Tag: Diet

Pulses & Legumes: An important component of vegetarian diet after bariatric surgery

Post-Bariatric surgery diet demands good quality protein intake. India, is pre-dominantly a vegetarian country, that’s why pulses and legumes become an essential part of the Indian diet, to fulfill daily protein needs. Apart from providing proteins, pulses also exhibit many nutritional values. Pulses are edible fruits or seeds of pod-bearing plants. Various varieties of pulses are available and are being used in various ways. Legumes (rajma, chholey, chana, lobia), husked-whole pulses (moong sabut, masoor sabut and urad sabut dal) and dehusked pulses (moong dhuli, masoor dhuli and arhar dal) are an important part of every Indian kitchen.

Especially in a vegetarian Indian diet, pulses are primary source of protein. The calorie content of pulses per 100g is almost similar to that of cereals but the they give about 20 to 25% protein that is double the amount of protein as compared to cereals. The per 100 g calorie value ranges between 315 to 372 Kcal and protein content ranges from 17 to 25 g/ 100g, legumes are generally rich in proteins and high fibre. Pulses contain calcium, iron, magnesium, zinc, potassium and phosphorus. Legumes are excellent source of B-complex vitamins. Antioxidant level is highest amongst Rajmah and Soyabean. Pulses generally generate low rise of blood sugar, due to their low glycemic index and provide more satiety than cereals due to the high protein content. During sprouting nutritive value is improved. Raw pulses do not contain vitamin C, however, it is synthesized during sprouting, as much as that sprouts can be substituted for fruits. Germination enhances concentration of n-3 and n-6 fatty acids, specially linoleic and linolenic acid and also PUFAs (poly unsaturated fatty acids) like EHA and DHA. Cowpeas (lobia), black gram (urad sabut dal) and Bengal gram (kala chana) helps in lowering high cholesterol levels. Fermentation of pulse based batters, like for idli and dhokla, improves nutritional value by increasing vitamin C and B-vitamins. Fermentation also improves availability of essential amino acids. Phytates present in legumes may play a protective role in reducing colon and breast cancer risk. Isoflavones present in Bengal gram may help reduce serum cholesterol levels if consumed over several weeks. Cluster beans (guar ki phalli) has been shown to reduce plasma cholesterol and improve blood sugar levels, with the help of guargum, a gel forming galactomannan polysaccharide present in it.

One medium katori cooked pulses and legumes provides 4 to 6 g protein and 2 serves should be included daily in the diet. Inclusion of different variations like cooked pulses, sprouts, pan cakes, cheelas, dhokla, kadhi and sambhar can make your daily diet interesting and variety full. Keep control over using oils and fats while cooking pulse based preparations to keep a check on total calorie intake. After bariatric surgery vegetarian patients should use pulses and legumes more frequently to meet protein requirements.

Why Gradual Diet Progression is Advised After Bariatric Surgery

Candidates for bariatric surgery often wonder why there is gradual progression of diet after weight loss surgery?? They ask me why they have to be on liquid diet for first 15 days, and they question me if they have to be on liquids for weight loss then why surgery is required?? It is important to make prospective patients understand that they have a key role in their healing process. They have undergone a major change physically and emotionally. The purpose of dietary phases is to provide appropriate time for proper healing. Also, gradual progression helps decrease acid reflux, provide early satiety, prevent dumping syndrome while maximize weight loss and at the same time should prevent lean body mass during the period of extreme weight loss.

That is why the gradual dietary progression must be adhered strictly in order to support tissue healing, aid in weight loss and to prevent possible complications.

The diet progresses in 4 phases, such as:

•  Clear liquids
•  Full liquids
•  Pureed diet
•  Soft to normal diet

Clear liquids include sugar free, non-aerated liquids which supply fluid and electrolytes and also helps in encouraging the restoration of gut activity after surgery. Patients usually follow this diet post-operatively during hospital stay only, i.e. 1 to 2 days. From the day of discharge, they may start introducing full liquids including skimmed milk, lassi, butter milk, strained veg/dal and chicken soups etc. and continue the same for 2 weeks. Then from week 3 they are advised to take pureed diet consisting of foods that have been blended or liquified to a puree consistency like milkshakes, well cooked and mashed pulses and vegetables, scrambled eggs and grilled fish. They need to be on pureed diet for next 2 weeks. After 4 to 5 weeks of surgery they may gradually progress from soft to normal diet including well cooked foods, avoiding sugary and fatty meals.

The post-surgery diet is designed to restrict calorie intake, as well as to help develop appropriate eating habits and diet behaviour to promote weight loss while maintaining good nutritional status.

The primary nutritional goals and diet behaviour involve:

•  Taking adequate liquids say around 1 to 1 .5 lts to stay hydrated.

•  Consume protein first in each meal to minimize loss of lean body mass and facilitate healing. It is usually difficult to get enough protein through food that is why protein supplements are recommended to meet the needs.

•  Avoid 5 “S”, i.e. Sugar, Spirits, Smoking, Soda and Straw.

Sugar and spirits are avoided to prevent dumping and also to aid weight loss, straw and soda may cause bloating and patients may suffer with stomach discomfort, pain or feeling of fullness. Smoking is prohibited to prevent reflux and marginal ulcers.

Bariatric surgery procedures alter gastro-intestinal tract, hence modifies many food related behaviours such as portion size, perception of taste and smell, likes and dislikes or food choices. Patients are advised and educated to learn new diet behaviours to easily adapt modifications. They should eat at regular intervals, by including 6 to 7 meals a day. They are advised to chew the food very well and eat at a slow pace. Avoid drinking liquids along and for 30 minutes before and after meals as drinking beverages along with meals can cause early satiety and may hinder adequate protein intake. The meals portion should be small to avoid over eating and vomiting.

At our Institute we assess each patient in detail pre-operatively to recognize their nutritional and dietary patterns as well as to evaluate their ability to incorporate nutritional changes after weight loss surgery.

Each patient may have different capacity and appetite to eat; one should listen to his/her body as to when to stop eating. Be definite to abide by the instructions of your surgeon and/or dietitian to reduce your risk of developing malnutrition and surgical complications and all of this will be well worth it!