FEB 29 2016 - PUREED STAGE

FEB 29 2016 - PUREED STAGE
Starting Tomorrow! (Yippi & Yikes all at the same time)!

Dr. Zavalza's Post-Op Diet-------------------------STAGE 3 (17-30 days after surgery)
Blended or pureed stage. Try to consume up to 500 calories.
Pureed Tuna
Scrambled eggs
Pureed beans
Cottage cheese
4 oz of Greek Yogurt
Broths
Protein Shakes
Water
Ground Ice
SF Jello
SF Gatorade

Phase II can be summarized as soft foods which can be easily mashed (non-carb), eaten with a spoon and can be tolerated easily (Protein first). This stage continues to allow your system to heal and slowly adjust to more dense foods. Attempting portions that are too large or advancing too rapidly into foods that are very dense or hard can cause food getting “stuck”, vomiting, and pouch irritation. This will be very painful. Talk to friends with kids, and ask for their kids small utensils, eat off of side plates or small bowls. Take a bite and chew it 30 times before swallowing.
Remember as your diet advances the liquids should remain separated from the solids. If you drink while eating you will push food through the pouch and speed up the emptying of the pouch. This will both make room to eat more, but be very painful, and push the food back up to vomiting. Try to limit the vomiting so you can absorb the nutrients ingested. Remind yourself that vomiting at this stage is normal as your new sleeve is being introduced to food again for the first time. Foods you previously ate, could not agree with your new sleeve. Someone who ate chicken their whole life, may not tolerate this anymore, and on the flip side people who hated beans may notice their sleeve enjoys them now. So be patient with yourself and proceed slowly.

During Phase II it is important to focus on adequate nutritional intake and inclusion of protein rich foods. The objective is to increase your intake while minimizing chewing and easing the digestive process. Stage II is also referred to as a pureed diet and all foods should resemble a baby-food consistency. Many people gravitate towards carbohydrates that include mashed potatoes, sweet potatoes and fruit but you need to remind yourself these foods will not agree with your new sleeve and should be avoided. These foods can be part of the meal plan if they agree with your sleeve but it is important that you meet your protein requirements first. Please keep in mind that baby-food is meant for growing babies and therefore although you might be able to tolerate its texture, it is not often an optimal nutritional choice at this stage.

Phase II Diet Reminders

•  You must continue to have protein shakes between one and three times a day to meet your protein target, but try to eat more soft solids each day.
• If you find that you are not hungry, then a protein shake can be substituted in place of a scheduled meal.
• Take small bites and estimate them to be about the size of a dime.
• Chew thoroughly before swallowing. Be sure that the food is apple sauce consistency before you swallow.
• Continue to drink slowly. Sip on non-caloric liquids throughout the day but stop drinking around meal times. Stop drinking 30 minutes BEFORE meal time and start drinking 60 minutes AFTER meal times. This will ensure that your pouch can hold solid foods and you will not experience nausea/vomiting.
• Continue to meet your protein target goal. You may use protein supplements until you are able to get all your protein from solid foods.
• Set consistent meal times and stick to these meal times to avoid emotional eating. Eat every 4 hours while you are awake. Do not go over 5 hours without eating anything.

Phase II Allowed vs. Avoid Food List

Food Group	Allowed	Avoid
Beverages	Water and ice chips, decaffeinated tea,  sugar free cocoa, crystal light, sugar-free Kool-aid, sugar-free Tang, sugar-free lemonade, diet Snapple, diet V-8 Splash, non-caloric flavored water	All sugar sweetened drinks, alcoholic beverages, coffee, caffeinated beverages, carbonated beverages
Starches	Cooked cereal, cream of rice, cream of wheat, Malt-O-Meal, thinned grits or oatmeal, mashed potatoes, mashed sweet potatoes, baked potatoes, baked beans	Sugar-sweetened cereals, cold cereals, pasta and all other starches
Fruits	Cooked or canned fruits. Be sure that the canned fruits are packed in their own juice and without sugar added	Raw fruits and sugary juices. Fruits that cannot be peeled like orange and grapefruit.
Dairy	Skim or fat free milk, low-fat yogurt, low-fat or fat-free cottage cheese	All others
Meat	Egg, canned chicken, shaved deli meats, almost any type of fish cooked by baking, boiling, slow cooker, foil wrapped	Beef, dry meat or poultry. Cooking methods: grilling, frying
Vegetables	Cooked or canned vegetables. Be sure to choose low sodium vegetables. Must be able to mash with fork.	Raw vegetables, stringy vegetables
Fats	I can’t believe it’s not butter cooking spray	Saturated fats, butter, margarine
Other	Sugar free popsicle, sugar free jello.You may choose low sugar baby food protein.	Sugar sweetened desserts, mixed dishes like lasagna

Please try a different variety of soft foods. Remember that if you feel full or have nausea then the best thing to do is to slow down a bit. Decrease your portion sizes and consider going back to 24 hours of just clear liquids again. It is normal to have some days better than others.

Sample Phase II Diet

Sample Day #1

Meal 1 – Oatmeal cooked with skim milk
Meal 2 – Boiled, shredded chicken mixed with light mayo
Meal 3 – Baked salmon
Meal 4 – Mashed peaches with fat-free cottage cheese

Sample Day #2

Meal 1 – Soft scrambled eggs
Meal 2 – Baked black beans with fat free sour cream and mashed avocado
Meal 3 – Canned tuna with light mayo
Meal 4 – Low fat, smooth yogurt

Sample Day #3

Meal 1 – Malt O meal cooked with skim milk
Meal 2 – Baked sweet potato
Meal 3 – Baked fish
Meal 4 – Shredded cheese and scrambled egg

Be sure to measure your food by volume. You should not exceed 4 ounces by volume of food at this time. Remember to take small bite size and chew well before swallowing. Be patient with yourself, and if you throw up, try again. Give yourself 10 minutes and start eating again. It will be trial and error, a learning period as your sleeve is reintroduced to food.
Continue to drink non caloric, non-carbonated, decaffeinated fluids in between meals.

Stay Tuned~ Nat
Body/Mind Under Construction