If you already follow a special diet such as vegetarian, vegan or gluten free, then you may wonder if there are healthy pre and post-operative diets to ensure your weight loss surgery is successful.

You’ll be pleased to know that continuing to follow these special diets is entirely possible if you choose to have weight loss surgery. The key to making your bariatric surgery successful is enjoying a wide variety of protein sources, getting creative and having fun finding new tasty combinations. It is useful to talk to a dietician or nutritionist who can give you specific advice for your individual requirements. If you are well-planned it is more likely you will stick to your diet, stay healthy and ultimately succeed with your weight loss targets.

1. The importance of protein

Your pre-op and post-op bariatric diet will focus on protein. Protein is needed by your body to function properly. Unlike fat and carbohydrates, protein is not stored by your body and so it needs to be eaten in sufficient quantities every day. The protein needs of a bariatric patient can range from 46 to 100 grams of protein per day depending on weight, gender, age and surgical procedure.

2. Vegetarians

There are ample vegetarian foods to consume in your pre and post-bariatric diet. In fact choosing meatless meals can decrease your intake of saturated fat and cholesterol, as well as increase your intake of heart-healthy unsaturated fats and fibre.

a) What is a vegetarian?

Vegetarian refers to those who abstain from animal products. The Vegetarian Society defines a vegetarian as: “Someone who lives on a diet of grains, pulses, nuts, seeds, vegetables and fruits with, or without, the use of dairy products and eggs. A vegetarian does not eat any meat, poultry, game, fish, shellfish or by-products of slaughter.” ¹

b) Vegetarian protein sources

As a vegetarian you will need to pay extra attention to eating enough protein in every meal. Non-meat foods usually have less protein per ounce than meat which means there is less room in your stomach for non-protein foods. Many foods including beans, tofu and even vegetables like broccoli contain protein. If you eat eggs and dairy products, consuming enough protein shouldn’t be difficult. Some variations of vegetarianism may be more challenging to ensure adequate protein is included in the diet but with forward planning this is achievable.

You may not realize some foods contain such a high percentage of protein. Listed below are a few foods showing the percentage of calories from protein (value per 100 grams of edible protein)²:

• Kidney beans 58%

• Soybeans 35%

• Tomato 19%

• Lentils 34%

• Mushrooms 56%

• Spinach 50%

• Watercress 84%

• Broccoli 33%

• Lettuce 36%

• Cauliflower 32%

The best vegetarian diet is varied and does not depend on one specific food type as its main source. The following list offers some tasty suggestions on healthy, vegetarian protein sources:

• Eggs – on average eggs have six grams of protein and provide healthy fats.

• Dairy – cottage cheese, yogurt, and other unsweetened dairy products are excellent vegetarian protein sources.

• Soy products – tofu, tempeh, and edamame are all excellent protein sources. Flavor plain soy products yourself for a healthier option.

• Legumes – protein-rich and high in fibre, beans, lentils, and peas should be a staple in vegetarian and non-vegetarian diets alike. Use them in stews or soups, as side dishes, or blended into creamy dips.

• Nuts – provide a boost of healthy fibre and fat but they are high in calories and should be eaten in moderation.

• Seeds – try including these high-fiber, protein packed seeds in your diet in the form of quinoa, millet.

• Whole grains – they may not offer a lot of protein, they are high in fiber and can often complete other plant proteins. Enjoy in moderation healthier options like brown rice, sorghum, kamut, and farrow.

c) Pre-operative vegetarian diet

Your bariatric surgeon may recommend a pre-operative diet to get you ready for surgery. This diet will be high in protein, but low in calories, fats, and carbohydrates, especially refined sugars and saturated fat. Your surgeon will provide advice for your pre-operative vegetarian diet.

d) Vegetarian options through the diet phases

Your bariatric surgeon or dietician will probably give you a meal plan. You can substitute vegetarian options for the items on your standard post-op meal plan. Here are some options:

Clear liquids- Prepare vegetarian broths instead of meat ones. Skip the Jell-O as it’s made from the hooves of horses and cows.

Full liquids- Try low-fat cream soups, skimmed milk, yogurts and protein shakes.Pureed foods- Puree things like beans, tofu and vegetarian chili. Include foods such as egg whites, yogurts, soft fruits and vegetables and cottage cheeses and ricotta cheese that are blended with water, fat free milk, juice with no added sugar and vegetarian broth.

Soft foods- For vegetarians soft protein foods include canned or soft fresh fruit, cooked vegetables, eggs, yogurt, cottage cheese and soft cheese. Avoid peanut butter and pasta as they are often too sticky for your new stomach to tolerate. Don’t eat crunchy nuts or hard cheeses yet as your stomach wont able to digest them.

Solid Foods- Vegetarians can eat any legumes especially beans, lentils, split peas and tofu. These are excellent protein sources and low-fat foods. Include at least three ounces of protein at each meal such as eggs, cottage cheese, beans or tofu. Don’t fill up on high-fat cheese instead of well-balanced meals. During the first three months avoid hard-to-digest foods including raw vegetables, apple skins and nuts. Your maintenance diet will focus on protein, fruits and vegetables and avoiding junk food or empty calories.

3. Vegan

If you are a vegan about to have weight loss surgery you can be assured there is ample variety of proteins to consume for success in your post-bariatric diet³. A vegan diet requires a lot of variety, because the proteins are not complete.

a) What is a vegan?

Veganism is a way of living which seeks to exclude, as far as is possible and practicable, all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose. They have a plant-based diet avoiding all animal foods such as meat, dairy, eggs and honey. A vegan diet is richly diverse and comprises all kinds of fruits, vegetables, nuts, grains, seeds, beans and pulses⁴.

b) Vegan protein sources

The biggest source of protein in most vegan diets is soy. Soybeans are generally low in carbohydrates and a high fibre source of protein. Soy also supplies iron, vitamin K, magnesium, copper, manganese, riboflavin and a variety of phytonutrients. Soybeans are versatile as they can be eaten right out of the pod, dried, in the form of tofu or as soy milk.

Tofu can be prepared in many different ways. It is great for post bariatric surgical diets because it is soft, easy to digest and it takes of the flavour of what it is cooked with.

c) Pre-operative vegan diet

If your surgeon recommends a pre-surgery diet it will probably be a liver shrinking diet which is low in dietary carbohydrate and fat and should be easy to follow on a vegan diet. Your surgeon or dietician will offer guidance for this diet as a vegan.

d) Vegan options through the diet phases after weight loss surgery

Here are some options for the diet phases you will move through as you work towards solid foods following your bariatric surgery:

Clear Liquids- Prepare vegetable based broths instead of meat ones.

Full Liquids- Use soy milk instead of skimmed milk in protein shakes. Use a soy protein powder instead of one made with whey, which is a milk product. Substitute regular yoghurt with soy yoghurt.

Pureed Foods- Puree soy products, legumes, soft fruits and vegetables and whole grains with water, fat free soy milk (read the nutrient label first as soy milk often has added sugars), juice with no added sugar and vegetarian broth.

Soft foods -For vegans soft protein foods include legumes, soy products, canned or soft fresh fruit, cooked vegetables and whole grains such as brown rice and farro. Don’t eat crunchy nuts at this stage as your stomach is not yet able to digest them

Solid Foods- Vegans can eat any legumes especially beans, lentils, split peas and soy products such as tofu, vegetables and fruits, nuts in moderation, seeds and whole grains.

Since plant-based foods are less protein-dense vegans may need to use protein supplements for a longer period of time to meet their daily goal of protein per day. A vegan diet has a risk of a Vitamin B12 deficiency which leads to increased levels of homocysteine and has been linked to heart disease and increased risk of stroke.

Other essential vitamins and minerals may not be consumed in appropriate quantities without supplementation. These deficiencies will vary between patients and their lifestyles. If you pursue a vegan diet and weight loss surgery it is best to be tested for vitamin and mineral deficiencies regularly.

4. Gluten free diets

a) What is gluten?

Gluten is a protein found in wheat, rye, barley and many processed foods including pasta, breads and cereals.

b) Why choose a gluten free diet?

Some people avoid gluten because they have Celiac disease, an auto-immune disorder whereby gluten damages the small intestine lining and results in abdominal pain, bloating, nausea and diarrhoea.

Other people avoid gluten because of gluten intolerance. Gluten intolerance mimics symptoms of Celiac disease without the immune response.

It is thought that the trauma of surgery, including weight loss surgery, may lead to the body having an abnormal immune response to eating gluten⁵.

c) Gluten free diet protein and fibre sources

If you are following a gluten free diet you will need to pay particular attention to your protein and fibre content.

There are countless gluten-free whole grains that provide just as much fibre, or often even more, than foods containing gluten. These include quinoa, amaranth, buckwheat, millet, sorghum, teff and wild rice. Vegetables, fish, lean meats and poultry, low fat milk, eggs, beans and nuts are good protein sources if you are following a gluten free diet.

d) Pre-operative gluten free diet

Your surgeon may recommend a liver shrinking diet for you before weight loss surgery. For gluten free diets you can eat vegetables, fish, lean meats, poultry, beans and fruit which are low in dietary carbohydrate and fat.

e) Post-operative gluten free diet

You will need to plan your gluten free diet through the diet phases following your bariatric surgery. Meals should always include high-protein food items such as lean meat, yoghurt and eggs.

Clear liquids – Initially after your surgery you will start with clear liquids such as water, tea, broths, diluted non-acidic fruit juices.

Full liquids -Once your body tolerates these you will be able to move onto full liquids such as low-fat cream soups, protein shakes, plain skimmed milk and gluten free yoghurt.

Pureed foods- The next phase is pureed foods and you can puree foods you would normally eat on a gluten free diet such as vegetables, fish, lean meats, poultry, low fat milk, eggs, beans, quinoa, amaranth and buckwheat.

Soft foods- When you move onto soft foods they might include ground or finely diced meats, fish, canned (taking care to check the labels for the sugar and salt content) or soft fruit, cooked vegetables, buckwheat, amaranth or other gluten free grains.

Solid foods -Eventually depending upon your tolerance you will be able to move on to a solid food diet. Include a wide variety of plain meats, fishes, vegetables, fruits and gluten free grains such as quinoa, amaranth and wild rice. Gluten free grains will provide you not only with the protein you need but also the minerals such as calcium and magnesium and also fibre to maintain a healthy diet.

You can still have weight loss procedures if you follow special diets such as vegetarian, vegan and gluten free.

References

https://wa.kaiserpermanente.org/static/pdf/public/bariatric/vegetarian-alternative.pdf

https://www.healthscience.org/health-science-magazine/recipes

https://www.vegsoc.org/definition

http://www.ehow.com/way_5598012_bariatric-diet-vegetarians.html

http://www.vegansociety.com/try-vegan/definition-veganism http://www.livestrong.com/article/304610-gluten-intolerance-after-weight-loss-surgery

There is a place where I live that makes great Middle Eastern food and I have gone to Ghossains Gourmet Mediterranean Foods for years as its quite healthy and very delicious.

But I wanted to learn to make my own, control what all went in it. So I wanted to share with you some of my recipes.

Baba ghanoush is a Middle Eastern dish made of cooked, mashed eggplant, tahini (sesame seed paste), and seasonings. Traditional recipes call for olive oil and salt, but I do not always use these ingredients, so they are often left out. I do like to serve this as a dip with fresh vegetables or pita but since my sleeve I go more for veggies.

2 one-pound purple eggplant

     1 small onion cooked

     4 garlic cloves cooked

    3 tablespoons lemon juice

    3 tablespoons chopped parsley

    3 tablespoons tahini (ground sesame seed paste)

    ½ teaspoon ground cumin

Instructions

    Preheat the oven to 375 °F. After washing and drying the eggplant, I poke it a few times with a knife tip and place it on a baking sheet or dish (with parchment paper). Roast for 60 minutes, until it is softened.

When done baking, set aside for at least 20-30 minutes because its to hot to handle.

   I cut the cooled eggplant in half lengthwise and scrape all of the insides into a bowl (including the seeds). Toss out  the skin and stem.

    Now you will mix the flesh of the eggplant with the remaining ingredients. In your food processor, blend until smooth. Transfer to a small bowl for serving or storing.

Enjoy !!!

Notes

In your serving you can also add some unflavored or vegetable soup flavored protein to it to get in added protein

If I have olive oil i will a bit if I don’t have any then I will make it without and its just as delicious.

Make it your own add any herbs and spices that you like, such as smokey  paprika, pinch of  of cayenne pepper, and or black pepper.

Garlic: You can use a small clove of fresh garlic in this recipe because it’s easier than roasting it. But I add mine to the cooking onions.   But even a small clove of raw garlic , is very strong.

Let me just say it: being fat really sucks, no matter what anyone says or does no one wants to be fat. Being fat has its own form of discrimination and bulling that so many just ignore at least that’s what I got out of all this…. many people look at what your eating,you hear kids and adults laugh or say rude things, you know you didn’t get the job because of your weight no matter how much you know.

I was always in pretty good shape and I became fat later on in life. I always hiked in my teens, 20s, 30s I roller skated in my 30s and 40s hell I still try to hike just not as steep of hillsides and I am in my mid 50s my bones just don’t allow me to do as much as I used to but the weight is also a big problem. I mean, I know we have to love and accept our-self and I do I really do but …. Others ignorance can make me feel terrible about myself.

When your fat now this is just my opinion … for me its the worse feeling, people try to make you feel less than I know I was judged. Like why is it because I’m now fat can I no longer be a candidate for a great promotion? Or even get the job…

I know its discrimination but try and prove it…

I mean they didn’t care why I was fat. They didn’t care that I had bone problems like osteoarthritis since age 35, at age 45 aprox isthmic spondylolisthesis yeah google that one thats a mouth full, then at age 51, I ended up with osteonecrosis after a torn medial meniscus cut off some of the blood flow to my knee , long before the weight, or that I also have hypothyroidism and hashimoto thyroiditis. They assumed that i was just lazy, didn’t exercise and liked to eat.

They had no idea how how much pain I lived with every day, all day. I wasn’t telling them about weight loss surgery either.

You see, I, like many others just like me, endure one of the few remaining acceptable forms of discrimination. Some people may judge me by the way I look and assume that I am dumb, lazy or that I eat chips and ice cream all day.

They may also assume I don’t care about myself. They only see the fat. They treat me differently than they treat thinner, more attractive women. I know this because I wasn’t always fat. When I resided in a different body, I didn’t know how different my life would be and how different I would feel about myself in a fat body.

My transformation has been remarkable. I went from being a confident, fun, smart and beautiful woman to a less outgoing less confident resemblance of my former self. I am somehow falling into my dutiful place in the world, trying not to been seen and feeling ashamed of me.

I am amazed at how inferior I feel now. I feel invisible. People avoid eye contact with me. I am often treated rudely or dismissed. Especially by doctors as well as by family, co workers, strangers but co workers are the worst.

They wanted everyone to be the picture of good no perfect health and to bad for you if don’t fit the part no matter how smart or how well you did your job. Have they looked in the mirror lately? funny the thin ones can go smoke wreak of cigarettes , eat Wendy’s and yet I the unhealthy one because I’m fat

This takes a toll on a persons self esteem .. what happened to human kindness ? Or just being nice to your co-workers? It wasn’t being bullied but it was a feeling of you don’t matter. But that’s ok to me I did matter and I would wake up everyday feeling good and happy and sure as hell if it wasn’t within 2 hours of being at my job at the time I felt less than. Add this on top of dealing with the ups and downs that come with chronic pain and and hypothyroidism fog and well it was a miserable day.

I had tried so many things to lose weight its not as if I just sat back and ate. I went to the gym it was a woman’s gym so i wouldn’t have to deal with men and yet I was still judged at the gym. So of course after getting that stare after a few months I stopped going there as well.

I felt like a balloon ready to pop and yet I wasn’t over eating and I didn’t eat junk. I felt like I was dying in a terrible way. I was not in control of my life well at least this part of my life. I was a flexitarian who ate mostly plant based to help my pain from bone problems I had.

Sure I ate junk, and I also noticed I was starting to feed my emotions.

People don’t just understand that the larger I got the less I liked myself, I hated to go visit people, I hated knowing I was being judged. I would avoid a camera and a mirror except from the neck up. I had 4 people I knew I could be around and be myself.

Mostly, I didn’t feel nor was I treated as if I had value. People who were always kind and happy to see you suddenly many acted as if they didn’t know you. You could feel the judgement. I was passed over for many great opportunities in life because of my life.

My parents were not heavy, they didn’t have thyroid issues…. But my grandmother had a goiter and her daughter my aunt was also suffering from hypothyroidism but not my mother.

So feeling frustrated at always eating healthy and still not losing weight I decided on the gastric sleeve.

So this is it a new beginning a new path to my wellness enough is enough, some where on the inside that confident woman still exists, I am ready to find her once again

The journey and work has begun