Posting it here:
Duodenal Switch Post-Surgery Diet
Dietary Recommendations, Weight Loss and Nutrition Regimen Following the Duodenal Switch Procedure.
Weight Loss: The greatest weight loss will occur in the first 3 months after the duodenal switch procedure. In order to sustain this weight loss in the long-term, it is critical that one’s bad habits are modified early in the postoperative period. Most patients will plateau after 6-12 months, and after this, additional weight loss will be difficult. There are 6 cardinal rules that one must follow in order to attain a weight that is close to one’s ideal body weight.
1) Consumption of an adequate amount of liquid, preferably water, is crucial.
Patients should consume a minimum of 1 1/2–2 quarts of liquid per day. This should be done slowly and throughout the day. For the first week post-op your stomach is swollen and it may take 30 minutes to drink a cup of liquid. Keep sipping all day to help prevent dehydration. Know that it gets easier as the weeks pass. Soon it will only take 5-10 minutes to finish a cup.
2) A diet consisting of 800 calories, 80-120 grams of protein, 60 grams of carbs and 27 grams of fat, should be the goal for the first 6 months. It has been estimated that Duodenal Switch patients' malabsorb 40% of their protein intake. As a result surgeons generally recommend a daily protein intake of 80-120 grams to their post-op patients. The primary source of nutrition should be protein.
40%-60% of all calories consumed should be Protein based (eggs, fish, meat, cheese, etc.) 30% of all calories consumed should be Carbohydrates (fruit, vegetables, bread, potatoes, beans etc.) 30% of all calories consumed should be Fats (olive oil, nuts, almonds, etc.).
3) Never drink liquids when eating solid food. Liquids should be avoided for a period of 35 minutes before and 35 minutes after eating solid food or meals.
4) Avoid food, which contains sugar. It will slow your weight loss.
5) All successful patients who have had the duodenal switch procedure have 2 things in common:
- they follow their dietary recommendations closely, and they initiate a regular exercise program. It is essential that you begin a regular exercise program within the first 6 weeks after surgery. Initially this may be simply walking around the neighborhood 4 times per week for 40-60 minutes. Later (2 months post-op), it will also involve low-impact resistance training (swimming, light weight-lifting, rowing, etc.). This will guarantee not only a good weight loss, but will also improve your stamina, energy level, and overall health.
6) Stop eating/drinking when you begin to feel full. Do not “stuff” yourself. This may cause your stomach pouch to stretch - or worst, burst – causing long-term problems and complications.
Postoperative Diet: The dietary plan following a duodenal switch procedure is broken up into phases. Liquid Diet - (phase 1), Pureed Diet - (phase 2), Soft Diet - (phase 3), and Regular Diet- (phase 4). A patient may move up to the next phase only after waiting a minimum amount of time and after feeling completely comfortable with the previous phase (no vomiting or nausea). If, after advancing to the next phase, problems develop, go back to liquids and advance only after you have tolerated liquids without any problems for 48 hours.
Phase 1 – CLEAR LIQUIDS
1) For the first 10 days following surgery, nothing other than clear liquids and a protein supplement should be consumed. ABSOLUTELY no solid food!!! Clear liquids consist of: sugar-free Jell-O, sugar-free Crystal Light, Propel Water, Protein Water by Kellogg’s, sugar-free popsicles, clear chicken, beef or vegetable broth, water, decaf tea, unsweetened apple grape or cranberry juice.
v A high quality protein supplement such as IsoPure or Whey protein should be used in order to obtain approximately 80 -120 grams of protein per day.
2) No sugar, caffeine, or carbonated beverages should be consumed during phase 1 of the diet.
These will cause unpleasant side effects and may also cause complications.
3) A total of 1 1/2 -2 quarts of liquid should be consumed to prevent dehydration. NEVER have more than 60cc or 2 oz. in a 15 minute period. Always sip – never gulp or drink quickly.
v Keep track of your daily intake to make sure you get enough liquids and protein. If it is hot or humid outside and you are perspiring, you will need to increase the amount by 10%-20%.
v If your urine is dark or your mouth is dry, you are not drinking enough liquid. Use these as guides to determine if you are drinking enough.
v Some patients report that clear water is harder to have. Turning water acidic with lemon or limejuice or adding Crystal Light tames the problem.
Phase 2 – FULL LIQUIDS
1) For the next 10 days, progress to Phase 2 provided you are not having any problems with clear liquids.
2) Full liquids are foods such as: 1 or 2% low fat milk, low fat cream soups, skim soy beverages, light yogurt, boiled pureed apples or pears, applesauce, sugar-free pudding, watermelon, papaya or melon in very small pieces, and protein shakes or protein powders mixed with milk.
3) The same rules as above apply – no sugar, caffeine, or carbonated beverages should be consumed during phase 2 of the diet. These will cause unpleasant side effects and may also cause complications.
4) Continue to supplement your diet with a protein liquid so that you consume a total of 80-120 grams of protein per day.
5) Once you have tolerated Phase 2 you can advance to Phase 3.
Phase 3 – SOFT AND BLENDED
1) You may stay in this phase for as little as 10 days or for 2-3 weeks.
2) Blended foods should be the consistency of a thick liquid (no chunks or solid material).
3) Soft foods are things such as: eggs, egg whites or eggs substitute (soft boiled or scrambled), light tofu, low-fat cottage cheese, cereal, oatmeal. Cream of wheat, grits, whole wheat pasta, brown rice, boiled pureed vegetables, avocado, well cooked and dried beans, lentils, mashed or baked potato and creamy peanut butter. Never have more than 2 oz. at one time. Take very small bites and eat slowly. These should be chewed until they are of a liquid consistency.
4) Limit food to 4 to 6 ounces per meal (approximately 8 to12 tablespoons).
Do not forget to consume protein first at each meal.
5) Have 5 very small meals a day – no more. Once you feel full you should stop eating and not resume eating anything other than liquids until the next meal. Anytime you eat anything blended, soft, or solid it counts as one of your meals.
6) Eat slowly, and remember to chew your food really well before swallowing.
7) Never drink liquids with your meals. Liquids should be avoided for a period of 30 minutes before and 30 minutes after eating solid food or meals.
8) Between meals, you may drink any clear liquid or protein supplement that you like, provided it doesn’t contain sugar, carbonation, or fat.
9) No caffeine or carbonated beverages should be consumed during phase 3 of the diet. These will cause unpleasant side effects and may also cause complications. You may add decaf coffee to your diet during this food stage.
10) Continue having 800 calories per day.
11) Once you have tolerated Phase 3 for 10 days without difficulty, then you may progress to Phase 4.
Phase 4 – REGULAR DIET
1) After 4 weeks of the soft food diet you should gradually introduce a Regular Diet with more food choices. Keep in mind that your diet needs to be low-fat, low calorie, sugar free, and portion controlled for the rest of your life.
2) The best foods to eat are fish (tuna, salmon, halibut, etc.), skinless/boneless chicken, turkey, and ostrich. These have high protein content. Red meat is fibrous and hard to digest. You can also try all vegetables and fruits.
CHECKLIST AFTER DUODENAL SWITCH SURGERY
ü 80-120 grams of protein a day
• Eat protein first at all meals
ü Eat slowly and chew well
• Meals should take 30-40 minutes
• Avoid snacking on high calorie foods in between meals
ü 48 - 64 oz of fluid a day (more if your urine is dark or you’re dizzy)
• Beverages should have less than 10 calories per serving
ü Exercise
· Aim for at least 30 minutes on most days of the week...15
minutes at a time, and gradually build up, as tolerated
· Incorporate light weights (about 2 months after surgery)
ü Regular coffee is permitted 6 months after surgery. Having regular coffee before this time may ause unpleasant side effects and may also cause complications. If having coffee (even after 6
months ) gives you acid problems please suspend it right away.
ü Carbonated beverages should NEVER be consumed by DS patients.
ü Alcohol should be avoided. If you have a drink once in a while it is not a problem but make sure you have food in your stomach and you are at least 30 days post op.
· If you are experiencing reflux after surgery, it is important that alcohol is not consumed; it will cause unpleasant side effects and may also cause complications.
· Be sure to monitor the calories so that you do not exceed your daily recommendation. Alcohol contains a lot of calories.
· You also need to be aware that alcohol will have a greater effect on you now. That means you will get dizzier faster so be careful.
· You will need to protect your stomach before having alcohol. Take 20 mg of PRILOSEC in the morning and 20 mg of PRILOSEC a few hours before having your drink; this will help you the next day with nausea and acid.
TIPS: Knowing How Much to Eat
This issue is understandably of significant concern for duodenal switch patients. There is not a single answer that fits all patients at all times following surgery, so guidelines are going to be laid out instead of a list of amounts and types of foods.
First, during the recovery phase from surgery (first 4-6 weeks) it is normal to have no appetite. During this time you are likely to consume far less food than would need over a long haul to stay healthy, but for this limited time period it is OK. Your surgeon wants you to be sure to consume adequate fluids (zero-calorie) to stay well hydrated, but he does not want you to force down food. At this stage, food should be used to begin to teach yourself new eating habits that will help you feel well and lose weight over the following year.
Don’t eat until you feel full-we are absolutely serious. The reason has to do with the fact that the nerves of satiety are “slow” nerves. There is delay of around 5 minutes from the time your stomach pouch gets comfortably filled to the time that the brain becomes aware of that fact. If you swallow even one additional bite then the pouch will be overfilled and you will experience painful nausea. Realistically, every patient will experience this overfilled feeling at least once or twice, and it will not damage your stomach if it does not become a pattern. The goal is to learn from the experience-remember how much was consumed and what kind of food it was. Next time use your memory and your eyes to know when to stop eating, before you feel full.
An irritated stomach stays irritated for a day or so. If you over eat or if you eat something that does not agree with you, the stomach pouch will be irritated from 12-24 hours. While it is irritated it will be less tolerant of food and liquid then usual and even small amounts of food can cause the overfull feeling to reoccur. The lesson here is that if you have an overeating episode, give the stomach pouch a chance to recover by taking only clear liquids for the next meal or two. You can apply this principle to any situation where the stomach pouch is irritated-if medication or an illness makes you feel unable to eat, simply consume only liquids to maintain hydration.
Your capacity will increase over the first 6-9 months following surgery. The pouch will become more pliable over a period of months after the duodenal switch. Many patients notice a dramatic increase in the amount of food they can handle comfortably. This is normal in the vast majority of cases.
This is the time that the good habits developed in the first few months will support further weight loss. If a patient has broken the old habit of using fullness as a signal to stop eating, then he will comfortably continue to eat restricted amounts of food and will continue to lose weight. On the other hand, if a patient has depended on the physical limitation imposed by the pouch to tell them when to stop eating this relaxation of restriction will become as an unpleasant surprise as their weight loss slows and comes to a halt.
So the bottom line on how much is the right amount: make a habit out of the type and amount of food that works well about 3 months following your duodenal switch surgery. Stick to this amount over the next several years to obtain excellent weight loss and health.
It is important that we hear from you every 10 days for the first 3 months and every month for the next year
Remember that I'm here to help you, Call me if you have any doubts or come and see me any time.
Sincerely,
Dr. J. Alberto Aceves
VITAMINS AND SUPPLEMENTS:
At Mexicali Bariatric Center we suggest a strong early protein and vitamin supplementation for our patients, daily protein shakes, chewable or liquid multivitamin, chewable Calcium, Zinc and Iron.
Supplement
Restrictive (Gastric Sleeve)
Gastric Bypass
Duodenal Switch
Protein Liquid Protein Isopure-Matrix-Unjury
60grs
80-100grs
80-100grs
Multivitamin
2 daily
2 every 12 hrs
2 every 12 hrs
Zinc Lozenge gel caps
50mg every 3rd day
50mg every 3rd day
50mg every 3rd day
Iron Liquid Iron Shots
100mg orally every day while fasting. 100mg Intramuscular once a month.
100mg orally every day while fasting. 100mg Intramuscular once a month.
100mg orally every day while fasting. 100mg Intramuscular once a month.
Calcium Citrate separate from Iron
600mg every 12 hrs chewable or liquid
600mg every 8 hrs chewable or liquid
1200mg every 12 hrs chewable or liquid
Vit D
2000 IU everyday or 500,000 IU every week orally
2000 IU everyday or 500,000 IU every week orally
Vit A
10,000 IU everyday
10,000 IU everyday
Vit K
200mcg everyday
200mcg everyday
Vit E
250 IU everyday
250 IU everyday
B complex sublingual shots
1 shot every month or 1 pill every week
1 shot every month or 1 pill every week
1 shot every month or 1 pill every week
