Tag: Nutrition

LOCAL INPUT: Hospital specific nutritional plan

During your hospitalisation, your healthcare team explained to you about the nutrition programme you will need to follow, both in the coming months and for the rest of your life. Adhering to this programme is the key to weight loss success. It’s important that you stick to the programme to ensure that you get the right nutrients and to avoid possible adverse effects.

Your patient engagement programme will keep track of everything you need to remember. And if you have any questions, please don’t hesitate to contact your healthcare team.  

Here are some helpful tips for modifying your behaviour to keep you on the path to better health.

• Eat very slowly – an easy trick is to put your fork down between each bite.
• Chew thoroughly – this is very important to prevent food from blocking the stomach opening.
• Set aside more time for meals – up to 45 minutes to eat a small amount.
• Stop eating as soon as you feel full. Do not force yourself to finish a portion or exceed the amount tolerated by your stomach.
• Drink fluids regularly between meals – at least 2 litres per day. Stop drinking 30 minutes before starting a meal and resume 30 minutes after finishing a meal.
• The carbonation in soft drinks and sparkling water can upset your stomach. Plain water or warm tea are best. Or add fruit slices or some mint for a bit of flavour.
• Avoid alcohol for the first six months after surgery, especially carbonated drinks and sugary mixes.
• Eat 6 to 7 small meals throughout the day, making sure to plan snacks between the main meals.
• Never skip a meal.
• Avoid all things sweet: sugar, honey, sweets, chocolate, jam, fruit pastes, sweet compotes, cookies, fruit syrups, commercial desserts, industrial beverages, ice cream, etc.
• Avoid hidden fats: pastries, popcorn, crisps, French fries, etc.
• Avoid high-fat foods even those generally considered healthy: mayonnaise, cream, bacon, cold cuts, dried fruits, avocado, olives, etc.
• Avoid raw, crunchy vegetables (carrots, celery, etc.) in large quantities as they can easily block the stomach opening.

Emotional eating is a common response to stressful, difficult feelings by eating – even when you’re not actually hungry.

Using food occasionally as a pick-me-up, a reward, or to celebrate is perfectly alright. But when eating becomes a primary emotional coping mechanism – when your first impulse is to open the refrigerator whenever you’re stressed, upset, angry, lonely, exhausted or bored – this can trigger an unhealthy cycle which may alleviate in the short term, but does not address the underlying feelings or problems.

Finding other fulfilment

Emotional hunger can’t be met with food. Eating may feel good in the moment, but eating does not make the feelings go away. And it can leave you feeling even worse, for instance because of the guilt associated with this type of behaviour.

It is important to learn to manage your emotions in a way that doesn’t involve food in order to sustainably maintain healthy eating habits. One reason why diets so often fail is because they offer logical nutritional advice without addressing the issues that trigger emotional eating.

Alternatives to emotional eating

The trick to stopping emotional eating is to find other ways to achieve emotional fulfilment. These might include:

Feeling out or sorts or lonely? Call someone who always makes you feel better, play with your dog or cat or look at a favourite photo or cherished memento.

Feeling anxious? Release nervous energy by dancing to your favourite song, squeezing a stress ball or taking a brisk walk.

If you’re exhausted? Treat yourself to a hot cup of tea, take a bath, light some scented candles or wrap yourself in a warm blanket.

Feeling bored? Read a good book, watch a comedy show, explore the outdoors or turn to an activity you enjoy.

If you need extra support, speak with your GP or psychologist.

What is an eating disorder?

Eating disorders are characterised by irregular eating habits and severe distress or concern about body image. Eating disorders commonly coexist with other conditions, such as anxiety disorders, substance abuse or depression.

Emotional eating can be a sign of a more serious condition.

Maintaining a healthy diet before surgery

A healthy diet is important for great health, but did you know that it’s also crucial for the lead up to your surgery? Maintaining a well-balanced, nutrient-rich diet will ensure your body has everything it needs to handle the stress of surgery. Furthermore, to reduce the risks associated with all types of surgery, your surgeon may ask you to lose weight.

Your pre-surgery diet plan has four primary goals:

• To make you as healthy as possible prior to your procedure, improving your surgical outcome and recovery from bariatric surgery.
• To help shrink the liver and reduce fat in the abdomen, making the procedure easier and reducing the risk. If the liver is too large, bariatric surgery may have to be postponed or performed as an open (invasive) procedure instead of as a less-invasive laparoscopic procedure.
• To help you begin forming better eating habits, so you can reach your post-op weight loss goal and maintain a healthy weight.
• To increase your protein intake, which can help preserve and protect muscle tissue post-surgery.

Healthy food and small portions

A healthy weight plays a key role in reducing the risks associated with a procedure like the one you are about to undergo.

Pre-surgery protein

Proteins provide fuel and force your body to use fat as an energy source, preventing loss of lean muscle. Lean meats, kidney beans and lentils are excellent, high-protein foods you can consume as part of your pre-surgery diet. Replacing sugars, fats and carbs with proteins also increases satiety (your sense of fullness) and appetite control, contributing to more effective long-term weight loss.

Don’t be discouraged! You may find it difficult to eat these types of foods at first, but it will get easier over time. If you have any special dietary requirements, such as diabetes, food intolerances, allergies or you are a vegetarian, be sure to inform your health care team.

Unhealthy foods and drinks

Foods to avoid

• Foods high in carbohydrates and starches: especially bread, pasta, potatoes, pizza, cereal and rice.
• Foods high in sugar: chocolatey desserts, cakes, biscuits, ice cream, etc. Drop fruit drinks from your liquid diet. Avoid packaged fruit drinks as well as freshly juiced fruit as both can cause your daily caloric intake to increase quickly.
• Foods high in fat: cheese, fried foods and fatty meats are all high in fat and calories and can wreak havoc on your digestive system.
• Soda and other carbonated beverages: including diet sodas and sparkling water. Artificial sweeteners can trigger an excessive insulin response. And carbonated drinks are prohibited after bariatric surgery, as the carbonation can cause bloating, pain and harmful stretching of the stomach.
• Sugary marinades or sauces: another source of hidden sugar.

Avoid alcohol

Reducing alcohol intake in the weeks prior to surgery will benefit your recovery immensely. It’s important to stop drinking alcohol at least 48 hours before your surgery – longer, if possible. If you generally have a very high consumption of alcohol, you may experience withdrawal symptoms. If this happens, be sure to bring this up with your health care team. They will suggest which protocol to follow before and after surgery.

Quitting anything is difficult, even if it’s only for a few weeks. These tips can help you stay motivated:

• Set a date by which you must stop. Write this date down to make it real.
• Associate an intention with your goal by identifying why you are stopping. For example,
  “I am quitting drinking next Tuesday so that I can recover well from my surgery.” 
• If you have habits or behaviours that trigger your desire to drink, avoid those behaviours.
• If you feel the urge for a drink, distract yourself by going for a walk or calling a friend to talk.
• Set milestones – one full day without drinking, one full week, etc. – and reward yourself when you reach them.

Pre-operative diet

Your typical daily pre-operative caloric intake may be reduced depending on your doctor’s recommendations. Because you will be consumer much fewer calories than what you are used to, staying hydrated is important.

Your diet plan will consist of set daily quantities of foods from 5 food groups daily. It will suggest 3 portions of carbohydrates (approximately 100 g), 2 portions of proteins and fruit (70 to 120 grams), 3–5 portions of vegetables and 2 portions of dairy, for a total of 3 meals and 2 or 3 snacks.

When preparing for bariatric surgery, it can be useful to start eating and drinking the same way you will after surgery.

The tables below list examples of food portion sizes:

Sources

http://www.med.navy.mil/sites/nmcsd/Patients/Documents/bariatric_form_nutritionrec.pdf

http://www.pacificbariatric.com/weight-loss-surgery/pre-op-diet

http://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/Eating_for_Health_after_Gastric_Bypass_Surgery.pdf

http://surgery.ucla.edu/bariatrics-nutrition-before-bariatric-surgery

https://www.livestrong.com/article/374304-diet-to-help-you-lose-weight-before-a-gastric-bypass/

http://www.wlshelp.com/pre-weight-loss-surgery-diet.html

http://www.ouh.nhs.uk/patient-guide/leaflets/files/101018bariatricdiet.pdf

American Society for Metabolic and Bariatric Surgery https://asmbs.org/patients/bariatric-surgery-faqs

http://www.ouh.nhs.uk

Maintaining a healthy diet after surgery

After surgery is when the real work starts. You will need to change your eating habits to avoid pain and vomiting, rupture of staple lines and, of course, to achieve your weight loss goals.

Changing your eating habits can also help prevent stomach obstruction. Swallowing food in pieces that are too big can make it difficult from the foods to pass into the intestine. It is critical that you eat slowly and chew your food very well to lower the risk of anything becoming caught. Your new motto should be: “slow, small, moist and easy”.

Stop eating as soon as you are full

Overeating even one spoonful can cause you to vomit and lead to harmful stretching of your stomach pouch. Pay attention to your body’s signals, not to the food left on your plate. Indications of fullness may not feel the same as before surgery. Here are some not-so-obvious signs that your stomach pouch is nearly full:

• A feeling of pressure or fullness in the centre of your abdomen, just below your rib cage.
• A feeling of nausea, regurgitation or heartburn. You may have a feeling of satiety several minutes after you are actually full. If your pouch is 30 cc, you can put 30 cc in it, and you will not feel full for about 5 minutes. To help you find the right portion size, try the following: Measure 30 cc of water, drink it and wait for a few minutes. If you feel full with this amount and are comfortable, measure this amount of food for each meal. This will prevent stretching of your stomach pouch and the discomfort caused by overeating.

After your surgery, it is easy to accidentally overeat at parties – especially when you are having fun and involved in conversations. It is also easy to nibble beyond fullness. Nibbling is a no-go after surgery, as you may find yourself eating tiny amounts all day long. We suggest making ‘party eating’ one of your meals for the day. Other tips for ‘party eating’ include:

• Never snack directly from a communal bowl, as it makes portions harder to estimate. Instead, place a portion of the food on a small plate, and take only the amount food you are planning to eat. Remember, you cannot eat more than a small child’s portion now.
• Take time to socialise more, have fun and enjoy the people at the party. Learn to focus on other things besides the food. Over time, will hopefully feel a sense of freedom from the drive to eat – use this opportunity to find new focus and enjoyments in life.

General mealtime tips

• Set aside 30 to 45 minutes for each meal. Chew each bite of food many times. If you wear dentures, which don’t chew as well, it may be necessary to stick to ground or soft foods. Learn to eat slowly and deliberately, to allow your body to feel the fullness and digest the food better. When you eat too fast, there is a greater risk of overeating and of not chewing your food well enough, which could cause vomiting.
• Explain to friends and family why you must eat slowly so they don’t urge you to eat faster.
• Take small bites of food. Try using a saucer instead of a plate to help with portion control.
• Use small utensils to help you identify the right portion.
• Pay attention to taste. Learn how to savour your food. You may find that your tastebuds have changed after surgery.
• Eat only at mealtimes as suggested by your health care team. Between-meal snacking or ‘nibbling’ on small amounts of food when not recommended by your health care team can sabotage your weight loss efforts.
• Avoid drinking liquids when eating solid foods. Liquids should be avoided for a period of 30 to 45 minutes before and 30 to 45 minutes after eating solid foods. Combining liquids and solids may cause nausea and may push foods through the stomach pouch faster, potentially causing you to eat more.
• Eat high-quality, fresh and all-natural foods. Fresh foods are higher in nutrients and more flavourful.

What to eat after surgery

Proteins

Protein is essential for your muscles as well as for your heart, brain and other organs. Our bodies require a constant supply of protein to repair and replace tissue that becomes worn out or damaged. Protein also helps fight infection.

Because your new stomach pouch has a very small capacity, it is important to eat high-protein foods with every meal to ensure your body gets enough protein to maintain itself.

Eat at least 60 grams of protein a day

A daily intake of at least 60 grams of protein should be the goal for the first 6 months. If you do not take in enough protein, after three weeks, your body will start to break down its own source of protein: muscle. This will cause you to feel nauseated and weak.

In the early days after your surgery, when you are drinking protein drinks, it is easy to keep track of how much protein you are consuming. Later, however, when you are eating regular food, it can be a bit more difficult. Use nutrition labels as your guide. Be careful with protein shakes, drinks and bars, as they tend to be high in sugar and calories.

In some cases, your dietitian may advise you to consume more protein.

Supplements

After bariatric surgery, the small stomach pouch does not allow you to eat enough to get all the nutrients you need through food alone. Moreover, the malabsorptive element of bariatric surgery decreases the body’s ability to process vitamins and minerals. To ensure you get enough nutrients, you will need to take multivitamin and mineral supplements daily for the rest of your life. Your health care team will tell exactly which supplements you need. Typically, they will prescribe some combination of the following: 

Vitamin B12: B12 deficiency can develop quickly, with little warning, and can be very dangerous. Food sources containing B12 include all types of animal products (meat, fish, poultry, dairy, eggs). Take care to have your vitamin levels checked regularly by your health care team.

Calcium: You will need to take a calcium supplement daily. Calcium is necessary for healthy bones, teeth and nerve transmission. With the reduced volume of food you can eat, it will not be possible to get enough calcium through diet alone.

Iron: Many patients, particularly women, will require an iron supplement to maintain adequate iron stores and prevent iron deficiency and anaemia. Iron is available in many different forms. Some forms can cause constipation. Consult your health care team regarding the type of iron supplement that is right for you.

Multivitamin complex: A multivitamin complex may be prescribed according to your needs.

Gallbladder medication: Bariatric surgery patients who still have their gallbladder may need to take specific medications during the period of maximum weight loss to minimise the risk of developing gallstones. Ask your health care team if this treatment is necessary for you.

Liquids

Drink 1.5 to 2 litres of still water per day between meals. (Increase this amount by 20% if you are sweating.) In addition to water, you can drink unsweetened, low-calorie and non-carbonated drinks. Juices are high in calories, provoke dumping syndrome (check in “my condition”/”caues and risk factors”)  and provide very little nutritional value. Here are some tips:

• Avoid carbonated beverages: When a cold carbonated beverage is consumed, it warms and releases gases, distending the stomach pouch and causing harmful stretching. This can cause discomfort and vomiting.
• Do not drink 30 to 45 minutes before or after meals to keep the stomach pouch from stretching and to prevent vomiting.
• Sip slowly and carefully.
• Sip liquids regularly all day long to prevent dehydration.
• Eliminate high-calorie drinks such as milkshakes, soda, alcoholic beverages and juices. High- calorie beverages tend to be low in nutritional value and contain simple sugars. They are also quickly absorbed and may cause dumping syndrome. 

NOTE: If your urine is dark or your mouth is dry, you are not getting enough liquids.

Get active: Physical activity improves your health. Being active doesn’t have to mean spending hours at the gym; there are many ways to fit more activity into your daily life. For example, try getting off the bus a stop early and walking the rest of the way home or taking the stairs instead of the lift.

Don’t get thirsty: Avoid dehydration by drinking still water regularly – at least 1.5 to 2 litres are recommended daily. All non-alcoholic drinks count, but still water and low-fat milk are healthier choices. Avoid soft drinks and fizzy drinks as they are high in sugar and calories, bad for your teeth and can cause discomfort and harmful stomach stretching.

Don’t skip breakfast:  If you skip breakfast, you can become so hungry that you overeat or eat lunch much too quickly.

Energy balance

Here are some suggestions to help you achieve the right energy balance to optimise weight loss:

Energy intake before and after surgery:

After surgery, your caloric intake will drastically decrease because of the smaller size of your stomach. As part of your diet plan, it is best to start getting your body used to the reduced calorie intake before your procedure.

Drop high-calorie foods

With your health care team’s supervision,replace high-calorie foods with low-calorie alternatives.

Eat protein with every meal

Protein is essential for proper muscle and brain development. It also helps you feel fuller longer.

Eat more fish – including fatty fish

Fish is a good source of protein and contains many healthy nutrients. Aim to eat at least two portions of fish a week, including at least one portion of fatty fish. Fatty fish (such as salmon, mackerel, herring and lake trout) contain omega-3 fats.