After Care :: Eating Smart (Post Surgery)

Eating Smarter After Gastric Bypass and Gastric Banding
Elizabeth Buchanan

As your dietitian, I am skilled to assess your progress and it is important that you keep your nutrition appointments. This is especially important during the rapid weight loss phase of the first 6-12 months.

The nutrition advice for these procedures is specialised. I will give you a specific plan for your particular needs before surgery. For two weeks prior to surgery you will be on a purée diet.

After surgery, and at each appointment it is likely that your eating plan will be adjusted. Your total kilojoule (calorie) intake will be dramatically reduced because serving sizes are very much smaller than you ate previously. Therefore, what you do eat must be good quality food. Typically you will be eating at first only a few teaspoons, then ½ cup, gradually increasing to the amount that fits on a small lunch plate or a rice bowl. It is of course vital that you do not overeat and stretch your new pouch, with either the gastric banding or gastric bypass procedure.

Following gastric banding procedures you could develop vitamin deficiencies during the weight loss period.

Gastric bypass procedure may induce nutrient deficiencies for iron, calcium, folic acid and vitamin B12.

That is why it is important to take your multi-vitamin tablets daily and to check your iron, folate, and vitamin B12 levels regularly. Vitamin B12 injections and folate, iron medication can correct any deficiencies.

After your operation

Immediately after surgery you will be on intra-venous fluid, and encouraged to sip water

Quantities at each meal are no more than 1/2cup. Initially you will eat only 1 tablespoon before you feel full. You will not feel hungry! As soon as you feel full, stop eating!

It is advisable and possible to select food carefully to maximise the nutritional quality of all your meals.

Fluids
Surgery does not affect your requirements for fluids. After surgery, you need as much fluid as before the surgery. Plan to sip all day and use a drink bottle to encourage regular sipping of water or low calorie drinks.

Eating Smarter - your new eating pattern

Eating smarter means selecting and enjoying a variety of foods from the different food groups - it is not a "diet". It means eating with pleasure and having good nutrition or nourishment. It is about making healthy choices. "Eating smarter" needs to be long term so that you remain in excellent health for many years after your bypass or banding surgery. The recommendations below are your long term goals.

• Protein foods
  I especially insist that you eat sufficient protein after your surgery to ensure that as you lose weight you are losing fat, not lean body mass (muscle). This will enhance your general health as you lose weight and gain health. It may prevent hair loss
  
  Recommendation Moderate amounts of fish, skinless chicken, lean meats and low fat dairy products:
  
  
• Meat, fish, chicken - 100g daily
  
• Choose red meats 2-3 times weekly
  
• Choose low fat (calcium enriched) milk, yoghurt or calcium enriched soy beverages such as:
  
  • calcium enriched low fat milk
    
  • 1 pottle low fat yoghurt
    
  • 2 Tbsp cottage cheese
    
  • 2 cm cube of Edam cheese
    
    
• Fruit and/or vegetables - should be included in all meals Recommendation "five plus" servings/day fruit and/or vegetables (A serving is ½ cup cooked or canned fruit/vegetable or the amount of raw fruit/vegetable that you can hold in your cupped hand). Vegetables and fruits are very high in vitamins, minerals and anti-oxidants but low in kilocalorie or energy value
  
  
• Carbohydrates -2 to 4 serves/day depending on activity
  Add a small portion of carbohydrate - wholegrain cereal, bread, pasta, rice, noodles (or potato, corn, kumera) Carbohydrate food provides a lot of energy so servings should remain very small. It is very important that these foods are not sweet.
  
  Whenever possible select whole grains
  
  
  • Cereal ½ cup Pasta ½ cup
  • Bread 1 slice Potato or kumera - 1 size of a medium egg
  • Rice ½ cup Baked beans or lentils ½ cup
  
  
  
• Fats - are still necessary but in small amounts. Use very small amounts of oils for cooking Choose margarines and salad dressings and mayonnaise made from canola, sunflower, soybean and olive oils, nuts, pumpkin or sunflower seeds and avocados provide many vitamins and nutrients as well as the small amount of poly- or monounsaturated fat your body needs. Recommendation: 3 teaspoons/day or substitute 1 teaspoon oil or margarine with a dessertspoon of nuts, seeds or avocado
  
  
• General Hints:
  
  
  • Select fish, skinless poultry or meat trimmed of all fat - include a small serve at both lunch and dinner
    
  • Include fish ( fresh or canned ) at least twice/week
    
  • Avoid all fatty meats including sausages and salami
    
  • Limit cheese to cottage cheese and low fat cheese slices
    
  • Include at least 1 vegetable or fruit serve at each meal, increasing servings as you are able to eat a little more
  
  
  
• Snacks - try to avoid all snacking between meals but if you must, choose one only of these snacks
  
  
  • 1 small sized piece of fresh fruit
    
  • 1 small pottle of yoghurt, or 1 small glass of low fat milk
    
  • 1 small handful of unsalted nuts
    
  • 1 cup of popcorn
    
  • 1-2 plain wholegrain low fat crackers with a topping of tomato, pickle, hummus, low fat cheese or cottage cheese
  
  

  Avoid all snack food which has been fried or is high in fat and/or sugar, potato chips, corn crisps, cakes, biscuits, chocolate, ice-cream, pastries, pies, pizza, hamburgers, creamy pasta dishes

• Sugars - these may not be well tolerated. In those who have had a gastric bypass, eating sugary foods may promote dumping syndrome, a very unpleasant reaction. Foods high in fat may also give a loose bowel response, sometimes immediate or sometimes a few hours later
  
  
• Alcohol - the enzyme in the stomach which helps digest alcohol is now not available so liver damage may occur. Alcohol is not recommended
  
  
• Vitamin B12 - this is normally produced in the stomach and facilitates the absorption of iron. However after a gastric bypass the B12 is no longer available and may have to be provided by regular injection
  


• Iron - small quantities of very lean red meat should ensure adequate iron. Lamb or chicken liver and lambs' kidney are also excellent sources. Less well absorbed but still useful are lentils, beans and tofu. Accompanying all meals with a food high in vitamin C (tomatoes, kiwifruit, lemons, oranges, tamarillos, fresh green vegetables, will enhance the absorption of iron from the meal
  


• Multi vitamins and iron - take these as prescribed by your doctor
  
  
• Exercise - Exercise daily - for best weight loss, exercise on an empty stomach.
  Recommendation: 30 minutes or more exercise daily to help you:
  
  
  • Continue weight loss and control your weight
    
  • Improve your long term health
    
  • Increase your energy levels
    
  • Lower blood pressure
    
  • Lower cholesterol
    
  • Improve your quality of sleep
    
  • Strengthen bones and muscles

Chew food slowly and savour the flavour - you are now eating small amounts of great quality food.

Enjoy it!