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Care Plan – Bariatric Surgery

Bariatric Diet

The bariatric diet is designed for patients who are recovering from bariatric surgery to help them properly lose weight and help change their eating habits. Your doctor or a registered dietician can help you with Bariatric Diet by guiding you with the appropriate post-op meal planning. Such a diet specifies what types of foods and how much of it you can eat at each meal.

Closely following your bariatric diet can help you lose weight safely and efficiently. To succeed in long term you will have to make permanent eating habit and life style changes.

Purpose

The bariatric surgery diet has several purposes.

  • To get you accustomed to eating smaller meals that is designed for your comfort and safety of your smaller stomach.
  • To help you with proper post-surgery weight loss and to avoid gaining weight in long term.
  • To take care of your daily nutritional requirements.
  • To prevent you from remaining hungry for more than 2 – 3 hours and to take care of your long-term nutritional requirements.
  • To prevent the feeling of weakness at any given point of time after your surgery and during the weight-loss period.
  • To avoid any post-surgery complications.
  • To aid your stomach heal after the surgery.
  • The diet is designed so as it takes care of your skin quality and hair quality. The laxity of skin after a bariatric surgery is a common problem, which can be reduced by a healthy diet intake.

Post Op Bariatric Sugery Diet

Bariatric surgery diet is designed to restrict your caloric intake in order to achieve desired weight loss, help you develop appropriate eating habits, and prevent disruption of your new pouch. This diet contains foods and liquids that can be easily prepared at your home. Usually fancy products and preformed foods are not advised, as it may be cumbersome for some patients to go to the market. Also, these packaged foods tend to be higher in total carbohydrates, sugars & trans-fatty acids, and low in protein content, which are inappropriate for you during post-surgery weight-loss period.

Such a diet will advance gradually, depending on your tolerance:

Phase I Clear liquid diet
Phase II Full liquid diet
Phase III Pureed diet
Phase IV Soft diet
Phase V Regular diet

Foods Allowed VS. Foods To Avoid

FOOD GROUP
FOODS ALLOWED
FOODS TO AVOID
BEVERAGES Water, coconut water, lemon water, vegetable/chicken
soup, herbal teas, tea, coffee – decaf
All carbonated or high sugar beverages, caffeinated beverages
Cereal Sooji porridge, pureed/thinned daliya, oats porridged
with skim milk, pureed khichadi
All others, especially bran
Dairy Low fat milk, buttermilk, yogurt, pureed/grated paneer,
cow milk and products (as tolerated)
Full cream milk and products
Eggs Scrambled, soft cooked, poached Fried egg, egg yolk
Fruits & juices Papaya, steamed/stewed fruits like apple, pear Fruits with skin and seeds like guava
Vegetables All cooked and pureed- avoid corn Raw & whole vegetables
Protein Washed daals, chicken, fish, egg white, paneer, soya
products like soy flour,soy milk, tofu
Undercooked whole pulses, mutton, beef, pork
Soups Home-made strained soups Cream soups, packed soups, soups made using maida & corn flour
Desserts Sugar-free puddings, thinned custard – sugar free Any dessert with nuts,coconut, whole fruit or seeds; sugary or high fat desserts
Sugar & sweets Sugar substitutes like sugar free, equal, splenda Sugar, honey, molasses, maple syrup, jaggery
Miscellaneous Salt, mild herbs, seasonings Chili powder, cloves, pickles, garammasala

Nutrients Of Importance

Water:

Water is one of the most important nutrients. Approximately 70% of the body is comprised of water. Without adequate hydration, nothing in the body can function properly. Water contains no calories or no carbohydrates. It assists the excretory system in flushing out toxins.
Most patients find that lukewarm water goes down easier than cold water.
If water does not taste good after surgery, you may add lemon or lime to add flavor.

Requirement: 6-8 glasses/day

Protein:

Proteinis the second most plentiful substance in the body next to water.

Functions:

  • It helps with the growth and maintenance of muscles, blood, internal organs, skin, hair, and nails.
  • It is also vital for the production of hormones, enzymes, and antibodies.
  • Essential body processes such as water balancing, nutrient transport, and muscle contractions require proteins
  • Protein is required as a source of energy

Sources: Common sources of protein are lean meats, poultry, eggs, paneer, beans, whey water, soya bean and skimmed milk.

Carbohydrates

Carbohydrates are not all created equal. Some are good for us; some are not, as they can promote weight gain and ill health. Carbohydrates can be categorized in two forms: those containing a low glycemic index (the good, also known as complex carbohydrates), and those containing a high glycemic index (the bad, also known as simple carbohydrates). High glycemic index carbohydrates have been implicated in many chronic diseases, such as type II diabetes, high blood pressure and heart disease. They tend to cause large swings in blood sugar levels.

The carbohydrates you should avoid are as follow:

  • All processed foods, white foods, starches and sugars
  • Bread, starchy vegetables (potato, yams, sweet potatoes), fruit juices, soft drinks, sweets and desserts

The carbohydrates that have low glycemic index and are encouraged are:

  • Whole fresh fruits
  • All fresh non-starchy vegetables
  • All whole grains, nuts (almonds, walnuts, sunflower seeds, flax seeds)

Low glycemic index/complex carbohydrates are necessary in the diet to prevent nutritional deficiencies, energy loss, depression and loss of body proteins.

Vitamins & Minerals:

After bariatric surgery, the small stomach pouch does not allow to eat enough to get adequate nutrition. Additionally, the malabsorptive part of the surgery decreases the body’s ability to process vitamins and minerals.

In order to have a change of getting enough vitamins and minerals, supplements must be taken for the rest of the life. Common deficiencies after a bariatric surgery are vitamin B1, folic acid, vitamin B12, iron, and calcium.

Vitamin B1 (Thiamine):

Thiamine is needed for energy metabolism and proper functioning of the nervous system. Thiamine deficiency may occur after weight loss surgery due to reduced acid production, restriction of food intake and frequent vomiting. This may lead to nerve problems and memory loss. Make sure your multivitamin contains sufficient thiamine, especially if you are vomiting frequently after surgery. These supplements will likely be needed for the rest of your life. Do not stop taking them without discussing with your bariatric surgeon.

Sources: whole grains, oatmeal, soya bean, peas, liver, kidney, legumes, fortified breakfast cereals, cauliflower, potatoes, oranges, eggs

Folic Acid:

Folate is a water-soluble vitamin, and therefore it is not stored in the body in significant quantities. Many patients experience a decrease in folate levels following a restrictive bariatric surgery, as their limited food intake fails to fulfill their folate requirements. Unlike vitamin B12, folate is absorbed through the small intestine. Therefore, malabsorptive procedures are not necessarily likely to promote a folate deficiency. However, vitamin B12 is needed to convert folate to its active form, so a vitamin B12 deficiency can lead indirectly to a folate deficiency.

Sources: green, leafy vegetables such as spinach, asparagus, Brussels sprouts, broccoli, strawberry, oranges, meat and liver.

Vitamin B12:

Roux-en-Y Gastric Bypass surgery is known to have a significant effect on B12 absorption. Studies show that about one-third of surgery patients experience a B12 deficiency one year after the surgery. It develops quickly, with little warning and it can become dangerous. B12 deficiency can lead to pernicious anemia, peripheral neuropathy, paralysis and depression. Therefore it is important to consume foods mentioned below regularly, as well as take vitamin B12 supplements as per your doctor’s recommendation.

Sources: meat, milk, eggs, soya milk, tofu

Iron:

Iron deficiency is common particularly among bariatric surgery patients. To compensate for a potential iron deficiency, a multivitamin with iron and vitamin C is recommended.

Avoid excess intake of tea as the tannins found in tea may decrease iron absorption. Maintain intake of iron rich food sources, some of these are mentioned below.

Sources: meat, dark green and leafy vegetables, spinach, raagi, dry-fruits.

Calcium:

Calcium is necessary for healthy bones, teeth, and nerve transmission. Most patients do not get enough through their diet. Some foods high in calcium are as follow:

Sources: skimmed milk and milk products, dark green leafy vegetables, drumsticks and eggnog

Exercise

The key to weight loss is expending more calories than consumed. Walking is an excellent way to start an exercise program. So, commit to an exercise plan even before going under the surgery, and continue afterwards. Many studies have shown that increasing lifestyle activities can have the same effect on overall health as a structured exercise program. For example

  • Taking stairs instead of the elevator.
  • Parking at the far end of the parking lot and walking to the office or store.
  • Getting up from the desk to deliver a message instead of using e-mail or intercom.
  • Walking to nearby places to do errands instead of driving.

Follow Up

Follow-up after bariatric surgery is a very important part to your success and health. During your follow-up visits the surgeon and dietitian will meet with you to discuss your progress, catch potential problems, ensure you understand what to do, check lab work, and give you an opportunity to ask questions.

A routine follow-up schedule would consist of:

  • A visit the next day after discharge
  • 7 day Post-op follow-up visit
  • Every 3 months over the next 12 months
  • Every 6 months during the second year
  • Long term we recommend bi-annually or at least once a year

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