DISCLOSURE DOCUMENTS: SECTION 10

You have just undergone a Laparoscopic Gastric Bypass with Roux en Y, and you are about to embark on a new “Lighter Lifestyle”. The surgery has provided you with a new tool to lose weight. Now, it is up to you to learn how to use this tool. The physical aspect of the surgery is tolerated very well. The emotional component of the surgery is more complex and will require your willingness to formulate new eating habits. It is not easy to “break” life-long, poor eating habits. You do not break habits; you learn new habits. You have made the commitment to change the way you eat. Now you must be dedicated to achieving this goal of establishing healthy eating and exercise plans. 

The first two weeks after surgery you may become confused, frightened and frustrated. The following suggestions are intended to minimize these feelings. Each patient is different. You cannot compare yourself to other patients who have had the same surgery. There is no specific postop “diet”. This is a new way of life. You need to discover what works best for you.

WEEKS ONE AND TWO POSTOP

1. Liquids Only---One of the main challenges after a gastric bypass is to maintain hydration. You should try to drink at least one liter of fluid per day. Liquids should be consumed on a near-constant basis. Initially, due to the size of your new stomach, you will need to sip your liquids. A child’s sipper cup or straw is very useful during this period. The emphasis should be on calorie-free liquids such as:

 

Also, your goal should be to consume 40+ grams of liquid protein per day. There are a multitude of protein drinks available. You need to find a protein supplement that agrees with you. Remember to sip all liquids SLOWLY.  The following suggestions may be helpful:

 Designer’s Protein Smoothie (GNC)

Challenge protein liquid (GNC)

Protein drink

-         1 package Carnation sugar-free instant breakfast

-         8 oz nonfat milk

-         2 tablespoons egg protein powder (GNC)

-         ½ frozen banana or other frozen fruit

-         place in blender and blend

·            Additional Protein Fluids

-         Creamed soups with nonfat milk

-         Sugar-free pudding

-         Yogurt (low fat and low sugar)

-         Yoplait Expresse

-         Sugar-free cocoa

-         Milk (skim, 1%, buttermilk)

·        Vitamins

-         Two chewable multivitamin/mineral supplements daily (Flintstones or chewable Gummy Bear vitamins [Trader Joe’s/Costco])

-         B-12 sublingual 1000 mcg daily (Trader Joe’s)

-         Four Tums for calcium daily

2.  Exercise---You need to walk at least one mile a day. The more you walk the better it is for you. This cannot be emphasized enough.

Water, protein and cardiovascular exercise are the crucial combination for your new Lighter Lifestyle.

WEEKS THREE AND FOUR POSTOP

1.  Soft foods

For the next two weeks you can add foods high in protein that are soft or crispy. Continue to eat very SLOWLY and to eat small amounts.  Learn to recognize when you are full, and at this point stop eating. Do not force food as this will place  stress on your new stomach pouch which can hold about one ounce, approximately the size of a shot glass or five bites of food. To have that “second bite” once you are full could distend your pouch and make you feel miserable. If you experience this, use it to learn how much of different kinds of foods it takes for you to feel full. To avoid this “miserable” feeling, train yourself to recognize the adequate amount of food it takes to feel full while it is still on your plate. There is a delay of approximately five  minutes from the time your stomach pouch gets comfortably filled to the time your

brain recognizes this full sensation. You need to learn from your eating experiences. Use your memory and eyes to recognize when to stop eating, before you feel full.

Remember this is a learning process; you have to learn how to eat with your new stomach pouch.

 

Psychologically, it is helpful to use a small plate and eating utensil for your meals. Put your fork or spoon down in between bites. Focus on eating and avoid distractions.

Do not drink fluids during meals and wait 30 minutes before or after the meal before drinking. Each meal should take between 20-30 minutes to eat. Taking less time means the meal was eaten too quickly, or was too small, and you will soon be hungry again. Taking more than 30 minutes to chew your meals means too much food has been eaten at one sitting. Liquids should be taken before solids i.e., a breakfast of coffee and a scrambled egg---drink the coffee first, then eat the egg.                         

    The following are examples of soft foods:                            

·        Dairy products

-         Low-fat cheese i.e., string cheese (avoid hard cheeses)

-         Yogurt (low fat and low sugar)

-         Cottage cheese (variations: add salsa, diced hard boiled egg, unsweetened applesauce, etc.)

-         Avoid ice cream/ice milk, any type of cream, whole milk

·        Eggs

-         Scrambled

-         Egg salad

-         Soft boiled/poached

-         Egg Beaters

-         Egg drop soup

-         Avoid fried eggs

·        Vegetables

-         Any soft-cooked vegetables

-         Avoid avocados, olives, green beans, raw vegetables

·        Legumes

-         Beans

-         Lentils

-         Peas

-         Examples: bean soups, split pea soup, “fat-free” refried beans

·        Animal Protein

-         Potted meats (Underwood Deviled Chicken, spreadable, soft meats)

-         Tuna (tuna salad, tuna with salsa, Starkist tuna salad lunch kit, etc.)

-         Deviled ham

-         Chicken salad

-         Pates

-         Liverwurst

-         Shrimp cocktail

-         Avoid oil packed protein

2.  Crispy Foods---Foods that will disintegrate if placed in water

Note: you can combine soft & crispy foods i.e., egg salad on crispy toast, refried beans on baked tortilla chips, tuna fish on crackers.

3. Miscellaneous Tips:

WEEK FIVE POSTOP

At this time, you can resume a REGULAR diet that is low in fat and sugar. Even though your stomach pouch is properly healed, it is still possible to weaken or over-distend the pouch. You must continue to be careful about what and how you eat. Intolerance to certain foods (Dumping) is individual, but often temporary. If you overeat or if you eat something that does not agree with you, the stomach pouch will be irritated for 12-24 hours. Allow the stomach pouch to recover by drinking clear liquids only for the next meal or two. Follow this regimen whenever your stomach pouch is irritated.

Since the quantity of your intake is limited, it is very important you eat highly nutritious foods. All meats, poultry and seafood can now be eaten. These solid proteins will meet your nutritional needs, and are the best foods to give you a feeling of satiety. When the pouch is filled with food, it sends signals to the brain that say hunger is satisfied---no additional food is necessary.

Two new habits must be learned:  1.Cut each piece of solid protein to the size of an eraser on a pencil, and 2. chew each piece of solid protein until it resembles the texture of pureed food before swallowing. These two new habits may take several weeks to develop before you feel comfortable doing them. Eating such small amounts of foods may seem strange, but it is all you need to be healthy and will promote maximum weight loss.

You should minimize your intake of simple carbohydrates i.e., pasta, rice, potatoes, bread, because of their effect on blood sugar. Simple carbohydrates are close relatives of sugar; the calories in these foods are easily absorbed into your system. This causes the blood sugar to go up quickly which could result in hypoglycemia.

It is crucial to form healthy eating habits during the first few months after surgery. These good habits will promote further weight loss. The first six months postop you do not have control of your weight. You lose weight automatically. The stomach pouch cannot handle enough calories to maintain weight. This is referred to as the “honeymoon” period after a gastric bypass. Your appetite and food capacity will gradually increase, signaling the end of the honeymoon period and a transition to your new life-long, Lighter Lifestyle eating habits. It is at this time you will be able to utilize the new eating habits you formulated during the first few months. Create new eating habits utilizing the type and amount of foods that work well for you approximately three months following your Gastric Bypass. Adhere to these habits over the next several years to obtain excellent weight loss and health. 

As you continue to eat restricted amounts of food, you will continue to lose weight. The key to successful weight loss is a “THREE MEALS A DAY” regimen with a fruit snack at 3-4 o’clock (if necessary). Eating between meals or grazing will cause this surgical procedure to fail.

Remember this formula as a key to successful goal weight --- 40+ grams of protein per day, at least one liter of water per day, and cardiovascular exercise, 45 minutes a day, five days a week. The goals of the long-term Gastric Bypass diet are:

You have been given the “tool” (your stomach pouch) to achieve a lower, healthy body weight and to maintain it. You will lose approximately 80-85% of your excess body weight within a 12-18 month period. In the early postop stages, you may get carried away and become fanatical about your successful weight loss. This is understandable since you probably have never experienced such weight loss success. Stay focused and be realistic about your goal weight. Do not become fearful or anxious when your weight loss slows down or you encounter a plateau (no weight loss). Continue with your new eating habits and increase your water intake and exercise. Eventually, you will break the plateau and continue to lose weight.

As you continue to lose weight, new emotional layers will be exposed, and you may become perplexed as to how to deal with them. Your coping mechanisms to alleviate stress have changed. You can no longer turn to food to satisfy unmet needs of boredom, loneliness, sadness, anxiety or anger. You need to develop new stress releases such as walking, gardening, reading, hobbies, or classes. The emotional aspect of this surgery is very intense. You need to discuss your feelings. You will have good and bad days. If you become depressed, and it persists and affects the quality of your life, do not hesitate to seek professional help. You are going through a “mourning period”; you are mourning the loss of your old eating habits.

It has taken tremendous courage on your part to undergo the Gastric Bariatric surgery. It is not the easy way out; there is nothing easy about being morbidly obese. You have made the commitment to begin your new, Lighter Lifestyle and with perseverance you will come to realize that the results are well worth it.