To make matters better (and more interesting) you do not feel too hungry anyways, and there are usually no cravings for food that go unfulfilled. It is not as if the operation will leave you salivating for a huge meal, and you are cursed with a tiny portion of it all your life. You will be happy with what (and how much) you can eat.

For three to four weeks after surgery, you will consume liquids only. 

Week One: Thin liquids only

Sample Full Liquid Meal Plan (1 week post-op)  

  7:00  am — 4 ounces of milk

8:00   am —  2 Tablespoons plain yogurt  

10:00  am — 1 ounce whey protein isolate drink (e.g. Isopure Zero Carb) with 4 ounces  

  of skim or 1% milk 

11:00 am — cup of dal

1:00 pm — 2 Tablespoons low fat cottage cheese (plain) 

3:00 pm — 4 ounces whey protein isolate drink  

6:00 pm —  tea

8:00 pm — 4 ounces whey protein isolate drink made with skim or 1% milk 

9:00  pm — 4 ounces of  vegetable/chicken soup  

 

Week Two to Week Four: Pureed/blenderized diet

Use natural, whole foods (like vegetables, meats, fish, dal and milk) and blenderize them till you obtain the consistency of a thick sauce. Strain out the larger particles/seeds/skin and use the rest. 

How to measure your portions: use a measuring spoon or shot glass or an ice tray (each cube in the tray measures 1 ounce.

 

Rules for the liquid/pureed diet after operation:

1. No colas, sodas, or alcohol.

2. No sugar, commercial ‘low-fat’ drink, honey, agave nectar, corn syrup or HFCS, chocolate syrup, ice cream, etc. Your protein shake (as in the pic) may be chocolate-flavored.

3. Very limited ghee, butter, or olive oil.

4. Avoid coffee, especially if you have heart problems or diabetes.

5. Avoid restaurant food (they generally tend to be unhealthy).

6. Avoid hard meats and nuts till well into your second month after surgery.

7. If you feel like having something sweet (like milk or tea or a smoothie), add a sugar substitute, avoiding overuse.

8. No processed foods like chips, cakes, cookies, breads, pizzas, burgers, whatever!

9. Total fluid consumption in a day should be at least 1.5 to 2 litres (including water)

10. Take time in having your meals- your stomach is not what it used to be!

11. Have only less than 4 ounces of feeds at a time. 

12. Eat 60 to 100 grams of proteins daily. 

13. Use an online food journal like Fitday to calculate your protein intake or contact us.

14. Drink water at a different time from your meal.

15. Avoid fruit juices– they have a high glycemic index and could raise your blood glucose. 

(pic source: here)

In regard to the above, weight training is as important, but that is another article!

(pic credit goes to this site)

If you have decided to go for a bariatric operation, you need to do some preliminary preparation for it.

1. We tell our patients to go on a liquid diet for 15 days before the day of surgery. This does not mean you can drink ghee, condensed milk, juices and colas. You can drink soups, milk, dal, meat stocks, etc. You could also take ultra-low calorie liquid supplements like Optifast. The caloric deficit created by this would lead to around 15-20 lbs of fat loss or even more. 

2. Significant fat loss immediately preceding bariatric surgery is good in terms of improving post-operative results and also in making the surgeon’s job easier. Much of the effects of the pre-operative low calorie diet is to shrink the size of the liver. This causes better visualisation during surgery. 

3. A last binge before surgery is NOT a good idea! This is understandable from the patient’s point of view, but really does not do much good to him/her. Often, the last binge gives rise to one more, and then one final one, and so on. Rather than losing weight, the patient puts on some more!

4. Stop smoking and drinking alcohol! This is simply non-negotiable. Bariatric surgery is not a painless, cosmetic solution to some excess blubber your body may have. It is a serious undertaking on your (and our) part, in order to restore health to your body. There can be no healthy life if you drink and smoke. One is not referring to the occasional social drink or cigar, but you know what we are talking about! Smoking increases post-operative respiratory complications like pneumonia, as well as heart attacks and deep vein thrombosis. All these complications are terrible and potentially fatal, so be careful! Nothing is worth losing your life and health to, so quit NOW!

5. Continue to take your diabetes and hypertension medicines, unless told otherwise. 

6. If you have respiratory problems like asthma, please see a respiratory physician or therapist who would treat your lungs with nebulisers, antibiotics (when indicated), and chest physiotherapy. In some patients, vaccines against respiratory pathogens (like Pneumococcus and Hemophilus influenzae) are also prescribed. Patients suffering from sleep apnea may need a CPAP machine that helps to oxygenate the lungs during sleep.

7. Walking every day or doing some mobility exercises is good for you– this is also important for you. We encourage patients to be ambulant immediately after surgery, and this helps.

8. Prepare a food journal– this should become a habit after your operation, so start anyways.

9. Ask other patients about how they have adapted to life after bariatric surgery. Remember that they may have a different procedure and their adaptations and restrictions may not apply to you!

10. Do you need further counselling? Are you nervous or unsure about anything? Don’t hesitate. Ask your bariatric surgeon!

Article source here.

A summary in Medpage Today says that “Among diabetics who followed a Mediterranean-style diet, only 44% required antihyperglycemic drug therapy, compared with 70% of patients who followed a standard low-fat diet (95% CI -31.1% to -20.1%, P<0.001)”.

“Compared with a low-fat diet, a low-carbohydrate, a Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes,” Dario Giugliano, MD, PhD, of the Second University of Naples, and colleagues wrote.

Full Medpage Today article may be read here.

In this scenario, they often resort to taking drugs to help with weight loss. One such drug, now popular all over the world, is Orlistat, sold over the counter in the US as Alli.

The drug works by inhibiting the digestion and absorption of ingested fat in the alimentary tract. Net result- the ingested fat is passed off in the stool. So, the patient can eat fats and not put it on– after all, it is not getting absorbed into the body. Cool, ain’t it?

Not really. The drug, as we have seen with rimonabant before, is not without its inherent problems. The stools become oily and loose, not to say foul-smelling. As a result of this, much time is spent in the toilet. If that is not bad enough, the oil trickles in through the anus and soils your clothes!

Orlistat (sold in India in the names of Reeshape or Obelit, among others) also causes malabsorption of fat-soluble vitamins and could be harmful if consumed for longer periods of time. Remember that fat is an important macronutrient for the body, even in fat people!

According to this report (and some others), Orlistat has been found to cause severe liver toxicity, including liver failure in several patients, leading the FDA to launch a product review on the drug.

FDA said it “is not advising healthcare professionals to change their prescribing practices with orlistat. Consumers currently taking Xenical should continue to take it as prescribed, and those using over-the-counter Alli should continue to use the product as directed.”

But the FDA advised orlistat users to “consult their healthcare professional if they are experiencing symptoms possibly associated with the use of orlistat and development of liver injury, particularly weakness or fatigue, fever, jaundice, or brown urine. Other symptoms may include abdominal pain, nausea, vomiting, light-colored stools, itching, or loss of appetite.”

However, if history is any indicator, it is our prediction that this will go the way of rimonabant and Ephedra and die a natural death in some time in the future.

The study was based in Chennai at the famous ‘Dr. Mohan’s Diabetes Speciality Center’.

While we could not access the original article for you, we found another one (from Kolkata) that discusses in details about the various Indian diets and the disease distribution related thereto. 

Paradoxically, while the study clearly identifies the role played by vegetable oils (with high amounts of omega-6 fatty acids) and carbohydrates in the incidence of heart disease, it espouses the same high carbohydrate diet as per the American Dietetic Association.

The study compares over 75,000 rural people and follows them up over ten years. The study has the interesting finding that the lower the BMI, the higher the mortality. This underscores once again that the problems of rural India are different from those of urban India. A similar study based on our city-based population could throw up interesting results.

From the abstract:

Background Although the detrimental effect of overweight and obesity has been extensively reported in Western populations, little is known on the association between body weight, weight change and mortality in Asian populations whose weight distribution and mortality differ considerably from the West.

Methods A cohort of 75 868 subjects aged 35 years and above, participants of the Trivandrum Oral Cancer Study—a cluster-randomized controlled trial originally implemented to evaluate the efficacy of visual inspection on oral cancer, in Kerala State, South India—were followed up from 1995 to 2004. Weight and height were measured both at baseline and in 3.5-year follow-up surveys. Early years of follow-up were excluded from the analyses. Relative risks of overall death and cause-specific death were estimated according to the body mass index (BMI) category of the WHO Asian population definitions, and to weight changes between two surveys.

Results Low BMI was a predictor of mortality, while high BMI was not. Mortality risks in men adjusted for age, smoking habits and other potential confounders, as compared with a BMI 18.5–22.9 kg/m², were 1.26 (95% CI 1.03–1.55) for BMI < 16 kg/m²; 1.16 (1.03–1.32) for BMI = 16–18.4 kg/m²; 0.95 (0.81–1.12) for BMI = 23–24.9 kg/m²; 0.85 (0.69–1.05) for BMI = 25–27.4 kg/m²; and 0.89 (0.65–1.21) for BMI  27.5 kg/m². Similar findings were observed in women. BMI was not associated with deaths from cancer, cardiovascular and cerebrovascular diseases, and diabetes. A low BMI (<16 kg/m²) was associated with increased deaths from chronic respiratory diseases. Smoking and socio-economical status did modify the association. A moderate weight gain of 4–10% between the two surveys was associated with decreased risk of death, while moderate and severe weight loss were predictive factors of death. Similar results were observed in both men and women.

Conclusions Among this Indian rural population, mild to severe leanness (BMI < 16 kg/m²) and weight loss were important determinants of mortality, especially from chronic respiratory diseases, while overweight and above (BMI > 23 kg/m²) did not show any detrimental effect.

I strongly urge you to maintain a food diary or journal where you can be judged as far as your nutrition is concerned. Various online journals like Fitday automatically and easily calculate your nutritional intake on a daily or even monthly basis, allowing yourself to judge where you are going wrong.

For example, you may realise that a lot of your calories are hiding behind the innocent biscuits and frapuccinos that you keep having, or the chips you absent-mindedly munched while watching TV.

Once you catch on to this, you can change your habits/eating style to effect a cutback in calorie intake. Similarly, you can detect the source of your caloric excess: usually they would be derived from carbohydrate sources like processed foods or sugary drinks.

So, I would say anyone keen on losing weight should first show me what they are eating. You really can’t plan nutrition unless you know the background of the patient.

However, at a point of time, calorie counting and portion watching and nutritional label checking grows to a point where people have an unguarded opinion that your sanity has taken a Southwards bend. Where you are actually a victim of orthorexia. When this happens, you have become neurotically obsessed about eating, health and getting thinner. This is also called OCE- Obsessive Compulsive Eating.

(image credit: awakeningcharlotte.com/…/ )

If you keep counting calories and macros (percent saturated fats, vitamin daily requirements, etc) to the point where you are using food as a capsule, not as a pleasurable source of sustaining your body’s engine, then you are losing out on life. You don’t want to end up unhappy and obsessed over crazy details. You want to get healthier and thinner without a ticket to the asylum.

There are ways to loosen up, enjoy life and food, and yet grow thinner. This can be achieved in various ways, which I will merely mention in this post. More detailed analysis will be separate posts for later.

1. Intermittent Fasting: If you fast for two days a week (for a full 24 hours each), you can lose 20% of your normal calorie intake in a week. Means losing fat. Provided you do some form of weight training, as you don’t want to lose muscle. You want to lose fat alone. There is growing research supporting IF.

2. The Warrior Diet: Popularised by Ori Hofmekler, the Warrior Diet also keeps you fasted through the day, and you end the day with a huge meal, eaten within a four hour span. This continues ad infinitum.

3. The Paleo Diet: More a lifestyle than a diet, the Paleo-philes advocate eating like Grok, the caveman. No processed foods, grains or dairy are allowed in this diet. It turns out to be a low carb, high protein and high fat diet. You can eat things like beef, pork, bacon, butter, ghee, etc. in plenty. If it is natural, it is likely to be Paleo. A great lifestyle, in my opinion!

4. The Cheat Diet: Not to be taken literally, if you eat sensibly through the week, you could have weekend cheat meals. This prevents uncontrollable cravings that generally destroy diets. It is considered important to give the patient some degree of flexibility in a diet.

5. Common Sense Approach: If you can eat sensibly, avoiding energy-dense foods like processed sugars, refined flour products, sugary drinks, and eat only when genuinely hungry, you can keep within reasonable caloric and nutritional balance. In this approach you eat natural foods as often as you can, but do indulge when you want to. If you are active physically, this might not get you into the gymnastics team, but you could manage in reasonable shape.

Too rigid a diet is counter-productive for several reasons:

* Dieters may go totally off the bandwagon if they succumb once to temptation. Studies back this up.

* They may decide the constant struggle for control is not worth it and give up.

* They may become orthorexic: constantly agonising over carbs, calories and other minutae.

* Not eating with other people (social eating) is a common phenomenon if you are very rigid about your diet. In this scenario, personality disorders can occur if you go overboard.

* Constant dieting may depress metabolic rate, something a cheat meal may kickstart. This may be a complex phenomenon acting through a leptin-mediated pathway.

Whichever diet plan you chose to follow, you must strike foot on rational ground, or you risk sliding into the morass of overating and bingeing with cyclical guilt trips, or becoming a Diet Nazi. Be careful!