Mount Carmel Bariatric Guide

mountcarmelhealth.com

February 2016 Table of Contents Nutrition Basics...... Page 2 Facts on Fats...... Page 4 Labels...... Page 6 Healthy Grocery Shopping Tips...... Page 7 Controlling Food Portions...... Page 9 Choosing Well When Out...... Page 10 Nutrition Guidelines Gastric Bypass & Sleeve Gastrectomy Surgery...... Page 12 Full Liquid ...... Page 16 Pureed and Soft Diet ...... Page 21 Regular/Long Term Diet...... Page 24 Bariatric Nutrition Support Group...... Page 27 Bariatric Contact Information...... Page 27

1 Nutrition Basics There are two types of nutrients that are needed by our bodies: Macronutrients and Micronutrients. • Macronutrients, which need to be consumed in fairly large amounts on a daily basis, are carbohydrate, protein, fat and water. • Micronutrients, which need to be consumed in much smaller amounts on a daily basis are and minerals. Carbohydrates Carbohydrates perform many functions in the body including: • Serve as a major source of energy. • Assist in fat metabolism. • Support growth of beneficial bacteria in the GI tract. • Help eliminate toxins from the body. • Help form connective and nerve tissue. There are three basic types of carbohydrates: sugars, starches, and fibers. Sugars Sugars make things sweet and are often referred to as “simple carbohydrates” or “simple sugars”. • Sugar in fruits is called fructose. • Sugar in milk is called lactose. • Sugar in sugar beets and cane is called sucrose, also known as “table sugar”. • Glucose is the type of sugar that our bodies use as fuel. Starches Starches are used to store energy in plants such as potatoes, corn, beans, and rice. Starch is also known as a “complex carbohydrate”. Fiber Fibers are found in plants such as fruits, vegetables, nuts and grains. • The most plentiful source of fiber is whole grains, especially wheat bran. • Fiber aids in transit time and also creates fecal bulk. • Positive effects of fiber: helps control weight, supports gastrointestinal health, prevents colon cancer, lowers blood cholesterol and helps the body absorb nutrients. • All carbohydrates contain 4 calories per gram. • Sources of carbohydrates include: bread, pasta, cereal, etc., fruit, milk and vegetables in small amounts.

2 Protein Amino acids are the building blocks of proteins. Some proteins contain hundreds or even thousands of amino acids. • There are 20 amino acids that make up over 100,000 different proteins in the human body. • Nine out of 20 are known as essential amino acids because our bodies cannot make them, we must get them from the that we eat. • Proteins can be structural or functional. Structural proteins play a major role in the solid material in all body tissues. Examples are hair, muscles, tendons and skin. • Other proteins help with the formation of enzymes, hormones, fluids and secretions. • Protein aides in the healing process and will be the bulk of calories. • Protein provides energy to enable a person to lose fat and keep muscle during weight loss. • Proteins contain 4 calories per gram. Fat There are 3 main purposes for fat in the body: energy storage, insulation and protection of internal organs. • Fats also play a part in formation of steroids and hormones, immune function, maintaining body temperature, and aid in the absorption of fat-soluble vitamins. • Fats can be saturated or unsaturated. Saturated fats are usually solid at room temperature, bacon grease and butter, for example, and have been linked to the development of heart disease. • Monounsaturated and polyunsaturated fats are liquid at room temperature, olive and canola oil, for example and are known as “healthy fats”. • Fats contain 9 calories per gram.

3 Facts on Fats Fat supplies the body with needed vitamins and provides energy for daily activities. Too much fat in the diet can lead to blocked blood vessels, which can cause heart attack, stroke, and other problems. How much fat do you need? Fat is a concentrated source of energy that provides 9 calories with every gram. The American Heart Association in May 2008 stated that 25% - 35% of daily calories should come from fat. Bariatric surgery patients should aim for 35 grams of mono- and poly-unsaturated fats daily. The type of fat that you eat is just as important as the amount of fat that you eat. Types of fat include: • Saturated fats This type of fat tends to raise blood cholesterol – especially LDL cholesterol – even more than does eating food high in cholesterol. • Trans fats Trans fatty acids are formed when a liquid fat is turned into a solid one during a process called hydrogenation. Trans fats have the same choles- terol-raising effect that saturated fats do. They also lower your HDL (good) cholesterol. Limit your trans fat intake as much as possible. • Cholesterol Eating animal foods can increase cholesterol. Cholesterol is needed, but the body makes all we need. Too much cholesterol in the diet has been linked to an increased risk of heart disease. • Monounsaturated fats This is the best type of fat. Eating monounsaturated fats rather than saturated fats will help reduce both total and LDL (bad) cholesterol. And, they do not lower HDL (good cholesterol). • Polyunsaturated fats Moderate amounts of polyunsaturated fats in the diet are fine. Substituting polyunsaturated fats for saturated fats will reduce both total cholesterol and LDL (bad cholesterol). Too many polyunsaturated fats in your diet may lower HDL (good) cholesterol. • Omega-6 fatty acids – decrease total and LDL cholesterol • Omega-3 fatty acids – decrease triglycerides

4 Check food labels for the type and number of grams of fat per serving. Listed below are different types and sources of fats in our food supply and their effect on blood cholesterol.

Type of Fat Food Sources Saturated Fats Animal fats – beef, pork, lamb, veal; lard, beef fat, Keep to 7% or less of total milk fat, bacon fat, butter; cheese, sour cream, fat. cream cheese, milk & (whole & 2%), , cream, Half-and-Half; coconut, palm, and palm kernel oil

Trans Fat Stick margarine, hydrogenated oils solid Strongly limit – not more shortening; nondairy creamer; cookies, crackers, than 1% of total fat. pastries, doughnuts

Cholesterol Egg yolks, liver, organ meats, squid, abalone (no Have 200 mg or less per saturated fat present) day. Limit egg yolks to 3 per week – one yolk has 200 mg cholesterol Meat, fish, poultry & shellfish 20 - 30 mg/oz; shrimp 40 - 50 mg/oz Monounsaturated Olive, canola, and peanut oil; peanuts, peanut Have up to 20 % of total butter, poultry, almonds, cashews, pistachios, fat. pecans, macadamia nuts, filberts; ; olives

Polyunsaturated Keep to 10% or less of total fat.

Omega-6 fatty acids Safflower, corn, soybean, and sunflower oil; walnuts, pine nuts, seeds; soft or tub margarine; Omega-3 fatty acids mayonnaise Salmon, trout, herring, anchovies, sardines, mackerel, fatty fish; nuts; flaxseed; canola and soybean oil

Rev.7/08, 4/11 ©Mount Carmel 2008

5 Reading Food Labels for Healthy Nutrition Facts 3 oz. Planning Servings Per Container 1 Amount Per Serving Reading food labels may seem confusing at times, but is Calories 180 Calories from Fat 90 helpful in planning healthy especially if you are trying % Daily Value* Total Fat 10g 15% to lose weight. Saturated Fat 4g 20% Trans Fat 0.5g Cholesterol 70mg 23% Serving Size Sodium 60mg 3% Total Carbohydrate 0g 0% 0g 0% First check the amount of food shown as a serving. This Sugars 0g may not be the amount you are eating, but it is the amount Protein 22g A 0% • 0% containing the nutrient values listed. Calcium 2% • Iron 15% * Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs: Calories Calories 2,000 2,500 Total Fat Less than 65g 80g Saturated Fat Less than 20g 25g While you may not need to count calories on a daily basis, it Cholesterol Less than 300mg 300mg Sodium Less than 2,400mg 2,400mg is important to know where your calories are coming from, Total Carbohydrate 300g 375g Dietary Fiber 25g 30g which foods are high or low calorie and about how many Calories per gram: Fat 9 • Carbohydrates 4 • Protein 4 calories you need for weight control. Calories do count. Total, Saturated and Trans Fat Fat contains more calories than protein or carbohydrates do – 9 calories/gram for fat and 4 calories/gram for protein and carbohydrates. You need some fat in your diet, but excess fat can mean excess calories resulting in weight gain. A diet low in saturated and trans fats is recommended to maintain healthy cholesterol levels and reduce the risk of heart disease. Choose meats, dairy, and packaged foods with 2 grams or less of saturated fat per serving. Keep total fats at 6 grams or less per meal. Protein Your body needs enough protein to provide nitrogen for protein building to prevent muscle loss. Eating a protein food with each meal helps reduce between meals. Lean protein foods with low saturated fat content are best for weight and cholesterol management. Meat, fish, and poultry each contain about 7 grams of protein per ounce (by weight). Low fat dairy, eggs, and legumes are also good sources of protein. Your goal is 65 - 75 grams of protein per day. Carbohydrates, Sugars, and Dietary Fiber Carbohydrates are found in starches and sweets. They are mainly a source of energy. To avoid excess calories, keep sugars at 6 grams or less per meal. Round out your meals with carbohydrates that contain dietary fiber. Fiber helps to prevent constipation and to control cholesterol. It also adds nutrients. Dev. 5/08, Rev. 1/09 J:\Mount Carmel Handouts\Nutrition\Reading Food Labels for Healthy Meal Planning.doc ©Mount Carmel 2009

6 Healthy Grocery Shopping Tips An essential step for losing weight is learning how to buy the right foods. Make a list and follow these tips to choose healthy and delicious foods at your next trip to the grocery store. • Plan your for the week. • Check ads for sale items and clip coupons. • Plan to buy a variety of items to provide balanced nutrition. • Assure plan includes Grains, Vegetables, Fruits, Dairy Products, Meat and Meat Alternatives, and Fats. Grains Whole wheat flour and whole grains provide fiber, vitamins and minerals. • Check the label to see that 100% whole-wheat flour is the first ingredient. • Choose bread and crackers that are whole grain and high in fiber. • Brown rice has the most nutrients and is high in fiber too. • Choose whole grain pasta and cereals only. • Read labels for sugar and fat content. • Cereal must have more fiber than sugar. Fruits and Vegetables Fruits and vegetables provide vitamins, antioxidants, fiber and are low in fat. • Shop for produce in-season, it’s most flavorful and saves money. • Long-lasting produce: carrots, apples, grapefruit, melons and oranges. • Frozen fruits and veggies are a good option as well. • Choose fruits packed in water or their own and vegetables canned without salt. • Opt for vegetables rich in color such as red, orange, and green. Dairy Products Dairy products provide calcium, riboflavin, vitamins A and D and are also a source of protein. • Plan to purchase a variety of products. • Stock up on skim milk, fat free yogurt and low-fat (2%) cheeses that are natural, for example: Cheddar, Swiss, Colby, Ricotta, Provolone, Mozzarella. • Read nutrition labels for fat and sugar content.

7 Meat and Meat Alternatives Choose a variety of lean meats to add protein, iron and . • Include fish, dry beans, eggs, and nuts. • Select eye round, top round, top sirloin and flank steak cuts for beef and loin cut for pork. Use beefitswhatsfordinner.com for more help. • Purchase skinless chicken or remove the skin before . • Healthy fish options include orange roughy, talapia, tuna, cod, haddock and salmon. Frozen fish is a good option and just as nutritious as fresh. Canned fish packed in water instead of oil is a lower calorie choice. Fats Both polyunsaturated and monounsaturated fats may help lower your blood cholesterol level when you use them in place of saturated and trans fats. When shopping choose: • Vegetable oils and margarines with liquid vegetable oil as the first listed ingredient. Examples are canola, corn, olive, peanut, safflower, sesame, soybean and sunflower oils. • Soft spreads or liquid/tub margarines low in saturated fats and trans fats. • Reduced-fat and no-fat salad dressings and mayonnaise. • Foods including fatty fish (such as salmon, mackerel, herring and trout), avocados, , and many nuts and seeds.

8 Controlling Food Portions Eating smaller portion sizes and balanced meals that contain a variety of foods are key steps in having a healthy lifestyle. If a portion you eat is larger than the single serving size, you are consuming more calories than what is shown on the food label. Daily Portion Control Tips • When dining out, share a meal or take half of your meal home to enjoy. Order small by having an appetizer as your meal. • Use , bowls, glasses and serving utensils to give the appearance of more food. • Select low-fat, low-sodium frozen meals that have “portion control” built into packaging. • Be sure to include fresh, frozen, or no added salt canned vegetables in every and meal. • Eat slowly and enjoy your meals. Research has shown that it takes 20 minutes for your stomach to signal that it is full. • Avoid buying foods in bulk. If you buy large food packages, divide a bargain-size bag into single portion servings. • Use a scale as well as measuring cups and spoons for proper portion control. Sizing Up Portions Many portions are larger than you think and also larger than the standard portions for the Food Guide Pyramid. Also, the serving sizes on food labels may differ from the serving sizes on the . Use the following guide to quickly measure single portion sizes. Proteins Carbohydrates Meat - 3 oz. Fruits: 1/2 tennis ball or 1/2 cup - 1/2 cup Dairy: 1/2 cup milk, yogurt Cheese - 1 oz. Grains: 1/2 cup cereal Nuts - 1/2 oz. Approximately 1/2 slice bread Beans - 1/2 cup 1/3 cup rice 1/3 cup pasta Fats 1 tsp margarine/oil 1 TBSP peanut butter

9 Choosing Well When Eating Out Eating out can be a challenge when you are trying to eat in a healthful way. When dining out, you must be aware of the choices you make. Many places offer low fat, low calorie options, or will prepare food to your request. Watch your portion sizes, too. Use these tips to ensure that you are eating healthfully: • Choose places that you know offer a healthy or will cater to your requests. • Steer clear of – portion control, as well as self control, is hard at such places. • Manage your portion sizes: - Split an entrée with a friend. - Order an appetizer as an entrée and add a salad. - Ask for a container before you begin eating – split the portion in thirds or half to take home. You’ll be less likely to overeat when you pack it away first. Be sure to refrigerate the food within three hours. - A serving of meat should be 3 ounces…the size of a deck of cards or the palm of your hand. • Avoid dishes with , cream sauce, cheese, or sour cream. • Choose foods that are baked, broiled, grilled, poached, roasted or steamed rather than deep fried. Breaded, batter-dipped and tempura all mean fried food. • Be aware of extras. Sandwich toppings such as cheese or bacon, or sauces such as mayonnaise, will add many calories. Ask for extra lettuce, , onions and mustard. • Ask for bread that has not been toasted with butter. Be careful about filling up on bread before the meal. Ask your server to skip the bread or chip basket. Choose whole wheat bread or buns. Avoid croissants, biscuits, potpies and quiches. • Salads are a great choice, but be careful about what you put on them. Limit cheese, bacon, and croutons. Choose mostly vegetables, and salads made with rich dark greens like or romaine rather than iceberg lettuce. • Always ask for salad dressings on the side. To cut down on calories and fat, try dipping your fork into the dressing and then spearing the lettuce. You will get a good taste of the dressing when you do this.

10 • Instead of french fries or other high fat side dishes, choose a , side salad, steamed vegetables or fresh fruit. • If a “lighter” version is on the menu, choose it. This will cut calories and fat grams. For example, use light salad dressing instead of regular dressing. • Watch for key words: - Avoid foods described as: fried, breaded, basted, braised, au gratin, crispy, creamed, escalloped, pan-fried, sautéed, stewed, buttery, or stuffed – these types of foods are high in fat. - Order foods that are: baked, steamed, broiled, grilled, roasted, or stir-fried to lessen the fat and calories. • Ask to have foods cooked without butter or margarine. • Don’t be afraid to ask for items that are not on the menu. Many will make special dishes or substitute one item for another. • Order a la carte. • Go easy on the alcohol. Wine or light beer are the best choices. If you are more than six months past surgery, only 1 drink then switch to water. • Eat slowly, enjoy the ambience and socializing. It is not about the food! • Many restaurants offer nutritional analyses of their food. Ask an employee for this or check out one of the following websites for a link to nutritional information for both sit-down and restaurants. • dwlz.com • calorieking.com • dietfacts.com\fastfood.asp • foodfacts.info • healthydiningfinder.com

Rev. 6/08, 4/11© Mount Carmel 2011

11 Nutrition Guidelines Gastric Bypass & Sleeve Gastrectomy Surgery One of the keys to successful gastric bypass surgery is preparation. This guide will help you to prepare for the diet changes before and after your surgery. You should attend a nutrition class 2 - 3 weeks after your surgery. Please call 614-234-LIFE (5433) to register for the class.

Before Surgery Helpful Tips • Practice sipping fluids slowly throughout the day. • Practice eating slowly and chewing food completely before swallowing. • Meals should take 20 - 30 minutes to consume. • Put down your eating utensil between bites. • Consider using a baby-sized utensil. • Discuss diet changes with the people that live with you. It is helpful if they try not to bring unhealthy foods into the home and focus on improving their own eating habits. • Begin keeping a food diary by either writing intake down or with an online website. Caffeine • You should not have any caffeine for the 3 days before your surgery. • You should not have any caffeine for 6 weeks after surgery. • Limit decaffeinated and regular products to 2 (8 oz.) cups daily long term. Carbonated Beverages • Do not drink carbonated beverages for 6 months after surgery. This can cause excess gas, bloating or irritation. Alcoholic Beverages • Do not drink alcoholic beverages for 6 months after surgery. Alcohol provides “empty calories” and should be consumed with caution.

12 Recovery Nutrition In order to give your body time to recover you will progress through the following phases: • Day of Surgery: Ice Chips and Sips of Water • Phase 1: Clear Liquid • Phase 2: Full Liquid • Phase 3: Puree • Phase 4: Soft • Phase 5: Regular Grocery List Below are foods that you are allowed to have in the first 3 weeks. They are separated into clear and full liquids so you will know the difference. If at any time you experience nausea and/or vomiting, try switching to clear liquids to allow your system to rest. Please do not eat anything that is not on these lists! Phase 1: Clear Liquids (Day 1) • Beef, chicken or vegetable bouillon or canned broth • Decaffeinated coffee or • Crystal Light® • Sugar-free gelatin • 100% – apple, grape or white grape, diluted 50/50 with water • Sugar-free Kool-aid® or lemonade • Sugar-free popsicles • Isopure® protein water (buy at health food store) Phase 2: Full Liquids (Eat 1/4 to 1/2 cup meals 6 times per day for 21 days.) • Cottage cheese – small curd, low-fat • Skim or 1% milk • Sugar-free • Sugar-free fudgsicles • Yogurt (no-sugar added, fat free) • Low-fat cream - strained (Cream of Mushroom, Chicken, Celery, Tomato, Potato) • Cooked cereals including (no added sugar), cream of wheat, cream of rice and grits. • Peanut butter (for recipes ONLY) • Hot cocoa mix (no sugar added) • Nonfat dry milk powder • Evaporated skim milk • Liquid egg whites, pasteurized (do not ) 13 Fluids • The goal for fluid intake is 64 ounces (8 cups) per day. • You are not expected to reach this goal until after you are home from the hospital. • Do not use a straw when you drink fluids. • Stop drinking fluids 30 minutes before a meal and not for 30 minutes after a meal. • All juices on your tray must be diluted 50:50 with water to prevent dumping syndrome. • You will be given standard portions of liquids on your hospital trays. • Do not try to consume all of it. This is the time for you to begin to pay attention to your body’s feeling of fullness. Try only what sounds good to you. • Maximum amount for each meal is 1/4 cup. Protein The protein intake goal is 65 - 75 grams per day or 11 - 13 grams per meal. • It is very important that you reach and maintain this level of protein intake long term to help prevent malnutrition and prevent muscle wasting. • You are not expected to reach this goal until after you go home from the hospital. Protein Supplements • Plan to put protein powder in most foods and beverages to help you reach your goal. • The supplement that you buy should be a whey, casein or soy protein ISOLATE. • An acceptable protein powder should contain between 15 - 20 grams of protein per scoop and little or no fat or sugar. • We recommend unflavored and flavored protein powders. Where to Buy Unjury® protein powder, and Syntrax® Nectar® protein powder sold by Mount Carmel Bariatric Program. You may also obtain protein powder from any drugstore, health food store or grocery store.

14 Lactose Intolerance The symptoms of lactose intolerance are: gas, bloating, and diarrhea. If you are lactose intolerant, try using lactose free milk or chewable lactase enzyme tablets before meals containing milk or dairy products. You may try soy milk but it will need to be low sugar and low fat. If the symptoms persist, please call the Bariatric Dietitian. Vitamins and Minerals One Week After Surgery • Take one adult chewable multivitamin with iron OR take two children’s chewable multivitamins with iron per day with food. Check that the product contains ferrous gluconate, ferrous fumarate or carbonyl iron. Six Weeks After Surgery • Take one multivitamin with iron per day. Check that the product contains carbonyl iron. • Take Calcium Citrate with daily (1200 - 1500 mg). Do not take at the same time as iron because iron interferes with calcium absorption. Do not take any other medications within 1 - 2 hours. Do not take more than 600 mg dose at one time. • Take one Vitamin B12 1000 - 1200 μcg (micrograms) sublingual tablet weekly. • Take other supplements as directed/recommended by your physician. Dumping Syndrome Dumping syndrome is caused by eating or drinking concentrated sources of sugar. Sugar cannot be broken down in your new small stomach and can cause large amounts of fluid to enter your intestine. This can result in facial flushing, increased heart rate, nausea, vomiting, and/or diarrhea. Not everyone gets dumping syndrome but we strongly recommend you avoid high sugar, empty calorie foods to promote weight loss. Fat Eating high fat foods can cause diarrhea because your body does not absorb fat as well after surgery. High fat foods usually contain a lot of calories which is not beneficial for weight loss.

15 Post-op Sample Menu The following is a sample menu to follow for the first 3 weeks after surgery. You may consume ANY of the foods/supplements/liquids on the full liquid list. Do not limit yourself to these foods only. Times are examples also.

8:00 a.m. 1/4 - 1/2 cup full liquid recipe (see below) 11:00 a.m. 1/4 - 1/2 cup strained cream with protein powder 1:00 p.m. 1/4 - 1/2 cup sugar free pudding with protein powder 4:00 p.m. 1/4 - 1/2 cup no sugar added yogurt with protein powder 7:00 p.m. 1/4 - 1/2 cup cooked cereal with protein powder 10:00 p.m. 1/4 - 1/2 cup full liquid recipe

Full Liquid Recipes These recipes are for full liquid that are high in protein. They will be especially helpful for the first several weeks after surgery, but you may choose to include one high protein item each day on an ongoing basis. Use a sugar free protein powder supplement for the following recipes. You may try freezing these recipes for a frozen treat. Try substituting Isopure® water for some of the clear beverages for added protein. Recipes that have berries with very small seeds should not be a problem for you. Make sure that these are well blended and that no large pieces remain.

The serving size for the first 2 weeks is1/4 cup, 6 times per day, gradually increasing to 1/2 cup, by 6 weeks after surgery. DO NOT exceed 1/2 cup amount at a meal during the first several months after surgery.

Banana Split 1/2 cup skim milk 1 scoop protein powder, chocolate 4” , ripe 1/8 cup pineapple, canned, packed in juice 3 strawberries, frozen, no added sugar Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 116, Protein - 12 g, fat - 1 g, sodium - 52 mg

16 Apple Shake 1/2 cup skim milk 1/4 cup light yogurt, no added sugar, vanilla 1/4 cup applesauce, no added sugar 1 scoop protein powder, vanilla 4” banana, ripe pinch cinnamon pinch nutmeg 2 drops vanilla extract Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 100, Protein - 12 g, Fat - 1 g, Sodium - 64 mg

Carnation Instant ® 1/4 cup orange juice, 100% 1/2 cup skim milk 1 package Carnation Instant Breakfast, no added sugar, vanilla 1 scoop Designer Whey protein, vanilla 4 ice cubes Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 120, Protein - 14 g, fat - 0 g, sodium - 100 mg

Protein Power Carnation Instant Breakfast® 1 cup skim milk 1 cup Carnation Instant Breakfast, no added sugar 1 scoop Designer Whey protein, natural Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 125, protein - 16 g, fat - 0 g, sodium - 130 mg

Protein Power Crystal Light® 1/2 cup Crystal Light 1 scoop protein powder 2 tablespoons Cool Whip Light® 4 ice cubes Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 62, protein - 10 g, fat - 0 g, sodium - 20 mg

17 Protein Power Pineapple Smoothie 2/3 cup pineapple juice 100% 1/2 cup cottage cheese, low fat 1 scoop Designer Whey protein, natural Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 134, protein - 18 g, fat - 1 g, sodium - 250 mg

Protein Power Iced Café Vienna 1 cup skim milk 1 scoop Designer Whey protein, natural 1 1/3 TBSP General Foods International Coffee®, Café Vienna, sugar-free 6 - 7 ice cubes Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 110, protein - 14 g, fat - 1 g, sodium - 116 mg

Chocolate Peanut Butter Cup 1/2 cup skim milk 1 scoop Designer Whey protein, chocolate 1 tsp peanut butter, creamy 4 ice cubes Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 88, protein - 12 g, fat - 2 g, sodium - 64 mg

Breakfast Boost Plus 1/2 cup orange juice, 100% 1/4 cup yogurt, vanilla, light, no added sugar 4 strawberries, frozen, no added sugar 3 , frozen, no added sugar 2 scoops Designer Whey protein, natural Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 160, protein - 20 g, fat - 0 g, sodium - 62 mg

18 Eggnog 1/2 cup skim milk 2 scoops Designer Whey protein, vanilla 1/2 tsp allspice 1/4 cup yogurt, vanilla, light, no added sugar 1/2 graham cracker (2 small squares) 4 ice cubes Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 166, protein - 22 g, fat - 0 g, sodium - 130 mg

Fruit Freeze 1/2 cup skim milk 5 strawberries 1/4 banana, ripe 2 peaches, frozen, no added sugar 1/4 cup pineapple, canned, packed in juice 1 scoop Designer Whey protein, natural Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 108, protein - 12 g, fat - 0 g, sodium - 54 mg

Key Lime Pie 6 ounces sugar/fat free key lime pie yogurt 1/8 cup skim milk 1 tsp gelatin, lime, sugar free 1 scoop Designer Whey protein, natural 1/2 graham cracker (2 small squares) Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 116, protein - 14 g, fat - 0 g, sodium - 90 mg

19 Hot Drinks Protein Power Café Vienna 1 cup skim milk 1 scoop Designer Whey protein, natural 1 1/3 TBSP General Foods International Coffee®, Café Vienna, sugar-free Heat milk to desired temperature. Put all ingredients into blender. Blend on low for 20 seconds. Makes one serving. Alternates: use General Foods International Coffees, French Vanilla Café and Swiss Mocha, sugar free. Nutrition information per 1/4 cup: Calories - 106, protein - 14 g, fat - 0 g, sodium - 118 mg

Protein Power Plus Hot Cocoa 1 cup skim milk 1 packet hot cocoa, no sugar added 2 scoops Designer Whey protein, natural or chocolate Heat milk to desired temperature. Put all ingredients into blender. Blend on low for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 166, protein - 26 g, fat - 2 g, sodium - 252 mg

Key Lime Pie 6 ounces sugar/fat free key lime pie yogurt 1/8 cup skim milk 1 tsp gelatin, lime, sugar free 1 scoop Designer Whey protein, natural 1/2 graham cracker (2 small squares) Put all ingredients into blender. Blend on high for 45 seconds. Makes one cup. Nutrition information per 1/2 cup: Calories - 116, protein - 14 g, fat - 0 g, sodium - 90 mg

20 Pureed and Soft Diet Guidelines for Gastric Bypass & Sleeve Gastrectomy Surgery Phase 3: Puree (Begin week 4) Helpful Tips for the Pureed Diet: • Continue with low sugar, low fat foods only. • Use broth, milk or juice to help with consistency when blending. You are trying to blend to a smooth consistency. • Add new foods one at a time so if you have any intolerance, you will know what caused it. • You may use stage 1 or stage 2 baby foods. Avoid stage 3 baby food or any foods with chunks or pieces. • You may season foods to taste. Avoid large amounts of salt. • Continue to eat slowly. You should be taking 20 – 30 minutes to consume a 1/4 - 1/2 cup meal. • Continue to consume 6 small meals per day. Each meal should be no more than 1/2 cup. • Continue to include 8 cups of fluid each day. Remember to stop drinking fluids 30 minutes before a meal and not resume until 30 minutes after a meal. • Avoid skins of raw fruits and vegetables when blending. • You may eat meats which have been very finely chopped, fish that has been flaked apart before eating and scrambled eggs, (substitute or whites only) without passing through the blender.

21 Recipes No Bake Lasagna 1/4 cup skim ricotta cheese 2 TBSP low sugar spaghetti sauce 1 TBSP shredded mozzarella cheese Place ingredients in a small bowl in the order listed and warm in the microwave.

Salsa Scramble 1/4 cup scrambled egg substitute 1 TBSP mild salsa (from jar) 1 TBSP 2% shredded cheddar cheese Scramble egg substitute until light and fluffy, sprinkle with cheddar cheese. Remove from heat. Top with salsa.

Baked Fish 2 oz. white fish of choice (Cod is recommended) 1 tsp margarine Fresh lemon Seasonings Place fish in foil. Squeeze fresh lemon over top followed by margarine and desired seasonings. Close foil tightly. Bake at 375º for 10 - 12 minutes or until fish is flaky.

Refried Beans 1/3 cup refried beans – fat free 1 TBSP mild salsa from jar 1 TBSP 2% shredded cheddar cheese 2 tsp plain Greek yogurt Place beans and salsa in blender or food processor and blend until smooth. Place in microwave and heat to desired temperature. Top with cheese and yogurt.

22 Phase 4: Soft (Begin week 6) Helpful Tips for the Soft Diet • Continue low sugar, low fat food choices only. Use low fat cooking methods such as grilling, baking, steaming or microwaving. • Continue to introduce new foods one at a time. • Whole grain breads and crackers may be introduced now. bread for the first few times, eat only1/4 of a slice until you are sure you can tolerate it. After that, the portion is 1/2 slice of bread or 2 - 3 crackers. Make sure you chew well. • Use canned fruits only, juice or water packed, none in heavy syrup. • You may choose soft cooked vegetables. • You may choose tender meats, cut into small pieces. Keep meats moist with fat free gravy or broth. • Avoid any food that is difficult to chew well. Examples: steak, asparagus, nuts, seeds. Vitamin/Mineral Guidelines at 6 weeks After Surgery: • Take one Multivitamin with Iron per day. Check that the iron source is carbonyl iron. • Take one Vitamin B12 1000 - 1200 micrograms (μg) sublingual tablet weekly. • Take 1200 – 1500 milligrams (mg) of Calcium Citrate with Vitamin D added, daily. Do not take at the same time as iron because iron interferes with calcium absorption. Do not take any other medications within 1 - 2 hours. Take no more than one dose at a time. • As directed by your surgeon for those with a history of anemia or menstruating women, take Iron 45 - 60 milligrams (mg) (carbonyl iron) daily. Do not take Calcium at same time. Do not take on an empty stomach. If you are taking an iron supplement, take a multivitamin without iron.

23 Regular/Long Term Diet after Gastric Bypass & Sleeve Gastrectomy Surgery Phase 5: Regular General Guidelines • Continue to eat 6 small meals per day, working slowly up to 1 - 1 1/2 cups 4 times daily by the end of the first year. • Continue to drink at least 8 cups of fluid per day. • Take fluids with you when you are away from home. • Remember to drink only between meals, not with meals. • Take vitamins and minerals as recommended by the dietitian and your surgeon. • Eat balanced meals as much as possible. Remember to start with high protein foods, add whole grains, fruits, vegetables and skim / 1% milk. • Write down what you eat and drink every day or use an online calorie counting website to keep track of your daily intake. Tips for Weight Loss • Pay attention to your body’s feeling of fullness. Do not eat unless physically hungry. (Not in recovery phase!) • Eat your meals at a table without TV or other distractions. • Avoid items (crackers, chips, etc.) and snacking between your 6 meals. • Develop a physical activity plan with your doctor’s approval and STICK TO IT! Protein Protein is important in helping to prevent hair loss and maintain muscle mass during weight loss. However, you can consume adequate amounts of protein and still have some hair loss. Iron and zinc intake, as well as some medications and the stress of surgery can all cause hair loss. This hair loss does not occur until 2 to 4 months after surgery. You can help prevent hair loss by eating adequate protein and taking vitamin/mineral supplements as recommended by your dietitian and surgeon.

24 Some examples include: Meats* (amount of protein in grams) 1 oz or 1/4 cup tender cooked meat (chicken, turkey, fish, pork, beef, veal) – 7 grams 1/2 cup low fat cottage cheese – 15 grams 1 slice or ounce low fat cheese – 7 grams 1 egg – 7 grams *NOTE: You may not tolerate all meats well after surgery. Remember to keep them moist with fat free gravy or broth. Substitute other high protein foods if you have difficulty.

Dairy 1 cup skim or 1% milk – 8 grams 1 cup yogurt – 8 grams

Legumes 1/2 cup beans – any type – 5 - 7 grams 1/2 cup low fat chili – 10 grams 1/2 cup bean soup – 3 - 5 grams 1 tablespoon peanut butter – 4 grams 2 tablespoons nuts – 2.5 grams

SOY FOODS 1/4 cup – 5 grams 1 cup soy milk – 7 grams 1 vegetable burger – 10 - 13 grams

Fat You will need to limit your fat and calorie intake to help promote weight loss. The goal is to eat no more than 35 grams of fat per day. Read food labels to monitor your fat and calorie intake. You will need to minimize portions or consume low fat or fat free versions of many foods. NOTE: Do not eat low fat or baked chips, fat free or sugar free , except in very limited quantities. These products are not calorie free and usually have little nutritional value.

25 Low Fat Cooking Tips Meat/Poultry • Use the leanest meat • Beef – Round or Sirloin • Chicken/Turkey – Skinless breast or white meat • Trim the fat off of meats • Use low fat cooking methods examples: bake, broil, grill, cooking sprays. • Drain off excess fat after cooking Vegetables • Avoid high fat sauces made with cheese, cream or butter. • Use low fat cooking methods examples: microwave, steam or bake. • Add low fat cheese or cottage cheese to starchy vegetables to increase protein intake. • Add salsa, herbs, balsamic vinegar, fat free salad dressing or lemon juice to flavor. • Add grated vegetables to soups, or sauces for an easy way to increase vegetable intake.

26 Stocking your Consider keeping the following foods on hand: Cupboard Water packed tuna Onions Canned beans Whole grain starches Olive or canola oil Potatoes Whole grain low fat crackers Fat-free refried beans Low sugar, high protein dry cereal Fat-free, low sugar pasta sauce Fat free chicken/beef broth Low-carb protein bars Low-fat/fat free mayonnaise Balsamic vinegar Low-sodium low fat canned soup

Refrigerator Low fat cottage cheese Non-fat low sugar yogurt Eggs (1 - 2 yolks/week) Salsa Fresh fruit/vegetables Lean turkey, ham or roast beef Low fat cheese V-8 juice Skim or 1% milk Mustard

Freezer Low fat frozen entree Lean ground turkey or beef Whole grain bread Fruit/Vegetables Chicken breasts Whole grain English muffins

Bariatric Nutrition Support Group Facilitated by our Bariatric Dietitian, this group offers puts the focus on ongoing nutrition education and support. From open discussions about weight management techniques and advice on eating healthy at restaurants to reading food labels, healthy snacking and more, you’ll learn what it takes to eat smart and healthy and make your weight loss permanent. This group meets at Mount Carmel West on the first Monday of every month from 5:30 – 6:30 pm. Call 614-234-LIFE (5433) to register. Bariatric Dietitian If you have questions or concerns please contact Andrea Mattison, RDN, LD, Bariatric Dietitian, at 614-234-1638 or [email protected].

27 28 Mount Carmel Bariatric Nutrition Guide

mountcarmelhealth.com

February 2016