Gastric Sleeve Resection

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Gastric Sleeve Resection

Huntington VA Medical Center

1540 Spring Valley Drive Huntington, WV 25704

1-800-827-8244 or 304-429-6741 Extensions 3356, 2391 or 2328

Gastric sleeve resection is a restrictive type of laparoscopic bariatric surgery which reduces the size of your stomach.

With gastric sleeve resection more than half of the stomach (the greater curvature) is surgically removed. A “new” stomach if formed. It is about the size and shape of a banana and has a volume of 3- 6 ounces (100-200 cc). This part of the surgery can not be reversed. There is no intestinal bypass, only stomach reduction. The stomach functions normally so most food items can be eaten but in small amounts.

Other names for the surgery are sleeve gastrectomy, vertical sleeve gastrectomy, and tube gastrectomy.

Advantages of this surgery – no foreign objects are placed in the body, all nutrients are absorbed, no dumping syndrome occurs because the lower part of the stomach (pylorus) which connects to the small intestine is preserved, and the portion of the stomach that produces hormones (ghrelin) which stimulate hunger is removed.

For about six (6) weeks after surgery, you will need to follow a liquid or semi-liquid diet to provide healing time. You must follow specific dietary instructions once solid foods can be used. You will only be able to eat a small quantity of food at a time to avoid stretching the stomach. All food must be chewed thoroughly. You can not eat and drink at the same time. You must avoid lying down too soon after you eat.

What are the side effects and risks of GSR?

The most common side effects are sore and swollen abdomen, vomiting, nausea, reflux, diarrhea and constipation.

There are some risks associated with general abdominal surgery as bleeding, pain, pneumonia, infection, pulmonary embolism, heart attack or stroke. Possible problems with the gastric sleeve resection are a fistula or leaking of the sleeve.

Questions?

Call the Bariatric Surgery Specialty Nurse at the Huntington VAMC 304-429-6741 or 1-800-827-8244

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Nutrition and Food Services

Bariatric Surgery Instructions

Huntington VA Medical Center 1540 Spring Valley Drive Huntington, WV 25704

1-800-827-8244 or 304-429-6741 Extensions 3356, 2391 or 2328

1. The day before surgery you must only use a clear liquid diet. You will drink magnesium citrate that evening for surgery preparation. You should not eat or drink anything after midnight.

2. You will need to report to the Huntington walk-in Nutrition Clinic in either the Green or Blue Team Primary Care areas for pre-surgery diet instruction. A

scheduled appointment is not required. The ambassador desk located on the ground floor once you enter the revolving glass doors can provide directions to the clinic.

3. Immediately after surgery, you will be NPO or have nothing by mouth, including ice chips. You will not be allowed to eat or drink anything until a special test is done the morning after your surgery. If there are no problems, a clear liquid diet (Stage 1) is ordered by the surgeon. Your portions will be very small, no more than 2-3 ounces.

4. You will be discharged on the Post Bariatric Stage 1, clear liquid diet with protein powder provided by the Huntington VAMC.

5. It is required that you telephone the Huntington outpatient (PACT) dietitian each week after your surgery for diet progression from one stage to the next. See the checklist on the next page for sample points of discussion.

1-800-827-8244 extension 3356, 2391, or 2328

6. It is important to have routine follow-up sessions with the registered dietitian at the same time as the Bariatric Clinic. If you have an appointment at the Huntington VAMC, use the walk-in Nutrition Clinic as listed above in #2. If you have a CVT-Telehealth appointment from your local facility, the Huntington registered dietitian will be available.

7. If you are enrolled in Myhealthevet, you can send a "secure" message to Nutrition at the Huntington VAMC with any questions or concerns. A registered dietitian will reply electronically.

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Bariatric Telephone Call Checklist

Please be prepared to provide this information to the dietitian. 1. Current Weight

2. Home Blood Sugar

3. GI status: Nausea ?

Vomiting? Reflux?

4. Hydration: Total ounces of fluid Types of fluid 5. Diet Stage:

6. Protein Intake Name of Supplement Content per serving: Grams of protein Grams of carbohydrate Calories

Total grams protein per day

7. Nutritional supplements MVI with minerals Chewable or tablet? Calcium

Calcium with vitamin D Vitamin B12

Iron (begin week 5) 8. Bowel routine Frequency

Discomfort? Bowel changes 9. Physical activity

10. Any concerns?

11. Local follow up appts? Notes:

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Gastric Sleeve Resection

Diet

Huntington VA Medical Center 1540 Spring Valley Drive Huntington, WV 25704

1-800-827-8244 or 304-429-6741 Extensions 3356, 2391 or 2328

With the gastric sleeve resection, you will need to make changes in your lifestyle and eating habits. You must eat smaller portions and make good choices, avoiding high calorie food and beverages. Although you feel full faster and longer with a smaller stomach, this does not

eliminate the emotional desire to eat. Your long-term goal is volume restriction while consuming a nutritionally balanced diet. Weight loss varies with each individual but is usually from 1 to 3 pounds per week during the first year.

After you have lost weight, you may be able to take less medicine. Check with your doctor on how to adjust all of your medications.

NUTRITION RECOMMENDATIONS

Gastric sleeve resection removes over half of your stomach. With the smaller stomach (100-200 cc’s) you will feel full faster and learn to reduce the amount you eat.

No surgery is without risk. Potential complications include nausea, vomiting, dehydration, diarrhea, excessive gas, lactose intolerance, constipation, gallstones, mineral and vitamin deficiency, protein calorie malnutrition, hair loss. Following instructions provided by the bariatric team will keep these problems to a minimum.

Learning new eating habits is essential. You will advance through 4 stages to a final low fat, low calorie, high protein diet which you should follow permanently. The amount of weight you lose will depend on how committed you are to the required lifestyle changes.

Advancing from one diet or stage to the next depends on the rate that you heal from surgery. It is important that you move from one stage to the next only when directed by the registered dietitian or surgeon.

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OUTPATIENT POST BARIATRIC DIET SUMMARY

Post Bariatric Diet Stage

Protein Supplement Daily Vitamins and Mineral Supplements

Week 1 and Week 2

Stage 1 - clear liquids Portion size:

2 - 3 ounces

Minimum of 60 grams from protein

supplement

2 adult or 4 children's chewable complete multivitamins with minerals

Chewable calcium antacid or chewable calcium tablet = 1500 mg

Vitamin B12 sublingual tablet, 500 micrograms

Week 3 and Week 4

Stage 2 - full liquids Portion size: 2 - 4 ounces

Minimum of 60 grams from protein

supplement

2 adult or 4 children's chewable complete multivitamins with minerals

Chewable calcium antacid or chewable calcium tablet = 1500 mg

Vitamin B12 sublingual tablet, 500 micrograms

Week 5 and Week 6 Stage 3 - pureed Portion size: 2 - 4 ounces Do not drink 15-30 minutes after eating

60 - 80 grams protein from food or

combination food and supplement

2 adult tablets - multivitamin with minerals

Calcium citrate tablets with vitamin D = minimum of 1500 mg calcium, 600 units vitamin D

Vitamin B12 tablet , sublingual 500 micrograms Elemental iron tablet , 27 milligrams

or Elemental iron tablet, 65 - 130 milligrams for menstruating female Week 7 and Week 8 Stage 4 - soft Portion size: 4 - 6 ounces Do not drink 15-30 minutes after eating

or Elemental iron tablet, 65 - 130 milligrams for menstruating female

Week 9 and Lifelong

Maintenance - High protein, low fat, Low calorie

Portion size: 4 - 6 ounces

or Elemental iron tablet, 65 - 130 milligrams for menstruating female

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GASTRIC SLEEVE RESECTION DIET BASICS

Avoid overeating. It is usually best to eat 6 small meals per day. Do not skip meals. Drink most of your fluids between your meals. Avoid constant nibbling.

Chew all food thoroughly.

Eat and drink very slowly. Right after your surgery, it should take 10-15 minutes to eat about 2

tablespoons of food. You will advance but still should take 30 minutes for each meal.

Stay hydrated. Drink at least 8 cups (64 ounces) of water or sugar free liquids daily. Drink only 1/4 - 1/3 cup at a time due to the pouch size. Do not use alcohol, beer, high sugar products, caffeine, or carbonated beverages.

“Listen to your smaller stomach.” Stop drinking and eating if you feel full. Pushing yourself to eat more will cause the stomach to stretch.

Monitor portions. Measure amounts carefully. Use measuring spoons and measuring cups.

Remember your stomach can only hold a few tablespoons at a time after surgery. Eventually it will hold about 1/2 to 1 cup.

Medicine cup = 2 ounces

Measuring spoons: Measuring Cups:

2 tablespoons = 1 ounce 1/4 cup = 2 ounces 1 tablespoon = 1/2 ounce 1/2 cup = 4 ounces 1 teaspoon = 1/3 ounce 3/4 cup = 6 ounces 1 cup = 8 ounces

Avoid foods or liquids with added sugar or fat. Do not add sugar, cream, or fats to any of your foods or liquids. These foods can lead to nausea and weight gain.

Have a high protein food with each meal. You will need 60-80 grams of protein daily. It may

be necessary to use a protein supplement.

Take nutrition supplements (vitamins and minerals) as advised. Set up a schedule for taking your supplements and medications.

Introduce one new food at a time. If you do not tolerate a food, wait at least

one week before trying it again. Foods that are dry, sticky, gummy, or stringy

in texture, with hard skins, nuts and seeds may present the biggest problems. Each person has different foods that work best for them.

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GASTRIC SLEEVE RESECTION DIET BASICS, CONTINUED

Substitute lactase-treated milk or calcium-fortified soy milk if youcannot tolerate regular milk. You may need to take lactase pills with dairy to help digest the lactose. They are available in a drug store. Ask your dietitian or pharmacist.

It is best to avoid chewing gum. If you do chose to use gum, do not swallow it.

HIGH FAT FOODS TO AVOID

Fat seems to be difficult to digest after bariatric surgery. Too much fat slows the emptying of the stomach and causes reflux (back-up of food and stomach acid into the esophagus). Eating high fat foods may cause cramping, diarrhea, nausea and vomiting. In addition, these foods are high in calories and may prevent you from reaching your goal weight.

Whole milk and whole milk dairy products Fried foods Butter, margarine Gravy, Sauces

Oils, shortening, lard Potato chips and other ''fried snacks" Cream cheese, sour cream Donuts, pastries, icing

Mayonnaise and regular salad dressings Ice Cream Olives, nuts Restaurant meals High fat meats as bacon, sausage, hot dogs,

luncheon meats, canned meats

HIGH PROTEIN IS REQUIRED

It is important to have protein in your diet after the surgery and with each stage of the gastric sleeve resection diet.

 to heal your incision and new stomach pouch

 to keep your muscle mass while you are losing weight.

 to prevent poor healing, hair loss, and a feeling of low energy

The amount of protein you will eat or drink is measured in grams. Your total protein depends on your body size, nutritional status, and possible need for increased protein. You should consume 60-80 grams of protein each day.

Protein Supplements

You will need a protein supplement after surgery to add at least 60 grams of protein daily. A whey protein powder is the best one to use. Read the product label and purchase one that has the following in one serving:

10-20 grams of protein no more than 100 calories 5 grams or less of total carbohydrates

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Protein Foods

Since you will be eating only small amounts of food at a time after surgery, you need to use high protein foods first at each meal, before you eat other foods.

Choose lean or low fat , lower calorie sources to prevent unwanted weight gain. The “Nutrition Facts” section on the food label provides information on the calories and grams of protein and fat in one serving. Prepare all foods without added fat.

Food/Beverage Serving

Size Protein Calories

Meat, Fish, Poultry

Shrimp, boiled 6 large 7 g 33

Peanut Butter 2 tbsp 8.5 g 190

Baby food meat (plain) 1 jar (2.5oz) 9-11 g 60-80

Ground turkey (97% lean) 2 oz 11 g 60

Salmon, baked 2 oz 12 g 115

Roast 2 oz 12 g 130

Baked ham 2 oz 13 g 100

Tuna, in water ¼ cup 14 g 45

Perch, flounder, sole, haddock (baked) 2 oz 14 g 65

Lean ground sirloin 2 oz 14 g 150

Tilapia 2 oz 15 g 72

Lobster 2oz 15 g 80

Chicken, dark, without skin 2 oz 15 g 115

Corned Beef 2 oz 15 g 140

Turkey, dark meat without skin 2 oz 16 g 92

Spare ribs 2 oz 16 g 224

Turkey, light meat without skin 2 oz 17 g 80

Pork chop 2 oz 17 g 109

Chicken, white, without skin 2 oz 19 g 90

Milk, Cheese, Yogurt

Egg white 1 egg white 3 g 20

Tofu ¼ cup 5 g 95

Yogurt, light ¾ - 1cup 5-9 g 80-100

Vanilla soymilk, non-fat 1 cup 6 g 70

Skim mozzarella 1 oz 6 g 80

Fat free American cheese 1 slice 7 g 35

Fat free or low fat cottage cheese ¼ cup 7 g 40

Egg substitute ¼ cup 7 g 50

Egg, large size 1 egg 7 g 65

Skim milk 1 cup / 8oz 8 g 90

Fat free cheddar, shredded ¼ cup 9 g 35

Non-fat dry milk ¼ cup 11 g 110

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Protein Foods, continued

Starches

Mashed potatoes ¼ cup 1 g 50

Baked potato, no skin ½ small potato

1.5 g 65

Beans/lentils ¼ cup 4 g 60

Fat free refried beans ¼ cup 4.5 g 68

Barley ¼ cup 6.5 g 50

Edamame, shelled ¼ cup 8 g 95

Soups

Broth ½ cup 1.5 g 25

Low fat creamed soup 1 cup 6-9 g 90

Chicken noodle soup 1 cup 4-6 g 100-150

Bean, Pea, or Lentil soup 1 cup 6-9 g 100-140

Minestrone soup 1 cup 5 g 100

Key: oz = ounce g = grams

1 oz = 2 tablespoons 2 oz = ¼ cup 3 oz = ⅓ cup 4 oz = ½ cup 6 oz = 3/4 cup 8 oz = 1 cup

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SUPPLEMENTS

Taking vitamins and minerals is required after gastric sleeve resection surgery and for the rest of your life. Without daily vitamin and mineral supplements, you could develop nutritional deficiencies with severe side effects.

1. Take a multivitamin with minerals daily.

a. Before surgery and for the first month after surgery, take 2 adult or 4 children’s chewable “complete” multivitamins with minerals or a liquid product.

b. After 1 month, 2 adult tablets/capsules may be used.

c. Avoid time-released supplements and enteric coating on tablets or capsules. 2. Vitamin B-12 is required.

a. 500 micrograms as sublingual tablet once a day or b. 1000 micrograms injection once a month.

3. Take extra calcium with vitamin D.

a. Before surgery and for the first month after surgery take chewable calcium antacids or chewable calcium with vitamin D = 1500 milligrams of elemental calcium.

b. After 1 month, change to calcium citrate with vitamin D. Take enough tablets to provide at least 1500 mg of calcium and 600 international units of vitamin D. c. Take the calcium and vitamin D two hours before or after the

multivitamin/mineral supplement.

4. After one month, begin an iron pill daily with 27 milligrams of elemental iron. For menstruating females, a larger dose (65 - 130 mg) is recommended.

5. Additional thiamine, folic acid, vitamin C, vitamin D and magnesium may be necessary. Your provider will tell you if one of these is needed and how much to take.

6. Do not take any fiber pills or powders or laxatives without permission from your physician.

7. Do not take over the counter medicines or herbal products unless approved by your physician.

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GASTRIC SLEEVE RESECTION - STAGE 1 - CLEAR LIQUIDS - 2 weeks

Stage 1 is the first diet ordered after surgery. Clear liquids will be started after an upper GI series test with gastrografin contrast shows that is safe for you to begin drinking.

You may not feel hungry but need to drink liquids to prevent dehydration. Signs of dehydration include thirst or dry mouth, headache, feeling dizzy, muscle cramps, and small amount or dark colored urine.

Sip liquids slowly. “Gulping” liquids may cause pain, nausea and vomiting. It is best to avoid using a straw as this adds air to your pouch and can cause discomfort.

Pay attention to your feeling of fullness.

Drink 64 ounces (8 cups) of water or sugar/caffeine free, non-carbonated beverages, every day. You should only drink 2 - 3 ounces at a time due to size of your stomach pouch.

You will be on clear liquids for 2 weeks.

You must use a protein supplement daily to add 60 grams of protein. An unflavored protein powder can be added to 1/3 cup of the clear liquid beverages or if flavored can be mixed with 1/3 cup of skim milk.

Take chewable forms of the multivitamin/mineral tablet and calcium.

STAGE 1 CLEAR LIQUIDS - 2 weeks

Food Group Choose Do not Use Beverages Water

Sugar free, non-carbonated flavored waters

Sugar free fruit drinks, ades Caffeine free coffee or tea

Carbonated beverages Sports Drinks

Sweetened fruit drinks, ades Regular coffee or tea Caffeine

Alcohol or beer

Fruit Diluted fruit juice Full strength fruit juice Other fruits

Meat

Meat Alternate/Protein None Protein powder All meat and meat products Milk Small amount of skim milk

if needed to mix with flavored protein powder

All other milk and milk products

Miscellaneous Sugar substitute Sugar free gelatin Sugar free popsicles

Sugar, honey, syrups

Regular gelatin or popsicles All solid food

Soups/Broth Clear beef, chicken, or vegetable broth

Cream soups

Starches None All

Vegetables None All

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GASTRIC SLEEVE RESECTION - STAGE 2 – FULL LIQUIDS - 2 weeks

Stage 2 prevents dehydration and provides protein for healing. 1. You will be on Stage 2 full liquids for 2 weeks.

2. Use six small feedings and no more than 1/2 cup (4 ounces) each feeding. 3. Introduce one new item at a time to see how your stomach will tolerate it. 4. Stop eating when you begin to feel full.

5. Drink 64 ounces (8 cups) of water or sugar free beverages every day. You should only drink 1/4- 1/3 cup at a time due to size of your stomach pouch. Sip liquids slowly. 6. If you cannot tolerate milk, use lactase-treated milk and lactase enzyme products. 7. Continue the chewable vitamin and mineral supplements and calcium.

STAGE 2 – FULL LILQUID

Food Group Choose Do Not Use Beverages Water

Sugar free, non-carbonated flavored waters Sugar free fruit drinks, ades

Caffeine-free coffee or tea

Sweetened fruit drinks, ades Regular coffee or tea

Caffeine Alcohol or beer Fruit Diluted fruit juice All fruit

Full strength fruit juices Meat

Meat

Alternate/Protein

Protein powder

Low fat soy milk All meats and meat products Milk/Milk Products 1 % or skim milk

Lactase-treated milk Non-fat dry milk powder

Low carbohydrate or sugar free instant breakfast powder mixed with non-fat milk Sugar free hot chocolate

Sugar free ice cream Sugar free pudding

Non-fat blended yogurt made with sugar substitute

Whole, 2 % milk, Cheese

Sweetened condensed milk Chocolate milk

Regular hot chocolate Regular milkshakes Regular ice cream, sherbet Regular pudding

Regular yogurt Miscellaneous Sugar substitute

Sugar free gelatin Sugar free popsicles Spices

Sugar, honey, syrups Regular gelatin Regular popsicles Sorbet

Soups Low fat strained cream soups made with skim milk

Chicken, beef or vegetable broth

Regular soups

Starches Very smooth cooked cereal as cream of

wheat, farina, grits, oatmeal Dry cereal, breads, crackers, potatoes, pasta, rice Vegetables Tomato or vegetable juice cocktail All solid vegetables

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GASTRIC SLEEVE RESECTION - STAGE 3 - PUREED- 2 weeks

All foods must be blended or pureed to the consistency of smooth applesauce. All foods should be cooked without added fat. Spices and herbs as tolerated may be added to flavor the food. For homemade: cut cooked food into small pieces and place in blender or food processor. Add liquid as fat free broth, non-fat milk, or fat free gravy and mix until smooth.

If you cannot tolerate milk, use lactase-treated milk and lactase enzyme products.

1. Stage 2 - Pureed is used for 2 weeks. 2. Eat protein food first.

3. Eat very slowly and chew food well.

4. Only eat 4- 8 tablespoons (1/4 cup to 1/2 cup) of pureed food at each meal. 5. Stop eating as soon as you feel full.

6. Eat six (6) small meals daily.

7. Add new food gradually, one at a time.

8. Drink 64 ounces (8 cups) of water or sugar free beverages between meals. You should only drink 1/4 - 1/3 cup at a time due to size of your stomach pouch. Sip liquids slowly. 9. Do not drink liquids 15 minutes before a meal and wait 15 – 30 minutes after a meal or

snack to sip liquids.

10. You can begin taking a tablet form of multivitamin/mineral supplement. calcium citrate with vitamin D, vitamin B12 and elemental iron.

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STAGE 3 PUREED - 2 weeks

Food Group Choose Do Not Use

Beverages Water

Sweetened fruit drinks, ades Regular coffee or tea

Caffeine Alcohol or beer Fruit Pureed no sugar added canned fruit

No sugar added applesauce Diluted fruit juice

Solid fruit

Full strength fruit juice Raw fruit

Fruit skin or seeds Meat

Meat Alternate/Protein Eggs, egg substitute Pureed low fat chicken, turkey, pork, beef, veal, lamb, seafood

Pureed legumes, lentils Smooth peanut butter Low fat soy milk, Tofu Whey protein

Fried or high fat meats Crunchy peanut butter Nuts

Milk/Milk Products 1 % or skim milk Lactase-treated milk Non-fat dry milk powder

Low carbohydrate or sugar free instant breakfast powder mixed with non-fat milk

Sugar free hot chocolate Sugar free ice cream Sugar free pudding

Low fat cottage or ricotta cheese Fat free sour cream

Whole, 2 % milk,

Regular hot chocolate Regular milkshakes Regular ice cream, sherbet Regular pudding

Regular yogurt All other cheeses Regular sour cream Miscellaneous Sugar substitute

Sugar free gelatin Sugar free popsicles Spices and mild herbs

Sugar, honey, syrups Regular gelatin Regular popsicles Sorbet Mayonnaise Salad dressings Popcorn Soups Low fat strained cream soups made with skim milk

Chicken, beef or vegetable broth Regular soups Starches Very smooth cooked cereal as cream of wheat,

farina, grits, oatmeal

Pureed cooked rice, noodles, pasta

Dry cereal, Bran Breads, crackers whole grains Vegetables Tomato or vegetable juice cocktail

Mashed white or sweet potatoes Pureed, cooked vegetables

Raw or fresh vegetables Vegetables with seeds Corn

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GASTRIC SLEEVE RESECTION - STAGE 4– SOFT- 2 weeks

The soft diet includes “solid” foods that can be mashed with a fork. All foods must be prepared without added fat. This stage begins six weeks following your surgery.

1. You will be on Stage 4- Soft for 2 weeks. 2. Eat protein food first.

3. Eat very slowly.

4. Take small bites (about the size of a dime) and chew food well. 5. Only eat 1/2 - 3/4 cup (4-6 ounces) of food at each meal.

6. Stop eating as soon as you feel full. 7. Eat 4 – 6 small meals daily.

8. Add new food gradually, one at a time.

9. Drink 64 ounces (8 cups) of water or sugar free beverages every day. You should only

drink 1/4 - 1/3 cup at a time due to size of your stomach pouch. Sip liquids slowly.

10. Do not drink liquids 15 minutes before a meal and wait 15 to 30 minutes after meals. 11. Take your multivitamin/mineral supplement, calcium citrate with vitamin D, vitamin

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STAGE 4 SOFT - FOOD/BEVERAGES

Food Group Choose Do Not Use

Beverages Water

Sweetened fruit drinks, ades Regular coffee or tea,caffeine Alcohol or beer

Desserts Sugar free products Cakes, candy, cookies, doughnuts

Fats Non-fat margarine Fat free gravies, sauces Fat free mayonnaise Fat free cream cheese

Regular mayonnaise or salad dressings

Regular cream cheese Fruit Lite or unsweetened canned fruit

Diluted fruit juice Full strength fruit juice Canned or frozen fruits in syrup

Fruit with peel or seeds Dried fruits

Meat/Meat Alternates Lean meats – chicken, turkey, pork, beef, veal, lamb, fish, shellfish,

Eggs, egg substitute

Tofu and soy protein products, low fat soy milk Dried beans cooked without fat

Reduced fat smooth peanut butter Whey protein

Fried or high fat meat Highly seasoned meat Spiced meats

Fried eggs Raw eggs

Chunky peanut butter Milk/Milk Products 1 % or skim milk

Lactase-treated milk Non-fat dry milk powder

Low carbohydrate or sugar free instant breakfast powder mixed with non-fat milk Sugar free hot chocolate

Sugar free ice cream Sugar free pudding

Low fat cottage or ricotta cheese Low fat mild cheese

Low fat sour cream

Whole, 2 % milk,

Regular hot chocolate Regular milkshakes Regular ice cream, sherbet Sorbet

Regular pudding Regular yogurt Regular cottage cheese Strong flavored cheese Regular sour cream Miscellaneous Sugar substitutes

Sugar free gelatin Sugar free popsicles Spices

Herbs

Sugar, honey, syrups Sugar alcohols Regular gelatin Regular popsicles Sorbet Coconut Pickles

Snacks Low fat crackers Popcorn, nuts, seeds Soups Low fat cream soups made with skim milk

Vegetable soup High fat soups Starches/Breads Cooked cereal – oatmeal, cream of wheat, farina,

grits, cream of rice Unsweetened dry cereal Pasta, rice (if tolerated) Toasted white bread Low fat crackers

Presweetened or sugar coated cereals

Bran, whole grain cereals Whole grain breads Bread with nuts or seeds Vegetables Tomato or vegetable juice cocktail

Soft cooked fresh, canned or frozen vegetables Creamed corn

Cooked white or sweet potatoes without skin

Whole kernel corn Raw vegetables Fried vegetables

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GASTRIC SLEEVE RESECTION- REGULAR DIET

Eight (8) weeks after your surgery, you will have progressed to a low fat, high protein diet with regular texture foods, including raw fruits and vegetables. Eating a sensible low fat and low calorie diet with controlled portions will help you to continue to lose weight and sustain your weight loss once you have reached goal.

1. Eat slowly and chew foods well.

2. If you experience nausea or abdominal discomfort, you may have eaten too quickly or too much.

3. Stop eating when feeling full.

4. Continue 4 to 6 small meals with 1/2 - 3/4 cup (4-6 ounces) of food at each meal. 5. Use moist, tender lean meats.

6. Eat a variety of low fat food for nutritional balance.

7. Eat protein with every meal and use 60-80 grams of protein daily. 8. Trim all fat from the meat before cooking.

9. Use low fat cooking methods: bake, broil, grill, roast, sauté, stir-fry in fat free broth, microwave, or steam.

10. Add “new” foods one at a time. If you do not tolerate a particular food well, wait about 1 week before trying it again. If you still do not tolerate the particular food, avoid it.

11. Avoid high fat foods, fried foods, sauces and concentrated sweets. 12. Add raw fruits and raw vegetables as tolerated.

13. Maintain adequate fluid intake with 8 cups (64 ounces) daily. It is still best to avoid carbonated beverages, fruit juices, caffeine and alcohol. . 14. Spices and herbs can enhance the flavor of food without adding fat. 15. Continue tablet form of the multivitamins with mineral, calcium citrate

with vitamin D, vitamin B-12 and iron.

Questions? Call the Primary Care PACT Registered Dietitian at the Huntington VAMC 1-800-827-8244 or 1-304-429-6741

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REFERENCES

Bariatric Nutrition: Suggestions for Surgical Weight Loss Patient, Article in Press, Surgery for Obesity and Related Diseases, www.soard.org, American Society for Metabolic and Bariatric Surgery, 3/08 Bariatric Sub-unit of the Weight Management Dietetic Practice Group, The American Dietetic Association

Center for Surgical Weight Control, Suite 101, 1115 Twentieth Street, Huntington. West Virginia Criteria and Standards for Bariatric Surgery, VHA Handbook 1102.6, Department of Veterans Affairs, Veterans Health Administration

Nutrition Guidelines for Bariatric Surgery Patients, Nutrition and Food Service, Clinical Resources, Clinical Practice Guidelines, March 2010 with revisions , vaww.nutrition.va.gov

Patient Education Material for Bariatric Surgery, Clinical Nutrition, Nutrition and Food Services Intranet, United States Department of Veterans Affairs, vaww.nutrition.va.gov

NUTRITION RESOURCES

www.eatright.org – Academy of Nutrition and Dietetics

www.move.med.va.gov – Veterans Health Administration Weight Management Program

www.myhealth.va.gov – My HealtheVet – Gateway to Veteran’s Health and Wellness

www.mypyramid.gov

www.nalusda.gov/fnic - Food and Nutrition Information Center

www.nhlbisupport.com/bmi - National Heart Lung and Blood Institute, Obesity Education Initiative

www.niddk.nih.gov – National Institute of Diabetes and Digestive and Kidney Disease, NIH

www.nutritiondata.com – free site for nutritional content of foods

The VAMC is not responsible for the availability or content of these external sites, nor does the VAMC endorse, warrant or guarantee the products, services, or information offered at these sites, references or facilities.

7/09 3/13 revised