exam 2

Question 1

Define IBS; discuss etiology, MNT and medical management.

Answer 1

• functional bowel disorder characterized by abdominal pain related to defecation or a change in bowel habit that occurs along with altered bowel habits at least 1 day/wk
• avoid large meals, FODMAPS and gas-producing food; peppermint oil reduces abdominal pain; turmeric may be anti inflammatory; prebiotics+probiotics+synbiotics

Question 2

How does non celiac gluten sensitivity differ from celiac disease?

Answer 2

no known genetic link, more common, often involves T cells and does not need sensitization first (not an adaptive immunity)

Question 3

What is gut dysbiosis and how might it affect IBS?

Answer 3

loss of beneficial microorganisms and biodiversity; increases permeability, less protection from pathogens (tight junctions loosen), nutrient malabsorption, altered motility, increased sensitivity to pain w gas and water in the gut, changes in gut/brain axis, immune changes

Question 4

Define and give example of prebiotics and probiotics

Answer 4

food (typically oligosaccharides) for healthy bacteria; resistant to digestion, hydrolysis and fermentation by colonic microbiota, selective stimulation or growth of one or limited # of bacteria-> beneficial health effects to the host; also can be broken down into SCFAs which are beneficial in decreasing colonic pH, decreased inflammation

Question 5

Discuss/define FODMAPs. Give example of foods eliminated on low FODMAP diet and food included.

Answer 5

fermented oligo, di, monosaccharides and Polyols; induce symptoms of IBS causing an increase in water content due to osmotic effect (distention)

Question 6

Compare a gluten free diet with a low FODMAP diet. Why are wheat, rye and barley eliminated on a low FODMAP diet?

Answer 6

wheat, rye, and barley are gluten containing oligosaccharides eliminated in a low FODMAP diet because they are fructans that are poorly digested or absorbed. a gluten free diet just removes gluten

Question 7

Describe the 3 phases of the low FODMAP diet. Why reintroduce FODMAPs?

Answer 7

• elimination (2-6 weeks remove all high FODMAP foods), reintroduction(6-8 weeks, add subtypes back into diet to identify food triggers), personalization (as needed, add back successfully reintroduced FODMAP foods to expand diet to personal tolerance)
• reintroduction stage is important because Elimination diet reduces bifidobacteria and those that produce SCFA and mucus, Stool pH increases slightly w low FODMAP diet- this may allow pathogenic microbes to grow, and Many FODMAP foods are prebiotic

Question 8

How might FODMAPs trigger pain in IBS.

Answer 8

Cause an increase in water content due to an osmotic effect and increase gas production by colonic bacteria. Thus, FODMAPs induce symptoms to those w IBS and others w functional GI disorders by distension and an osmotic laxative effect

Question 9

Define GERD, its symptoms and etiology.

Answer 9

backwards flow of acidic stomach contents into the esophagus due to reduced pressure of lower esophageal sphincter; symptoms include heartburn, ulcers, scar tissue, and increased salivation; caused by foods/alcohol/caffeine that decreases LES pressure, hiatal hernia, abdominal pressure, vomiting, or delayed gastric emptying caused by high fat diets

Question 10

What are the complications of GERD?

Answer 10

Chronic inflammation can lead to barrett’s esophagus (severe scarring) with premalignant cells and increased risk for esophageal cancer

Question 11

Describe MNT and its rationale for GERD.

Answer 11

• Avoid large high fat meals esp 3-4 hrs before laying down
• Prevent pain and irritation during acute phase by avoiding foods high pH and spices
• Prevent reflux by avoiding foods that cause decrease in LES pressure (High fat foods, alcohol, spearmint & peppermint, chocolate,coffee (regular & decaf))
• Decrease acidity of gastric secretions by Avoiding caffeine, coffee, alcohol, pepper, large meals
• Obesity is highly associated w GERD; weight loss is recommended

Question 12

Outline GERD medical management and drugs for acid
suppression.

Answer 12

• Elevate head of bed
• Avoid smoking
• Drugs: antacids, foaming agents, H2 receptor antagonists- block histamine; proton pump inhibitors (suppress acid production), prokinetics

Question 13

Describe EoE and what groups of people have it.

Answer 13

severe type of food allergy among children and young adults; autoimmune inflammatory response triggered by allergic rxn

Question 14

How is EoE treated?

Answer 14

Empiric (6) food elimination diet: Cows milk, wheat, eggs, soy, legumes/tree nuts, and seafood

Question 15

Review the efficacy of dietary treatment for EoE.

Answer 15

most effective is elemental diet or 6FED; elemental diet is more challenging and restrictive so 6FED is the way to go esp. for children

Question 16

Why can the designation of “medical food” be used for
specialized foods used to treat EoE?

Answer 16

elemental amino acid based diets are used for 90% remission in some clinical spaces

Question 17

Review the structure and function of the stomach including secretions.

Answer 17

fundus, body, antrum (3 sections); gastroesophageal sphincter and pyloric sphincter; 1-3 L/d gastric juice: water, mucus, HCl, enzymes & electrolytes; Parietal cells – HCl & intrinsic factor; Chief cells – pepsinogen & lipase; Enterochromaffin-like cells – histamine

Question 18

What macronutrients undergo digestion and absorption in the stomach?

Answer 18

carbs, proteins, lipids, alcohol start being broken down (fat less so)

Question 19

Review secretion of HCl from gastric parietal cells and acid suppression therapy with PPI for peptic ulcer disease (PUD) and in the ICU. What are nutritional complications of chronic use of PPI?

Answer 19

• HCl activates pepsin, denatures proteins, bacteriostatic, releases b12 from food, and increases calcium and iron solubility
• PPI is used to prevent stress ulcers, but could cause deficiency in b12, calcium, iron

Question 20

Define dyspepsia, gastroparesis and gastritis.

Answer 20

• dyspepsia (indigestion) occurs as a possible result of GERD, gastritis, gallbladder disease or cancer or PUD; could also be caused by stress or diet changes
• gastroparesis: delayed gastric emptying due to damaged vagus nerve which controls peristalsis
• gastritis: inflammation and tissue damage from erosion of mucosal layer of stomach.

Question 21

What causes PUD in most cases? What populations are at risk for H pylori infection and its long term complications if untreated?

Answer 21

H. pylori infection; people with poor hygiene; causes gastric cancer and chronic gastritis; hemorrhage or perforation of pyloric sphincter could occur, leading to required pyloroplasty or vagotomy

Question 22

Describe MNT & underlying rationale for PUD?

Answer 22

diet is not a causative factor for PUD, but to reduce symptoms, reduce intake of foods that increase acid secretion in the stomach, like caffeine, coffee, alcohol, and black/red pepper

Question 23

Why does dumping syndrome occur after gastric surgery? describe the time course of the symptoms.

Answer 23

if patient eats too quickly or too large of a meal, water rushes into the small intestine to dilute osmotic load bc of food entering too quickly into duodenum from stomach (no control of pyloric sphincter)
◼ Early, within 10-20 min of eating: decrease blood volume-weakness, dizzy and rapid heart rate
◼ Intermediate, 20-30 min after eating; abdominal distention, bloating, flatulence, pain, diarrhea
◼ Late, 1-3 hr after eating: reactive hypoglycemia after eating simple CHO due to rapid absorption of glucose and release of insulin

Question 24

Describe MNT and rationale for dumping syndrome.

Answer 24

Small meals spread throughout the day, lying down and avoiding PA to slow gastric emptying, high protein moderate fat complex carbs (avoid simple sugars), no liquids with meals

Question 25

Describe how the anatomy of the SI increases absorptive surface area and how celiac disease may cause malabsorption.

Answer 25

villi inside the lining are folded, and have microvilli on each enterocyte, which have brush border enzymes on them for maximum absorption.

Question 26

Discuss two types of malabsorption – defect in digestion or defect in absorption/transport. Give examples for CD.

Answer 26

defect in digestion: caused by gastric resection, or issues with brush border enzymes or pancreatic enzymes/bile acids defect in absorption/transport: celiac or crohn's, genetic abnormalities, short bowel syndrome, dumping syndrome

Question 27

Define etiology and diagnosis for celiac disease (CD).

Answer 27

inappropriate T cell-mediated immune response caused by gliadin (& secalin and hordein) in genetically predisposed people → chronic inflammation of small intestinal mucosa. * production of IgA antitissue transglutaminase (anti-tTG) and antiendomysial (EMA) and antigliadin (AGA) antibodies; antibodies serve as diagnostic

Question 28

The sensitivity and specificity of tTG antibody testing is 90% and 95%, respectively. What does this mean?

Answer 28

sensitivity: test will correctly identify if someone has the disease specificity: test will correctly identify if someone does NOT have the disease

Question 29

What factors may account for the increasing incidence of CD?

Answer 29

diet, GMOs, and aging population

Question 30

What is gluten and gliadin? What foods contain gluten?

Answer 30

gliadin is a protein in gluten (protein complex) that causes the inflammation; rye, wheat, and barley endosperm contains gluten. gluten stays in the lumen and is resistant to digestion

Question 31

Describe MNT for CD.

Answer 31

* Lifelong gluten free diet = remove all sources of gluten: wheat, rye, barley, malt * Oats, contamination of oats with other grains * Malt is derived from barley * Symptoms improve by 2-8 weeks in 70% cases * May initially restrict lactose (secondary malabsorption) * Restore nutritional status, vitamin-mineral supplement is often needed.

Question 32

What nutrients may be limiting in a gluten-free diet?

Answer 32

fe, b12, folate

Question 33

Review fat digestion and absorption and disorders that may result in fat malabsorption.

Answer 33

fat malabsorption is caused by: - Lack of bile – Liver disease – Biliary tract obstruction, stones or tumors – Ileal dysfunction, ↓ reabsorption bile acids – Small intestine bacterial overgrowth * Pancreatic disease, cystic fibrosis – ↓ lipase * Mucosal damage –impairs fat absorption * Genetic disorders of metab – ↓ chylomicron - staetorhea

Question 34

How is fat malabsorption diagnosed?

Answer 34

72 hour fecal fat test – Consume 100 g of dietary fat per day (LCT) prior to & during fecal collection – Collect all stool/feces for 3 days & analyze for fat content * D-xylose (simple sugar) and Shillings test * Small bowel X-ray with barium swallow

Question 35

Define steatorrhea and discuss its consequences.

Answer 35

– steatorrhea or fat malabsorption occurs when there is >6 g/d of fat in stool – Does not determine cause * Energy loss, up to 40 g fat/day = 360 kcal * Diarrhea – watery stools ≥ 3 times per day * ↓absorption of fat soluble vitamins & calcium * Calcium oxalate nephrolithiasis * Abdominal pain, cramping, diarrhea

Question 36

Describe MNT for steatorrhea

Answer 36

Restrict intake of long chain triglyceride, LCT * Provide fat/energy with MCT – Contain medium chain fatty acids – 6-12 carbons – Mostly consist of TAG with fatty acids of 8 & 10 carbons in length – provide 8.3 kcal/g MCT * Oral lipase supplement, used in cystic fibrosis * Treat deficiencies of fat soluble vitamins with special water soluble formulations.

Question 37

Define MCT and contrast its digestion and absorption with LCT.

Answer 37

Medium chain triglycerides are absorbed directly into the bloodstream without being processed through the lymphatic system like LCT

Question 38

Why is steatorrhea associated with renal calcium oxalate stones?

Answer 38

* Limit oxalate to < 50 mg/d; avoid ↑ oxalate foods: spinach, rhubarb, beets, black tea, chocolate, wheat bran, almonds, cashews & peanuts * Ca at each meal (150 mg) to bind oxalate * Low fat diet <30% energy from fat * Avoid large Vitamin C supplements - oxalate binds to calcium but when fat sits in the intestine it reacts with calcium, causing oxalate build up

Question 39

Define small intestine bacterial overgrowth. What causes it and how does it affect nutritional status?

Answer 39

Cross contamination of bacteria from colon → SI due to weak ileocecal valve, fistula, IBS, or bariatric surgery – Bacteria deconjugate bile acids = toxic to mucosa and ↓ micelle formation → steatorrhea→ poor absorption of fat soluble vitamins – CHO malabsorption→ when bacteria ferment lactose – Bacteria use thiamin and vit B12 for their own growth

Question 40

Define fistula, how might it cause bacterial overgrowth.

Answer 40

abnormal opening of the GI tract (stomach or SI) that leaks, cells join between intestinal walls or goes through skin; because of this additional opening, attracts harmful bacteria

Question 41

Review the 6 GI sphincters and MNT for nutritional disorders associated with each sphincter.

Answer 41

Upper esophageal sphincter (dysphagia), Lower esophageal sphincter (GERD), pyloric(dyspepsia, gastroparesis, dumping syndrome), ileocecal (IBS), internal anal and external anal

Question 42

How do prebiotics and probiotics exert benefits in the MNT of diarrhea?

Answer 42

- prebotics Replenish gut microbiota depleted by diarrhea –↑ short chain fatty acids (SCFA, <6C): * Decrease luminal pH=< favorable for pathogens * Energy source for colonocytes * Promotes absorption of water & electrolyte - probiotics: live organisms that when administered in adequate amounts confer a health benefit to the host (Expert Consensus Statement, 2014). * Fermented foods provide safe, time-tested sources * Probiotic Literature: probiotic benefits are strain-, dose and disease-specific. * Most studied with strong evidence: – antibiotic-associated diarrhea, Saccharomyces – colitis, Bifodobacterium and Lactobacillus – necrotizing enterocolitis in preterm infants, Bifodobacterium

Question 42

What are food sources of prebiotics and how do they relate to FODMAP foods.

Answer 42

foods that are not digestible by enzymes in the small intestine travel to the large intestine to feed the microflora and they break them down for our body to absorb those nutrients or excrete them. FODMAPs are these fermentable carbohydrates and polyols

Question 42

Why might probiotic therapy be used in conjunction with a low FODMAP diet?

Answer 42

probiotic supplementation prevents the complete destruction of microbiome in the elimination phase of the Low fodmap diet (i.e. bifidobacterium supp.)

Question 42

Discuss the evidence base for the use of probiotics.

Answer 42

very disease/dose specific - antibiotic-associated diarrhea, Saccharomyces – colitis, Bifidobacterium and Lactobacillus – necrotizing enterocolitis in preterm infants, Bifidobacterium

Question 42

What are emerging connections between the gut microbiota, diet and health?

Answer 42

obesity is associated with gut dysbiosis in general and an overall lack of gut microbiome diversuty

Question 43

What constitutes a healthy gut microbiota?

Answer 43

variety of bacteria

Question 44

How does Covid-19 affect the GI tract?

Answer 44

Viral diarrhea occurs in COVID patients: invades GI tract via angiotensin converting enzyme 2 (ACE-2) and is found in the feces of COVID patients

Question 45

Describe screening, risk factors & treatment for colon cancer.

Answer 45

colonoscopy; polyps are precancerous; risk factors include Family history. IBD, consumption of Red meat and processed meats ,^ Whole grains, Ca, decreased. Vit D

Question 46

Define IBD and discuss potential mechanisms for causation.

Answer 46

crohn's disease or Ulcerative colitis; autoimmune chronic inflammation of the GI tract (LI into the ileum)

Question 47

Compare and contrast the pathophysiology of Crohn’s disease and ulcerative colitis.

Answer 47

CD: patches throughout the colon, can get to ileum; thickening of tissue UC: usually continuous, starting at the rectum and continuing up through sigmoid colon; thinning and ulcers

Question 48

How does IBD increase the risk for malnutrition?

Answer 48

inflammed and scar tissue of enterocytes causes malabsorption; "Fat malabsorption (Crohn’s) due to Loss of gut SA bc of inflammation or resection Depletion of circulating bile salt pool, terminal ileum B-12 malabsorption in distal ileum (Crohn’s) Exudative diarrhea- enteric leakage of protein, blood/iron, Zn, Se, electrolytes (both) Potential drug nutrient interactions (both) Aminosalicylates reduce folate absorption Corticosteroids cause Dec. Calcium retention Protein wasting ^ blood glc Prednisone decreases folate absorption"

Question 49

Review MNT for IBD and the use of exclusive or partial enteral nutrition.

Answer 49

Goals: Restore and maintain nutritional status Control symptoms, induce and maintain remission Personalized nutrition Individually tailored diet Ppl w IBD at increased risk of malnutrition Timely nutritional support to prevent malnutrition Parenteral feeding if obstructions, fistulas, severe disease or major GI resections (otherwise tube feed) Feeding into the GI tract is preferred High protein and kcal-protein needs may ^ 50% Low fat, maybe use MCT Low lactose Low fiber if lumen narrowing Vitamin-mineral supp. Are essential

Question 50

What micronutrients are of special concern in IBD and why?

Answer 50

b12, iron, magnesium, calcium and vitamin D, folate; mostly due to GI surgeries or lower intake due to pain associated with energy intake

Question 51

What does the 2017 Gastroenterology article teach about “diet as a trigger for IBD”?

Answer 51

Exclusive enteral nutrition With elemental, semi-elemental and defined formula diets helps children w crohn;s and reduces inflammation and dysbiosis EEN as bridge therapy for Crohn’s disease to dec. drugs Partial enteral nutrition may be useful w a flare up of disease High intake of red meat, protein, alcohol, and sulfate increases risk of flare-up Vit D, soluble fiber, curcumin (from turmeric) may ^ efficacy of IBD therapy Emulsifiers from processed food may increase risk of IBD based on animal studies Effect of low fodmap diet in patients w quiescent IBD Greater relief of gut symptoms - decreases bloating and increases quality of life Decreased bifidobacterium that synthesize SCFA and regulate immune response

Question 52

How does the FODMAPs diet affect IBS symptoms based on the randomized trial from 2020; 158:176-88 Gastroenterology

Answer 52

overall improves symptoms; especially improves microbiome status if supp. of bifidobacterium probiotic included

Question 53

Define diverticular disease and discuss its etiology.

Answer 53

Chronic insufficient bulk Long term increased colonic pressures Rare in countries w lifelong high fiber diet

Question 54

describe MNT of diverticulosis compared with diverticulitis.

Answer 54

Between attacks, diverticulosis- high fiber diet During flare ups (diverticulits) low fiber diet Low fat diet will also decrease intensity of colonic smooth muscle contractions and help control pain Transition from low fiber diet to high fiber diet is best w slow addition of fiber and ample fluid (2-3 liters)

Question 55

Describe the treatment of constipation.

Answer 55

Adequate fiber- 25 g/d women and 38 g/day men Regular meals Adequate fluid- 2 or 3 L/day Regular evacuation times Exercise Impactions may require meds, large amts of fluids, enemas or digital disimpaction

Question 56

Define short bowel syndrome and intestinal failure. Why does it occur and how does it’s etiology differ in adults vs children?

Answer 56

Home Parenteral Nutrition- expensive Side effects: sepsis and liver failure Drugs- decreased GI motility and secretion Intestinal transplantation New drug: teduglutide, a GLP-2 analog, shows promise to decrease need for PN post-OP MNT after Bowel Resection PN+ restore and maintain nutrient status EN= start early and increase feeding gradually etiology in children includes most genetic diseases, most adult etiology related to chronic disease

Question 57

Why does postoperative MNT after bowel resection encourage early oral feeding?

Answer 57

The presence of food in the intestines provides a stimulus to the residual bowel to grow and increase functional capacity to digest and absorb nutrients

Question 58

Describe MNT for SBS depending on whether there is residual colon present.

Answer 58

MNT for SBS IF colon is present Increase complex carbohydrates and prebiotics -> SCFA Decrease fat; MCT supplementation Decrease dietary oxalate (leafy greens, sweet potato, etc.) 5-6 meals/day Lactose (as tolerated) MNT if no colon present Supplement PN with small amt of oral feeding Decrease CHO (40-50%), increase fat 30-40%, protein 20% Oxalate is not a problem bc there is no colon to absorb Vit b12 injections monthly Individualize lactose restriction Oral rehydration solution

Question 59

Describe the traditional approach to postsurgical diet progressions after abdominal/intestinal surgery and the controversy regarding this approach.

Answer 59

Clear liquids Purpose is to supply fluid and energy in a form that requires minimal digestion and stimulation of the GI tract Composition: water and carbohydrates Inadequate in cals and essential nutrients Limit to 24-48 hours Foods: broth, tea, clear fruit juices, gelatin, and carbonated beverages Full liquids Purpose: transition between clear liquids and solid food; used for patients who are unable to chew, swallow, or digest solid food Comp: foods that are liquid or semi-liquid at room temp clear liquids, cream soups, milk, pudding, ice cream, yogurt May present problem with large amounts of lactose

Question 60

Describe and contrast the efficacy of various approaches to treat obesity.

Answer 60

Lifestyle modifications Medication Endoscopic bariatric therapies (non-invasive stomach size reduction)

Question 61

Describe 2 types of endoscopic bariatric therapy.

Answer 61

- Intragastric balloon Delays gastric emptying and occupies gastric space Clinical cases show 15% Total body weight loss Symptoms: nausea, vomiting, abdominal pain, reflux Rare effects include esophageal tear, ulcer, aspiration, pneumonia or obstruction/migration of balloon - Aspiration therapy Percutaneous gastrostomy tube connects to aspire assist device; siphons off 25-30% of calories (2-3x a day) Accounts for 50-80% of weight loss 14% TBWL at 1 year Early removal rate of 26%, complicated challenging therapy

Question 62

Contrast the indications, complications and ability to promote long term weight loss for sleeve gastrectomy compared with Roux-en-Y gastric bypass.

Answer 62

- Vertical sleeve gastrectomy Safer, easier, more common and less costly than gastric bypass Lower long-term weight loss compared with gastric bypass 7 yrs post surgery, patients has 24% wt loss Removes 85% stomach; remain is size and shape of banana Decreases amt of food u can eat at one time No rerouting of intestines; decreased risk for nutritional deficiencies Preferred bariatric surgery for patients without comorbidities of obesity - Roux en Y gastric bypass most studied for long-term effects on diabetes and cardiovascular disease morbidity Lose 60-80% excess weight Most effective for patients with T2DM and GERD Expensive AF; Costs ~30K, often out of pocket; insurance is starting to cover the cost of this procedure Constructs a small stomach pouch and creates an outlet directly to the jejunum

Question 63

Explain the surgical procedure and re-routing of the intestines with Roux-en-Y bypass.

Answer 63

attachment of jejunum of intestine to fundus of stomach just below the lower esophageal sphincter

Question 64

Why does weight loss occur with the Roux-en-Y bypass?

Answer 64

decreased caloric intake or malabsorption; 3500 cals-> 1300kcal/day or malabsorption of 130kcal/day secretion through fecal matter (higher cals lost if jejunum is attached further away)

Question 65

What are the medical complications and nutritional implications of Roux-en-Y Bypass?

Answer 65

- complications: abdominal pain, nausea, vomiting,dumping syndrome most common; calcium oxalate kidney stones, gallstones (prevented by treating patients with bile acid binding medication); herniation, bleeding, short bowel syndrome - nutrition implications: Since we bypass most of the stomach, were also bypassing the functions: iron, calcium, b12 absorption, folate and b6 also Protein not malabsorbed bc intestine adapts

Question 66

Long term, why is food intake reduced leading to weight loss after Roux-en-Y gastric bypass?

Answer 66

pain in eating too much, nutrient malabsorption, lifestyle changes

Question 67

What are the actions of StuGLP-2?

Answer 67

stimulates intestinal growth; regulates gastric motility, gastric acid secretion, intestinal hexose transport, and increases the barrier function of the gut epithelium.

Question 68

Define incretin hormone.

Answer 68

GI hormones, specifically GLP-1 and GIP or gastric inhibitory polypeptide, that mediate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells by a blood glucose-dependent mechanism.

Question 69

Describe the actions of GLP-1 after Roux-en-Y gastric bypass and the use of GLP-1 receptor antagonists to treat Type 2 diabetes.

Answer 69

After a meal, GLP 1 levels increase after bypass; fasting levels are unchanged

Question 70

Why does a shorter Roux limb length produce a greater increase in GLP-1 levels and greater wt loss?

Answer 70

Shorter Roux limb length (jejunum attached more distally) produces a greater increase in postprandial GLP1 levels and greater weight loss because inhibit glucagon secretion slows gastric emptying increases satiety/fullness

Question 71

What does the August 2020 NEJM study conclude about the cause of improved insulin sensitivity after Roux-en-Y bypass in patients with Type 2 diabetes?

Question 72

Review nutritional recommendations for patients given Roux-en-Y bypass surgery presurgery, postsurgery and lifelong.

Answer 72

Presurgery nutritional assessment by RDN, diet and vitamin/mineral supplementation Preop weight loss to reduce liver volume to make procedure safer for patient Common deficiencies= vit b12, thiamin, iron, folic acid, vitamin D Small intestine bacterial overgrowth is common w obesity and bariatric surgery Posturgery diet progression Liquids no more than ½ cup 1-2 week pureed diet soft diet at wk 2 2 months post-op= regular diet Eating behaviors: 3-5 small meals/day; avoid grazing and liquid diets; emphasize protein Nutrition for common GI symptoms like dumping syndrome, dysphagia, vomiting, and dehydration Recommend lifelong vitamin/mineral supplementation and nutritional follow up Gastric bypass diet Stomach pouch holds only 1-2 oz Maximum size of meal is 8 oz Water between meals never with 3-5 meals per day, protein first Avoid concentrated sweets Stop eating with first sign of fullness Vitamin and mineral supplement

Question 73

List 5 bullet points for the post-op gastric bypass diet at 1 month after surgery.

Answer 73

soft foods and protein shakes; no water with meals, supplement vitamins. avoid grazing, whey protein isolate