BARIATRIC		
                         NUTRITION		
                               GUIDE	
                                       	
                                        
         
         
         
         
         
         
         
        November	2015	
                                        
         
                  TABLE	OF	CONTENTS	
                  	
                  	
                  INTRODUCTION	                  	         	          	         	          	         	          	         	          	         	          3	
                  	
                  DIGESTION	–	BEFORE	AND	AFTER	THE	SURGERY	                                          	          	         	          	         	          3	
                  	
                  THE	DUMPING	SYNDROME	AND	HOW	TO	AVOID	IT	                                                     	         	          	         	          3-4	
                  	
                  NUTRITION	AT	A	GLANCE		                             	         	          	         	          	         	          	         	          4	
                  	
                  DEHYDRATION	RISK	                        	          	         	          	         	          	         	          	         	          4	
                  	
                  HOW	TO	UNDERSTAND	INGREDIENT	LISTS	 	                                              	          	         	          	         	          4-5	
                  	
                  HIDDEN	SUGARS	AND	SUGAR	SUBSTITUTES		                                              	          	         	          	         	          5	
                  	
                  HOW	TO	READ	A	FOOD	LABEL	 	                                   	          	         	          	         	          	         	          5	
                  	
                  DIETARY	GUIDELINES	AFTER	SURGERY		                                       	         	          	         	          	         	          6-8	
                  	
                  GENERAL	RULES	AFTER	SURGERY	                                  	          	         	          	         	          	         	          8	
                  	
                  GENERAL	GUIDELINES	FOR	PORTION	CONTROL	FOR	MEALS	                                                       	          	         	          9	
                  	
                  BEHAVIOR	MODIFICATION	                              	         	          	         	          	         	          	         	          9	
                  	
                  YOUR	BODY’S	PROTEIN	NEEDS	 	                                  	          	         	          	         	          	         	          10	
                  	         	
                  PROTEIN	SOURCES		                        	          	         	          	         	          	         	          	         	          11	
                  	
                  VITAMIN	AND	MINERAL	SUPPLEMENTS	                                         	         	          	         	          	         	          12	
                  	
                  DINING	OUT	AT	RESTAURANTS		                                   	          	         	          	         	          	         	          12	
                  	
                  	
                  	
                  	
                  	
                  Bariatric	Nutrition	Guide	November	2015	-	FHSH/ALSA	                                                                        2 
                  	
                  INTRODUCTION	
                  	
                  Bariatric/Metabolic	Surgery	has	been	developed	to	help	you	lose	weight.		However,	it	is	not	magic;	
                  50%	of	the	attainable	results	are	dependent	on	your	postoperative	compliance.		The	surgery	requires	
                  a	major	change	in	your	eating	and	exercise	habits	to	achieve	and	maintain	your	desired	weight	loss.		
                  It	is	essential	that	you	follow	the	nutritional	plans	that	are	outlined	in	this	handout.		Your	team:	
                  doctor,	nurses,	counselor,	and	dietitian	are	available	to	answer	questions	and	provide	any	other	
                  support	you	may	need.		By	using	your	surgically	reduced	stomach	pouch	effectively,	you	will	have	a	
                  positive	impact	on	your	overall	health.		Staying	within	the	guidelines	and	following	the	dietary	
                  protocol	will	help	you	maximize	the	benefits	of	your	surgery.	
                  	
                  HOW	DOES	NORMAL	DIGESTION	WORK?	
                  	
                  Digestion	starts	in	the	stomach,	which	receives	chewed	and	swallowed	food.	Typically	the	stomach	
                  stores	food	for	up	to	four	hours	and	initiates	digestion	by	breaking	down	protein	and	killing	bacteria	
                  with	strong	acidic	gastric	juice.	From	here,	it	moves	into	the	first	part	of	the	small	intestine.	The	
                  duodenum	functions	to	break	down	food	into	simple	nutrients	and	absorb	a	variety	of	nutrients,	
                  including	iron	and	calcium.	The	next	stop	is	the	jejunum,	which	functions	to	absorb	our	nutrients.	
                  Digestion	continues	in	the	ileum	and	finishes	in	the	large	intestine	with	a	bowel	movement.	
                  	
                  HOW	WILL	DIGESTION	WORK	AFTER	THE	GASTRIC	BYPASS	SURGERY?	
                  	
                  By	creating	a	small	pouch	in	the	stomach	and	reattaching	the	jejunum	to	this	pouch,	food	intake	is	
                  significantly	reduced	and	the	duodenum	is	bypassed.	As	explained	above,	the	main	function	of	the	
                  duodenum	is	digestion	and	absorption	of	iron	and	calcium.	Therefore,	it's	important	to	chew	food	
                  thoroughly	and	take	vitamin	and	mineral	supplements	to	prevent	nutritional	deficiencies	of	these	
                  nutrients.		There	are	no	digestive	changes	after	the	sleeve	gastrectomy	or	lap-band	procedures.	
                  	
                  WHAT	IS	THE	DUMPING	SYNDROME?	
                  	
                  A	potential	side	effect	of	the	Gastric	Bypass	surgery,	the	dumping	syndrome	is	caused	by	stomach	
                  contents	moving	too	rapidly	through	the	small	intestine.	Your	body	compensates	by	sending	fluids	
                  from	the	bloodstream	to	dilute	the	food	causing	a	rapid	decrease	in	the	volume	of	circulating	blood	
                  and	a	rapid	increase	of	fluid	in	the	intestine.	Symptoms	include:	
                  	
                       •    Feeling	faint	                                                          •    Nausea	
                       •    Sweating	                                                               •    Diarrhea	
                       •    Weakness	                                                               •    Rumbling	stomach	
                       •    Rapid	pulse	                                                            •    Anxiety	
                  	
                  To	prevent	the	dumping	syndrome,	it	is	recommended	that	you	avoid	consuming	foods	with	high	
                  sugar	and	fat	content,	eat	more	slowly,	and	allow	30	minutes	between	consuming	food	and	fluids.	A	
                  list	of	foods	that	can	potentially	cause	the	dumping	syndrome	is	provided	on	the	next	page.
                  Bariatric	Nutrition	Guide	November	2015	-	FHSH/ALSA	                                                                        3 
                  	
                  AVOID	THESE	POTENTIAL	DUMPING	FOODS:	
                                                                                          	
                       •    Sugar	                                        •     Cake	                                         •    Frozen	yogurt	
                       •    Honey	                                        •     Soda	                                         •    Ice	cream	
                       •    Syrup	                                        •     Pie	                                          •    Milkshakes	
                       •    Jam/Preserves	                                •     Cookies	                                      •    Creamy	salad	
                       •    Candy	                                        •     Donuts	                                            dressings	
                       •    Chocolate	                                    •     Sherbet	
                       •    Pudding	                                      •     Fruit	yogurt	
                  	
                  NUTRITION…AT	A	GLANCE	
                  	
                  Food	serves	as	an	important	vehicle	for	taking	nutrients	into	the	body.	Food	is	broken	down	into	
                  specific	nutrients	that	the	body	requires.	These	nutrients	are	called	carbohydrates,	fats,	proteins,	
                  vitamins,	and	minerals.		
                  	
                       •    Protein	–	helps	build,	maintain	and	repair	body	tissue.	
                       •    Carbohydrate	(starches	and	sugars)	–	provide	energy.	Eat	more	complex	carbohydrates	such	
                            as	whole	grains	and	fruits/vegetables.	Avoid	simple	sugars.	
                       •    Fat	–	provides	energy	and	fat-soluble	vitamins	
                       •    Water	–	supports	all	body	functions.	It	carries	nutrients	through	the	body	and	removes	waste.	
                  	
                  Protein	and	water	will	be	the	most	important	nutrients	you	consume	after	your	surgery.	Protein	is	
                  necessary	to	help	heal	and	preserve	muscle	tissue	while	you're	losing	weight.	A	lack	of	fluid	can	
                  result	in	dehydration.	
                  	
                  DEHYDRATION	RISK	
                  	
                  After	bariatric	surgery	you	are	at	risk	for	dehydration	because	you	cannot	consume	large	quantities	of	
                  fluid	quickly,	instead	you	will	have	to	sip	on	fluids	during	the	day.	This	may	be	a	challenge	for	some	
                  and	a	new	habit	to	create.	Your	fluid	goal	is	6-8	cups	per	day	or	48-64	oz.	You	can	achieve	this	goal	by	
                  sipping	on	1	oz	of	fluid	every	15	minutes	or	4	oz	every	hour.	Symptoms	of	dehydration	include:	
                  increased	thirst,	dry	mouth,	dizziness,	confusion,	headache,	decreased	urine	output,	or	dark	urine.	
                  	
                  HOW	TO	UNDERSTAND	INGREDIENT	LISTS		
                  	
                  Ingredient	declaration	is	required	on	all	foods	that	have	more	than	one	ingredient.	The	ingredients	
                  are	listed	in	order	of	predominance	by	weight;	so	the	ingredient	that	weighs	the	most	is	listed	first	
                  and	the	ingredient	that	weighs	the	least	is	listed	last.	The	common	or	usual	name	for	ingredients	is	
                  listed	unless	there	is	a	regulation	that	provides	for	a	different	term.		
                  	
                  Protein	may	be	listed	on	labels	as	caseinate,	whey,	soy,	pureed	meat	or	individual	amino	acids.	Fat	
                  may	be	listed	as	partially-hydrogenated	oil,	soy,	canola,	corn,	sunflower,	safflower	or	medium	chain	
                  Bariatric	Nutrition	Guide	November	2015	-	FHSH/ALSA	                                                                        4