Quick Nutrition Guide For Bariatric Surgery

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104 pounds lighter.Tons healthier.A million times happier.Quick Nutrition Guidefor Bariatric Surgery

ContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Tips for Limiting Sugary, Greasy, and Processed Foods . . . 15Nutrition Expectations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Tips For Dining Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Surgery and Lifestyle Changes . . . . . . . . . . . . . . . . . . . . . . . . . . 5Changes after Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Supplement Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Weeks Pre-Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Special thanks to the University of Mississippi Medical Center,Bariatric Surgery Center for providing educational material forthis publication.Post-Surgery Band Fill Instructions . . . . . . . . . . . . . . . . . . . . . . 8Post-Surgery Stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Sample Menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Additional Menu Ideas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

IntroductionBariatric surgery, whether it is Vertical Sleeve Gastrectomy orRoux-en-y Gastric Bypass (RYGB), is a life changing procedure.Vertical Sleeve Gastrectomy restricts the amount of food thestomach can hold by creating a thin, vertical sleeve in thestomach. The sleeve is about the size of a banana. RYGB usesboth restrictive and absorption-blocking methods for weightloss. By bypassing most of the stomach and part of the smallintestine, less area to store food is created. This leads to eatingfewer calories and a risk of vitamin deficiencies.This education guide coversseveral important topics. Basic nutrition and tips forreducing fat Nutrition expectationsprior to bariatric surgery Potential complicationsand their solutionsSince all surgeries require change to the structure andfunction of the stomach, it’s important that you follow properdietary stages. What is eaten must be ‘nutrient-dense’ andwell tolerated. Careful planning and daily supplements arerequired for adequate health maintenance. Bariatric surgerynot only changes eating habits, but requires behavioralchanges as well. Stages of the post-surgerybariatric diet Sample menus Tips for dining outYou need to adjust the amount of food eaten before and aftersurgery to help achieve weight loss goals.3REMEMBER:It’s a good idea toread through thisguide several timesbefore surgery. Thiswill help you feelmore confident andprepared.

Nutrition Expectations P ractice taking very smallbites/sips of foods andbeverages (use smallutensils and small plates). C hew foods thoroughly(30 times) to the textureof applesauce beforeswallowing. P ractice eating anddrinking very slowly.Take at least 20-30minutes to finish eatinga meal. Set fork downbetween bites of food toslow eating pace.Prior to BariatricSurgeryLifestyle changes areencouraged to improvehealth before surgery, helpyou tolerate surgery betterand provide for a successfulrecovery period. Permanentlifestyle changes are neededfor success after surgery,which is why it’s important tostart making changes now. B egin keeping a food log.Record foods and drinks,portion sizes, time, mood,location and hunger level. I nclude fruits, vegetables,whole grains, lean proteinand low-fat dairy to havea well-balanced meal planprior to surgery. L imit or eliminate simplesugars and high fat foods. B egin the day withbreakfast to boostmetabolism and reducehunger. S top smoking and allforms of tobacco use. C hoose only waterand sugar-free,decaffeinated, noncarbonated beverages. E liminate alcohol. Itcan cause diarrhea, addexcess empty calories,cause metabolismchanges (with RYGB)and introduce the risk ofaddiction. D rink 48-64 ounces (6-8cups) non-carbonated,decaffeinated fluids daily. P ractice not drinkingwith meals: See sectionon sugar and lifestylechanges. T he doctor will require afull liquid diet two weeksprior to surgery to shrinkthe liver. A ttend support groupmeetings and educationalsessions to prepare forsurgery. M anage blood sugars. E liminate carbonatedbeverages due to theirdiuretic effect. Excess gasproduced can bloat andstretch your pouch. E liminate straws becausethey can cause gas due toswallowed air. E liminate caffeinebecause it can stimulateappetite, add emptycalories and causediarrhea.Practice taking very small bites of food and sips of beverages.Use small utensils and small plates.4

Surgery and Lifestyle Changes D o not drink liquidswith calories except formilk and protein drinks.Liquids that containcalories include regularsoft drinks, sports drinks,sugary fruit drinks, sweettea, and coffee with sugar.Fruit juices have calories,but in small amounts canalso provide vitamins andminerals. If fruit juices aredesired, choose 100% fruitjuice and limit the servingsize (4 oz. is considered aserving of juice).Exercise regularly; or as recommendedby the physician or exercise physiologist.Useful Tools for Weight Losssurgery performed. It mayalso cause vomiting.Remember, bariatric surgery is a tool that helps makethe necessary lifestyle changes for weight loss. It doesn'tguarantee lifestyle changes. The surgery makes the stomachinto a small pouch. The new pouch, along with behaviorchanges, helps with portion control. Below are helpful rules tomake the tool work. If the rules and other dietary guidelinesin this guide aren't followed, complications or problems canoccur after surgery. E at slowly and chewfood thoroughly. If ameal is eaten too fast itmay become hard to feelsatisfied before it's toolate. This may lead toovereating, vomiting orpossible blockage.Rules for Weight Loss: D o not drink with meals.Drinking will flush foodquickly through the pouchand/or lead to overeatingat meals. Avoid drinkingfluids 10-15 minutes beforemeals (sleeve patientsmay drink up to the meal).Also avoid drinking duringmeals and 30-60 minutesafterwards. E at three meals a dayand one or two snacks(if needed). Snacking toomuch between meals addsextra calories. This willslow weight loss, causeweight regain, or result in aweight loss plateau. Whenused wisely, snacks canhelp you meet your proteingoals and can controlhunger between meals. A lways stop eating ordrinking as soon as youfeel satisfied. Eatingpast the point of fullnesswill cause the pouch tostretch/slip depending on5 A void caffeinated,carbonated, and/oralcoholic beverages.This includes coffee,tea, bubbly drinks andany alcohol. A lways eat the proteinsource first at meals.This will help you getthe required proteinrecommendations. C hoose healthy, nutrientdense foods. The qualityof food you eat is moreimportant after surgerybecause the amount ismuch smaller. T ake all necessarysupplements daily; seeSupplement Guidelines: andVitamins, pp. 6-7. E xercise regularly or asrecommended by thephysician or exercisephysiologist.

Supplement GuidelinesProteinThe following protein drinks, bars and other products canbe used to help you reach 60-80 grams of protein daily.The following supplements may be found at area stores orordered online. See guidelines for choosing supplements.High Protein Drinksand Shakes: E AS Carb Control drinksand whey powders G eniSoy Products:MLO Super High Proteinpowder, MLO Brown RiceProtein powder, MLO Milkand Egg Protein powder,MLO Vegetable Proteinpowder U NJURY Proteinpowders and broth forbariatric surgery patients O ptimum ProteinDiet Shakes B ariatric Fusion ProteinSupplement B odytech Whey Pro 24High Protein Bars: G eniSoy Low CarbCrunch Bars S lim Fast High ProteinMeal Bars P remier protein bars Q uest protein barsUnflavored High ProteinPowders: B eneprotein Guidelines for Choosing SupplementalProtein Sources: G eniSoy Ultra XTSoy Protein P rotein drinks and shakes:20-35 grams protein perserving. Milk can be usedwith powdered protein toincrease the total proteinvalue. Protein bars: 10-20grams protein per serving U NJURY unflavoredprotein powder forbariatric surgery patients G NC Pro Performance100% Whey P remier whey proteinpowders or ready to drink T otal fat: five grams orless per serving 1 st Phorm Level-1 T otal carbohydrates: 10grams or less per serving Z ero Carb Isopure powders and drinks andPerfect Whey Proteinpowder P roducts should be lowin sugar, five grams or lessper serving P ure Protein wheypowders G arden of Life rawprotein6Nutrition FactsServing Size 1 Cup (228 g)Servings Per Container: 3As ServedAmount Per ServingCalories from Fat 30Calories 90% Daily ValueTotal Fat 3 gSaturated Fat 0gCholesterol 0gSodium 300 mgTotal Carbohydrate 10gDietary Fiber 3gSugars 3gProtein 30 gVitamin A 80%Calcium 4% 5%0%0%13%4%12%22%Vitamin C 60%Iron 4%Percent Daily Values are based on a 2,000 caloriediet. Your daily values may be higher or lowerdepending on your calorie needs:Total FatSat FatCholesterolSodiumTotal CarbohydrateDietary FiberCalories2,0002,500Less thanLess thanLess thanLess g30g

VitaminsIt is recommended that all bariatric patients take some formof vitamin supplement after surgery. Chewable or liquidsupplements are absorbed best.Multivitamin:All bariatric patients F or specific brands,dosage and frequency,see a dietician for acurrent list. A void takingmultivitamins at the sametime as calcium to avoidabsorption problems.Because you're eating smalleramounts of food after surgery,getting enough vitamins maybe difficult.Biotin: Most patients 1 000 mcg per dayREMEMBER: Herbalsupplements are notrecommended because theycan interfere with somemedications and may haveblood thinning properties D o not take gummyvitamins.Sample Vitamin Regimen:7:30 a.m. Chewable Calcium D o not take a 50 plusmultivitamin.10 a.m. Chewable Vitaminand B12 (if needed)Calcium citrate withVitamin D: Most bariatricpatients T ake two or three per day(at least 1000mg/day);no more than 600mg ata time, separately frommultivitamin.1 p.m. Chewable Calcium4 p.m. Chewable Vitamin7 p.m. Chewable Calciumand Biotin C alcium Citrate is bestabsorbed for both surgerytypes.Vitamin B12: All bariatricpatients S ublingual Vitamin B12:1000 mcg twice weekly O R Intramuscularinjection of B12: 1000mcg per month (must beprescribed by MD)7

Two Weeks Pre-SurgeryPost-SurgeryLiquid DietBand Fill InstructionsWhy is this necessary?The two-week liquid diet is to decrease the size ofthe liver before surgery. This makes it easier to do theoperation because the liver can block access to thestomach. If the liver is too large, the surgery may bepostponed and the full liquid diet attempted again. Yourcompliance with this diet is important to make yoursurgery as safe and successful as possible.For LAP band patients onlyThese instructions are important for when you have bandadjustments, or “fills” after surgery. This is when the band is“tightened” by filling your band with solution.Before the Fill:1. Don't eat a large dinner the night before your fill.2. Eating a small, solid-food meal the morning beforeis okay.Week 1: Replace two meals a day with approved liquids.Some programs allow a small meal of solid food as well.Talk to your dietitian about your guidelines.After the Fill:Week 2: All meals are liquids only. Calorie intake isapproximately 700-800 calories.1. For the first 24 hours follow a full liquid diet. Examples ofliquids were listed in the pre-surgery diet.Daily Goals: 6 0-80 grams of protein, or as instructed by your dietitian2. The next day you may progress to puree or mechanicalsoft foods for another 24 hours. 4 8-64 ounces (6-8 cups) or more of water3. Always maintain good hydration. Drink six to eightcups of sugar-free, non-carbonated and decaffeinatedbeverages between meals.Examples of liquidsyou may have: Protein shakesPost-Surgery Stages Skim milkPost-Surgery Bariatric Diet Sugar-free gelatinAfter bariatric surgery, the pouch won’t be able to hold asmuch food or liquid. Initially, it can only hold about ¼ cup offood or 2 ounces at a time. To allow the new pouch to healcompletely, introduce liquid and solid foods slowly. This slowintroduction is done in different stages. The first stage startssoon after surgery. Sugar-free pudding Fruit juices (limit to 4 oz.) Broth or bouillon Sugar-free popsiclesThe stages of the diet are as follows: Stage 1: Full Liquids Stage 2: Pureed Stage 3: Mechanical Soft Stage 4: Solid Foods L ow fat, sugar free yogurt(artificially sweetened)8

There are two things that will change in each stage:Foods NOT Allowed: Any drinks with added sugar, caffeine,or carbonation, whole milk, solid foods and orange juice orgrapefruit juice (these may cause gastritis/ulcer formationin the pouch).Amount: The portions that are recommended aremaximums — eat less if needed. It is important to eat onlyto the point of feeling satisfied.Amounts: About 1-2 oz. (2-4 Tbsp.) at a time. Take tiny sipsduring the day.Texture: The stages start off with very liquid-type foodsand will progress toward normal solid foods.Reminders: It is important to get at least 6-8 cups of fluidbetween meals to stay hydrated. Include protein drinks/supplements daily for adequate protein.The eating rules discussed earlier won’t change during anystage of the diet. To review, here are the rules again:Rules for EatingSip liquids slowly; it is not possible to drink the amounts listed onthe menu right after surgery.1. Eat three meals a day and one or two snacks if needed.Sample Menu: Full Liquids (Post-Op amounts are listed)2. Always stop eating or drinking when startingto feel satisfied.Breakfast:7 a.m. — 4 Tbsp. (2 oz.) light vanilla yogurt3. Eat slowly. It should take at least 20-30 minutesto finish each meal.8-8:30 a.m. — Protein drink made with 8 oz. skim milk4. Do not drink with meals.10 a.m. — 8 oz. water or Crystal Light 5. Do not drink liquids that have calories except forlow-fat milk or protein liquids.Lunch:Noon — 2-4 Tbsp. (1-2 oz.) strained fat-free cream soup6. Always eat protein first at meals. Each meal should bebalanced by providing protein, vegetables and somecarbohydrates (starch or fruit source).2-4 Tbsp. (1-2 oz.) fat-free, sugar-free pudding7. Take vitamin/mineral supplements daily.3 p.m. — 4 oz. water8. Exercise daily, 30 minutes or as recommended byyour doctor or exercise physiologist.4 p.m. — 4 oz. beef broth with unflavored protein powder1 p.m. — Protein drink made with 8 oz. skim milkSupper:5 p.m. — 2-4 Tbsp. (1-2 oz.) strained fat-free cream soup9. Remember to advance your diet slowly per doctor’srecommendations.2-4 Tbsp. (1-2 oz.) light vanilla yogurtStage 1: Full Liquids6 p.m. — Protein drink made with 8 oz. skim milkFollow this diet for two weeks before and one to two weeksafter surgery; DO NOT advance diet until instructed to do soby your surgeon’s office.8 p.m. — 8 oz. Crystal Light Summary: This diet helps with hydration and focuses oneating the recommended amount of protein needed daily:60-80 grams.Foods Allowed: Water, sugar-free drinks, sugar-freepopsicles, sugar-free gelatin, 100% fruit juices, broth orbouillon, skim or 1% milk, lactose-free milk, low-fat soy milk,protein drinks, light yogurt, fat-free/sugar-free pudding, lowfat strained creamed soups, and thinned cream of wheat.Add protein powder as needed, to meet protein needs.9

Stage 2: PureedSample Menu: PureedThis diet lasts about 2 weeks. DO NOT advance diet untilinstructed to do so by the surgeon’s office.Breakfast:7 a.m. — ¼ cup scrambled egg or egg substituteSummary: This diet gets the pouch ready for soft foods,along with providing the 60-80 grams of proteinneeded daily.4 Tbsp. (2 oz.) Cream of Wheat made with skim milk —very thin or milk-like consistency8 a.m. — Protein drink made with 8 oz. skim milkFood Allowed: All liquids or foods on the previous stage(refer back to full liquids), also scrambled eggs, scrambledegg whites, scrambled egg substitute, low-fat cottage cheese,thinned cream of wheat made with milk, mashed beans,applesauce, baby food, and any pureed fruits, vegetables,and/or meats (use a blender for this).10 a.m. — 8 oz. water or Crystal Light Lunch:Noon — 4 Tbsp. (2 oz.) pureed turkey2 Tbsp. (1 oz.) pureed green beansFood NOT Allowed: Any liquids or foods not allowed on theprevious stage, along with whole milk, any solid foods thataren’t pureed, fried foods, and any concentrated sweets.Avoid oranges, grapefruits, and their juices (the acid fromthese may cause gastritis/ulcer formation in the pouch).2 Tbsp. (1 oz.) mashed potatoes1 p.m. — 4 oz. grape juice2 p.m. — Protein drink made with 8 oz. skim milk4 p.m. — 4-8 oz. waterAmounts: About 2-4 oz. (4-8 Tbsp.) or ¼-½ cup at one time.Supper:5 p.m. — 4 Tbsp. (2 oz.) pureed chickenReminders: It is necessary to get at least 6-8 cups of fluiddaily to stay hydrated. Stop drinking 15 minutes before meals,and avoid drinking until 30 minutes after meals.2 Tbsp. (1 oz.) pureed carrotsA sample menu of the pureed diet is on the next page.Remember to sip liquids slowly — it isn’t possible to drink theamount listed on the menu all at one time; drink over a periodof about 30-60 minutes.2 Tbsp. (1 oz.) mashed potatoes6 p.m. — Protein drink with 8 oz. skim milk7 p.m. — 8 oz. Crystal Light Instructions for pureeing foods: Consider purchasing orborrowing a blender or food processor for this stage if oneisn’t already available.Stage 3: Mechanical SoftThis diet lasts until you’re able to tolerate solid food. DO NOTadvance diet until instructed to do so by the surgeon’s office.1. Cut food into small pieces about the size of a thumbnail.2. Place food in the blender or food processor.Summary: This diet helps prepare the pouch for thetransition to solid foods, along with providing the 60-80grams of protein needed daily.3. Add enough liquid (ex: fat free chicken broth, fat freegravy, milk, or yogurt), to cover the blades.Foods Allowed: All liquids or foods on the previous stages(refer back to full liquids and pureed diet), also eggs, eggwhites, egg substitute, low-fat cottage cheese, fish, tofu,ground lean meat, low-fat canned chicken and fish, cannedfruits (in own juice or water), soft fresh fruits as tolerated, softcooked vegetables as tolerated, potatoes without skin, cookedcereals made with milk, beans, toasted whole wheat breads.4. Blend until smooth like applesauce.5. Strain out any lumps, seeds, or whole pieces of food.6. Use herbs and spices to flavor food (avoid really spicy andhigh sodium flavorings).7. Use ice cube trays to freeze pureed foods, and pop out intoZiploc bags to avoid wasting any. This helps with portioncontrol as each cube is about 2 oz. (4 Tbsp.).Foods NOT Allowed: Any liquids or foods not allowed on theprevious stages, along with whole milk, solid/crunchy foods,rice, popcorn, high-fat meats, high-fat starches, fried foods,10

Stage 4: Solid Foodsand any concentrated sweets. Avoid oranges, grapefruits,tomatoes and their juices (the acid from these may causegastritis/ulcer formation in the pouch).Once this stage is reached, this diet is life long.Summary: It is important to progress the diet slowly, andadd new foods in one at a time to assess tolerance. The mostimportant point to remember when starting to eat solidfoods is to eat very slowly and make sure to chew foods verywell before swallowing. Each meal needs to be balanced byproviding both protein and carbohydrates, along with a smallamount of fat.Note: Any food with a husk or shell may get stuck in thepouch opening if not well blended or chewed thoroughly.Amounts: About ½-1 cup of food at each meal. Meals shou

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