A “normal-tummy” looks at the food pyramid from the bottom up – six to eleven servings of grains, then fruits and vegetables – then the protein groups: meat and beans and the milk group. The fats, oils and sweets are incidental.
After gastric bypass we can read the pyramid from the top down. Scoot to the side the fats, oils and sweets – we don’t eat those anymore. Start with the protein groups – remember the rule – protein first! Then have a sample from the fruits and vegetable groups. Then, only if there is room, a taste from the grains group. Fats and oils will be incidental to the diet; sweets should rarely be eaten. It is unlikely a tiny tummy will ever meet the food pyramid quantity guidelines – six to 11 servings from the grains group is totally unrealistic for a bariatric patient. However, WLS patients can gain significant nutritional benefits and satiation from incorporating foods from every group into their small meals. The key is to create a healthy eating pattern using the Food Guide Pyramid as a reference point for making sound nutritional choices.
Nutritional Benefits of each group:
Meat & Beans Group: Meat, poultry, fish and beans are the healthful and hearty members of this food group. Fifty percent of food intake after WLS will be protein from the meat and beans group. Animal proteins provide a rich source of B vitamins, iron and zinc. Nutritionally, it is best to choose meats low in fat and calories – lean round steak, skinless poultry, fish and shellfish. Legumes – including soy-based products – are a great meat substitute because they provide protein and have added fiber without the extra cholesterol, fat and calories found in meats. However, legumes are often difficult for the patient to eat – they quickly fill the tiny tummy causing discomfort. Some patients report an intolerance for beans and legumes that leads to vomiting. Test your own tolerances and learn what your body likes.
Milk Group: Milk, eggs, cheese and yogurt comprise the milk group. These foods are calcium rich and contain protein and other vitamins and minerals. But these foods can also be high in fat. Most bariatric patients report a very good tolerance for low-fat cottage cheese and mozzarella cheeses. Patients should use caution as they introduce foods from the dairy group back into their diet: many patients report dumping or lactose intolerance from foods in this group.
Fruit Group: Fruits are nature’s gift of sweetness to us, and a bonus, most fruits are low in fat and calories, but great sources of soluble fiber and antioxidants. Unfortunately, the natural sugars in fruit can cause a sugar (glucose) imbalance and dumping. The fiber in fruits – particularly citrus – can cause discomfort to the tiny tummy. Small bites must be taken as a patient re-introduces these foods to the bariatric system. Most patients report favorable results eating melon. Berries with seeds – such as raspberries or strawberries – should be avoided immediately after surgery to avoid lodging the seeds in the healing stomach seam. After healing is complete, many patients enjoy berries in their diet. Apples have also received favorable results from gastric bypass patients.
Vegetable Group: Vegetables add vitamins, fiber and flavor to the diet. When meats are braised vegetables can be added to the pot to add flavor and nutrition and a bit of natural moisture. Vegetables should be served in the purest form, lightly steamed without added creams or sauces. Raw vegetables, including leafy salads, can be difficult for the tiny tummy to digest, and when poorly chewed may cause a temporary blockage of the stomach exit. Some raw vegetables may cause gas or bloating after gastric bypass surgery. As always, use caution when introducing foods to the diet after gastric bypass.
Grains Group: This is the group of comforting energy giving carbohydrates we love to eat – the pastas, breads, rice couscous and other grains. As morbidly obese people most of the foods we loved (sweets, breads, pastas) came from this group, but as recovering obese people we must carefully control our intake of these foods. Science is proving that these foods are most quickly converted to fat and stored by body. The less food we intake from this group, the more our body is forced to use the stored fat. When introducing foods from this group try the purest forms: oatmeal cereal, one or two bites of whole-wheat bread, one bite of rice. Be very careful with grains and carbohydrates from the grains group: these foods can cause discomfort, dumping or worse – weight gain.
Fats & Oils: Fats are extremely concentrated forms of energy that contain little water and carry a lot of flavor. The body needs fat to function properly. Dietary fat carries fat-soluble vitamins – vitamins A, D, E and K – from food into the body. Bariatric patients report lost desire for high fat foods. In addition, high fat greasy foods are poorly tolerated and cause nausea. Patients will achieve a better quality of health by focusing on foods made with unsaturated fats and reducing the saturated fat intake in the diet. A way to include more unsaturated fat in the diet is to sauté with olive oil instead of butter. Canola oil should be used in baking. Replace bacon bits on salad with slivered almonds or sunflower seeds – nuts are a wonderful source of natural unsaturated fat. Avoid eating potato chips or processed crackers; they are made with hydrogenated oils – a lethal fat. Use avocado slices in place of cheese on sandwiches. Have fish – particularly omega-3 rich salmon or mackerel – for your protein a couple of times a week.
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