WEIGHT LOSS BEFORE  BY-PASS/ LAP-BAND SURGERY

This is your lifestyle one-year after surgery and is what you will do 1-2 months prior to surgery.

Initiate the new lifestyle prior to surgery.

This will shrink your liver prior to the surgery to prevent a complete abdominal incision. 

You will be used to the new way of eating and will  be very familiar with the process so that after surgery this will be a much easier transition.

NOTE: 
The eating pattern is the same as after surgery except you will be consuming regular serving sizes for a normal sized stomach.  Before surgery you are not required to eat pureed foods unless you chose to do so.

THE EATING PATTERN:

4-5 servings of protein foods
2 servings of vegetables
2 servings of fruit
2 servings of starch
3 servings of Fat

DIABETIC NOTE :

Diabetics will eat 3 fruit servings and 2 starch servings if they eat 5 times a day and 2 fruit servings and 2 starch servings if they eat 4 times a day.  Every snack/meal must be eaten every 4 hours and must contain 1 carbohydrate serving and 1 protein serving to prevent low blood sugars.

IMPORTANT NOTE FOR DIABETICS:

If your diabetic, you must inform your physician that you will be starting this new way of eating to prepare for surgery.

Explain to your physician that you will be consuming 75-90 grams of carbohydrate per day and consuming 15 grams (or 1 serving) every 4 hrs so that your Dr. may adjust the medications.

Remember to have 1 serving of protein and 1 serving of carbohydrate at each snack/meal every 4 hours to maintain blood sugar control.

Check your blood sugar in the morning upon awakening and 2 hours after meals to make sure your blood sugar does not drop below 70 mg/dl.

The diabetic medications you are taking now are covering the carbohydrate you are currently eating.

Once we change the amount and type of carbohydrates eaten, blood sugars will lower and, you may not need the current amount of medication you are taking.

Excess medication covering a small amount of carbohydrate may lead to low blood sugars.

 
PORTION CONTROL:

1. Eat only the serving size amount of the food listed on the top of each food label.
   
2. Practice measuring foods on a dessert-sized plate at home so that you will visually recognize a serving 
       size.
   
3. All foods should be low fat, sugar-free or low sugar (see cheat sheet for the grocery store).
   
4. Low fat/Light on the food label is defined as 3-4 grams of total fat and 1-2 grams or less of saturated 
       fat.  Fat is 9 calories per gram.  
   
5. I recommend high fiber/ whole grain starches such as 100% whole-wheat breads, brown rice, spinach
       or whole wheat pasta.
   
6. High fiber/whole grain products prevent constipation, cancer, heart disease, high cholesterol, high     
       blood sugars, diverticulitis, and will cause you to remain full over a longer period of time since
       digestion of these products is much slower.
   
7. Look at food labels, if dietary fiber is 2 grams or more it is a good source of fiber, and 3 grams or greater is an excellent source. It is recommended for chronic disease prevention to consume 25-35 grams of dietary fiber daily. 
    
8. Drink a minimum of 6 measuring cups of fluids that are 10 calories or less per serving.  Fluids must 
       be carbonation free and caffeine free without straws. You do not want any large amount of calories
       coming from your fluids.
   
9. Drink fluids between meals (take baby sips, do not gulp) Gulping causes chest pain and possible 
       vomiting.  Gastric By-pass patients must Stop drinking fluids 30 minutes before the meal and resume 
       sipping fluids 30 minutes after the meal.
   
10. With the lap-band operation stop sipping fluids 30 minutes before the meal and resume sipping fluids
           60 minutes after meal.
    
11. Eat every 4 hours a small snack meal; emphasize 1 serving of protein with each meal.
    
12. Begin an exercise regimen.  I recommend working up to 30 minutes or more daily, as you are able. 
           Start out with 10-15 minutes at a moderate level activity 2-3 times a week.

FOOD SERVING SIZES

PROTEIN:

NOTE: 
Do not eat more than 1 serving each daily of low-fat cheese, nuts and peanut butter.  They are nutritious foods, but high in calories.

3 ounces (a deck of cards size) of lean Meats/fish/seafood

Nuts =Follow serving size listed on food label.

4 ounces of beans (1/2 cup) chick peas, Lima beans, tofu

1 ounce or 1 slice of low-fat cheese

1 egg or � cup egg beaters

1 measuring cup of 1%, Skim, soy, rice, or Lactaid milk

Low-fat cottage cheese =Follow serving size listed on food label

2 Tbsp. peanut butter 

Yogurt =Follow serving size listed on food label

PROTEIN FOODS THAT ARE ALSO CARBOHYDRATES:

� cup beans, 1 cup milk, 2/3 cup lima beans, � cup fat-free or low-fat cottage cheese are each equal to one carbohydrate serving or 15 grams of carbohydrate.

VEGETABLES (non-starch):

� cup 100% tomato juice unsweetened

1 cup of raw vegetables or � cup cooked vegetables

FRUITS (carbohydrate): 

(General Rule if it fits in your hand it is a serving)

� cup of 100% juice

1 small apple, � banana, � a grape fruit, 18 medium sized grapes, 1 small orange, ~1 cup or 1 slice of melon, 2 small plums

STARCHES (carbohydrate):

Cereal/Crackers =Follow serving size listed on food label

� cup cooked pasta

1/2 cup cooked rice

1 small baked potato or � cup of mashed potatoes

� cup or 1 medium ear of corn

� cup winter squash, peas, or yams

Small sweet potato

2/3 cup Lima beans

1 slice of bread

Other Miscellaneous Starches:
Sugar-free cookies, Splenda Cake and pies, pretzel's, Baked Lay's potato chips, baked Tortilla chips, whole wheat fajita wraps and pita bread (Follow serving size listed on food label)

FATS: 

1-tbsp. (Trans fat-free) light margarine
Smart Balance light
Benecol light
Promise light

1-tbsp. Canola oil, Flaxseed oil, "High-Oleic Sunflower, Safflower oil, Enova oil, (cold-pressed) Olive oil.

1 tbsp. Light/ Low-Fat/or Fat-free
Mayonnaise/Sour Cream/Cream Cheese/Salad Dressing

Do not cook with Flaxseed oil and very minimally with Olive oil.  When these are heated to a certain temperature they give off free radicals which are cancer causing.

SNACK MEALS EXAMPLES:

1. Granny Smith Apple sliced with 2-tbsp Skippy Natural peanut butter  Equals (1 fruit, 1 protein).
   
2. Scrambled egg, low-fat margarine, 100% whole wheat or whole grain toast.  Equals (1 protein, 1 fat, 1 
       starch).
   
3. 3 ounces of ground sirloin hamburger with 1 slice low-fat cheese, and green beans.  Equals (2 proteins,
       1 non-starch vegetable).
   
4. 1-cup assorted vegetables, low-fat salad dressing, and 3 ounces of Purdue seasoned chicken strips
       with 1 whole grain roll.  Equals (1 non-starch vegetable, 1 fat, 1 protein, 1 starch).
   
5. 1 Dannon Lite and Fit Creamy yogurt, 1-cup raw baby carrots.  Equals (1 protein, 1 non-starch
       vegetable).
   
6. 3 ounces of low-fat tuna fish with reduced fat whole-wheat crackers and celery sticks.  Equals (1
       protein, 1 starch, 1 non-starch vegetable).
   
7. 1 slice of grilled lean ham with 1-cup grits, and 1 orange.  Equals (1 protein, 1 starch, 1 fruit).
   
8. 1 lean pork chop, � cup sauerkraut, � cup unsweetened applesauce.  Equals (1 protein, 1 non-starch
       vegetable, 1 fruit).
   
9. � cup whole grain pasta, 2 large low-fat turkey or ground sirloin meat balls and low-fat tomato  
       sauce with extra vegetables added, dash of Parmesan cheese, salad with fat free dressing.  Equals (1
       starch, 1 protein, 1 non-starch vegetable).
   
10. Sliced tomatoes with part skim mozzarella cheese and olive oil salt and pepper.  Grilled or cold. 
          Equals (1 non-starch vegetable, 1 protein, 1 fat).
    
11. 1 whole wheat fajita wrap with south western seasoned Purdue chicken strips sautéed in water and   
          fajita seasoning packet, sautéed sliced pepper and Vidalia onions in Enova oil,  top with canned diced
          Jalapeno tomatoes, shredded low-fat cheddar cheese, fat free sour cream,  Equals (1 starch, 1
          protein, 1 non-starch vegetable,  1.5 fats)
    
12. Low-fat pizza.  1 whole-wheat pita, low-fat spaghetti sauce, diced mushrooms, sliced peppers, grill
         Gimmie Lean sausage in a little Canola oil, place on pizza, top with part skim mozzarella cheese.  Heat
          up in the oven.  Equals (1 starch, non-starch vegetables, 1.5 proteins, 1 fat).
    
13. Grilled Salmon steamed asparagus.  Equals (1 protein, 1 non-starch vegetables).
    
14. Fresh strawberries and plain Vanilla Yogurt.  Equals (1 fruit, 1 protein).
    

TIPS ON HOW TO GET STARTED:

Plan and prepare ahead of time.

Set up a grocery shopping day.  Shop for the week.

Keep foods stored at work.

Go to the bookstore/local library/ or onto the web sites     
 listed for low-fat/ low-sugar recipes.

Make one or two items and freeze for the week.  Be 
creative with recipes so as not to get bored.

If your working 8 hours remember you'll need to eat every                  
4 hours.  You will need 2 meals for an 8 hour day.

Remove all tempting foods from the house, and avoid  
eating out at restaurants.

Use low-fat quick meals such as Healthy Choice and Lean Cuisine  meals when in a bind.
 

Purchase easy foods to prepare such as Fat-free hot dogs/soups, lean cold cuts, bagged salads, pre-washed/pre-cut fruits and vegetables to save time.

HEART HEALTHY RECIPE WEB SITES:
www.paralumun.com/dietone.htm
www.deliciousdecisions.org
www.nihlbi.nih.gov/health/publicheart/other
or type in low-fat or low-sugar recipes under general search

Reading the Nutrition Facts Label Information To Take To The Grocery Store

What Nutrient Claims About Fat Really Mean

Fat Free foods have less than � gram of fat per serving.  The food may also be referred to as "nonfat".

Low Fat foods have less than three grams of fat per serving.

Reduced Fat foods have at least � less fat per serving than the regular version of the food.  They may also be referred to as "lower fat".  You will need to look at grams of saturated fat and total fat to determine if a reduced fat product will work or not.

Light foods must have at least 1/3 fewer calories or � the fat of the regular version of the food.

Lean foods have less than 10 grams of total fat. 4 � grams of saturated fat, and less than 95 milligrams of cholesterol per serving.

Extra Lean foods have less than 5 grams of total fat, 2 grams of saturated fat, and less than 95 milligrams of cholesterol per serving.

Note: 
If a product states fat free, light, low fat, lean, or extra lean purchase the product and eat it.  If the label says nothing, or states it is reduced fat look at total grams of fat, total grams of saturated fat, and total grams of trans-fat to determine if the product is acceptable or not.

Alcohol=7 calories per gram.
 

Alcohol is digested processed and stored as fat.

Alcohol is dehydrating.  Do not drink any alcohol until you can get in 64 ounces of fluid daily and then only have a drink on special occasions.

Alcohol will not harm Lap-Band patients post-surgery, but will cause increases in caloric intake.

Alcohol & Gastric By-pass Patients

Gastric By-Pass patients do not have any gastric juice in the new pouches to slow down the absorption of alcohol or help with the digestion of it.

Patients get very drunk on a small amount of alcohol due to a high blood content.

Overtime a patient will build a tolerance level to the alcohol.

The alcoholdehydrogenase enzyme that breaks down alcohol is very limited after surgery.

Alcohol goes into the blood stream whole unprocessed and undigested and then is delivered to the liver whole undigested.
 

Overtime alcohol in daily dosages or large binge amounts in-frequently may lead to Cirrhosis of the liver

WATCH OUT FOR THESE HIDDEN SUGARS :

These sugars should be listed as the fifth or greater ingredients on the food label prior to eating the food.  Otherwise dumping may occur which leads to malabsorption of nutrients and dehydration.

Do not look at grams of sugar on the label for the first month after surgery, rather count the first 4 ingredient s listed on the ingredients list.  The chance of By-Pass patients dumping is much greater during the first month post-surgery.

One month after surgery you may look at the grams of total sugar on the food label and if there are 5 grams of  total sugar or less you may eat one serving of the product.
  

The food labels combine natural milk sugar (Lactose) and natural fruit sugar (Fructose) in with the total sugar grams found on the food label.
  

Therefore, products that contain milk sugar (Lactose) like yogurt, or natural fruit sugar (Fructose) like canned fruit in its own natural juice, you must count the first 4 ingredients in search of the hidden sugars listed above in the grid.

All sugars are 16 calories per tsp. except the underlined Sugar Alcohol's.  Sugar Alcohol's are 4 calories per gram, and you will only absorb 2 calories due to their laxative effect on the body.

Sugar Alcohol's will initially lead to diarrhea and dehydration.  You may slowly add small amounts of the Sugar Alcohol's (underlined sugars above) once you are 1 month out of surgery.

 EXAMPLE OF HOW TO READ THE LABEL FOR SUGAR

Ice Cream
                      1         2        3           4
Ingredients:  Milk, Cream, Sugar, Dessert Solids, Corn Syrup, Stabilizer/Emulsifiers, and Artificial Flavor.

This food is unacceptable to eat because sugar is the 3rd ingredient listed rather than 5th or greater.

Important Notes

Only count the first 4 major ingredients outside of the brackets.
 

Ignore all ingredients inside the brackets.
 

The first four ingredients are what the product is primarily made of.

All food labels list the ingredients in order of the concentrated amount in the product.

All labels list the highest concentrated ingredient first and the least concentrated ingredient last.

EXAMPLE:

Protein Bar
                            1
 Ingredients:  Protein Blend (Calcium Caseinate, Whey Protein                                                          
                                                          2              3
  Isolate, Soy Protein Isolate) Glycerine, Malitol Coating (Malitol,

  Palm Kernel Oil, Cocoa, Whey Powder, Lecithin Natural Flavor)     
       4
  Sorbitol, Filtered water, Fructoologosaccharides, Lecithin, Salt,

  Natural and Artifical Flavor, Sucralose, (Splenda brand)

NOTE: 
This product is not acceptable for the first month after surgery due to high levels of Sugar Alcohol's and the risk of diarrhea and dehydration.

Read the Food Label

Food labels can help you choose foods lower in sodium, as well as calories, saturated fat, total fat, and cholesterol. The label tells you:

Number Of Servings
The serving size is 1 cup. The package contains about 3 servings.

Amount Per Serving
Nutrient amounts are given for one serving. If you eat more or less than a serving, add or subtract amounts. For example, if you eat 1 cup of peas, you need to double the nutrient amounts on the label.

Percent Daily Value
Percent Daily Value helps you compare products and tells you if the food is high or low in sodium. Choose products with the lowest Percent Daily Value for sodium.

Nutrients
You'll find the milligrams of sodium in one serving.

EXAMPLE OF FOOD LABEL INFORMATION

Frozen Peas    
Serving Size 1 cup
Servings Per Container about 3   
     
Amount Per Serving   
Calories 60                  Calories from Fat 0  
     
                                    % Daily Value*   
 Total Fat 0g                                0% 
 Saturated Fat 0g                         0%
 Trans-Fat                                    0% 
 Cholesterol 0mg                            0% 
 Sodium 125 mg                             5% 
 Total Carbohydrate 11g                 4% 
 Dietary Fiber 6g                         22% 
 Sugars 5g  
 Protein 5g  
 Vitamin A                                    15%  
 Vitamin C                                    30% 
 Calcium                                          0%  
  Iron                                               6% 
 * Percent Daily Values are
based on a 2,000 calorie diet.
   
Pay Attention To:

Serving Size
Dietary Fiber= 2+ grams is a good source
Sugar= 5 grams or less per serving
Total Fat = 3-5 grams per serving
Saturated Fat=1-2 grams per serving
Trans-fat=1 grams or less per serving

AFTER SURGERY
Pay attention to grams of Protein.

High Fiber Food Examples

Total Cereal
Grapenuts Cereal
All Bran Cereal
Oatmeal
Plain Cheerios Cereal
Barrilla Plus Pasta
Harvest Pasta
Brown Rice
All Beans
7 Grain Bread
100% Whole Wheat Bread
All Fruit
All Vegetables
100% Whole Wheat Pita
100% Whole Wheat Fajita
Triscuit Crackers