1. THE SURGERY
The Adjustable Lap Band is a silicone band that is placed around the stomach just below the gastro-esophageal junction. Tubing connects the inner shell of the band to a port where saline is injected to restrict the stoma opening. The band is adjusted based on symptoms that you feel as a patient.
Weight loss is slower with this procedure than other bariatric surgery procedures. The average weight loss is about 1-2 pounds per week.
REQUIRED SUPPLEMENTS
Protein
Protein is a very important part of your diet. It is used to repair and replace damaged tissues. A protein supplement will be required for at least one month after surgery. They can be purchased at drug stores, health food stores or on the Internet. Your goal is between 60-70 grams per day. As your diet progresses you will be able to reduce your use of a supplement, as the foods you will eat will contain protein.
POWDERS- There is a variety of protein powders on the market. These powders are added to your food or made into a “shake”.
LIQUIDS-Protein drinks/shakes seem to be better tolerated. Some of the brands that have been tried are as follows:
2. Pure protein shake-35 grams/can (Body Source-473-3830 or 1-800-854-5019)
VITAMINS- Should be taken for the rest of your life. Start taking them as soon as you get home form the hospital.
Multivitamin
One multivitamin per day (chewable with iron such as Flintstones complete, any adult chewable or bariatric advantage vitamins (www.bariatricadvantage.com)).
Folic Acid- Take 400 milligrams per day.
MINERALS
Calcium- Chewable- 1,000-1,200 milligrams per day
GENERAL NUTRITION GUIDELINES
Alcohol
Alcohol is problematic for several reasons. It is packed with “empty” calories, which will only contribute to total calorie intake, it dehydrates the body, which impacts kidney function and waste removal. We do not recommend alcohol immediately after surgery.
Low Fat
Fat may be difficult to tolerate after surgery. You may experience nausea and bloating after a high fat meal. NO FRIED FOODS. Sometimes the symptoms are similar to those of “dumping syndrome”. Also a high fat food can cause acid reflux or heartburn. Most importantly high fat foods are high in calories, which could slow down your weight loss rate. You do need some fat in your diet (minimum of 20 grams per day). It is better to choose oils (olive, canola), nuts (when you are allowed to eat them), and avoid saturated fats. Ask your dietitian for further details.
Liquids
It can be easy to become dehydrated after Lap-Band surgery because you are only able to sip small amounts of liquid at one time (1-2 ounces at a time). It will be important for you to carry fluid with you throughout your day. The following are guidelines for drinking fluids.
*All fluids should be low calorie and non-carbonated
*Drink fluids between meals NOT with meals. Drinking with meals allows your food to slide down past the band without giving you the sense of fullness.
*Stop drinking 30 minutes before and after you plan to eat a meal.
*Begin by drinking 4-6 ounces slowly between meals and then increase to 8 ounces six times per day.
*Avoid caffeine-containing beverages, as they are appetite stimulants
*If you would like to drink fruit juice, it must be diluted.
Fiber: If you feel hungry soon after a meal or notice your portion sizes have increased, then it is time to add more fiber to your diet.
TIPS FOR OPTIMAL WEIGHT LOSS
YOU MUST LEARN THE GUIDELINES OF YOUR DIET BEFORE SURGERY IS PERFORMED.
1. Take your time while eating or drinking. Allow plenty of time to eat your meal (20-45 minutes).
2. Stop eating at the FIRST sign of fullness. A feeling or pressure or fullness in the center of your abdomen just below your rib cage.
3. Sip at least 48-64oz. of calorie free non-carbonated beverages
4. Wait at between 45 minutes to one hour between eating and drinking
5. Take small bites and CHEW YOUR FOOD WELL. Chew 30 times.
6. Take your vitamins and minerals daily
7. Do not lie down immediately after eating
PORTION SIZES
**If you eat more than you should, you are risking injury to your surgery site, stretching your pouch, and physical discomfort such as bloating and vomiting.**
ADJUSTMENTS
As you know your Lap-Band will need to be adjusted. Some people may need their band adjusted as early as six weeks, others wait longer. If you notice that you have not lost weight, or you no longer have to restrict your meals, you may need an adjustment. Call your surgeon.
DIET PROGRESSION
AT HOME (Day 1-2)
Clear liquids- when you get home you should follow a clear liquid diet. Drink about 2ounces of clear liquids every 20 minutes. Foods that you can have for the first two days include apple, cranberry or grape juice, diet gelatin, clear broth, sugar free water ice and decaffeinated tea. It is good idea to drink out of a medicine cup to help control your portions. A sample meal plan follows:
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Breakfast
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Every 20 minutes
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Lunch
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Every 20 minutes
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Dinner
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2 ounces Apple juice
2 ounces Diet gelatin
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2 ounces of clear liquid
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2 ounces. Broth
2 ounces Sugar free water ice
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2 ounces of clear liquid
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2 ounces Grape juice
2 ounces Broth
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*Try to sip 2oz over a 10-15 minute time period. If you feel full, pain, or nausea stop sipping until the feeling passes.
Examples of clear liquids: Crystal light (sugar free), diet lemonade, Propel, Broth, sugar free Popsicles, sugar free Jell-O, apple juice, water
POST-OPERATIVE DIET (Day 3-5)
Full liquids- Once you are able to tolerate clear liquids you will progress to a full liquid diet. These foods contain protein and vitamins your body needs for healing. Your food is still in liquid form because your stomach is swollen and tender. Continue to drink clear liquids, but now add the following high protein drinks:
Full liquids: skimmed or 1% milk, Lactaid milk, sugar free fudgesicles, strained cream soup, low carbohydrate protein drinks
Sample Meal Plan
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Breakfast
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Snack
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Lunch
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Snack
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Dinner
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Snack
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1/4 cup milk
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1/2 sugar free fudgesicle
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1/4 cup strained cream soup
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1/4 cup of low carbohydrate protein drink
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1/4 cup of milk
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1/4 cup sugar free hot chocolate
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Between each “feeding” drink water and your protein drink. Remember your protein goal is 60-70 grams of protein per day and 36-48ounces of fluid per day.
POST OPERATIVE DIET (Day 5-21)
Blended diet- Foods in this stage should be SMOOTH (no lumps or seeds). Your protein supplement is crucial at this point. During this stage you may have a small frequent meals (i.e. 1/4 cup of low fat milk). Space your meals about three hours apart. A guideline and sample meal plan follows: If you eat solid foods you could create a blockage and be forced to vomit.
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Breakfast
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Snack
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Lunch
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Snack
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Dinner
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Snack
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4-6 oz Cream of Wheat
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4-6 oz. skim or 1% cup milk
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4-6oz cup sugar free strained yogurt
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4-6oz Carnation Instant Breakfast no added sugar
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4-6oz cup low fat strained soup
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4-6oz cup sugar free pudding
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GUIDELINE FOR DAYS 5-21
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Category
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Choose
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Avoid
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Beverages
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Crystal Light, vegetable juice, skim or low fat milk, diluted unsweetened fruit juice, decaffeinated tea
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Soda, fruit drinks, sugar iced tea, alcohol, coffee, tea, and carbonated beverage
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Soups
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Reduced fat cream soup, pureed meat and vegetable soups, broth. All soups must be pureed and lumps strained
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All others
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Starches
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Crackers in soup, oatmeal, cream of wheat, mashed potatoes
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No pasta, rice, French fries, chips, dry cereals, bread, donuts, croissants, biscuits, muffins, popcorn, waffles
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Vegetables
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Pureed vegetables, vegetable juices
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Raw vegetables, lettuce, celery, asparagus
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Fruits
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Unsweetened applesauce, pureed fruit without seeds or skins, mashed banana, unsweetened baby food fruits
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Fresh fruits excluding bananas, dried fruit
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Meat, Protein
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Pureed skinless turkey/chicken breast, white fish (baked or grilled), tuna fish (light mayo), extra lean ground beef, scrambled eggs, refried beans, pureed bean soup
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Fried meats, tough meat, lamb, veal, pork, bacon, breaded meat, sausage, nuts, seeds
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Milk and Milk products
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Low fat milk, plain or sugar free yogurt, Carb control smoothie, low fat cheese or cottage cheese
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Chocolate milk, regular cheese, whole milk
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Others
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Sugar free pudding, custard
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All others
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GROCERY LIST FOR POST OPERATIVE DIET (Day 5-21)
__1% milk
__Plain soymilk
__Plain yogurt
__Sugar free yogurt (smooth consistency-Colombo raspberry, Dannon Key Lime Pie)
__Sugar-free hot chocolate
__Sugar free Popsicles
__Liquid protein supplements
__Low fat cream soup
__Cream of Rice
__Cream of Wheat
__Oatmeal
__Infant strained fruits and vegetables
__Herbal Tea
__Water
__ Carnation Instant Breakfast (No sugar added)
__Crystal Light
__Nonfat dry milk
__Low fat cottage cheese
__Low fat cheese
__Potato (to make mashed potato)
__Eggs
__Saltine crackers
__Tuna Fish (in water)
__Low fat mayonnaise
__Smooth peanut butter
__Plain white fish (flounder)
__Fruit H2O
__Tomato juice/ V-8 juice
__Orange juice (diluted)
__Apple Juice (diluted)
__Pureed soups such as bean, lentil (thin consistency)
__Dannon Carb control smoothie
POST-OPERATIVE DIET (Day 22-35)
Soft Food- After three weeks you can slowly introduce soft foods to your diet, and as soon as you can tolerate soft foods you can introduce solid food. Add solid foods gradually. There will be some foods of which even at 2-3 months after the surgery may still cause some difficulty. (i.e. Red meat, rice, bread)
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Breakfast
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Snack
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Lunch
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Snack
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Dinner
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Snack
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1 egg
1oz of cheese
½ slice toast
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4-6oz sugar free yogurt
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4 Tbsp. Tuna salad
3 saltines
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4-6oz sugar free pudding
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3 Tbsp meatloaf
2 Tbsp. Cooked carrots
1 cube of cantaloupe
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1/3-1/2 cup of Cottage cheese
2Tbsp. Blueberries
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GUIDELINES FOR DAY 22-35
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Category
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Choose
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Avoid
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Beverages
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Crystal Light, coffee, tea, vegetable juice, skim or 1% milk, diluted fruit juice, water,
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Soda, alcohol, fruit drinks, sweetened tea/lemonade, whole milk, milkshake
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Soups
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Reduced fat cream soup, vegetable soups
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Full fat cream soups
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Starches
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Cold (no bran) or hot cereal, saltines, toast, potato, rice
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White bread, bagels, chips, pasta in sauce, fried potatoes, popcorn, high fat crackers
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Vegetables
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Soft cooked vegetables
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Raw vegetables, celery, peas, corn
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Fruits
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Canned fruit (unsweetened), bananas, diluted fruit juice, fresh fruit
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Fresh fruit with tough skins
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Meat, protein
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Soft flaky fish, eggs, low fat cheese, low fat cottage cheese, ricotta cheese, hummus, fat free refried beans, skinless chicken, pork chops, smooth peanut butter, lean ground beef, Tuna fish salad
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High fat cuts of meat, fried meats, ground veal, lamb chops, Canadian bacon, sausage, goose
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Milk and milk products
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Skim or 1% milk, “lite” or plain yogurt, soft cheese, low fat cottage or ricotta cheese
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Chocolate milk, condensed milk, whole milk
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Others
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|
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GROCERY LIST FOR DAY 22-35
__Non fat or 1% milk
__Plain soymilk
__Reduced calorie smooth yogurt
__Plain yogurt
__Sugar-free pudding
__Sugar-free custard
__Protein supplements
__Low fat cream soup
__Soup- including “chunky” and bean
__Cream of Rice
__Cream of Wheat
__Unflavored oatmeal
__Rice (whole grain, brown, wild rice)
__Unsweetened pulp-free juice
__Fresh fruits and vegetables (soft, well cooked)
__Unsweetened applesauce
__ Tuna Salad made with mayonnaise (no celery or onions)
__Minced clams
__Fresh fish (soft and cooked moist)
__Low fat cottage cheese or ricotta cheese
__Eggs (poached, boiled or egg salad)
__Egg Beaters
__Low fat mayonnaise
__Herbal Tea
__Water
__Crystal Light
__Skinless chicken
__Smooth peanut butter
__ Cold cereal (Cheerios)-avoid dried fruit and nuts
__ Whole Wheat toast
__ Lean ground beef (to make meatloaf, meatballs)
__ Cheese (American, Muenster, Feta)
__ Deli meat-Turkey, Ham, Chicken (Avoid Salami, Pepperoni, Pastrami, Bologna, Corned Beef)
SEVEN WEEKS AFTER SURGERY
At this time there are no texture restrictions for your food choices. However, it is recommended that you follow a well-balanced low fat diet with a focus on protein. You can try to introduce raw vegetables, high fiber cereals nuts and seeds into your diet at this time. At this point you should have only three meals with one snack. (Consuming 6 meals per day may slow down your rate of weight loss)
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Breakfast
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Lunch
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Dinner
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Snack
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1-2scrambled eggs
1 slice toast
1tsp. butter
¼ cup low fat yogurt
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3 ounces of Turkey salad
4 Saltines
¼ cup of tomato juice
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3 ounces of Flounder
4 Tbsp. of Rice
¼ cup of soft carrots
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1slice of American cheese
1oz. f whole wheat pretzels
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REMINDERS
1. Eat all your meals. Skipping meals can slow down your metabolism.
2. Plan to eat your meals 5-6 hours apart.
3. Chew your food WELL.
4. Drink liquids throughout the day
5. Choose high quality nutrient rich foods, which will prolong your feeling of fullness.
6. Begin an exercise program
ALWAYS EAT THE PROTEIN IN YOUR MEAL FIRST
Note: This is just a guide. Never force yourself to eat if you are full.
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Meal
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Food
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Calories
|
Gram of Protein
|
|
|
Breakfast
8:00am
|
1 egg or egg substitute made with 2 Tbsp. Cottage Cheese
1 slice Whole Wheat toast
1 tsp. Butter/Margarine
|
75
30
80
45
|
7
3
2
|
|
|
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Total
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230
|
12
|
|
|
|
|
|
|
|
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Lunch
1:00pm
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3 ounces Sliced turkey
1 Tbsp. Light Mayo
½ slice of Whole Wheat Bread
¼ cup of yogurt (plain)
|
105
50
40
28
|
21
1
2
|
|
|
|
Total
|
223
|
24
|
|
|
|
|
|
|
|
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Dinner
5pm
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3 oz. Salmon broiled with lemon
½ cup of cooked vegetables
2 Tbsp of rice
|
232
25
40
|
21
1
1
|
|
|
|
Total
|
297
|
23
|
|
|
|
|
|
|
|
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Snack 8pm
|
1/3 of a peeled apple
2 ounces of low fat cheese
|
30
150
|
14
|
|
|
|
Total
|
180
|
14
|
|
|
|
Daily total
|
930
|
73
|
|
|
|
|
|
|
|
|
|
|
|
|
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Sample Meals after 3 months
REMEMBER>>>>>>Always eat the protein first, vegetable/fruit second and the starch last. Stop when you are satisfied NOT stuffed.
Breakfast ideas:
1. Scrambled egg or eggbeaters with a 1 slice of low-fat cheese and soft cooked vegetables.
2. ½ cup of oatmeal made with skim milk
3. ½ cup whole grain cereal (Kashi, wheaties) with skim milk
4. 1 slice of whole-wheat toast with 1 slice of low-fat cheese or 2 tsp. Smooth peanut butter or 1-2 Tbsp. Low fat ricotta or cottage cheese.
Lunch ideas:
1. ¼ cup tuna/egg/chicken salad with 3-4 crackers
2. 2-3 oz. chicken or fish with ½ cup mixed greens/cooked vegetables an oil/vinegar
3. 2-3 slices of low fat deli meat rolled up with lettuce
4. ¼ cup shrimp/seafood salad on bed of lettuce with 2 tomato slices and 2 whole wheat crackers
5. ¼ cup of turkey chili with 2-3 whole grain crackers
Dinner ideas:
1. 2-3oz. chicken stewed with tomatoes, onion, and peppers. Served with ¼ cup brown rice.
2. 2-3oz. Broiled fish with ¼ cup steamed broccoli and ¼ cup sweet potato
3. 2 small meatballs with tomato sauce, ¼ cup zucchini, ¼ cup pasta
4. 2-3oz. meatloaf served with ¼ cup green beans
Snack ideas:
1. ½ cup sugar free yogurt with ½ cup sliced strawberries/blueberries
2. ½ protein bar (Atkins, pure protein)
3. 1 ounce of low cheese with 2 apple slices
4. 2 tsp smooth peanut butter and 1/3 banana
5. 3 baby carrots with onion dip made with nonfat sour cream.