of “sugar free” products can add up and slow down weight loss success. “Sugar-free”
products generally contain sugar alcohols or artificial sweeteners, which may lead to stomach discomfort if consumed in excess.
PROTEIN
Protein is a primary component in every cell and tissue in the body. It is used to make hair, skin, nails,
muscles, organs, blood cells, nerves, bone and brain tissue, and much more!
Importance of Protein
An adequate protein intake is important following surgery. Since your stomach capacity is severely
restricted, you must be sure to eat enough protein every day to keep you healthy.
Protein is necessary to:
-Preserve muscle tissue and allow the body to lose fat instead of muscle
-Allow wounds to heal properly
-Prevent protein deficiency
-Reduce your hunger. Protein is more satisfying and filling than carbohydrates. You are less
likely to feel the need to snack between meals.
• Women need about 60-70 grams of protein a day, men need about 70-80 grams
• Foods that are high in protein include lean red meats, pork, poultry, fish, cheese, eggs, tofu, and
seafood.
• At each meal, CONCENTRATE ON EATING YOUR PROTEIN FOODS FIRST so you don’t fill up
on other foods before meeting your protein needs.
• Be sure to select lean sources of protein to help keep your total fat intake low and to help prevent
unwanted weight gain. The table on the next page lists the protein and calorie content of various
protein-rich foods to help guide your choices.
Protein Deficiency
Signs of protein deficiency include poor wound healing, fatigue, hair loss, muscle wasting, and patchy
or scaly skin.
Keep Proteins Moist
After surgery, many people have difficulty tolerating dry or tough pieces of meat. Chicken breast,
pork, and steak are some protein foods that may become tough and/or dry. Remember to prepare
protein foods in a moist way such as braising, or cooked in the crock-pot. Also, preparing foods with a
little bit of moisture (such as a low sugar marinade/sauce or a small amount of low fat gravy) will also
help these dry foods to be better tolerated. Moist protein foods that are often better tolerated include
fish, cottage cheese, yogurt, eggs, and tofu.
In order to meet your protein needs, you will need to eat approximately 70 to 80 grams of protein a
day. Most protein foods have 7 grams of protein per ounce. Choose lean meats to limit calories and
fat intake. One ounce of protein looks like the size of a domino or golf ball. Three ounces of protein
equals approximately 21 grams of protein which is the size and thickness of a deck of cards.
Serving Size
1
2
¼ cup
1 ounce
1 ounce
1 ounce
1 ounce
1 ounce
¼ cup
1 ounce
1 ounce
1 ounce
1 ounce
¼ cup
¼ cup
1 ounce
4 ounce
4 ounce
4 ounce
4 ounce
½ cup
4 ounce
¼ cup
¼ cup
Food
Egg
Egg whites
Egg substitute
Chicken Breast (without
skin)
Chicken Thigh (without
skin)
Luncheon meat (turkey,
ham, chicken, turkey pastrami)
Fish (tilapia, salmon, halibut, cod, catfish, trout, orange roughy, mahi mahi)
Ground beef/turkey (lean)
Tuna (water packed)
Shrimp, lobster or crab
Ham (lean)
Roast Beef or lamb
Pork Loin or Tenderloin
Cottage cheese (non fat)
Cottage cheese (low-fat)
Cheese (low-fat – regular)
Soy milk
Non fat milk
1 % low fat milk
2 % low fat milk
Tofu (regular)
Yogurt (nonfat – regular)
Beans/lentils
Most vegetables
Grams of Protein
(per serving)
7 grams
7 grams
7 grams
7 grams
7 grams
Calories
(per serving)
75 calories
35 calories
35 calories
35 calories
35 calories
7 grams
35 calories
7 grams
35 - 55 calories
7 grams
7 grams
5.5 grams
5 grams
7 grams
7 grams
7 grams
7 grams
8 grams
3.5 grams
4 grams
4 grams
4 grams
5 grams
4 grams
3 grams
2 grams
35 - 55 calories
35 calories
35 calories
55 calories
55 calories
55 calories
35 calories
55 calories
60-80 calories
35-50 calories
45 calories
55 calories
70 calories
75 calories
35-50 calories
60 calories
25 calories
FAT
Fat is a necessary but often overeaten component of the average diet. Fat contains over twice the
calories (energy) as protein or carbohydrates, so be careful to avoid foods high in fat. Excessive fat
intake before surgery can make it hard to achieve your pre-op weight loss goal. Too much fat after
surgery can result in poor weight loss success.
TYPES OF FATS:
There are four different types of fats found in foods: saturated fat, monounsaturated fat, polyunsaturated fat, and trans fats.
Monounsaturated fats
-Are liquid at room temperature.
-Are the most heart healthy of the three types of fats and are required for health.
-Sources of monounsaturated fats include olives, olive oil, canola oil, nuts and avoca
dos.
It is important to limit total fat intake to 30 to 40 grams or less each day after surgery. However, when
you do eat fat, monounsaturated fats should be your FIRST choice.
Polyunsaturated fats
-Are liquid at room temperature and are found in vegetable oil, corn oil, sunflower oil,
and margarine spreads.
-Are more heart healthy than the saturated fat, but less so than the monounsaturated
fats.
These fats should be your second choice.
Saturated fats
-Are solid at room temperature (butter or lard).
-Are found in animal fats and in tropical oils (palm oil, palm kernel oil, coconut oil).
-Eating foods high in saturated fat may increase the risk of heart disease by increasing
the ‘bad’ or LDL blood cholesterol.
Saturated fats should be chosen less often or avoided by removing the visible fat from meats, selecting lean cuts of meats, removing the skin from poultry products, and switching to lower-fat cheese or
milk products.
Trans fats are created in a process called ‘hydrogenation’ where a liquid oil is converted into a solid
fat. Food manufacturers created trans fats to increase the shelf life of foods and to improve their
texture and flavor. Foods rich in trans fats include vegetable shortenings, some margarines, crackers,
cookies, snack foods, and other foods made with or fried in partially hydrogenated oils. Trans fat, like
saturated fat, raises the ‘bad’ LDL cholesterol that increases your risk for heart disease.
Tips for low-fat eating:
• Read food labels! A low-fat food = less than 3 to 5 grams of fat per 100 to 150 calories.
• Select skinless chicken, turkey, fish, and shellfish instead of fatty meats such as bacon, sausage,
salami, and high fat beef.
• Bake, broil, roast, grill, or steam your foods instead of frying them or preparing them with heavy
sauces.
• Use nonstick sprays or cookware.
• Avoid all fast food.
• Choose low-fat and lean foods more often. For example, when you shop for meats look for labels
that read 95-99% lean. This indicates that the meats contain a higher percentage of protein than
fat.
• Cut back on bacon. Bacon has more fat than meat and is not a healthy low fat choice.
REMEMBER!
Low fat DOES NOT mean low calories. While low fat is better for your heart, food manufacturers
often substitute sugar to improve the flavor of a low fat product. Make sure, as always, to read your
labels completely, looking at the fat, sugar and the total calorie count.
FLUID REQUIREMENTS
Carry a water bottle with you at all times
It is very important that you drink at least 64 ounces of decaffeinated, noncarbonated fluid each day
to prevent dehydration. Immediately after surgery, it will be more difficult to drink all 64 oz because of
the small size of your stomach.
• You must sip your liquids slowly, consuming about a half-cup to three-quarters of a cup (4 to 6 oz)
every hour between meals throughout the day.
• Consuming the recommended 64 oz will help
i. promote weight loss
ii. encourage wound healing
iii. help prevent constipation
• Do NOT drink and eat at the same time after surgery. When you eat and drink at the same time,
the fluid liquefies the food and causes it to empty out of the pouch sooner. Empty pouches trigger
your body to feel hungry and to want to eat again.
• You may drink up until 10 to 30 minutes BEFORE meals. Waiting will allow time for the fluid to
empty out of the pouch.
• Wait 30 minutes AFTER your meals to begin drinking again.
Recommended Beverages: all of these fluids can contribute to the 64 oz fluid you need to consume
every day.
Water
Crystal Light
Diet Snapple
Gatorade (diluted 3 to 1)
Powerade Zero
Aquifina flavored water
Special K Protein Water
Decaffeinated tea
Decaffeinated coffee
Sugar free beverages
Propel water (limit each 16 oz serving has 25
calories)
Vitamin Water Zero
Dasani flavored water
SOBE Lifewater
Avoid carbonated beverages because the bubbles may cause cramping and discomfort. The high-calorie drinks listed below will impair your weight loss and may cause dumping syndrome. These drinks
are common reasons for weight gain.
Beverages to AVOID
Regular or Diet soda
Fruit juice
Carbonated beverages
High calorie coffee drinks
SOBE
Sparkling water
Starbucks coffees
Whole milk or flavored milk
Milkshake
Alcoholic beverages
Vitamin Water
Energy Drinks: Red Bull, Monster, Full Throttle,
etc.
Gatorade / Powerade
Kool Aid
Tips for low-fat eating:
• Read food labels! A low-fat food = less than 3 to 5 grams of fat per 100 to 150 calories.
• Select skinless chicken, turkey, fish, and shellfish instead of fatty meats such as bacon, sausage,
salami, and high fat beef.
• Bake, broil, roast, grill, or steam your foods instead of frying them or preparing them with heavy
sauces.
• Use nonstick sprays or cookware.
• Avoid all fast food.
• Choose low-fat and lean foods more often. For example, when you shop for meats look for labels
that read 95-99% lean. This indicates that the meats contain a higher percentage of protein than
fat.
• Cut back on bacon. Bacon has more fat than meat and is not a healthy low fat choice.
REMEMBER!
Low fat DOES NOT mean low calories. While low fat is better for your heart, food manufacturers
often substitute sugar to improve the flavor of a low fat product. Make sure, as always, to read your
labels completely, looking at the fat, sugar and the total calorie count.
FLUID REQUIREMENTS
Carry a water bottle with you at all times
It is very important that you drink at least 64 ounces of decaffeinated, noncarbonated fluid each day
to prevent dehydration. Immediately after surgery, it will be more difficult to drink all 64 oz because of
the small size of your stomach.
• You must sip your liquids slowly, consuming about a half-cup to three-quarters of a cup (4 to 6 oz)
every hour between meals throughout the day.
• Consuming the recommended 64 oz will help
i. promote weight loss
ii. encourage wound healing
iii. help prevent constipation
• Do NOT drink and eat at the same time after surgery. When you eat and drink at the same time,
the fluid liquefies the food and causes it to empty out of the pouch sooner. Empty pouches trigger
your body to feel hungry and to want to eat again.
• You may drink up until 10 to 30 minutes BEFORE meals. Waiting will allow time for the fluid to
empty out of the pouch.
• Wait 30 minutes AFTER your meals to begin drinking again.
Recommended Beverages: all of these fluids can contribute to teh 64 oz fluid you need to consume
every day.
Water (the best)
Crystal Light
Diet Snapple
Gatorade (diluted 3 to1)
Powerade Zero
Aquafina flavored water
Special K Protein Water
Decaffeinated tea
Decaffeinated coffee
Sugar free beverages
Propel water (limit each 16 oz serving has 25
calories)
Vitamin Water Zero
Dasani flavored water
SOBE Lifewater
Avoid carbonated beverages because the bubbles may cause cramping and discomfort. The high-calorie drinks listed below will impair your weight loss and may cause dumping syndrome. These drinks
are common reasons for weight gain.
Beverages to AVIOD:
Regular or Diet soda
Fruit juice
Carbonated beverages
High calorie coffee drinks
SOBE
Sparkling water
Starbucks coffees
Whole milk or flavored milk
Milkshake
Alcoholic beverages
Vitamin Water
Energy Drinks: Red Bull, Monster, Full Throttle,
etc.
Gatorade / Powerade
Kool Aid
Pre-op Meal Plan (Before Surgery)
A 1200 calorie meal plan is provided to help you lose weight prior to surgery and is designed to be well-balanced and healthy.
Calories: 1200 calories per day
Protein: 70-80 grams per day
Carbohydrate: 130 grams per day
Fat: 30 grams per day
Fluid: at least 64 ounces per day
• Practice principals of mindful eating
• Eat at least 3 meals per day; no snacking or grazing
• Drink at least 64 oz of decaffeinated, non carbonated fluid per day (8 cups)
• Eat slowly (one bite a minute); chew food completely (30X)
• In each meal, be mindful of your portion size
Pre-op 1200 calorie meal plan
Breakfast
2 protein
0 vegetables
1 fruit
1 milk
0-1 starch
1 fat
Beverage ( between meals)
Breakfast
¼ cup low fat/fat free cottage
cheese, 1 scrambled egg
1 cup strawberries
0-1 slice whole grain toast
1 cup fat free unsweetened
yogurt
1 teaspoon trans free margarine
Decaf coffee or tea (between
meals)
Breakfast
½ cup egg substitute
1 medium orange
Lunch
2-3 protein
2 vegetables
1 fruit
0 milk
1 starch
1 fat
Beverage (between meals)
Sample Meals
Lunch
2 ounce low fat turkey
Dinner
3 ounce broiled halibut
2 cups salad greens with cucumber, tomatoes
5-6 whole grain crackers
1 medium apple
1 cup steamed broccoli
½ cup small potato
1 cup non fat milk
1 tablespoon low fat salad
1 teaspoon trans free margarine
dressing
Decaf iced tea (between meals) Sugar free jello
0-1 slice whole grain toast
Lunch
3 ounces tuna canned in water
2 cup salad, tomato, cucumbers, raw vegetables
5-6 whole grain cra
1 cup non fat milk
½ cup fresh fruit salad
1 teaspoon trans free margarine
1 tablespoon low fat mayonnaise
Water with lemon (between
meals)
Decaf coffee or tea (between
meals)
Dinner
3 protein
2 vegetables
0 fruit
1 milk
1starch
1 fat
Beverage (between meals)
Dinner
3 ounces skinless chicken
breast
½ cup broccoli and ½ cup peppers
½ cup baked yam or sweet
potato
1 cup non fat milk
1 teaspoon olive oil
Decaf iced tea, water (between
meals)
Each Item (Dot) Below Equals one Serving
Very Lean Protein choices have 35 calories, 7 grams of protein and 1 gram of fat per serving. One
serving equals:
1 oz. Turkey breast or chicken breast, skin
¼ cup
Cottage cheese, nonfat
removed
1 oz. Fish Fillet (flounder, sole, cod, haddock, 2 each Egg whites
halibut)
1 oz. Canned tuna in water
¼ cup
Egg substitute
1 oz. Shellfish (clams, lobster, scallop, shrimp) 1 oz.
Fat free cheese
Lean Protein choices have 55 calories , 7 grams of protein and 2-3 grams of fat per serving. One
serving equals:
1 oz. Chicken – dark meat, skin removed
1 oz. Veal, roast, or lean chop*
1 oz. Turkey – dark meat, skin removed
1 oz. Lamb, roast, or lean chop*
1 oz Salmon, swordfish, herring, catfish, trout
1 oz. Pork, tenderloin, or fresh ham*
1 oz. Lean beef (flank steak, London broil, ten- 1oz. Low fat cheese (3 grams or less of fat per
derloin, roast beef)*
ounce)
2 medium Sardines
1 oz. Low fat luncheon meats (with 3 grams or
less of fat per ounce)
¼ cup Cottage cheese, low fat
* limit to 1-2 times per week
Medium Fat Proteins have 75 calories, 7 grams of protein and 5 grams of fat per serving. One serving equals:
• 1 oz.
Beef (any prime cut), corned beef, ground beef**
• 1 oz.
Pork chop
• 1 each Whole egg (medium)**
• 1 oz.
Mozzarella cheese
• ¼ cup Ricotta cheese
• 4 oz
Tofu (note this is a heart healthy choice)
** Choose these very infrequently
Vegetables contain 25 calories, 2 grams of protein, and 5 grams of carbohydrate. One serving
equals:
• ½ cup Cooked vegetables (carrots, broccoli, zucchini, green beans, tomato, onion, cabbage,
asparagus, spinach, mushrooms, bell peppers, eggplant, brussels sprouts, cauliflower, artichoke
hearts, beets, okra, kale, collards, swiss chard, turnips, etc.)
• 1 cup
Raw vegetables or salad greens (lettuce, spinach, spring mix, arugula, cucumbers, carrots, tomato, bell peppers, jicama, radishes, etc)
• ½ cup Vegetable juice
• ¼ cup Tomato sauce or low-sugar pasta sauce
Milk (Fat Free and 1%) contains 100-110 calories, 8 grams protein, 12-15g carbohydrate per serving.
One serving equals:
• 8 oz.
Milk: fat free(skim) or 1% (low-fat)
• 6 oz
Yogurt: plain, nonfat, low-fat, light, or artificially sweetened
Nonfat Greek yogurt (look for >13 grams protein, ~15 grams carbohydrate)
Fruits contain 60 calories and 15 grams of carbohydrates. One serving equals:
• 1 small Apple, orange, nectarine (size of baseball)
• ½ Banana
• 1 mediumFresh peach
• 1 Kiwi
• ½ Grapefruit
• ½ Mango
• 1 cup
Fresh berries (strawberries, raspberries, or blueberries)
• 1 cup
Fresh melon cubes(honeydew, cantaloupe, watermelon)
• 4 Fresh apricots
• 12 Fresh cherries
• 17 small Grapes
• ½ cup Pineapple
• 2 small Tangerines
• ½ cup Any other fruits
Starches contain 80 calories, 0-3 grams of protein, and 15 grams of carbohydrate and per serving.
These foods contain only 2-4 grams of protein and will not meet protein needs. Remember untoasted
breads, rice and pasta may not be tolerated after surgery. One serving equals:
• 5-6 Whole grain crackers
• ½ cup Baked potato, yam, sweet potato, corn, butternut squash, acorn squash
• 1/3 cup Brown rice, quinoa, barley (cooked)
• 1/3 cup Whole grain pasta (cooked)
• ½ cup Whole grain cereal, oatmeal (cooked)
• 1 slice Whole grain bread
• 2 slices Sandwich thins or reduced calorie bread
• ½ Whole wheat pita or English muffin
• 6 inch
Corn or whole grain tortilla
• ½ cup Beans, cooked (black beans, kidney, chickpeas, lima, pinto, navy, peas, or lentils) count
as 1 starch/bread and 1 very lean protein
Fats contain 45 calories and 5 grams of fat per serving. One serving equals:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1 tsp.
1 tsp.
1 tsp.
1 tsp.
1 T
1 T
6 10 16 4 2 T.
1/8
8 large
10 large
1 slice
2 tsp.
Oil (canola, olive)
Butter
Trans-fat free margarine or spread
Mayonnaise
Reduced fat margarine or mayonnaise
Light Salad dressing, cream cheese
Almonds, Cashews
Peanuts
Pistachios
Walnut halves,Pecan halves
Light cream cheese
Avocado
Black olives
Stuffed green olives
Bacon
Peanut, cashew, almond butter (creamy)
Beverages : Water is best. Look for under 15 calories per serving.
Crystal Light
Decaffeinated tea or coffee
Diet Snapple
Propel Water
SOBE Life Water
Vitamin Water Zero
Sugar Free Tang
V8 Juice (acidity may upset stomach)
Water (with natural lemon or lime)
Herbs / Seasonings
Basil
Oregano
Cilantro
Parsley
Cinnamon
Pepper
Curry Powder
Pickles
Dill
Pickle Relish, 1 T
Garlic
Rosemary
Garlic Powder
Saffron
Ginger
Salt
Marjoram
Soy Sauce
Mustard
Thyme
Vinegar
Chicken or Vegetable Broth
Lemon Juice
Non stick cooking spray
Hot pepper sauce
Worcestershire sauce
Flavor Extracts (vanilla, almond, pepper mint
Cocoa Powder
Salsa, ¼ c
Taco Sauce, 1 T
Onion Powder
7 Days of Sample Meals for 1200 calorie plan
Breakfast
Lunch
Dinner
Monday
2 oz low fat
cheese 1 slice
toast 1 tbsp reduced fat/ trans
fat-free margarine
1 c skim milk 1
small orange
Tuesday
2 hard boiled
eggs, ¼ c granola, 6 oz low
calorie yogurt, 6
almonds, ½ medium grapefruit
Wednesday
2 oz deli ham,
1 slice whole
grain toast, 1
tbsp reducedfat/ trans fat-free
margarine, 1 c
skim milk, ½ c
applesauce
Thursday
2 scrambled
eggs, ½ English
muffin, 1 tbsp
reduced-fat/
trans-fat free
margarine, 6
oz low calorie
yogurt, 1/3 small
cantaloupe
½ c chicken
½ c tuna salad, 2 oz turkey
¾ c low-fat cotbreast, 6 crack- salad with 1 c
1 slice whole
tage cheese ½
celery, onions,
English muffin, 2 grain bread, 2 c ers, 2 c baby
spinach and
pickles, 1 Tbsp
c carrots, sliced
lettuce, tomato
sliced tomatoes, light mayonand cucumber
cucumbers, 2
naise, 6 wheat
1 Tbsp fat-free
Tbsp low-fat salad salad, 2 Tbsp
dressing, 1 small low-fat dressing, dressing, 1 small crackers, 1 c
sugar-free Jell-O
1 ¼ c strawber- pear
peach
with ½ banana
ries
and fat-free cool
whip
3 oz top sirloin
3 oz pork ten3 oz chicken
1 stuffed green
steak, ½ c baked derloin, 2 small
breast, ½ c pota- bell pepper with
potato, 1 Tbsp
oven browned
to, 1 c zucchini, 3 oz 10% fat
light sour cream, potatoes, 1 c as- 1 c skim milk
ground beef
1 c green beans, paragus spears,
and 1 6” tortilla,
1 c skim milk
1 c skim milk
1 c salad with
1 Tbsp low-fat
dressing, 6 oz
yogurt
Friday
2 oz string
cheese, ½
English muffin,
1 c skim milk, ¾
c blueberries, 1
tsp butter
Saturday
Omelet made
with 2 egg
whites, 1 oz
low-fat cheese,
1 tsp canola oil,
1 slice toast,
6 oz yogurt, ½
banana
Sunday
1 oz turkey
sausage, 1 fried
egg white with 1
tsp canola oil, ½
English muffin,
1 c skim milk, 15
grapes
2 Tbsp peanut
butter, 1 slice
whole grain
toast, 1 c carrots, 1 Tbsp light
ranch dressing,
¼ c cottage
cheese, ½ pineapple
1 chicken leg
with low sugar
BBQ sauce, ½ c
baked potato, 2
c green beans, 1
Tbsp light margarine, 1 ¼ c
watermelon
3 oz shrimp
sautéed with 1
tsp olive oil and
garlic, ½ c linguini pasta, 1 c
broiled eggplant,
12 cherries
3 oz broiled
halibut, ½ c
potato, 1 Tbsp
trans-fat free
margarine with
a dash of parmesan cheese,
½ c tomato, ½
c broccoli, 1 c
skim milk
4 small turkey
meatballs, ½ c
spaghetti sauce,
1 c cooked
green beans, 1
slice garlic toast
made with 1 tsp
butter and garlic
powder/salt, 6
oz yogurt
1 chicken taco:
1, 6” tortilla, 2
oz chicken, 1 oz
low-fat cheese,
lettuce, tomato,
1/8 avocado, ¼
c salsa, 1 c skim
milk
Food Log
Monday
Breakfast
Lunch
Dinner
Protein
Fruit
Vegetables
Starch
Milk
Fat
Tuesday
Breakfast
Lunch
Dinner
Protein
Fruit
Vegetables
Starch
Milk
Fat
Wednesday
Breakfast
Lunch
Dinner
Lunch
Dinner
Protein
Fruit
Vegetables
Starch
Milk
Fat
Thursday
Breakfast
Protein
Fruit
Vegetables
Starch
Milk
Fat
Food Log
Friday
Breakfast
Lunch
Dinner
Protein
Fruit
Vegetables
Starch
Milk
Fat
Saturday
Breakfast
Lunch
Dinner
Protein
Fruit
Vegetables
Starch
Milk
Fat
Sunday
Breakfast
Protein
Fruit
Vegetables
Starch
Milk
Fat
Lunch
Dinner
Success Habits: Before and After Surgery
Adopting healthy lifestyle changes before surgery is vital to success after surgery.
There are two copies please tear one out and place where you will SEE it EVERY DAY.
EAT MINDFULLY
WHAT you eat:
• Eat low fat PROTEIN FIRST at each meal.
• NO high calorie snack food (i.e. ice cream, candy, chips, nuts, and seeds)
• NO alcoholic beverages
• NO juice and other high calorie beverages such as Starbucks, Jamba Juice etc
• NO crash diets such as Slim Fast, Ensure, Atkins, South Beach Diet, etc
• Stop other diet plans such as Weight Watchers, Jenny Craig, LA Weight Loss
• Always have “safe food” and water in your car, in case of an emergency.
WHEN you eat:
• Eat at least THREE meals a day: Breakfast, Lunch and Dinner. NO SNACKING
• NO SKIPPING MEALS
• NO fluids with your meals. STOP 10 to 30 minutes beforehand. Drink fluids 30 minutes after
meals.
• Complete meals in a timely manner. Avoid grazing on your meals.
WHERE you eat:
• Do not eat on the run, at your desk, in the car, or watching TV. Eat at the table.
• Make healthy choices at restaurants – even salads from fast foods chains can contain up to 700
calories or more! Ask for nutrition information or look up restaurant chains on line ( ex CalorieKing.
com).
• When out, ask the waiter to bring you a half order or pack up half the order to go BEFORE it is
served.
• Pack your meals for work to help avoid poor food choices at work.
HOW you eat:
• Eat S-L-O-W-L-Y, take time to eat.
• Take small bites and chew food 30 times a bite.
• Carefully monitor portion sizes (with a food scale).
• Use a SMALL plate and SMALL spoon.
• Do NOT drink fluids with your meals. STOP 10 to 30minutes beforehand. Drink fluids 30 minutes
after meals.
• Stop eating at the first sign of fullness.
• Get involved in a regular EXERCISE routine a minimum of 5 days a week
• Take your VITAMINS every day.
• Join a SUPPORT group
Success Habits: Before and After Surgery
Adopting healthy lifestyle changes before surgery is vital to success after surgery.
There are two copies please tear one out and place where you will SEE it EVERY DAY.
EAT MINDFULLY
WHAT you eat:
• Eat low fat PROTEIN FIRST at each meal.
• NO high calorie snack food (i.e. ice cream, candy, chips, nuts, and seeds)
• NO alcoholic beverages
• NO juice and other high calorie beverages such as Starbucks, Jamba Juice etc
• NO crash diets such as Slim Fast, Ensure, Atkins, South Beach Diet, etc
• Stop other diet plans such as Weight Watchers, Jenny Craig, LA Weight Loss
• Always have “safe food” and water in your car, in case of an emergency.
WHEN you eat:
• Eat at least THREE meals a day: Breakfast, Lunch and Dinner. NO SNACKING
• NO SKIPPING MEALS
• NO fluids with your meals. STOP 10 to 30 minutes beforehand. Drink fluids 30 minutes after
meals.
• Complete meals in a timely manner. Avoid grazing on your meals.
WHERE you eat:
• Do not eat on the run, at your desk, in the car, or watching TV. Eat at the table.
• Make healthy choices at restaurants – even salads from fast foods chains can contain up to 700
calories or more! Ask for nutrition information or look up restaurant chains on line ( ex CalorieKing.
com).
• When out, ask the waiter to bring you a half order or pack up half the order to go BEFORE it is
served.
• Pack your meals for work to help avoid poor food choices at work.
HOW you eat:
• Eat S-L-O-W-L-Y, take time to eat.
• Take small bites and chew food 30 times a bite.
• Carefully monitor portion sizes (with a food scale).
• Use a SMALL plate and SMALL spoon.
• Do NOT drink fluids with your meals. STOP 10 to 30minutes beforehand. Drink fluids 30 minutes
after meals.
• Stop eating at the first sign of fullness.
• Get involved in a regular EXERCISE routine a minimum of 5 days a week
• Take your VITAMINS every day.
• Join a SUPPORT group
Nutrition Guidelines for
Gastric Bypass and Gastric Sleeve
Read these guidelines carefully
Once you have decided to have gastric bypass surgery, you MUST make significant changes to your
eating and lifestyle habits. THIS SURGERY NOT A QUICK FIX OR DIET. Surgery is a tool for you to
use to achieve weight loss and improve your quality of life. Once you have surgery, your stomach will
be forever changed and you must maintain healthy eating habits for a LIFETIME. In order to achieve
weight loss and maintain good health, it is important to develop and maintain proper eating habits
before and after surgery. Failure to modify eating habits will result in weight regain and complications
such as dumping syndrome etc.
Your New Anatomy & Nutrition Basics
Keep a plastic egg around as a reminder of your new stomach
The size of your new stomach will be approximately 1 oz. (2 tbs.) With such a small stomach size, the
nutritional value of the food you eat becomes very important. Only foods with high nutritional quality should be eaten, such as protein, vegetables, and fruits. Food of low nutritional quality such as
popcorn, chips, and candy should be avoided. If you overeat or eat past the point of feeling full, you
will feel very uncomfortable and may vomit. If you snack frequently throughout the day or drink highcalorie beverages, you will not lose as much weight as you potentially could and will regain weight. To
lose weight, you must eat at least three small well-balanced meals each day and avoid snacking and high-calorie beverages.
Your New Stomach Size
Vitamin and Mineral Supplements
Absorption of Nutrients in the Gastrointestinal Tract
STOMACH
Water
Vitamin B12
Copper
Iodine
JEJUNUM
Calcium, Magnesium, Phosphorus
VITAMINS:A,C,B1, B2, Niacin,
B6,D,E K, Biotin
Folate
MINERALS: Iron, zinc, chromium, manganese, molybdenum
DUODENUM
Calcium, Magnesium, Phosphorus,
VITAMINS:Biotin, Niacin,
A,D,E,K,B1, B2 B 12
MINERALS: Iron, , zinc
copper, selenium, zinc
After surgery, you are at risk for vitamin deficiencies for several reasons:
• You are eating a smaller amount of food.
• Because your stomach has been “bypassed” you now lack the acid needed to break off some essential vitamins and minerals from food.
• Part of your intestine has been bypassed.
You will need to take supplements for the REST OF YOUR LIFE to prevent SERIOUS nutritional deficiencies. THESE ARE AS IMPORTANT AS ANY PRESCRIPTION MEDICATION.
MULTIVITAMIN/MINERAL WITH IRON
Why: To prevent nutrient deficiencies
• Take multivitamins with percentages of ingredients that exceed the RDA [i.e. greater than 100%
DV (Daily Value)].
• Take 2 regular vitamins a day with Iron in DIVIDED doses .i.e. one twice a day.
• For large pills, it may be necessary to cut them.
• AVOID Children’s chewable vitamins and liquid multivitamins because they often lack minerals.
• AVOID Men’s and Senior Formulas. Most do not contain iron. Everyone needs some iron after
surgery and taking a multivitamin that is lacking iron could lead to anemia.
• Avoid the “Diabetic Pack” of vitamins. Although it is complete, these packs often contain 5 or more
pills and can be cumbersome to take every day
When: Start before surgery and immediately after surgery
Multivitamin brands to CHOOSE:
Centrum
Kaiser Adult’s Daily Formula (red label)
Kirkland (Costco) Regular Multivitamin with Minerals
Equate (Walmart) Complete Multivitamin
Target Multivitamin and Mineral
Walgreens Milltrium Multivita
Optisource Post Bariatric Formula Chewable
Multivitamin (4 a day)
Centrum Chewables (you need to take Selenium
200mcg three times a week)
Multivitamin brands to AVOID:
Centrum Liquid Formula
Lil’ Critters or Adult Gumi Vites
Viactiv multivitamin chews and Flavor Glides
Juice plus
Nature made diabetes health pack
Flintstones
Mega Multivitamin or Premium Performance
Prenatal Vitamins
Bariatric Advantage Chewable Multi
Centrum Silver
VITAMIN B1 (THIAMIN)
Why: To prevent nerve and brain damage (beriberi)
• Take a minimum of 50 mg to 100mg every day.
• Avoid 250 mg a day.
When: Start before surgery and immediately after surgery
VITAMIN B12
Why: To avoid nerve and brain damage and bone marrow dysfunction.
• Take 3000 mcg (micrograms) sublingual (under the tongue) each week. B12 can be found in 100
mcg, 500 mcg, 1000 mcg, and 2500 mcg doses. Take as many tablets as you need to get to 3000
mcg per week.
• Oral (tablets swallowed) will NOT be absorbed. Do NOT use these.
When: Start before surgery and immediately after surgery.
IRON
Why: Prevent iron deficiency anemia, especially in menstruating women.
• You will be obtain about 36 mg of Elemental Iron in your multivitamin.
• Your doctor will advise you if you need additional iron. Usually all menstruating women need iron.
Most post op patients end up needing additional Iron based on lab values.
• You will need to read the ingredients section to determine how much ELEMENTAL iron is in a
tablet.
• Take iron as Ferrous fumarate or Ferrous gluconate.
• AVOID Ferrous sulfate as this can be irritating to the pouch.
• Try and find an iron tablet combined with Vitamin C as this improves absorption. Or you can take
a separate tablet of 500 mg of Vitamin C. Do not take it with meals, multivitamin, calcium or tea as
these interfere with absorption. Leave a gap of 2 hours. Just before bed is a good time.
• Iron is available in pill, liquid, or chewable forms.
• Ferrimin 150 www.dialyvite.net or 1866-358-9773 has 150mg elemental iron per tablet.
When: Start before surgery and immediately after surgery per MD recommendations.
VITAMIN D
Why: Prevents osteoporosis and osteomalacia.
• Take a minimum of 4000 IU a day.
• This will come from the vitamin D in your calcium and multivitamin and a separate vitamin D tablet.
When: Start before surgery and immediately after surgery.
CALCIUM CITRATE
Why: To maintain bone density, protect teeth, and prevent osteoporosis.
• Take 1500 mg total a day from supplements.
• Calcium is absorbed best in 500 mg doses. Do NOT take all of your calcium supplements at the
same time.
• Make sure to look at the serving size. Usually you will need 5-6 tablets a day.
• Make sure you always take Calcium Citrate. Look under the Supplement Facts or the list of ingredients on the label to find out what kind of calcium your supplement contains.
• You will only absorb 4% of calcium carbonate. Do NOT take this.
• Take anytime as calcium citrate does not need stomach acid to be absorbed.
• Eating calcium-rich foods such as yogurt and cheese will also help.
When: Start before surgery and again at the start of Modified Full Liquid Diet (Stage III 2 weeks postop)
Calcium Brands To CHOOSE:
Kaiser Adult’s Daily Formula (red label)
Kirkland (Costco) Regular Multivitamin with Minerals
Equate (Walmart) Complete Multivitamin
Target Multivitamin and Mineral
Walgreens Milltrium Multivita
Optisource Post Bariatric Formula Chewable
Multivitamin (4 a day)
Centrum Chewables (you need to take Selenium
200mcg three times a week)
Calcium Brands To AVOID:
Lil’ Critters or Adult Gumi Vites
Viactiv multivitamin chews and Flavor Glides
Juice plus
Nature made diabetes health pack
Flintstones
Mega Multivitamin or Premium Performance
Prenatal Vitamins
Bariatric Advantage Chewable Multi
Centrum Silver
If you are having difficulty swallowing the Calcium Citrate pills, try the following LIQUID OR
CHEWABLE ALTERNATIVES.
Brand
Serving Size Calcium
Contact Info
Amount per Day
Bariatric Advantage
4 Wafers
1600 mg
www.bariatricadvan- Take 4 wafers per
Calcium Citrate
tage.com
day
Lozenges
1-800-898-6888
Bariatric Advantage Cal- 1 Chew
cium Citrate Chews
Calcet Creamy Bites
1 Chew
250mg
Take 6 chews a day
500mg
Celebrate Calcium
Chewable
1000mg
www.achievepharma. Take 3 chews a day
com
www.celebratevita- Take 6 tablets a day
mins.com
1-877-424-1953
Take 3 tablets a day
4 Tablets
Celebrate Calcium
3 Tablets
Chewable Plus 500
Wellesse Bone Health
1 Tablespoon
Liquid
Twinlab Calcium Citrate 4 Wafers
1500 mg
Reviva High Absorption
Liquid Calcium Citrate
2 Tablespoon
1000 mg
Lifetime
Mg + Ca liquid
1 Tablespoon
750 mg
UpCal D Calcium Citrate Powder
Buried Treasure
Liquid Calcium Plus
Scoop/packet
500 mg
2 Tablespoons
1000mg
500 mg
1000 mg
www.wellesse.com
1-800-232-4005
www.twinlab.com
1-800-645-5626
www.revivanutirion.
com
1-866-991-5240
Costco.com
www.vitaminworld.
com
1-800-228-4533
www.globalhp.com
1-800-638-2870
www.lifelinefoods.com
1-800-216-3231
Take 3 tablespoons
a day
Take 6 wafers a day
Take 3 tablespoons
a day
Take 2 tablespoons
a day
Take 3 scoops or
packets a day
Take 3 tablespoons
a day
HERBAL MEDICATION.
Do NOT take additional herbal medication unless you first discuss this with your doctor. These may
interfere with the absorption of essential vitamins and may also increase your risk of pouch irritation
and ulceration.
VITAMIN AND SUPPLEMENT SCHEDULE
Below is ONE possible way to schedule your vitamins:
Breakfast
Lunch
Multivitamin
1
Calcium Citrate plus
2
2
Vitamin D
Vitamin B12 (500 mcg
ANYTIME under your tongue
daily, 1000 mcg three
times a week, 2500 mcg
twice a week)
Vitamin B1 (50-100mg) 1
Iron plus Vitamin C
Vitamin D 2000 IU
ANYTIME
Dinner
1
2
Bedtime
1
HERBAL MEDICATION.
Do NOT take additional herbal medication unless you first discuss this with your doctor. These may
interfere with the absorption of essential vitamins and may also increase your risk of pouch irritation
and ulceration.
SEE VITAMIN CHART AT THE END OF NUTRITION CHAPTER
After Gastric Bypass/Sleeve Meal Guidelines
Your small stomach pouch is your new “tool” to obtain early satiety (a sense of fullness).
• Eat at least 3 small meals a day without snacking between meals.
• To get through the day without hunger between meals, space your meals about 4 ½ to 5 hours
apart (i.e. breakfast at 8am, lunch at 1 pm, and dinner at 6 pm).
• Do not skip meals or you will not meet your protein and nutrient requirements.
• You should also take between 30 to 45 minutes to eat each meal. Eating slowly and chewing each
bite 30 times will help prevent vomiting and obstructions. Do not eat your meal over several hours.
“Grazing” on your meal will allow you to take in more calories.
• The ideal post-op meal should include:
o 3-4 oz lean protein at each meal
o
vegetables
o
limited amounts of fruits and whole grains
o
These foods are likely to stay in your stomach longer, producing a greater sense of full
ness, and will also meet your nutrient needs.
• Do not drink liquids of any kind with your meals. Keeping solid food in your stomach will cause
longer periods of satiety (fullness).
Nutrition Components After Surgery
Calories: initially 400-900 calories per day as you progress through the post op stages to approximately 1200 calories a day after one year to maintain weight/loss
Protein: 70-80 grams per day: from low fat sources
Carbohydrates: 30-130 grams per day as you progress through the post op stages: from vegetables
and limited amounts of fruit and whole grains
Fat: Limit to 30 grams per day: choose more mono-and polyunsaturated fats
Fluids: 64 ounces per day minimum: start drinking 30 minutes after meals and stop drinking 10-30
minutes before meals
Supplements:
Multivitamin with minerals and Iron
B1 (Thiamin)
B12 (sublingual)
Calcium citrate plus Vitamin D
Vitamin D
Iron (per MD)
Bariatric Clear Liquids
(Stage I)
Start: Begins day after surgery.
End: Until your surgeon advances you to Bariatric Modified Full Liquids (Stage II) (usually 1-2 days).
You will still be in the hospital.
Goal: HYDRATION IS THE MAIN CONCERN: aim for 64 ounces a day, although you may only
be able to take in 30-40 ounces.
Description
• Consists of CLEAR, SUGAR-FREE, CAFFEINE-FREE, NON-CARBONATED fluids.
• Sip fluids SLOWLY and do not gulp or take large mouthfuls of fluids. Your mouth will be bigger
than your stomach so even a mouthful of fluid may be too much and cause discomfort. Drinking
too much fluid at one time may cause pain.
• Avoid drinking through a straw as it may give you gas or you may accidentally take in too much
fluid at one time.
• Stop drinking when you feel comfortably full.
• We recommend diluting juice to at least 1 part juice to 3 parts water to keep the sugar content low
and prevent the dumping syndrome.
• Your goal intake is approximately 4 to 6 ounces each hour.
• Liquids that are extremes in temperature (too hot or too cold) may not be well tolerated during the
first few weeks or months. Room temperature fluids may be better tolerated.
It is normal to have a reduced appetite in the days following surgery. Because food choices are limited on this stage, do not worry about the amount of protein you are consuming. Beef, chicken, and
turkey broth contain a little protein and are good choices initially.
Suggested List of Clear Liquids
Water
Broth
Crystal Light, Crystal Light Hydration Bouillon
Diet Snapple
Decaffeinated Tea
Decaffeinated Coffee
Sugar-free Jell-O
Propel Water
Ice chips
Gatorade (Diluted)
(1 part Gatorade to 3 parts water)
Diet Tang
Diet Kool-Aid
Sugar-free Popsicles
Juice (Diluted)
(1 part juice to 3 parts water)
Meal Serving Size:
Remember that the size of your new stomach is 1 ounce (the size of your thumb) that can expand up
to 2-3 ounces. You may find that you get full on just a few sips of fluid.
SAMPLE MENU BARIATRIC CLEAR LIQUIDS (STAGE I)
BREAKFAST
Sugar-free Jell-O (1-2 oz)
Decaffeinated tea (1-2 oz)
LUNCH
Vegetable broth (1-2 oz)
Diet Snapple (1-2 oz)
DINNER
Chicken broth (1-2 oz)
Propel Water (1-2 oz)
BREAKFAST
Apple juice (diluted) (1-2 oz)
Sugar-free Jell-O (1-2 oz)
LUNCH
Beef broth (1-2 oz)
Sugar-free Popsicle (1)
DINNER
Vegetable broth (1-2 oz)
Decaffeinated tea (1-2 oz)
**The amount of food you will be able to tolerate will be different for everyone. Sip on liquids
until you feel comfortably full. You may get full on ¼ cup of fluid or less.
Bariatric Modified Full Liquid
(Stage II)
Start: About 2-4 days after surgery.
End: About 2 weeks later when your surgeon advances you to Bariatric Soft Food (Stage III) at your
first post operative appointment.
Goal: HYDRATION: aim for 64 or more ounces fluids, ¼ cup food or more as tolerated 3 or more
TIMES A DAY.
Description
• Consists of all of the foods found in Bariatric Clear Liquid (Stage I), PLUS
• SOFT, LOW-SUGAR foods that are LIQUID OR SEMI-LIQUID. This stage also consists of some
pureed foods that have a smooth, soft texture that requires no chewing. If you had sleeve gastrectomy your surgeon may request that you stay on liquids for one week after surgery.
• It is best to add one new food at a time to assess tolerance.
• Begin your PROTEIN SUPPLEMENT (see below). You may experience taste changes and sample
several varieties of protein supplements.
• Continue to sip water and other clear liquids between meals, aim for 64 ounces a day. Do not be
overly concerned if you take less than this amount, the goal is to prevent dehydration.
• This stage permits a gradual transition to more solid foods. During this stage, soft textured foods
are very important as your stomach and intestines are in the early stages of recovery.
For sleeve gastrectomy patients:
Suggested List of Liquid Foods for first week following surgery:
Protein drink, water, decaffeinated coffee or tea, sugar free beverages, Crystal Light, soy milk,
lactaid milk, diluted fruit juice (1 part juice to 3 parts water), strained cream soup, strained pureed
soups, consommé, including all Stage I foods such as broth, boullion, sugar free jello and sugar free
popsicles.
SAMPLE MENU BARIATRIC ONE WEEK LIQUID DIET (Sleeve Gastrectomy)
BREAKFAST
¼ - ½ cup sugar
free jello
Between meals
Protein supplement
(25-30 grams
protein)
LUNCH
Between meals
¼ - ½ cup strained Protein supplecream soup
ment
(25-30 grams
protein)
DINNER
¼ - ½ cup strained
pureed tomato
soup
Bariatric Modified Full Liquid
(Stage II)
Start: About 2-4 days after surgery.
End: About 2 weeks later when your surgeon advances you to Bariatric Soft Food (Stage III) at your
first post operative appointment.
Goal: HYDRATION: aim for 64 or more ounces fluids, ¼ cup food or more as tolerated 3 or more
TIMES A DAY.
Description
• Consists of all of the foods found in Bariatric Clear Liquid (Stage I), PLUS
• SOFT, LOW-SUGAR foods that are LIQUID OR SEMI-LIQUID. This stage also consists of some
pureed foods that have a smooth, soft texture that requires no chewing. If you had sleeve gastrectomy your surgeon may request that you stay on liquids for one week after surgery.
• It is best to add one new food at a time to assess tolerance.
• Begin your PROTEIN SUPPLEMENT (see below). You may experience taste changes and sample
several varieties of protein supplements.
• Continue to sip water and other clear liquids between meals, aim for 64 ounces a day. Do not be
overly concerned if you take less than this amount, the goal is to prevent dehydration.
• This stage permits a gradual transition to more solid foods. During this stage, soft textured foods
are very important as your stomach and intestines are in the early stages of recovery.
For sleeve gastrectomy patients:
Suggested List of Liquid Foods for first week following surgery:
Protein drink, water, decaffeinated coffee or tea, sugar free beverages, Crystal Light, soy milk,
lactaid milk, diluted fruit juice (1 part juice to 3 parts water), strained cream soup, strained pureed
soups, consommé, including all Stage I foods such as broth, boullion, sugar free jello and sugar free
popsicles.
SAMPLE MENU BARIATRIC ONE WEEK LIQUID DIET (Sleeve Gastrectomy)
BREAKFAST
¼ - ½ cup sugar
free jello
Between meals
Protein supplement
(25-30 grams
protein)
LUNCH
Between meals
¼ - ½ cup strained Protein supplecream soup
ment
(25-30 grams
protein)
DINNER
¼ - ½ cup strained
pureed tomato
soup
Suggested List of Bariatric Modified Full Liquid (Stage II) foods
FOOD CHOICES
Protein (can use
water, broth,
soymilk or milk
for thinner consistency)
Beverages
Fruit /Vegetables
(use strainer for
fibrous foods)
Dairy
Soup
Sugar substitutes
Miscellaneous
SUGGESTED FOODS
Protein Drink (between meals), cottage cheese, ricotta cheese, silken/soft
tofu, strained baby food meat (chicken, turkey, ham), melted/shredded low fat
cheese, well cooked pureed beans/lentils*, hummus*
Water, decaffeinated coffee or tea, other sugar-free beverages, soy milk, crystal light, diet Snapple, plus, all of Stage I fluids
No sugar added applesauce, pureed baby/canned fruit in natural juices (apple, banana, pear), fruit cocktail. Any fruit flavored juice, but it must be diluted
(1 part juice to 3 parts water). Fruit juice is to be avoided in later stages of
your diet. Pureed baby/canned/cooked vegetables (carrots, green beans,
peas*, sweet potato*, potato*, onions)
Lower-carbohydrate yogurt/Greek yogurt (less than 20 grams of total carbohydrate), Lactaid milk, calcium-enriched soy milk, sugar free pudding, sugar
free custard
Strained cream soup, broth, bullion, consommé, pureed homemade vegetable soup, homemade bean soup, (avoid using rice/pasta)
Sugar substitute (Splenda, Equal, Sweet n Low, etc), Sugar free popsicles
Salt, flavorings, mild herbs
*These foods are also considered starchy foods
Meal Serving Size
Remember that the size of your new stomach is 1 ounce (the size of your thumb) that can expand up
to 2 to 3 ounces. It is difficult to tell you exactly how much you can expect to eat at this point. Some
feel full after only 2-3 bites of food, while others can eat 7-8 bites of food. The most important thing to
remember is to eat slowly and to stop eating when you feel comfortably full.
BREAKFAST
Between meals
LUNCH
Between meals
DINNER
1/4 cup cottage
Protein supple¼ cup strained
Protein supple1/4 cup strained
cheese
ment
cream soup
ment
cream soup
1/4 cup yogurt
(25-30 grams
¼ cup unsweet(25-30 grams
1/4 cup sugar-free
Sugar substitute
protein)
ened applesauce protein)
pudding
**The serving sizes listed above may not be appropriate for everyone. Eat until you feel comfortably
full, but do not feel that you have to eat all of the portions listed above.
If your pouch has problems adjusting return to Bariatric Clear Liquid Diet (Stage I)
The clear liquid foods of the Bariatric Clear Liquid Diet (Stage I) are NOT nutritionally adequate and
therefore you should not follow the Bariatric Clear Liquid Diet (Stage I) for more than one to two days
at a time.
Protein Supplement
Although the Bariatric Modified Full Liquid (Stage II) foods are soft in texture, they are not typically
rich in protein. The Bariatric Modified Full Liquid (Stage II) foods alone will not supply you with the
protein you need for wound healing after surgery. In our experience, individuals who do not drink
the recommended amount of protein supplement often complain of feeling weak, tired, and hungry.
Therefore, during Bariatric Modified Full Liquid (Stage II) meal plan, you will use a protein supplement
between meals. The solid protein foods you will eat during Bariatric Soft Foods (Stage III) will meet
your protein needs, however, you may not be able to eat 70-80 grams of protein. You may need to
use protein supplements at the end of the day until you can eat enough protein in your meals. Protein
supplements are not to be used as meal replacements.
How To Select A Protein Supplement:
There are literally dozens and dozens of protein drinks on the market. Whey based protein supplements are preferred. Some are better than others. Here’s a guide to select an appropriate protein
powder:
Per 2-3 serving size scoops, the powder should have
• 50 to 55 grams of protein, AND
• 5 to 7 grams of sugar or less AND
• 3 to 5 grams of fat or less.
Directions:
Mix 2-3 scoops with water, soymilk or Lactaid milk (8 ounces or per instructions per label). Mix in
Blender. Add ice (optional). Add small piece of fruit (optional) such as 3-4 frozen strawberries or ¼
banana.
AVOID Slim Fast, Atkins, Carnation Instant Breakfast, Boost, Ensure. These often have too much fat,
sugar and/or calories.
Flavored Vs. Unflavored Protein Supplements:
Most of the protein supplements available have a flavor (chocolate, vanilla, berry, etc). Some, however, are specifically made to be flavorless so you can add them to other foods such as soup, apple
sauce, yogurt, etc. Both kinds are fine to take after surgery, just remember, if you are using a flavorless protein supplement to take in enough scoops to reach the 50 to 55 grams of protein you need
each day. Your taste may change after surgery, so you may want to have samples of several
types of protein supplements available (powder, ready to drink, different flavors). Vitalady.com
is a popular on line site to buy protein samples. The table on the next page lists common protein supplements used by patients in our clinic.
Protein Supplement Goals: (Per 2-3 scoops or containers) 55 or more grams protein, 5-10 grams of sugar or less, 3-5 grams of fat or
less
Walmart
GNC
Costco
Vitamin Shoppe
Trader Joe’s
Six Star Professional
Optimum Procomplex
EAS Premium Protein (6 Gold Standard 100%
Worldwide Pure ProStrength (powder)
(4.4 lb powder)
lb powder)
Whey (5 lb powder) Per tein(11 oz can) 170 cal,
Per scoop: 130 cal
Per scoop: 120 cal
Per scoop: 150 cal, 27
scoop: 120 cal, 24 grams 35 grams pro
23 grams pro
22 grams pro
grams pro
pro
Nature’s Best Isopure (3 Whey Protein Isolate (3lb Syntrax Nectar (2.2 lb
Designer Whey (2.1 lb
EAS 100% Whey (powder)
lb powder)
powder)
powder) Per scoop: 90
powder) Per scoop: 100
Per scoop: 120 cal, 23
Per scoop: 105 cal, 30
Per ounce: 110 cal, 20
calories, 23 grams pro
cal, 18.5 grams pro
grams pro
grams pro
grams pro
Nature’s Best Isopure (3 Met Rx (2 lb powder) Per
Nature’s Best Isopure
Wellements Premium
Body Fortress 100%
lb powder)
scoop: 110 cal, 23 grams
Pro-rated (6 lb powder)
Premium Whey (powder) Zero Carb (20 oz clear
pro
Per scoop: 170 cal, 25
Per scoop: 105 cal, 30
Per scoop: 110cal, 23
liquid bottle) $ 3.99 per
grams pro
grams pro
bottle
grams pro
160 cal, 40 grams pro
Premier Nutrition (11oz
Nature’s Best Isopure
Gold Standard 100%
EAS Advantage Carb
shake) Per shake: 160
Zero Carb (20 oz clear
Whey (5 lb powder)
Contol (11oz liquid)Per
cal, 30 grams pro
liquid bottle,
Per scoop: 120 cal
can: 119 cal , 17 grams
160 cal, 40 grams pro
pro
24 grams pro
Designer Whey (2.1 lb
GNC Pro Performance
Whey Protein Fruit
Splash (by Weider ) Per powder) Per scoop: 100
(6lb powder)
scoop: 90 cal, 20 grams cal, 18.5 grams pro
Per scoop: 130 cal,
pro
20grams pro
Cytomax Protein Pure
Worldwide Protein (11oz
Performance drink (20
liquid can)
oz bottle) Per bottle: 160
Per can: 170 cal, 35
grams pro
cal, 40 grams pro
Online Resources for Protein Supplements/Samples:
www.vitalady.com, www.bariatric.eating.com, www.bariatricadvantage.com, www.bariatrix.com, www.bodybuilders.com, www.bbvitamins.com, www.gnc.com, www.BariatricChoice.com, www.obesity.com, www.asbs.org, www.bariatricdiet.com, www.affordablesupplements.com, www.cheapvitamins.com, www.vitaminshoppe.com, www.unjury.com, www.wellements.com/prorated.asp, www.optimumnutrition.com, www.nature’sbest.com, www.allthewhey.com, www.eas.com, www.designerwhey.com, www.resource.walgreens.com, www.
globalhp.com,
Shopping List for Bariatric Clear Liquid (Stage I) & Bariatric Modified Full Liquid (Stage II)
Tools for Success
Food Scale to measure meat/protein
Strainer (to strain chunky soups)
Measuring Cups
Non-stick pots and pans
Small plate, bowl, fork and spoon
Food timer
Counter-top grill
Food processor (for Bariatric Clear liquid Stage 1 & Bariatric Modified Full Liquid Stage II)
Blender (for protein drink During Stage I & II) Ice cube tray (pour soup in ice cube tray and freeze it.
You’ll have pre-portioned serving sizes)
Groceries For Bariatric Clear Liquid (Stage I) & Bariatric Modified Full Liquid (Stage II)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Protein Supplement
Broth soups (any kind)
Creamy soups (any kind, but blend it or strain out the larger chunks of food)
Low-fat or fat-free soy milk
Low-fat or fat-free Lactaid milk
No sugar added applesauce
Yogurt (Dannon Light N’ Fit, any flavor, nonfat/ low fat Greek Yogurt)
Sugar-free Jell-o
Low-sugar custard
Sugar-free pudding
Sugar-free popsicles
No sugar added rice pudding (example: Kozy Shack)
Decaf tea
Decaf coffee
Low-fat or fat free cottage cheese
Low-sugar/calorie beverages (Diet Snapple, Crystal Light, SOBE Lean, Propel, etc).
Water
Flavor enhancers (for protein supplement or other foods)
o
Splenda, Equal, NUtra Sweet
o
Toranu sugar-free syrups
o
Salt/Pepper, Herbs/Seasonings (as long as it is of a soft consistency)
BARIATRIC SOFT FOODS
(Stage III)
Start: At your first post operative appointment.
End: About 6-8 weeks later at your 6-8 week post operative appointment.
Goal: INCREASE FLUIDS TO 64 OZ A DAY. Approximately ¼ cup or more soft protein based
meals 3 TIMES A DAY.
Description
• SOFT SOLID foods.
• Be aware of portion sizes, eat slowly, and always stop eating when you feel comfortably full.
• Eat three meals a day with NO snacks.
• BEGIN each meal with protein-rich foods to ensure your protein needs are met.
• Start WEANING OFF your protein supplement as you tolerate more protein rich foods.
• Add one new food at a time to assess tolerance. Don’t try any new food for the first time while
eating out. If you become sick or feel discomfort after trying a new food, you can always return to
Stage 1 for a day to rest your stomach.
• Avoid fluids with meals to prevent rapid emptying of the pouch and weight regain.
• After 8 weeks, you may begin to try other, more complex foods (such as chicken breast, beans
and raw vegetables).
During the recovery period you may experience occasional diarrhea, cramping, or vomiting after eating. These problems should resolve if you continue to follow the dietary guidelines. If these symptoms
persist, contact your primary care provider.
Suggested Food List for Bariatric Soft (Stage III):
FOOD CHOICES
SUGGESTED FOODS
Beverages
Water, decaffeinated coffee and tea, other sugarfree beverages
Dairy*
Lower-carbohydrate yogurt (less than 20 grams
of total carbohydrate), low fat or non-fat soy milk,
low-fat or non-fat Lactaid milk, sugar free pudding, sugar free custard
Eggs
Scrambled, soft cooked, poached, hard boiled or
egg substitute
Fats (use sparingly as these are high in calories) Cooking spray, olive oil, canola oil, or vegetable
oil, butter, trans fat-free margarine, low-fat mayonnaise.
Fruits
No Sugar Added apple sauce, banana, all fruits
(peel the tough skins), canned fruits (Extra Lite
variety only, pour out juice in the can and rinse).
Vegetables
All cooked and pureed vegetables, carrots, green
beans, zucchini, eggplant, broccoli, etc
Protein
Steamed or poached fish, cottage cheese, soft
low-fat cheeses, tofu, thinly sliced or moist turkey
or chicken, lunch meat, protein powder
Starch/Carbohydrate
Mashed potato without skin or instant mashed
potatoes, saltine crackers, well-toasted bread
Cream soup made with pureed vegetables,
broth, bullion, consommé
Lower-carbohydrate yogurt (less than 20 grams
of total carbohydrate), low fat or non-fat soy milk,
low-fat or non-fat Lactaid milk, sugar free pudding, sugar free custard
Sugar substitutes (Splenda, Sweet n Low, Equal,
etc.), sugar free popsicles
Salt, flavoring extracts, mild herbs and seasonings, lemon or lime juice
Soup
Sugar substitutes
Eggs
Miscellaneous
* Many people become lactose intolerant after surgery
SAMPLE MENU, BARIATRIC SOFT (STAGE III)
BREAKFAST
¼ - ½ cup cottage cheese
1-2 small slices pear
(no skin)
LUNCH
DINNER
1-2 oz tuna (with low fat mayon- 1-2 oz deli sliced meat
naise)
1 oz cheese
2 saltine crackers
1-2 tsp low fat cream cheese
1-2 crackers
BREAKFAST
1 poached egg
1-2 Tbsp cheese
¼ small banana
LUNCH
¼ - ½ cup cottage cheese
1-2 slices peach
DINNER
1-2 oz fish
1/8 cup cooked vegetables
*** Eat until you feel comfortably full, but do not feel that you have to eat all of the portions listed
above. Most patients are only able to eat 1-2 ounces (7-14 grams) of protein at a meal. Continue using a protein supplement (30 to 40 grams) at end of the day until you are able to eat 3-4 oz of
protein (20-25 grams) per meal.
Vitamins and Supplements:
Continue all your vitamins and supplements. You will need to take these FOR LIFE.
BARIATRIC REGULAR
(STAGE IV)
Start: At your 6-8 week post operative appointment.
End: Continue for the rest of your life.
Goal: LOW FAT, PROTEIN RICH MEALS and 64 OZ FLUIDS A DAY.
Description
• REGULAR CONSISTENCY Foods
• Whereas in the Bariatric Soft (Stage III) phase you must cook your vegetables, the Bariatric Regular (Stage IV) diet includes raw salad and vegetables. Try one new food at a time.
• It is important that you always EAT PROTEIN FIRST.
• Eat at least three solid meals a day, NO snacks. Solid foods will stay in your pouch longer and
produce satiety.
• It is important that you continue to integrate your new eating behaviors into your lifestyle.
• Practice mindful eating.
• Review the Success Habits (page 22). We recommend you pull out a copy and place somewhere
you will see it every day (e.g. fridge door)
• Meals should include 3-4 ounces lean protein, followed by vegetables, then small amounts of fruit
and whole grains.
• Do not eat your meal over several hours. Take approximately 30-45 minutes to eat meals. Chew
each bite 30 times, wait between bites.
• Keep a food journal to track your calories, protein, carbohydrates and fat. There are many online
sites (FitDay.com, Sparkpeople.com, Calorieking.com, MyFitnessPal.com, LostIt.com, etc) to help
you calculate your intake.
SAMPLE MENU, BARIATRIC REGULAR (STAGE IV)
6 weeks post op to 3 months post op approximately 400-900 calories
BREAKFAST
1 -2 poached egg
1/8 cup yogurt
LUNCH
1 -3 oz crab or tuna with light
mayonnaise
1-2 saltine crackers
1-2 slice apple (no skin)
DINNER
1-3 oz lean ground beef
¼ cup zucchini
1/8 cup mashed potatoes
BREAKFAST
¼-3/4 cup cottage cheese
2 slices of canned peaches
LUNCH
1 oz string cheese
2 oz luncheon meat
1/8 cup yogurt
1-2 slice orange
DINNER
1-3 oz lean moist ham
1/4 cup cooked green beans
1/8 cup sweet potato
BREAKFAST
¼-1/2 cup egg beater scramble
1/4 cup yogurt
1 small slice pear (no skin)
LUNCH
1-3 oz chicken (moist)
¼-1/2 cup lettuce
1-2 tsp salad dressing
1-2 slice nectarine
DINNER
1-3 oz moist fish
1/4c cup cooked carrots
1/8 cup baked potato
*** Eat until you feel comfortably full, but do not feel that you have to eat all of the portions listed
above. Most patients are only able to eat 2 ounces (14 grams) protein at a meal. Continue using
protein supplement (30 to 40 grams) at end of the day until you are able to eat 3-4 oz protein
(20-25 grams) per meal.
Vitamins and Supplements:
Continue all your vitamins and supplements. You will need to take these FOR LIFE. Refer to the end
of the nutrition chapter for the vitamin chart.
BARIATRIC REGULAR
(STAGE IV)
Start: At your 6-8 week post operative appointment.
End: Continue for the rest of your life.
Goal: LOW FAT, PROTEIN RICH MEALS and 64 OZ FLUIDS A DAY.
Description
• REGULAR CONSISTENCY Foods
• Whereas in the Bariatric Soft (Stage III) phase you must cook your vegetables, the Bariatric Regular (Stage IV) diet includes raw salad and vegetables. Try one new food at a time.
• It is important that you always EAT PROTEIN FIRST.
• Eat at least three solid meals a day, NO snacks. Solid foods will stay in your pouch longer and
produce satiety.
• It is important that you continue to integrate your new eating behaviors into your lifestyle.
• Practice mindful eating.
• Review the Success Habits (page 22). We recommend you pull out a copy and place somewhere
you will see it every day (e.g. fridge door)
• Meals should include 3-4 ounces lean protein, followed by vegetables, then small amounts of fruit
and whole grains.
• Do not eat your meal over several hours. Take approximately 30-45 minutes to eat meals. Chew
each bite 30 times, wait between bites.
• Keep a food journal to track your calories, protein, carbohydrates and fat. There are many online
sites (FitDay.com, Sparkpeople.com, Calorieking.com, MyFitnessPal.com, LostIt.com, etc) to help
you calculate your intake.
List of foods to eat after surgery
(The following list of foods may be used as shopping list both before and after surgery)
Protein
Beans (navy, pinto, black,
etc)***
Beef (very lean, thinly sliced,
ground)
Chicken (moist, no skin)
Clams (caution, may be tough!)
Low fat cheese (swiss, cheddar,
mozzarella, baby bel, ricotta,
provolone, american, havarti,
gouda)
Cottage cheese (low fat, nonfat)
Crab / Imitation crab
Egg substitute
Lamb
Egg whites / Whole Egg
Lobster
Game Meats
Ham (low fat)
Seafood / Fish
(cod, tuna, trout, salmon, bass,
scallops, shrimp)
Pork (lean cuts, loin)
Tofu / Soy Beans / Edamame
Soy Milk / Lactaid Mi
Turkey (light or dark, no skin)
Veggie Burger (made with soy)
Veal
Yogurt (15-18 g Total Carbohydrate)
Vegetables – Make sure vegetables are well cooked for the first 6-8 weeks after surgery
Alfalfa sprouts
Chard
Radish
Artichoke
Collard greens
Red, Green, Yellow peppers
Arugula
Cucumber
Salad / Spinach / Mustard
greens
Asparagus (well cooked)
Eggplant
Seaweed
Beets
Jicama
Shallots
Broccoli***
Green snap beans
Tomato
Brussels sprouts***
Leeks
Water Chestnuts
Cabbage***
Mushroom
Yellow squash
Carrots
Onions
Zucchini
Cauliflower***
***caution – may cause gas
Fruit
Apple (without peel)
Apricots (remove skin)
Banana
Blueberries
Cantaloupe
Cherries
Grapefruit
Grapes
Kiwi
Lemons (acidity)
Mandarin oranges
Nectarines
Papaya
Peach (remove fuzz)
Pears (remove skin)
Pineapple
Raspberries
Strawberries
Tangerine
Watermelon (remove seeds)
Oranges (remove skin)
Applesauce (unsweetened)
Plums
Guava
Fat
Olive oil
Canola oil
Vegetable oil
Pam Spray
Avocado
Olives
Peanut butter
Molly McButter
Sour Cream (Low Fat)
Margarine (No Trans Fat)
Cream Cheese (Low Fat)
Miscellaneous
Vinegar
Pickles / Pickle Relish
Garlic / Garlic Powder
Cinnamon
Mrs. Dash
Salt / Pepper
Soy Sauce
Mustard
Hummus
Herbs / Seasonings
Onion Powder
Ginger
Italian Seasonings
Curry
(basil, oregano, thyme, etc)
***Go easy on Ketchup (catsup): 1 Tbsp = 3 g sugar*
Foods to be careful with after surgery
The following lists of foods may cause
• Weight gain
• Dumping syndrome
• Pouch intolerance
• Hypoglycemia (low blood sugars)
Starch
Bagels
Biscuits
Bread Sticks
Bread (Untoasted)
Cereals, Cold or Hot
Croissants
Doughnuts
Rice Cakes
May Block the Anastomosis
Coconut
Nuts / Seeds
Dried Fruit
Potato Skins
Corn
Muffins
Noodle
Oatmeal
Pancakes
English Muffins
French Toast
Grits
Rolls
Stuffing
Tortillas
Waffles
Pastas
Pastry
Pita Bread
Rice
Gum
Hot Dog Skins
Popcorn
Celery, Raw (cooked celery in
soup is ok)
Oranges (be careful of the pulp)
Skins and Seeds of Fruits and
Vegetables
May Cause Dumping Syndrome or Hypoglycemia
Ice Cream
Candy / Candy Bars
Cookies
Coffee Drinks/Mochas
Cake
Soda
Fruit Juice
Frozen Yogurt
Juice Smoothies
Milkshake
Foods High in Fat
Creamy Sauces
Fried Food
Bacon
Fried Egg Roll
Sausage
Potato Chips
Onion rings
Mayonnaise
French Fries
Pizza
Hash browns
Salad Dressing
Miscellaneous Foods
Alcohol
• Will increase your risk of ulcers
• Has a high number of LIQUID non nutritional calories.
• Increases your risk of alcoholism.
Your tolerance of any alcohol will be significantly reduced, increasing your risk of DUI.
Remember
• Milk may cause gas and discomfort after surgery. Try soymilk or Lactaid instead.
• Steak is very tough and fibrous and may be difficult to tolerate after surgery. It is recommended to
wait 6 months to 1 year before trying to eat steak.
Nutrition Problems after Bariatric Surgery
NAUSEA AND VOMITING: most common problems
Nausea typically occurs because of temporary changes to taste and smell after surgery. If you vomit
after eating, it is probably because:
• You ate or drank too much at one time
• You ate too fast or didn’t chew your food thoroughly
• You ate foods that disagreed with you
• You lay down too soon after eating
• You are dehydrated
If nausea and vomiting increase when you advance through the stages of diet post-op, return
to Bariatric Clear Liquid (Stage I) or Bariatric Modified Full Liquid (Stage II) diet to rest your stomach
for 1-2 days. If these symptoms persist or if you are vomiting regularly, contact the bariatric clinic.
BLOCKAGE OF THE ANASTOMOSIS
Blockage of the anastomosis (connection between the stomach pouch and the small intestine) may
occur if fibrous or tough foods are eaten. Fibrous foods include: dry or tough meat, coconut, hot dog
skins, nuts, seeds, popcorn, and skins of some fruits and vegetables. If food has blocked the anastomosis try adding one spoonful of Adolf’s meat tenderizer to ¼ cup warm water and sip slowly. If the
vomiting continues throughout the day, stop eating solid foods and sip only clear liquids for the next
4 hours (water, decaffeinated coffee or tea, or non-carbonated beverages). If vomiting continues for
more than 24 hours, call your doctor. Continued vomiting may indicate that the outlet from your stomach pouch into your small intestine has become blocked and you may be at risk for dehydration.
Sometimes food blockages must be removed using an instrument called an endoscope that is passed
through your mouth into your stomach. The best way to avoid this is to chew all foods to the consistency of baby food, and avoid foods that are fibrous or hard to digest. In some cases, the outlet to the
small intestine becomes narrowed over time even though you are following the dietary guidelines.
This condition is called stenosis. The treatment is an endoscopic procedure performed on an outpatient basis using a small balloon to stretch (dilate) the outlet so food can pass through. Sometimes
a second dilatation procedure will be necessary. Continued vomiting over 24 hours may be a sign of
stenosis, and must be reported to your bariatric doctor.
DEHYDRATION
Cause:
• Drinking less than 64 ounces of fluid each day
• Vomiting and/or diarrhea
Symptoms: dark colored urine, little urine output, dry mouth, dry skin, nausea and dizziness.
Treatment:
• Drink a MINIMUM of 64 ounces of fluid everyday.
• Men and active people may need 100 ounces a day or more.
• Sip your liquids slowly throughout the day to prevent dehydration.
• Keep water bottles around your house as a reminder to drink.
• Talk to your doctor if you are experiencing symptoms of dehydration.
• Avoid diuretics such as tea and coffee.
DUMPING SYNDROME (“Behavior Modification with a Vengeance”)
Cause:
• Dumping syndrome occurs when a large dose of sugar is released rapidly into the small intestin
• Foods or beverages high in sugar (candy, ice cream, pastry, soda, fruit juices, and other foods
high in sugar).
Symptoms: nausea, cramps, diarrhea, perspiration, weakness, and lightheadedness
Treatment
• Lie down and rest until these symptoms resolve.
• It may take 30 minutes to 2 hours or more for symptoms to resolve.
• Most people who have experienced the dumping syndrome are very careful not to eat sugary
foods again.
Although the dumping syndrome is unpleasant, it is a beneficial part of your new tool and can help
prevent you from eating high calorie/high sugar foods that can lead to weight gain. However not everyone will experience dumping. This does NOT mean it is ok to eat or try these foods
CONSTIPATION: (very common)
Cause:
• The high protein diet lacks FIBER.
• Not enough FLUIDS
• Limited intake of food and fluid in total.
Treatment:
• As you progress with your diet, after the first 3-4 months, try to add more fiber to your food such
as fibrous vegetables and fruit.
• If you cannot tolerate fruit or vegetables, consider adding natural fiber supplements such as
Metamucil, Benefiber or Citrucel.
• Start slowly and gradually increase over a few weeks. This will help avoid effects such as gas and
bloating.
• Make sure to drink plenty of water if you use these as they can make things worse if your fluid
intake is poor.
• Get plenty of exercise since this helps move the bowels.
• Add a stool softener such as Colace (ducosate sodium), up to 200mg twice a day is also safe to
use.
• Add Milk of Magnesia daily (PROVIDED your kidney function is normal).
GAS (very common)
Treatment:
• Unfortunately, there is no good treatment other than letting it subside with time.
• In the days just leading up to surgery, people who have light meals seem to have less gas distress
after surgery than those who had heavy meals or ate gas-forming foods.
• Avoid spicy and gassy foods such as beans, cabbage, and broccoli.
• Sipping through straws may also contribute to gas pains from swallowing extra air.
• A trial of either Gas X or Beano is reasonable and will not harm your pouch.
GOUT
Gout is caused by the build-up of uric acid in the joints which causes inflammation, swelling, and pain.
Gout flare-ups may occur with weight loss. If you are experiencing gout during the weight loss process, you may need to have your eating plan individualized for you. Food modifications and drinking
more fluids may help to relieve the symptoms of gout. Talk with your bariatric dietitian to help develop
your meal and fluid plan. Remember for your gout flares you cannot take medications such as Motrin,
Aleve, Advil (NSAIDS).
HAIR LOSS: (also known as “Telogen Effluvium”) is very common after surgery
Cause:
• Any major surgery
• Crash dieting
• Major weight loss
You have ALL three risk factors.
• Iron and protein deficiency can make it worse. Make sure you are taking all your supplements and
adequate protein. Your multivitamin should have adequate (at least 15mg) Zinc in it. Do NOT take
an additional zinc supplement as this can irritate the pouch.
• Avoid too much traction to your hair, such as through aggressive brushing and combing or tying it
up tightly.
No other intervention is needed; full regrowth of your hair is expected once your body stabilizes. Expensive hair products may not help.
HYPOGLYCEMIA: (low blood sugars)
Cause:
• This is usually your body overreacting to sugars in your diet by releasing too much insulin which in
turn causes low blood sugars. It may take considerable time for your pancreas to adapt. This occurs even if you did NOT have diabetes prior to surgery.
• Continued use of diabetic medication as you lose weight.
• Very rarely other reasons.
Treatment:
• Keep a very careful log of what you eat, when you eat it, and when the symptoms occur. Check
your finger-stick blood sugars if possible. This will usually reveal a consistent pattern of association with sugars or carbohydrates in your food.
• The danger is eating more frequently; this will lead to weight gain.
• Instead focus on a high protein diet
• If you “must” eat sugars try to choose “low glycemic index” carbohydrates. Think of brown (whole
grain, fiber rich).
• Fruit can have natural sugars; limit portions
• Your diabetic medication may need reduction. CONSULT your primary care physician.
• CONSULT your primary care physician to rule other out causes. (rare)
• If symptoms persist despite adjusting your diet, please contact the Bariatric clinic.
CHANGES IN TASTE AND SMELL
After surgery you may experience sensitivity to tastes and smells. For example, foods that you enjoyed before surgery may take on a new flavor and may not be as appealing to you after surgery.
Sensitivity to smells such as food odors or perfumes is also common after surgery. Hang in there,
these changes usually resolve a few months after surgery.
ORTHOSTATIC HYPOTENSION: (low blood pressure when you stand up)
Cause:
• After weight loss surgery, your ability to drink fluids has decreased.
• You are exercising more, sweating more, and losing water and salt as you do so.
• You may still be on the high blood pressure medication you took before surgery.
• Anemia will make it worse.
Treatment:
• REVIEW symptoms of dizziness, weakness with your primary care physician to confirm the diagnosis
• Try to drink 64oz fluids a day.
• Avoid diuretics such as tea (including Green tea and Coffee).
• Avoid hot drinks as these can make you sweat and lower your blood pressure further.
• If you are exercising a lot, replace your fluid with a NON calorie drink which contains sodium. (e.g.
“Crystal Lite Hydration”). This is better than water.
• Your blood pressure medications may need reduction. Review this with your primary care physician.
• Get up SLOWLY. Allow your body time to adjust to changes in gravity.
WEIGHT PLATEAUS
During the journey of weight loss, it is common for some people to experience periods of no, or very
slow, changes in weight. Plateaus are normal and everyone loses weight at different rates. The following list may help you to resume weight loss should you experience a plateau:
• Follow the nutritional guidelines.
• Exercise regularly. Remember, the goal is to exercise for 40-60 minutes, 6-7 days a week.
• If you are already exercising, give your metabolism a kick start by changing your exercise pattern
(i.e. increase the intensity a little, add 1-2 days a week of strength training, or try a new activity).
• Drink at least 64 ounces of fluid each day.
• Write down everything you eat and weigh and measure your food. Your portions may be creeping
up without you realizing it.
• Stick to protein foods first. Some people experience plateaus in weight if they migrate back to eating more carbohydrate foods. Carbohydrate foods will not fill you up the same way protein foods
will and may cause you to become hungry again soon after eating. Frequent snacking on carbohydrate foods may cause you to hit a plateau.
• Continue to take your measurements. It can help keep you motivated. You may be losing inches
although your weight is stable, especially if you are lifting weights. Muscles weigh more than fat,
so the number on the scale may be deceptive.
Nutrition Guidelines for Lap-Band
How the Band works:
• It reduces how much you can eat at a time. You are satisfied with a smaller amount of food.
• It reduces the hunger you will feel between meals. (i.e. increased satiety)
The Lap-Band is designed to restrict SOLIDS NOT LIQUIDS.
This operation will only work if you eat SOLID food.
• Drinking liquids with meals or immediately after meals will simply flush the food through the band
opening allowing you to eat more.
• High calorie liquids will also pass very easily through the band opening without much restriction.
You will absorb ALL of these calories.
• Soft foods such as soups, puddings, yogurts will also pass easily through the band
• The band limits how much you can eat at any ONE time. You can however eat small meals or
snacks through out the day thereby bypassing the band’s effect. With frequent snacking or “grazing” you can consume a large amount of calories throughout the day.
• Food must be chewed well to pass through the band. Do not make the mistake of choosing foods
that do not need to be chewed to save time or effort. These will pass easily through the band leaving you feeling hungry.
• The band creates a small pouch of approx 2oz (size of an egg). If you try to eat more than this at
one time you may become nauseated and vomit. Eat SLOWLY to allow your body to receive “full”
signals. It may take some time to learn what this feels like. It can be different for everyone.
Meal Guidelines
Please CAREFULLY REVIEW the Stage I-IV post operative diet descriptions described earlier in the
nutrition chapter of this book.
Stage I While you are still in hospital.
Stage II On discharge from hospital and continued for 2 weeks after surgery
Stage III 2 weeks after surgery and continued until you see your surgeon at 6 weeks after sur
gery.
Stage IV Once given the all clear by your surgeon at your 6 wk follow up appointment continued
for THE REST OF YOUR LIFE.
After a fill: After each band fill, stay on Stage II for one to two days, but advance to the solid protein
based meals of Stage IV as soon as tolerated.
Important points:
• You will not experience dumping syndrome with this restrictive surgery. “Sweet eaters” may have a
harder time losing weight.
• Patients may have more frequents follow-ups because they may not experience the accelerated
weight loss phase after Lap-Band as there is with Gastric Bypass patients.
• Your success with the Lap-Band depends on your motivation and commitment to follow a new way
of eating.
Vitamin Supplementation: Although this surgery is only a restrictive procedure, you can get vitamin
deficiencies. Take vitamins for the rest of your life! After a fill you may find it easier to tolerate chewable supplements.
SEE LAP-BAND VITAMIN CHART AT END OF THE
NUTRITION CHAPTER
10 Rules of LAP-BAND SURGERY
1. Eat only three small meals a day. Large meals could stretch your new stomach pouch. If you eat
too much you may become nauseated and may also vomit. Frequent vomiting can also cause certain complications, such as stomach slippage. Eating more than three times a day could develop a
habit of grazing, preventing successful weight loss.
2. Eat S-L-O-W-L-Y and chew food thoroughly. Food must be chewed adequately in order to pass
through the new stoma, which will be about the width of a dime. Use a baby spoon or fork, take
small bites and chew 30 times per bite.
3. Stop eating as soon as you feel full. Take your time during meals to monitor for and recognize
feelings of fullness. It takes time for our stomach to signal the brain that we are full. If you rush
through a meal, you may eat more than your body needs. This can lead to nausea and vomiting.
4. Do not drink while you are eating. (Stop 30 minutes before a meal and do not start drinking
again until 30 minutes following a meal.) The Lap-Band can work only if you eat solid foods.
If you drink with meals, food will become more liquefied and reduce the effectiveness of the LapBand by flushing food through the stomach too quickly. You will feel hungry sooner and end up
eating more than you need.
5. Do not eat between meals (avoid snacking/grazing). Eating between meals is one of the major
reasons for weight-loss failure after surgery. If you feel that you are getting too hungry between
meals you may need to have you band fill-level adjusted.
6. Eat only good quality foods. You are only able to eat small amounts of food, so make it count!
Look for nutrient dense foods that are high in protein, vitamins and minerals. Choose lean meats,
fresh or frozen fruits and vegetables and limited amount of whole grains. Avoid fruit juices and
foods high in sugar and fat.
7. Avoid fibrous foods. Foods that contain many fibers may block the stoma. If you would like to
eat fibrous foods once in a while be sure to cut them into small pieces and cook thoroughly. Fibrous foods may include celery, asparagus, broccoli, artichokes, corn, popcorn and pineapple.
8. Drink 64 ounces or more of fluid each day. Not only do you needs fluids to prevent dehydration,
but fluids help rid your body of the waste products that result from fat/weight loss.
9. Drink only no/low calorie decaffeinated, non- carbonated beverages. If you drink high calorie
liquids like soda, juice, smoothies and other sweetened beverages, you will have difficulty losing
weight.
10.Exercise at least 30 minutes per day. Start moving and gradually increase exercise. It is very
important to successful weight loss and maintenance.
Common Problem Foods
Dry meat
Shrimp
Untoasted bread, bagels.
Pasta
Rice
Peanut Butter
Dried fruit
Fibrous vegetables: Cook them well. Even still they can be hard to chew well enough.
Nuts
Coconut
Greasy or fried foods
Poor quality meats with gristle: Choose small soft high quality steak instead.
Seeds and skins of fruits and vegetables
Introduce these foods slowly and individually to see if they are tolerated. CHEW WELL.
Cook foods gently over lower heat. BBQ may be too dry. Mircowaves can also make food tough and
dry.
Alcohol
• Will increase your risk of ulcers and band removal.
• Has a high number of LIQUID non nutritional calories.
• Increases your risk of alcoholism.
• Your tolerance of any alcohol may be reduced, increasing your risk of DUI.
Additional Nutrition Resources
Restaurant Survival After Surgery
As you recover after surgery you will want to resume normal activities, such as occasionally eating
out at a restaurant. The following tips can make the difference between an enjoyable night out or a
painful experience.
• Select protein foods first.
• Have a meal plan in mind before you go out to eat so you won’t be tempted to make an unhealthy
food choice once you get to the restaurant.
• If your visit a particular restaurant frequently, take a copy of the menu and research the healthiest
options at home.
• Be careful of the kid’s menu. It is tempting because of its smaller portions, however, the kid’s
menu is often high in fat and calories and not a good choice.
• Ask the server to pack up half of the meal before he or she brings it to you. Even a half of a restaurant sized-meal may be too much food for you after surgery.
• Order from the appetizer menu or share the meal with a friend or family member.
• Ask the server to put ALL sauces and dressings on the side. These may be high in sugar and fat
and could cause dumping. Bring your own “safe” salad dressings.
• If the menu doesn’t appear to have what you are looking for, ask the server for food substitutions.
Replace French fries with a salad or steamed vegetables.
• Avoid the bread or chips on the table before the entrée arrives. Filling up on starchy foods will not
leave enough room in your stomach for healthy protein foods.
• Select moist foods such as fish. Dry foods are difficult to tolerate and may lead to discomfort.
• Don’t try new foods for the first time while eating out. If you are unable to tolerate the new food, it
may create an uncomfortable situation.
• Ask your server how a particular dish is prepared. Avoid fried and fatty foods as they will provide
extra calories and slow down your weight loss progress.
• Make healthy food choices at fast food places.
High Fat Terms: Battered-Fried
Basted in it’s own Gravy
Crispy
Hollandaise Sauce
Fried
Beer Battered
Cheese Sauce
Sauté
Cream Sauce
Butter Sauce
In Rich Butter
Low Fat Terms:
Broiled
Dry Grilled
Poached
Roasted
Steamed
Charbroiled
Pick up a Restaurant Card at our office. These cards state that you are only able to eat a small food
portion due to surgery. The card may allow you to share a meal or eat for a reduced rate. Remember
that restaurants are not obligated to honor the card. Some restaurants will accept it, others will not.
Cooler Emergency Kit
Keep this handy in your car when you are going to a party, friend’s house or out to dinner just in case
there are no appropriate foods to eat.
Insulated Cooler with ice pack
Drinks:
• Bottled Water
• Crystal Light “On the Go” packs
• Herbal, decaf tea
Food: (keep protein foods refrigerated under 41 degrees Fahrenheit, do not keep at room temperature for more than 4 hours)
• Sliced lean luncheon meat
• Boiled eggs
• Egg salad
• Low fat cottage cheese, sliced cheese, string cheese
• Yogurt (no added sugar), Greek yogurt
• Tuna packs
• Low sugar turkey or beef jerky
• Crab/shrimp salad
• Dried or cooked vegetables
• Edamame
• Tofu
Sweet:
• Sugar-free jello
• Fruit
• Unsweetened applesauce
Vitamins and Protein Supplement
NUTRIENT DATA LABORATORY
Measure Equivalents
Measure Equivalents
1 tablespoon (tbsp) =
1/16 cup (c) =
1/8 cup =
1/6 cup =
1/4 cup =
1/3 cup =
3/8 cup =
1/2 cup =
2/3 cup =
3/4 cup =
1 cup =
1 cup=
8 fluid ounces (fl oz) =
1 pint (pt) =
1 quart (qt) =
4 cups =
1 gallon (gal) =
16 ounces (oz) =
1 milliliter (ml) =
1 inch (in) =
Metric Convertion Factors
Multiply
Fluid Ounces
Ounces (dry)
Grams
Grams
Kilograms
Pounds
Pounds
Quarts
Quarts (dry)
Quarts (liquid)
Liters
Gallons
Gallons
3 teaspoons (tsp)
1 tablespoon
2 tablespoons
2 tablespoons + 2 teaspoons
4 tablespoons
5 tablespoons + 1 teaspoon
6 tablespoons
8 tablespoons
10 tablespoons + 2 teaspoons
12 tablespoons
48 teaspoons
16 tablespoons
1 cup
2 cups
2 pints
1 quart
4 quarts
1 pound (lb)
1 cubic centimeter (cc)
2.54 centimeters (cm)
By
29.57
28.35
0.0353
0.0022
2.21
453.6
0.4536
0.946
67.2
57.7
1.0567
3,785
3,785
To Get
grams
grams
ounces
pounds
pounds
grams
kilograms
liters
cubic inches
cubic inches
quarts
cubic centimeters
liters
Food facts image
Nutrition label image
1. Serving Size
Look at this VERY CAREFULLY. Often a package will contain more
than one serving so you will have to multiply the total calories, sugar
by the serving size if you eat the whole package. In this example a
whole package has 500 calories (250 x 2 servings)
2. Amount of Calories
If you want to manage your weight (lose, gain, or maintain), this section is especially helpful. The amount of calories is listed on the left
side. The right side shows how many calories in one serving come
from fat.
Tip: Remember that a product that’s fat-free isn’t necessarily caloriefree.
3. Limit these Nutrients
Eating too much total fat (including saturated fat and trans fat), cholesterol, or sodium may increase your risk of heart disease, some cancers, or high blood pressure. The goal is to stay below 100%DV for
each of these nutrients per day.
4. Get Enough of these Nutrients
Remember to aim for approximately 70 grams of protein total a day.
Avoid products with more than 5 -10 grams of sugars per serving in it
to help prevent dumping syndrome or hypoglycemia. Some dairy products have natural sugars, limit the total carbohydrates to less than 20
grams per serving.
5. Percent (%) Daily Value
This section tells you whether the nutrients (total fat, sodium, dietary
fiber, etc.) in one serving of food contribute a little or a lot to your total
daily diet.
The %DVs are based on a 2,000-calorie diet. Long term after surgery
you will probably be on a 1200 calorie diet. It is ESSENTIAL you take
your vitamin supplements lifelong. You will NOT get enough in food to
avoid nutrient deficiencies.
6. Footnote with Daily Values (%DVs)
The footnote provides information about the DVs for important nutrients, including fats, sodium and fiber. The DVs are listed for people
who eat 2,000 or 2,500 calories each day.
Resources
Web
General Information
www.nlm.nih.gov/medlineplus/weightlosssurgery.html
www.obesityhelp.com www.win.niddk.nih.gov/publications/gastric.htm
www.lapband.com www.obesityaction.org
Food Log / Journaling/Calorie Counting (these sites also can be downloaded as phone application)
www.thedailyplate.com
www.fitday.com
www.sparkpeople.com
www.writingthejourney
www.mycaloriecounter.com
www.mynetdiary.com
www.myfitnesspal.com
www.livestrong.com
www.fatsecret.com
Mindful Eating
www.mindfuleating.org
www.tcme.org
www.bodymindinspiration.com
www.OA.Org (Overeaters Anonymous)
www.TOPS.Org (Taking Off Pounds Sensibly)
Supplements / Products
www.bariatricadvantage.com www.vitalady.com
www.bariatriceating.com www.unjury.com
General Information Books
The Patient’s Guide to Weight Surgery: Everything You Need to Know About Gastric Bypass and
Weight Loss Surgery by S. Ross, MD
The Success Habits of Weight Loss Surgery Patients by Colleen M. Cook
Exodus From Obesity: The Guide to Long-Term Success After Gastric Bypass Surgery by Paula F.
Peck, RN
Weight Loss Surgery: Finding the Thin Person Hiding Inside You by Barbara Thompson
Living and Eating Well After Weight Loss Surgery by Susan Maria Leach
Weight Loss Surgery for Dummies by Kurian
The Expert’s Guide to Wt Loss Surgery by Garth Davis, MD
Cookbooks
Eating Well After Weight Loss Surgery by Pat Levine
Culinary Classics: Essentials of Cooking For the Gastric Bypass Patient by David Fouts
Eating Healthy for Life, A Recipe Guide to Healthy Eating for Bariatric Surgery Patients by Mitch
Sivadon-Smith
Mindful Eating
Mindful Eating by Susan Albers, PsyD
Mindless Eating: Why We eat More Than We Think by Brian Wansink
Savor by Thich Nhat Hahn
Breaking Free From Emotional Eating by Geneen Roth
Emotional and Binge Eating by Geneen Roth
Mindful Eating: A Guide to Rediscovering a Healhty and Joyful Relationship with Food by Jan Chozen
Bays, MD
The Food and Feelings Workbook: A Full Course Meal on Emotional Health by Kren Koenig, LCSW
Eat What You Love, Love What you Eat, Michelle May, MD
The Cognitive Behavioral Workbook for Wt Management, The Cognitive Behavioral Workbook for
Weight Management: A Step-by-Step Program by Michele Laliberte Ph.D, Randi E. McCabe Ph.D,
Valerie Taylor
The End Of Overeating, Kessler, MD
The BeckDietSolution by Judith Beck, PhD
Overcoming Binge Eating by Christopher Fariburn, PhD
Binge No More: Your Guide to Overcoming Binge Eating by Joyce Nash, PhD