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Wired Jaw

After jaw surgery, you many need to stick to a special diet (liquid or semi liquid) for 1 to 6 weeks based on your surgeon’s recommendations. This may be a challenge for you to get enough during this time as your jaws are wired or rubber banded together. It is important to eat a variety of to get all of the your body needs during this time to help wound healing and to lower .

Genera l guidelines

- Eat at least 6 small to meet nutritional needs. Eat every 2-3 hours.

- Prepare all foods to a very smooth and thin consistency. Use a blender or processor.

Strain the blended food if it has lumps or chunks. Thin with varied liquids to preferred

consistency.

- Include a variety of foods from each of the food groups (protein, carbohydrate, fat, fruit and

vegetables) to achieve a balanced diet.

- Most foods can be blended.

- Prepare foods and freeze in 1-2 cup containers before surgery if possible.

- plenty of liquids (choose liquids with calories).

- Take a liquid multivitamin daily.

- If you are losing weight, increase calories (see chart below)

- Eat the same foods that your family eat but in a liquid consistency.

- Use a thermos to bring prepared food from home if microwave is unavailable.

- Commercial nutritional supplements can be used for convenience and to increase calorie

and protein intake.

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Wired Jaw Diet

Suggested liquid supplements

- Boost Plus – 8 ozs (350 calories/14 gms protein) - Boost High Protein – 8 ozs (240 calories/15 gms protein) - Boost High Protein powder mix (270 calories/14 gms protein when mixed with 1 cup 2% milk) - Carnation Instant – 1 packet (280 calories/13 gms protein when mixed with 1 cup whole milk) - Komplete – vegan replacement (1 carton = ~320 calories/18 gms protein) - Orgain – protein shake (1 carton = ~250 calories/17 gms protein) - Ovaltine – 4 Tbls (170 calories/9 gms protein) when mixed with 1 cup whole milk - – 8 ozs (240 calories/10 gms protein) - Ensure Plus – 8 ozs (355 calories/14 gms protein) - Hot cocoa mix – 8 ozs (260 calores/12 gms protein when mixed with 1 cup whole milk) - Chocolate milk – 8 ozs (240 calories/8 gms protein) - Sustacal – 8 ozs (240 calories/14.5 gms protein) - ProMod protein powder (1 oz = 100 calories/10 gms protein) - Scandishake – 3 oz envelope (600 calories, 14 gms protein when mixed with, 8 ozs whole milk) - Meritene Vanilla drink – 8 ozs (280 calories/17 gms protein when mixed with 8 ozs whole milk) - Resource 2.0 drink – 8 ozs (480 calories, 20 gms protein) ** Check ingredients for Vegan, Vegetarian, Lactose Intolerance and Gluten sensitivities.

Most above supplements powders can be mixed with soy, rice, or almond milk.

Calorie Boosters: - 1 Tablespoon smooth peanut butter (~100 calories) - 1 Tablespoon vegetable oil - avocado, hemp, grape seed, canola or olive oil (~120 calories) - 2 Tablespoons avocado (~45 calories) - 1 Tablespoon dried milk powder (~50 calories) - 28 gms (1 oz) Whey protein powder (~ 50 calories) - 28 gms (1 oz) Soy protein powder (~96 calories) - 1 Tablespoon flaxseed meal powder (~45 calories) - 1 Tablespoon smart balance margarine (~45 calories) - 2 Tablespoons cream (~45 calories) - 1 Tablespoon coconut milk (~45 calories) - 1 Tablespoon butter (~120 calories) - Fortified milk – 1 quart of milk, 1 cup NF milk powder (blend together for 5 mins in food processor (12 gms protein per cup)

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Wired Jaw Diet

Food Chart Guide

Food Recommended Preparation Consistency How to Optimize Special Diet Foods Options Calories and Protein Considerations Whole Milk n/a n/a Add dried milk Vegan: Rice, Soy, or Milk 1 serving = 8 ozs = 1 & Soy, Rice, or powder, Carnation Almond milk

dairy Almond Milk Vegetarian: cows milk & rice, soy, or almond milk GF: No restrictions Sweetened, plain Blend fruit yogurt, Thin with milk as Full fat yogurt Vegan: soy yogurt, Yogurt 1 serving = 2/3 cup = or Greek yogurt strain out large pieces needed Kefir coconut yogurt 1 dairy Lactose Intolerance: use soy or lactose- free yogurt Vegetarian: No restriction

Cottage Full fat Cottage Blend until smooth, Thin with milk Add dry powdered Vegan: restricted Cheese strain as needed milk Lactose Intolerance: Cheese use lactose-free 1 serving = ¼ cup = 1 cottage cheese protein Vegetarian: No restriction

Any soup of choice Blend all soups and Thin with milk, cream, Add healthy oils Vegan: use vegetable Soups 1 serving = 1 cup = 2 strain to remove any or chicken/vegetable (Olive, Canola, & broth

veggies, 1 starch solid broth to desired Avocado Oils) Lactose Intolerance: consistency use lactose-free milk Vegetarian: use vegetable stock GF: thicken with potato or tapioca starch

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Wired Jaw Diet

Meats, Fish, Chicken, Fish, until tender, Thin with broth, Add healthy oils Vegan: Turkey, Pork, Egg blend, strain to sauces, gravies Vegetarian: Tofu & Poultry, Eggs, (without skin or remove large pieces Eggs Tofu bones) GF: no restrictions 1 serving = 1 oz = 1 Lactose Intolerance: protein no restrictions Fruit skins and Cooked or raw. Blend Thin with fruit juice or Add honey, syrup, Vegan: no restrictions Fruit 1 serving = 1 small seeds removed, until desired milk sweetened juice, ice Vegetarian: no

fruit , ½ cup canned fresh, canned, frozen, consistency and cream, sorbet, restrictions or ½ cup juice = 1 or cooked strain. sherbet GF: no restrictions fruit Lactose Intolerance: no restrictions Vegetables skins Cooked or raw. Blend Thin with V-8, tomato Add healthy oils Vegan: no restrictions Vegetables 1 serving = ½ cup and seeds removed, until desired juice, broth, or cream Vegetarian: no

cooked, 1 cup raw = 1 fresh, canned, frozen, consistency and restrictions

vegetable or cooked strain. GF: no restrictions Lactose Intolerance: no restrictions Hot cereals: Cream Cook hot cereal with Thin with milk Add powdered milk, Vegan: Rice, Soy, or Starches 1 serving = ½ cup of Wheat, Rice, Millet, milk. Blend & strain honey, syrup, butter, Almond milk

cooked cereal, ½ cup & Quinoa Soak cold cereal in cream, pureed fruit Vegetarian: no dry cereal, ½ cup Cold cereals milk, blend & strain restrictions mashed potatoes = 1 Lactose Intolerance: starch Potatoes: all types Cook potatoes, Thin with broth or Add cream and milk Soy, rice, or almond mashed mash/blend with milk milk milk or broth GF: use GF cereals

Desserts Ice cream, Frozen No nuts, seeds, fruit n/a 1 serving = ½ cup = Yogurt, Sherbet, chunks or . ~2-4 fats, Popsicles, Puddings,

~1-2 starch Custards, Jello

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Wired Jaw Diet

Sample

Day 1 Calories Protein (approx) (gms)

Breakfast: 350 11 ½ cup cooked Oatmeal with 1 cup milk, 1 tbsp melted butter, blend and thin to desired consistency : 350 16 1 cup milk (almond, soy or rice milk), 2 tbsp smooth peanut butter, blended : 450 16 Raspberry Snack: 130 2 ½ cup frozen yogurt, softened : 250 10 2 cups Chicken and vegetable soup, blended and thinned to desired consistency

Day 2 Calories Protein (approx) (gms)

Breakfast: 400 11 ½ cup cooked cream of wheat with 1 cup milk, 1 tbsp Flaxseed meal, 1 tbsp melted butter, blend and thin to desired consistency Snack: 120 1 cup pulp-free orange juice Lunch: 500 16 Strawberry and Banana Smoothie Snack: 320 15 8 ozs Carnation Instant breakfast made with whole milk Dinner: 400 10 2 cups Cream of broccoli soup, blended and thinned to desired consistency

© 2014, The Permanente Medical Group, Inc. All rights reserved. Santa Clara Health Education. Page 5 of 16 Department of Maxillofacial Surgery. RL 7

Wired Jaw Diet-Nutritional Booklet

Day 3 Calories Protein (approx) (gms)

Breakfast: 600 14 Mango and Peach Smoothie

Snack: 250 12 1 cup almond milk with 1 tbsp almond butter, blend Lunch: 350 16 1 cup cottage cheese, ½ cup canned peaches, blend, thin with milk to desired consistency Snack: 100 4 1 can V-8 juice Dinner: 400 26 2 cups Chicken, vegetable and potato stew, blended and thinned with broth

Day 4 Calories Protein (approx) (gms)

Breakfast: 420 18 ½ cup cooked quinoa made with 1 cup milk of choice, 1 tbsp Flaxseed meal, 1 tbsp melted butter/oil, blend and thin to desired consistency Snack: 230 18 1 cup fruit yogurt, blended and thinned with milk of choice Lunch: 400 12 Banana and Broccoli Smoothie Snack: 400 12 1 can chocolate boost with ½ cup vanilla ice cream, blended Dinner: 420 16 2 cups Lentil and vegetable soup blended and thinned with vegetable or chicken broth

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Wired Jaw Diet

Day 5 Calories Protein (approx) (gms)

Breakfast: 330 20 2 scrambled eggs, 1 tbsp oil, thinned with milk of choice Snack: 470 12 1 can strawberry ensure plus with ½ cup sorbet, blend Lunch: 275 4 Kale and Banana Smoothie Snack: 350 16 1 cup cottage cheese, ½ cup canned fruit cocktail, blended with milk of choice Dinner: 375 20 2 cups split pea soup blended and thinned with vegetable or chicken broth

Day 6 Calories Protein (approx) (gms)

Breakfast: 400 11 ½ cup cooked cream of millet with 1 cup milk choice, 1 tbsp flaxseed meal, 1 tbsp oil, blend and thin to desired consistency Snack: 200 1 can apricot nectar Lunch: 375 4 Banana and Spinach Smoothie Snack: 220 10 1 cup vanilla yogurt, ½ cup apple sauce, blended and thinned Dinner: 350 20 2 cups fish soup with vegetables, blended and strained

© 2014, The Permanente Medical Group, Inc. All rights reserved. Santa Clara Health Education. Page 7 of 16 Department of Maxillofacial Surgery. RL 7

Wired Jaw Diet

Day 7 Calories Protein (approx) (gms)

Breakfast: 400 11 ½ cup cooked cream of rice with 1 cup milk of choice, 1 tbsp flaxseed meal, 1 tbsp oil, blend and thin to desired consistency Snack: 300 1 cup sorbet, softened Lunch: 430 18 Soy Smoothie Snack: 380 15 1 can carnation instant breakfast, 1 cup milk of choice, 1 cup strawberries Dinner: 500 25 2 cups beef stew with mashed potatoes, blended, thinned with broth and strained

The above meal choices are suggestions only. Please feel free to mix and match based on your appetite and caloric needs. Make substitutions when needed – for example, use almond milk, tofu, vegetable broth etc. if vegan. For extra protein, add protein powder from soy or non fat milk powder.

© 2014, The Perm anente Medical Group, Inc. All rights reserved. Santa Clara Hea lth Education. Page 8 of 16 Department of Maxillofacial Surgery. RL 7

Wired Jaw Diet-Recipes

Banana Peanut Butter Shake (~ 600 calories, 17 gms protein ) ¼ cup whole milk, soy, almond, rice, or coconut milk 1 cup sliced banana (1 large banana) 1 ½ cups ice cream (sorbet, sherbet, non-dairy ice cream) ¼ cup smooth peanut butter 3 Tbsp chocolate malted milk powder Place all ingredients in a blender, blend until completely smooth. Thin to preferred consistency with soy milk or juice. Strain if needed.

Soy Smoothie (~430 calories, 18 gms protein) ¾ cup vanilla soy milk, almond, rice or coconut milk ½ cup apple juice 1 Tbsp honey 1 cup blueberries 1 banana 1 cup strawberries 1 cup non-dairy frozen frozen yogurt 1 scoop (10 gms soy protein powder or tofu) Place all ingredients in a blender. Blend until smooth. Thin to preferred consistency with milk or juice. Strain if needed.

Strawberry Smoothie (~ 300 calories, 15 gms protein.) 1 cup vanilla soy milk, rice, almond, cow or coconut milk) 1 cup sliced strawberries 1 banana 1 packets of carnation instant breakfast or 1 scoop protein powder of choice) Place all ingredients in a blender. Blend until smooth. Thin to preferred consistency with milk or juice. Strain to remove seeds.

Raspberry Smoothie (~450 calories, 16 gms protein) ¾ c apple juice 1 Tbsp honey 1 ½ cups diced cantaloupe 1 ½ cups diced raspberries (strained to remove seeds) 1 cup vanilla ice cream (frozen yogurt or non-dairy ice cream) 1 scoop (10 gms protein powder of choice) Place all ingredients in a blender. Blend until smooth. Thin to preferred consistency with milk or juice. Strain if needed.

© 2014, The Permanente Medical Group, Inc. All rights reserved. Santa Clara Health Education. Page 9 of 16 Department of Pediatrics. RL 7

Wired Jaw Diet-Recipes

Strawberry and Banana Smoothie (~ 500 calories, 16 gms protein) 1 cup vanilla soy milk, rice, almond cow’s or coconut milk) ½ cup orange juice 1 Tbsp agave syrup 1 ½ cups strawberries 1 banana 1 carton strawberry banana yogurt (or soy yogurt) Place all ingredients in a blender. Blend until smooth. Thin to preferred consistency with milk or juice. Strain if needed.

Fruit Smoothie: (~ 450 calories, 18 gms protein.) ¾ cup apple juice 1 Tbsp maple syrup 1 banana 1 cup peeled, diced peaches 1 cup peach yogurt (or soy yogurt) 1 scoop (10 gms )protein powder of choice Place all ingredients in a blender. Blend until smooth. Thin to preferred consistency with milk or juice. Strain if needed.

Mango and Peach Smoothie: (~600 calories/14 gms protein) ½ can (8 ozs) peach nectar 1 Tbsp agave syrup 1 cup peeled and diced peaches ½ cup mango sorbet ½ cup vanilla yogurt 1 scoop (10 gms) protein powder of choice ½ cup crushed ice Place all ingredients in a blender. Blend until smooth. Thin to preferred consistency with V-8 juice. Strain.

Vegetable Smoothie (~170 calories/4 gms protein) 1 small cucumber (seeds removed) 1 cup (packed) spinach 1 apple, cored 1 inch fresh ginger, peeled and minced (~1 Tbsp) Juice of 1 lime 1 Tbsp honey Ice cubes Place all ingredients in a blender. Blend until smooth. Thin to desired consistency with V- 8 juice. Strain.

© 2014, The Permanente Medical Group, Inc. All rights reserved. Santa Clara Health Education. Page 10 of 16 Department of Pediatrics. RL 7

Wired Jaw Diet-Recipes

Banana and Broccoli Smoothie: (~400 calories/12 gms protein) 1½ cups almond milk (rice or soy) 1 ripe banana 1 cup broccoli florets (stems removed) 1 Tbsp ground flaxseed meal 1 Tbsp agave syrup Place all ingredients in a blender, blend until smooth. Strain.

Kale and Banana Smoothie: (~275 calories) ½ cup packed flat-leaf parsley 1 cup Kale (center ribs removed) 1 cup mixed berries (fresh or frozen) 1 ripe banana 1 Tbsp flaxseed meal or 1Tbsp smooth peanut butter Ice cubes Place all ingredients in blender, blend until smooth, strain.

Banana and Spinach Smoothie: (~375 calories) 1 ripe banana ½ ripe avocado 1 cup (packed) spinach) ½ Tbsp honey 1 cup ice Place all ingredients in a blender, blend until smooth, strain.

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Wired Jaw Diet-Recipes

Soup Recipes:

Lightly Curried Butternut Squash Soup: (adapted from “ A Snap , Good and Cheap” by Leanne Brown)

1 butternut squash or other winter squash

3 Tbsp olive oil

1 medium onion, diced

1 green pepper, diced

3 cloves garlic, finely chopped

1 tsp cumin

1 tsp coriander powder

1 tsp turmeric powder

1 tsp cayenne pepper

1 can coconut milk

3 cups vegetable stock

Salt and pepper

To prepare squash, peel off the tough skin with a potato peeler. Cut the squash in half lengthwise with a sharp knife, scoop out the insides. Slice off the stem and very bottom of the squash and discard. Slice the squash into thick slices and dice roughly. Heat olive oil in large pot or dutch oven on medium heat, add the onion, pepper and garlic and sauté for 2 minutes.

Add the diced squash and spices and stir it all together. Cover and cook for another 2 minutes. Add the coconut milk and vegetable stock and stir.

Bring the soup to a boil then turn down the heat and simmer for about 30 minutes until squash is tender. Taste and correct seasoning as needed. Blend and strain.

To add extra calories stir in cream or sour cream.

© 2014, The Permanente Medical Group, Inc. All rights reserved. Santa Clara Health Education. Page 12 of 16 Department of Pediatrics. RL 7

Wired Jaw Diet-Recipes

Creamy Broccoli Soup with Cheddar: (adapted from “For the love of Soups” by Jeanelle Mitchell)

1 Tbsp olive oil

1 onion, chopped

2 garlic cloves, minced

1 stalk celery, chopped

1 carrot, peeled and chopped

2 cups chicken or vegetable stock

1 cup water

3 cups chopped broccoli

1 large potato, peeled and cubed

1 Tbsp chopped fresh oregano or 1 tsp dried oregano

1 cup low-fat milk

1 Tbsp Dijon mustard

½ cup grated cheddar cheese

Sea salt and freshly ground pepper

In a large saucepan, heat oil over medium heat. Add onion, garlic, celery and carrot and sauté for 4 minutes.

Add stock, water, broccoli, potato and oregano and bring to a boil. Lower heat, cover and simmer for 15 minutes or until vegetables are tender. Remove from heat and let cool slightly.

Puree soup in the saucepan using an immersion blender or transfer in batches to a blender or food processor and blend until smooth, then return soup to the saucepan. Stir in the milk (leave out if vegan), mustard, and cheddar; simmer until cheese melts and soup is heated. Do not boil. Season with salt and pepper to taste. Strain and thin to preferred consistency.

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Wired Jaw Diet-Recipes

Creamy Chickpea Soup: (adapted from “For the love of Soups” by Jeanelle Mitchell)

1 Tbsp olive oil

1 large leek, white and light partly only, cut in half lengthwise and thinly slices

4 large garlic cloves, minced

1 large sweet red pepper, diced

2 cups chicken broth or vegetable stock

2 cups water

Two 19 oz cans chickpeas, drained and rinsed

1 tsp chopped fresh thyme, or ¼ tsp dried thyme

1 bay leaf

2 Tbsp fresh lemon juice

2 Tbsp chopped fresh cilantro or flat-leaf parsley

Freshly ground pepper

In a large saucepan, heat oil over medium heat. Add leek, garlic, and red pepper and sauté for 4 minutes.

Add stock, water, chickpeas, thyme, bay leaf, lemon juice and cilantro or parsley and bring to a boil. Lower heat, cover, and simmer for 15 minutes. Remove from heat, let cool slightly, and discard bay leaf.

Puree soup in the saucepan using an immersion blender, or transfer to a blender or food processor and blend until smooth, strain, and then return pureed soup to the saucepan and simmer until heated. Season with pepper to taste.

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Wired Jaw Diet-Recipes

Ginger Orange Carrot soup: (adapted from “For the love of Soups” by Jeanelle Mitchell)

1 Tbsp unsalted butter

1 Tbsp olive oil

1 large sweet onion, chopped

4 cups peeled and chopped carrots

2 tsp grated ginger

2 cups chicken or vegetable soup

2 cups water

1 cup orange juice

Sea salt and freshly ground pepper

½ cup low-fat yogurt or sour cream, or more to taste (optional)

2 Tbsp chopped fresh chives or flat-leaf parsley.

In a large saucepan, melt butter with oil over medium heat. Add onion and carrots and sauté for 4 minutes. Stir in ginger and cook for 2 minutes longer.

Add stock, water and orange juice, parsley and chives, and bring to a boil. Lower heat, cover, and simmer for 20 minutes or until carrots are tender. Remove from heat and let cool slightly.

Puree soup in the saucepan using an immersion blender, or transfer soup in batches to a blender or food processor and blend until smooth, strain, then return soup to the saucepan. Season with salt and pepper to taste. Simmer until heated through. Stir in optional yogurt, cream or sour cream.

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Wired Jaw Diet-Recipes

Velvety Red Lentil Dahl: (adapted from “the cancer-fighting ” by Rebecca Katz)

2 Tbsp extra-virgin olive oil

1 ½ tsp cumin seeds

1 ½ tsp black or brown mustard seeds

1 onion, diced small

1 Tbsp minced fresh ginger

2 tsp turmeric

2 tsp ground cumin

Sea salt

2 cups chopped tomatoes, or 1-14-oz can diced tomatoes, drained

8 cups vegetable broth

2 cups red lentils, rinsed well

1 cinnamon stick

1 tsp freshly squeezed lime juice

½ tsp agave nectar or maple syrup

¼ cup finely chopped fresh cilantro or mint

Heat the oil in a soup pot over medium heat. Add the cumin and mustard seeds and sauté for 3 minutes, add the tomatoes and ¼ tsp of salt and sauté for 2 minutes more. Pour in ½ cup of the broth to deglaze the pan and cook until the liquid is lowered by half.

Add the red lentils and stir well, then add the remaining 7 ½ cups broth and the cinnamon stick and stir in the lime juice and agave nectar.

In a blender, puree the soup in batches until very smooth, strain and thin with more broth if needed.

© 2014, The Permanente Medical Group, Inc. All rights reserved. Santa Clara Health Education. Page 16 of 16 Department of Pediatrics. RL 7