Tips to Remember FOREVER - University of Rochester

Highland Hospital Bariatric Surgery Center

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3 MONTH – 6 MONTH BARIATRIC LIFESTYLE MEAL PLAN (1000 – 1300 Calories Daily) (60 Grams Protein Daily)

• 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.

Tips to Remember FOREVER

The bariatric meal plan consists of three small well balanced 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 daily

LOW FAT / LOW SUGAR


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Potential Problem Foods

Some foods have difficulty passing through the opening of the stoma and may cause blockage if not chewed well. Potential problem foods should be eaten with caution. These foods should be cooked well and cut into small 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 like to eat asparagus or other fibrous foods once in a while, then you must be sure to cook them well, cut them into very small pieces first and then chew thoroughly.

SAMPLE MEAL PLAN

Breakfast

1 egg scrambled w/ diced tomato & 1 Tbsp avocado

Snack

1 light, low-fat yogurt

Lunch

2-3 oz. tuna with light mayo, cucumber slices

Snack

low fat cheese stick and apple slices

Dinner

2-3 oz. chicken with 1/2 cup broccoli

Snack

¼ - ½ cup low-fat cottage cheese w/ ¼ cup allowed fruit

Note: If not consuming at least 60 grams of protein in the meal plan you may continue to use 1 protein drink/day.


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F O O D G R O U P S & D A I L Y S E R V I N G S

PROTEIN *minimum 8-9 ounces dai ly

Lean Meats Meat Substitutes Dairy (Low Fat) recommend 3 servings daily

FRUITS 1 – 3 servings dai ly

VEGETABLES 3 or more servings dai ly

STARCH (WHOLE GRAINS) 0 – 2 servings dai ly

FATS 3 – 4 servings dai ly


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Lean MeatsChicken (No skin) 3 oz. protein Poultry skin, duck, goose, Turkey (No skin) 3 oz. protein wings, dark meatFish/Seafood 3 oz. protein Fish fry, battered fish Water packed tuna 3 oz. protein Fish canned in oilVenison 3 oz. protein Breaded meatsLean beef, pork, or veal 3 oz. protein Bake, broil or grill loin Spareribs, hot dogs, bacon, or round cuts sausage, pepperoni, ham hocks Prime cuts of beef, well-marbled meats, chuckCanadian Bacon 3 oz. protein Salami, bologna, liverwurst

Meat Substitutes Eggs: Egg whites 2 = 1 oz. protein Whole egg (with yolk) 1 = 1 oz. protein Eggbeater ¼ cup = 1 oz. protein Legumes (Beans) ½ cup = 1 oz. protein Peanut butter or nut butter 2 T. = 1 oz. protein Quinoa 1 cup = 1 oz. protein and 2 starches Veggie Burger 1 patty = 2 oz. protein Bean based soup 1 cup = 1 oz. protein Tofu ½ cup = 1 oz. protein Nuts ¼ cup = 1 oz. protein

Dairy (Low Fat) 3 servings/day Milk – 1% or Skim 8 fluid oz. = 1 oz. protein Whole or 2% milkSoy Milk 8 fluid oz. = 1 oz. protein Chocolate milkFlavored Yogurt: light, low fat 6 – 8 oz. = 1 oz. proteinFlavored Greek Yogurt: light, low fat 6 oz. = 2 oz. protein Plain Yogurt, low fat 6 – 8 oz. = 1 oz. proteinPlain Greek Yogurt, low fat 6 oz. = 2 oz. protein Cheese – low fat 1 oz. = 1 oz. protein Regular cheeseRicotta cheese – low fat ½ cup = 2 oz. proteinCottage cheese – low fat ½ cup = 2 oz. protein 4% milk fat cottage cheese

PROTEIN *Minimum 8 – 9 oz. Protein Equivalents per day

Adequate daily protein intake is essential for optimum nutrition, recovery and long-term health.

FOOD CHOICES PORTION SIZES TIPS OMIT

*Based on Individual Needs


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VEGETABLES 3 or more servings dai ly

FRUITS 1-3 servings dai ly


Non-Starchy Vegetables Vegetables prepared in cream or cheese sauceDark Green: broccoli, greens, 1 cup leafy raw vegetables Fill half your plate Leafy green vegetables cooked dark green leafy lettuce, spinach with vegetables. with fatty meats (Try skin-free smoked turkey, liquid smoke, or skimmed chicken broth.)Red & Orange: carrots, ½ cup cooked vegetables red peppers, tomatoes Fried vegetablesOther: asparagus, beets, You can have unlimited Satisfy your appetite by Brussels sprouts, cabbage, amounts of non-starchy choosing more vegetable cauliflower, celery, cucumbers, vegetables. servings. eggplant, green or wax beans, mushrooms, okra, onions, turnips

Starchy VegetablesBecause of the high starch Choose raw vegetables content vegetables such as to increase fiber intake. potatoes, corn, and peas do not count as a vegetable but, instead, count as a starch.

Fruit Fresh fruit 1 mediumFresh berries 1 cupMelon cubes 1 cupGrapes 15Canned fruit ½ cup (packed in water or juice) – no sugar addedFrozen fruit – no sugar added ½ cupDried fruit ¼ cupFruit juice – no sugar added Maximum ½ cup/day


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STARCH (WHOLE GRAINS) 0–2 servings dai ly


Cooked pasta ½ cup Choose whole grain products Pasta and rice dishes with butter, cream, or cheese sauce

Cooked rice ½ cup Chow mein noodles, Fried rice, Ramen noodles Hot cereal ½ cup Lentil/Bean soup ½ cup Cold Cereal (no sugar coating) 1 cup Broth or 1 cup Tomato based canned soup 98% fat free cream soup 1 cup made with fat free milk Bread 1 slice Choose breads and cereals Donuts, Danish, biscuits, English muffin ½ each with 2 grams or more of muffins, croissants Hamburger roll ½ each fiber/serving Hot dog roll ½ each Small bagel ½ each Pita ½ each Waffle 1 (4 inch) Pancake 1 (4 inch) Tortilla 1 (6 inch)

Starchy Vegetables Corn ½ cup Peas ½ cup Potatoes ½ cup French fries, home friesSweet Potato ½ cup Winter Squash ½ cup Legumes (kidney beans, lentils, ½ cup Lima beans, etc.)


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FATS 3–4 servings dai ly


Canola, olive, sesame, 1 teaspoon Because fat is the most Palm oil or peanut, grapeseed or concentrated source of avocado oil calories, closely monitor portion sizes. Butter or margarine 1 teaspoonLight margarine 1 Tablespoon Mayonnaise 1 teaspoon Fat backLight mayonnaise 1 Tablespoon Pork RindsSalad dressing 1 Tablespoon Use horseradish or mustard LardReduced fat salad dressing 2 Tablespoon on sandwiches to replace Sunflower seeds 1 Tablespoon mayonnaise. Ground flaxseed 1 TablespoonParmesan cheese 2 Tablespoons Use non-fat vegetable or CreamLight sour cream 2 Tablespoons margarine spray Half & HalfLight cream cheese 2 Tablespoons Whipped toppingNuts 2 Tablespoons Sour creamPeanut butter/nut butter 1 TablespoonAvocado 1/8 or 2 Tablespoons Cream cheeseLarge olives 8

MISCELLANEOUS Calorie free sweetener as desired Read food labels to check Sugar, brown sugar, honeySpices as desired for added sweeteners maple syrup, molasses,Herbs as desired and avoid those with corn syrup, high fructoseSugar free jam or jelly 2 Tablespoons ingredients on the Omit List. corn syrup, jam or jellySugar free syrup 2 Tablespoons

BEVERAGES Water, flavored water Drink 6 – 8 cups/day for Sip slowly (no more than CarbonationDecaffeinated coffee adequate hydration one ounce at a time) Caffeine (no moreUnsweetened, decaffeinated tea than 6 oz./day) Sugar Free beverages Sweetened beverages


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SNACKS/DESSERTS

Snack guidelines per serving: 100 - 150 calories less than 5 grams of sugar less 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.org

KEEPING 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 week

Strive 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 lots

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PROTEIN TALLYSERVING PROTEIN GRAMS OF KCAL PROTEIN DAY’S SIZE SOURCES PROTEIN OZ. TALLYLEAN MEAT3 oz Chicken Breast 26 140 3 oz. Chicken thigh- no skin 19 140 3 oz. Chicken sausage 14 150 2 oz. Turkey light meat 19 135 3 oz. Turkey grounded 90% lean 14 122 2 oz. Turkey deli meat 14 90 2 oz. Turkey sausage 23 195 3 oz. 2 oz Turkey bacon 8 140 1 oz. 2oz Canadian bacon 10 70 2 oz. 3 oz Beef 95% lean sirloin 24 160 3 oz. 3oz Beef ground, 95% lean 22 140 3 oz. 3 oz Pork Loin, chop 24 177 3 oz. FISH SEAFOOD3 oz Fish - tuna, haddock, salmon etc. 20 100 3 oz. 3oz Shrimp 17 80 3 oz. 3oz Scallops 22 120 3 oz. DAIRY½ cup Cottage Cheese low fat 14 80 2 oz. ¼ cup Ricotta Cheese low fat 9 113 1 oz. 1 oz Cheese low fat 8 100 1 oz. 1oz Cheese stick mozzarella made with 1% 7 85 1 oz. 6 oz Yogurt light, low fat or plain 5-7 80-100 1 oz. 6 oz Greek Yogurt- light, low fat, plain 15 100 2 oz. 1 cup Milk skim or 1% 8 80–100 1 oz. EGGS2 Egg whites 7 35 1 oz. 1 Egg 6 80 1 oz. ¼ cup Egg beaters 6 30 1 oz. BEANS 1 cup Lentil soup 9 150 1 oz. ½ cup Refried Beans no fat 7 120 1 oz. ½ cup Beans (variety) 7 100 1 oz. ½ cup Split Peas 8 120 1 oz. 2 tbsp Peanut butter 8 200 1 oz. SOY PRODUCTS / MEATLESS / VEGETARIAN1 Vegetarian meatless burger 15 130 2 oz. 2 Morning Star sausage links 9 80 1 oz. 1 cup Soy Milk 7 100 1 oz. 4 oz Tofu 8 117 1 oz. 1 oz Nuts 7 159 1 oz.

DAY’S TOTAL PROTEIN

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HELPFUL HINTS – 2-3 MONTHS AFTER SURGERY

CALL 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 THE

EMERGENCY ROOM. IF YOU HAVE QUESTIONS OR CONCERNS THAT ARE NOT LIFE THREATENING, PLEASE CALL THE

OFFICE BEFORE GOING TO THE EMERGENCY ROOM (585-341-0366).

MEDICATIONS Gastric Bypass Sleeve Gastrectomy

Complete Multivitamin/ Mineral OR Celebrate One/60 chews or tabs

2x daily for the rest of

your life OR

Celebrate 60, twice a day for the rest of your

life

2x daily for the rest of your

life OR

Celebrate One, once a day for the rest of your life

Calcium citrate 600 MG/ Vit D400 IU (Total of 1200-1500 mg daily)

2x per day for the rest of

your life

2x per day for the rest of

your life

Calcium Carbonate can be

used but should be taken with food.

Ursodiol – helps you to avoid gallstone formation

• 2x per day for 6 months, only if you have a gallbladder

Iron Ferrous sulfate 325 mg daily (Total of 65 mg elemental iron daily)

1x daily

If you are taking Celebrate you do not

need to take additional iron

Your provider will let you know if you need to take

this

Separate calcium and iron by 2 to 3 hours for best

absorption of both minerals

Vitamin B12 1000 mcg daily

1X daily

If you are taking Celebrate, you do not

need to take this

1X daily

If you are taking Celebrate, you do not

need to take this

.

Thiamin (B1) (minimum of 12 mg daily)

1x daily if you are NOT

taking a bariatric specific vitamin

1x daily if you are NOT

taking a bariatric specific vitamin

Doses are usually 50 to 100

MG

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HYDRATION

• It is important that you drink 64 ounces of fluid each day. Not getting the recommended daily fluid intake can cause nausea, headaches, decreased energy levels and constipation.

DIET- Lifestyle Bariatric Meal Plan • Now that you are resuming the lifestyle meal plan all foods will gradually be re-introduced one new food at

a 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 2-3

servings 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.

PROTEIN

• Pre-planning menus will help you consume all of your required protein (at least 60 grams) and nutritional needs for the day. It is recommended that you periodically keep a food diary and calculate the amount of

protein and calories you are consuming.

HYPOGLYCEMIA • If 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 1-3 hours 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 Drugs • Do 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. EXERCISE

• Aim for at least 30 minutes of exercise 5 days per week. A good fitness routine will include a combination of flexibility, cardio and strength training.

CONSTIPATION

Constipation is common after bariatric surgery due to iron supplement, pain medication, decreased fluid intake and decreased fiber intake. What you can do:

• Increase your fluid intake • Increase 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 your diet plan.

• If you have not had a bowel movement for 2-3 days and if you are not taking Colace or Miralax, start with Miralax and Colace twice per day. If you do not have results and you feel bloated and uncomfortable, you may 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 magnesia o Magnesium citrate

o Dulcolax pills or suppository o Fleets enema

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BOWEL MOVEMENTS Bowel movements after bariatric surgery tend to be varied (they may be frothy, foamy, hard, floating to top of toilet bowl). There is no normal.

GAS You may experience foul smelling gas. This is related to the rearranging of your intestines and the breakdown

and absorption of your food. You may try Beano or Gas X. Some patients have tried Acidophilus (over the counter) with some success. Unfortunately, for some people, this will be a lifelong issue.

SMOKING

NO SMOKING! Smoking increases your risk of gastritis or ulcers in your pouch.

BIRTH CONTROL Weight loss can increase fertility. You should continue to use birth control if sexually active. We strongly recommend that you DO NOT BECOME PREGNANT until 2 years after surgery. It has been shown that

women who had absent or irregular periods before surgery are likely to begin regular cycles and ovulation with weight loss. If you were not able to get pregnant before surgery, this can change with weight loss

MONARCH SUPPORT GROUP The Monarch meetings are held on the 2nd Wednesday of each month from 6:00pm-7:00pm via Zoom. You can

register for these meetings through our event page located on our website. A great opportunity to share and learn.

ENERGY LEVEL Your energy level should be back to normal, if not better than before.

HAIR LOSS

Some hair loss is common following surgery and typically occurs between the third and sixth months following surgery. This is a result of several factors including the physiologic stress, the emotional stress of the

adjustments 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 by

one year after their surgery.

YOUR WEIGHT LOSS • Do not weigh yourself more than 1x per week. Fluid intake and constipation can affect weight. This can be

discouraging to you. • Make sure you are eating and drinking as recommended in this packet. You will be weighed at each of your

office 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 of

weight loss differs between people. Try not to compare yourself with anyone else.

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OFFICE VISIT SCHEDULE Research shows that patients who consistently follow up with visits to their surgeon’s office maintain a higher percentage of weight loss.

2-3 months post op Today’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 MyChart Lab Letters: You will receive a MyChart message or a letter from this office if your labs are abnormal and

require any adjustment to your vitamins/supplements. If your labs are all within normal limits you will not receive a letter.

How to access your lab results: You may access your labs through MyChart at mychart.urmc.edu. Click on

the button “Request activation code” on the left side of the screen under “New User?” We will check the following labs at each visit:

• CBC • Chemistry • Vitamin D • Iron

• Ferritin • B12 • Folate • PTH

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Tips to Remember FOREVER - University of Rochester