Can I ever lose too much weight?
Will my skin sag?
Can I regain my weight?
How long will it be before I can get back to work?
How long will I not be able to eat solid foods after surgery?
Why should I drink so much water?
What’s the youngest age for bariatric surgery?
What’s the oldest recommended age for bariatric surgery?
Can this operation be reversed?
What is the risk of death from bariatric surgery?
Is bariatric surgery approved by the FDA?
What quantity of food will I be able to eat after my surgery?
What kinds of food should be avoided after surgery?
How much will surgery cost if it is not covered by my insurance?
Can rapid weight loss be dangerous?
What if I am a smoker?
How should I go about selecting a gastric bypass surgeon?
How do I know if I am a candidate for this surgery?
Why is it important to treat severe obesity?
Does the procedure ever fail? Is there a chance I will gain back my weight?
Does MISI have any support groups for bariatric patients?

Can I ever lose too much weight?
It is unlikely than someone would lose too much weight. Obstruction of the pouch outlet can occur which may lead to rapid weight loss: this would be corrected with an out patient procedure called an endoscopy of EGD, although surgery can sometimes be successful.

Will my skin sag?
Weight loss is rapid for the first 6 months and the skin will not be able to keep up initially. Eventually the skin may conpensate to a certain degree. The compensation process is greater in younger patients, however exercise improves this process in all patients.

Can I regain my weight?
The largest amount of weight loss occurs in the first 6 months. Most people continue to loose weight slowly for the following twelve to eighteen months. The weight loss typically plateaus at two years and some people will regain a small portion.

How long will it be before I can get back to work?
Every person is different. It can be anywhere from 1to 4 weeks off from work. If you have a physically demanding job it may be even longer. The length of time willbe influenced by the particular job, the particular procedure that is performed and the response of the patient.

How long will I not be able to eat solid foods after surgery?
Most doctors recommend about 4 weeks or more after surgery. A liquid diet with semi-solid foods may be recommended until healing has adequately occurred. MISI will provide a very specific listing of appropriate foods to eat for the first several months after the surgery.

Why should I drink so much water?
Drinking lots of water helps to get rid of wastes from the body. This helps in the weight loss process. However, the most important reason for the intake of water is to prevent dehydration. Because the newly created pouch can only hold 20cc (four tablespoons) at any one time, it can be difficult to ingest enough water to avoid some degree of dehydration. Therefore, it is recommended to drink small amounts throughout the day.

What’s the youngest age for bariatric surgery?
The National Institutes of Health recommendations are that these procedures for those who are 18 or older. It’s important that young (and older) weight loss patients understand the lifelong eating and lifestyle change.

What’s the oldest recommended age for bariatric surgery?
The risks of any surgical procedure is increased in the older age groups. There are no absolute limits but more commonly this is limited to patients that are younger than 62-65 years of age.

Can this operation be reversed?
Generally, the bypass operation cannot be reversed, except in very unusual situations. This is a very risky undertaking. The LapBand, however, can be reversed.

What is the risk of death from bariatric surgery?
About 1 in every 200 patients nationally. This will vary according to the operative procedure performed.

Is bariatric surgery approved by the FDA?
Yes. It was approved in June 2001.

What quantity of food will I be able to eat after my surgery?
1-2 ounces of food per meal. 3 meals a day and no snacks between the meals.

How much will surgery cost if it is not covered by my insurance?
The price of the surgery depends on the hospital and the part of the country that you are in. Please contact MISI to learn more and to find out if your insurance will cover your weight-loss surgery.

Can rapid weight loss be dangerous?
Usually not. To help prevent complications weight-loss surgery patients are asked to take vitamins, supplements, and undergo certain blood tests to check their health status.

What if I am a smoker?
You must quit smoking at least 6 weeks before you have your surgery. Smoking can cause many problems and risks with the surgery and healing process. It can also cause a change in the effect of anesthetics during surgery.

How should I go about selecting a gastric bypass surgeon?
It is recommended that your surgeon be experienced in gastric bypass surgery and also a surgeon that does the procedure on a routine basis. A strong compliment of support personnel and support groups is preferred.

How do I know if I am a candidate for this surgery?
The surgery is only for people who are severely overweight. This would include patients who are twice their ideal body weight or are more than 100 pounds overweight. The actual decisions will be based upon your height relative to your weight and any medical conditions that you may have.

Why is it important to treat severe obesity?
In the United States, obesity is the second leading cause of preventable death. People with obesity have a shorter lifespan than those without obesity. About 300,000 people die each year from obesity and obesity-related problems. Medicare has recently declared that obesity is a chronic illness.

Does the procedure ever fail? Is there a chance I will gain back my weight?
Most people lose weight after bariatric surgery. But, it is possible in years after the surgery to gain some weight back. How you diet and exercise will have a large effect on how much weight you will lose and for how long. Remember, these procedures are 'tools' and not 'cures'. You must follow your body's needs.

Does MISI have any support groups for bariatric patients?
Yes. MISI has a support group especially for their bariatric patients. This support group is called “NooMee.” Even if you have not had the surgery and are just considering it, everyone is welcome to the “NooMee” meetings. To find out more about the “NooMee” support group, contact MISI at (877) 464-7452 or go to www.NooMee.com.

Where do I begin?
How long will I be in the hospital after the surgery and what must I be prepared?
to do while I am there?
How do I take care of myself once I am home?
When should I call my doctor after I am discharged from the hospital?
What will my diet be like once I am home?
What foods should I avoid eating?
How will I achieve the best results?
When will my diet be like in the following months?
How should I regulate my eating?
What's so important about protein, anyway?
Is it possible to consume too much dietary protein?
What are my daily protein requirements?
With so many supplements to choose from is there really a difference between products?
When and how should I take my supplements?
Where can I find Protein Supplement Recipes?
Can I create my own Protein Supplement Recipes?
What about the exercise?

The Pathway

Where do I begin?

Your process begins with the weight loss seminar or office intake. You will receive the information packet regarding the procedures and obesity health risks. If you feel you are a candidate for the procedure and feel this is an option you wish to pursue, we ask that you fill out the Patient Information Questionnaire and indicate which procedure you are interested in pursuing (this can be dropped off at our office, mailed, or faxed to 225-766-6996). We will evaluate this information to see if you meet initial screening criteria and may schedule you for an appointment. We will evaluate you for morbid obesity co-morbidities and discuss procedures with you at that time. We may also call you to provide some additional information from some of your other physicians. We will then evaluate this information to write a letter of medical necessity to your insurance company. Once we write the letter to your insurance company, it may take 2-6 weeks to hear from them regarding their response.

If your insurance approves the procedure, we will schedule you for a work-up visit. This may entail an evaluation by the surgeon and may also entail scheduling you for appointments with other specialists to be sure we have you in the best shape possible for the procedure. You may also be scheduled for a psychological screening evaluation. Additional tests may also be ordered at this time.

Once all specialist evaluations and tests have been done, you will be seen back in the office for a preoperative physical and to be scheduled for your procedure. You may also have a picture taken at that time and you will be given further diet information. You may also be given information regarding preoperative preparation and time to be present at the hospital prior to your procedure. You will be admitted the day of your procedure. Our office staff will give the information regarding where to be and what times to you. You will be evaluated by the nursing staff in the preoperative holding area and will be seen by an anesthesiologist and/or nurse anesthetist at this time. You may have an IV placed and may be given an injection of a blood thinner to prevent deep vein thrombosis (blood clots).

How long will I be in the hospital after the surgery and what must I be prepared to do while I am there?

After your operation you will be monitored in the recovery room for a period which varies between 2-4 hours. Most of our Gastric Bypass patients will be monitored in the Intensive Care unit overnight. The nursing staff may instruct you to perform deep breathing exercises, as well as pumping your feet back and forth to prevent pneumonia and blood clots respectively. You may be asked to sit up in bed the night of your procedure and you may have an intravenous patient controlled analgesia device, which will allow you to control your pain medications.

The day following your surgery, you may proceed to the radiology department for a swallowing study. You will swallow a small amount of contrast material that will be watched by the radiologist on a special x-ray viewing screen. This may allow us to be able to detect any problem associated with your procedure as early as possible. If this test is normal, upon arrival to your room you may be started on a clear liquid diet.

Our patients may have one or two drainage tubes coming out of their abdomen after the procedure. Most of the patients will have a clear drainage tube, which is placed, near the area of your anatomists, which is the hook up between your stomach and small intestines. This is a safety device as if there is a complication of a leak at this site it will be detected by this drain and possibly treated by this drain to allow your body to heal this problem without a second operation. This drainage tube will stay in place for 5-7 days and will either be removed in the hospital or at your first postoperative visit. Rarely, some of our patients may have a second tube, which is tan in color. This tube will drain the stomach, which has been excluded from your esophagus or swallowing tube. This is also a safety device as some patients may develop fluid or air build-up in this isolated stomach pouch, which can be alleviated with this drainage catheter. This tube will remain in place f! or 3-4 weeks after your operation, at which time it will be removed in the office setting.

As you progress during the postoperative phase, you may be asked to walk at least three times daily in the halls from postoperative day one. Therefore, from the day after the operation we will be asking you and assisting you to walk in the halls. This will aid in your recovery and may help prevent any blood clots forming in the legs. We will also check your pain control, as well as how well you are tolerating the liquid diet. Most of our patients may be discharged home after the second or third day postoperatively if you had the laparoscopic procedure, or the fourth or fifth day postoperatively if you had an open procedure.

How do I take care of myself once I am home?

Upon your discharge, you will be given instructions on how to care for yourself at home. These are as follows:

DRAINAGE CATHETER CARE: We ask that you drain the catheter twice daily and record on an output sheet which you will be given at the hospital. This catheter is attached to a drainage bulb, which nurses will teach you how to care for. We ask that you clean around the site with peroxide and apply a fresh bandage daily. As stated earlier, this will be removed between the 5th and 7th day after your operation. If you are a patient with a gastrostomy tube, most gastrostomy tubes will be capped before you are discharged home. This will require no care other than caring for the skin around the site. For both types of drains, we ask that you clean around the site where the catheter exits the skin at least twice daily with peroxide. We ask that you place a fresh bandage on this area daily.

WOUND CARE: It is okay to shower and wash your hair 48 hours after your operation. It is okay for water to hit the incision. We ask that you not take a bath or submerge your incision in water for at least two weeks from the time of your operation. You will have band-aids covering the incisions, as well as white paper strips under the band-aids. We ask that you leave the white paper strips on your incisions for two weeks after your operation. If they fall off before that time, this is fine. They do not need to be replaced if the incisions are closed. If there is a small opening in the incision, we ask that you clean this with peroxide and apply a band-aid.

NUTRITION: You will be given a comprehensive nutrition guide for the first month. We ask that you follow this guide exactly as stated.

MEDICATIONS: We ask that you continue taking your medications you were on before your operation when you are discharged. Our medical doctor will assist you with any changes that may need to be made. We ask that you not take any hormone pills for a period of two weeks before your operation and two weeks after your operation. You may resume hormone pills after that period of time. If you have diabetes you may not require insulin after your procedure. We ask that you monitor your blood sugar and take the medications as needed. Most patients do not require insulin upon discharge from the hospital even if they were requiring this before their operation. We may even have to curtail some of your oral blood sugar medications to keep your blood sugar from going too low. We ask that you continue to monitor your blood sugar carefully. We will ask your primary doctor to assist with controlling your blood sugar. You may be given liquid pain medication upon discharge to take fo! r pain. Sometimes these medications contain narcotics and may cause nausea. If this is a particular problem for you and your pain is not very intense, you may change to liquid Tylenol. We ask that you start taking chewable vitamins and your b12 one week after your operation. Begin taking your vitamins then and take them twice daily with the b12 either daily in a sublingual fashion or at least three times per week. You may progress to a pill form one month after your procedure.

ACTIVITY: We ask that you do not drive for a period of two weeks after your operative procedure. We also ask that you avoid lifting greater than 15-20 pounds for four weeks after your procedure if you have had a laparoscopic procedure. If you have had an open gastric bypass, we ask that you limit your lifting to less than 15-20 pounds for six weeks after your operation. We recommend that you walk around for at least 5-10 minutes every hour at home. This will prevent blood clots in the legs, as well as enhance your healing ability. We ask that you practice deep breathing at least once every 15-30 minutes if you are sitting. We ask that if you can avoid travel for two weeks after surgery do so. If you must travel, stop and walk for 3-5 minutes every hour while you are traveling.

When should I call my doctor after I am discharged from the hospital?

1. Vomiting: First, make sure you are not eating too fast or eating past your feeling of being full. If vomiting continues, call your doctor.
2. Swelling or pain in the legs.
3. If you are experiencing shortness of breath.
4. If you experience a change in the color or quantity from your drainage tube.
5. Fever greater than 101.5 degrees F.
6. Sudden or new pain in the left upper abdomen or left shoulder which is a sudden change from your normal pain from the incision.
7. Redness of drainage from your incision.
8. If you feel that there is anything you need to address with your doctor.

What will my diet be like once I am home?

First month:

During the first month after surgery, your stomach and the opening into your intestines are swollen and very small. You will be able to eat only very limited amounts of food. It is important that you concentrate on eating the most important foods for healing: PROTEINS. All proteins must be very soft, moist, and well chewed in order to pass through your new little stomach successfully. If you eat too fast or too much, it will feel like heartburn and may cause you to become sick, so be careful.

Grocery list of Protein Foods:

1. Cottage Cheese (low-fat or non-fat).
2. Yogurt (low-fat, non-fat, plain, or artificially sweetened).
3. String cheese
4. Eggs (any style, limit yolks).
5. Tofu
6. Refried beans
7. Lentil or black bean soup
8. Fish (soft and moist).
9. Small amounts of cooking spray
10. Small amounts of non-fat mayonnaise or mustard to moisten food.

How to eat:

1. Eat one to two meals a day (you must eat at least one meal each day).
2. Do not force yourself to eat just because it is mealtime.
3. Eat only when hungry, and stop when satisfied.
4. Do not take any longer than 20 minutes to eat a meal.
5. Chew food very well and eat slowly.
6. Do not drink water or liquids 30 minutes before or 30 minutes after eating your meals. Do not drink liquids while eating a meal.
7. Season as you wish, but use caution.

Water: Build up to eight 8-oz glasses every day, drinking small amounts frequently. Avoid all other beverages, especially alcohol, coffee, tea, and sodas.

Vitamins: Multivitamin with iron is to be taken twice daily and vitamin b-12 in a sublingual form should be taken 3x per week. Take vitamins as chewable or swallow one at a time with water or yogurt. You may cut the vitamins in half if swallowing it in pill form.

What foods should I avoid eating?

Avoid foods containing fats, sugars, starch, and of course crunchy foods.

How will I achieve the best results?

Exercise: Walk at least 20-30 minutes every day.

Follow-up: For optimal weight loss and best surgical outcome, it is vital for you to keep all your follow-up appointments.

Support Group: Third Thursday of every month, 6:00p.m. in the Administration Building Board Room at Vista Surgical Hospital.

Four Rules for Successful Weight Loss:

1. Eat protein only at mealtime--one or two meals per day.
2. Never snack between meals.
3. Drink plenty of water.
4. Exercise 20-30 minutes every day.

When will my diet be like in the following months?

Second through fourth month

What to eat: Eat mostly protein. You may begin to add very small amounts of soft cooked fresh, frozen, or canned vegetables, and fresh non-citrus or unsweetened canned fruits (packed in water or natural juices).

Grocery List

1. Eggs any style.
2. Fish (soft, moist, fresh, or canned, and shellfish).
3. Chicken (canned or fresh, moist, thinly-sliced deli--NO barbecued or fried).
4. Turkey (soft, moist, fresh, canned, thinly-sliced deli--NO barbecued, Fried, or Honey-cured).
5. Liver
6. Tofu
7. Refried beans
8. Peanut butter (natural style, pour off the oil).
9. Cottage cheese, yogurt (non-fat, low-fat, plain, or artificially sweetened).
10. Cheese (non-fat, low-fat).
11. String-cheese (non-fat, low-fat).
12. Lentil or black bean soup.
13. Small amounts of cooking spray.
14. Small amounts of non-fat mayonnaise, salad dressing, or mustard to moisten food.

Vegetables:

1. Vegetables must be boiled or very well steamed and soft
2. Carrots (soft cooked, fresh, canned, or frozen).
3. Beets (soft cooked, fresh, canned, or frozen).
4. Mushrooms (soft cooked, fresh, canned, or frozen).
5. Spinach (soft cooked, fresh, canned, or frozen).
6. Squash (soft cooked, fresh, canned, or frozen).
7. Green beans (soft cooked, fresh, canned, or frozen).
8. Asparagus (soft cooked, fresh, canned, or frozen).
9. Broccoli (very-well steamed, fresh, or frozen).
10. Cauliflower (very-well steamed, fresh, or frozen).

Fruits:

1. Fresh fruits, peeled and cored (non-citrus).
2. Bananas

Fats:

1. Small amounts of margarine, oil, or cooking sprays (preferably olive oil).
2. Small amount of non-fat or low-fat mayonnaise, salad dressing, or mustard to moisten food.

Beverages:

1. Water, eight 8-oz glasses daily.
2. Decaffeinated coffee or tea.
3. Avoid alcohol or sodas.

Vitamins: Multivitamin with iron is to be taken twice daily and vitamin b-12 as a sublingual form should be taken 3x per week. Take all vitamins as prescribed by your physician. You may change from chewable to tablet form as tolerated.

How should I regulate my eating?

1. Eat one to two meals a day (you must eat at least one meal each day).
2. Do not force yourself to eat just because it is mealtime
3. Eat only when hungry, and stop when satisfied (don't try to finish eating everything on your plate).
4. Do not take any longer than 20 minutes to eat a meal.
5. Chew, Chew, Chew all foods very well and eat slowly
6. Do not drink water or liquids 30 minutes before, or within 30 minutes following a meal (1 cup of decaffeinated coffee or tea following a meal is okay).
7. Season as you wish, but use caution.
8. Always follow the four rules.

The later months.

Advancing your Diet after surgery fifth month and beyond

What to eat: eat any proteins, vegetables, or starches as tolerated.

Remember:

1. Eat protein first.
2. Make it at least half of your meal.
3. Then eat vegetables and fruits.
4. And starches last if there is any room left.

A note about:

1. Red Meat--beef, lamb, and pork will always and forever have to be chewed extremely well to pass through your small stomach opening. The very leanest cuts (i.e., filet mignon or round steak) are your best choices.
2. Pasta and Rice--some people never tolerate pasta and rice very well. Pasta and rice need to be over-cooked so they won't continue to swell in your stomach.
3. Alcohol--after the gastric bypass surgery, alcohol can be dangerous. It is absorbed much more quickly after surgery and will reach much higher levels in your blood, which flows into the liver. You will experience a greater degree of intoxication on very little alcohol because of its rapid absorption. The simple rule is: Never more than two drinks (standard bar size) within a 24 hour period--and only on special occasions, such as birthdays or anniversaries. If you choose to drink alcohol, do not drive. Red wine is the best choice of alcohol out of all forms.
4. Sweets and sugars--avoid or limit foods that contain sugar (such as sweet fruit juices, candy, sugary deserts, some salad dressings, and some barbecue sauces). Not only can these foods lead to "dumping syndrome"; they can retard weight loss as well. If you want to eat something sweet, such as a piece of fruit, do it only at the end of your meal and only as part of a meal. Do not use sweets as a snack between meals.
5. Beverages--eight 8oz glasses of water per day is vital. It is the only truly recommended beverage. Avoid/limit flavored beverages such as sodas, fruit juices, alcohol, and milk. Sugar-free sparkling water is allowed.
6. Fats--fats have very high-calorie content. Any significant intake of fats like cooking oil, salad dressings, mayonnaise, margarine, and/or butter will seriously decrease the rate of your weight loss and may cause "dumping syndrome." Learn to avoid fats and to become aware of how they hide in other foods. Use small amounts of margarine, oil, or cooking sprays when preparing foods, and small amounts of non-fat or low-fat mayonnaise or salad dressing to moisten foods. Use mustard instead of mayonnaise when you can. Use olive oil in place of vegetable oil. Of utmost importance, avoid greasy fat foods. Remember to read all labels on foods.

How to eat:

1. Eat one to three meals a day (you must eat at least one meal a day)
2. Do not force yourself to eat just because it is mealtime.
3. Eat only when hungry and stop when satisfied. Don't try to finish eating everything on your plate.
4. Do not take any longer than 20-30 minutes to eat a meal.
5. Chew, Chew, Chew all food very well and eat slowly.
6. Do not drink water 30 minutes before, during, or within 30 minutes following a meal (1 cup of decaffeinated coffee or tea following a meal is okay).
7. Always, Always eat your protein first and make it most of your meal. Eating vegetables and fruit next, and starches last.
8. Season as you wish but use caution.
9. Always follow the four rules.

Vitamins: Take all vitamins as prescribed by your physician. You may change from chewable to tablet form as tolerated. Multivitamin with iron is to be taken twice daily and vitamin b-12 as a sublingual form should be taken 3x per week.

Exercises: Continue walking a minimum of 20-30 minutes daily. Once cleared, you may begin exercising using resistance training and increasing your aerobic exercises as tolerated. Remember to check with your physician before beginning any other forms of exercise.

Follow-up: Remember, it is absolutely vital to keep all your follow-up appointments for optimal weight loss and best surgical outcome.

Support Group: Support group is held the third Thursday of every month at 6p.m. at the Administration Building Board Room of Vista Surgical Hospital.

Four Rules for Successful Weight Loss:

1. Eat protein only at mealtime, one or two meals per day.
2. Never snack between meals.
3. Drink plenty of water (eight 8oz glasses per day).
4. Exercise 20-30 minutes every day.

What's so important about protein, anyway?

The nutrient protein plays a vital role in providing the body with essential amino acids necessary to sustain all living things. Next to water, protein makes up the greatest portion of our body. If the body does not get enough protein from our diet, it cannot properly build new cells and tissues. Such a condition is called protein energy malnutrition and restricts growth, impairs the healing of wounds and increases our susceptibility to infection. Initial signs of protein deficiencies may appear as general weakness, loss of muscle, brittle nails and most common hair loss. While dietary protein will not directly increase muscle size, it will help avoid further loss of muscle tissue that occurs during periods of bed rest, stress, injury, or illness. Bariatric surgery is an example of such trauma increasing protein needs that can often cause the "catabolism" or muscle wasting to supply the body with its increased energy needs.

The effect of surgery on our body and the need for increased protein intake, which can only be accomplished through liquids due to the new small-restricted pouch, should now be clear. But how much protein should we consume? The Recommended Dietary Allowance (RDA) is 44 grams a day for the average woman and 56 grams for the average man. However, this recommendation is for individuals in a non-trauma state. Confusing the issue further is the conflicting recommended number of protein grams needed to be consumed daily for the bariatric surgery patient.

Is it possible to consume too much dietary protein?

Even though many health professionals do not advocate diets high in protein because of possible adverse effects on the kidneys and liver, the fact is there is little documented evidence of problems due to a high protein intake. Such myths of protein danger have been thoroughly tested and proved quite conclusively that high protein intake does not result in kidney or liver dysfunction. However, high protein intake may exacerbate pre-existing kidney or liver disease in which your surgeon may not recommend bariatric surgery until conditions improve.

What are my daily protein requirements?

Average Jane - 44g/day Average Bariatric Jane - 55g/day Ideal Bariatric Jane - 80g/day

Average Joe - 56g/day Average Bariatric Joe - 65g/day Ideal Bariatric Joe - 100g/day

With so many supplements to choose from is there really a difference between products?

Company products researchers and marketing professionals want you to believe there is a difference, but generally to the surgical patient there is not. The exception to this assertion is supplement manufacturers that use cheap proteins listed as gelatin or collagen as its major source of protein. Such proteins hold a very low bioavailability. Biological value or bioavailability is the most common measure of a protein supplement's quality. Such a value is based on four principles:

1. Amino acid pattern of the protein supplement
2. Digestibility for the specific protein type to convert into a form for assimilation
3. Assimilation or absorption of specific proteins.
4. How the body uses such protein or utilization units.

Specific protein types that hold acceptable biological values are whey, casein, egg, and soy. Most protein powders available contain either one or more of the above protein sources and require little more than a glass of water and spoon or blender to prepare. Protein meal replacement supplements are ideal for individuals who must consume excessive volumes of food or have limited appetites. Liquid fasting with an approved high protein supplement may not always be required, but recommended by the top bariatric surgery programs in the nation. The following is a short list of the many protein supplements that can be found at your local health food store and consumed after surgery. As mentioned before, you should find at least one high protein supplement that is acceptable to you for it may be used for up to the first year after surgery.
When evaluating your supplement to purchase, read the label carefully and look for sugar-free products, as well as high-quality proteins.

Top selling protein supplements <<make that a link
The following information is not a specific supplement endorsement and should not be consumed without first being approved by your surgeon and dietician.

Lean body by Labrada
One packet mixed with 12 ounces water, milk, or juice provides 30 grams of whey protein, 200 calories with water and only 1 gram of sugar. Lean body Protein is available in a twenty-pack box with an average cost of $35.00 and offers the following flavors: Chocolate and Vanilla Ice Cream.

Met-rx Original Drink Mix
One packet mixed with 16 ounces of water, milk, or juice provides 37 grams of caseinate and whey proteins, 250 calories with water and only 3 grams of sugar. Met-rx is available in a twenty-packaged box with a cost of $45.00 and offers the following flavors: Chocolate and Vanilla.

Myoplex Lite by EAS
One packet mixed with 10 to 12 ounces of water, milk, or juice provides 25 grams of whey, soy, and casein proteins, 190 calories with water and only 2 grams of sugar. Myoplex Lite is available in a box of 20 individual packets with an average cost of $40.00 and offers the following flavors: Chocolate Cream, Vanilla Cream, Cappuccino Ice, and Tropical Variety pack.

90% Plus Protein by Weider
Three tablespoons mixed with 8 ounces of water, milk, or juice provides 24 grams of soy, whey, and egg proteins, 120 calories with water and 0 grams of sugar. Weider 90% Plus Protein is available in a 16-ounce container with an average cost of $10.00 and offers the following flavors: Chocolate and Vanilla Malt.

Pro Blend 55 by MD Labs
Two scoops mixed with 8 to 12 ounces of water, juice, or milk provides 55 grams of whey, egg, and casein proteins, 240 calories and only 4 grams of sugar (when mixed with water). Pro Blend 55 is available in a 2lb canister with an average cost of $34.00 and offers the following flavors: Swiss Chocolate, Alpine Vanilla, Strawberry Twist, and Mocha Cappuccino.

Simply Protein Complete Whey by EAS
Two scoops mixed with 4 to 6 ounces of water, juice, or milk provides 20 grams of whey protein, 115 calories, and only 3 grams of sugar (when mixed with water). Simply Whey is available in a 5lb canister with an average cost of $24.00 and offers the following flavors: Chocolate and Vanilla.

Challenge Milk and Egg Protein by GNC
Two tablespoons mixed with 6 to 8 ounces of water, juice or milk provides 21 grams of protein, 100 calories and only 3 grams of sugar (when mixed with water). Protein is available in a 16 ounce canister with an average cost of under $15.00 and offers the following flavors: Chocolate and Vanilla.

Designer Protein by Next Proteins International
Two scoops mixed wtih 10 to 12 ounces of water, milk, or juice provides 35 grams of whey protein, 190 calories with water and only 2 grams of sugar. Designer Protein is available in a 2lb container with an average cost of under $17.50 and offers the following flavors: Chocolate and Vanilla.

Pure Egg Protein by Vitalabs
One scoop mixed with 6 to 8 ounces of water, juice, or milk provides 24 grams of egg protein, 100 calories and 0 grams of sugar (when mixed with water). Vitalabs Egg Protein is available in a 2lb canister with an average cost of under $17.50 and offers the following flavors: Chocolate and Vanilla.

100% Egg Protein by Optimum Nutrition
www.optimumnutrition.com One scoop mixed with 8 ounces of water, juice, or milk provides 24 grams of egg protein, 100 calories and 0 grams of sugar (when mixed with water). Optimum Egg Protein is available in a 1lb canister with an average cost of under $19.00, 2lbs for $35.00 and 4lbs for $60.00 and offers the following flavors: Chocolate and Vanilla

AdvantEdge Whey Protein by EAS
One scoop mixed with 6 to 8 ounces of water, juice, or milk provides 20 grams of whey protein, 115 calories, and only 3 grams of sugar (when mixed with water). AdvantEdge Whey Protein is available in a 12 ounce canister with an average cost of under $10.00 and offers the following flavors: Chocolate and Vanilla.

Amino Fuel Liquid Concentrate by Twinlabs
*The only liquid protein known not to be made of poor proteins like gelatin and collagen. 3 tablespoons equal 15 grams of predigested whey, egg, and soy proteins and 104 calories. Harsh citrus flavor in a 16 ounce bottle for around $10.00.

Carb Solutions High Protein Drinks by Richardson Labs
One 9.5ounce ready to drink beverage provides 20 grams of casein protein, 200 calories and only 2 grams of sugar. Carb Solutions ready-to-drink beverages are available in a box of four bottles at an average cost of $8.00 and offers the following flavors: Rich Chocolate, Creamy Vanilla, and Delicious Cappuccino.

Carnation Instant Breakfast (No Sugar Added) by Nestle
As a last resort the following grocery store bought items can be used. Mix one packet of no sugar added Carnation Instant Breakfast to 8 ounces of skim milk and 1/4 cup of powdered non-fat dry milk. This three-step mixture will provide 22 grams of protein and 223 calories. No sugar added CIB is available in Chocolate, Vanilla, and Strawberry flavors.

100% Whey Protein by Optimum Nutrition
www.optimumnutrition.com One scoop mixed with 8 ounces of water, juice, or milk provides 22 grams of whey protein, 110 calories and only 1 gram of sugar (when mixed with water). Optimum Whey Protein is available in a 2lb canister with an average cost of under $18.00 and 5lbs for $40.00 and offers the following flavors: Chocolate, Vanilla, and Strawberry.

When and how should I take my supplements?

Your protein supplement initiation and instructions

Once you have obtained your surgical teams' approval of your protein supplement of choice and intentions, the following plan will be beneficial. Although most supplements provide near 100% of the recommended daily allowances (RDA's) for vitamins and minerals, research has proven the need for additional protection. Follow your surgeon's advice on multivitamin supplementation. Be aware that while on a full or liquid diet you may experience temporary dizziness as a result of fluid loss. Therefore, try not to make any rapid changes in body position such as standing up quickly. If temporary lightheadedness does occur, increase your fluid intake by one-quart (23 ounces) daily. It may also be normal to experience a change in bowel movements. It is not uncommon to have a bowel movement once every two days if adequate fluids are not consumed. If you become uncomfortable with this change, continue exercising and use sugar-free Metamucil. Also, the iron and vitamins in such a ! liquid diet may cause your stools to appear dark in color. Most importantly, follow the amount of protein supplements prescribed and avoid jeopardizing your health by consuming an inadequate amount of calories and do not hesitate to call your doctor with questions or concerns.

Additional Supplementation

The following supplements should be added to assist in reassuring proper nutritional status. Think of it as health insurance.
Multiple Vitamin -- it is wise for all patients to begin taking a chewable vitamin and mineral supplement twice a day until your surgeon allows you to consume a one-a-day capsule. You should be consuming twice the recommended label's instructions and the vitamin should contain iron. When shopping for a multivitamin, it should be at a reasonable price and mimic the Centrum label that happens to also make a liquid formula.
Calcium -- calcium supplementation is essential in preventing the possible loss of calcium leading to or accelerating bone loss leading to osteoporosis. Initially, calcium carbonate from the counter antacid Tums is acceptable. You should chew 2 Tums after each meal until your surgeon allows you to swallow capsules. Then 1500mg of calcium citrate should be taken at bedtime. Such an ideal supplement is Citracel caplets plus vitamin D.
Vitamin b-12 -- (Roux - en - Y Gastric Bypass only) Following the gastric bypass procedure the body's main location of b-12 absorption is detoured possibly causing deficiency leading to pernicious anemia and fatigue.
L-Glutamine -- this amino acid is the most abundant of all amino acids in our body's muscles and readily available when needed for the synthesis of skeletal tissue. Supplemental glutamine powder added to your protein beverage may benefit your body's absorption of protein and assist in the prevention of muscle wasting. Research has indicated that in times of stress, such as surgical trauma, up to one third of the muscles' glutamine may be released causing muscle loss.

Where can I find Protein Supplement Recipes?

The recipes may be used to increase the taste of your protein supplement and may prevent taste fatigue.

Double Deluxe Chocolate Fudge - mix one chocolate protein supplement according to directions. Then, add one packet of Swiss Miss fat-free hot cocoa mix and three ice cubes. Blend at high speed for 45 seconds and enjoy.

Cookies and Cream - mix one vanilla or chocolate protein supplement according to directions. Next, add four drops of peppermint extract and three ice cubes. Blend at high speed for 45 seconds. Then, add four low-fat chocolate Nilla wafers, blend at low speed for 10 seconds and enjoy.

Frozen Fruit Dream - mix one vanilla protein supplement according to directions. Next, add 1/2 ripe banana, 1/4 cup chopped pineapple, three frozen strawberries and three ice cubes. Blend at high speed for 45 seconds and enjoy.

Chocolate Mint Mocha - mix one chocolate protein supplement according to directions. Then, add 1 1/2 tbsp. of general foods Coffees Swiss Mocha sugar-free, fat-free instant coffee, 4 drops of peppermint extract, and three ice cubes. Blend at high speed for 45 seconds and enjoy.

Key Lime Pie - mix one vanilla protein supplement according to directions. Next, add two tablespoons frozen lime juice, one graham cracker (four small squares) and three ice cubes. Blend at high speed for 45 seconds and enjoy.

Chocolate Peanut Butter Cup - mix one chocolate protein supplement according to directions. Then, add one tablespoon of all-natural peanut butter and three ice cubes. Blend at high speed for 45 seconds and enjoy.

Cinnamon Roll Supreme - mix one vanilla protein supplement according to directions. Next, add 1/2 tsp of ground cinnamon, 1 tsp fat-free Butter Buds, and three ice cubes. Blend at high speed for 45 seconds and enjoy.

Protein Cup of Joe - mix one vanilla or chocolate protein supplement with 50% prepared decaf coffee and 50% skim milk. Next, add 2 tsp of sugar-free coca and three ice cubes. Blend at high speed for 45 seconds and enjoy.

Broccoli Soup - makes three servings. 1 1/2 cup of chopped broccoli, 1/4 cup of chopped onion, 1 cup of chicken broth, 1/2 cup of grated fat-free cheese (cheddar or Swiss), 2 cups of skim milk, 2 tbs cornstarch, dash of pepper, and three scoops of Designer Protein (Natural flavor). Boil vegetables and broth in large saucepan. Reduce heat and cover until tender (about ten minutes). Add milk, pepper, and cornstarch. Stir until soup thickens. Remove from heat and add cheese stirring until melted. Cool, and then add Designer Protein.

Orange Dreams - mix one vanilla protein supplement according to directions less 2 ounces of liquid. Then add 2 ounces of no pulp orange juice, 1/4 teaspoon of orange sugar-free TANG and three ice cubes. Blend at high speed for 30 seconds and enjoy.

Vanilla-maple Drink - mix one vanilla protein supplement according to directions. Next, add one teaspoon of pure maple extract and three ice cubes. Blend at high speed for 30 seconds and enjoy.

Lemon Crystal - mix one vanilla protein supplement according to directions substituting water with crystal light lemon flavored drink. Next, add three ice cubes blend at high speed for 30 seconds and enjoy.

Raspberry Tea Chiller - mix one vanilla protein supplement according to directions substituting water with sugar-free raspberry flavored fruit tea. Next, add 1/2 teaspoon of rum flavoring and three ice cubes. Blend at high speed for 30 seconds and enjoy.

Can I create my own Protein Supplement Recipes?

With flavorful additions like:
Sugar-free drinks--any Kool-aid or Crystal Light flavors
Extracts - imitation flavors and real flavor extracts also bolster supplement taste. However, if you use extracts that contain alcohol, limit the amount you use to 1 1/2 teaspoons per beverage because alcohol contains wasted calories.
Remain limited to the following low calorie extracts (calories per teaspoon):
Black Walnut - 4
Chocolate - 7
Coconut - 8
Vanilla, imitation - 3
Pineapple - 6
Vanilla - 8
Maple - 6

High Power Pudding - mix one small pack of sugar-free pudding (chocolate, vanilla, or pistachio) to 2 cups of skim milk and 1/2 cup of non-fat dry milk and chill. One 1/2 cup serving provides 9.5 grams of protein and 120 calories as mixed.

Protein Pudding - mix one vanilla protein supplement with approx. two ounces less liquid than directions call for. Next, add three tablespoons of your favorite sugar-free, fat-free instant pudding and five ice cubes. Blend at high speed for 60 seconds and enjoy.

Orange Pudding - 3 ounces of boiling water, 1 1/2 teaspoons (2/3 envelope) orange flavored sugar-free gelatin, 7 ounces of sugar-free TANG and your protein powder. Mix well and chill.

Fruit Cubes - 1 cup of heated diet soda (not boiling) to one envelope of unflavored gelatin. Then mix in your protein powder and 1/2 cup of cold diet soda and pour into an ice tray and chill. Eat all the cubes as one serving.

Slush Recipes

Designing your own -- Mixing instructions
1. Pour 3 ounces of fluid into a measuring cup. Add ice until fluid line reaches 12-ounces.
2. Pour ice mixture into blender.
3. Add flavoring and protein powder.
4. Blend on low speed 2 to 3 seconds with quick pulses, then blend on high speed until mixture is the consistency of slush.

Raspberry Slush - 6 ounces of sugar-free raspberry flavored fruit tea and ice to 1/2 teaspoon of rum flavoring and protein powder. Blend and serve.

Hot Beverages

Designing your own -- Mixing instructions
1. Mix dry ingredients together.
2. Heat water until steaming, either in a saucepan or microwave. Do not boil.
3. Add 9 fluid ounces of hot water to the dry ingredients.
4. Immediately mix with spoon until powder is completely dissolved.
5. Do not use a blender or shaker as hot liquids may splash and burn.
6. Do not mix protein powder and water prior to cooking in microwave as this will cause lumps to form.

Coca - mix 1 teaspoon of cocoa to 2 packets of Equal sweetener, a dash of cinnamon and 9 ounces of water to chocolate or vanilla protein powder.

Peppermint Coca - 1 teaspoon of cocoa, 1 teaspoon of chocolate flavoring, 1/8 teaspoon of peppermint extract, a dash of cinnamon and 3 packets of Equal sweetener to 9 ounces of water and vanilla or chocolate protein powder.

Mousses

Designing your own -- Mixing instructions
1. Mix 1/2 cup boiling water into gelatin. Stir vigorously with wire whip until dissolved.
2. Add remaining ingredients to gelatin mixture.
3. Mix well.
4. Pour into container with tight fitting lid.
5. Put in freezer until set and very cold, but not frozen.
6. Mix with electric mixer on high speed until peaks form and mixture is lightly fluffy.
7. Serve at once.
8. Due to the increased caloric content of these mousse recipes limit to one per day.

Chocolate Mint Mousse - 1/2 cup boiling water, 1/2 envelope (1-1/8) Knox unflavored gelatin to 2 packets of equal sweetener. A dash of cinnamon, 1 teaspoon of creme de menthe extract to 1/2 cup of water and chocolate protein powder.

Chocolate Almond Mousse - 1/2 cup boiling water, 1/2 envelope (1-1/8) Knox unflavored gelatin to 2 packets of equal sweetener. A dash of cinnamon, 1 teaspoon of cocoa, 1/4 teaspoon of pure almond extract to a 1/2 cup of water and chocolate protein powder.

What about the exercise?

Begin exercise program at 6 weeks after your operation. Perform exercises 5 days per week and resting 2 days every week.

1st thru 3rd week: Brisk walk for 15 minutes on first day. Increase by 2 minutes per exercise day until after 2 weeks you are walking for 35 minutes.

4th thru 6th week: Continue brisk walking 5 days per week for 35-40 minutes per session.

7th thru 10th week: Begin resistance training using bands. Perform upper body training for 15 minutes 3 days per week and lower body resistance training for 15 minutes 2 days per week. Follow resistance training with 15 minutes of brisk walking (or some form of cardiovascular exercise).

11th week and Beyond: Alternate 2 weeks of cardiovascular exercise (brisk walking, jogging, or biking) for 35 to 40 minutes (exercise 5 days, rest for 2 days) with 2 weeks of combination training (15 minutes resistance training and 15 minutes cardiovascular training).


Remember…this is a lifelong process and the operation is designed to get you to a position where, with continued compliance and healthy eating habits, you will remain at a healthy weight. Surgery is a ‘tool’ not a ‘cure’.

• www.ASBS.org
• www.WeightLossSurgeryInfo.com
• www.GastroplastyInfo.com