Nutrition Guidelines: A Mindful Way of Eating

Mindful eating page 2-8

The Components of Eating Calories page 9 Carbohydrates page 10 Protein page 12 Fat page 14 Fluids page 16

1200 calorie meal plan page 17-23 Food Log (make copies) page 22 7 days of sample meals for 1200 calorie plan page 23

Success Habits: Before and After Surgery page 24

Nutrition Guidelines for Gastric Bypass and Sleeve page 26 Vitamin and Mineral Supplementation page 27-31 Meal Guidelines page 32 Post Operative Stage I Bariatric Clear Liquids page 33 Post Operative Stage II Bariatric Soft/Blended ModifiedFullLiquid page35 Protein Supplements page 37 Post Operative Stage III Bariatric Soft Foods page 40 Post Operative Stage IV Bariatric Solid Foods page 42 NutritionProblemsAfterBariatricSurgery page49-53

NutritionGuidelinesforLap-Band page54

Additional Resources RestaurantSurvival page58 CoolerEmergency page59 Measure Equivalents page 60 Reading Food Labels page 61 Websites and Books page 64

Vitamin Charts for Gastric Bypass, Sleeve and Lap-Band end of chapter 4

SUCCESSFor maintenance of long term weight loss, patients:• Must exercise• Must follow a low calorie diet

LIFELONG

Mindful Eating and Eating Behaviors

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 eat-ing

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. Do you often eat standing up? Yes No2. Is it difficult for you to remember everything you ate today or yesterday? Yes No3. Do you often eat between meals Yes No4. Do you tend to finish your food before others? Yes No5. Do you often not use plates or utensils when eating? Yes No6. Do you frequently do other activities while eating? Yes No

7. Is the quality of food more important than quantity? Yes No8. Do you tend to eat slowly? Yes No9. Do you enjoy trying different types of food? Yes No10. Do you love high-fat or high-sugar foods? Yes No11. Do you pass on food that isn’t tasty? Yes No12. Is eating one of your greatest pleasures? Yes No

13. Are you a nervous or high-strung person? Yes No14. Do you snack when you are tense or uptight? Yes No15. Is it hard for you to resist eating something that is right in front of you? Yes No16. Is it difficult for you to relax? Yes No17. Is the act of eating often more important than what you are eating? Yes No18. Are you a worrier? Yes No

19. Is it difficult for you to be assertive? Yes No20. Do you have upsetting dreams? Yes No21. Do you often eat to avoid thinking about upsetting things? Yes No22. Is it hard for you to identify your feelings? Yes No23. Do you have problems that seems impossible to overcome? Yes No24. Are you a people pleaser? Yes No

25. Do you have special feel good foods? Yes No26. Does eating initially give you a lift or a high? Yes No27. Do you often feel sad, bored, or down in the dumps? Yes No28. Do you often plan out foods treats for yourself? Yes No29. Are you over critical of yourself? Yes No30. Do you lack energy or enthusiasm? Yes 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: AVOIDANCEeater:Youwouldrathereatthanfaceadifficultsituationorundertakean unpleasant task. You may need assertiveness training.

MostlyYEStoquestions25-30. 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 TriggersCommon 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 de-

serve 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:

ReadWorkonapredefinedprojectDo a puzzle (Have it Ready to use)Call a friendTake a classTake up a new hobbyPlay an instrumentWalkStretchgo to the gymDo an exercise video

Environmental Changes: To help avoid temptation, I can:

Keeptemptationoutofthehouse,office,and carAviod places that tempt meAviod people that tempt meChange my routine/route to avoid tempta-tionUse the buddy system in places or situa-tions that tempt me.

Stress Management/Relaxation Tech-niques:

JournalDeep breathingDeep relaxationTake a shower or bathTalk to someoneMeditateListen to musicDo yoga

Challenges: I need to prepare for

the food available at workWork/school schedules that interfere with regular mealsSocial eating with family or friendsOrdering meals from menusFood shopping temptationsThe food court at the mallTravel

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 Judge Effectiveness and Sug-gest Changes

Example: Don’t eat while watching TV

Not working Its too hard just to sit there...I’ll try knitting while the TV’s on instead.

Bring healthy food to work instead of using vending ma-chines

Working Continue...I’m surprised its so easy

The Components of NutritionCalories

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 fol-lowing a low calorie diet (1200 calories). Your surgeon may ask you to lose weight prior to your sur-gery and follow a low calorie diet.

EXCESS calories add weight! 100 calories extra a day = 36,500caloriesextraayear = 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 activi-ties. 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 70-80 grams of protein a day or that over 10 grams of fat in a meal is too much.

CARBOHYDRATESCarbohydrates 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 veg-etables, fruits, and dairy.

Simple Carbohydrates: SugarSugar 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(ProblemsafterSurgeryPage50)• Slow the rate of weight loss by providing extra calories

Read labels carefully to be sure foods are low in sugar.

Avoidfoodswithmorethan5-10gramsofsugarperserving.Foodsthatcontainanyofthefollowingtypesofsugars,listedasoneofthefirst3ingredients,arelikely to be high in sugar.

Sugar FructoseBrown sugar GlucoseCorn Syrup SucroseHigh Fructose Corn Syrup DextroseModifiedfoodstarch MaltoseHoney Maple syrupPowdered sugar Molasses

Foods High in Sugars

Gum Honey Regular SodaBBQ Sauce Kool Aid Ice creamBBQ Sauce Frozen yogurt CakeJam/Jelly Pies PopsicleChocolate milk Donuts Regular puddingJuice Bars Sweetened Tea Sports drinksSweetened Juices Fudgesicles Flavored syrup

Complex Carbohydrate (Bread/Pasta/Rice Products)

Complex carbohydrates (untoasted bread, pasta, rice, etc.) can be a problem after gastric bypass surgerybecausethesefoodscanbecomedoughyandcanbedifficulttotolerate.Inaddition,eatingtoomanycarbohydratescanfillupthestomachpouchandcrowdoutproteinfoods.Asmallamountof very well toasted bread, crackers, and baked/sweet potato (no skin) may be eaten after surgery but onlyafteryouhaveeatenyourproteinfirst.

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 thatthereisnotruedefinitionforthephrase“lowcarb”andtheuseofthisphraseisnotregulatedbythe 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 en-tice 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” productsgenerallycontainsugaralcoholsorartificialsweeteners,whichmayleadtostomachdis-comfort 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 ProteinAn 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 -Preventproteindeficiency -Reduceyourhunger.Proteinismoresatisfyingandfillingthancarbohydrates.Youarelesslikely to feel the need to snack between meals.

• Women need about 60-70 grams of protein a day, men need about 70-80 grams• Foodsthatarehighinproteinincludeleanredmeats,pork,poultry,fish,cheese,eggs,tofu,and

seafood.• Ateachmeal,CONCENTRATEONEATINGYOURPROTEINFOODSFIRSTsoyoudon’tfillup

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 DeficiencySignsofproteindeficiencyincludepoorwoundhealing,fatigue,hairloss,musclewasting,andpatchyor scaly skin.

Keep Proteins MoistAftersurgery,manypeoplehavedifficultytoleratingdryortoughpiecesofmeat.Chickenbreast,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,cottagecheese,yogurt,eggs,andtofu.

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 andfat 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 Food Grams of Protein(per serving)

Calories(per serving)

1 Egg 7 grams 75calories2 Egg whites 7 grams 35calories¼ cup Egg substitute 7 grams 35calories1 ounce1 ounce

Chicken Breast (without skin)Chicken Thigh (without skin)

7 grams7 grams

35calories35calories

1 ounce Luncheon meat (turkey, ham, chicken, turkey pas-trami)

7 grams 35calories

1 ounce Fish (tilapia, salmon, hali-but,cod,catfish,trout,or-ange roughy, mahi mahi)

7 grams 35-55calories

1 ounce Ground beef/turkey (lean) 7 grams 35-55calories¼ cup Tuna (water packed) 7 grams 35calories1 ounce Shrimp, lobster or crab 5.5grams 35calories1 ounce Ham (lean) 5grams 55calories1 ounce Roast Beef or lamb 7 grams 55calories1 ounce Pork Loin or Tenderloin 7 grams 55calories¼ cup¼ cup

Cottage cheese (non fat)Cottage cheese (low-fat)

7 grams7 grams

35calories55calories

1 ounce Cheese (low-fat – regular) 8 grams 60-80 calories4 ounce Soy milk 3.5grams 35-50calories4 ounce4 ounce4 ounce

Non fat milk1 % low fat milk2 % low fat milk

4 grams4 grams4 grams

45calories55calories70 calories

½ cup Tofu (regular) 5grams 75calories4 ounce Yogurt (nonfat – regular) 4 grams 35-50calories¼ cup Beans/lentils 3 grams 60 calories¼ cup Most vegetables 2 grams 25calories

FATFat 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, polyunsatu-rated 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 -Areliquidatroomtemperatureandarefoundinvegetableoil,cornoil,sunfloweroil, 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, select-ing 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 textureandflavor.Foodsrichintransfatsincludevegetableshortenings,somemargarines,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:

• Readfoodlabels!Alow-fatfood=lessthan3to5gramsoffatper100to150calories.• Selectskinlesschicken,turkey,fish,andshellfishinsteadoffattymeatssuchasbacon,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

thatread95-99%lean.Thisindicatesthatthemeatscontainahigherpercentageofproteinthanfat.

• 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 oftensubstitutesugartoimprovetheflavorofalowfatproduct.Makesure,asalways,toreadyourlabels completely, looking at the fat, sugar and the total calorie count.

FLUID REQUIREMENTS

Carry a water bottle with you at all timesIt is very important that you drink at least 64 ouncesofdecaffeinated,noncarbonatedfluideachdaytopreventdehydration.Immediatelyaftersurgery,itwillbemoredifficulttodrinkall64ozbecauseofthe 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,

thefluidliquefiesthefoodandcausesittoemptyoutofthepouchsooner.Emptypouchestriggeryour body to feel hungry and to want to eat again.

• Youmaydrinkupuntil10to30minutesBEFOREmeals.Waitingwillallowtimeforthefluidtoempty out of the pouch.

• Wait 30 minutes AFTER your meals to begin drinking again.

Recommended Beverages:allofthesefluidscancontributetothe64ozfluidyouneedtoconsumeevery day.

Water Decaffeinated teaCrystal Light Decaffeinated coffeeDiet Snapple Sugar free beveragesGatorade (diluted 3 to 1) Propelwater(limiteach16ozservinghas25

calories)Powerade Zero Vitamin Water ZeroAquifinaflavoredwater DasaniflavoredwaterSpecial K Protein Water SOBE Lifewater

Avoid carbonated beverages because the bubbles may cause cramping and discomfort. The high-cal-orie 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 WholemilkorflavoredmilkFruit juice MilkshakeCarbonated beverages Alcoholic beveragesHigh calorie coffee drinks Vitamin WaterSOBE Energy Drinks: Red Bull, Monster, Full Throttle,

etc.Sparkling water Gatorade / PoweradeStarbucks coffees Kool Aid

Tips for low-fat eating:

• Readfoodlabels!Alow-fatfood=lessthan3to5gramsoffatper100to150calories.• Selectskinlesschicken,turkey,fish,andshellfishinsteadoffattymeatssuchasbacon,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

thatread95-99%lean.Thisindicatesthatthemeatscontainahigherpercentageofproteinthanfat.

• 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 oftensubstitutesugartoimprovetheflavorofalowfatproduct.Makesure,asalways,toreadyourlabels completely, looking at the fat, sugar and the total calorie count.

FLUID REQUIREMENTSCarry a water bottle with you at all timesItisveryimportantthatyoudrinkatleast64ouncesofdecaffeinated,noncarbonatedfluideachdaytopreventdehydration.Immediatelyaftersurgery,itwillbemoredifficulttodrinkall64ozbecauseofthe 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,

thefluidliquefiesthefoodandcausesittoemptyoutofthepouchsooner.Emptypouchestriggeryour body to feel hungry and to want to eat again.

• You may drink up until 10 to 30 minutes BEFOREmeals.Waitingwillallowtimeforthefluidtoempty out of the pouch.

• Wait 30 minutes AFTER your meals to begin drinking again.

Recommended Beverages:allofthesefluidscancontributetoteh64ozfluidyouneedtoconsumeevery day.

Water (the best) Decaffeinated teaCrystal Light Decaffeinated coffeeDiet Snapple Sugar free beveragesGatorade (diluted 3 to1) Propelwater(limiteach16ozservinghas25

calories)Powerade Zero Vitamin Water ZeroAquafinaflavoredwater DasaniflavoredwaterSpecial K Protein Water SOBE Lifewater

Avoid carbonated beverages because the bubbles may cause cramping and discomfort. The high-cal-orie 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 WholemilkorflavoredmilkFruit juice MilkshakeCarbonated beverages Alcoholic beveragesHigh calorie coffee drinks Vitamin WaterSOBE Energy Drinks: Red Bull, Monster, Full Throttle,

etc.Sparkling water Gatorade / PoweradeStarbucks coffees 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 de-signed 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 Lunch Dinner2 protein 2-3 protein 3 protein

0 vegetables 2 vegetables 2 vegetables1 fruit 1 fruit 0 fruit1 milk 0 milk 1 milk

0-1 starch 1 starch 1starch1 fat 1 fat 1 fat

Beverage ( between meals) Beverage (between meals) Beverage (between meals)

Sample MealsBreakfast Lunch Dinner

¼ cup low fat/fat free cottage cheese, 1 scrambled egg

2 ounce low fat turkey 3 ounce broiled halibut

1 cup strawberries 2 cups salad greens with cu-cumber, tomatoes

1 cup steamed broccoli

0-1 slice whole grain toast 5-6wholegraincrackers ½ cup small potato1 cup fat free unsweetened

yogurt1 medium apple 1 cup non fat milk

1 teaspoon trans free margarine 1 tablespoon low fat salad dressing

1 teaspoon trans free margarine

Decaf coffee or tea (between meals)

Decaf iced tea (between meals) Sugar free jello

Breakfast Lunch Dinner½ cup egg substitute 3 ounces tuna canned in water

1 medium orange 2 cup salad, tomato, cucum-bers, raw vegetables

3 ounces skinless chicken breast

0-1 slice whole grain toast 5-6wholegraincra ½ cup broccoli and ½ cup pep-pers

1 cup non fat milk ½ cup fresh fruit salad ½ cup baked yam or sweet potato

1 teaspoon trans free margarine 1 tablespoon low fat mayon-naise

1 cup non fat milk

Decaf coffee or tea (between meals)

Water with lemon (between meals)

1 teaspoon olive oil

Decaf iced tea, water (between meals)

Each Item (Dot) Below Equals one Serving

Very Lean Proteinchoiceshave35calories,7gramsofproteinand1gramoffatperserving.Oneserving equals:1 oz. Turkey breast or chicken breast, skin removed

¼ cup Cottage cheese, nonfat

1oz.FishFillet(flounder,sole,cod,haddock,halibut)

2 each Egg whites

1 oz. Canned tuna in water ¼ cup Egg substitute1oz.Shellfish(clams,lobster,scallop,shrimp) 1 oz. Fat free cheese

Lean Protein choices have55calories,7gramsofproteinand2-3gramsoffatperserving.Oneserving 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*1oz Salmon,swordfish,herring,catfish,trout 1 oz. Pork, tenderloin, or fresh ham*1oz. Leanbeef(flanksteak,Londonbroil,ten-derloin, roast beef)*

1oz. Low fat cheese (3 grams or less of fat per 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 Proteinshave75calories,7gramsofproteinand5gramsoffatperserving.Oneserv-ing 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

Vegetablescontain25calories,2gramsofprotein,and5gramsofcarbohydrate.Oneservingequals:• ½ cup Cooked vegetables (carrots, broccoli, zucchini, green beans, tomato, onion, cabbage,

asparagus,spinach,mushrooms,bellpeppers,eggplant,brusselssprouts,cauliflower,artichokehearts, beets, okra, kale, collards, swiss chard, turnips, etc.)

• 1 cup Raw vegetables or salad greens (lettuce, spinach, spring mix, arugula, cucumbers, car-rots, tomato, bell peppers, jicama, radishes, etc)

• ½ cup Vegetable juice• ¼ cup Tomato sauce or low-sugar pasta sauce

Milk (Fat Free and 1%)contains100-110calories,8gramsprotein,12-15gcarbohydrateperserving.One serving equals:• 8 oz. Milk: fat free(skim) or 1% (low-fat)• 6oz Yogurt:plain,nonfat,low-fat,light,orartificiallysweetened NonfatGreekyogurt(lookfor>13gramsprotein,~15gramscarbohydrate)

Fruitscontain60caloriesand15gramsofcarbohydrates.Oneservingequals:• 1 small Apple, orange, nectarine (size of baseball)• ½ Banana• 1 medium Fresh 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

Starchescontain80calories,0-3gramsofprotein,and15gramsofcarbohydrateandperserving.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:• 5-6Wholegraincrackers• 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 WholewheatpitaorEnglishmuffin• 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 contain45caloriesand5gramsoffatperserving.Oneservingequals:

• 1 tsp. Oil (canola, olive)• 1 tsp. Butter• 1 tsp. Trans-fat free margarine or spread• 1 tsp. Mayonnaise• 1 T Reduced fat margarine or mayonnaise• 1 T Light Salad dressing, cream cheese• 6 Almonds, Cashews• 10 Peanuts• 16 Pistachios• 4 Walnut halves,Pecan halves• 2 T. Light cream cheese• 1/8 Avocado• 8 large Black olives• 10 large Stuffed green olives• 1 slice Bacon• 2 tsp. Peanut, cashew, almond butter (creamy)

Beverages :Waterisbest.Lookforunder15caloriesperserving.Crystal LightDecaffeinated tea or coffeeDiet SnapplePropel WaterSOBE Life WaterVitamin Water ZeroSugar Free TangV8 Juice (acidity may upset stomach)Water (with natural lemon or lime)

Herbs / SeasoningsBasil Oregano Chicken or Vegetable BrothCilantro Parsley Lemon JuiceCinnamon Pepper Non stick cooking sprayCurry Powder Pickles Hot pepper sauceDill Pickle Relish, 1 T Worcestershire sauceGarlic Rosemary Flavor Extracts (vanilla, almond, pepper mintGarlic Powder Saffron Cocoa Powder Ginger Salt Salsa, ¼ cMarjoram Soy Sauce Taco Sauce, 1 TMustard Thyme Onion PowderVinegar

7 Days of Sample Meals for 1200 calorie plan

Monday Tuesday Wednesday Thursday Friday Saturday SundayBreak-fast

2 oz low fat cheese 1 slice toast 1 tbsp re-duced fat/ trans fat-free margarine 1 c skim milk 1 small orange

2 hard boiled eggs, ¼ c gra-nola, 6 oz low calorie yogurt, 6 almonds, ½ me-dium grapefruit

2 oz deli ham, 1 slice whole grain toast, 1 tbsp reduced-fat/ trans fat-free margarine, 1 c skim milk, ½ c applesauce

2 scrambled eggs, ½ English muffin, 1 tbsp reduced-fat/trans-fat free margarine, 6 oz low calorie yogurt, 1/3 small cantaloupe

2 oz string cheese, ½ English muffin, 1 c skim milk, ¾ c blueberries, 1 tsp butter

Omelet made with 2 egg whites, 1 oz low-fat cheese, 1 tsp canola oil, 1 slice toast, 6 oz yogurt, ½ banana

1 oz turkey sausage, 1 fried egg white with 1 tsp canola oil, ½ English muffin, 1 c skim milk, 15 grapes

Lunch ¾ c low-fat cot-tage cheese ½ English muffin, 2 c carrots, sliced cucumbers, 2 Tbsp low-fat salad dressing, 1 small peach

½ c tuna salad, 1 slice whole grain bread, 2 c lettuce, tomato and cucumber salad, 2 Tbsp low-fat dressing, 1 ¼ c strawber-ries

2 oz turkey breast, 6 crack-ers, 2 c baby spinach and sliced tomatoes, 1 Tbsp fat-free dressing, 1 small pear

½ c chicken salad with 1 c celery, onions, pickles, 1 Tbsp light mayon-naise, 6 wheat crackers, 1 c sugar-free Jell-O with ½ banana and fat-free cool whip

2 Tbsp peanut butter, 1 slice whole grain toast, 1 c car-rots, 1 Tbsp light ranch dressing, ¼ c cottage cheese, ½ pine-apple

1 chicken leg with low sugar BBQ sauce, ½ c baked potato, 2 c green beans, 1 Tbsp light mar-garine, 1 ¼ c watermelon

3 oz shrimp sautéed with 1 tsp olive oil and garlic, ½ c lin-guini pasta, 1 c broiled eggplant, 12 cherries

Dinner 3 oz top sirloin steak, ½ c baked potato, 1 Tbsp light sour cream, 1 c green beans, 1 c skim milk

3 oz pork ten-derloin, 2 small oven browned potatoes, 1 c as-paragus spears, 1 c skim milk

3 oz chicken breast, ½ c pota-to, 1 c zucchini, 1 c skim milk

1 stuffed green bell pepper with 3 oz 10% fat ground beef and 1 6” tortilla, 1 c salad with 1 Tbsp low-fat dressing, 6 oz yogurt

3 oz broiled halibut, ½ c potato, 1 Tbsp trans-fat free margarine with a dash of par-mesan 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

Protein

Fruit

Vegetables

Starch

Milk

Fat

Thursday Breakfast Lunch Dinner

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 Lunch Dinner

Protein

Fruit

Vegetables

Starch

Milk

Fat

Success Habits: Before and After SurgeryAdopting 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 MINDFULLYWHAT 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• NOfluidswithyourmeals.STOP10to30minutesbeforehand.Drinkfluids30minutesafter

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.• DoNOTdrinkfluidswithyourmeals.STOP10to30minutesbeforehand.Drinkfluids30minutes

after meals.• Stopeatingatthefirstsignoffullness.

• GetinvolvedinaregularEXERCISEroutineaminimumof5daysaweek• Take your VITAMINS every day.• Join a SUPPORT group

Success Habits: Before and After SurgeryAdopting 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 MINDFULLYWHAT 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• NOfluidswithyourmeals.STOP10to30minutesbeforehand.Drinkfluids30minutesafter

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.• DoNOTdrinkfluidswithyourmeals.STOP10to30minutesbeforehand.Drinkfluids30minutes

after meals.• Stopeatingatthefirstsignoffullness.

• GetinvolvedinaregularEXERCISEroutineaminimumof5daysaweek• Take your VITAMINS every day.• Join a SUPPORT group

Nutrition Guidelines forGastric Bypass and Gastric Sleeve

Read these guidelines carefullyOnce you have decided to have gastric bypass surgery, you MUSTmakesignificantchangestoyoureating 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 BasicsKeep 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 qual-ity 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 high-calorie 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 snack-ing and high-calorie beverages.

Your New Stomach Size

Vitamin and Mineral SupplementsAbsorption of Nutrients in the Gastrointestinal Tract

DUODENUMCalcium, Magnesium, Phospho-rus,VITAMINS:Biotin, Niacin, A,D,E,K,B1, B2 B 12MINERALS: Iron, , zinccopper, selenium, zinc

JEJUNUMCalcium, Magnesium, Phos-phorusVITAMINS:A,C,B1, B2, Niacin, B6,D,E K, BiotinFolateMINERALS: Iron, zinc, chromi-um, manganese, molybdenum

STOMACHWaterVitamin B12CopperIodine

Aftersurgery,youareatriskforvitamindeficienciesforseveralreasons:• You are eating a smaller amount of food.• Because your stomach has been “bypassed” you now lack the acid needed to break off some es-

sential 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 SERIOUSnutritionaldefi-ciencies. THESE ARE AS IMPORTANT AS ANY PRESCRIPTION MEDICATION.

MULTIVITAMIN/MINERAL WITH IRONWhy:Topreventnutrientdeficiencies• 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.• Avoidthe“DiabeticPack”ofvitamins.Althoughitiscomplete,thesepacksoftencontain5ormore

pills and can be cumbersome to take every day

When: Start before surgery and immediately after surgery

Multivitamin brands to CHOOSE: Multivitamin brands to AVOID:Centrum Centrum Liquid FormulaKaiser Adult’s Daily Formula (red label) Lil’ Critters or Adult Gumi VitesKirkland (Costco) Regular Multivitamin with Min-erals

Viactiv multivitamin chews and Flavor Glides

Equate (Walmart) Complete Multivitamin Juice plusTarget Multivitamin and Mineral Nature made diabetes health packWalgreens Milltrium Multivita FlintstonesOptisource Post Bariatric Formula Chewable Multivitamin (4 a day)

Mega Multivitamin or Premium Performance

Centrum Chewables (you need to take Selenium 200mcg three times a week)

Prenatal Vitamins

Bariatric Advantage Chewable MultiCentrum Silver

VITAMIN B1 (THIAMIN)Why: To prevent nerve and brain damage (beriberi)• Takeaminimumof50mgto100mgeveryday.• Avoid250mgaday.

When: Start before surgery and immediately after surgery

VITAMIN B12Why: 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,500mcg,1000mcg,and2500mcgdoses.Takeasmanytabletsasyouneedtogetto3000mcg per week.

• Oral (tablets swallowed) will NOT be absorbed. Do NOT use these.

When: Start before surgery and immediately after surgery.

IRONWhy:Preventirondeficiencyanemia,especiallyinmenstruatingwomen.• 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.• TryandfindanirontabletcombinedwithVitaminCasthisimprovesabsorption.Oryoucantake

aseparatetabletof500mgofVitaminC.Donottakeitwithmeals,multivitamin,calciumorteaasthese 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.• Ferrimin150www.dialyvite.netor1866-358-9773has150mgelementalironpertablet.

When: Start before surgery and immediately after surgery per MD recommendations.

VITAMIN DWhy: 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 CITRATEWhy: To maintain bone density, protect teeth, and prevent osteoporosis.• Take1500mgtotaladayfromsupplements.• Calciumisabsorbedbestin500mgdoses.DoNOTtakeallofyourcalciumsupplementsatthe

same time.• Makesuretolookattheservingsize.Usuallyyouwillneed5-6tabletsaday.• Make sure you always take Calcium Citrate. Look under the Supplement Facts or the list of ingre-

dientsonthelabeltofindoutwhatkindofcalciumyoursupplementcontains.• 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:StartbeforesurgeryandagainatthestartofModifiedFullLiquidDiet(StageIII2weekspost-op)

Calcium Brands To CHOOSE: Calcium Brands To AVOID:Kaiser Adult’s Daily Formula (red label) Lil’ Critters or Adult Gumi VitesKirkland (Costco) Regular Multivitamin with Min-erals

Viactiv multivitamin chews and Flavor Glides

Equate (Walmart) Complete Multivitamin Juice plusTarget Multivitamin and Mineral Nature made diabetes health packWalgreens Milltrium Multivita FlintstonesOptisource Post Bariatric Formula Chewable Multivitamin (4 a day)

Mega Multivitamin or Premium Performance

Centrum Chewables (you need to take Selenium 200mcg three times a week)

Prenatal Vitamins

Bariatric Advantage Chewable MultiCentrum 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 DayBariatric AdvantageCalcium CitrateLozenges

Bariatric Advantage Cal-cium Citrate Chews

4 Wafers

1 Chew

1600 mg

250mg

www.bariatricadvan-tage.com

1-800-898-6888

Take 4 wafers per day

Take 6 chews a day

Calcet Creamy Bites 1 Chew 500mg www.achievepharma.com

Take 3 chews a day

Celebrate Calcium Chewable

Celebrate Calcium ChewablePlus500

4 Tablets

3 Tablets

1000mg

1500mg

www.celebratevita-mins.com

1-877-424-1953

Take 6 tablets a day

Take 3 tablets a day

Wellesse Bone Health Liquid

1 Tablespoon 500mg www.wellesse.com1-800-232-4005

Take 3 tablespoons a day

Twinlab Calcium Citrate 4 Wafers 1000 mg www.twinlab.com1-800-645-5626

Take 6 wafers a day

Reviva High Absorption Liquid Calcium Citrate

2 Tablespoon 1000 mg www.revivanutirion.com

1-866-991-5240Costco.com

Take 3 tablespoons a day

LifetimeMg + Ca liquid

1 Tablespoon 750mg www.vitaminworld.com

1-800-228-4533

Take 2 tablespoons a day

UpCal D Calcium Ci-trate Powder

Scoop/packet 500mg www.globalhp.com1-800-638-2870

Take 3 scoops or packets a day

Buried TreasureLiquid Calcium Plus

2 Table-spoons

1000mg www.lifelinefoods.com1-800-216-3231

Take 3 tablespoons a day

HERBAL MEDICATION.DoNOTtakeadditionalherbalmedicationunlessyoufirstdiscussthiswithyourdoctor.Thesemayinterfere with the absorption of essential vitamins and may also increase your risk of pouch irritation and ulceration.

VITAMIN AND SUPPLEMENT SCHEDULEBelow is ONE possible way to schedule your vitamins:

Breakfast Lunch Dinner BedtimeMultivitamin 1 1Calcium Citrate plus Vitamin D

2 2 2

VitaminB12(500mcgdaily, 1000 mcg three timesaweek,2500mcgtwice a week)

ANYTIME under your tongue

VitaminB1(50-100mg) 1Iron plus Vitamin C 1Vitamin D 2000 IU ANYTIME

HERBAL MEDICATION.DoNOTtakeadditionalherbalmedicationunlessyoufirstdiscussthiswithyourdoctor.Thesemayinterfere 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.• Togetthroughthedaywithouthungerbetweenmeals,spaceyourmealsabout4½to5hours

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.• Youshouldalsotakebetween30to45minutestoeateachmeal.Eatingslowlyandchewingeach

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 approxi-mately 1200 calories a day after one year to maintain weight/lossProtein: 70-80 grams per day: from low fat sourcesCarbohydrates: 30-130 grams per day as you progress through the post op stages: from vegetables and limited amounts of fruit and whole grainsFat: Limit to 30 grams per day: choose more mono-and polyunsaturated fatsFluids: 64 ounces per day minimum: start drinking 30 minutes after meals and stop drinking 10-30 minutes before mealsSupplements: Multivitamin with minerals and IronB1 (Thiamin)B12 (sublingual)Calcium citrate plus Vitamin DVitamin DIron (per MD)

Bariatric Clear Liquids(Stage I)

Start: Begins day after surgery.

End:UntilyoursurgeonadvancesyoutoBariatricModifiedFullLiquids(StageII)(usually1-2days).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• ConsistsofCLEAR,SUGAR-FREE,CAFFEINE-FREE,NON-CARBONATEDfluids.• SipfluidsSLOWLYanddonotgulportakelargemouthfulsoffluids.Yourmouthwillbebigger

thanyourstomachsoevenamouthfuloffluidmaybetoomuchandcausediscomfort.Drinkingtoomuchfluidatonetimemaycausepain.

• Avoid drinking through a straw as it may give you gas or you may accidentally take in too much fluidatonetime.

• 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

firstfewweeksormonths.Roomtemperaturefluidsmaybebettertolerated.

It is normal to have a reduced appetite in the days following surgery. Because food choices are lim-ited 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 LiquidsWater Broth Diet TangCrystal Light, Crystal Light Hydration Bouillon Diet Kool-AidDiet Snapple Decaffeinated Tea Sugar-free PopsiclesDecaffeinated Coffee Sugar-free Jell-O Juice (Diluted) (1 part juice to 3 parts water)Propel Water Ice chipsGatorade (Diluted)(1 part Gatorade 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 to2-3ounces.Youmayfindthatyougetfullonjustafewsipsoffluid.

SAMPLE MENU BARIATRIC CLEAR LIQUIDS (STAGE I)

BREAKFAST LUNCH DINNERSugar-free Jell-O (1-2 oz)Decaffeinated tea (1-2 oz)

Vegetable broth (1-2 oz)Diet Snapple (1-2 oz)

Chicken broth (1-2 oz)Propel Water (1-2 oz)

BREAKFAST LUNCH DINNERApple juice (diluted) (1-2 oz)Sugar-free Jell-O (1-2 oz)

Beef broth (1-2 oz)Sugar-free Popsicle (1)

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 firstpostoperativeappointment.

Goal:HYDRATION:aimfor64ormoreouncesfluids,¼cupfoodormoreastolerated3ormoreTIMES 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 gastrec-tomy 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:SuggestedListofLiquidFoodsforfirstweekfollowingsurgery:

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 Between meals LUNCH Between meals DINNER¼ - ½ cup sugar free jello

Protein supple-ment(25-30gramsprotein)

¼ - ½ cup strained cream soup

Protein supple-ment(25-30gramsprotein)

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 firstpostoperativeappointment.

Goal:HYDRATION:aimfor64ormoreouncesfluids,¼cupfoodormoreastolerated3ormoreTIMES 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 gastrec-tomy 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:SuggestedListofLiquidFoodsforfirstweekfollowingsurgery:

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 Between meals LUNCH Between meals DINNER¼ - ½ cup sugar free jello

Protein supple-ment(25-30gramsprotein)

¼ - ½ cup strained cream soup

Protein supple-ment(25-30gramsprotein)

¼ - ½ cup strained pureed tomato soup

Suggested List of Bariatric Modified Full Liquid (Stage II) foods

FOOD CHOICES SUGGESTED FOODSProtein (can use water, broth, soymilk or milk for thinner consis-tency)

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*

Beverages Water, decaffeinated coffee or tea, other sugar-free beverages, soy milk, crys-tallight,dietSnapple,plus,allofStageIfluids

Fruit /Vegetables (use strainer for fibrousfoods)

No sugar added applesauce, pureed baby/canned fruit in natural juices (ap-ple,banana,pear),fruitcocktail.Anyfruitflavoredjuice,butitmustbediluted(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)

Dairy Lower-carbohydrate yogurt/Greek yogurt (less than 20 grams of total carbo-hydrate), Lactaid milk, calcium-enriched soy milk, sugar free pudding, sugar free custard

Soup Strained cream soup, broth, bullion, consommé, pureed homemade vegeta-ble soup, homemade bean soup, (avoid using rice/pasta)

Sugar substitutes Sugar substitute (Splenda, Equal, Sweet n Low, etc), Sugar free popsiclesMiscellaneous Salt,flavorings,mildherbs

*These foods are also considered starchy foods

Meal Serving SizeRemember that the size of your new stomach is 1 ounce (the size of your thumb) that can expand up to2to3ounces.Itisdifficulttotellyouexactlyhowmuchyoucanexpecttoeatatthispoint.Somefeel 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 DINNER1/4 cup cottage cheese1/4 cup yogurtSugar substitute

Protein supple-ment(25-30gramsprotein)

¼ cup strained cream soup¼ cup unsweet-ened applesauce

Protein supple-ment(25-30gramsprotein)

1/4 cup strained cream soup1/4 cup sugar-free 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

AlthoughtheBariatricModifiedFullLiquid(StageII)foodsaresoftintexture,theyarenottypicallyrichinprotein.TheBariatricModifiedFullLiquid(StageII)foodsalonewillnotsupplyyouwiththeprotein 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,duringBariatricModifiedFullLiquid(StageII)mealplan,youwilluseaproteinsupplementbetween 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 supple-ments 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• 50to55gramsofprotein,AND• 5to7gramsofsugarorlessAND• 3to5gramsoffatorless.

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:Mostoftheproteinsupplementsavailablehaveaflavor(chocolate,vanilla,berry,etc).Some,how-ever,arespecificallymadetobeflavorlesssoyoucanaddthemtootherfoodssuchassoup,applesauce,yogurt,etc.Bothkindsarefinetotakeaftersurgery,justremember,ifyouareusingaflavor-lessproteinsupplementtotakeinenoughscoopstoreachthe50to55gramsofproteinyouneedeach 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 pro-tein 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 lessWalmart GNC Costco Vitamin Shoppe Trader Joe’sSix Star Professional Strength (powder)Per scoop: 130 cal23 grams pro

Optimum Procomplex (4.4 lb powder)Per scoop: 120 cal22 grams pro

EAS Premium Protein (6 lb powder)Per scoop: 150 cal, 27 grams pro

Gold Standard 100% Whey (5 lb powder) Per scoop: 120 cal, 24 grams pro

Worldwide Pure Pro-tein(11 oz can) 170 cal, 35 grams pro

EAS 100% Whey (pow-der)Per scoop: 120 cal, 23 grams pro

Nature’s Best Isopure (3 lb powder)Per scoop: 105 cal, 30 grams pro

Whey Protein Isolate (3lb powder)Per ounce: 110 cal, 20 grams pro

Syntrax Nectar (2.2 lb powder) Per scoop: 90 calories, 23 grams pro

Designer Whey (2.1 lb powder) Per scoop: 100 cal, 18.5 grams pro

Body Fortress 100%Premium Whey (powder)Per scoop: 110cal, 23 grams pro

Nature’s Best Isopure Zero Carb (20 oz clear liquid bottle) $ 3.99 per bottle160 cal, 40 grams pro

Wellements Premium Pro-rated (6 lb powder) Per scoop: 170 cal, 25 grams pro

Nature’s Best Isopure (3 lb powder)Per scoop: 105 cal, 30 grams pro

Met Rx (2 lb powder) Per scoop: 110 cal, 23 grams pro

EAS Advantage Carb Contol (11oz liquid)Per can: 119 cal , 17 grams pro

Gold Standard 100% Whey (5 lb powder)Per scoop: 120 cal24 grams pro

Premier Nutrition (11oz shake) Per shake: 160 cal, 30 grams pro

Nature’s Best Isopure Zero Carb (20 oz clear liquid bottle,160 cal, 40 grams pro

GNC Pro Performance (6lb powder)Per scoop: 130 cal, 20grams pro

Whey Protein Fruit Splash (by Weider ) Per scoop: 90 cal, 20 grams pro

Designer Whey (2.1 lb powder) Per scoop: 100 cal, 18.5 grams pro

Worldwide Protein (11oz liquid can)Per can: 170 cal, 35 grams pro

Cytomax Protein Pure Performance drink (20 oz bottle) Per bottle: 160 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.bbvita-mins.com, www.gnc.com, www.BariatricChoice.com, www.obesity.com, www.asbs.org, www.bariatricdiet.com, www.affordablesupple-ments.com, www.cheapvitamins.com, www.vitaminshoppe.com, www.unjury.com, www.wellements.com/prorated.asp, www.optimumnu-trition.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 & BariatricModifiedFullLiquidStageII)

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(DannonLightN’Fit,anyflavor,nonfat/lowfatGreekYogurt)• 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:Atyourfirstpostoperativeappointment.

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.• Addonenewfoodatatimetoassesstolerance.Don’ttryanynewfoodforthefirsttimewhile

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.

• Avoidfluidswithmealstopreventrapidemptyingofthepouchandweightregain.• 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 eat-ing. 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 FOODSBeverages Water, decaffeinated coffee and tea, other sugar-

free beveragesDairy* 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 pud-ding, 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 may-onnaise.

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 Steamedorpoachedfish,cottagecheese,softlow-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

Soup Cream soup made with pureed vegetables, broth, bullion, consommé

Sugar substitutes 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 pud-ding, sugar free custard

Eggs Sugar substitutes (Splenda, Sweet n Low, Equal, etc.), sugar free popsicles

Miscellaneous Salt,flavoringextracts,mildherbsandseason-ings, lemon or lime juice

* Many people become lactose intolerant after surgery

SAMPLE MENU, BARIATRIC SOFT (STAGE III)BREAKFAST LUNCH DINNER

¼ - ½ cup cottage cheese1-2 small slices pear(no skin)

1-2 oz tuna (with low fat mayon-naise)2 saltine crackers

1-2 oz deli sliced meat1 oz cheese1-2 tsp low fat cream cheese1-2 crackers

BREAKFAST LUNCH DINNER1 poached egg1-2 Tbsp cheese¼ small banana

¼ - ½ cup cottage cheese1-2 slices peach

1-2ozfish1/8 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 us-ing 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 Regu-

lar (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.• Donoteatyourmealoverseveralhours.Takeapproximately30-45minutestoeatmeals.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 LUNCH DINNER1 -2 poached egg1/8 cup yogurt

1 -3 oz crab or tuna with light mayonnaise1-2 saltine crackers1-2 slice apple (no skin)

1-3 oz lean ground beef¼ cup zucchini1/8 cup mashed potatoes

BREAKFAST LUNCH DINNER¼-3/4 cup cottage cheese2 slices of canned peaches

1 oz string cheese2 oz luncheon meat1/8 cup yogurt1-2 slice orange

1-3 oz lean moist ham1/4 cup cooked green beans1/8 cup sweet potato

BREAKFAST LUNCH DINNER¼-1/2 cup egg beater scramble1/4 cup yogurt1 small slice pear (no skin)

1-3 oz chicken (moist)¼-1/2 cup lettuce1-2 tsp salad dressing1-2 slice nectarine

1-3ozmoistfish1/4c cup cooked carrots1/8 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 Regu-

lar (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.• Donoteatyourmealoverseveralhours.Takeapproximately30-45minutestoeatmeals.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)

ProteinBeans (navy, pinto, black, etc)***

Egg substitute Lamb

Beef (very lean, thinly sliced, ground)

Egg whites / Whole Egg Lobster

Chicken (moist, no skin) Game Meats Pork (lean cuts, loin)Clams (caution, may be tough!) Ham (low fat) Tofu / Soy Beans / EdamameLow fat cheese (swiss, cheddar, mozzarella, baby bel, ricotta, provolone, american, havarti, gouda)

Seafood / Fish(cod, tuna, trout, salmon, bass, scallops, shrimp)

Soy Milk / Lactaid Mi

Cottage cheese (low fat, nonfat) Turkey (light or dark, no skin) VealCrab / Imitation crab Veggie Burger (made with soy) Yogurt(15-18gTotalCarbohy-

drate)

Vegetables–Makesurevegetablesarewellcookedforthefirst6-8weeksaftersurgeryAlfalfa sprouts Chard RadishArtichoke Collard greens Red, Green, Yellow peppersArugula Cucumber Salad / Spinach / Mustard

greensAsparagus (well cooked) Eggplant SeaweedBeets Jicama ShallotsBroccoli*** Green snap beans TomatoBrussels sprouts*** Leeks Water ChestnutsCabbage*** Mushroom Yellow squashCarrots Onions ZucchiniCauliflower***

***caution – may cause gasFruitApple (without peel) Kiwi RaspberriesApricots (remove skin) Lemons (acidity) StrawberriesBanana Mandarin oranges TangerineBlueberries Nectarines Watermelon (remove seeds)Cantaloupe Papaya Oranges (remove skin)Cherries Peach (remove fuzz) Applesauce (unsweetened)Grapefruit Pears (remove skin) PlumsGrapes Pineapple Guava

FatOlive oil Avocado Sour Cream (Low Fat)Canola oil Olives Margarine (No Trans Fat)Vegetable oil Peanut butter Cream Cheese (Low Fat)Pam Spray Molly McButter

MiscellaneousVinegar Salt / Pepper Onion PowderPickles / Pickle Relish Soy Sauce GingerGarlic / Garlic Powder Mustard Italian SeasoningsCinnamon Hummus CurryMrs. Dash Herbs / Seasonings (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)

StarchBagels Muffins StuffingBiscuits Noodle TortillasBread Sticks Oatmeal WafflesBread (Untoasted) Pancakes PastasCereals, Cold or Hot EnglishMuffins PastryCroissants French Toast Pita BreadDoughnuts Grits RiceRice Cakes Rolls

May Block the AnastomosisCoconut Gum Hot Dog SkinsNuts / Seeds PopcornDried Fruit Celery, Raw (cooked celery in

soup is ok)Potato Skins Oranges (be careful of the pulp)Corn Skins and Seeds of Fruits and

Vegetables

May Cause Dumping Syndrome or HypoglycemiaIce Cream Candy / Candy BarsCookies Coffee Drinks/MochasCake SodaFruit Juice Frozen YogurtJuice Smoothies Milkshake

Foods High in FatCreamy Sauces Sausage French FriesFried Food Potato Chips PizzaBacon Onion rings Hash brownsFried Egg Roll Mayonnaise 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.Yourtoleranceofanyalcoholwillbesignificantlyreduced,increasingyourriskofDUI.

Remember• Milk may cause gas and discomfort after surgery. Try soymilk or Lactaid instead.• Steakisverytoughandfibrousandmaybedifficulttotolerateaftersurgery.Itisrecommendedto

wait 6 months to 1 year before trying to eat steak.

Nutrition Problems after Bariatric Surgery

NAUSEA AND VOMITING: most common problemsNausea 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 toBariatricClearLiquid(StageI)orBariatricModifiedFullLiquid(StageII)diettorestyourstomachfor 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 occuriffibrousortoughfoodsareeaten.Fibrousfoodsinclude:dryortoughmeat,coconut,hotdogskins, nuts, seeds, popcorn, and skins of some fruits and vegetables. If food has blocked the anas-tomosis 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 stom-ach 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 consis-tencyofbabyfood,andavoidfoodsthatarefibrousorhardtodigest.Insomecases,theoutlettothesmall 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 outpa-tient 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:• Drinkinglessthan64ouncesoffluideachday• Vomiting and/or diarrhea

Symptoms: dark colored urine, little urine output, dry mouth, dry skin, nausea and dizziness.Treatment:• DrinkaMINIMUMof64ouncesoffluideveryday.• 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.

Althoughthedumpingsyndromeisunpleasant,itisabeneficialpartofyournewtoolandcanhelpprevent you from eating high calorie/high sugar foods that can lead to weight gain. However not ev-eryone 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• Limitedintakeoffoodandfluidintotal.

Treatment:

• Asyouprogresswithyourdiet,afterthefirst3-4months,trytoaddmorefibertoyourfoodsuchasfibrousvegetablesandfruit.

• Ifyoucannottoleratefruitorvegetables,consideraddingnaturalfibersupplementssuchasMetamucil,BenefiberorCitrucel.

• Start slowly and gradually increase over a few weeks. This will help avoid effects such as gas and bloating.

• Makesuretodrinkplentyofwaterifyouusetheseastheycanmakethingsworseifyourfluidintake 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.

GOUTGoutiscausedbythebuild-upofuricacidinthejointswhichcausesinflammation,swelling,andpain.Goutflare-upsmayoccurwithweightloss.Ifyouareexperiencinggoutduringtheweightlosspro-cess,youmayneedtohaveyoureatingplanindividualizedforyou.Foodmodificationsanddrinkingmorefluidsmayhelptorelievethesymptomsofgout.Talkwithyourbariatricdietitiantohelpdevelopyourmealandfluidplan.RememberforyourgoutflaresyoucannottakemedicationssuchasMotrin,Aleve, Advil (NSAIDS).

HAIR LOSS:(alsoknownas“TelogenEffluvium”)isverycommonaftersurgeryCause:• Any major surgery• Crash dieting• Major weight loss

You have ALL three risk factors.• Ironandproteindeficiencycanmakeitworse.Makesureyouaretakingallyoursupplementsand

adequateprotein.Yourmultivitaminshouldhaveadequate(atleast15mg)Zincinit.DoNOTtakean 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. Ex-pensive 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 oc-curs 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

yourfinger-stickbloodsugarsifpossible.Thiswillusuallyrevealaconsistentpatternofassocia-tion 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,fiberrich).• 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 SMELLAfter surgery you may experience sensitivity to tastes and smells. For example, foods that you en-joyedbeforesurgerymaytakeonanewflavorandmaynotbeasappealingtoyouaftersurgery.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:• Afterweightlosssurgery,yourabilitytodrinkfluidshasdecreased.• 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:• REVIEWsymptomsofdizziness,weaknesswithyourprimarycarephysiciantoconfirmthediag-

nosis• Trytodrink64ozfluidsaday.• 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.• Ifyouareexercisingalot,replaceyourfluidwithaNONcaloriedrinkwhichcontainssodium.(e.g.

“Crystal Lite Hydration”). This is better than water.• Your blood pressure medications may need reduction. Review this with your primary care physi-

cian.• Get up SLOWLY. Allow your body time to adjust to changes in gravity.

WEIGHT PLATEAUSDuring 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 fol-lowing 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).• Drinkatleast64ouncesoffluideachday.• Write down everything you eat and weigh and measure your food. Your portions may be creeping

up without you realizing it.• Sticktoproteinfoodsfirst.Somepeopleexperienceplateausinweightiftheymigratebacktoeat-

ingmorecarbohydratefoods.Carbohydratefoodswillnotfillyouupthesamewayproteinfoodswill and may cause you to become hungry again soon after eating. Frequent snacking on carbohy-drate 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-BandHow the Band works:• Itreduceshowmuchyoucaneatatatime.Youaresatisfiedwithasmalleramountoffood.• 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.

• Drinkingliquidswithmealsorimmediatelyaftermealswillsimplyflushthefoodthroughthebandopening 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 “graz-ing” 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 leav-ing 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 GuidelinesPlease 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 surgeryStage 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.

Afterafill:Aftereachbandfill,stayonStageIIforonetotwodays,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.Takevitaminsfortherestofyourlife!Afterafillyoumayfinditeasiertotoleratechew-able supplements.

SEE LAP-BAND VITAMIN CHART AT END OF THE NUTRITION CHAPTER

10 Rules of LAP-BAND SURGERY1. 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 cer-tain 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. Ifyoudrinkwithmeals,foodwillbecomemoreliquefiedandreducetheeffectivenessoftheLap-Bandbyflushingfoodthroughthestomachtooquickly.Youwillfeelhungrysoonerandendupeating 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 mealsyoumayneedtohaveyoubandfill-leveladjusted.

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.Foodsthatcontainmanyfibersmayblockthestoma.Ifyouwouldliketoeatfibrousfoodsonceinawhilebesuretocutthemintosmallpiecesandcookthoroughly.Fi-brous foods may include celery, asparagus, broccoli, artichokes, corn, popcorn and pineapple.

8. Drink 64 ounces or more of fluid each day.Notonlydoyouneedsfluidstopreventdehydration,butfluidshelpridyourbodyofthewasteproductsthatresultfromfat/weightloss.

9. Drink only no/low calorie decaffeinated, non- carbonated beverages. If you drink high calorie liquidslikesoda,juice,smoothiesandothersweetenedbeverages,youwillhavedifficultylosingweight.

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 meatShrimpUntoasted bread, bagels.PastaRicePeanut ButterDried fruitFibrous vegetables: Cook them well. Even still they can be hard to chew well enough.NutsCoconutGreasy or fried foodsPoor 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 ResourcesRestaurant 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.• Selectproteinfoodsfirst.• 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 res-

taurant 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.• Selectmoistfoodssuchasfish.Dryfoodsaredifficulttotolerateandmayleadtodiscomfort.• Don’ttrynewfoodsforthefirsttimewhileeatingout.Ifyouareunabletotoleratethenewfood,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 GravyCrispy Hollandaise SauceFried Beer BatteredCheese Sauce SautéCream Sauce Butter SauceIn Rich Butter

Low Fat Terms:Broiled RoastedDry Grilled SteamedPoached Charbroiled

PickupaRestaurantCardatouroffice.Thesecardsstatethatyouareonlyabletoeatasmallfoodportion 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 packDrinks:• 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 tem-perature 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 LABORATORYMeasure Equivalents

Measure Equivalents1 tablespoon (tbsp) = 3 teaspoons (tsp)1/16 cup (c) = 1 tablespoon1/8 cup = 2 tablespoons1/6 cup = 2 tablespoons + 2 teaspoons1/4 cup = 4 tablespoons1/3 cup = 5tablespoons+1teaspoon3/8 cup = 6 tablespoons1/2 cup = 8 tablespoons2/3 cup = 10 tablespoons + 2 teaspoons3/4 cup = 12 tablespoons1 cup = 48 teaspoons1 cup= 16 tablespoons8fluidounces(floz)= 1 cup1 pint (pt) = 2 cups1 quart (qt) = 2 pints4 cups = 1 quart1 gallon (gal) = 4 quarts16 ounces (oz) = 1 pound (lb)1 milliliter (ml) = 1 cubic centimeter (cc)1 inch (in) = 2.54centimeters(cm)

Metric Convertion FactorsMultiply By To Get

Fluid Ounces 29.57 gramsOunces (dry) 28.35 gramsGrams 0.0353 ouncesGrams 0.0022 poundsKilograms 2.21 poundsPounds 453.6 gramsPounds 0.4536 kilogramsQuarts 0.946 litersQuarts (dry) 67.2 cubic inchesQuarts (liquid) 57.7 cubic inchesLiters 1.0567 quartsGallons 3,785 cubic centimetersGallons 3,785 liters

Food facts image

Nutrition label image

1. Serving SizeLook 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 CaloriesIf you want to manage your weight (lose, gain, or maintain), this sec-tion 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 calorie-free.

3. Limit these NutrientsEating too much total fat (including saturated fat and trans fat), cho-lesterol, or sodium may increase your risk of heart disease, some can-cers, or high blood pressure. The goal is to stay below 100%DV for each of these nutrients per day.

4. Get Enough of these NutrientsRemember 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 prod-ucts have natural sugars, limit the total carbohydrates to less than 20 grams per serving.

5. Percent (%) Daily ValueThis 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 nutri-ents, including fats, sodium and fiber. The DVs are listed for people who eat 2,000 or 2,500 calories each day.

Resources

WebGeneral 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.comwww.sparkpeople.com www.writingthejourneywww.mycaloriecounter.com www.mynetdiary.comwww.myfitnesspal.comwww.livestrong.comwww.fatsecret.com

Mindful Eatingwww.mindfuleating.org www.tcme.orgwww.bodymindinspiration.comwww.OA.Org (Overeaters Anonymous)www.TOPS.Org (Taking Off Pounds Sensibly)

Supplements / Productswww.bariatricadvantage.com www.vitalady.comwww.bariatriceating.com www.unjury.com

General Information BooksThe 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

CookbooksEating 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 EatingMindful 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