MORE TIPS ON FOOD CHOICES FOR YOUR DIET

As you increase your food intake, you might be tempted to eat foods that are high in fat. Please avoid this temptation as it will hinder or even undo your weight loss. Remember these tips as you choose your foods:

-All fried foods have a lot of fat, whether they are vegetables (like fried zucchini, fries, hash browns, fried plantains, or onion rings), poultry (like fried chicken, chicken nuggets, or buffalo wings), beans (like refried beans) or snacks (like Cheetos®, Doritos®, Fritos®, or potato chips). Other fried foods to avoid are grilled cheese sandwiches, egg rolls, French toast, chow mein noodles, croutons, and hard taco shells.

-Use low fat cooking methods instead of frying, bake, broil, roast, grill, poach, steam, or boil your meat, poultry, or fish.
Use a non-stick pan and/or a cooking spray (like PAM®) when cooking on the stove. If you need to use oil, use as little as you can (1 tsp should be enough). Do not use these fats in your cooking: bacon grease, fatback (or salt pork), shortening (like Crisco®), lard, or beef tallow.

-Avoid high fat meats/poultry such as spareribs, sausages, oxtails, chicken/turkey wings, chopped chicken livers, ground pork, regular ground beef, luncheon meats that have 5 grams or more of fat per ounce (like bologna, pimento loaf, salami), hot dogs (beef, turkey, or chicken), bacon (unless you count it as a fat serving: 1 slice = 1 fat serving).

Use ground turkey or chicken breast instead of regular ground turkey or chicken.Use ground sirloin or beef that is 91% to 99% lean instead of regular ground beef/chuck.

The best choices for luncheon meats are: turkey/chicken breast, roast beef, any of the hams, or Healthy Choice® luncheon meats.
Chicken or turkey hot dogs are almost as fatty as regular beef hot dogs. Choose low fat beef hot dogs instead.
Canadian bacon has much less fat than regular bacon. It is a better choice.

-Take off the skin from poultry as most of the fat in poultry is in or near the skin.

-Cut off all visible fat from meat.

-Keep using fat free, 1%, Skim Plus®or Smart Balance® milk and light or fat free yogurt.

-Only eat cheeses that have 3 grams of fat or less per ounce. When you eat out, you can assume that the cheese on your food is full fat cheese. Either skip it or eat less of it.

-Olives count as a fat: 8 large black/green olives = 1 fat serving 10 small black or green, stuffed olives = 1 fat serving. ) Nuts count as a fat and they might be hard for you to digest, so be careful!! 4 halves of pecans, walnuts = 1 fat serving 10 whole peanuts or pistachios = 1 fat serving 6 almonds or cashews = 1 fat serving 1 TBSP sesame, pumpkin, or sunflower seeds = 1 fat serving 2 tsp peanut butter = 1 fat serving J)

Foods made with mayonnaise such as egg, tuna, chicken, macaroni and potato salads, and cole slaw are high in fat, mostly because of the full fat mayo that is used to make them. One teaspoon of mayo has 45 calories and 5g of fat. You get much more mayo than one teaspoon in one serving of these foods. Either stay away from these items when you eat out or make them at home using low fat or fat free mayonnaise [Hellmann’s® Light (flavored varieties are OK) or Reduced Fat Mayonnaise products are good options]. Tartar sauce is made from mayonnaise, so it is high in fat. Make your own tartar sauce using low fat or fat free mayonnaise. You can find good recipes online.

-Opt for water-packed tuna instead of oil-packed tuna. This way, you can cut down on 10 calories and 2 grams of fat for every ounce. Store-bought tuna salad is also high in fat because it uses oil-packed tuna and high fat mayo. 

Likewise, you can save around 30 calories and 3g of fat per ounce by choosing sardines without skin and bones that are packed in water rather than oil. 

-The salad dressings that come with your order are usually loaded with fat. Request low fat or fat free dressings and have them “on the side” (in a separate bowl from your salad). Drizzle salad dressing lightly over your salad or dip your fork into the dressing first, then pick up your lettuce leaves. 

These methods will reduce the fat intake from an otherwise healthy food. 45 calories and 5 grams of fat: 1 TBSP regular salad dressing 2 TBSP’s low fat salad dressing Less than 20 calories with no fat: 1 TBSP fat free salad dressing 2 TBSP’s fat free Italian salad dressing 

-“Light” olive oil refers to its mild flavor. It has the same amount of fat and calories as regular olive oil. 

-Other foods that are rich in fat include: cream soups (made with heavy cream and butter), granola (cooked in oil), mashed potatoes (usually made with regular milk and butter), regular popcorn (cooked in oil), crackers filled with cheese or peanut butter, avocado (a good fat but 1⁄8 of one = 45 calories and 5g fat), sauces such as alfredo, béarnaise, hollandaise, white clam and pesto (made with cream, mayonnaise, butter and/or oil), “light” tomato sauce (has cream added to make it pale in color), coconut (meat, cream and milk), hummus (made with olive oil and tahini paste, both good fats) and croissants (made with a lot of butter). 

-You can use herbs and spices to flavor your foods. Avoid eating too much of hot, spicy foods like hot pepper sauce, jalapeno peppers, red pepper flakes, etc. These may produce excess stomach acid, leading to an ulcer in your stomach pouch. 

Other seasonings and condiments that are okay to use with foods are: Flavoring extracts Garlic Ketchup Lemon juice Pimentos Lime juice Soy sauce* Mustard* Salsa Vinegar Worcestershire Sauce* *High in sodium 

-Limit yourself to one starch serving per day for the next month. 

-Different people have different food intolerances. You will discover which foods are agreeable and which ones are not by experimenting. 

-Sometimes a food that is fine one day is not fine the next day. This is normal. Don’t forget to include a variety of foods in your diet and keep trying.

Following these dietary guidelines diligently will support your recovery and optimize the benefits of your ESG procedure. For further assistance or clarification, do not hesitate to contact our nutrition and dietetics department.

As you progress to the regular diet stage, it’s crucial to shift your focus towards sustaining a long-term healthy eating pattern. Remember, your goal isn’t merely to consume small portions to reduce calorie intake and shed pounds but also to adopt a balanced and nutritious eating plan.

 -Aim to have three balanced meals each day. Avoid skipping meals, as prolonged periods without eating can actually hinder weight loss.

 -Mindful Eating: Take your time to eat slowly and stop when you feel satisfied. Rushing through meals can lead to overeating, as there’s a delay between eating and your brain signaling fullness. Chewing food thoroughly is essential for proper digestion.

 -Prioritize Protein, Vegetables, and Carbohydrates: Consume your meals in the order of protein, vegetables, and carbohydrates. Begin with protein, as it’s the most satiating component. If you feel full before finishing your meal, prioritize protein over carbohydrates.

 -Embrace Solid, Balanced Foods: Opt for solid foods like lean meat or fish paired with vegetables, as they provide prolonged satisfaction and help in portion control. Follow a diet aligned with healthy eating guidelines, emphasizing low-fat and low-sugar options while incorporating lean protein and fiber-rich foods.

 -Portion Control: Limit your meal sizes to those of a ‘side plate’ or ‘tea plate.’ Using smaller plates can aid in portion control over the long term. Refer to the small dinner plate diagram for guidance.

 -Beware of Unplanned Snacking: Avoid developing a habit of constant grazing throughout the day. Stick to structured meals to maintain consistency in your eating pattern.

 -Opt for Low-Calorie Beverages: Choose non-carbonated, low-calorie drinks to avoid unnecessary calorie intake. Liquids pass through the stomach quickly, and high-calorie beverages can contribute to excess calorie consumption without providing satiety.

Limit intake of high-calorie drinks such as alcohol, fruit juices, smoothies, sweetened squash/cordial, non-diet soft drinks, sports drinks, and milk-based drinks, excluding low-fat milk in moderate amounts. Steer clear of fizzy drinks, as they can cause discomfort and potentially stretch the stomach.

Cooking Suggestions:

• Prior to cooking, ensure to trim off all visible fat and skin from meat or chicken.

 • Utilize low-fat cooking methods like grilling, baking (consider wrapping in foil to retain moisture), steaming, or boiling.

 • Limit the use of oil or butter when preparing vegetables or salads. Instead, enhance flavor with seasonings or a modest amount of low-calorie dressing or vinegar.

 • When oil is necessary to prevent sticking, opt for spray oil.

 • Enhance dishes with flavor using herbs, spices, seasonings, lemon juice, ginger, onions, and garlic.

Avoid adding oil or butter to your carbohydrates; opt for simplicity.
 • Opt for high-fiber carbohydrate choices whenever feasible, as they promote longer-lasting fullness and aid in preventing constipation. Consider options such as wholegrain bread, pasta, rice, crackers, and leave the skins on potatoes.

Multivitamins and Minerals  After ESG

Following your procedure, it’s improbable that you’ll obtain all the essential vitamins and minerals solely from food. Hence, it’s crucial to incorporate a multivitamin and mineral supplement into your routine:

 • Multivitamin and Mineral (A-Z) Options:

 • Forceval™ (available by prescription) – Take 1 capsule daily

 • Over-the-counter alternatives (1 tablet daily) such as Sanatogen A-Z™, Centrum A-Z™, Tesco A-Z™, Lloyds A-Z™

 • Vitamin D 2000IU: Take 1 tablet daily

 • If you have a pre-existing deficiency (e.g., iron), continue any prescribed supplements.

Long-Term Nutritional Monitoring

Regular blood tests are essential to monitor for nutritional deficiencies (insufficient levels in your body). It’s recommended to undergo blood tests at 6 and 12 months during the first year post-procedure, followed by annual testing thereafter.

Considerations for Eating After Endoscopic Sleeve Gastroplasty:

Remember that ESG converts the stomach from a larger sac to a narrow tube. While less restrictive than other procedures, such as gastric bypass or adjustable gastric banding, the stomach’s storage capacity is significantly reduced.

Eating too much or too quickly can cause discomfort or vomiting. Patients should eat slowly and stop when feeling full. Liquids pass through the system without restriction and can contribute excess calories, so calorie-dense liquids like juices, milk, and protein shakes should be avoided.

Opt for no-calorie or low-calorie liquids such as water, artificially sweetened beverages, and skim or 1% milk. Protein supplementation should be in powder form and added to solid food. Adhering to these guidelines maximizes the effectiveness of the gastric sleeve procedure and promotes optimal weight loss.

*Individual results may vary based on factors such as surgery type and adherence to the aftercare program. As with any medical procedure, there are risks and potential complications. Testimonials are not indicative of typical results and are voluntarily provided by patients.

Nausea and vomiting are common during the initial week post-surgery. Medications prescribed to manage these symptoms include:

 • Prilosec (omeprazole): Take one tablet daily to reduce acid.

 • Zofran (ondansetron): Dissolve one tablet under the tongue every 6 hours for nausea.

 • Phenergan (promethazine): Take 1-2 tablets by mouth every 4-6 hours for nausea.

 • Levsin (hyoscyamine): Dissolve one to two tablets under the tongue every 4 hours as needed for spasm or cramping.

If vomiting persists despite medication use, contact your healthcare provider for further guidance.

In Summary Helpful Tips:

 • Plan 3 meals and 2 snacks.

 • Maintain good posture during meals and while drinking fluids to aid tolerance.

 • Stop eating when full (Hiccup sensation indicates fullness; one additional bite may be too much).

 • Avoid drinking 30 minutes before and after meals.

 • Refrain from eating 3 hours before bedtime.

 • Use anti-nausea medications as prescribed.

Once you feel well enough (typically 3-7 days post-surgery), begin an exercise program without restrictions. Aim for 10,000 steps per day using an activity tracker like a FitBit to enhance weight loss.

How to deal with common issues?

Constipation: If you have constipation, you can try these remedies:

Take two tablespoons of Milk of Magnesia twice a day, or use a Dulcolax suppository or a Fleets® enema.

Drink at least 48 ounces of fluids every day.
Eat more foods that are rich in fiber, such as beans, vegetables, fruits, and high-fiber cereals.

Walk regularly.

Use a daily stool softener (like Colace) or a fiber supplement (like LiquaFiber, Benefiber, sugar-free Metamucil®, or sugar-free Citrucel®).

Gas: If you have gas, you can try these solutions:

Take Gas-X tablets that are available over the counter.
Use liquid bean-O® if certain foods give you gas (such as beans).
Walk regularly.
Eat and drink slowly and avoid skipping meals.

Vomiting: If you have vomiting, you can try these tips:

Make sure your bites are no larger than a dime.
Eat slowly and chew well. Put your spoon down after each bite and wait for 15 seconds before taking another one.

Avoid foods that are too dry, such as overcooked chicken breast or fish. Do not drink during your meal and wait for 30 minutes after eating before drinking again.

If you keep vomiting every time you eat, stop eating and drinking for four hours and then have clear liquids for one day before trying solid food again. If vomiting continues, contact your gastroenterologist’s/surgeon’s office. If you also have abdominal pain, go to an emergency room.

Regurgitation: 

For managing regurgitation:

 • Steer clear of carbonated beverages, cabbage, leeks, onions, cucumbers, peppers, and garlic.
 • Avoid heavily seasoned or spicy foods.
 • Eat slowly in a relaxed setting, refraining from talking while eating.
 • Avoid chewing gum.

How to exercise 

Hopefully, you have been enjoying your walking program and doing well with it. Make sure you do cardio-vascular exercise that raises your heart rate for at least 30 minutes every day. It is also important to include resistance exercises in your exercise routine (get approval from your nurse practitioner or surgeon first).

However, you will need the guidance of a trained professional for this. The most successful patients are those who change their body composition. They reduce their fat mass (by doing aerobic exercises like walking, running, treadmill, bike, rowing, elliptical, etc.) and increase their muscle mass (by doing resistance exercises like weights, machines in the gym, exercise bands, Pilates, etc.).

Regular meetings with your support team for nutritional training and progress monitoring are essential for successful lifestyle changes. The target weight loss during the first 6 months is 25-50 pounds, with higher-BMI patients aiming for the higher end and lower-BMI patients aiming for the lower end. However, weight loss outcomes may vary based on individual adherence to the program.