“HOW TO USE YOUR NEW TOOL SUCCESSFULLY” TEXAS CENTER FOR MEDICAL & SURGICAL WEIGHT LOSS Nutrition After Weight Loss Surgery Gastric Bypass Sleeve Gastrectomy.

“HOW TO USE YOUR NEW TOOL SUCCESSFULLY”

TEXAS CENTER FOR MEDICAL & SURGICAL WEIGHT LOSS

Nutrition After Weight Loss SurgeryGastric Bypass Sleeve Gastrectomy Gastric Banding

Basics

Nutrition and Behavior Modifications for long-term success

Diet Progression Remember your new stomach or pouch is delicate and

healing

Vitamin Program

WEPNSS

W- waterE- exerciseP- protein firstN- no snacking or grazingS- supplements (vitamins and minerals)S- support group

WEPNSS

These are the basic rules to live by.They work.Following them will make you as successful

as you want to be.Remember them. Live by them.

(WEPNSS) Water Water Water

Minimum 64 oz daily.This is critical.The single most important thing for you to do

after surgery is to get in at least 64 oz water daily!

“Rinse out” waste products that you will be producing during weight loss.

Maintain adequate hydration of tissues.Required for proper wound healing.It is okay to add a small amount of sugar-free

flavoring but limit to a couple per day.

Water!

Consequences of not getting in enough water: Dehydration Nausea Vomiting Kidney problems Poor wound healing Stricture of anastomosis (connection site) Re-hospitalization

Dehydration Cycle

Spacing Water and Meals

Separate water from your meals. Wait 1 hour after meals.

Water during meals flushes your food through faster, making you hungry again sooner.

(WEPNSS) Exercise

Helps to preserve lean body mass.Helps to burn more calories day to day.Increase PURPOSEFUL MOVEMENT!

Wear a pedometer Take the stairs Park further away Increase housework

Exercise

Cardiovascular + Resistance (weights/bands/body weight)

Cardiovascular exercise helps to burn fatStrength training/resistance

helps to maintain your muscle mass while you are losing fat

Speeds up metabolism Helps to maintain good bone health

Goal = minimum of 30 minutes cardio 5x/wk and 15 minutes

strength/resistance 3x/wk

Cardiovascular Activity

Start walking from day 1 after surgery and progress from there.

Gradually increase your time each week Week 1: 10 minutes/day 5/week Week 2: 12 minutes/day Week 3: 14 minutes/day

Work up to the a minimum of 30 minutesOnce you stop adding time than focus on intensity

Focus on your target heart rate (220-Age x 80%) Increase speed Interval training

MIX IT UP and make it fun!

Strength Training

Start 3-4 weeks after surgery or use light weights less than 20 pounds

Progression is key Gradually increase repetitions, sets, weight as it

should be challenging for youWork with a trainer to get on a program

that works for you.Mix it up over time to jump over plateaus

(WEPNSS) Protein

60 – 80 grams daily

At least 50% of every meal you eat should be proteinTry to eat your protein foods first

Early benefits of protein Helps protect against loss of lean body mass (muscle) Main building blocks of our bodies

Late benefits of protein Protein gives a feeling of satiety (satisfied) Fewer calories per gram than fat and more satiety (satisfied)

than carbohydrates

Protein

Protein

Early on, getting enough protein in every day is difficult.

Therefore, most people need to have a protein supplement for one meal per day in the beginning. Texas Center for Medical & Surgical Weight Loss offers

shakes, soups, and several other forms of high-protein meal replacements that are easy to tolerate.

Track your protein intake using a checklist or a food tracking system such as myfitnesspal

Meal Composition

No Snacking or Grazing

Fasting periods lead to fat-burning.Grazing lessens your body’s need to burn its

fat stores because you are frequently giving it energy (calories).

Snacks are habit-forming.Improving your protein intake at each meal

and increasing the amount of water you drink during the day will decrease your desire to snack.

(WEPNSS) No Snacking or Grazing

Our bodies cannot differentiate well between hunger and thirst

When you want to snack your body may actually need the water in the food.

Drink water instead of snackingDon’t be fooled!!!

Theoretically, it only takes an extra 100 calories per day to gain 10 pounds in a year!

YOU NEED VITAMINS FOR THE REST OF YOUR LIFE, NO MATTER HOW GREAT YOU FEEL!

( WEPNSS) Supplements

Why Do I Need Vitamins?

We need vitamins and minerals every day in adequate amounts in order for our bodies to function properly.

Weight loss surgery can contribute to deficiencies because of: Decreased intake of food Eating different foods Decreased absorption of certain foods due to change in

anatomyDeficiencies develop slowly and you may not notice

them until they are severe!

Why Will I Need Vitamins and Minerals After Weight Loss Surgery?

Why Will I Need Vitamins and Minerals After Weight Loss Surgery?

Why Will I Need Vitamins?

When our body is lacking in nutrients of days, weeks, or months, life threatening or debilitating consequences can occur. Fatigue/anemia Poor immune function contributing to cancer risk,

cardiovascular disease, side effects of diabetes Bone loss/fractures Neuropathy or neurological impairment Damage to the heart Blindness

Why Will I Need Vitamins?

To protect your health it is important to:1. Be compliant with a supplement program.

2. Get your vitamin profiles checked EVERY year.

Deficiencies are easy to correct if found early

Difficult to correct if we wait for visible signs of vitamin deficiencies.

Which supplements will I need?

High Potency Multivitamin which includes a minimum of: 100-300% of daily value of B2, B3 (niacin), B5

(pantothenic acid), Folate and Biotin At least 200% of B1 (thiamin) 30-200 IU of vitamin E (preferably in a natural form, will

have a “d-” in in front such as d-alpha tocopheryl acetate or succinate not a “dl-”, which is synthetic)

100-200% of vitamin A 60-500mg of vitamin C 100% of daily value for zinc, selenium, copper,

manganese, chromium, molybdenum Ideally also contains choline and inositol

Which supplements will I need?

Iron Up to 45 mg daily in gastric bypass and some sleeve

gastrectomy patients Your provider will help evaluate the type and quantity of

iron that you should be taking Separate from calcium by 2 hours as it inhibits

absorption Vitamin B12

1000 mcg sublingual (under the tongue) weekly Oral methylcobalamin Nasal sprays or injections are also an option

Which supplements will I need?

Calcium Needs to be in the form of calcium citrate for improved

absorption 1500-1800 mg per day total (may include amount in

multiple and/or the diet) Body can only absorb 500 mg at a time, so needs to be

divided into 3 doses throughout the day Vitamin D

3000 IU per day (can include amounts in multi and calcium)

Why take a bariatric vitamin?

Vitamin preparations vary a lot in terms of contents, nutrient forms, and nutrient levels.

We recommend bariatric specific vitamins because they are delivering the dosage of nutrients needed with your new anatomy as well as in a way that the new anatomy can actually absorb and utilize the nutrients. They are specifically designed with the needs of the weight loss

surgery in mind! Less gastric acid post surgery to break down particularly tablets

to the point the body is able to absorb the nutrients

We see improved vitamin profiles in patients taking bariatric vitamins.

Why take a bariatric vitamin?

Cost Bariatric Vitamins typically cost $35-65 per

month for all of the recommended nutrients depending on the type of form that you choose to take.

Compared to increased quantity of over the counter supplements as well as the cost of vitamin deficiency complications, you may not be saving moving.

INVEST in Your New Healthy Life!

Consider these comparisons

Cost The average American consumes

2 soft drinks per day $2/day for soft drinks=$60/month

The average American eats at a fast food restaurant 2-3 times per week $6/3 times per week=$72/month

INVEST in YOU and PROTECT YOUR HEALTH!

Supportive Nutrients

Probiotics Support healthy digestive and immune function Studies are showing a statistically significant greater

weight loss in post bypass patients

Fiber Soluble fiber to promote regularity

Anti-inflammatory Omega 3 fatty acids Curcumin

Amino Complex Promotes and maintains lean muscle mass

(WEPNSS) Support

General support groups are once a month. Join us 3rd Thursday at 6:30 Check the schedule and videos of past support groups at

www.texasbariatric.com The people who do the best attend support groups

regularly. It’s fun . It’s educational. Your attendance, questions, and support, will help other

people, even if you think that you don’t necessarily need it.

You will almost always walk away with something you gained from the meeting.

(WEPNSS) Support

Website (www.texasbariatric.com) Post-Operative Resources

Recipes, tips, etc Password: Tex@s2013

Smart Phone App Search “Texas Center for Medical and Surgical Weight

Loss”Like us on facebook

https://www.facebook.com/texasbariatricFollow us on Pinterest

EATING AFTER BARIATRIC SURGERY

Post – Operative Eating

Sugar-Free Clear LiquidsSugar-Free Clear Liquids

Water Plain Sugar-free flavoring

BrothSugar-free Jell-OSugar-free

popsiclesDecaf coffee or tea

Post-Op: Week 1 Liquid Diet

You will start supplements at post-op class

Supplements

Post-Op : Week 2- Advancing Diet

Week 2: you are now allowed to advance your dietYou will do best if you start with semi-solid foods:

Low fat, low carb yogurt Protein meal replacement shakes, soups, gelatins, etc. Cottage cheese - low fat or fat-free Refried beans - fat free and moistened Low fat cheeses – i.e. string cheese Eggs- cooked any way, but not fried

May add soft cooked veggies and small amounts of canned fruit.

Start all vitamin supplements.

3 Weeks and Beyond : Advancing Diet

If you tolerate the semi-solid foods, SLOWLY add one new food item from the list (one at a time) gradually: Fish Chicken Turkey Shellfish Tofu Soy Pork Lean beefFoods should be baked, barbecued, or broiled– NOT fried!

CHEW, CHEW, CHEW

Poorly Tolerated Foods in the first 6-12 weeks

Spicy foods (such as curry, salsa, chili peppers) Acidic foods (such as tomato sauce or citrus fruits) Rice, pasta, bread, and other sticky or doughy foods Stringy and fibrous foods (such as coconut, corn, popcorn, whole

beans, seeds, nuts) Stringy vegetables (such as celery or asparagus stalks) Bran cereals Dried fruits, seeds, skins of fruit Dry meats (may need to moisten with broth) Sugary foods including undiluted fruit juice, cookies, candy, sweets,

sauces and condiments that contain added sweeteners-these foods should also be avoided for the long term

ADD NEW FOODS SLOWLY!

Nutritional Numbers

Protein: 60-80 grams per day

Carbohydrate: <60 grams per day

<15 grams of sugar per meal

Fat intake: <20 grams per day

Low fat is considered <3 grams of fat per 100 calories

A Word (or two) on Carbohydrates

Sugars = carbohydrates.Carbs/sugars give little satiety and cause you

to become hungry again sooner.

Blo

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glu

cose

Time

A Word (or two) on Carbohydrates

Foods like white bread, rice, potatoes, soft drinks, bagels, crackers, and fruit juices are bad choices.

Watch out for the hidden sugar in sauces and dressings.

Carbs by themselves can cause dumping symptoms.

They are addictive/habit forming and lead to snacking behaviors.

Dumping Syndrome

When sugars/starches/fats from your stomach enter your intestine, hormones can be released from your intestine and cause you to feel ill.

Flushing, sweating, heart pounding, lightheadedness, nausea, abdominal discomfort, sometimes vomiting and sometimes diarrhea are typical symptoms.

A Word (or two) on Fats

Fats are higher in calories (9 calories/gram) than protein and carbohydrates (4 calories/gram).

They are habit forming/addictive.Diets high in fat can lead to heart disease

(primary cause of death in our country.)Our bodies are very efficient at storing fat.

A Word (or two) on Fats

Look out for hidden fatsSalad dressings, butter, other dressingsFats can cause dumping symptoms

A Word (or two) on …

Milk– has lactose (sugar) and fat in it– may cause dumping symptoms. Lactaid milk/fat-free is okay. If you cannot tolerate lactose, try fat free Mootopia® milk – 1 ½

x the protein and ½ the sugar

Fruit: Do not eat by itself. Small amounts with your meal are fine

Coffee/tea Caffeine is a stomach irritant None for the first 3 months because it can dehydrate you. Limit MAX 1 per day after that. Decaffeinated is ok, but watch out for hidden calories (milk,

sugar)

A Word (or two) on …

Artificially sweetened drinks (like diet soft drinks): Many artificial sweeteners may stimulate appetite. Consuming regularly may increase craving for sweets. Use very small amount of flavoring for your water.

Alcohol: New anatomy makes you particularly sensitive to alcohol. 1 alcoholic beverage has the toxicity of 4 drinks now. This

does not mean you will necessarily feel 4 times more inebriated.

No alcohol for first 3 months; max one drink in 24 hour period thereafter.

WEPNSS

REMEMBER THESE RULES!!They will serve you well.They are the key to maximizing your success

with your new tool!

Contacts

Texas Center for Medical & Surgical Weight Loss 210-651-0303 www.texasbariatric.com

Patient Support Post-Operative Education and Resources Password: Tex@s2013

TEXAS CENTER FOR MEDICAL & SURGICAL WEIGHT LOSS

Congratulations on starting the journey to a new you!