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Prakash Chandran (Host):  If you’re considering weightloss surgery, you need to follow some important dietary guidelines to ensure your procedure is a success. We’re going to learn about them today with Cheryl Robertson, a Registered Dietician at North Florida Regional Medical Center. This is Helmet of Health, the podcast from North Florida Regional Medical Center. I’m Prakash Chandran. So, Cheryl, let’s start with the basics here. what types of surgery are commonly performed for weightloss?

Cheryl Robertson (Guest):  Well what we do here at North Florida Regional is that we have the lap band procedure, the sleeve gastrectomy and then the gastric bypass.

Host:  I see and all of those surgeries I’m told restrict the stomach in some way, right, they make the stomach smaller?

Cheryl:  That is correct. With the lap band, then we use the band to really restrict the size of the stomach. With the sleeve and the bypass, then parts of the stomach are surgically either removed or revised in order to have the portions restricted.

Host:  Okay. So, let’s talk about what you have to do before the actual procedure. I’m assuming that you have to stop eating certain foods or restrict yourself from intaking certain things to prepare your body for the procedure. Is that correct?

Cheryl:  That is correct. A lot of times people have to do a medically supervised diet in order for their insurance to authorize and pay for the surgery. So, all of that is done as part of the preparation for surgery meeting all the requirements that the insurance has them do. But then everyone regardless if they have to do that for insurance or not, needs to do what we call a liver shrinking diet which is a two week right before surgery high protein, low carb, low calorie, low fat trying to get the liver to shrink up so we are trying to get as much glycogen out of the liver as possible in order to make it a safer surgery.

Host:  What exactly do the meals consist of when you are in the liver shrinking phase?

Cheryl:  The ways ours is based is that you have one meal a day which is high protein, low carb and then the other meals of the day are comprised of protein drinks or protein bars. And then the calories are based on gender and height as far as somewhere between 1100 and 1400 calories a day.

Host:  Okay so let’s move on to immediately after the procedure is done. What types of foods are permitted directly after surgery?

Cheryl:  Really no food is permitted. Generally for the lap band; it’s going to be the first ten days will be liquids. For the sleeve and the bypass; the first 14 days are liquids and then after that we are going to slowly advance the diet from liquids to solids. That process is going to be about three weeks for the band, eight weeks for the sleeve and the bypass where we gradually advance the texture of the diet so you don’t go from clear and full liquids to pureed to soft and then to regular textures and the purpose of that is to let everything inside heal without having any kind of complications due to trying to eat something that you are not yet ready to digest.

Host:  So, after that period is done; when can people start going back to the normal foods that they were eating prior to the surgery?

Cheryl:  Well regular textures again, for the band are going to be at the three week mark. It’s going to be at the eight week mark for the sleeve and the bypass. And again, that’s just the textures of the diet depending on what someone’s diet was before hand, we may not really want them incorporating some of those foods every again.

Host:  I see. So, can you talk to us about how things change after a procedure is done? So, I’m told obviously most people feel just satiated faster, so they are just not eating as much. But in terms of the types of foods that they are putting in, can you talk to us a little bit about what that looks like and what’s generally restricted?

Cheryl:  The forevermore diet is what I call it, what you’ll be eating for the rest of your live is going to be mostly protein, vegetables, with small amounts of starchy foods and small amounts of fruits. The portions will be extremely small, usually one cup or less and we really have to work to make sure that the proteins needs are being met. So, when you’re looking at the plate, probably at least half of the plate would be your protein whether it’s meat or dairy is the primary foods there. And then we want plenty of non-starchy vegetables and then small amounts of starch and small amounts of fruit. As far as toleration, there are certain foods that cannot be tolerated. Rice and pasta usually doesn’t work really well after any of the surgeries. Stringy vegetables doe not work well with the band. But then like beef and steak also do not work with the band. Sugar does not work well with the bypass. So, there will be individual tolerances depending on the surgery and then also just with each person but generally, what we are looking for is a good balanced diet with real foods, whole foods, lean meats, fruits and vegetables, whole grains, healthy fats and then we want people to stay away from as much packaged and processed foods which just generally are going to be very, very high calorie but low nutrient density.

Host:  So, I’m sure for the people listening to this that are considering this surgery; their primary concern is how to keep the weight off after the surgery is done. So, are you saying that if they stick to the diet and the procedures that you are mentioning; that the weight will stay off indefinitely?

Cheryl:  Yes, generally. And what we encourage people to do is follow up with us regularly, stay on top of things. what we typically find happens is that things are going on great but then people have some sort of a major life problem and sometimes emotional eating comes back into play, routines and structures that they had set up as part of their surgery, things get disrupted and so the main thing is this is a lifelong journey, it’s not a destination. It’s that you have to consistently make sure that you’re eating habits and your exercise patterns stay where they need to be but constantly correcting based on life to keep those calories low and keep those nutrients high.

Host:  All right Cheryl, well I really appreciate your insight here today. That’s Cheryl Robertson, a Registered Dietician at North Florida Regional Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.nfrmc.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.