Drinking Alcohol after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains how to incorporate alcohol in a healthy diet after weight loss surgery.

People considering weight loss surgery often ask if it is possible to safely incorporate alcohol into a healthy diet and lifestyle after surgery. The short answer is “yes,” but gradually and with modifications. Here’s why:
       
Altered metabolism
Research shows that blood alcohol levels peak higher and faster and take longer to return to normal due to altered metabolism after gastric bypass surgery. In addition, many post-surgical patients consume less food when they’re drinking alcohol, which contributes to expedited absorption of alcohol in the blood stream. For many post-surgical patients, all it takes is a single drink to elevate blood alcohol level to the point of legal intoxication. This is important to remember for maintaining a healthy diet and before getting behind the wheel.

Low blood sugar
Rapid weight loss and low carbohydrate intake can lead to reduced sugar or glycogen in your body. Alcohol consumption further depletes glycogen, which causes your blood sugar levels to drop, putting those who have had bariatric surgery at higher risk for developing low blood sugar.

Hypoglycemia, or low blood sugar, is a dangerous condition that can lead to loss of consciousness, brain and nerve damage or even death if left untreated. As a result, it’s important to be on the lookout for symptoms, which include loss of coordination and balance, slurred speech, poor vision and confusion.

If you experience symptoms of hypoglycemia, drink diluted juice or take a glucose tablet immediately to raise your blood sugar level, and then have a snack with complex carbohydrates and protein to sustain it. If hypoglycemic episodes occur frequently even without alcohol consumption, make sure you seek proper medical treatment.

Excess calories
Alcohol is high in calories and low in nutrients, which is why excess calories from alcohol can slow weight loss or even contribute to weight gain. 

Addiction transfer
Patients with a history of addiction are at higher risk for developing a new addiction. With the dramatic reduction of food consumption after bariatric surgery, some patients may trade their food addiction for other addictive behaviors, including drugs, shopping, gambling, sex and alcohol.

Guidelines for drinking:
Follow these guidelines to re-introduce alcohol without compromising your commitment to a healthy lifestyle after weight loss surgery:

• Avoid alcohol for the first six months after bariatric surgery.
• When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers. 
• Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar. 
• Never drink and drive, even after consuming only minimal alcohol. 
• Only drink with meals or while eating to help slow absorption of alcohol. 
• Be aware of the calorie content of alcohol.
• If you find yourself drinking regularly to cope with emotions or stress, seek help by consulting with your doctor.

- Cara Stewart

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Tips for Healthy Holiday Eating After Weight Loss Surgery

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for managing your post-surgical diet during the holidays.

There is no getting around it. Food is a central part of the holiday season. Whether you’re enjoying holiday food with friends and family or inundated with unhealthy treats at the office, it is hard to maintain your healthy eating goals over the holiday season, but it is possible.

These tips can help you stay on track with your post-surgical diet and lifestyle changes while still allowing you to enjoy the holiday festivities.

Don’t skip meals
Always make time for breakfast, lunch and dinner. Going long stretches without eating can lead to eating too much or too quickly and cause nausea or vomiting in people who have had weight loss surgery. It can also result in unhealthy food choices due to overwhelming hunger.

Be selective about food choice
Resist the temptation to try foods that are high in sugar and fat. After gastric bypass surgery, fatty and sugary foods can cause “dumping syndrome,” resulting in severe abdominal pain and cramping, diarrhea, nausea and vomiting. Instead, choose low-calorie party foods such as raw vegetables, fruit with yogurt dip or boiled shrimp with lemon or cocktail sauce.

Stay well hydrated
Stay hydrated by drinking water and low-calorie beverages. Avoid alcoholic beverages and try to separate eating and drinking by 30 minutes.

Keep a food diary
Research* shows that recording what you eat helps you stay on track during the holidays. It also helps you meet your protein and fluid goals. Take a minute each night to record your food and fluid intake for the day.

Click here for more healthy eating tips for you and your family.

- Karen Buzby, RD, LDN


*Cornett R, Akers J, Salva J, Zoellner J, Davy B. Daily self-monitoring during the winter holiday period: a feasible strategy for holiday weight maintenance. SCAN’s PULSE. Fall 2011, Vol 5, No 4: 1 – 6.

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Eat Right When Eating Out

Karen Buzby, RD, LDN, and Cara Stewart, RD, LDN, members of the Penn Metabolic and Bariatric Surgery team, offer these tips for eating healthy when dining out.

Dining out can be a challenge for anyone trying to follow a healthy eating plan, but it is especially difficult if you have had weight loss surgery. Restaurant portions are notoriously large and the meals are often packed with sodium and hidden calories from fats, sugars and sauces. Before weight loss surgery, larger portions may have tempted you to eat more than you wanted or needed. After weight loss surgery, the food may go to waste or cause discomfort. 

The following tips can help you enjoy your meal out while sticking to your diet plan.

Limit calories:

• Be conservative with food selection, especially during the first few months after surgery. Stick with simple prepared foods.
• Before ordering, ask yourself: “Is this food pouch worthy?” Make sure you order foods that are a good source of protein and fiber.
• Look for heart-healthy, low-fat or light options. U.S. Food and Drug Administration (FDA) regulations require restaurants to back up their health claims. Feel free to ask for nutrition information if it is not already provided.
• Stay away from the bread and chip baskets as well as dessert and alcohol menus. Ask the server not bring out the dessert cart. If you choose to eat bread, opt for a small, plain yeast roll and avoid items with added fat like garlic bread, cornbread, croissants and muffins.  
• Salad dressings are often high in calories and fat. Always order dressing on the side and ask for low-fat dressing, a lemon wedge or flavored vinegar instead of the full fat and calorie version. 
• Don’t drink your calories. Quench your thirst with calorie-free drinks like water or unsweetened iced tea. Limit or avoid alcoholic beverages.
• If your job requires socializing or doing business over meals, call ahead or go online to learn about your options in advance. Inform the restaurant manager of your dietary restrictions and make special requests ahead of time if necessary.
• Savor each bite of food, enjoy the company and take your time. Allow at least 20 to 30 minutes for each meal. Remember, conversation is calorie-free!

Control portion sizes:

• Watch your portion size. People who have had bariatric surgery receive a “restaurant card” to request smaller portions when dining out. Use it to make sure your meals are an appropriate size.
• Share a meal or order a smaller portion. This reduces portion size and the expense as well.  
• Order from the lunch menu if it is available. Often the lunch menu offers smaller and less expensive entrees.
• Order from the children’s menu if there are healthy selections available.
• Order an appetizer as a main entrée. The portions of appetizers are usually two to four ounces, which is the ideal meal size after weight loss surgery. 
• Ask the waiter to split the main dish and box half before serving it. You can also request a “doggie bag” as soon as you feel satisfied to avoid the temptation of overeating. 
• Try a tapas restaurant, which serves snack-sized appetizers and entrées.  

Manage leftovers:

• When you take home leftovers, remember to refrigerate the food promptly to avoid food-borne illness. Food left out for more than two hours may not be safe to eat.
• Write the date of purchase or preparation on leftovers and remember to discard the food after three to five days. Always follow the mantra: “When in doubt, throw it out.” Plus, you don’t want your refrigerator to turn into a jungle of leftover containers. 
• Reheat food thoroughly.

- Karen Buzby, RD, LDN and Cara Stewart, RD, LDN

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Ten Easy Ways to Start Eating Better

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, recommends small diet and lifestyle changes for eating healthier and losing weight.

It is helpful to take a step back and assess your eating behavior to make sure you’re on a healthy track. This is particularly important both before weight loss surgery as you’re preparing for significant lifestyle changes, and after as you commit to long-term weight loss.

These simple, easy-to-implement diet and lifestyle changes can significantly improve your overall health and increase your chance for long-term weight-loss success.

1. Plan ahead. If you grab food on the go, dine out often or eat on an irregular schedule, your eating habits might be contributing to your difficulty losing, or even gaining, weight. By planning ahead, you can prepare healthy meals and snacks and avoid the common pitfalls of last-minute food choices. Make a weekly menu and write a grocery list. Be sure to include low-fat dairy, whole-grain products, lean meats, skinless poultry, fish, beans and “nature’s fast foods” - fresh fruit and vegetables.

2. Shop the perimeter of the grocery store. The healthiest food is often located around the perimeter of the grocery store. This includes fresh produce, meat, poultry, fish and dairy products. Next time you go to the grocery store, do the majority of your shopping around the perimeter and avoid the aisles, which frequently contain less nutritional items.

3. Not enough time? Shop online. If do not have sufficient time to shop frequently for fresh food, try ordering your groceries online. Some stores prepare your order in advance so it is ready to pick up when you arrive and others offer home delivery options.

4. Prepare meals at home. Make time to cook. Cooking gives you control over ingredients, preparation and portion size. When cooking, try to simplify your meals by focusing on lean protein, vegetables and salads. If you have a busy weekday schedule, prepare your meals in advance over the weekend.

5. Make time to eat at least three meals a day. Eating regularly decreases the likelihood of grabbing food on the go, making unhealthy food choices and overindulging due to extreme hunger. Carve out time in your everyday life for at least three meals every day.

6. Take your time. Sit down at a table and spend at least 20 minutes eating each meal. Eating too quickly can cause you to ignore feelings of fullness and overeat.

7. Be aware of portion size. Always look at the portion size and calories per serving listed on the nutrition facts label. In general, the more you put on your plate, the more you eat. Use a smaller plate to reduce your food intake.

8. Bring your lunch to work. Whether it is dinner leftovers, a quick tossed salad with a hard-boiled egg or a pre-prepared frozen entrée, bringing your lunch to work saves money, time and calories.

9. Drink calorie-free beverages. Drinks like juice, regular soda, alcoholic beverages, sports drinks and coffee concoctions often contain significant amounts of calories. Eliminate liquid calories that sneak into your diet by choosing diet beverages.

10. Keep a food diary. Record your intake of meals, snacks and beverages for at least one week including the portion size and meal location in a food diary. Bring the food diary with you to your surgical consultation. At the Penn Metabolic and Bariatric Surgery Program, the dietitian reviews your food diary and suggests strategies to improve your eating choices and behaviors.

- Karen Buzby, RD, LDN

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Want to Lose Weight? Don’t Drink Your Calories

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for lowering calorie intake from beverages.

Looking for ways to cut your calorie intake? An easy place to start is with your beverages. Drinks like juice, soda and coffee are often high-calorie and can sabotage your weight loss efforts -- or even contribute to weight gain! Always read the nutrition facts to determine the calories per serving and servings per container before drinking a beverage.

Follow these tips to reduce your liquid calorie intake:

Drink plenty of water – Whether you drink regular or flavored water made from natural fruit essence, it is hydrating, refreshing and calorie-free.

Keep your coffee low-calorie – Black coffee is calorie-free but adding creamer, sugar or flavored syrups can make coffee as caloric as an entire meal! For a healthy but tasty coffee beverage, use nonfat, 1 percent or light soy milk and sweeten it with a teaspoon or single packet of sugar, calorie-free artificial sweetener or sugar-free flavored syrup.

Drink regular or iced tea instead of fruit juice – Fruit juice is high in fructose, a naturally occurring sugar, but home-brewed or diet tea is calorie-free. You can flavor tea without adding a lot of calories by adding a slice of lemon, a splash of fruit juice or fresh mint leaves.

Avoid sodas and sports drinks – These beverages often come in supersized portions and contain large amounts of sugar and empty calories. If you are craving a soda or sports drink, try a diet version to limit your sugar and caloric intake.

Stick to low-fat or nonfat milk - Milk is an excellent source of protein and calcium and a healthy, low-calorie choice. Make sure to select nonfat or 1 percent milk to reduce the fat content.

Try a smoothie – Smoothies made from fruit or low-fat yogurt can be a healthy beverage choice or snack option as long as the ingredients are low-fat and low-sugar.

Cut down on alcohol - Alcoholic beverages are high calorie and dehydrate the body. If you choose to have an alcoholic beverage, make sure you drink in moderation. For women, that means no more than one alcoholic drink a day and for men, it is no more than two alcoholic drinks a day.

- Karen Buzby, RD, LDN

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