Penn Metabolic & Bariatric Surgery Program

Penn Metabolic & Bariatric Surgery Update

Monday, September 21, 2015

Fasting After Bariatric Surgery

After bariatric surgery your digestive tract is physically different and can no longer accommodate large amounts of food. However, it’s just as bad for you to consume no food.

You know that after bariatric surgery, it’s critical to have an adequate intake of fluids and nutrients. Because of the quick weight loss, you need to make sure you get all of the nutrients, vitamins and minerals you need to recover.

People who observe a fast, whether for religious or lifestyle reasons, face several challenges.

Your new eating and drinking habits are being established. Since you can’t consume large amounts in one sitting, you should be sipping fluids throughout the day. A complete fast can put you at risk for dehydration and poor calorie and nutrient intake. Additionally, an inadequate intake of protein can reduce lean body mass and metabolic rate.

Fasting for long periods of time could result in vomiting, compounding dehydration and poor nutritional intake. Foods that are usually eaten at the end of a religious fast are sweets, carbohydrates and fats that can also put you at risk for dumping syndrome and steatorrhoea (excess fat in feces caused by fat malabsorption). Sounds pleasant, right?

Moreover, the small amount of volume in the stomach may make it difficult to fit the proper amount of food, nutritional supplements and medications at meal times after a fast.

We recommend that you avoid the fast and stick to foods that are high in protein and low in fats and sugars. Protein is great because it builds tissue and regulates various bodily processes necessary for good health. You also don’t need to eat as large an amount to feel full.

If you have any questions about fasting or your diet, contact your doctor, nurse practitioner or bariatric dietitian.

If you want to learn more about weight-loss surgery and its results, sign up for a free informational session.

Monday, September 14, 2015

Back to School, Back to Basics

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers bariatric-friendly lunch recipes to keep both you and your kids on track.

Now that school has started, many of my bariatric patients have expressed that they are ready to “get back on track” after enjoying the summer. An easy way to start heading in the right direction is to start packing your lunch along with your kids’.

Preparing meals and snacks is a great way to stay focused so that you are not tempted to purchase unhealthy foods. Here are some recipe suggestions for quick and easy make-ahead lunches.

Low-Carb Tuna Melts

  • 2 thick slices of tomato
  • 1 can tuna packed in water, water drained
  • Low-fat mayo (optional- Dijon mustard)
  • 2 thin slices of low-fat cheddar cheese (or any other cheese you like!)

Prepare tuna salad by mixing one can of tuna with either mayo, Dijon mustard, or a combination of the two. Use only enough mayo/Dijon to form the tuna into a salad.

Lay the tomato slices on an aluminum foil covered baking sheet.

Place one to two ounces of prepared tuna salad on each tomato slice, then top each with a slice of low-fat cheddar cheese.

Place under the broiler in the oven, or toast in a toaster oven until cheese melts.

Serve warm, or pack and reheat in the microwave at a later time.

Egg Salad with Cucumber Chips

  • 2 hard-boiled eggs, shells removed
  • Low-fat mayo
  • Dijon mustard
  • Salt and pepper
  • Optional - fresh chives or parsley
  • Cucumbers, sliced in ¼ slices

To prepare egg salad, chop hard boiled eggs and mix together with equal parts low-fat mayo and mustard. Only use enough mayo/mustard to create a salad. If desired, mix in chopped chives or parsley. Add salt and pepper to taste.

Serve egg salad on cucumber slices.

Making roll-ups are a quick and easy way to get in both protein and veggies. Roll-ups are a bariatric-friendly way to capture the flavors of your favorite sandwiches without the excessive carbohydrates! Here are a few of my favorites.

Turkey Hoagie Roll-ups

  • Lettuce leaves, such as Romaine Bibb, Boston, or other leaf lettuce, washed and dried
  • Low-sodium, low-fat deli turkey
  • Low-fat deli American cheese
  • Dried Oregano
  • Red wine vinegar
  • Optional - thin slices of tomato and/or red onion

Lay 1 lettuce leaf on a clean counter or cutting board. Top with one to two slices of turkey and one slice of American cheese. If desired, lay one to two thin tomato slices and thinly sliced red onion on top.

Sprinkle oregano over the top and add a few drops of red wine vinegar.

Roll lettuce leaf tightly, making sure to roll in all of the toppings.

Roast Beef Roll-ups with Low-fat Horseradish Sauce

Ingredients for roll-ups
  • Roast beef deli slices
  • Low-fat cheddar cheese
  • Baby spinach
  • Roasted red pepper
Ingredients for low-fat horseradish sauce
  • Grated horseradish
  • Plain Greek yogurt
  • Salt and pepper

Lay one slice of roast beef on a clean counter or cutting board, then top with one slice of low-fat cheddar cheese. Place roughly five baby spinach leaves in the center and top with one to two thin slices of roasted red pepper. Roll roast beef up tightly making sure to pack in the spinach leaves and roasted red pepper.

To make the low-fat horseradish sauce, mix one-fourth cup Greek yogurt with enough grated horseradish to meet your liking. Add salt and pepper to taste.

Cuban Roll-ups

  • Low-fat deli ham
  • Low-fat Swiss cheese
  • Pickle spear
  • Yellow mustard

Lay one slice of ham on a clean counter or cutting board, then top with one slice of low-fat Swiss cheese. Spread a thin layer of yellow mustard over the cheese. Roll meat and cheese slices around one pickle spear to create the roll-up.

I hope these recipes help to get you back on track! Remember, deli meats and cheese can be very high in sodium so purchase low-sodium options when they are available. You can also use thin slices of home-cooked meats to lower the sodium intake.

Monday, August 24, 2015

Alcohol Intake After Bariatric Surgery

Samantha Stavola, RD, LDN
Samantha Stavola is a registered dietitian with the Penn Metabolic and Bariatric Surgery program. In this article, Sam gives information and recommendations for drinking alcohol after bariatric surgery.

Alcohol consumption after surgery is one of our most frequently discussed topics with patients.

Generally, it’s recommended to avoid alcohol for six months after bariatric surgery, whether you have undergone the sleeve gastrectomy or roux-en-y procedure.

When you undergo bariatric surgery, the large fundus, or reservoir, portion of the stomach has either been totally bypassed or removed from the rest of the GI tract.  Because of this, alcohol enters the body more rapidly for processing, which can increase your risk of developing alcohol poisoning.

How one drink affected your body before surgery now is equal to three to four drinks after surgery.

Alcohol consumption can also increase your risk of developing a stomach ulcer by eroding the lining of your stomach wall, which left untreated, can lead to an internal bleed.

After the initial six months, you may choose to drink alcohol. We recommend only doing so on special occasions and in small amounts. Remember that the intoxicating effects of alcohol occur a lot sooner than before surgery, and alcohol can slow down weight loss.

If you do drink, consider drink options that are lower in sugar content and avoid mixed cocktails with juices or soda and added sugars. Those contain minimal nutrients, promote hunger and can cause blood sugar spikes.

If you have any questions about alcohol intake or your diet, contact your doctor, nurse practitioner or bariatric dietitian.

If you want to learn more about weight-loss surgery and its results, sign up for a free informational session.

Thursday, August 13, 2015

Healthy Picnic Ideas

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers her favorite healthy foods to bring on a picnic.

Nothing says summer like a picnic in the park or at the beach! There are easy ways to make your favorite packed lunches a little more bariatric friendly. Try some of the suggestions below the next time you have lunch on the go.

Bean Dips

Everyone loves an easy appetizer! Bring hummus or a low fat bean dip with a mix of raw veggies for dipping.

Low-Calorie Breads

Make a high protein sandwich on low calorie bread. When in the bread aisle look for 100 calorie bread thins. These usually look like a round, flat roll for only 100 calories! Make sure to add a lean source of protein, such a chicken or turkey, and a few veggies to make an easy and healthy sandwich.

Low-Carb “Pasta” Salad

Pasta salad is usually a crowd favorite at picnics. Try replacing the pasta with zucchini noodles in your favorite pasta salad recipe. Zucchini noodles can be made with a commercial vegetable noodle maker or by using a veggie peeler or mandolin to make thin strips of zucchini to act as noodles.

Antipasto Platter

Bringing an antipasto platter makes any picnic seem a little more exotic! Pack small take-along containers with lower sodium / lower fat meats and cheeses along with grilled vegetables of choice, such as roasted red peppers, grilled zucchini, or grilled eggplant. Top with balsamic vinegar or pile your favorites in a lettuce wrap for a low-carb Italian sandwich.

Rotisserie Chicken

Packing a rotisserie chicken is an easy way to make sure you have a lean protein at your picnic. Add rotisserie chicken to a mixed veggie salad or on your low calorie bread or in a lettuce wrap for an easy sandwich.

The best part of a picnic is that you can either pack food from home or purchase foods out. Whichever you choose, make sure to incorporate lean proteins and plenty of vegetables to ensure a healthy meal wherever you are.

Thursday, August 6, 2015

Kidney Stones After Bariatric Surgery

Samantha Warner-Grimsley
Samantha Warner-Grimsley, RN, BSN, CBN, works as a clinical nurse for Penn bariatric surgery patients. Since many patients worry about developing kidney stones after surgery, she explains what makes kidney stones form, symptoms and ways to prevent them.

After bariatric surgery, patients have an increased risk for kidney stones.

Research shows that gastric bypass patients have changes in urine and higher levels of particles, called oxalates, which form kidney stones. You see, the gastrointestinal (GI) tract naturally absorbs oxalate. However, once the GI tract is altered during surgery, higher levels of oxalate can occur in the urinary tract. The oxalate can form crystals, which may lead to the formation of kidney stones.

Symptoms of kidney stones include:
  • Back pain 
  • Blood in the urine
  • Nausea or vomiting
  • Fever and chills
  • Urine with a bad smell
  • Cloudy urine
If you have symptoms of a kidney stone, contact your doctor or nurse practitioner. You may be asked to drink extra fluid to flush out the stone in the urine, and then strain your urine so that a stone can be sent to a lab for testing.

There are ways to prevent kidney stones from forming.

1. Drink lots of water. 

You’ve probably heard again and again from your dietician that you need to consume water throughout the day to help your body function, keep up with physical activity and keep the hunger at bay. In addition, proper hydration helps the body get rid of waste and keeps digestion on track.

2. Limit oxalate-containing food. 

Foods that contain oxalates include beets, spinach, rhubarb, strawberries, nuts, chocolate, tea, wheat bran and dry beans.

3. Reduce sodium intake. 

Reduce the amount of salt you eat, as well as red meat. Too much sodium can trigger kidney stones because it causes you to get dehydrated, and the minerals will crystalize when there is not enough fluid in the body to dilute them. It also may raise the level of calcium in your urine.

Because the GI tract will absorb less calcium (in addition to oxalate), a lot of people believe that a build-up could lead to kidney stones. In actuality, kidney stones have no relationship to calcium; the oxalate is really the problem. You need calcium in your diet, so make sure you keep taking your calcium supplements as directed.

If you have any questions about kidney stones or your diet, contact your doctor, nurse practitioner or bariatric dietitian.

If you want to learn more about weight-loss surgery and its results, sign up for a free informational session.

Thursday, July 30, 2015

High Protein Recipe Remakes

Nicole Guiere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers some creative ways to swap the fat and carbs for protein in your favorite foods.

Many of the foods we love tend to be higher in fat and carbohydrates. Making some simple switches can change any food into a bariatric-friendly, high-protein meal or snack. Try some of the suggestions below to increase your protein intake while still enjoying your favorite foods.

High-Protein, Low-Fat Ranch Dressing

There are two ways to whip up an easy, lower fat version of ranch dressing.
  1. Look in the dressing aisle of your grocery store for a powdered ranch seasoning pack. Slowly add seasoning to a plain Greek yogurt until your desired flavor. Use as a dip for veggies, or thin out with low fat milk to create a creamy ranch dressing for salads.
  2. Dried ranch packages contain a lot of salt. If you are watching your sodium intake, try making your own dried ranch mix with equal parts dried parsley, dried dill weed, dried chives, dried onion flakes or powder, garlic powder, and a little salt and pepper to taste. Add your dry mix to Greek yogurt for dip, or thin out with low fat milk if desired. 

High-Protein Cheese Taco Shells

Ditch your high carbohydrate tortillas and try these delicious cheese taco shells instead!

Preheat the oven to 375 degrees. Line a baking sheet with parchment paper and place three slices of provolone cheese on baking sheet, making sure they don't touch. Bake for 10 minutes until golden brown. Take out of the oven and immediately form into taco shells. Here are a couple ways to do this: 
  1. Pull parchment paper off baking sheet. Fold parchment paper around cheese to form taco shells, and then peel the shell from the parchment paper and let it cool. 
  2. Using a flat spatula, lift cheese and place over something to form shells, such as wooden spoon handles or the tall sides of a baking pan covered with foil. 
Once cooled, stuff your taco shells with lean proteins and lots of veggies. Your taco shells do contain fat, so make sure not to add extra fats inside the shell.

High-Protein Cheesecake Bites

It’s hard to be at a summer barbecue and not be tempted by cool, refreshing treats at the dessert table. Offer to bring this high protein dessert to your next summer gathering so that you can enjoy something sweet without the guilt.
  • 2 cups low fat cottage cheese
  • ¼ cup fat free cream cheese
  • 1 scoop vanilla protein powder
  • 3oz box of sugar-free lemon gelatin dissolved in ½ cup boiling water 
Blend all ingredients in a food processor or blender until very smooth. Pour into a mini muffin tin lined with cupcake liners and place in refrigerator until set. Top with fruit, low sugar fruit jam or preserves, or with fat-free whipped cream.

Increasing the protein content in foods can be as easy as adding a scoop of unflavored protein powder to your recipe.  How do you add protein to your meals?  Try experimenting with your favorite dishes, and let me know how it goes!

Want to lose weight?

Monday, July 20, 2015

Healthy Food Options While Traveling

Nicole Giguere
Nicole Giguere, MA, RD, LDN, clinical and bariatric dietitian at Pennsylvania Hospital, offers her favorite healthy snacks to bring or buy during your travels.

During summer vacation, there can be many temptations that make it harder to stick to the bariatric diet. One way to stay on track is to prepare for your trip with healthy snacks. Below are some bariatric-friendly snacks that can be pre-packed or purchased at the airport or gas station during your travels.

100-Calorie Nut Packs

Nuts are loaded with healthy fats, protein and fiber to keep you fuller for longer. Though nuts are good for us, they are a high calorie food. Purchase pre-portioned packs or portion out nuts in small baggies to prevent overeating.

Homemade Trail Mix

Making your own trail mix helps to control the sugar content, which may be higher in pre-packaged trail mixes. Try mixing your favorite nuts and seeds with a few dark chocolate morsels or dried fruit for a sweet mix. You can also try adding spices such as cinnamon, nutmeg, or even cayenne pepper to mix up the flavor of your trail mix.

Beef or Turkey Jerky

Though beef jerky and turkey jerky are loaded with protein, it also contains a lot of salt (also called sodium) to help preserve the meat. Be sure to stick to small portions of jerky and to drink plenty of water and eat fresh fruits and vegetable to balance out the salt content.

High Protein Chips

If you really need something crunchy to munch on during your trip there are a few brands of bariatric friendly chips to try. The best places to purchase these high protein low carbohydrate chips are either online or at your local vitamin and supplement shop. Try searching “bariatric chips” on the internet to find the brand and flavor that suits you best!

Individual Peanut Butter Packets with Whole Wheat Crackers

Individual peanut butter or other nut butter packets are an easy way to stick to proper portion sizes. Pair with whole wheat crackers for a quick easy snack.

Other Great Snacks

Packing a cooler for your trip? Here are some high protein snacks that are best refrigerated.
  • Protein shakes
  • Fresh fruit
  • Cheese sticks
  • Low fat cheese and crackers
  • Low fat yogurt
Remember, going on vacation does not mean giving up on your diet! Packing ahead of time ensures that you are prepared for whatever eating challenges arise. Continue to choose healthy options wherever you go and enjoy your vacation this summer.

Related Posts Plugin for WordPress, Blogger...