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“HOW TO USE YOUR NEW TOOL SUCCESSFULLY”
TEXAS CENTER FOR MEDICAL & SURGICAL WEIGHT LOSS
Nutrition After Weight Loss SurgeryGastric Bypass Sleeve Gastrectomy Gastric Banding
Basics
Nutrition and Behavior Modifications for long-term success
Diet Progression Remember your new stomach or pouch is delicate and
healing
Vitamin Program
WEPNSS
W- waterE- exerciseP- protein firstN- no snacking or grazingS- supplements (vitamins and minerals)S- support group
WEPNSS
These are the basic rules to live by.They work.Following them will make you as successful
as you want to be.Remember them. Live by them.
(WEPNSS) Water Water Water
Minimum 64 oz daily.This is critical.The single most important thing for you to do
after surgery is to get in at least 64 oz water daily!
“Rinse out” waste products that you will be producing during weight loss.
Maintain adequate hydration of tissues.Required for proper wound healing.It is okay to add a small amount of sugar-free
flavoring but limit to a couple per day.
Water!
Consequences of not getting in enough water: Dehydration Nausea Vomiting Kidney problems Poor wound healing Stricture of anastomosis (connection site) Re-hospitalization
Dehydration Cycle
Spacing Water and Meals
Separate water from your meals. Wait 1 hour after meals.
Water during meals flushes your food through faster, making you hungry again sooner.
(WEPNSS) Exercise
Helps to preserve lean body mass.Helps to burn more calories day to day.Increase PURPOSEFUL MOVEMENT!
Wear a pedometer Take the stairs Park further away Increase housework
Exercise
Cardiovascular + Resistance (weights/bands/body weight)
Cardiovascular exercise helps to burn fatStrength training/resistance
helps to maintain your muscle mass while you are losing fat
Speeds up metabolism Helps to maintain good bone health
Goal = minimum of 30 minutes cardio 5x/wk and 15 minutes
strength/resistance 3x/wk
Cardiovascular Activity
Start walking from day 1 after surgery and progress from there.
Gradually increase your time each week Week 1: 10 minutes/day 5/week Week 2: 12 minutes/day Week 3: 14 minutes/day
Work up to the a minimum of 30 minutesOnce you stop adding time than focus on intensity
Focus on your target heart rate (220-Age x 80%) Increase speed Interval training
MIX IT UP and make it fun!
Strength Training
Start 3-4 weeks after surgery or use light weights less than 20 pounds
Progression is key Gradually increase repetitions, sets, weight as it
should be challenging for youWork with a trainer to get on a program
that works for you.Mix it up over time to jump over plateaus
(WEPNSS) Protein
60 – 80 grams daily
At least 50% of every meal you eat should be proteinTry to eat your protein foods first
Early benefits of protein Helps protect against loss of lean body mass (muscle) Main building blocks of our bodies
Late benefits of protein Protein gives a feeling of satiety (satisfied) Fewer calories per gram than fat and more satiety (satisfied)
than carbohydrates
Protein
Protein
Early on, getting enough protein in every day is difficult.
Therefore, most people need to have a protein supplement for one meal per day in the beginning. Texas Center for Medical & Surgical Weight Loss offers
shakes, soups, and several other forms of high-protein meal replacements that are easy to tolerate.
Track your protein intake using a checklist or a food tracking system such as myfitnesspal
Meal Composition
No Snacking or Grazing
Fasting periods lead to fat-burning.Grazing lessens your body’s need to burn its
fat stores because you are frequently giving it energy (calories).
Snacks are habit-forming.Improving your protein intake at each meal
and increasing the amount of water you drink during the day will decrease your desire to snack.
(WEPNSS) No Snacking or Grazing
Our bodies cannot differentiate well between hunger and thirst
When you want to snack your body may actually need the water in the food.
Drink water instead of snackingDon’t be fooled!!!
Theoretically, it only takes an extra 100 calories per day to gain 10 pounds in a year!
YOU NEED VITAMINS FOR THE REST OF YOUR LIFE, NO MATTER HOW GREAT YOU FEEL!
( WEPNSS) Supplements
Why Do I Need Vitamins?
We need vitamins and minerals every day in adequate amounts in order for our bodies to function properly.
Weight loss surgery can contribute to deficiencies because of: Decreased intake of food Eating different foods Decreased absorption of certain foods due to change in
anatomyDeficiencies develop slowly and you may not notice
them until they are severe!
Why Will I Need Vitamins and Minerals After Weight Loss Surgery?
Why Will I Need Vitamins and Minerals After Weight Loss Surgery?
Why Will I Need Vitamins?
When our body is lacking in nutrients of days, weeks, or months, life threatening or debilitating consequences can occur. Fatigue/anemia Poor immune function contributing to cancer risk,
cardiovascular disease, side effects of diabetes Bone loss/fractures Neuropathy or neurological impairment Damage to the heart Blindness
Why Will I Need Vitamins?
To protect your health it is important to:1. Be compliant with a supplement program.
2. Get your vitamin profiles checked EVERY year.
Deficiencies are easy to correct if found early
Difficult to correct if we wait for visible signs of vitamin deficiencies.
Which supplements will I need?
High Potency Multivitamin which includes a minimum of: 100-300% of daily value of B2, B3 (niacin), B5
(pantothenic acid), Folate and Biotin At least 200% of B1 (thiamin) 30-200 IU of vitamin E (preferably in a natural form, will
have a “d-” in in front such as d-alpha tocopheryl acetate or succinate not a “dl-”, which is synthetic)
100-200% of vitamin A 60-500mg of vitamin C 100% of daily value for zinc, selenium, copper,
manganese, chromium, molybdenum Ideally also contains choline and inositol
Which supplements will I need?
Iron Up to 45 mg daily in gastric bypass and some sleeve
gastrectomy patients Your provider will help evaluate the type and quantity of
iron that you should be taking Separate from calcium by 2 hours as it inhibits
absorption Vitamin B12
1000 mcg sublingual (under the tongue) weekly Oral methylcobalamin Nasal sprays or injections are also an option
Which supplements will I need?
Calcium Needs to be in the form of calcium citrate for improved
absorption 1500-1800 mg per day total (may include amount in
multiple and/or the diet) Body can only absorb 500 mg at a time, so needs to be
divided into 3 doses throughout the day Vitamin D
3000 IU per day (can include amounts in multi and calcium)
Why take a bariatric vitamin?
Vitamin preparations vary a lot in terms of contents, nutrient forms, and nutrient levels.
We recommend bariatric specific vitamins because they are delivering the dosage of nutrients needed with your new anatomy as well as in a way that the new anatomy can actually absorb and utilize the nutrients. They are specifically designed with the needs of the weight loss
surgery in mind! Less gastric acid post surgery to break down particularly tablets
to the point the body is able to absorb the nutrients
We see improved vitamin profiles in patients taking bariatric vitamins.
Why take a bariatric vitamin?
Cost Bariatric Vitamins typically cost $35-65 per
month for all of the recommended nutrients depending on the type of form that you choose to take.
Compared to increased quantity of over the counter supplements as well as the cost of vitamin deficiency complications, you may not be saving moving.
INVEST in Your New Healthy Life!
Consider these comparisons
Cost The average American consumes
2 soft drinks per day $2/day for soft drinks=$60/month
The average American eats at a fast food restaurant 2-3 times per week $6/3 times per week=$72/month
INVEST in YOU and PROTECT YOUR HEALTH!
Supportive Nutrients
Probiotics Support healthy digestive and immune function Studies are showing a statistically significant greater
weight loss in post bypass patients
Fiber Soluble fiber to promote regularity
Anti-inflammatory Omega 3 fatty acids Curcumin
Amino Complex Promotes and maintains lean muscle mass
(WEPNSS) Support
General support groups are once a month. Join us 3rd Thursday at 6:30 Check the schedule and videos of past support groups at
www.texasbariatric.com The people who do the best attend support groups
regularly. It’s fun . It’s educational. Your attendance, questions, and support, will help other
people, even if you think that you don’t necessarily need it.
You will almost always walk away with something you gained from the meeting.
(WEPNSS) Support
Website (www.texasbariatric.com) Post-Operative Resources
Recipes, tips, etc Password: Tex@s2013
Smart Phone App Search “Texas Center for Medical and Surgical Weight
Loss”Like us on facebook
https://www.facebook.com/texasbariatricFollow us on Pinterest
EATING AFTER BARIATRIC SURGERY
Post – Operative Eating
Sugar-Free Clear LiquidsSugar-Free Clear Liquids
Water Plain Sugar-free flavoring
BrothSugar-free Jell-OSugar-free
popsiclesDecaf coffee or tea
Post-Op: Week 1 Liquid Diet
You will start supplements at post-op class
Supplements
Post-Op : Week 2- Advancing Diet
Week 2: you are now allowed to advance your dietYou will do best if you start with semi-solid foods:
Low fat, low carb yogurt Protein meal replacement shakes, soups, gelatins, etc. Cottage cheese - low fat or fat-free Refried beans - fat free and moistened Low fat cheeses – i.e. string cheese Eggs- cooked any way, but not fried
May add soft cooked veggies and small amounts of canned fruit.
Start all vitamin supplements.
3 Weeks and Beyond : Advancing Diet
If you tolerate the semi-solid foods, SLOWLY add one new food item from the list (one at a time) gradually: Fish Chicken Turkey Shellfish Tofu Soy Pork Lean beefFoods should be baked, barbecued, or broiled– NOT fried!
CHEW, CHEW, CHEW
Poorly Tolerated Foods in the first 6-12 weeks
Spicy foods (such as curry, salsa, chili peppers) Acidic foods (such as tomato sauce or citrus fruits) Rice, pasta, bread, and other sticky or doughy foods Stringy and fibrous foods (such as coconut, corn, popcorn, whole
beans, seeds, nuts) Stringy vegetables (such as celery or asparagus stalks) Bran cereals Dried fruits, seeds, skins of fruit Dry meats (may need to moisten with broth) Sugary foods including undiluted fruit juice, cookies, candy, sweets,
sauces and condiments that contain added sweeteners-these foods should also be avoided for the long term
ADD NEW FOODS SLOWLY!
Nutritional Numbers
Protein: 60-80 grams per day
Carbohydrate: <60 grams per day
<15 grams of sugar per meal
Fat intake: <20 grams per day
Low fat is considered <3 grams of fat per 100 calories
A Word (or two) on Carbohydrates
Sugars = carbohydrates.Carbs/sugars give little satiety and cause you
to become hungry again sooner.
Blo
od
glu
cose
Time
A Word (or two) on Carbohydrates
Foods like white bread, rice, potatoes, soft drinks, bagels, crackers, and fruit juices are bad choices.
Watch out for the hidden sugar in sauces and dressings.
Carbs by themselves can cause dumping symptoms.
They are addictive/habit forming and lead to snacking behaviors.
Dumping Syndrome
When sugars/starches/fats from your stomach enter your intestine, hormones can be released from your intestine and cause you to feel ill.
Flushing, sweating, heart pounding, lightheadedness, nausea, abdominal discomfort, sometimes vomiting and sometimes diarrhea are typical symptoms.
A Word (or two) on Fats
Fats are higher in calories (9 calories/gram) than protein and carbohydrates (4 calories/gram).
They are habit forming/addictive.Diets high in fat can lead to heart disease
(primary cause of death in our country.)Our bodies are very efficient at storing fat.
A Word (or two) on Fats
Look out for hidden fatsSalad dressings, butter, other dressingsFats can cause dumping symptoms
A Word (or two) on …
Milk– has lactose (sugar) and fat in it– may cause dumping symptoms. Lactaid milk/fat-free is okay. If you cannot tolerate lactose, try fat free Mootopia® milk – 1 ½
x the protein and ½ the sugar
Fruit: Do not eat by itself. Small amounts with your meal are fine
Coffee/tea Caffeine is a stomach irritant None for the first 3 months because it can dehydrate you. Limit MAX 1 per day after that. Decaffeinated is ok, but watch out for hidden calories (milk,
sugar)
A Word (or two) on …
Artificially sweetened drinks (like diet soft drinks): Many artificial sweeteners may stimulate appetite. Consuming regularly may increase craving for sweets. Use very small amount of flavoring for your water.
Alcohol: New anatomy makes you particularly sensitive to alcohol. 1 alcoholic beverage has the toxicity of 4 drinks now. This
does not mean you will necessarily feel 4 times more inebriated.
No alcohol for first 3 months; max one drink in 24 hour period thereafter.
WEPNSS
REMEMBER THESE RULES!!They will serve you well.They are the key to maximizing your success
with your new tool!
Contacts
Texas Center for Medical & Surgical Weight Loss 210-651-0303 www.texasbariatric.com
Patient Support Post-Operative Education and Resources Password: Tex@s2013
TEXAS CENTER FOR MEDICAL & SURGICAL WEIGHT LOSS
Congratulations on starting the journey to a new you!