Carbohydrates go down very easily—mashed potatoes, chips, ice cream. Some weight loss surgery patients fool themselves into thinking that it is better to have these foods than it is to have nothing. This is the carbohydrate trap. Until your BMI reaches 25, potatoes are a good thing to look forward to occasionally, but they are not a substitute for protein. Soft foods do go down easily, but there are better choices: tuna fish with mayonnaise, chicken salad, cottage cheese, and broiled Cornish game hens. There are two reasons to avoid high Glycemic index carbohydrates in the early post operative period:
- You need the protein. You need protein to heal your wounds. Weight loss surgery requires that we cut things and sew them back together. Protein is required as a building block for healing. The less protein you eat the more likely you are to develop a hernia or other postoperative problems.
- Carbohydrates inhibit weight loss. You have a limited amount of room in your stomach. Using that for carbohydrates will slow your weight loss. Some carbohydrates are better for you than others.
Fruits, fruit juices, and sodas contain a lot of carbohydrates, and these inhibit weight loss. So, be cautious of these. Anything that isn’t a protein should be used in moderation.
Don’t eat yourself – self-cannibalization
Any time you don’t take in enough protein, your muscle tissue, and “lean body mass” will start to break down. You will feel weak, lethargic, be lightheaded, and have nausea. The most common time this occurs is right after weight loss surgery, which is also the most dangerous. Protein is needed to heal the anastomosis, to heal the incision, and for the increased energy requirements your body has after weight loss surgery. Swelling of the ankles and calves is another sign of protein malnutrition— it is normal immediately after weight loss surgery to have swelling, but this should resolve a few days after you return home.
There are special machines to measure lean body mass, a percent of fat content, and these are helpful to determine if your weight loss is coming from fat or from muscle tissue. We use the Tanita (http://www.tanita.com) body fat scale in our office to monitor patients after bariatric operations.
Grazing is okay for cows – not for duodenal switch patients
If you are taking longer than 30 minutes to eat a meal, you are grazing. Grazing will kill any bariatric operation, including the duodenal switch. While we want you to get protein into your body, we don’t want you to graze. So, eat three meals a day and make certain that they are high protein meals. It is easy to have a bit, wait, and have a bit more, wait—that is gazing. Ever wonder how we would do the duodenal switch on an animal with five stomachs?
With the duodenal switch a lot less fat is absorbed.
That is the good news. The bad news is that the fat comes out like an oil slick in Prince William Sound. The first few months, avoiding high fat foods will make you less prone to loose stools, gas, diarrhea, and accidents. While fats make food taste good—gives the creamy texture to fine ice creams—avoiding fats the first few months will help you avoid some embarrassing moments. Some bariatric patients even report “oil slicks” on their undergarments so, put the bacon away, trim the fat off the meat, and concentrate on those proteins that are “high quality,” or low in fat and high in protein, such as shrimp, fish, tofu and other soy products.
How duodenal switch patients should prepare foods
Chef Terry will be available on the food channel soon enough, but until then, or until we come to our chapters about menus and diets, here are a few simple tips to make your food easy to tolerate:
- Do not deep fry foods. Fried foods do not go down well, and the fats can cause some problems. For whatever reason, the stomach doesn’t like fried foods the first few months.
- Do not overcook food. I had a neighbor who thought the only way to cook a steak was to make sure it was overcooked. His steaks were useful to repair side panels on automobiles. Dried-out, well-done meat does not sit well on your stomach after bariatric operation, nor do other well-done foods.
- Keep food moist: a slow cooker (known to most of us as a Crock Pot®) is the gift that keeps on giving. You get a slow cooker for your wedding, it stays in the original box, and when the next couple gets married, you pass it on to them. Kind of like fruitcake. Keeping meat on the moist side is best, and the slow cooker is a wonderful key to doing that.