Johns Hopkins bariatric recommendations

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I'm going to paste the most important stuff here, but the whole file is worth reading:

Nutrition Guidelines for Weight Loss Surgery

Why should I follow these recommendations?

1. Help to prevent nutritional deficiencies that may result from a decreased intake of food, maldigestion and/or malabsorption of nutrients.
2. Help to achieve the maximum amount of weight loss.
3. Help to prevent nausea, vomiting, dehydration, hair loss, dumping syndrome and other potential side effects

Getting Ready for Surgery…

It is a good idea to start making changes before surgery to help you prepare for your new lifestyle after surgery.

1. Chew your food thoroughly. This becomes very important after surgery. With the reduction in the size of your stomach and other changes in your anatomy you must be able to chew food to a liquid consistency before swallowing. Not chewing your food enough could result in pain, nausea and vomiting.

• Start with smaller bites. Cut food into tiny pieces (i.e. pencil eraser-size) and/or use a small utensil (i.e. child’s fork) to control bite size.
• Chew each bite approximately 20 times or until liquid.

1. Practice eating slowly and stop eating when you feel full or comfortably satisfied. After surgery, it is important to eat slowly in order to recognize your feeling of fullness and prevent intolerance. When you feel a pressure in your upper stomach area, this is your new full feeling. If you experience pain, you probably took one too many bites, or perhaps ate too quickly.

• Sit down and focus on eating. Avoid activities (i.e. reading, watching TV, on computer) where you can become distracted. Practice mindful eating.
• Savor each bite, noting its aroma, flavor and texture. Engaging all your senses can increase satisfaction and help prevent over eating.
• Put your fork down between bites.

1. Practice sipping beverages slowly and drink between meals. Drinking too quickly, gulping and/or drinking too soon after eating solid food may cause pain, discomfort or other intolerances.

• When you return home after surgery it may seem difficult to get fluids in initially because of inflammation. Aim for 4-8 oz of fluid over an hour.
• Eventually you should be able to take 8 oz of fluid over 5-15 minutes.
• Drinking fluids before the meal is OK.
• Avoid fluids during the meal.
• Wait 30 minutes after the meal is over before you resume drinking.

● Straws, especially large straws, may introduce air into your stomach (like gulping) and cause bloating or discomfort.

1. Drink adequate amounts of fluids to prevent dehydration. Fluid needs are individual and some people may require more fluid to maintain adequate hydration than others. Your dietitian can help determine the amount of fluid that is best for you.

• Aim for at least 64 ounces (oz) per day unless you have been given a higher goal.
• Increase your fluid intake if you are having signs or symptoms of dehydration:

decreased or dark urine, nausea, headache, dizziness, lack of energy, dry skin, dry mouth or a white coating on the tongue.

1. Wean off of beverages containing carbonation, caffeine, sugar and alcohol.

Carbonation may cause abdominal discomfort and may stretch out your new stomach over time. Caffeine may irritate the stomach and increase your risk for an ulcer after surgery. Caffeine as well as alcohol may also contribute to dehydration. Beverages containing sugar and alcohol are high in calories and will hinder your weight loss. They may also cause Dumping Syndrome after the Gastric Bypass procedure. And last but not least, alcohol metabolism is altered and you may feel the effects more quickly.

• Water is a great beverage choice! If you are having trouble tolerating plain water, try adding a wedge of citrus fruit or sliced cucumbers.
• Sugar free or light beverages with less than 10 calories per serving are also appropriate.
• Try beverages sweetened with artificial or non-nutritive sweeteners.
• Try True Lemon/Lime/Orange® for touch of flavor without artificial sweetener.
• Switch to decaffeinated coffee and tea.
• Avoid ALL beverages with carbonation, even diet soda and sparkling water.

• If you choose to drink alcohol in moderation after surgery, please do not plan on driving.

1. Read food labels. Begin by identifying the amount of sugar, fat and protein in a particular food.

• Sugar

Food and beverages high in sugar will slow down the rate of weight loss and may even cause weight re-gain. For patients having Gastric Bypass surgery, food and beverages that are high in sugar may cause symptoms of flushing, dizziness, weakness, headache, nausea, vomiting, diarrhea and abdominal discomfort known as Dumping Syndrome.

• Avoid high sugar foods such as sweets, candy, fruit drinks and sodas.
• Limit foods that contain sugar in the first 3 ingredients on the food label.  Aim for no more than 15 grams of sugar per serving.

• Sugar alcohols

Sugar alcohols are sometimes used in foods to provide a sweet taste without the calories of sugar. You may find sugar alcohol in sugar free foods such as sugar-free candies, cookies, ice cream and chewing gum. You may even find sugar alcohol in foods not labeled sugar free such as protein bars. If a product contains sugar alcohol the type (i.e. sorbitol, xylitol, mannitol, maltitol, starch hydrolysates, etc.) will be included on the list of ingredients and the amount will be included on the nutrition facts label. Limit sugar alcohol to less than 10 grams per serving as greater amounts may lead to cramping, abdominal pain, excess gas and/or diarrhea.

• Fat

Food and beverages high in fat are high in calories and like sugar will slow down the rate of weight loss and may even cause weight re-gain. High fat intake may also cause symptoms of intolerance or Dumping Syndrome.

• Avoid obviously high fat foods such as fried foods; fast food; snack chips; high fat meats like bacon, sausage, hot dogs, bologna, pepperoni and wings; cream soups and sauces like Alfredo; whole milk, ice cream; donuts; cakes; cookies; and pastries.
• Choose foods that are labeled “light”, “low fat” or “fat free”.
• When looking at a food label…Choose foods with 5% or less of the Daily Value (DV) for total fat. Avoid foods with 20% or more of the Daily Value for total fat. These would be considered a high fat foods.
• Choose lean cuts of meat. Lean cuts include round, chuck, sirloin and tenderloin and meats that are greater than 90% lean.

• Protein

Protein is important for wound healing, immune function and maintaining muscle mass. Needs are individual but ranges of 60-80 grams or 80-100 grams per day are often suggested. Your dietitian can help determine the amount of protein that is best for you. Protein should be consumed first at each meal, then vegetables and fruits, then whole grains.

• Eat protein with each meal.
• Eat protein foods first. Take 2-3 bites of protein followed by a bite of vegetable or fruit and then a bite of starch/whole grains.
• Avoid dry meats, they are usually not tolerated well.

1. Explore, purchase and begin taking protein supplements (see handout).

Choose supplements with:

• At least 20-30 grams of protein per serving.
• Less than 5 grams of sugar per serving.
• Less than or equal to 200 calories.
• IPlease account for the additional calories of any fluids or foods mixed or blended in (i.e. fruit, yogurt, peanut butter, milk, etc).

• Choose whey protein isolate over whey protein concentrate and milk protein concentrate if you are lactose intolerant or feel symptoms of gas, bloating or are having loose bowel movements after surgery. Whey protein isolate is absorbed well and has no lactose or milk sugar.
• Avoid and/or limit products with collagen (not a complete protein).
• If you mix protein powder with skim or 1% milk you will get an additional 8 grams of protein per 8 oz.

1. Explore, purchase and begin taking vitamin and mineral supplements.

Vitamins and minerals are not only important for good health but also for maximum weight loss and long-term weight maintenance.

• Begin taking a multivitamin (MVI) now if you do not already. Look for a MVI that contains 100% Daily Value for iron (18mg), folic acid (400mcg), thiamine (1.5mg) and copper (2mg).
• Vitamins and minerals are absorbed differently after surgery therefore daily supplementation is needed for the rest of your life. See surgery specific handout for recommendations after surgery.
• 9 include physical activity in your daily routine. Exercise is recommended as a life-long habit and is known to improve over-all health, mood and sense of well-being as well as maximize weight loss. And, a more toned body before surgery can help reduce excess skin after surgery. The American College of Sports Medicine recommends:

30-60 minutes of moderate aerobic activity at least 5 days a week. One continuous session or multiple shorter sessions of exercise can achieve the same goal.​

Strength training 2-3 days a week. Use a variety of exercises and equipment to work each major muscle group.​

Before beginning any exercise routine, please consult with your doctor to make sure it is safe for you to exercise.​

1. Establish support. Social support is associated with increased weight loss after weight loss surgery.

• Involve family and friends in appointments before and after surgery. They can provide encouragement and help you achieve your goals for a healthier lifestyle.
• Multiple studies show Support Group attendance after weight loss surgery is associated with greater post-operative weight loss. Johns Hopkins Bariatric Center holds Support Groups on the 2nd and 3rd Thursday of the month from 5-6pm.
• Remember to see health care providers regularly.

from Johns Hopkins, available online.​