Transcript Post-op nutrition and behavior presentation

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