NUTRITIONAL PLANNING
NUTRITION BEFORE SURGERY:
One you have been cleared for surgery and have a surgical date you will need to prepare for surgery with a PRE-OP Diet. This is essentially a liquid diet that is done for 2-3 weeks
WHY A PRE-OP DIET
One of the most difficult challenges our surgeons can encounter while performing a weight loss surgery is an enlarged liver. This condition is common among bariatric surgery patients and can make an otherwise simple operation much more complex. A low calorie diet two weeks before surgery can significantly shrink the size of the liver and make your weight loss surgery shorter and safer. For TWO WEEKS BEFORE your operation, you should follow this diet to prepare your body for surgery. You will be informed of the date to begin the preoperative diet by the bariatric team. The recommended preoperative diet will consist of a prescribed amount of a high protein drink
WHY THE CHANGE?
Bariatric surgery changes the anatomy of your gastrointestinal tract. As such- the way you approach food must change as well. This means that you will need to chose foods differently and chew foods differently. The goal here is to start building habits for your new gut. This means- the more you practice for what life looks life after surgery- the more likely you will find these habits easy to adapt. In short- your meals and your mealtimes are going to be different. THEY HAVE TO BE. The sooner you adopt these habits, the sooner they become just how you do things and the easier and healthier life will be after surgery. Not only do we want this to be the BEST treatment for you- we want this to be the SAFEST. The key here is nuritional planning and adopting nutritional behaviours.
We’ve summarized all these steps in the BARIATRIC CHECKLIST. We refer to this a great deal- it is a working list of things to focus on.
It is so important to explain to you why each step is on the checklist. We always do better when we understand the WHY. When the principles of treatment are explained- it is so much easier to understand why things need to get done.
A GOOD PLACE TO START…. The Nutritional Orientation Video and learning module is an excellent resource for understanding the reasons behind the nutritional changes needed in preparation for bariatric surgery. Please make sure you watch the video and complete the learning module.
Below are some key principles and steps to consider and the reasons why these actions must happen. We divided these into principles and then gave you steps to do.
PROTEIN:
WHAT IS PROTEIN? Protein is a macronutrient that works within every cell of your body. It is required for muscle development and regulating body tissues and organs. It’s made from a chain of amino acids considered the building blocks of protein. There are 20 total amino acids comprised of nine essential amino acids and 11 non-essential amino acids.
WHAT HAPPENS WHEN YOU DON’T GET ENOUGH PROTEIN:
Protein is one of the key building blocks for muscle development. It is a basic nutritional requirement that helps our bodies function in every day life. Protein deficiency not only leads to loss of muscle mass and an impairment in cell function. This translates into:
Muscle weakness
Impaired Wound Healing
Weakened Immune System
Weight Regain
WHAT FOODS HAVE PROTEIN IN THEM?
Below is a link to our “protein handout”. It lists all protein based foods (animal and plant based) and the amount of protein in each. As a rule human beings should consume about 1 gram of protein per kg of lean body mass- This translate into about 75-100 grams of prottetin per person per day.
WHAT TO DO:
You will need to consume at least 25 grams of protein per meal.
This is because your system does not absorb as it used to. We want to make sure you do not become protein deficient. Aiming for 25 grams per meal spces out the protein throughout the day. Your body needs 75-100 grams a day. After surgery you won’t be able to eat more than 1/2 cup at a time- you won’t be able to get enough protein in that small volume if you don’t space out your protein throughout the day. In short- you will need to adopt what we call the PROTEIN FIRST approach to your plate.
Here’s a perfect visual about how to approach your plate. The idea here is PROTEIN FIRST.
PROTEIN SUPPLEMENTS
Why do you need protein supplements?
Protein is important for building muscle and healing after surgery. After surgery the size of your new stomach pouch will be much smaller. It will make it hard for you to eat all the protein you need. So, it is important for you to take protein supplements for at least the first 4 weeks after surgery.
There are 2 types of protein supplements:
1. Protein powders
2. Protein shakes
PROTEIN POWDERS
The best protein powders are made from milk (whey), soy or egg. These come in
plain or a variety of different flavours.
You can add plain powders to hot or cold foods. Try adding it to oatmeal, cream of wheat, cream soups, yogurt, mashed potatoes, pureed vegetables or fruit. You can also make your own shake by adding protein powder to milk or water. Do not mix them with juice.
When you are adding protein powders to hot drinks dissolve them first in cold water and tthen mix that with warm/hot water.
DO NOT ADD SUGAR OR JUICE TO YOUR PROTEIN POWDERS OR PROTEIN SHAKES
What should you look for in protein powder?
30 grams of protein powder should have:
20 to 30g of protein
Less than 5g of carbohydrate
CHEWING:
Food needs to be digested in order to be used for fuel and nutrients. In order to do that- it has to be converted from a solid into a liquid. This starts with chewing and swallowing. When food enters our stomachs it is physically digested- meaning it is actually physically ground up by the stomach and chemically digested by the acids in our stomach. It is in this way that solid food becomes a “soup” that can then be absorbed by your small intestine. When you only have less than 20% of your stomach this process is severely impaired. It is for this reason- your teeth have to make up the difference. Food needs to be chewed to the consistency of baby food in order to be properly digested by what will be a much smaller stomach after surgery. the more you practice now- the better. As well it is going to take much longer to eat after surgery. Because your stomach will be smaller it will fill sooner and there will be less room to accommodate food. As a rule it takes about 20-30 minutes for the stomach to empty. Less room in the stomach will mean that only a certain amount of food fits in it. Meals will take 30 minutes to eat.
WHAT TO DO:
Practice chewing food to the consistency of apple sauce or baby food.
Practice taking your time with your meals (20-30 mintues) Sitting down….
Focus on the meal and try to eat your meals without a distraction of a computer or a TV.
DRINKING:
Again, because the stomach is so much smaller, if you drinks with a meal there will be no room for food. We need to make sure you are getting your nutrients. As such wait 20 minutes between eating and drinking. Filling your stomach with liquids means you won’t be able to eat. This only applies to when you are eating a meal. If you are drinking a protein shake for breakfast, for example- this does not matter.
WHAT TO DO:
PRACTICE KEEPING YOUR LIQUIDS OFF THE TABLE DURING MEAL TIMES.
WATER:
Fluids are so important after surgery. Not only will you be eating less because of a smaller stomach, you’ll be drinking less as well. It is for this reason that you can run the risk of getting dehydrated. Dehydration is often manifested as CONSTIPATION after surgery.
WHAT TO DO:
Carry a water bottle with you all day long. Fill it up in the moring. Sip it throughout he day and
HOW MANY CALORIES DO YOU NEED?
Your body is unique. Everyone needs a different number of calories. How many calories you will need will change over time after surgery and will depend on how active you are and how much weight you have lost. There are many free online programs and smartphone applications that tell you how many calories are in the foods you eat. The website advice about how many calories you need is probably not meant for people who have had weight loss surgery therefore you should follow the advice of your Registered Dietitian. We recommend using the app BARITASTIC. This is specifically geared towards people who are going for bariatric surgery.
The link to their website is below.
VITAMINS AND SUPPLEMENTS
A vitamin or mineral deficiency means that your body is not getting enough of a vitamin or mineral.
Why does this happen?
There are 2 main reasons why this happens:
You are eating less food.
Because of the change in your digestive tract your body absorbs fewer nutrients than it did before surgery.
This is common after bariatric surgery. You will have blood work done regularly after surgery to screen for this in order to address this.
What vitamin and mineral deficiencies are common?
Iron
Vitamin D
Vitamin B1 (thiamine) - MORE COMMON AFTER BYPASS SURGERY
Folate
Calcium
What are the signs and symptoms?