Transcription
Highland Hospital Bariatric Surgery Center3 MON TH – 6 M O N T H BARIAT RIC L I F E S T YL E ME A L P L A N (1000 – 1300 Calories Daily)(60 Grams Protein Daily)LOW FAT / LOW SUGARThe bariatric meal plan consists of three small wellbalanced meals daily plus one to two snacks as needed. Once you have completed the puree and soft meal plan you will move on to the bariatric lifestyle meal plan. Meal sizes gradually increase from ¼ - ½ cup to 1 - 1¼ cup portion Introduce only one new food dailyTips to Remember FOREVER Eat 5 - 6 small feedings daily (three meals plus 2 snacks) Balance all meals with protein, vegetables and or fruit Eat protein foods first Eat one hour within waking Don’t go over 4 - 5 hours without eating Take your time eating meals (at least 30 minutes) Keep meals small Don’t drink with meals Chew food to applesauce consistency Eat food as tolerated Stop eating when full or have met meal size Sip fluids slowly Avoid high fat and high sugar foods Avoid carbonated beverages Drink 6 - 8 cups or more of no sugar added beverages daily Measure portion sizes Take vitamins and mineral supplements as recommended Try only one new food daily AVOID rice, bread, pasta until comfortably consuming a serving of protein at each mealplus 2 - 3 serving of dairy and fruit and vegetables servings daily.5.161
Highland Hospital Bariatric Surgery CenterPotential Problem FoodsSome foods have difficulty passing through the opening of the stoma and may cause blockage if not chewedwell. Potential problem foods should be eaten with caution. These foods should be cooked well and cut intosmall pieces first. These foods include: red meat (beef and pork) shrimp untoasted or doughy bread pasta rice peanut butter dried fruit nuts coconut popcorn greasy or fried food seeds and skins of fruits and vegetables membrane of citrus fruits fibrous vegetables like corn, asparagus and celery**Fibrous food should be avoided as they have the potential to block the stoma. If you would liketo eat asparagus or other fibrous foods once in a while, then you must be sure to cook them well, cut them intovery small pieces first and then chew thoroughly.SAMPLE MEAL PLANBreakfast1 egg scrambled w/ diced tomato & 1 Tbsp avocadoSnack1 light, low-fat yogurtLunch2-3 oz. tuna with light mayo, cucumber slicesSnacklow fat cheese stick and apple slicesDinner2-3 oz. chicken with 1/2 cup broccoliSnack¼ - ½ cup low-fat cottage cheese w/ ¼ cup allowed fruitNote: If not consuming at least 60 grams of protein in the meal plan you may continue to use 1 protein drink/day.5.162
Highland Hospital Bariatric Surgery CenterF O O DG R O U P S&P R OTEI ND A I L YS E R V I N G S* m i n i m u m 8-9 o u n ces d ai l yLean MeatsMeat SubstitutesDairy (Low Fat) recommend 3 servings daily5.16FRU I TS1 – 3 s erv i n g s d ai l yVE G ETA BLES3 o r m o re s erv i n g s d ai l yS TA RCH ( WH O LE G RA I N S)0 – 2 s erv i n g s d ai l yFATS3 – 4 s erv i n g s d ai l y3
Highland Hospital Bariatric Surgery CenterPROTEIN*Minimum 8 – 9 oz. Protein Equivalents per dayAdequate daily protein intake is essential for optimum nutrition, recovery and long-term health.FOOD CHOICESPORTION SIZESTIPSOMITLean MeatsChicken (No skin)3 oz. proteinPoultry skin, duck, goose,Turkey (No skin)3 oz. protein wings, dark meatFish/Seafood3 oz. proteinFish fry, battered fishWater packed tuna3 oz. proteinFish canned in oilVenison3 oz. proteinBreaded meatsLean beef, pork, or veal3 oz. proteinBake, broil or grill loinSpareribs, hot dogs, bacon,or round cutssausage, pepperoni, ham hocksPrime cuts of beef, well-marbledmeats, chuckCanadian Bacon3 oz. proteinSalami, bologna, liverwurstMeat SubstitutesEggs:Egg whites2 1 oz. proteinWhole egg (with yolk)1 1 oz. proteinEggbeater¼ cup 1 oz. proteinLegumes (Beans)½ cup 1 oz. proteinPeanut butter or nut butter2 T. 1 oz. proteinQuinoa1 cup 1 oz. proteinand 2 starchesVeggie Burger1 patty 2 oz. proteinBean based soup1 cup 1 oz. proteinTofu½ cup 1 oz. proteinNuts¼ cup 1 oz. proteinDairy (Low Fat)Milk – 1% or SkimSoy MilkFlavored Yogurt: light, low fatFlavored Greek Yogurt:light, low fatPlain Yogurt, low fatPlain Greek Yogurt, low fatCheese – low fatRicotta cheese – low fatCottage cheese – low fat3 servings/day8 fluid oz. 1 oz. protein8 fluid oz. 1 oz. protein6 – 8 oz. 1 oz. protein6 oz. 2 oz. protein6 – 8 oz. 1 oz. protein6 oz. 2 oz. protein1 oz. 1 oz. protein½ cup 2 oz. protein½ cup 2 oz. proteinWhole or 2% milkChocolate milkRegular cheese4% milk fat cottage cheese*Based on Individual Needs5.164
Highland Hospital Bariatric Surgery CenterVEGETABLES 3 or mo re s e rv in g s d a ilyFRUITS 1-3 ser vings dailyFOOD CHOICESPORTION SIZESTIPSNon-Starchy VegetablesDark Green: broccoli, greens,1 cup leafy raw vegetables Fill half your platedark green leafy lettuce, spinachwith vegetables.Red & Orange: carrots,½ cup cooked vegetablesred peppers, tomatoesOther: asparagus, beets,You can have unlimitedSatisfy your appetite byBrussels sprouts, cabbage,amounts of non-starchychoosing more vegetablecauliflower, celery, cucumbers,vegetables.servings.eggplant, green or wax beans,mushrooms, okra, onions, turnipsStarchy VegetablesBecause of the high starchcontent vegetables such aspotatoes, corn, and peas do notcount as a vegetable but,instead, count as a starch.OMITVegetables prepared in creamor cheese sauceLeafy green vegetables cookedwith fatty meats (Try skin-freesmoked turkey, liquid smoke, orskimmed chicken broth.)Fried vegetablesChoose raw vegetablesto increase fiber intake.FruitFresh fruit1 mediumFresh berries1 cupMelon cubes1 cupGrapes15Canned fruit½ cup(packed in water or juice)– no sugar addedFrozen fruit – no sugar added½ cupDried fruit¼ cupFruit juice – no sugar addedMaximum ½ cup/day5.165
Highland Hospital Bariatric Surgery CenterSTARCH (WHOLE GRAINS)0–2 ser vings dailyFOOD CHOICESPORTION SIZESOMITCooked pasta½ cupChoose whole grain productsPasta and rice dishes withbutter, cream, or cheese sauceCooked rice½ cupHot cereal½ cupLentil/Bean soup½ cupCold Cereal (no sugar coating)1 cupBroth or1 cupTomato based canned soup98% fat free cream soup1 cupmade with fat free milkBread1 sliceChoose breads and cerealsEnglish muffin½ eachwith 2 grams or more ofHamburger roll½ eachfiber/servingHot dog roll½ eachSmall bagel½ eachPita½ eachWaffle1 (4 inch)Pancake1 (4 inch)Tortilla1 (6 inch)Chow mein noodles, Fried rice,Ramen noodlesStarchy VegetablesCorn½ cupPeas½ cupPotatoes½ cupSweet Potato½ cupWinter Squash½ cupLegumes (kidney beans, lentils,½ cupLima beans, etc.)5.16TIPSDonuts, Danish, biscuits,muffins, croissantsFrench fries, home fries6
Highland Hospital Bariatric Surgery CenterFATS3 –4 ser vings dailyFOOD CHOICESPORTION SIZESTIPSOMITCanola, olive, sesame,1 teaspoonBecause fat is the mostPalm oilor peanut, grapeseed orconcentrated source ofavocado oilcalories, closely monitorportion sizes.Butter or margarine1 teaspoonLight margarine1 TablespoonMayonnaise1 teaspoonFat backLight mayonnaise1 TablespoonPork RindsSalad dressing1 TablespoonUse horseradish or mustardLardReduced fat salad dressing2 Tablespoonon sandwiches to replaceSunflower seeds1 Tablespoonmayonnaise.Ground flaxseed1 TablespoonParmesan cheese2 TablespoonsUse non-fat vegetable orCreamLight sour cream2 Tablespoonsmargarine sprayHalf & HalfLight cream cheese2 TablespoonsWhipped toppingNuts2 TablespoonsSour creamPeanut butter/nut butter1 TablespoonAvocado1/8 or 2 TablespoonsCream cheeseLarge olives8MISCELLANEOUSCalorie free sweeteneras desiredRead food labels to checkSpicesas desiredfor added sweetenersHerbsas desiredand avoid those withSugar free jam or jelly2 Tablespoonsingredients on the Omit List.Sugar free syrup2 TablespoonsBEVERAGESWater, flavored waterDrink 6 – 8 cups/day forSip slowly (no more thanDecaffeinated coffeeadequate hydrationone ounce at a time)Unsweetened, decaffeinated teaSugar Free beverages5.16Sugar, brown sugar, honeymaple syrup, molasses,corn syrup, high fructosecorn syrup, jam or jellyCarbonationCaffeine (no morethan 6 oz./day)Sweetened beverages7
Highland Hospital Bariatric Surgery CenterSNACKS/DESSERTSSnack guidelines per serving:100 - 150 caloriesless than 5 grams of sugarless than 5 grams of fatSugarThe use of any sugar substitute is acceptable.Avoid regular sugar, brown sugar, jelly, honey, syrup and molasses.Nutrition References:www.choosemyplate.gov – General healthy food guidelineswww.cfsan.fda.gov - Reading a food labelwww.nal.usda.gov/fnic/- nutrition, fitness and behavior modification informationwww.shapeup.org/10000steps.html - Exercise informationwww.eatright.orgKEEPING ACTIVE You must stay active to burn calories, build muscle mass and increase your metabolism.You will increase your chance of success if you follow a fitness routine weekly.Establish a weekly exercise routine: Schedule your routine on the same day, at the same time every week Aim for at least 30 minutes, 5 days each weekStrive to be physically active every day: Walk or ride your bike to locations whenever possible Take the stairs instead of the elevator Park further away from entrances in parking lots5.166.158
Highland Hospital Bariatric Surgery CenterP R OTEI N TA LLYSERVINGSIZELEAN MEAT3 ozPROTEINSOURCESGRAMS OF KCALPROTEINChicken BreastChicken thigh- no skinChicken sausageTurkey light meatTurkey grounded 90% leanTurkey deli meatTurkey sausageTurkey baconCanadian baconBeef 95% lean sirloinBeef ground, 95% leanPork Loin, 701601401773 oz.3 oz.2 oz.3 oz.2 oz.2 oz.3 oz.1 oz.2 oz.3 oz.3 oz.3 oz.201722100801203 oz.3 oz.3 oz.2 oz2oz3 oz3oz3 ozFISH SEAFOOD3 ozFish - tuna, haddock, salmon etc.3ozShrimp3ozScallopsDAIRY½ cupCottage Cheese low fat¼ cupRicotta Cheese low fat1 ozCheese low fat1ozCheese stick mozzarella made with 1%6 ozYogurt light, low fat or plain6 ozGreek Yogurt- light, low fat, plain1 cupMilk skim or 1%EGGS2Egg whites1Egg¼ cupEgg beatersBEANS1 cupLentil soup½ cupRefried Beans no fat½ cupBeans (variety)½ cupSplit Peas2 tbspPeanut butterSOY PRODUCTS / MEATLESS / VEGETARIAN1Vegetarian meatless burger2Morning Star sausage links1 cupSoy Milk4 ozTofu1 ozNuts149875-7158DAY’STALLY2 oz.1 oz.1 oz.1 oz.1 oz.2 oz.1 oz.7663580301 oz.1 oz.1 oz.977881501201001202001 oz.1 oz.1 oz.1 oz.1 oz.159787130801001171592 oz.1 oz.1 oz.1 oz.1 Y’S TOTAL PROTEIN9
GP3HELPFUL HINTS – 2-3 MONTHS AFTER SURGERYCALL THIS OFFICE IF YOU ARE EXPERIENCING ANY OF THE FOLLOWING: Increasing abdominal pain.Nausea and vomiting and are unable to consume the recommended food and fluid.IF YOU ARE EXPERIENCING A LIFE THREATENING CONDITION, CALL 911 OR GO DIRECTLY TO THEEMERGENCY ROOM.IF YOU HAVE QUESTIONS OR CONCERNS THAT ARE NOT LIFE THREATENING, PLEASE CALL THEOFFICE BEFORE GOING TO THE EMERGENCY ROOM (585-341-0366).MEDICATIONSGastric BypassSleeve GastrectomyComplete Multivitamin/MineralORCelebrate One/60 chewsor tabsCalcium citrate 600 MG/Vit D400 IU(Total of 1200-1500 mgdaily)Ursodiol – helps you toavoid gallstone formationIronFerrous sulfate 325 mgdaily(Total of 65 mg elementaliron daily)Vitamin B121000 mcg daily2x daily for the rest ofyour lifeORCelebrate 60, twice aday for the rest of yourlife2x daily for the rest of yourlifeORCelebrate One, once a dayfor the rest of your life2x per day for the rest ofyour life2x per day for the rest ofyour life Calcium Carbonate can beused but should be taken withfood.2x per day for 6 months, only if you have a gallbladder1x dailyIf you are takingCelebrate you do notneed to take additionalironYour provider will let youknow if you need to takethis1X dailySeparate calcium and iron by2 to 3 hours for bestabsorption of both minerals1X dailyIf you are takingCelebrate, you do notneed to take thisIf you are takingCelebrate, you do notneed to take this.Thiamin (B1)(minimum of 12 mg daily)12/08/20201x daily if you are NOTtaking a bariatric specificvitamin1x daily if you are NOTtaking a bariatric specificvitaminDoses are usually 50 to 100MG
GP3 HYDRATIONIt is important that you drink 64 ounces of fluid each day. Not getting the recommended daily fluidintake can cause nausea, headaches, decreased energy levels and constipation.DIET- Lifestyle Bariatric Meal PlanNow that you are resuming the lifestyle meal plan all foods will gradually be re-introduced one new food ata time.Eat 5-6 times per day (3 balanced meals 2-3 healthy snacks)Avoid rice, bread, and pasta until comfortably consuming a serving of protein at each meal plus 2-3servings of dairy and fruit and vegetables daily.Gradually increase your volume of food to 1- 1 ¼ cup of food per meal and 1000 - 1300 calories a day.Do not drink 30 minutes before, during and after meals. PROTEINPre-planning menus will help you consume all of your required protein (at least 60 grams) and nutritionalneeds for the day. It is recommended that you periodically keep a food diary and calculate the amount ofprotein and calories you are consuming. HYPOGLYCEMIAIf you wait too long in between meals or skip meals you may experience hypoglycemia (low blood sugar).Symptoms include lightheadedness, shakiness, and feeling in a “fog”. These symptoms often occur 1-3hours after meals. Hypoglycemia can be prevented by eating 5-6 times daily, eating at regular intervals,meeting daily protein needs, and avoiding sweets. DO NOT TAKE NSAIDS Ever (for the rest of your life)!Non-Steroidal Anti-Inflammatory DrugsDo not take NSAID medications. For example ibuprofen, naproxen, Motrin, Aleve, Celebrex and Mobic.These medications will increase your risk of ulcer formation and GI bleeding.EXERCISEAim for at least 30 minutes of exercise 5 days per week. A good fitness routine will include a combinationof flexibility, cardio and strength training.CONSTIPATIONConstipation is common after bariatric surgery due to iron supplement, pain medication, decreased fluidintake and decreased fiber intake. What you can do: Increase your fluid intakeIncrease your fiber intake by adding a high fiber unsweetened cold cereal such as All Bran or Bran Flakes.Avoid any cold cereal with seeds, nuts, or dried fruit. Other appropriate fiber rich foods are outlined in yourdiet plan.If you have not had a bowel movement for 2-3 days and if you are not taking Colace or Miralax, start withMiralax and Colace twice per day. If you do not have results and you feel bloated and uncomfortable, youmay increase the Miralax up to three times a day for one day. If you do not have results after Miralax use,you may use ONE of the following. Please follow package instructions:o Milk of magnesiao Magnesium citrate12/08/2020o Dulcolax pills or suppositoryo Fleets enema
GP3BOWEL MOVEMENTSBowel movements after bariatric surgery tend to be varied (they may be frothy, foamy, hard, floating to top oftoilet bowl). There is no normal.GASYou may experience foul smelling gas. This is related to the rearranging of your intestines and the breakdownand absorption of your food. You may try Beano or Gas X. Some patients have tried Acidophilus (over thecounter) with some success. Unfortunately, for some people, this will be a lifelong issue.SMOKINGNO SMOKING! Smoking increases your risk of gastritis or ulcers in your pouch.BIRTH CONTROLWeight loss can increase fertility. You should continue to use birth control if sexually active. We stronglyrecommend that you DO NOT BECOME PREGNANT until 2 years after surgery. It has been shown thatwomen who had absent or irregular periods before surgery are likely to begin regular cycles and ovulation withweight loss. If you were not able to get pregnant before surgery, this can change with weight lossMONARCH SUPPORT GROUPThe Monarch meetings are held on the 2nd Wednesday of each month from 6:00pm-7:00pm via Zoom. You canregister for these meetings through our event page located on our website. A great opportunity to share andlearn.ENERGY LEVELYour energy level should be back to normal, if not better than before.HAIR LOSSSome hair loss is common following surgery and typically occurs between the third and sixth months followingsurgery. This is a result of several factors including the physiologic stress, the emotional stress of theadjustments and the nutritional stress following surgery. This is temporary, and an adequate intake of protein,vitamins and minerals will help to ensure hair re-growth. Most patients report that this problem has resolved byone year after their surgery. YOUR WEIGHT LOSSDo not weigh yourself more than 1x per week. Fluid intake and constipation can affect weight. This can bediscouraging to you.Make sure you are eating and drinking as recommended in this packet. You will be weighed at each of youroffice visits.Our goal is for you to lose 60% or more of your excess body weight at the end of your first year. The rate ofweight loss differs between people. Try not to compare yourself with anyone else.12/08/2020
GP3OFFICE VISIT SCHEDULEResearch shows that patients who consistently follow up with visits to their surgeon’s office maintaina higher percentage of weight loss.2-3 months post opToday’s visit. Labs will be drawn at this visit and at every visit from now on.6 months post op.Labs will be drawn.1 year post op.Labs will be drawn. You should return to this office every year.YOUR LAB RESULTS and MyChartLab Letters: You will receive a MyChart message or a letter from this office if your labs are abnormal andrequire any adjustment to your vitamins/supplements. If your labs are all within normal limits you will notreceive a letter.How to access your lab results: You may access your labs through MyChart at mychart.urmc.edu. Click onthe button “Request activation code” on the left side of the screen under “New User?”We will check the following labs at each visit: CBC Ferritin Chemistry B12 Vitamin D Folate Iron PTH12/08/2020
Milk - 1% or Skim 8 fluid oz. 1 oz. protein Whole or 2% milk . Calorie free sweetener as desired Read food labels to check Sugar, brown sugar, honey . Avoid regular sugar, brown sugar, jelly, honey, syrup and molasses. Nutrition References: www.choosemyplate.gov - General healthy food guidelines www.cfsan.fda.gov - Reading a food label
