CHI Health Immanuel Bariatric Surgery Program

Patient Education Guide

Table of Contents
Mission Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 1

Mental & Emotional Preparation for Surgery. . . . . . . . . . . . page 2

Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . page 4

Preparing for Bariatric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . page 6

Skin Treatment Instructions Before Surgery. . . . . . . . . . . . . page 8

Morning of Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 8

During Your Hospital Stay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 10

Discharge Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 14

Possible Problems After Surgery . . . . . . . . . . . . . . . . . . . . . . . page 23

Follow Up and Support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 32

Diet Progression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 34

Spiritual Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 72

CHI Health Immanuel Bariatric Surgery Program

Mission Statement
CHI Health Immanuel’s Bariatric Surgery Program is committed
to relieve suffering from obesity by providing unsurpassed
multidisciplinary care through scientific knowledge, medical
technology, and surgical expertise in collaboration with
psychological, social and spiritual support. We pledge to provide
high quality care and to respect the dignity of each patient.
The Bariatric Surgery Program will offer medical and dietary
information before, during, and after surgery. The Program
will provide regular support group meetings and educational
opportunities to assure long-term weight loss and maintenance.
We strive to improve health by achieving lasting weight loss
that reduces life-threatening risk factors, improves overall health,
improves self-esteem, and enhances the quality of life of each of
our patients.

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 Mental and Emotional
Preparation
Be honest with yourself, as well as your family and friends, about
your feelings and concerns. Exploring and understanding what
causes you to act the way you do and understanding yourself as a
person before your surgery will make your recovery easier. Being
overweight may contribute to a number of problems but it is rarely
the only cause. Having bariatric surgery and losing weight will not
solve all of your problems.

Listen to the feelings and concerns of those close to you. Even

healthy relationships may suffer after your bariatric surgery. If you are
in the middle of social distress such as divorce, family death, stress
at home, etc., your relationships may suffer even more. Make sure
it’s the right time in your life for bariatric surgery to ensure the best
possible outcomes.

Consider arranging for psychological, emotional, and spiritual

support before and after surgery. Don’t be afraid to seek professional
help. You can contact the mental health professional that provided
your psychiatric evaluation prior to your surgery or talk with your
primary care physician. For many patients, seeing a mental health
provider after bariatric surgery has increased their success and long
term weight loss.

Surgical weight loss requires making major changes in your eating

and exercise behaviors. In order to deal with the stress that this can
cause, we encourage you to attend our Bariatric Support Group

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which meets monthly. All patients are required to attend at least
one meeting, but we recommend you attend as many meetings as
possible during the time of preparation for surgery. Patients who
have had surgery are present and can offer support and information
that will help the pre-op patient.

Changing Habits
Eating habits develop over a lifetime and are influenced by a variety
of things. By the time you are an adult, those eating habits are well
ingrained. But that doesn’t mean you can’t change them.

Start making small changes in your eating habits before surgery. This
will make the changes you will be required to make after bariatric
surgery easier to handle. Before surgery, practice:
»» eating slower
»» chewing food well
»» drinking at least 64 oz of non-calorie fluid per day
»» eating 5-6 smaller meals and snacks throughout the day
»» choosing low-calorie, protein based snacks
»» reducing saturated fat and sugar intake
»» avoiding carbonated and/or caffeinated drinks

Caffeine withdrawal can be a very unpleasant experience after

surgery. You may want to restrict or at least reduce your intake of
caffeine for several weeks before your scheduled surgery date. It
will be easier to cut down gradually before surgery than to stop
suddenly the day of surgery. For most people, it takes about 7-10
days to completely get through caffeine withdrawal symptoms.

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 When will I begin losing weight?
You will probably begin to lose while on your pre-surgery liquid
diet. Most patients lose 8 to 10 pounds or more on this during this
phase. You probably will gain a few pounds from all the fluid and
immediately after surgery. But this weight and even more will be lost
prior to coming to see the surgeon 1-2 weeks after your surgery.

How long will I continue to lose weight?

Most weight loss occurs in the first eighteen months after surgery.
Weight loss slows after that and then stabilizes. There is a risk of
weight regain if good eating habits and exercise habits are not
continued.

How much weight will I lose?

You can expect to lose 50-80% of the total number of pounds that
you are over your ideal body weight. This means that if you are 100
pounds over the ideal body weight for your height, you should
expect to lose between 50 and 80 pounds over the first one-two
years after surgery. The rate at which you will lose weight is very

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 Frequently Asked
Questions (FAQs)
About Weight Loss

different for everyone, and will continue to fluctuate through the

first year. The amount of weight loss will depend on how well you
follow the diet and exercise recommendations. There may be a short
period of time where you do not lose any weight. This is a plateau,
and it is a normal part of weight loss.

Will I need more surgery later?

Weight loss surgery can result in loose skin in the stomach, arms, and
thigh areas. If you have an open procedure, you will have a mid-
line abdominal scar. If you choose, you may have plastic surgery to
correct the loose skin and/or scar. This procedure should be done
only after you have lost all your weight, and usually is performed
about 2-3 years after the initial bariatric surgery. The plastic surgery
may be considered cosmetic surgery, which insurance may not
cover. Each individual’s insurance is different, so check with your
insurance company or benefits administrator. Sometimes more
surgery is necessary to correct certain complications.

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 10 Days to 2 Weeks Before Surgery
»» Begin the pre surgical diet, full liquid diet. A copy of the diet is
included in this booklet.

One Week Before Surgery

»» Make an appointment with your primary care physician 1-2 weeks
before surgery for your pre-surgical history and physical. You will
have received paperwork from the surgeon’s office to take with
you that lists the tests that are required.

Before Surgery
»» The SAC office nurse will call you a few days before the surgery
date with the time you need to be at the hospital, medications
you are to take that morning, and any other instructions. At the
latest, they will call you the day before your surgery.

»» Shower the night before and the morning of surgery with your
surgical soap. You will need to purchase this at your local drug
store. Do not use any powder, lotion, or deodorant after your
shower the morning of the surgery. Your skin needs to be very
clean to help prevent infection.

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 Preparing for
Bariatric Surgery

»» Remove all makeup, including eye makeup, nail polish, and lipstick.

»» Leave jewelry, credit cards, cash, and other valuables at home.

Remove all piercings

»» If you wear contacts, bring your solution with you. You may want
to bring a pair of glasses to wear while you are in the hospital.

»» If you have sleep apnea and use a CPAP or BiPAP machine, bring
the machine with you.

»» Bring all your medications in their pharmacy bottles.

»» Recommended items (but not required) to bring to the hospital

• Robe
• Slippers (slip-on with hard soles are the best)
• Comfortable, loose fitting clothes to wear home
• Toothbrush
• Toothpaste
• Hair brush or comb
• Special shampoo and conditioner (if you want)
• Lip balm
• Reading materials or puzzles
• Electronic device of choice
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 Patient Instructions for
Preop Skin Treatment
We highly recommend you shower the night before and morning
of surgery with Hibiclens (Chlorhexadine) or its generic brand (CHG),
which is available at your pharmacy. Research shows that repeated
use of this soap enhances the ability to reduce bacterial counts
(germs) on your skin, not only during the immediate period after
your shower using CHG, but for a number of hours afterward.

Wash your hair and face as you would normally do. Turn off the
shower and apply Hibiclens from the neck down to your toes with
your hands, gently wipe. Women should avoid contact with mucous
membranes such as the vaginal/perineal area. Concentrate on the
surgical site for 5 minutes, and 10 minutes if having bone surgery.
Leave the Hibiclens on your skin for 5 minutes. No lotions, perfumes,
or colognes after showering. It is recommended that you refrain
from hair removal below the neck 72 hours before your procedure.
When you arrive at the Procedure Center, you will be instructed on
how to use antibacterial skin wipes.

Morning of Surgery
The SAC office nurse will tell you what time to come the morning of
your surgery. Take medications that you are instructed to take that
morning with a sip of water. DO NOT take any medication unless you
have been instructed to do so. Please bring all of your medications in
their original pharmacy bottles.

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There may be emergencies or changes in the surgery schedule that
could put your surgery either ahead or behind the scheduled time. We
appreciate your understanding when schedule changes have to be made.

When you are in the preoperative area, nurses, physicians, and the
anesthesiologist will ask you questions and tell you what to expect
in the operating room. An IV will be started, followed by an antibiotic
and medication to help you relax. You will get an injection of a blood
thinner (a clot preventing medication called Lovenox) in the fat of
your stomach. The needle is very small and fine.

Your family and friends can wait with you in the preoperative area
until you go to the surgical room. Your family will then return to the
family room. They will give your surgeon or other team member
their phone number and will receive a call once your surgery
is done. They should return to the family room to visit with the
surgeon at this time.

You will be taken from the surgical room to recovery. You will stay in
recovery 1-3 hours or more. You will then go to your hospital room.
Your family will be able to see you when you are settled in your
hospital room.

Practice taking deep breaths before surgery. After surgery, in

recovery, you will be asked to take deep breaths to help blow off the
anesthesia and keep your lungs clear.

If you wear glasses, contacts, hearing aides, or dentures, you will

be asked to remove them before you go to the surgical room. All
piercings must be removed. If you wear contacts, bring your glasses
to wear while in the hospital. Bring all appropriate storage containers
for your personal items.

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 During Your Hospital Stay
After your surgery is complete, you will be taken to the
postoperative recovery room. Once your breathing and vital signs
are stabilized, you will be taken up to your hospital room.

Pain Management
After surgery it is important that your pain be controlled. When you are
not in pain you are able to breathe better, move around quicker, and rest
better. The major way pain is controlled after surgery is by narcotics.

Narcotics: Your pain medication will be given through your IV for

the first day. This is independent on patient allergies and surgeon
preferences. Once you are able to take oral fluids well, you will be
given a liquid pain medication. This will be the pain medication you
are to use at home.

We will rely on you to tell us how you are feeling. Tell us:
» how much pain you have
» where it hurts
» what makes it better
» what makes it worse
» if the pain medication is helping

You will be asked to use a pain scale. The scale uses numbers or
faces to rate the intensity of your pain. “0” means you are not having
pain and “10” means the worst pain you have ever felt. You can then
describe the pain you are having.

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Tubes and Drains
A urinary catheter may be placed in your bladder after you are
asleep in the operating room. The catheter could be removed as
early as the first day after surgery. You will have a drain or drains,
which can be either a flat drain (Penrose) or a bulb type (Jackson
Pratt or JP). There will be a large dressing over the Penrose drain.
Most drains will be removed before you leave the hospital.

You may have a sore throat or sore nose after surgery from the
breathing tubes used during your surgery. This soreness should
go away in a day or two. You may also still need oxygen, which is
delivered by soft prongs in your nose. If you have oxygen, you will
have a pulse oximeter attached by either a clamp or tape to your
finger. This will help the nurses and respiratory therapists regulate
your oxygen needs.

You will have an intravenous catheter in your hand or arm. This will
deliver fluids and medications until you are able to take oral fluids
and medications.

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 Activity and Circulation
Getting active early in your recovery is very important. Walking
about your room or in the hallways will help prevent pneumonia,
blood clots, gas, and constipation. Activity is also essential in your
weight loss regimen. You will get up the day of surgery, usually
within a few hours after the surgery. Walking and activity will actually
help you speed your recovery and is the best way to prevent a blood
clot in your leg.

After you are asleep in the OR suite, sequential compression devices

will be applied to both your legs. These gently squeeze your legs to
help the circulation in your feet and legs. These sleeves help prevent
blood clots and should be worn any time you are in bed during your
hospital stay.

Breathing Exercises
You will be asked as you are waking up from surgery to take deep
breaths and cough. This will help rid your lungs of the anesthesia
and help prevent lung complications after surgery. Respiratory
therapy or the nurses will instruct you on how to use your incentive
spirometer. You should use the incentive spirometer as instructed
every hour when you are awake. Take the spirometer home with
you and continue using this for the first week you are home. Deep
breathing and coughing are also excellent ways to prevent lung
problems. Hold a blanket or pillow to your incision area while
coughing.

If you have asthma, bring your inhalers with you to the hospital.

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Gastrograffin Swallow Study
Depending on surgeon’s thoughts and your surgical case, they may
order a gastrograffin swallow study. You will have to drink liquid
contrast and the x-ray will be taken. This will verify that your staple line
is intact and you have no leaks/excessive swelling at that time and
that the bowels have started to work again. This can be unpleasant
primarily because of the taste. The nurses will give you anti-nausea
medication and pain medication prior to the test, if ordered.

Not everyone will have this test done in the hospital.

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 »» Ask your doctor, nurses or bariatric surgery team any questions
you have about doing things at home. Don’t be afraid to ask.

»» An adult friend or family member must be available to drive you

home from the hospital. You cannot drive yourself home.

»» If you are traveling a long distance, get out of the car and walk and
stretch every hour. This will help prevent stiffness and blood clots
in your legs

Bariatric Surgery
Discharge Education
Signs and Symptoms you should call for
»» Chest pain that is getting worse
»» Difficulty breathing (at rest) that is getting worse
»» Pain, redness or swelling in legs (would want to assess for blood clot)
»» Fever that is getting worse or above 101
»» Drainage coming out of drain site or change of color/odor of drainage
»» Pain should be improving each day

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 Discharge
Instructions

Activity
»» Please be up and walking every hour to prevent blood clots, stairs
are okay
»» No lifting over 20 lbs for the first 4-6 weeks

Bathing
»» No bathing or swimming (showers are fine) until incisions have
scabbed and healed. You may shower, let the hot soapy water
run over incision sites, pat them dry but no ointments, lotions or
powders

Vitamins
»» DO NOT START ANY VITAMINS
»» The bariatric team will instruct you when to start your vitamin
regimen
»» The samples you received at pre-surgery class will be the first
vitamins you try.

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 Medications
»» For the first 4-6 weeks after surgery, any pill larger than the end
of a pencil eraser will need to be cut in half, crushed or opened.
To crush tablets or open capsules; mix each tablet or capsule
contents with one spoonful of sugar free pudding, yogurt, or
applesauce (once diet allows).
»» Capsules that contain medication «beads» on the inside, can still
be sprinkled onto food of choice as described above but must be
swallowed INTACT; that is, do NOT bite down or chew them.
»» Avoid NSAIDs (non-steroidal anti-inflammatory drugs) after surgery.
These include over the counter agents such as ibuprofen, Advil,
Motrin, Naproxen, Aleve. It is OK to take Tylenol (acetaminophen).
»» If you take Aspirin, it may be resumed one week after your surgery
date, preferably in the lowest possible dose (81mg = «baby» aspirin).

Hydration/Nutrition
»» The MOST important thing for you to do this week is to stay hydrated.
»» Make sure you are drinking 4 oz per hour
»» Once home you will return to the same liquid diet you were on
prior to surgery. This includes protein shakes, low sugar, low fat
yogurts (no seeds or chunks), water, low fat soups (no chunks) etc.
Everything on the list is considered liquid so the “no drinking with
meals” rule does not apply until we advance to soft proteins (after
your follow-up with the surgeon)
»» Don’t worry if you cannot get in the full 60 grams of protein in
this week, it is a work in progress. If you can great, if not, focus on
hydration until you are seen for follow-up.
»» Play around with temperatures, brands, flavors, and dilute as
needed; thick liquids will feel heavier. Remember NO CHUGGING,
you must slowly sip fluids
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Stage 1: Post-op Full liquid sample meal plan
Meal size = 4 fluid ounces
7 am 4 oz water
8 am 4 oz protein shake
9 am 4 oz protein shake
10 am 4 oz water
11 am 4 oz Greek yogurt
Noon 4 oz water
1 pm 4 oz protein shake
2 pm 4 oz protein shake
3 pm 4 oz water
4 pm 4 oz water
5 pm 2 oz low fat strained cream soup + 2 oz broth
6 pm 2 oz low fat strained cream soup + 2 oz broth
7 pm 4 oz protein shake
8 pm 4 oz sugar free popsicle
9 pm 4 oz water
10 pm 4 oz water

Emergency
»» If you feel an emergency arises through the week/weekend please
contact the surgeon’s office
»» If you’re concerns are not urgent please refer to your book or write
down your questions and you can discuss them when you get a
follow-up phone call next week or when you see the surgeon for
your first follow-up
»» Someone will call you early next week to see how your weekend
went and make sure you have a follow-up appointment
»» If you are in an emergency situation and cannot get in touch with
the surgeon’s office go to the nearest emergency room or call 911

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 Dr. Anthone’s office: 402-991-3393
Dr. Hovey’s office: 402-717-4900
Dr. Nandipati’s office: 402-717-4900
Bariatric Surgery Program 402-572-3684
Office: Bariatric Dietitian: 402-572-3771
Nurse Practitioner: 402-572-2781
Activity

It is normal for you to feel tired and worn out. Plan rest periods in
between your activities. Your energy level will improve in the weeks
and months ahead.

You have activity restrictions when you return home.

» No lifting of anything more than 20 pounds for four to six weeks,

or until cleared by a physician.
» No heavy housework (vacuuming, mopping, lifting laundry
baskets, etc . ) for at least two weeks .
» No driving until you no longer are taking pain medication. Do not
drive if you hurt when you turn around or look over your shoulder.
» No sexual intercourse for at least two weeks.
» Stairs may be used as tolerated.

Exercise is the key to continued success after any weight loss

surgery. Exercise is important in improving overall health as it
decreases the risk of heart disease, improves sleep patterns, increases
energy and burns calories . Exercise requires that you go above and
beyond your normal daily activities.

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Start with 15 to 30 minutes per day and gradually increase your
exercise program to 30 to 60 minutes five times a week.

You will begin your exercise program the first time you walk in the
hallway after your surgery. You must continue your exercise after you
return home. Blood clots in the legs or lungs or pneumonia can still
develop if you don’t walk regularly after discharge from the hospital.
You should continually challenge yourself with increasing your
distance or walking faster.

There are many different types of exercise for you to try. If you have
joint problems, swimming or aquatic exercises may be the best
option. You will have to wait about four weeks after surgery to begin
swimming. Ask your surgeon when you can start. Some patients
prefer bicycling, aerobic exercise, exercising at a gym, or other forms
of exercise. Talk with your surgeon about when you can start these
activities. Your coordinator can refer you to programs or therapists
that can set up programs for you.

Care of Your Incisions

You will have five to six small incisions on your abdomen that are
closed with dissolvable sutures under the skin. Small adhesive tapes
(steri-strips) or glue are closing these incisions. Leave the strips in
place for at least 10 days after your surgery. If you have staples, they
will be removed in about 1-3 weeks from your surgical date.

You will have an open wound where the drain was. Keep this covered
with a clean dressing until there is no longer any drainage. In order to
prevent infection, you must keep the incisions clean. Take a shower
every day and let the soap and water run over them. Pat them dry and
get dressed. If you have an open wound at the drain site, remove the

19
 dressing before getting into the shower and let the water and soap run
over the wound. Then pat it dry and redress with a clean dry dressing.
Do not put any creams, ointments or lotions over your incisions.

Call your surgeon or nurse if you notice any of the following:

»» Increased drainage, swelling or pain at your incision sites
»» Drainage that is green or thick (like pus) or has a foul smell
»» Fever over 101° F and/or chills
»» Open areas on skin or at incision lines

If these symptoms occur, you may have a wound infection. Call the
surgeon’s office if you suspect a wound infection.

It is normal to have some drainage from the open wound. This

drainage will be yellowish-red in color and odorless. As the drain
heals the drainage will begin to get darker yellow, but again will
be odorless. Keep the wound clean, dry and covered when there is
drainage present.

Pregnancy
You MUST avoid getting pregnant the first year after gastric bypass/
sleeve gastrectomy surgery. It is dangerous for you and the baby
during the first year because of the rapid weight loss. This may
decrease your ability to nourish you and the baby and may result
in birth defects for the baby or health problems for you. Please take
precautions, such as IUD, NuvaRing; or other methods to prevent
pregnancy. Please use a back-up birth control method if taking
oral contraceptives. Note that birth control pills may not be as
effective because of malabsorption. Please use a back-up if taking
contraceptives. Many women that have had problems in the past
getting pregnant are suddenly fertile because of the rapid weight loss.

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Emotional Changes
Be prepared for ups and downs. Some patients feel like they are
on an emotional roller coaster after surgery. These feelings are
completely normal and usually improve with time.

To improve your emotional well-being:

»» Eat adequate amounts of protein (at least 60-90 grams a day)
»» Get out of the house
»» Exercise
»» Use resources like the support group or online support groups
»» Don’t weigh yourself more than once a week

Consider support from a therapist or reach out to the provider who

did your psychological evaluation for further therapy.

Medications
Large pills should be crushable, chewable, able to split in half, or
liquid. Large pills can get stuck in the small outlet. Do not take all
your pills at once. Space the pills out to one every 10 minutes to
prevent them getting stuck in the outlet.

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 Vitamins
You must take a chewable adult-strength multivitamin with iron,
preferably a bariatric multivitamin, for the rest of your life. Along with
the multivitamin, you will need to take enough chewable calcium
citrate to reach the goal of 1200 to 1500 mg of calcium citrate per
day. There are a number of chewable products available. You will
receive samples of these are your pre-surgery class. Depending
on which multi-vitamin you choose and you blood work results,
additional vitamins may need to be added to your regimen. Some of
the most common vitamin deficiencies include Vitamin D, thiamine,
B12 and iron. However, you are at risk for ALL vitamin/mineral
deficiencies. Once again, this is all very individual.

Medications to Avoid
Do not use the following medications, as they will cause ulcers in
your stomach pouch:

»» Advil, Motrin, Ibuprofen, Aleve, Meloxicam, Naproxen and Celebrex

»» Aspirin
»» Pepto Bismol
»» Excedrin, Mobic

You should permanently avoid taking non-steroidal anti-

inflammatory drugs as they greatly increase the risk of ulcer.

Ulcers are very serious, especially after bariatric surgery. Ulcers can
cause severe pain and bleeding after eating and/or drinking, which
can quickly lead to dehydration and malnutrition.

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Possible Problems
After Surgery
All surgical procedures have risks. Bariatric surgery includes the same
risks that come with all major surgeries. Patients who are overweight
have added risks of complications. Death is one of the risks.
These complications may require re-operation or hospitalization.
The following is a discussion of the most frequently occurring
complications with bariatric surgery.

Nausea and Vomiting

Vomiting may occur if you eat too fast, too much, drink with your
meals or do not properly prepare your foods. Most patients do
vomit, at some point.

Think about what may have caused the vomiting. Did you eat too
fast? Eat too much? Advance your diet too quickly? Is the food too
dry or not chewed well? If you are vomiting and you are unsure why,
call the surgeon’s office. Another reason why you are vomiting is
that you may have a stomal stenosis. It is important that you see the
surgeon for evaluation of the bypass outlet to prevent any further
complications. Persistent vomiting is not normal and should be
evaluated by your surgeon.

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 Stomal Stenosis (Gastric Bypass)
This is a tightening or “stricture” of the opening between your
stomach and intestine. The most common time for this to occur is
4 weeks after surgery. Symptoms are:
»» Vomiting after eating and/or drinking that gets worse as time
passes
»» Having the sensation that food is stuck
»» Not able to tolerate foods that were once eaten
»» Unable to advance diet from full liquids
»» Pain with eating solid food

Stomal stenosis is treated by outpatient endoscopy but needs to

be treated as soon as possible. If you have any of the symptoms of
stomal stenosis, call the surgeon’s office. It is helpful if you have kept
a food diary so we are able to determine the source of vomiting.
Don’t allow the problem to continue for days before calling.

Ulcer
Ulcers are possible any time after bariatric surgery. Ulcers are usually
treated with anti-ulcer medication such as Nexium, Carafate or
Prilosec. Symptoms are usually severe, persistent nausea and pain
with eating. If ulcers are left untreated, they can develop into very
serious problems. Ulcers can cause a great deal of pain and bleeding
after eating and/or drinking. Early detection and treatment are
essential. Smoking exponentially increases your risk for an ulcer.

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Changes in Bowel Habits
Constipation after bariatric surgery is common. Constipation
needs to be prevented to avoid hemorrhoids, hernias or intestinal
blockage.

The best way to prevent constipation is to drink adequate fluids. If,

however, you still have problems then you can take a dose of Milk
of Magnesia, MiraLAX, or use a glycerin suppository. Do not use
laxatives on a regular basis and call the surgeon’s office if you have
persistent problems.

Tips on how to stay regular

»» Eat unsweetened applesauce, cream of wheat, or unsweetened
pureed prunes daily (no more than 1/8-1/4 cup initially) .
»» Sprinkle 1 Tbsp of raw Wheat Bran or ground flax seed (can
be found in health food stores or grocery stores) into shakes,
applesauce or hot cereal; refried beans.
»» Drink lots of water
»» Exercise regularly

Gas problems can be troublesome after bariatric surgery. Exercise

can help eliminate gas pains. You can also try simethicone drops
or Gas-X . If you have continued problems, call the dietitian for
suggestions on dietary changes to reduce the gas production.

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 Hair Loss
During the rapid weight loss phase there may be some hair thinning.
This is quite common. However, hair loss after bariatric surgery
is usually a direct result of not eating enough protein. Adequate
protein is at least 60 grams per day, but can be highly individual.
You may need more than this to prevent hair loss, or to stop it if it’s
already started. If you deprive your body of protein, damage of the
hair root occurs. In about two months, the hair breaks off as it grows
through the scalp. Once this damage occurs, you cannot repair it.
The hair will grow back, but it takes quite some time.

Tips to prevent hair loss

»» Eat your recommended grams of protein per day
»» Keep a food diary every day and add up the grams of protein that
you are eating each day. Make changes if you are not getting the
recommended grams.
»» If you are unable to eat enough food to give you at least 60 grams
of protein a day, use a high protein powder mixed with milk or
water.

Leak
A leak is leakage of intestinal juices from the incision(s) inside your
body. The cause is unknown. Leaks can occur 2-3 days after surgery,
as well as after a patient is discharged.

If you have symptoms of a leak you must report these to the

surgeon’s office or go to the emergency room if it is after hours.

26
Symptoms of a leak are:
»» Persistent left shoulder pain
»» Severe pelvic pain (pain in the very lower stomach)
»» Fever (usually over 101° F)
»» The feeling that you have to move your bowels or empty your
bladder, but cannot
»» Anxiety, sweating, chills
»» Nausea and vomiting
»» Persistent hiccups (accompanied with other symptoms from list)
»» Color change is drainage coming from drain site

The most common sign of a leak is left shoulder pain. If you have
any of the above symptoms, it is not a sure sign you have a leak,
but you need to call the surgeon’s office immediately or go to the
emergency room is it is after hours.

Dumping Syndrome
Dumping syndrome is severe diarrhea, nausea, light-headedness,
and stomach cramps. It is caused by eating and drinking at the same
time or eating sweets or high fat foods. Do not drink fluids with
your meals, limit sugar intake, and choose low-fat foods. This usually
occurs more frequently with gastric bypass surgery.

27
 Weight Gain
Bariatric surgery is a “tool” to help you lose weight and keep it off.
But you must work with it. Following these simple rules will help you
lose weight and keep it off.

»» Eliminate all added sugar from your diet (especially liquid forms
like soda, juice, sports drinks, etc…)
»» Limit high fat foods, especially foods high in saturated fat.
»» Change your behaviors. Old behaviors will destroy your success
after surgery, and it is possible to regain all of your weight
»» Never lose sight of your goals and what it takes to achieve and
maintain them. Remind yourself what motivates you regularly.
Focus on WHY you wanted this surgery when you first started.
»» Avoid: potato chips, corn chips, fast food, French fries, microwave
popcorn, onion rings, pork rinds, fried food .
»» Make sure you are getting your minimum amounts of protein and
non-starchy vegetables. Good foods will keep you satisfied and
can help boost your metabolism and energy levels.
»» * Remember to always eat mindfully and with intention. Mindless
and/or passive eating/snacking can sabotage your goals.

If you are starting to have problems with weight regain after surgery,
get a hold of your support time right away. Never feel embarrassed
or ashamed, we are ALWAYS here to help.

Hypoglycemia
Hypoglycemia (low blood sugar) can occur after bariatric surgery. It
usually happens long after surgery, even years. Symptoms include
dizziness, feeling clammy and sweaty, and possibly passing out. It

28
can be confused with dumping syndrome. If left untreated it can
lead to seizures.

You may never experience hypoglycemia. But if you are having

symptoms, please call the surgeon’s office.

Smoking
You may not smoke or use nicotine replacements after bariatric
surgery. Not only is smoking the number one cause of preventable
death in the United States, but it causes delayed healing. It also
increases your risk for blood clots, pneumonia, ulcers, wound
infections, and other medical problems. Patients who choose to start
smoking again will be in the hospital frequently with complications.

Alcohol
Do not drink regularly after bariatric surgery. Alcohol is a liquid
calorie source, which can sabotage your weight loss efforts and
greatly increases your risk of gastric ulceration. Also, alcohol can
cause dumping syndrome. Gastric bypass patients are at a higher risk
of rapid intoxication with small amounts of alcohol ingested. Men
should never have more than 2 drinks in a 24 hr period, and women
should never have more than 1 in a 24 hr period. There is also an
increased risk for alcoholism after any bariatric surgery. If you have
any family history of addiction, alcohol/drug abuse, or you yourself
have had issues in the past, consider abstaining from alcohol after
surgery. Be aware!

29
 Gastric Band Slippage and Erosion
The two most common complications associated with the gastric
banding procedure are band slippage (up to 3-5%) and band erosion
(up to 1%). A band slippage can be described as when a portion
of the stomach slips up through the band and causes dysphagia
(difficulty swallowing), nausea/vomiting, and acid reflux. Band
slippage can be caused by a repeated or sudden increase in intra-
abdominal pressure. This could be related to repeated vomiting
or even trauma caused by a car accident. A band slippage usually
requires the patient to return to the operating room for repair. A
band erosion is related to the pressure of the band being wrapped
around a hollow organ. Over time, the band may erode through the
stomach wall and if this occurs, reoperation is required.

Esophageal Dilation (Gastric Band)

Some patients have experienced failure of normal esophageal peristalsis
(swallowing function) after the gastric banding procedure. If this occurs,
it causes painful swallowing, reflux, or regurgitation. Band deflation or
removal is required. More recent studies suggest that the occurrence of
esophageal failure arises from tightening the band too aggressively, and
that this complication can be almost completely avoided.

Port Difficulties (Gastric Band)

Infrequently the port may become mal-aligned. With weight loss,
tissues can change and pull the port out of position. The port can
either flip on to its side or on its back. This makes it impossible to adjust
the band. Also, it may cause more discomfort if it is not placed in the
proper position. The port placement will be checked during a fill.

30
Gastric Band Fills
How much does a fill cost?
The surgeons’ fee will be filed to insurance.

How is the fill done?

After cleaning the area with some antiseptic, the surgeon will inject
a small amount of local anesthetic by your port site. A long, very fine
needle will be placed in the middle part of the port. If the fill is done
under x-ray, the surgeon will ask you to drink some barium liquid and
will take x-ray to determine the amount of restriction of the band. He
will then either put fluid in or take fluid out. You will have to take a few
swallows of the barium to assure the band is adjusted appropriately. If
the fill is done in the office, fluid will be put in or taken out as needed
and you will be asked to take a few drinks of water to assure it is
properly adjusted. A band aid will be put on the injection site.

What do I do after the fill?

You will start on a liquid diet for at least 24 hours to let the band and
pouch rest. Then the diet can be advanced to a soft and then regular diet.

How will I know if the fill is the right amount?

If you are now losing weight steadily (1 to 2 pounds per week is
average) and you feel some restriction when eating solid foods, the
fill is right. If you have trouble advancing your diet, you should stay
on the liquid diet for a couple of more days then try to advance to
soft solid foods. If you have vomiting or cannot advance your diet
after the first week, please call. You can call the bariatric coordinator’s
office at 402-572-3684 or the surgeon’s office at if you have
questions or think that you need to change the adjustment.

31
 Appointments with your support team
It is important to monitor you closely after bariatric surgery to
ensure good results. You will have regularly scheduled visits with
the surgeon. At each of these appointments, you will be provided
education about your weight loss and may obtain blood tests. In
addition to the surgeon visits, you will see your family physician
regularly. Your family physician will be regulating all of your
medications and may draw your blood tests. Don’t forget, you can
always reach out to your bariatric surgery team for information or
support. We are here for you long after your surgery is done! Make
sure you keep our contact information!

Support Group
Morbid obesity causes psychological and emotional distress. But
the surgical treatment of this disease also causes major stress in
your life. One effective method of dealing with the increased stress
and the major lifestyle changes associated with your bypass surgery
is to meet and interact with other people who have undergone
the procedure. These patients are at all stages of the surgery, from
preoperative to many years postoperative.

32
 Follow-up
and Support

Bariatric Support Group Schedule

(schedule is subject to change) Look, feel, live better.

It helps to know you’re not alone. LOCATIONS

We encourage you to gain support from our CHI Health Immanuel Campus
bariatric experts as well as others going 6901 North 72nd Street Omaha,
through similar experiences. We at CHI Health NE 68152
invite prospective, current, and past patients
Third Tuesday of the month at 6 p.m.
to come and join us at one of our locations. in the Immanuel Conference Center
CHI Health Bariatric Support Groups are offered (backside of Immanuel hospital), led by
CHI Health bariatric dietitian
monthly at CHI Health Immanuel & Mercy Council
Bluffs campuses. It is also offered at CHI Health CHI Health Mercy Council Bluffs
St. Elizabeth campus every other month. Topics Campus
vary from month to month. 801 Harmony Street
Council Bluffs, IA
CHI Health Immanuel Campus & CHI Health
First Thursday of the month at 6 p.m. in
Mercy Council Bluffs months offered: the Mercy Medical Building Two, Room
206, led by CHI Health bariatric dietitian
• January, February, March, April, May, June,
July, August, September, October, November, CHI Health St. Elizabeth Campus
and December 555 South 70th Street Lincoln, NE
68510
CHI Health St. Elizabeth Campus months
offered: First Tuesday of every other month at
6 p.m. in the Rose Room (lower level),
• February, April, June, August, October, and led by CHI Health bariatric dietitian
December Questions:
*Registration is not required however there will be a sign in Contact CHI Health Weight Management
sheet upon arrival. If you should have any questions please Team: 402-572-3684
contact the CHI Health Weight Management team * For campus locations, see back-side
at 402-572-3684.

33
 Before Surgery Liquid Diet
10 days to 2 weeks prior to surgery you will begin a full liquid, low
carbohydrate diet. Please follow this list of foods for the amount of time
your surgeon specifies. This will also be the diet you will follow when you
return home from surgery. **Diabetics: please contact your physician for
monitoring insulin/diabetic medications as they may need to be decreased.

Items included on diet

»» High protein, low carbohydrate drinks such as:
• Atkins® Shake
• EAS Advantage®
• Body Fortress, Premier Protein, or Jay Robb protein powders
»» 100% whey, soy, or egg protein powders at GNC, Wal-Mart,
Hy-Vee, Whole Foods, No Name Nutrition, etc. that have less than
15 grams of total carbohydrates and at least 15 grams of protein
»» Skim or 1% Milk
»» Strained cream soups, reduced-fat
»» Tomato soup: Find a “no sugar added,” low-fat version, and thin
down with water (not milk)
»» Broth/bouillon

34
 Diet Progression

»» Low-carb, low-fat yogurt without pieces of fruit or seeds that have

less than 10 grams of sugar
»» Sugar-free pudding
»» Sugar-free gelatin and popsicles
»» Vegetable juices (dilute 1 part juice + 1 part water) – No fruit juices.
»» Cream of wheat or cream of rice (thinned to liquid consistency)
»» Crystal Light®, sugar free Kool-Aid®, Mio
»» Decaf tea or coffee, herbal teas (unsweetened, can use sugar
substitutes and sugar-free creamer)

Basic Guidelines
»» Avoid carbonated beverages
»» Avoid caffeinated beverages
»» Avoid straws
»» Avoid alcoholic beverages
»» Goal fluid intake at least 64 ounces
»» Goal protein intake per day: at least 60 grams per day
• Try to drink your protein drink at least four times a day
»» Drink/eat regularly throughout day – up to 6 to 8 times per day of
full liquids other than water.

This tends to get easier after day 3 or 4, so hang in there!

35
 Tips to Increase Protein Intake
»» Add nonfat powdered milk or unflavored protein powder to
creamy foods, i .e. soups, milk, pudding
»» Mix and match items on your list to try to keep things interesting!

Please call the bariatric dietitian at 402-572-3771 if you have

questions.

Stage 1:
After Surgery Liquid Diet:
Weeks 1-2
(4 oz of liquid per hour)

You will continue the full liquid diet after surgery. For the first
three months, avoid solid food particles in soups and nuts, fruits or
preserves in yogurt or other foods. These fine particles can get stuck
in the staple lines and cause irritation or infection.

»» High protein, low carbohydrate drinks such as:

• Atkins® Shake
• EAS Advantage®
• Body Fortress, Premier Protein, or Jay Robb protein powders
»» 100% whey, soy, or egg protein powders at GNC, Wal-Mart,
Hy-Vee, Whole Foods, No Name Nutrition, etc. that have less than
15 grams of total carbohydrates and at least 15 grams of protein
»» Skim or 1% Milk

36
»» Strained cream soups, reduced-fat
»» Tomato soup*: Find a “no sugar added,” low-fat version, and thin
down with water (not milk)
»» Broth/bouillon
»» Low-carb, low-fat yogurt without pieces of fruit or seeds that have
less than 10 grams of sugar
»» Sugar-free pudding
»» Sugar-free gelatin and popsicles
»» Vegetable juices (dilute 1 part juice + 1 part water) – No fruit juices.
»» Cream of wheat or cream of rice (thinned to liquid consistency)
»» Crystal Light®, sugar free Kool-Aid®, Mio
»» Decaf tea or coffee, herbal teas (unsweetened, can use sugar
substitutes and sugar-free creamer)

AVOID carbonated beverages, alcoholic beverages, and try to

limit caffeine as it is a mild diuretic and may affect your ability to
stay hydrated. It also can act as an appetite stimulant. Carbonated
beverages must be avoided after surgery.

Drink at least 64 ounces of fluids per day (anything on this list counts
as fluid on this stage)

To add protein to creamy drinks or foods (such as puddings, yogurt

or cream soups) add nonfat dry milk powder or unflavored protein
powder.

Slowly begin increasing your activity. Walking is a great way to start.

*Please take care in diluting tomato soup thoroughly after surgery.

Many of these soups are too high in sugar and carbohydrates, and if
not diluted properly could cause dumping syndrome or reflux.

37
 Stage 2:
Soft Proteins: Weeks 3-4
(1/4-1/3 cup per meal or snack)

Advancing Your Diet and Exercise

During your first month after surgery, your stomach pouch and the
opening into the intestine is swollen and very small. You will be
able to eat a very limited amount of food. It is important that you
concentrate on eating the most important food for healing- protein.
All proteins must be soft, moist, and well-chewed in order to pass
through your small stomach successfully. If you eat too fast or too
much, it will feel like heartburn and may make you sick. Be Careful!

Food List
» Cottage cheese (low-fat or non-fat)
» String Cheese
» Eggs (any style- moist and soft)
» Tofu
» Refried beans (low-fat or vegetarian)
» Lentil, split pea, or black bean soup (strain out hulls)
» Miso or egg drop soup
» Chicken (soft, moist, fresh, canned, thinly sliced deli- NO BBQ or fried)
» Turkey (soft, moist, fresh, canned, thinly sliced deli- NO BBQ or fried)

38
» Fish or shellfish (soft, moist, fresh, canned)
» To cook and moisten foods use:
• Small amounts of cooking spray
• Small amounts of non-fat mayonnaise or salad dressing
• IF having issues with constipation, can add 1/8-1/4 cup of
unsweetened applesauce or mashed prunes daily

How to eat
» Eat regularly. It is impossible to make up nutrition by having one
meal a day.
» Stop when you feel satisfied.
» Chew, chew, chew all food very well and eat slowly.
» Do not drink water or fluids 30 minutes before, during or within
30 minutes after meals.
» Season as you wish!

Foods to avoid
Avoid food containing fats, sugars, starches, and coarse or crunchy
foods.

Water
You should be drinking at least 64 fluid ounces of non-calorie fluid
(water, crystal light, etc…) every day. Limit coffee and tea; avoid
alcohol and soda (or any other carbonated beverages).

39
 Vitamins
This is the stage when you start taking vitamins. One week after
advancing to Stage 2, start to try the sample vitamins you received
during the pre-surgery class. Try 1-2 different vitamins each day,
until you know which vitamin you tolerate the best. Make sure you
can tolerate the taste, and the vitamin doesn’t make you nauseous or
cause you to vomit.

Once you find “your vitamin,” purchase and start taking as prescribed
on the back of the bottle. If you are having a hard time choosing
which vitamin to take, you can always call or email your dietitian.

Exercise
Exercise for at least 20-30 minutes every day. Walking is best the first
six weeks, or until you are cleared by your physician to start a more
strenuous exercise regimen. If you aren’t sure, ask!

Follow-up
Keep all your follow-up appointments with your surgeon and your
primary care physicians.

Transitioning from liquids to solids can be the most confusing point

in your diet progression. Please don’t hesitate to call your dietitian
with any questions. Nutrition after bariatric surgery isn’t always
intuitive, so if you aren’t sure about something, it’s always best to ask.

40
Stage 3:
Fruits & Vegetables:
Weeks 5-20
(1/2-3/4 cup per meal or snack)

What to Eat
Eat mostly protein. You may begin to add small amounts of soft-
cooked, fresh*, frozen, canned vegetables and fresh*, non-citrus or
unsweetened canned fruits (packed in water or natural juices). Eat
three meals and two high protein snacks per day.

Food List: Proteins

» Cottage cheese (low-fat), can start to try different varieties
» Yogurt (low-fat or non-fat, plain, no berries or coarse fruit)
Looking for less than 10 grams sugar per serving.
» Cheese (non-fat, low-fat)
» Eggs – any style
» Tofu
» Peanut butter (natural style- creamy, no crunchy) and other nut
butters (almond and cashew). Avoid reduced fat nut butters,
these tend to have added sugars.
» Refried beans (low fat or vegetarian)
» Lentil, split pea, or black bean soup (strain out hulls)
» Miso or egg drop soup

41
 » Chicken (soft, moist, fresh, canned, thinly sliced deli- no fried)
» Turkey (soft, moist, fresh, canned, thinly sliced deli- no fried)
» Fish or shellfish (soft, moist, fresh, canned)
» Beef – This tends to make many people nauseous after surgery,
however if it doesn’t bother your stomach, beef is OK to consume
in small amounts. Stick to lean versions.

If you are having a hard time preparing your meats/keeping

them moist, considering trying a Nu-Wave oven. This is a small
appliance that uses heated air to “fry” the meat without using
oil, and tends to produce a very moist product. Slow cookers are
also very good for this. You can also ask your support team for
suggestions.

Food list: Vegetables and Fruits

» Carrots (soft cooked, fresh, canned or frozen)
» Beets (soft cooked, fresh, canned or frozen)
» Mushrooms (soft cooked, fresh, canned or frozen)
» Spinach (soft cooked, fresh, canned or frozen)
» Squash (soft cooked, fresh, canned or frozen)
» Green beans (soft cooked, fresh, canned or frozen)
» Asparagus (soft cooked, fresh, canned or frozen)
» Broccoli (very well steamed, fresh or frozen)
» Cauliflower (very well steamed, fresh or frozen)
» Fresh fruits, peeled and cored (avoid citrus)
» Bananas (fresh)

*Can start fresh/raw fruits and vegetables 12 weeks after surgery.

42
Food list: Fats
» Small amounts of healthy fats to use for cooking (olive or canola
oil, grass-fed butter)
» Small amounts of non-fat or low-fat mayonnaise or salad dressing
to moisten food

Beverage List
» Water (64 ounces per day- eight 8-ounce glasses)
» Decaffeinated coffee or tea
» AVOID alcohol and carbonated beverages

Foods to avoid
» Any foods not listed above.

How To Eat
» Breakfast
» Mid-morning snack (smaller than the meal)
» Lunch
» Mid afternoon snack
» Dinner
» Low calorie night time snack such as sugar free Jell-O or popsicles
» Stop eating when you are satisfied. If you’ve eaten until you are
full, you’ve eaten too much.
» Eating a meal should take around 20 minutes
» Chew, chew, chew all food very well and eat slowly

43
 » DO NOT drink water or fluids 30 minutes before or during wait 30
minutes after your meal to start drinking again.
» Always eat your protein first. Make protein most of your meal. Eat
vegetables next, then fruits, and starches last.
» Season as you wish.
» Rinse off canned fruits before consuming to remove excess sugar,
even if it says “packed in natural juices.” Sugar is sugar, no matter
where it comes from!

Vitamins
» You should be taking your vitamins regularly and at full strength
by this stage.

Exercise
» Exercise a minimum of 20-30 minutes per day. Check with your
family physician before beginning a strenuous exercise program.
Be sure to include both cardiovascular training and resistance
training in your routine. Choose activities you enjoy! This will help
increase consistency, and overall happiness and well-being.

Follow-up
It is vital for you to keep your appointments with your surgeon to
assure optimal weight loss and surgical outcome. Routine blood
work must be done and should be completed before your visit with
your surgeon. These tests can be done through your primary care
physician or through the surgeon’s office.

44
Stage 4:
Regular Foods: Week 20 +
(3/4-1 cup per meal or snack)

What to Eat
Eat any proteins, vegetables, and fruits/starches (in small amounts) as tolerated.

Remember
» Eat protein first!
» Make protein at least half of your meal
» Vegetables are second
» Fruits/Starches are third, ONLY if you have room

Notes
» Take care with some meats: Beef, lamb, and pork will always have
to be chewed extremely well to pass through your small stomach
opening. Lean cuts, such as filet mignon, are the best choices.
» Pasta and Rice: Some people never tolerate pasta and rice well
after surgery. Pasta and rice need to be overcooked to keep
them from continuing to swell in your stomach. These should be
consumed in minimal amounts.
» Alcohol: Alcohol can be dangerous after any bariatric surgery.
Alcohol is absorbed more quickly after surgery and will reach
high levels in the blood. You will experience a greater degree of
intoxication with a small amount of alcohol because of its rapid
absorption. The rule is: Never drink more than 2 drinks (standard
bar size) within a 24 hour period. Drink only on special occasions,
such as your birthday or anniversary. If you do drink, DO NOT drive.
45
 » Sweets and Sugars: Avoid or limit foods that contain sugar,
such as fruit juices, honey, candy and sugary sweets, some salad
dressings, and some barbecue sauces. Eating sweets may cause
“dumping syndrome” and will decrease your weight loss. Fruit at
the end of a meal is a much better choice.
» Beverages: Eight 8-ounce glasses of water a day (64 fluid
ounces) is vital. Water is the most recommended beverage. Avoid
flavored sugary beverages, sodas, fruit juices, alcohol, and 2% or
whole milk. Sugar-free, non-carbonated beverages are acceptable.
» Fats: Fats have the highest calorie count of all nutrients. Humans
do need some fats for basic health, but significant intake of fats
will slow down weight loss. Stick to healthy fats that contain
Omega-3 fatty acids, such as olive or canola oil, and nuts/nut
butters. Be aware that fats can also cause “dumping syndrome”.
Learn to avoid over-consumption of fats and be aware that fats
hide in many foods. Check the nutrition label and ingredient lists
on all packaged food. Avoid fast food.

How to Eat
» Suggested eating pattern:
• Breakfast – 30 minutes to 1 hour after waking.
• Mid-morning snack - 2 to 3 hours after breakfast
• Lunch - 2 hours after mid-morning snack
• Mid afternoon snack - 2 to 3 hours after lunch
• Dinner - 2 hours after midafternoon snack
• Low calorie night time snack - 2 hours before bed
» Meal plates should be 1/2 protein, 1/4 vegetables, 1/4 fruits/starch.
Eat all protein first, then vegetables, then fruit/starch.
» Stop when you are satisfied – if you’ve eaten until you’re full,
you’ve eaten too much.

46
» It should take around 20 minutes to eat a meal.
» Chew, chew, chew all food very well and eat slowly
» Do not drink fluids or water 30 minutes before or during wait 30
minutes after a meal to start drinking again.
» Always eat your protein first and make it most of your meal. Eat
vegetables next, and fruits/carbohydrates last.
» Use small plates and utensils
» Season as you wish.

Vitamins
Continue to take your chewable bariatric vitamins as instructed on
the bottle. At this point you can switch to capsules if you would
like (most bariatric vitamin companies make both chewables and
capsules, check with your dietitian if you are having a hard time
finding these).

Exercise
Exercise 20-30 minutes every day. By now you should have a solid
exercise regimen in place. Focus on activities you enjoy!

Follow-up
It is important that you continue to follow-up with the surgeon
and your primary care physician, and any specialists that you see
regularly. Optimal weight loss and best surgical outcomes rely on
regular follow-up. Routine blood tests should be scheduled with
your family physician as he/she recommends based on your health
issues.

47
 Getting The Biggest “Bang” For Your Nutrition Buck
Not all protein is created equal---many vary in fat and calorie
content. Some proteins are “complete” while others are “incomplete”
proteins. This basic primer on protein is designed to help you make
more informed protein choices, so you can get the most protein for
the least amount of calories.

What is a “complete” protein?

A protein that contains all of the eight essential amino acids
(building blocks of protein)--your body is unable to make these
amino acids and you need to get them from your food

Which foods have a “complete protein”?

» Animal proteins, i .e. beef, pork, poultry, fish, eggs, milk, cheese
» Soy proteins, i .e. soy milk, tofu, tempeh

Which foods have an “incomplete” protein?

» Plant proteins, i .e. grains, legumes, seeds, and nuts

48
 The Protein Primer

How can you make an “incomplete” protein into a

“complete” protein?
(More important for vegans/vegetarians, those consuming animal
products will be getting adequate amounts of complete proteins).

» Combining two plant sources to form a complete protein—grains

+ legumes or legumes + seeds/nuts
» Grains—barley, bulgur, cornmeal, oats, rice, pasta, whole grain
pasta
» Legumes—dried beans, peas, lentils, peanuts
» Seeds/nuts—sesame, sunflower, cashews

How much protein should I eat in a day?

Most men and women need at least 60 grams of protein a day,
preferably more.

You may need more protein in your diet if you are: losing your hair,
wounds are not healing, skin is breaking down, your legs begin to
swell with fluids, or you are getting in a lot of strenuous physical
activity.

49
 What do I need to eat to get 50 grams of protein?
Example: 3 ounces of meat, 1 egg, 1 cup skim milk, 2 ounces of
cheese

What do I need to eat to get 60 grams of protein?

» Example: 4 ounces of meat, 1 egg, ½ bottle of Premier Protein
Shake, 2 ounces of cheese

What do I need to eat to get 70 grams of protein?

» Example: 4 ounces of meat, 1 egg, 1 cup skim milk mixed with
protein powder, 1 ounce of cheese

50
 Carbo-
Protein Fat hydrate
Food Item Serving Size Calories (grams) (grams) (grams)
BEANS
Baked beans ½ cup 191 7 6.5 27
Black beans ½ cup 114 7.1 0.45 20.4
Chick peas ½ cup 143 6 1.35 27
Kidney beans ½ cup 103 6.6 0.4 19
Pinto beans ½ cup 103 5.6 1 18
White beans ½ cup 153 9.5 0.4 29
BEEF
Eye Round 1 ounce 47 7 1.4 0
Top Round 1 ounce 50 7 1.4 0
Round Tip 1 ounce 53 7 2.0 0
Top Sirloin 1 ounce 57 7 2.0 0
Bottom Round 1 ounce 60 7 2.1 0
Top Loin 1 ounce 60 7 2.7 0
Tenderloin 1 ounce 60 7 2.8 0
Rib Steak 1 ounce 63 7 3.3 0
Chuck Blade Roast 1 ounce 70 7 3.7 0
Ground Beef—90% lean 1 ounce 70 7 3.7 0
CHEESE
American processed cheese 1 ounce 106 6.28 8.86 0.45
Bleu 1 ounce 100 6 8.1 0.66
Reduced-fat cheddar or colby 1 ounce 80 9.0 5.0 0.54
Cheddar 1 ounce 114 7 9.4 0.36
Colby 1 ounce 112 6.7 9.1 0.73
Cottage cheese, 2% milkfat ¼ cup 50 8 1 2
Cottage cheese, 1% milkfat ¼ cup 40 7 0.5 1.5
Farmer’s cheese 1 ounce 80 6 6 <1.0
Monterrey 1 ounce 106 6.9 8.5 0.19
Mozzarella, part-skim 1 ounce 79 7.79 4.85 0.89
Swiss 1 ounce 107 8.06 7.78 0.96

51
 Carbo-
Protein Fat hydrate
Food Item Serving Size Calories (grams) (grams) (grams)
CHICKEN
Breast (skinless) 1 ounce 40 8 0.5 0
Breast (with skin) 1 ounce 57 8 2.3 0
Drumstick (skinless) 1 ounce 43 7.6 1.3 0
Drumstick (with skin) 1 ounce 57 7.6 3 0
DAIRY
Powdered dry milk 1/3 cup 82 8 0 12
Whole milk (3.25% fat) 1 cup 150 8 8 11.37
Reduced fat milk (2% fat) 1 cup 121 8 4.69 11.71
Low-fat milk (1% fat) 1 cup 104 8.5 2.38 12.18
Skim milk 1 cup 90 8.75 0.6 12.3
Chocolate Reduced-fat milk 1 cup 179 8 5 26
Low-fat yogurt with fruit 1 cup 243 9.75 2.8 45.6
Plain Low-fat yogurt 1 cup 154 12.8 3.8 17.3
Regular plain yogurt 1 cup 138 7.88 7.38 10.6
Low-fat vanilla yogurt 1 cup 208 12 3 33.8
Sugar-free low-fat fruited yogurt 6 ounces 100 6 0 19
EGGS
Small 1 55 4.6 3.7 0.45
Medium 1 66 4.4 5.5 0.54
Large 1 75 6.25 5 0.61
Extra large 1 86 7.24 5.8 0.71
Jumbo 1 97 8.12 6.5 0.79
Egg white 1 17 3.5 0 0.34
Egg substitute ¼ cup 30 6.0 0 1.00
FISH/SEAFOOD
Blue crab 1 ounce 33 6.67 0.33 0
Catfish 1 ounce 47 5.67 3 0
Clams 4 small 33 7.33 0.5 0
Cod 1 ounce 30 6.67 0.17 0
Flounder/Sole 1 ounce 33 7 0.5 0

52
 Carbo-
Protein Fat hydrate
Food Item Serving Size Calories (grams) (grams) (grams)
FISH/SEAFOOD (continued)
Halibut 1 ounce 37 7.67 0.67 0
Lobster 1 ounce 27 5.67 0.17 0
Orange Roughy 1 ounce 27 5.33 0.33 0
Oysters 4 medium 33 3.33 1.33 0
Pollock 1 ounce 30 6.67 0.33 0
Rainbow Trout 1 ounce 47 7 2 0
Salmon, Atlantic 1 ounce 53 7.33 2.33 0
2 large, or
Scallops 40 7.33 0.33 0
5 small
Shrimp 1 ounce 27 6 0.33 0
Whiting 1 ounce 37 6.33 1.5 0
Whiting 1 ounce 37 6.33 1.5 0
GRAINS/PASTA
Barley ½ cup 96.5 1.75 0.35 22.2
Brown Rice ½ cup 108 2.5 0.9 22.4
Bulgur ½ cup 75 2.8 0.2 16.9
Cornmeal ½ cup 221 5.0 2.2 46.9
Pasta ½ cup 98.5 3.3 0.45 19.9
Wild Rice ½ cup 83 3.25 0.3 17.5
Quinoa ½ cup 111 2 4 18
Whole Wheat Pasta ½ cup 87 3.75 0.4 18.6
LAMB
Shoulder, Arm chop 1 ounce 57 8 2.67 0
Shoulder, Blade chop 1 ounce 60 7.33 3.33 0
Shank 1 ounce 53 8.67 1.67 0
Rib roast 1 ounce 67 7.33 3.67 0
Loin chop 1 ounce 60 7.33 2.67 0
Leg, whole 1 ounce 53 8 2.33 0

53
 Carbo-
Protein Fat hydrate
Food Item Serving Size Calories (grams) (grams) (grams)
NUTS/SEEDS
Almonds 1 ounce 165 5.6 14.6 5.7
Cashews 1 ounce 163 5.0 13.1 8.0
Peanuts 1 ounce 166 6.7 14.1 6.1
Peanut butter 1 Tbsp. 95 4.1 8.1 7.0
Pecans 1 ounce 189 2.69 18.3 6.3
Pistachios 1 ounce 162 6 13.7 7.0
Sunflower seeds, hulled 1 ounce 165 5.5 14 6.8
Walnuts 1 ounce 180 4.0 18.0 5.0
PORK
Shoulder, Blade Steak 1 ounce 63 7.66 3.66 0
Loin, Country style ribs 1 ounce 70 7.66 4.33 0
Loin, Rib chop 1 ounce 63 8.66 2.66 0
Center chop, loin 1 ounce 57 8.66 2.33 0
Top loin, chop 1 ounce 57 8.66 2.33 0
Top loin, roast 1 ounce 57 8.66 3 0
Loin, Tenderloin Roast 1 ounce 47 6.67 1.33 0
Loin, Sirloin Roast 1 ounce 60 8.33 3 0
Spareribs 1 ounce 83 7.67 5.67 0
PROCESSED MEATS
Bacon, cured, pan-fried 1 slice(8g) 41 3 3 0
Bacon, cured, pan-fried 1 ounce 154 11.25 11.25 0
Beef Jerky, Oh Boy! Oberto
1 ounce 80 10 1 0
Natural Style Beef Jerky
Beef sticks 1 ounce 155 6 14 2
Bologna, beef 1 slice 88 3 10 1
Bologna, light 1 slice 57 3 3 2
Bratwurst, beef and pork 1 ounce 84 3.4 7.3 0.4
Bratwurst, lite pork, beef, &
1 ounce 53 4.3 3.9 0.4
turkey
Canadian bacon 1 ounce 34 8.5 1.5 0.5
Frankfurter, beef 1 ounce 93 3.1 8.1 1.25
Frankfurter, fat-free beef,
1 ounce 31 3.5 0.5 3
pork, & turkey
54
 Carbo-
Protein Fat hydrate
Food Item Serving Size Calories (grams) (grams) (grams)
PROCESSED MEATS (continued)
Ham, extra lean (5% fat) 1 ounce 41 6 1.67 0.33
Polish sausage, beef & pork 1 ounce 85.8 3.37 7.5 0.74
Pork sausage, fresh patty 1 patty 100 5.3 8.4 0.5
Pork sausage, fresh link 1 link 48 2.6 4.1 0
Salami, beef cotto 1 slice 98 7 7 1
SOY FOODS
Isolated soy protein 1 ounce 107 25 1 0
Roasted soy nuts 1 ounce 122 10 6 9
Whole cooked soybeans 1 cup 254 22 12 20
Soy nut butter 2 Tbsp. 170 10 12 5
Firm tofu 4 ounces 120 13 6 3
Silken tofu 4 ounce 72 9.6 2.4 3.2
Soy milk, low fat 8 ounces 127 11 5 11
TURKEY
Breast with skin 1 ounce 55 8.3 2.3 0
Breast without skin 1 ounce 46 8.5 1.3 0
Wing with skin 1 ounce 68 7.7 4.3 0
Leg with skin 1 ounce 61 8 3.3 0
Dark meat with skin 1 ounce 66 7.7 4.3 0
Dark meat without skin 1 ounce 55 8 2.3 0

55
 Carbo-
Serving Size/ Protein Fat hydrate
Food Item Flavor Calories (grams) (grams) (grams)
PROTEIN SUPPLEMENTS — This is a short list of available protein supplements.

Atkins Advantage® Low Carb 11 ounces 170 20 9 4-5

Ready–To-Drink Shakes Vanilla
www.atkins.com Strawberry
Can order online or buy at: Supreme
• Cactus Low Carb Superstore Choc. Delight
• No Name Nutrition Choc. Royale
• Jane’s Health Market Café au Lait
• GNC Orange
• Wal-Mart Cream
• Walgreens Vanilla
• Vitamin World Caramel
• Baker’s Cream

Body Fortress Super 2 scoops 270 52 4 7

Advanced Whey Protein Chocolate PB
Shake Chocolate
www.bodyfortress.com Vanilla
Strawberry
Cookies n
Cream

11 ounces 110 15 0 2-3

EAS Advantage®
www.eas.com Carb Control
French
Can order online or buy at: Vanilla
• GNC Strawberry
• Vitamin World Choc. Fudge
• Rick’s Fitness Warehouse Dark Choc.
• Hy-Vee Coffee House
• Personalized Fitness
• SuperTarget 11 ounces 60 15 0 2
Carb Control
Fruit-flavored
Fruit Citrus
Splash
Mixed Berry
Lemon Twist

Jay Robb Egg Protein 1 scoop 100 24 0 <1

Powder® Chocolate
www.jayrobb.com Strawberry
Vanilla
Unflavored

56
 Carbo-
Serving Size/ Protein Fat hydrate
Food Item Flavor Calories (grams) (grams) (grams)
PROTEIN SUPPLEMENTS (continued)

Nature’s Best® 15 ounces 240 50 1.5 7

www.naturesbest.com ProSmoothie
www.bodybuilding.com Chocolate
http://www.bodybuilding.com
Vanilla
Can buy at:
• GNC 20 ounces 160 40 0 0
• Vitamin Shoppe Zero-Carb
Isopure
• Vitamin World
Apple Melon
Blue
Raspberry
Grape Frost
Icy Orange
Alpine Punch
Mango Peach
Banana
Pineapple
Orange
Passion Fruit
Nestle® No Sugar Added 1 packet 70 4-5 0-1 12
Carnation Instant Breakfast® (without
www.carnationinstantbreak- milk)
fast.com Rich Milk
Can order online or buy at: Choc.
• Hy-Vee French
Vanilla
• Baker’s
Chocolate
• Wal-Mart Malt
• SuperTarget Strawberry
Sensation

NNW Whey Protein 1 scoop 108 22 2 1

Chocolate
Peanut Butter
Vanilla
Strawberry
Vanilla
Caramel
Swirl
Cinnamon
Bun

57
 Carbo-
Serving Size/ Protein Fat hydrate
Food Item Flavor Calories (grams) (grams) (grams)
PROTEIN SUPPLEMENTS (continued)

Novartis Beneprotein 1 scoop 25 6 0 0

Powder® Unflavored
Can order at:
www.walgreens.com
local Walgreens store may
carry it or be able to order it
for you

Optimum 100% Whey 1 scoop 120 24 1 3

Protein Powder® Extreme Milk
Can order at: Chocolate
www.optimumnutrition.com French
GNC Vanilla Crème
Chocolate
Chocolate
Mint
Cookies &
Cream
Rocky Road
Strawberry
Tropical
Punch

Predator ™ Ultimate 1 scoop 118 22 2 3

Protein Powder Chocolate
Can order at: Strawberry
www.lionfootweardirect.com Vanilla

Revival Soy® 1 packet 130 20 2.5 7

www.revivalsoy.com Soy Shake
Can order online or call Choc.
1-800-738-4825 for catalog. Daydream
Van.
Daydream
Strawberry
Smile
Just Peachy
Banana
Blessings
Straw/
Banana Bliss
Blueberry
Blush
Plain
(Made w/
Splenda)

58
 Carbo-
Serving Size/ Protein Fat hydrate
Food Item Flavor Calories (grams) (grams) (grams)
PROTEIN SUPPLEMENTS (continued)

Slim-Fast ® 11.5 ounces 190 20 9 6

Low Carb Diet Shake Café Latte
www.slim-fast.com Chocolate
Most grocery stores and Royale
pharmacies. Creamy
Chocolate
Strawberries
N’ Cream
Vanilla Cream

Syntrax Nectar® 8 ounces 90 23 0 0

www.syntrax.com Apple Ectasy
http://www.syntrax.com Cherry
Crystal Sky
Fuzzy Navel
Roadside
Lemonade
Lemon Tea
Strawberry
Kiwi

Syntrax Matrix 2.0 or 5.0 1 scoop 120 23 1.5 2

www.syntrax.com +Milk
http://www.syntrax.com Chocolate
Mint Cookie
Bananas &
Cream
Cookies &
Cream
Orange
Cream
Perfect
Chocolate
Strawberry
Crème
Simply
Vanilla

UNJury® 8 ounces 80-90 20 3 0

www.unjury.com Strawberry
Can order online or call Chocolate
1-800-517-5111 with Splenda
Chocolate
Vanilla
Chicken Soup
Unflavored

59
 Carbohydrates
What exactly is a carbohydrate?
Dietary carbohydrates, also known as ‘carbs,’ are a quick source of
energy for our body that comes from plant-based foods. They come
in a variety of forms:

» Sugar - think of the ‘sweet’ stuff such as candies, ice cream, fruit,
cookies, pastries, pies, etc .
» Starch - think of the ‘feel good’ foods such as potatoes, rice, pasta,
bread
» Fiber - think of the ‘colorful’ stuff such as broccoli, peppers, greens
beans, spinach

Rather than drive yourself crazy figuring out what is a carb and what
isn’t, understand that many of the things we eat have carbohydrates
in some form.

Beware Of Hidden Carbs!

Carbohydrates (carbs) are everywhere! There are many foods that
are not as well known for containing carbohydrates . Below is a list of
sauces, beverages, fast food items, and a variety of other foods and
their carbohydrate amount.

60
Reference the following table for foods and serving sizes that
contain about 15g of carbs:

3 cups popped popcorn,

1/4 of a large bagel 1 cup watermelon
all types

2 1/2” across biscuit 2-4” across rice cakes 1/2 cup apple juice

1 slice white bread 9-13 potato chips 1/2 cup orange juice

1 slice whole wheat bread 1 medium apple 1/3 cup grapefruit juice

1/2 cup unsweetened

1/2 english muffin 1/3 cup grape juice
applesauce

1/2 hamburger bun 1 small banana 8 oz. white milk, all types

6” across flour tortilla 3/4 cup blackberries 6 oz. plain yogurt

1/2 cup cooked oatmeal 3/4 cup blueberries 1/2 cup chocolate milk

4 in. square waffle 1 cup diced cantaloupe 1/2 cup regular soda

1/2 cup grits 12 fresh cherries 1 cup gatorade

1/3 cup cooked couscous 1/2 a grapefruit 1 1/4” square brownie

1/3 cup cooked pasta 1 cup honeydew melon 1/2 cup pudding

1/3 cup cooked white rice 1 medium kiwi 5 pieces chocolate kisses

3/4 cup mandarin oranges,

1/3 cup cooked brown rice 1 Tbsp jam or jelly
canned
1/2 cup mashed white or sweet
1 medium nectarine 1 Tbsp sugar
potato

1/4 large white or sweet potato 1 medium orange 1 Tbsp maple sugar

1/2 donut (think Krispy

6 saltine crackers 1/2 cup pineapple
Kreme)

6 round butter-type crackers 1 cup strawberries 1/2 cup regular ice cream

2 1/2” square graham cracker 2 Tbsp raisins 1/2 cup fat free ice cream

61
 Beverage (serving size) Carbohydrates (grams)
Gatorade G2 (8 oz) 7g
Gatorade (8 oz) 14g
McDonald’s Nonfat Caramel Cappuccino (Medium) 41g
McDonald’s Iced Nonfat Latte (Medium) 9g
McDonald’s Iced Nonfat Latte with Sugar Free Vanilla Syrup (Medium) 14g
Starbucks Caffe Vanilla Frappuccino® Blended Coffee – no whip (Tall) 49g
Starbucks Espresso Frappuccino® Blended Coffee (Tall) 27g
Starbucks Tazo® Black Shaken Iced Tea (Tall) 16g
Sauces, Dressings, Marinades and Condiments (serving size) Carbohydrates (grams)
A1 Steak Sauce ( 1 Tbsp) 3g
A1 Steak Sauce Smokey Mesquite (1 Tbsp) 8g
Ketchup (1 Tbsp) 4g
Hidden Valley Ranch (2 Tbsp) 1g
Hidden Valley Fat Free Ranch (2 Tbsp) 6g
Kraft Cheez Wiz Dip Original (1 Tbsp) 4g
Mrs. Dash® Zesty Garlic Herb 10-Minute Marinade (1 Tbsp) 3g
Barbecue Sauce (1 Tbsp) 2g
Kraft Roasted Red Pepper Salad Dressing (2 Tbsp) 5g
Grape Jelly (1 Tbsp) 13g
Cocktail Sauce (2 Tbsp) 8g
Balsamic Vinegar (1 Tbsp) 2g
Croutons, plain (1/4 cup) 6g
Hummus (1 Tbsp) 2g
Kraft Free Classic Caesar Salad Dressing (2 Tbsp) 11g
Mustard, yellow (1 tsp) 0g

62
Sauces, Dressings, Marinades and Condiments - continued Carbohydrates (grams)
Dijon Mustard (1 tsp) 0g
Grey Poupon (1 tsp) 1g
Honey Mustard (1 tsp) 2g
Mayonnaise, regular (1 Tbsp) 0g
Mayonnaise, reduced-fat/light (1 Tbsp) 2g
Mayonnaise, fat-free (1 Tbsp) 3g
Miracle Whip (1 Tbsp) 2g
Miracle Whip, light (1 Tbsp) 3g
Red Wine Vinegar (2 Tbsp) 0g
Olive Oil (1 Tbsp) 0g
Hidden Valley Light Ranch (2 Tbsp) 3g
French Dressing, average (2 Tbsp) 5g
Kraft Roasted Red Pepper Salad Dressing (2 Tbsp) 5g
Caesar Dressing, average (2 Tbsp) 2g
Thousand Island, average (2 Tbsp) 5g
Buffalo Wing Sauce, average (1 Tbsp) 1g
Horseradish Sauce, average (1 tsp) 0g
Tabasco Sauce (1 Tbsp) 0g
Au Jus Gravy (1/4 cup) 2g
Chicken, Beef or Turkey Gravy, average (1/4 cup) 4g
Tartar Sauce (2 Tbsp) 4g
Teriyaki Sauce (2 Tbsp) 6g
Soy Sauce (2 Tbsp) 2g
Chili Sauce (1 Tbsp) 4g
Cocktail Sauce (2 Tbsp) 8g
Worcestershire (1 Tbsp) 1g
Heinz 57 Sauce (1 Tbsp) 4g
Hunt’s Hickory & Brown Sugar BBQ Sauce (2 Tbsp) 18g
Bullseye BBQ Sauce (2 Tbsp) 13g
Sour Cream, regular (2 Tbsp) 1g
Sour Cream, reduced-fat (2 Tbsp) 2g
Sour Cream, fat-free (2 Tbsp) 5g
63
 Sauces, Dressings, Marinades and Condiments - continued Carbohydrates (grams)
Ragu Rich & Meaty, Classic Italian Style (1/2 cup) 9g
Lawry’s 30 Minute Marinade, Caribbean Jerk/Teriyaki (1 Tbsp) 6g
Lawry’s 30 Minute Marinade, Lemon Pepper (1 Tbsp) 2g
Chick Fil-A Sauce (1 container) 6g
Chick Fil-A Polynesian Sauce (1 container) 13g
Arby’s Sauce (1 pkg) 4g
McDonald’s Sweet and Sour Sauce (1 pkg) 12g
McDonald’s Hot Mustard Sauce (1 pkg) 9g
McDonald’s BBQ Sauce (1 pkg) 12g
Taco Bell Fire Sauce (1 pkg) 1g
Wendy’s Ancho Chipotle Ranch Dressing (1 pkg) 3g
Food (serving size) Carbohydrates (grams)
Arby’s Jalapeno Bites (regular 5) 29g
Arby’s Mozzarella Sticks (regular 4) 38g
Chick-fil-A Chicken Nuggets (12 count) 15g
Chick-fil-A Cole Slaw (6.5 oz) 20g
Chick-fil-A Chargrilled Chicken Cool Wrap (1) 49g
McDonald’s Chicken Select® Premium Breast Strips (5 pc) 39g
Chili’s Broccoli Cheese Soup (1 cup) 12g
Ricotta Cheese (1/4 cup) 3g
Del Monte Midget Pickles (3 pickles) 10g
Hormel Fat Free Hot Dog (1 link) 5g
Boston Market Squash Casserole (3/4 cup) 20g
Oscar Meyer Thick Cut Bologna (2 oz slice) 2g
Burger King Chicken Tenders (5 pieces) 11g
Mrs. Paul’s Mini Crabcakes (6 cakes) 22g
Boston Market Meat Loaf and Brown Gravy (7 oz) 19g
Boston Market Meat Loaf and Chunky Tomato Sauce (8 oz) 22g
Baked Beans, Plain (1/2 cup) 27g
Cashews, Roasted, Whole (1 oz = 1/4 cup) 9g
Almonds, Roasted, Whole (1 oz = 1/4 cup) 5g

64
Food (serving size) - continued Carbohydrates (grams)
Trail Mix (1/2 cup) 34g
Arrow Head Mills Organic Nature O’s Cereal (1 cup) 25g
Ben & Jerry’s Chocolate Fudge Brownie Organic Ice Cream (1/2 cup) 30g
White Bread (1 slice) 13g
Whole Wheat Bread (1 slice) 13g
Fruits (serving size) Carbohydrates (grams)
Apple (1 medium: 2 3/4” diameter) 19g
Applesauce, Unsweetened (1/2 cup) 14g
Banana (1 medium: 7-7.5” long) 27g
Blackberries (3/4 cup) 15g
Blueberries (3/4 cup) 15g
Cantaloupe, diced (1 cup) 14g
Cherries, canned (1/2 cup) 15g
Cherries, fresh (12) 15g
Cranberries (1/2 cup) 5g
Dates (5 medium) 27g
Figs (3 medium) 34g
Fruit Cocktail/Salad (1/2 cup) 15g
Grapefruit (1/2 fruit) 12g
Grapes (1 cup) 25g
Honeydew Melon (1 cup) 14g
Kiwi (1 medium) 11g
Mandarin Oranges, canned (3/4 cup) 15g
Mango (1/2 cup) 14g
Nectarines (1 medium: 4 oz) 11g
Orange (1 medium: 3” diameter) 15g
Papaya (1/2 cup cubed) 7g
Passionfruit (1 medium) 4.5g
Peaches (1 large: 6 oz) 15g
Peaches, canned in light sauce (1/2 cup) 13g
Pears (1 medium: 6.5 oz) 24g

65
 Fruits (serving size) - continued Carbohydrates (grams)
Pineapple, fresh (1 cup) 19g
Pineapple, canned (1/2 cup) 15g
Plaintains (1/2 cup) 22g
Plums (1 small: 1 3/4” diameter) 7g
Pomegranate (1/2 fruit) 13g
Prunes (1 large) 5g
Raisins (2 Tbsp) 22g
Raspberries (1/2 cup) 7g
Strawberries (1 cup: 5 1/2 oz) 10g
Tangerine (1 medium: 2 1/2” diameter) 11g

Watermelon (1 cup) 11g

Food Label 101

Serving Size
The best place to start…it’s the key to understanding just how much
of the other nutrients you are truly consuming. Ask yourself:

» How is it measured?
» How many servings total?
» How much am I consuming?

Carbohydrates
» Look at TOTAL GRAMS

There are 34g of TOTAL carbs per serving, but 68g for the entire
container.

66
Daily Value Chart (Right column numbers)
These numbers are essentially useless to you after surgery, as your
total nutrient needs are very different from the general population.
Same with the vitamins/minerals listed towards the bottom.

Example: This product states is provides 15% of your total thiamine

needs for the day. This is no longer true for you, since you need
more thiamine than the general public.

These numbers CAN give you an idea if a certain food is LOW or

HIGH in certain nutrients, but the actually percentages do not apply.

67
 VEGETABLES (non-starchy)

• FREE – Use these foods multiple times daily

Artichoke Cucumber Radishes

Artichoke Hearts Eggplant Tomato**
Asparagus Garlic Spinach
Beets** Green Onions Summer Squash
Bean Sprouts Greens (collard, mustard, Salad Greens (endive,
turnip, kale) escarole, lettuces)
Beans (green, wax, Italian)
Kohlrabi Turnips
Broccoli
Leeks Water chestnuts
Brussels Sprouts
Mushrooms Watercress
Cabbage (all varieties)
Okra Zucchini
Carrots**
Onions
Cauliflower
Peppers (all varieties)
Celery

VEGETABLES (starchy)

• FREE if used 1-2 times a week; if used more often, COUNT THE CARBS!

Baked Beans Pumpkin (1 cup) Corn on the Cob (5 oz)

Squash (acorn or Peas, green Lentils
butternut – 1 cup)
Plantain Beans & Peas (garbanzo,
Lima beans (2/3 cup) pinto, white, kidney,
Corn
black, red, black-eyed)

Serving Size listed = 15 g carbohydrate

68
FRUITS

• Count these Carbs!

Apple, small (1) Grapefruit sections (3/4 cup) Pineapple, fresh (3/4 cup)
Applesauce, no sugar Grapes (16) Pineapple, canned (1/2 cup)
(1/2 cup)
Honeydew (1 cup cubes) Plums, small (2)
Apricots, fresh (4 whole)
Kiwi (1) Plums, canned (1/2 cup)
Apricots, canned (1/2 cup)
Mandarin oranges Prunes, dried (3)
Banana, small (3/4 cup)

MILK

• Count these Carbs!

Whole Milk (1 cup) Fat Free/Skim Milk (1 cup) Kefir (1 cup)

2% Milk (1 cup) Goat’s Milk (1 cup) Plain Yogurt (3/4 cup)
1% Milk (1 cup) Buttermilk (1 cup)

Serving Size listed = 15 g carbohydrate

69
 American Society for Metabolic and Bariatric
Surgery Supplement Recommendations

Vitamin Deficiency Chart

ASMBS Daily Early signs of Late signs of

Vitamin Intake guidelines Food Sources deficiency deficiency

Thiamin 12 mg meat (esp. pork) poor appetite, heart failure with

(Vitamin B1) sunflower seeds, staggering while shortness of breath, fast
grains, vegetables walking, sensation heartbeat, fluid buildup
of tingling, tickling, on limbs or lungs, nerve
pricking, or burning, pain, loss of reflex,
muscle cramps, changes in memory
irritability

Cobalamin 500 mcg meat, dairy, eggs pale skin and eyes, anemia, changes in
(Vitamin (animal products) fatigue, light- mental status, decrease
B12) headedness, shortness in proper nerve
of breath, ringing in function and nerve
ear, rapid heartbeat or communication, changes
palpitations, numbness in mental status
and tingling, poor
appetite, sore/red
tongue

Folate* 400-800 mcg vegetables (esp. diarrhea, sore tongue, anemia, neural tube
leafy greens) fruit, scaling lips defects in infants (during
enriched grains pregnancy)

Iron** 18 mg meats, fish, fatigue, rapid heartbeat anemia, leaky gut

poultry, eggs, or palpitations, syndrome
enriched grains, impaired learning
dried fruit, some ability, spoon-shaped
vegetables and nails, decreased work
legumes performance

Calcium 1200-1500 mg dairy products, increased parathyroid osteoporosis, muscle

(RNY/Sleeve) leafy green hormone, leg spasms become severe
vegetables, cramping, low calcium and difficult to control
legumes fortified levels and involuntary
BPD/DS 1800-2400 mg foods muscle spasms

Vitamin D3 3000 IU fortified dairy calcium deficiency and Extremely soft bones,
products, fatty symptoms of calcium frequent bone fractures/
fish, eggs, fortified deficiency, fatigue breaks
cereal

70
*Folate: Women of child bearing age need 800-1000 mcg daily
**Iron: Menstruating females need 45-60mg daily
***Vitamins A & K: If you are planning to get pregnant or could get pregnant, please contact your
bariatric surgery dietitian regarding your vitamin supplementation. High amounts of vitamins
A and K can be dangerous and harmful to your baby!

If you are found to be deficient in any of the above vitamins/minerals, the recommended amounts
may change to get your levels back to normal.

ASMBS Daily Early signs of Late signs of

Vitamin Intake guidelines Food Sources deficiency deficiency

Vitamin A*** 5000-10,000 IU liver, dairy night blindness, dry Irregular spots of
(RNY/Sleeve) products, fish, eyes, poor wound discoloration on whites
dark fruits and healing of the eye
DS 10,000 IU veggies

Zinc 16-30 mg meat, liver, eggs, poor appetite, poor hair loss, muscle
oysters, peanuts, wound healing, wasting, decreased taste
whole grains irritability, diarrhea, sensation, alterations in
skin infection sense of smell

Vitamin C 120 mg citrus fruits, red, Dry or splitting hair, Easy bruising, swollen/
orange, & yellow bleeding gums bleeding gums, gingivitis,
vegetables, dry or scaly skin,
broccoli, kale nosebleeds

Copper 1-2 mg Sunflower seeds, Fatigue, paleness Anemia, joint

almonds, lentils, inflammation/pain,
asparagus, beef frequently getting
liver sick, osteoporosis, hair
thinning or balding
Biotin 600 mcg Nuts, salmon, Low appetite Nausea, depression,
organ meats, muscle pain
pork, banana,
soybeans,
mushrooms
Vitamin 90-120 mcg Kale, spinach, Bleeding gums, easy Nose bleeds, heavy
K*** turnip greens, bruising menstrual periods,
collards, Swiss bleeding from the GI
DS 300 mcg chard, Brussels tract, blood in the urine
sprouts, broccoli, or stool
cauliflower, liver

Vitamin E 15 mg Almonds, Diarrhea, greasy stools Muscle weakness, vision

sunflower issues, unsteady walking
seeds, pine nuts,
avocado, quinoa,
eggs

71
 Spiritual Wellness
Spiritual Needs of People on a Weight Loss Journey
Deciding to lose a significant amount of weight can challenge your
understanding of who you are and what you had planned for your
life. All of the changes that can happen to your body during this
process may cause you to reflect on the meaning and purpose of
life. You may question your sense of self and may challenge your
relationships with others and with your God/higher power. This
may actually become a time for deepening those relationships. The
purpose of this page is to give you a few suggestions for exploring
your spiritual resources.

Meaning, Purpose and Hope

As a human being, you have faced many things, both joyful and
challenging in life. What has helped you cope in the past? Explore
the inner strengths you already have and know that those strengths
will support you now throughout your weight loss. Many people,
when dealing with change, find that their spiritual beliefs give them
the support they need. Others find their faith wavering and seek
the support of family, close friends, chaplains, clergy, and/or faith
communities to help find comfort and purpose.

72
Self-Worth and Respect
So much of who we are revolves around our accomplishments,
relationships, and social roles. Losing weight can alter this identity
and self-esteem, causing changes in relationships and increasing our
need to understand that God’s love is unchanging. A spiritual view of
the world can help you re-connect and to grow in self confidence in
the midst of your weight loss process.

Isolation and Loneliness

You may turn to food because of feelings of being alone or isolated
from others. Or you may have family members or friends who
encourage you to stay as you are, saying they love you no matter
what. Weight loss may mean that some relationships change and
at the same time new friends may emerge, people who have
journeyed through their own weight loss and want to walk with you
through yours. Finding forgiveness for those who have not been
supportive and gratitude for those who have joined in your journey
is a part of your spiritual healing.

Changing Priorities
Your weight loss journey may cause you to examine your entire life,
looking for both the positives and the challenges. This may be a time
of forgiving and letting go of the past and focusing on how you
want to interact with life and with those you love.

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 Living in the Present
We spend much of our lives reminiscing about the past or worrying
about our future. A weight loss journey can magnify both the
reminiscing and the worrying if you focus only on the future. This
journey can also call you to focus on the present, to be grateful
for every moment and to find joy in little things. It can be an
opportunity to live deeply, fully the life you have and to share it
intentionally with the people who love you.

Spiritual support is a part of your weight loss treatment. Please

contact the CHI Health chaplains, your clergy, and any other person
you trust to be a part of your spiritual journey.

To contact a chaplain from CHI Health Pastoral Care call:

Creighton University
Medical Center - Bergan Mercy 402-398-6030
Immanuel 402-572-2164
Lakeside 402-717-8180
Mercy Council Bluffs 712-328-5050
Midlands 402-593-3107

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A Prayer for
Your Weight Loss Journey
Lord,

I’m so tired of feeling the way I do. I want to feel light, energized
and healthy. I haven’t been able to get there on my own, and I’m so
frustrated with my total focus on food. Lord help me to focus on you,
on your will for my life. I surrender to your will and ask you to help
me to do the things that will allow me be radiantly healthy and live
as you intended. When I fail Lord, help me to pick up and start again
knowing that your love is ever present.

Amen

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 Lord,

Grant me the strength, courage, determination and hope that I

need for my weight loss journey. Remind me that I deserve the
improved health and energy that achieving my goals will bring.

Most of all, thank you for your ever present love. Amen

Lord,

It’s hard. There are temptations all around and I want so badly to
give in to them. Help me stay focused on my ongoing decision to
lose weight, to be healthier, to do the things I want to do. Thank
you for your encouraging presence on my journey.

Lord,

I’ve made a choice for weight loss and a healthier life. I know you
love me no matter what, but please strengthen me as I work to
achieve my goal. When I stray, help me get back on the path I’ve
chosen. May your love be my companion and my guide.

Amen

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Lord,

I am on my weight loss journey and I’m determined to succeed,

but sometimes I find myself tempted to eat for reasons other than
hunger.

Help me Lord….

When I’m tempted; give me strength

When I’m angry; may I feel your peace

When I’m worried; calm my mind

When I’m anxious; grant me reassurance

When I’m fearful; give me courage

When I’m hurt; remind me to forgive

When I’m sad; allow me to feel your hope

When I’m frustrated; may I turn control over to you When I’m
overwhelmed; grant me fortitude to say no When I’m helpless;
show me my strength.

With you, I can do this. Thank you for your loving, guiding
presence. Amen

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 Notes

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