VLED program. What is a VLED? Will I be hungry? Potential side effects. Adjusting medication

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1 VLED program What is a VLED? A VLED (Very Low Energy Diet) program provides protein, vitamins and minerals with a reduced energy (kilojoule) intake for weight loss. A VLED product can be used to replace one, two or three meals each day, depending on your weight loss goals and lifestyle. VLED products are not intended to be consumed in addition to a meal. The program works by restricting your body of its preferred energy source, carbohydrates. The body is then required to use body fat for energy, achieving weight loss. A prescribed VLED program will provide adequate protein to reduce muscle loss. Will I be hungry? You may feel hungry for the first four days, after which time hunger should reduce, especially if you are replacing three meals per day with VLED products. Once the carbohydrate intake is reduced and fat stores are used for energy, ketones are produced in the body. Ketones help suppress appetite. Replacing one or two meals may not reduce carbohydrate intake enough to produce ketones. Therefore the effect on appetite reduction can be less. Potential side effects Most commonly people may experience an initial fatigue, breath odour and constipation. Chewing sugar free gum or mints or drinking peppermint tea can assist with breath. Including a fibre supplement such as Metamucil, Benefibre or psyllium husk may support regular bowel function and increase your feeling of fullness. Contact your treating doctor if you experience any of the following, less common, side effects: Sensitivity to cold Muscle cramp Dry skin or skin rash Menstrual disturbance Hair loss Frequent headache Adjusting medication Some people may require an adjustment to current medication before commencing or while completing a VLED program. Discuss this with your treating doctor especially if you are taking medication which may cause low blood glucose levels or lower blood pressure.

2 Recommended VLED products Optifast Shakes: Banana, Caramel, Chai, Chocolate, Coffee, Strawberry, Vanilla Bars: Berry Crunch, Cappuccino, Cereal, Chocolate Soups: Chicken Flavour, Tomato, Vegetable Desserts: Chocolate, Lemon Crème Purchase: Online: Stores: AMCAL, Chemist Warehouse Optislim (Classic formula, NOT Platinum, Life or Optiman) Shakes: Banana, Chocolate, Espresso Coffee, Strawberry, Vanilla Bars: Caramel Crunch, Choc Berry Crunch, Choc Fudge Soups: Chicken, Pumpkin, Tomato Purchase: Online: Stores: Chemist Warehouse Proslim (Standard formula, NOT Rapid) Shakes: Chocolate, Espresso, Strawberry, Vanilla Bars: Berry Crunch, Caramel Crunch, Cookies & Cream, Mocha Soups: Creamy Chicken, Creamy Pumpkin, Tomato Purchase: Online: Stores: Priceline, Discount Drug Store Adapting VLED products for variety Shakes Mix powder with ml water (rather than the directed 200ml) for extra volume. Add ice-cubes and blend to make a slushie. Add flavoured essence, spice or instant coffee for variety (e.g. mint essence or coffee to a chocolate shake, rosewater or cinnamon to a vanilla shake). Blend with low-carbohydrate berries or vegetables to create a smoothie (e.g. frozen raspberries to a banana flavoured shake or spinach leaves to a vanilla shake). Bars Break one bar into half or thirds and eat as snacks with a cup of tea or coffee across the day or evening (note: this still counts as 1 VLED serve for the day). Soups Add low-carbohydrate vegetables to increase fibre and soup volume. Puree soup with low-carbohydrate vegetables to create a thick, smooth texture. Add konjac noodles (e.g. Changs Super Low-Cal or Slendier Calorie Clever) to increase fibre and soup volume. Add herbs or spices for additional flavour such as pepper, paprika, chilli, parsley or cumin. Desserts Add strawberries or fresh passionfruit or flavoured essence for variety (e.g. lemon crème with passionfruit or chocolate with coconut essence). Once prepared, freeze desserts for an ice-cream / granita like texture. Add 1 Tablespoon of chia seeds and leave to set overnight for extra fibre and a thickened texture.

3 VLED Replacing 3 meals per day Using a VLED to replace three meals per day is the most intensive of the VLED phases. During this phase, in addition to 3 x VLED products, only low-carbohydrate vegetables, some berries or passionfruit, some artificially sweetened products and low-energy (kj) fluids can be consumed. This phase is most likely to achieve the greatest rate of weight loss and is the phase most people are advised to follow before bariatric surgery. Depending on individual requirements, some people may be instructed to use 4 x VLED/day or include an additional protein serve to achieve nutritional adequacy. Example daily meal plans Breakfast Snack Lunch Snack Dinner Snack VLED shake Vegetable snack VLED bar & salad Strawberries Vegetable stir-fry & konjac noodles VLED dessert & raspberries Breakfast Snack Lunch Snack Dinner Snack VLED dessert & berries ½ VLED bar tea/coffee* Steamed mix vegetables ½ VLED bar tea/coffee* VLED soup & vegetables Diet jelly * Tea and coffee can be served black or with a dash of milk no milk based tea/coffee (e.g. chai latte or café latte) How long should I use 3 x VLED per day? This phase commonly lasts for 2 12 weeks, depending on weight loss goals and personal preference. Some people may benefit from an extended time period. Discuss this with your dietitian. The expected rate of weight loss is variable between people, but is usually kg per week.

4 Additional food and drink choices VLED 3 per day Fluid Aim for at least 2 litres per day Vegetables Aim for 2 or more cups per day Fats and Oils Enjoy Water tap, mineral, soda Vegetable Juice tomato, V8, green blend (no fruit) Coffee, Tea black or with dash of milk (no sugar) Diet cordial, Diet soft drink Lower carbohydrate vegetables: Alfalfa sprout Celery Onion Asian greens Cucumber Radish Asparagus Eggplant Rocket Bean shoot Fennel Snow pea Broccoli Green Bean Spinach Brussel sprout Kale Silver beet Cabbage Lettuce Squash Capsicum Mung bean Tomato Carrot Mushroom Zucchini Cauliflower Okra Suitable examples: 1 tablespoon of extra virgin olive oil OR canola oil OR 3 tablespoons avocado OR 30g nuts Avoid Milk, Fruit juice, Regular cordial, Regular soft drink, Alcohol Higher carbohydrate vegetables: Corn, Potato, Sweet potato, Peas, Pumpkin, Lentils / Legumes Butter, Cream, Coconut oil, Coconut cream, Mayonnaise Fruit Blackberries, Strawberries, Passionfruit, Raspberries All other fruit Bread, Cereal and Grain Konjac noodle, Rice, Pasta (e.g. Slendier Calorie Clever) Empower Power Wrap (1 per day) Vegetable alternatives to rice, noodle and pasta: cauliflower rice OR shredded cabbage noodles OR zucchini ribbon pasta OR Kelp noodles Bread, Cereal & Grain foods (e.g: Bread, Crackers, Oats, Cereal,Rice, Noodles, Pasta, Couscous, Quinoa, Freekeh) Dairy Dash of milk in tea or coffee Milk, Yoghurt, Cheese Protein Discuss individual requirements with your Dietitian Fatty meat, Processed meat, Chicken skin Stock, Sauce, Condiment, Pickle Capers Clear stock / broth Dill cucumber Fish sauce Kimchi Lemon juice and zest Mustard Olives (x10) Pickled onion Sauerkraut Seaweed / nori Soy sauce (unsweetened) Tomato paste Vinegar Worcestershire sauce Sweet chilli sauce, Tomato sauce, BBQ sauce, Stir-Fry sauce, Sweetened chutney

5 Herbs & Spices Other Enjoy All fresh and dried herbs and spices (e.g. parsley, coriander, cumin, oregano, cinnamon) All fresh or dried Garlic, Ginger, Chilli, Lemongrass Equal, Splenda, Natvia Sugar free maple syrup, Matcha green tea powder Sugar free lollies, Mints and Gum (e.g. Extra, Jols, DDs) Diet jelly Avoid Cinnamon sugar, Vanilla sugar, Seasoning blends with added sugar Sugar, Honey, Chocolate, Lollies, Ice cream, Custard, Cake, Biscuit, Muffin

6 VLED replacing 2 meals per day Using a VLED to replace two meals a day allows for flexibility with the inclusion of one meal per day. Some people find this option better suits their work, social or family commitments. Which two meals you choose to replace with a VLED can be changed day to day. In addition to 2 x VLED products, low-carbohydrate vegetables and low-energy (kj) fluids, the following is suggested: one balanced meal one serve of fruit one serve of dairy Discuss personalised options with your Dietitian as some people may benefit from a modified version of this plan. Example daily meal plans Breakfast Snack Lunch Snack Dinner Snack VLED shake x1 fruit VLED bar & salad Vegetable snack Grilled chicken, vegetables, 2/3 cup rice 200g yoghurt Breakfast Snack Lunch Snack Dinner Snack 1 cup chopped fruit ½ VLED bar 4 Ryvita, 40g cheese, vegetables ½ VLED bar Asian style vegetable broth with konjac noodle VLED dessert and berries How long should I follow 2 x VLED per day? This phase commonly lasts 4 12 weeks, depending on weight loss goals and personal preference. Some people may commence a VLED program using 2 x VLED/day. Other people may transition to this phase after following 3 x VLED/day plan.

7 Additional food and drink choices VLED 2 per day Fluid Aim for at least 2 litres per day Vegetables Aim for 2 or more cups per day Enjoy Water tap, mineral, soda Vegetable juice tomato, V8, green blend (no fruit) Coffee, Tea black or with dash of milk (no sugar) Diet cordial, Diet soft drink *1 serve milk as part of dairy allowance 1 serve = 250ml reduced fat dairy or soy milk Lower carbohydrate vegetables: Alfalfa sprout Celery Onion Asian greens Cucumber Radish Asparagus Eggplant Rocket Bean shoot Fennel Snow pea Broccoli Green Bean Spinach Brussel sprout Kale Silver beet Cabbage Lettuce Squash Capsicum Mung bean Tomato Carrot Mushroom Zucchini Cauliflower Okra Avoid Milk*, Fruit juice, Regular cordial, Regular soft drink, Alcohol Higher carbohydrate vegetables*: Corn, Potato, Sweet potato, Peas, Pumpkin, Lentils / Legumes *Optional 1 serve carbohydrate vegetable at 1 main meal as the carbohydrate choice 1 serve = 1 small potato OR 1 cob corn OR 1 cup peas OR 1 wedge pumpkin OR ½ cup cooked lentils Fats and Oils Suitable examples: 1 tablespoon of extra virgin olive oil OR canola oil Butter, Cream, Coconut oil, OR 3 tablespoons avocado OR 30g nuts Coconut cream, Mayonnaise Fruit Blackberries, Strawberries, Passionfruit, Raspberries All other fruit* Protein *1 serve higher carbohydrate fruit per day 1 serve = 1 large fruit (e.g. 1 orange) OR 2 small fruit (e.g. 2 mandarin) OR 1 cup chopped fruit 1 serve per day of lean protein Discuss individual requirements with your Dietitian 1 serve = 2 eggs OR 100g Tofu OR 100g raw lean meat OR skinless chicken OR 150g raw fish OR 75g canned fish Fatty meat, Processed meat, Chicken skin

8 Bread, Cereal and Grain Dairy Stock, Sauce, Condiment, Pickle Herbs & Spices Other Enjoy Konjac noodle, rice, pasta (e.g. Slendier Calorie Clever) Empower Power Wrap (1 per day) Vegetable alternatives to rice, noodle and pasta: cauliflower rice OR shredded cabbage noodles OR zucchini ribbon pasta OR Kelp noodles *Optional 1 serve at 1 main meal as the carbohydrate choice 1 serve = 1 2 slices bread OR 1 wrap OR 4 8 crispbread OR ½ cup oats OR ¾ cup cereal OR ½ cup cooked rice OR grain OR pasta Option: Herman Brot Lower Carb bread, pasta, muesli (note: energy (kj) is similar to regular varieties) 1 serve per day of Milk or Yoghurt or Cheese 1 serve = 250ml milk OR 200g yoghurt OR 40g hard cheese OR 80g cottage / ricotta Capers Clear stock / broth Dill cucumber Fish sauce Kimchi Lemon juice and zest Mustard Olives (x10) Pickled onion Sauerkraut Seaweed / nori Soy sauce (unsweetened) Tomato paste Vinegar Worcestershire sauce All fresh and dried herbs and spices (e.g. parsley, coriander, cumin, oregano, cinnamon) All fresh or dried garlic, ginger, chilli, lemongrass Equal, Splenda, Natvia Sugar free maple syrup, Matcha green tea powder Sugar free lollies, mints and gum (e.g. Extra, Jols, DDs) Diet jelly Avoid Bread, Cereal and Grain foods* (e.g: Bread, Crackers, Oats, Cereal, Rice, Noodles, Pasta, Couscous, Quinoa, Freekah) Sweet chilli sauce,tomato sauce, BBQ sauce, Stir-Fry sauce, Sweetened Chutney Cinnamon sugar, Vanilla sugar, Seasoning blends with added sugar Sugar, Honey, Chocolate, Lollies, Ice cream, Custard, Cake, Biscuit, Muffin

9 VLED replacing 1 meal per day Using a VLED to replace one meal a day is most common after people have completed 2 x VLED per day phase. However some people may use 1 x VLED per day as a way to manage one particular meal time they find challenging (e.g. as a quick breakfast option or evening meal when arriving home late). Which meal you choose to replace with a VLED can be changed day to day. In addition to 1 x VLED product, low-carbohydrate vegetables and low-energy (kj) fluids, the following is suggested: two balanced meals (see page 12) two serves of fruit one serve of dairy Discuss personalised options with your Dietitian as some people may benefit from a modified version of this plan. Example daily meal plans Breakfast Snack Lunch Snack Dinner Snack VLED shake 1 small banana Tuna and salad wrap 200g yoghurt Steak, 1 potato mashed, vegetables 1 cup chopped fruit Breakfast Snack Lunch Snack Dinner Snack Poached eggs, tomato, spinach, 1-2 toast Small milk coffee VLED Soup flavoured with extra herbs Apple Fish, mixed vegetables, 2/3 cup quinoa Diet jelly and fruit How long should I follow 1 x VLED per day? This phase commonly lasts 4 12 weeks, depending on weight loss goals and personal preference. Some people may choose to use this phase intermittently for convenience or to assist weight loss maintenance in the longer term.

10 Additional food and drink choices VLED 1 per day Fluid Aim for at least 2 litres per day Vegetables Aim for 2 or more cups per day Enjoy Water tap, mineral, soda Vegetable juice tomato, V8, green blend (no fruit) Coffee, Tea black or with dash of milk (no sugar) Diet cordial, diet soft drink *1 serve milk as part of dairy allowance 1 serve = 250ml reduced fat dairy or soy milk Lower carbohydrate vegetables: Alfalfa sprout Celery Onion Asian greens Cucumber Radish Asparagus Eggplant Rocket Bean shoot Fennel Snow pea Broccoli Green Bean Spinach Brussel sprout Kale Silver beet Cabbage Lettuce Squash Capsicum Mung bean Tomato Carrot Mushroom Zucchini Cauliflower Okra Avoid Milk*, Fruit juice, Regular cordial, Regular soft drink, Alcohol Higher carbohydrate vegetables*: Corn, Potato, Sweet potato, Peas Pumpkin, Lentils / Legumes Fats and Oils *Optional 1 serve carbohydrate vegetable at 1 2 main meals as the carbohydrate choice 1 serve = 1 small potato OR 1 cob corn OR 1 cup peas OR 1 wedge pumpkin OR ½ cup cooked lentils Suitable examples: 1 tablespoon of extra virgin olive oil or canola oil OR 3 tablespoons avocado, PLUS 30g nuts Butter, Cream, Coconut oil, Coconut cream, Mayonnaise Fruit Blackberries, Strawberries, Passionfruit, Raspberries All other fruit* *1 serve higher carbohydrate fruit per day 1 serve = 1 large fruit (e.g. 1 orange) OR 2 small fruit (e.g. 2 mandarin) OR 1 cup chopped fruit Protein 1 serve lean protein at 1 2 meals per day Discuss individual requirements with your Dietitian. 1 serve = 2 eggs OR 100g Tofu OR 100g raw lean meat OR skinless chicken OR 150g raw fish OR 75g canned fish Fatty meat, Processed meat, Chicken skin

11 Bread, Cereal and Grain Dairy Enjoy Konjac noodle, rice, pasta (e.g. Slendier Calorie Clever) Empower Power Wrap (1 per day) Vegetable alternatives to rice, noodle and pasta: cauliflower rice OR shredded cabbage noodles OR zucchini ribbon pasta OR Kelp noodles *Optional 1 serve at 1 main meal as the carbohydrate choice 1 serve = 1 2 slices bread OR 1 wrap OR 4 8 crispbread OR ½ cup oats OR ¾ cup cereal OR ½ cup cooked rice OR grain OR pasta Option: Herman Brot Lower Carb bread, pasta, muesli (note: energy (kj) is similar to regular varieties) 1 serve per day of Milk OR Yoghurt OR Cheese 1 serve = 250ml milk OR 200g yoghurt OR 40g hard cheese OR 80g cottage / ricotta Avoid Bread, Cereal and Grain foods* (e.g: Bread, Crackers, Oats, Cereal, Rice, Noodles, Pasta, Couscous, Quinoa, Freekah) Stock, Sauce, Condiment, Pickle Capers Clear stock / broth Dill cucumber Fish sauce Kimchi Lemon juice and zest Mustard Olives (x10) Pickled onion Sauerkraut Seaweed / nori Soy sauce (unsweetened) Tomato paste Vinegar Worcestershire sauce Sweet chilli sauce, Tomato sauce, BBQ sauce, Stir-Fry sauce, Sweetened chutney Herbs & Spices Other All fresh and dried herbs and spices (e.g. parsley, coriander, cumin, oregano, cinnamon) All fresh or dried garlic, ginger, chilli, lemongrass Equal, Splenda, Natvia Sugar free maple syrup, Matcha green tea powder Sugar free lollies, mints and gum (e.g. Extra, Jols, DDs) Diet jelly Cinnamon sugar, Vanilla sugar, Seasoning blends with added sugar Sugar, Honey, Chocolate, Lollies, Ice cream, Custard, Cake, Biscuit, Muffin

12 What is a balanced meal? Aim to follow the plate guide: Low-GI carbohydrate (¼ plate) Pasta, rice sweet potato, corn, lentils, legumes and bread Portion = Fist size Some people may be encouraged to limit or avoid carbohydrate intake at some meals during a VLED program or after completion of the program. Discuss suggested portion sizes with your dietitian. Lean protein (¼ plate) Trimmed meat, skinless chicken, fish, seafood, tofu, egg Portion = Palm size Vegetables (½ plate) Raw or cooked: Carrot, broccoli, peas, capsicum, cucumber, beans, beetroot, cabbage, bok choy, eggplant, lettuce, spinach, mushrooms, tomato, onion etc. Portion = 2 open hands For more information see the Baker Institute s Plating it up: the portion guide Recipe ideas Suitable recipes for any phase of a VLED program: includes free recipes and optional ebook Opticook s Kitchen($6.95 download) Meal ideas when re-introducing 1-2 balanced meals/day: If a recipe includes nutritional information, ideally select recipes that have less than 1500kJ per serve and less than 30g carbohydrate per serve. Suggested resources include: The CSIRO Low-Carb Diet (RRP $34.95) includes free recipe ideas - discuss options with your dietitian

13 What about social occasions and eating out? Managing social occasions and eating out can be a challenge. Strategies include: Skip the scheduled VLED for that meal and choose a meal that includes lean protein and lowcarbohydrate salad or vegetables e.g.: - grilled steak / fish fillet with vegetable based salad OR - stir-fry chicken / tofu with Asian greens OR - poached eggs with grilled tomato and spinach. Request sauces or dressings on the side. Avoid extra bread if provided at the table. Avoid deep fried or crumbed foods. Order 2 entrée size dishes instead of entrée and main, and add a side of salad or green vegetable. Choose water, sparkling water, tomato juice, diet soft drink as preferred drink choices. Order a pot of tea or black coffee to finish the meal instead of dessert. Alcohol Alcohol is not recommended while completing a VLED program and will reduce weight loss results due to the high energy (kj) content. If you intend to drink alcohol, limit your intake and consider the following suggestions: Alternate alcoholic drinks with water or a diet soft drink or tomato juice. Order wine by the glass rather than by the bottle and sip slowly. Mix a spirit with diet cola or soda water. Avoid regular soft drink, juice or pre-mixed options. Choose a light beer rather than full-strength beer and a pot instead of a pint. Avoid cider and other sweet dessert wines due to the higher carbohydrate content. Long term habits After achieving weight loss and the re-introduction of balanced meals, it is important to maintain healthy food habits which may include smaller serve sizes and a lower intake of higher fat and carbohydrate foods. Ongoing support from your dietitian can assist with this process. Additionally, making time for daily physical activity will assist with weight loss maintenance by helping to maintain muscle mass and metabolism. Baker Heart and Diabetes Institute Level 4, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004 Australia T (03) F (03) W Baker Heart and Diabetes Institute Review date: 2019 Literacy Level assessed. No part of this information may be copied or reproduced in any form without written permission of the Baker Heart and Diabetes Institute.

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